MyMedR

INTRODUCTION: Acute cholecystitis (AC) is a common problem encountered in surgical practice. This occurs due to obstruction of the cystic duct by calculi resulting in inflammation of the gallbladder. Increasingly, contrast enhanced computed tomography (CECT) and Magnetic Resonance Imaging (MRI) scans are being used for assessment. While the imaging features of AC are well recognized and extensively described in the literature, radiological features of the rarer complications related to AC such as pseudoaneurysm formation and gallbladder volvulus are less well known. We aim to describe these rarer findings in our pictorial review, to better educate the clinician and radiologist, such that timely diagnoses can be reached, and relevant management can be affected.

METHODS: A collection of cases showing the common acute gallbladder pathologies and complications such as acute cholecystitis, gangrenous cholecystitis, emphysematous cholecystitis, haemorrhagic cholecystitis, Mirizzi's syndrome, gallbladder perforation and abscess formation, were collected between July 2016 and March 2018 at two different medical institutions in Singapore. In addition, rarer cases of gallbladder volvulus and vascular complications such as cystic artery pseudoaneurysms and vessel erosions, were also followed up.

RESULTS: The CT and MRI imaging features of these conditions were discussed, with key diagnostic imaging features emphasized.

CONCLUSION: Acute gallbladder pathologies are commonly encountered in day-to-day radiology practice. Knowledge of the rarer gallbladder pathologies and their key imaging features will help the radiologist, in particular, the on call radiologist in training, improve diagnostic accuracy and allow for timely management.

The transmission of an avian filarioid Cardiofilaria nilesi to the jird, Meriones unguiculatus

Chiang GL, Cheong WH, Eng KL, Samarawickrema WA

J Helminthol, 1987 Dec;61(4):349-53.

PMID: 3437114

This paper reports the experimental transmission of a bird parasite into jirds. Infective larvae of Cardiofilaria nilesi obtained from laboratory colonized Coquillettidia crassipes mosquitoes which had fed on an infected chicken were inoculated subcutaneously into jirds. The number of larvae per jird varied from 10 to 228. Microfilaraemia appeared 22 to 89 days after inoculation of the infective larvae. Experiments were carried out with 24 jirds through six generations extending over a period of 22 months and 17 produced patent infections. At present 8 infected jirds are being maintained in the laboratory; their patent periods ranging from 6 to 13 months. However, the longest patent period observed was about thirteen months. The percentage of adults recovered in autopsied jirds ranged from 0 to 40 with an average of 16. The chicken showed a microfilarial periodicity with the peak microfilarial density around 2200 hours. However, in jirds there was a change in sub-periodicity. This model in the jird may be very useful for the screening of filaricides and in immunological work.

Dengue hemorrhagic fever in Malaysia: the 1973 epidemic

Wallace HG, Lim TW, Rudnick A, Knudsen AB, Cheong WH, Chew V

Southeast Asian J. Trop. Med. Public Health, 1980 Mar;11(1):1-13.

PMID: 6105712

The first major Malaysian epidemic of dengue hemorrhagic fever with severe manifestations occurred in 1973, with 969 reported cases and 54 deaths. In a detailed study of 138 clinically diagnosed and laboratory confirmed cases at the General Hospital in Kuala Lumpur, hemorrhagic manifestations were observed in 68.7% and shock in 18.1% of the patients. The cases occurred mainly from May to September, largely in urban and suburban areas of the majority of the states in the country. A main focus of infection was Jinjang, a heavily populated outlying district of Kuala Lumpur, where unusually high incidences of morbidity, severe disease and mortality were seen. Severe disease was seen mostly in children under the age of 15 years, although a significant number of adults suffered milder illnesses. The Chinese population was chiefly affected, due to their living in crowded, low-income housing where the vector, Aedes aegypti, occurred in the greatest numbers. All four dengue types were recovered during the epidemic period, although dengue 3 (DEN-3) was incriminated as the major epidemic type. Entomological data revealed high indices of A. aegypti throughout the country and left little doubt that this epidemic was aegypti transmitted. Spraying and fogging operations were carried out in attempts to control vector populations.

Biochemical genetic relationship in three taxa of the malaria mosquito Anopheles balabacensis complex

Yong HS, Cheong WH, Chiang GL, Dhaliwal SS, Loong KP, Sarjan R

Comp. Biochem. Physiol., B, 1983;76(3):611-3.

PMID: 6641178

Three taxa of the malaria mosquito Anopheles balabacensis complex representing three geographical regions (Thailand, Peninsular Malaysia and Sabah) in Southeast Asia, were analysed for genetic variation at 15 gene-enzyme systems. The Sabah taxon was monomorphic for all the 15 gene-enzyme systems. Only two gene-enzyme systems (esterase and glucose phosphate isomerase) were variable in the Thailand and Peninsular Malaysia taxa. The average heterozygosity or gene diversity was 0.007 for the Thailand taxon and 0.028 for the Peninsular Malaysia (Perlis) taxon. There were no unique gene-enzyme markers in the three taxa studied. The average values of genetic identities (0.933-0.997) and genetic distances (0.003-0.069) indicate that these three taxa are of subspecific status.

