Paragangliomas are slow growing hypervascular tumour arising from neural crest cell derivatives throughout the body. In the head and neck region, the major paraganglial cells are located at the carotid bifurcation (carotid body), along the ganglia of the vagus nerve and along the nerves supplying the middle ear and jugular bulb. Less common locations include the larynx, orbit, nose and the aortic arch. Carotid body tumours are very rare neoplasms constituting less than 0.5% of all tumours. The true nature of the tumour is established at the time of attempted biopsy or surgical resection, sometimes with disastrous consequences. Only a few of the more than 500 cases reported in the literature have been studied and diagnosed preoperatively. These tumours must be considered in the evaluation of any lateral neck mass, even one located far from the carotid bifurcation. We report a case of bilateral carotid body tumours detected using 16-slice MDHCT in a patient who presented with pulsatile neck swelling for two years. This tumour is rarely malignant; however it produces serious problems by its progressive enlargement and impairment of adjacent structures in the neck. The treatment of choice is surgical resection; preferably to excise this lesion when it is small, because large, very vascular tumours are intimately attached to the carotid vessels and make surgical resection more hazardous. Pre-operative embolization can be performed in large tumours, as to facilitates surgery and reduce complication. In most of the cases, there is strong attachment of the tumour to the carotid arteries. When this is the situation, removal of the tumour means complete excision of both great arteries as well, and the mortality rate is 40 to 45 %. When surgical removal is not feasible, radiotherapy may help to control the tumour growth, although the results have not been encouraging. As it is very slow growing tumour with the growth rate of less than 5 mm per year tumours in old patients with significant risk factors for surgical intervention can be managed by observation alone.
Hepatocellular carcinoma (HCC) presenting with right atrial metastases and pulmonary tumour embolism is rare . Intracavitary cardiac metastasis is uncommon and metastasis to the right atrium is even less common. The majority of such cases are believed to be due to advanced HCC such as Stage III or IV, in which the progression rate is high, and in infiltrative HCC it tends to be associated with vascular invasion. The diagnosis of pulmonary intravascular tumour emboli is difficult to establish both clinically and with conventional radiographic studies. We report a case hepatocellular carcinoma associated with tumour thrombus in the inferior vena cava (IVC), right atrium and pulmonary tumour embolism detected with multidetector helical computerized tomography (MDHCT).
Extramedullary hematopoiesis (EH) is a rare but well-known compensatory mechanism of red blood cell production when the normal site of red bone marrow is unable to produce sufficient number of red blood cells. When the body demands for erythrocyte cells is high this lead to EH. This occurs mainly outside the bone marrow, usually paraspinally and sites which are normally observed in the fetus as in the liver, spleen, lymph nodes and less frequently at other sites such as adrenal, thymus, kidneys, pleura, breast, skin, gastrointestinal tract, dura mater and brain.This is more frequent in thalassaemia major (incidence up to 15% of cases), in myelofibrosis, myeloproliferative diseases (polycythemia rubra vera, chronic myeloid leukemia,), hemolytic anemias such as hereditary spherocytosis, pyruvate-kinase deficiency, medullary tuberculosis and in Paget’s disease of the bone. In some cases the cause of the EH are not identified [3]. We describe a case of EH in the presacral space that mimicked an ovarian mass on ultrasound in a patient with beta-thalassaemia intermedia.
Pulmonary sequestration is defined as a segment of ç separated from the tracheobronchial tree and receiving its blood supply from a systemic artery rather than a pulmonary arterial branch. Classically, it has been described in two forms: (1) intralobar sequestration (ILS), in which the sequestrated part of lung lies within normal pulmonary visceral pleura, and (2) extralobar sequestration (ELS), in which the abnormal segment of lung is completely separate and enclosed in its own pleural investment. The term sequestration was coined by Pryce in 1946 to describe a disconnected bronchopulmonary mass or cyst with an anomalous systemic artery. Since this original description, terminology has become confusing as investigator has recognized many variants of sequestration not strictly meeting the original description. The spectrum now recognized as a continuum, with normal vessels supplying abnormal lung at one end and abnormal vessels supplying normal lung at the other end. Recently, we incidentally found an asymptomatic, intralobar pulmonary sequestration during CT pneumocolon.