Field studies on the surveillance of Coquillettidia crassipes (Van der Wulp) and the isolation of a strain of Cardiofilaria in peninsular Malaysia

Chiang GL, Samarawickrema WA, Eng KL, Cheong WH, Sulaiman I, Yap HH

Ann Trop Med Parasitol, 1986 Apr;80(2):235-44.

PMID: 2875691

Surveillance methods for Coquillettidia crassipes were studied in an open housing estate near Kuala Lumpur using three types of traps Trinidad 10 trap, modified Lard can trap and IMR trap, each baited with chicken or pigeon. All traps attracted Cq. crassipes. There was no significant difference in the catches in the three traps. There was also no significant difference between chicken and pigeon as bait. Catches at heights of 1.5, 3, 4.5 and 6 m did not show any significant difference in density. Cq. crassipes was active at night with an early peak during the first hour of the night and a minor peak between 0100 and 0200 hours. The activity of the parous and nulliparous sections of the population was similar, except that a higher proportion of the parous females was active during the second peak compared with the nulliparous females. The parous rate was 22.3%, and the probability of survival through one day for two gonotrophic cycles was 0.711 and 0.650. The infection rate for Cardiofilaria was 29 out of 1052 (2.76%) and the infective rate (L3 larvae) was 13 out of 1052 (1.24%). 48.3% of the infected Cq. crassipes had a worm burden of more than ten larvae. One of the chickens in the traps was positive for microfilariae of Cardiofilaria four weeks after exposure as bait. Laboratory bred Cq. crassipes fed on this chicken produced infective larvae in ten days, and these were inoculated into clean chickens and pigeons. Microfilariae appeared in the chickens but not in pigeons. The adult worms recovered await identification.

Anopheles flavirostris incriminated as a vector of malaria and Bancroftian filariasis in Banggi Island, Sabah, Malaysia

Hii JL, Kan S, Vun YS, Chin KF, Lye MS, Mak JW, et al.

Trans R Soc Trop Med Hyg, 1985;79(5):677-80.

PMID: 3913069

Seven villages in Banggi Island, Sabah, Malaysia, were surveyed four times to evaluate the roles of local mosquitoes as vectors of malaria and Bancroftian filariasis. 11 species of Anopheles were found biting man. 53.9% of the anophelines caught were An. flavirostris, 27.1% An. balabacensis, 6% An. donaldi and 4.2% An. subpictus. Infective malaria sporozoites, probably of human origin, were found in two of 336 An. flavirostris and 12 of 308 An. balabacensis. Sporozoites, probably of a non-human Plasmodium, were found in An. umbrosus. Nine of 1001 An. flavirostris and four of 365 An. balabacensis harboured L2 or L3 filarial larvae identified as those of Wuchereria bancrofti. This is the first record of An. flavirostris as a natural vector of malaria and W. bancrofti in Sabah.

Filariasis in Bengkoka Peninsula, Sabah, Malaysia: vector studies in relation to the transmission of filariasis

Chiang GL, Cheong WH, Samarawickrema WA, Mak JW, Kan SK

Southeast Asian J. Trop. Med. Public Health, 1984 Jun;15(2):179-89.

PMID: 6150551

Using seven methods of surveillance, 58 species of mosquitoes from nine genera were in Pantai and the two neighbouring villages during two visits in 1982. Ma. bonneae was the most prevalent species attracted to man. In the forest shade Ma. bonneae and Ma. dives showed activity throughout the 24 hours with peak biting during 1900-2100 hours. An. balabacensis exhibited peak activity shortly after midnight. Inside and outside house, Ma. bonneae showed similar activity except that it ceased during the day. Mansonia was only mildly zoophilic. CDC light traps gave poor yields of mosquitoes. Pyrethrum spray catch inside houses early morning did not include any Mansonia. Outdoor day resting catch included Ma. bonneae fed on man. Transmission of Brugia, probably human filariasis, by Ma. bonneae occurred in Pantai and in the two neighbouring villages. One infection in Ma. dives was found in Pantai. The monthly infective biting rate and monthly transmission potential for Ma. bonneae were estimated at the forest shade and outside the house in Pantai.

Phosphoglucomutase polymorphism in two species of Armigeres mosquitoes

Yong HS, Chan KL, Dhaliwal SS, Cheong WH, Mak JW, Chiang GL

Southeast Asian J. Trop. Med. Public Health, 1980 Sep;11(3):424-5.

PMID: 6108615

Field and laboratory observations on Coquillettidia crassipes in relation to transmission of Brugia malayi in Peninsular Malaysia

Chiang GL, Samarawickrema WA, Mak JW, Cheong WH, Sulaiman I, Yap HH

Ann Trop Med Parasitol, 1986 Feb;80(1):117-21.

PMID: 2873797

Field observations were made on Coquillettidia crassipes during a study of Mansonia in a swamp forest ecotype in Tanjong Karang. There was an increase in abundance in July consistent with the increase in abundance of Mansonia and an increase in rainfall. The biting cycle showed a dramatic early peak during the period 1900-2000 hours. The probability of daily survival through one day for the first three gonotrophic cycles was 0.770, 0.722 and 0.759. Two of the 54 Cq. crassipes dissected were infective, with two and 25 L3 larvae of Brugia. Both subperiodic B. malayi and B. pahangi developed into L3 larvae in laboratory bred Cq. crassipes. The index of experimental infection was higher for B. pahangi. Mansonia bonneae and Ma. uniformis showed higher indices of experimental infection than Cq. crassipes for subperiodic B. malayi. It is concluded that in an endemic area with a high density of Cq. crassipes it could act as a secondary vector of Brugian filariasis.

Studies on the epidemiology of subperiodic Brugia malayi in Malaysia: problems in its control

Mak JW, Cheong WH, Yen PK, Lim PK, Chan WC

Acta Trop, 1982 Sep;39(3):237-45.

PMID: 6128892

The dynamics of the transmission of subperiodic Brugia malayi in a typical endemic area in Malaysia was studied over a period of 4 years. Mass chemotherapeutic control with diethylcarbamazine citrate was found to be inefficient, new cases being detected even after the fifth treatment cycle of 6 mg/kg X 6 days per cycle. This is in marked contrast to the situation in periodic b. malayi areas where mass treatment efficiently controlled the infection. The disparity in results in these two areas is attributed to zoonotic transmission of subperiodic B. malayi from non-human primates where a mean infection rate of 76.3% was found.

The 1973 epidemic of dengue haemorrhagic fever in Malaysia: (a preliminary report)

Lim TW, Wallace HG, Rudnick A, Cheong WH, Knudsen AB, Chew V

Southeast Asian J. Trop. Med. Public Health, 1974 Sep;5(3):453-4.

PMID: 4432105

Laboratory colonization of Mansonia uniformis, Ma. indiana and Ma. bonneae in Malaysia

Chiang GL, Cheong WH, Loong KP, Eng KL, Samarawickrema WA

J Am Mosq Control Assoc, 1985 Jun;1(2):186-90.

PMID: 2906664

Methods are described for the laboratory colonization of Mansonia uniformis, Ma. indiana and Ma. bonneae in Malaysia. Gravid females oviposited in 500 ml beakers with a layer of water covered with small leaves of Salvinia. Newly hatched larvae were set up in a basal medium of guinea pig dung and water or liver powder, yeast powder and water. Larvae attached to aquatic plants or 'Keaykolour' ruffia snow white paper. The cultures with paper gave better yields than those with plants. Production of Ma. uniformis was higher than the other two species. Twelve generations of Ma. uniformis and 11 generations of Ma. indiana and Ma. bonneae were monitored in the laboratory.

Genetics of glucose phosphate isomerase and phosphoglucomutase in Aedes albopictus (diptera: culicidae)

Yong HS, Chan KL, Dhaliwal SS, Cheong WH, Chiang GL, Mak JW

Theor Appl Genet, 1981 Nov;59(6):345-8.

PMID: 24276567 DOI: 10.1007/BF00276447

Glucose phosphate isomerase (E.C. 5.3.1.9) and phosphoglucomutase (E.C. 2.7.5.1) were found to be polymorphic in a laboratory colony of Aedes albopictus. The glucose phosphate isomerase locus is represented by two alleles resulting in three genotypes, while the phosphoglucomutase locus is represented by at least five alleles giving rise to a total of 15 genotypes. The inheritance of these two enzymes is of the Mendelian type with codominant alleles. Present data indicate that these genes are not linked.Of 105 mosquitoes analysed for these two gene-enzyme systems, the frequencies for glucose phosphate isomerase alleles are Gpi (S)=0.68 and Gpi (F)=0.32, while the frequencies for phosphoglucomutase alleles are Pgm (A)=0.16, Pgm (B)=0.11, Pgm (C)=0.19, Pgm (D)=0.30 and Pgm (F)= 0.24. The frequencies of the three glucose phosphate isomerase genotypes are in accord with Hardy-Weinberg expectations (X 1 (2) =2.74). Similarly, the frequencies of the 15 phosphoglucomutase genotypes probably do not differ significantly from Hardy-Weinberg expectations (X 10 (2) = 18.45).

Genetics of glucosephosphate isomerase in Aedes togoi (Diptera: Culicidae)

Yong HS, Cheong WH, Mak JW, Chiang GL, Chan KL, Dhaliwal SS

Biochem Genet, 1980 Oct;18(9-10):939-45.

PMID: 7225086

The genetics of glucosephosphate isomerase (E.C. 5.3.1.9) in two strains (Malaysian and Taiwan) of Aedes togoi is reported. Three electrophoretic phenotypes were presented in both sexes. The zymogram patterns were identical in both strains of A. togoi. The phenotypes were governed by a pair of codominant alleles. The allele frequency of the slow-moving band was 0.63 in the Malaysian strain adn was 0,86 and 0.82 in F161 and F169 generations, respectively, of the Taiwan strain. The sample studied was in good accord with Hardy-Weinberg expectation.

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