Introduction: Mammography is commonly regarded as the single most important tool for screening and for early detection of breast cancer. However it is not generally recommended for women under 40 years of age and in those taking hormone replacement therapy as the increased density of the breast parenchyma may make mammography more difficult to read and interpret. The limitations of mammography have spurred attempts to find new techniques that can be used either separately or in conjunction with mammography. Purpose: The aim of this study was to quantify the clinical value of using electrical impedance scanning (EIS) or Trans Scan as an adjunct to mammography in order to identify cancerous tissue based upon its inherent altered local dielectric properties. Methods and Materials: The patients were examined using Trans Scan (Trans Scan Medical, Ltd., distributed by Siemens AG. The study population was derived from patients with suspicious breast lesions categorized as BIRADS 3 or 4 detected during mammography or ultrasound. Results: Fifty-three women with 53 mammographically and/or sonographically suspicious findings were examined using EIS. With respect to the histopathological findings (15 malignant and 38 benign lesions) 13 of 15 (86.6% sensitivity) malignant lesions were correctly identified using EIS whereas, 33 of 38 (81.5% specificity) benign lesions were correctly identified. Negative and positive predictive values of 93.9% and 65% were observed respectively. Two benign lesions were correctly identified in a dense breast. The smallest lesion detected in this study measured 20 x 14 mm, which was an infiltrating ductal carcinoma. Conclusion: Electrical impedance scanning as an adjunct to mammography or ultrasound in classifying suspicious lesions is promising because it increases the sensitivity for cancer detection and may reduce biopsy of equivocal lesions. The additional use of EIS with negative predictive value of 93.9% may be useful to exclude some benign lesions from further diagnostic or invasive procedures. Artifacts, such as signals from superficial skin lesions, poor contact and bubbles are currently a limitation
Invasive Lobular Carcinoma of the breast is less common than Invasive Ductal Carcinoma and the presentation can be different from other types of breast carcinomas. It can present as diffuse swelling or thickening of breast rather than a mass. Sometimes, it can present as metastatic deposits from a very small primary breast lesion. These make the diagnosis of this type of breast carcinoma difficult and challenging for the radiologist and surgeon. We describe a case of Invasive Lobular Carcinoma of the breast, which presented with a left sterno-chondral metastasis and discuss the imaging findings and treatment of this condition.
The facial nerve divides within the parotid gland into upper temporozygomatic and lower cervicofacial branches. The two branches further subdivide and emerge from the parotid gland as five main branches. We observed a rare anomalous branching pattern of the facial nerve along with double parotid duct on the right side of a 50-year-old male cadaver. The two parotid ducts emerged at the level of the anterior border of parotid gland then united to form one single duct thereby opened into the oral cavity. The first duct (D1) emerged from the upper one third of the anterior border of the parotid gland and traversed horizontally for 9 mm to join the second duct. Knowledge of anomalous branching pattern of facial nerve and double parotid ducts may be beneficial for maxillofacial surgeons.
Introduction: Reduced cerebral blood fl ow is associated with neurodegenerative disorders and dementia, in particular. Experimental evidence has demonstrated the initiating role of chronic cerebral hypoperfusion in neuronal damage to the hippocampus, the cerebral cortex, the white matter areas and the visual system. Permanent, bilateral occlusion of the common carotid arteries of rats (two vessel occlusion - 2VO) has been introduced for the reproduction of chronic cerebral hypoperfusion as it occurs in Alzheimer’s disease and human aging. Increased generation of free radicals through lipid peroxidation can damage neuronal cell membrane. Markers of lipid peroxidation have been found to be elevated in brain tissues and body fl uids in neurodegenerative diseases, including Alzheimer’s disease, Parkinson disease and amyotrophic lateral sclerosis. Materials and Methods: Malondialdehyde (MDA), fi nal product of lipid peroxidation, was estimated by thiobarbituric acid-reactive substances (TBARS) assay kit at eight weeks after induction of 2VO in the rats and control group. Results: Our study revealed a highly signifi cant (p
Introduction: A validated diagnostic questionnaire is needed in the South-East Asia region, particularly in Malaysia to detect Premature Ejaculation (PE). The objective of this study was to determine the linguistic validity of the Malay Premature Ejaculation Diagnostic Tool (MAPET). Materials and Methods: This study was conducted in a teaching hospital. The first phase involved experts’ group discussions to develop the face, content, and factorial validity of the MAPET. The second phase measured the concurrent validity of MAPET. Results: We found that the MAPET has specificity, sensitivity, positive predictive value, and negative predictive value of 79.3%, 92%, 76.7% and 93.1%, respectively in the assessment of PE. The higher score indicates severity of PE. Conclusions: MAPET is a valid self-report instrument for the assessment of PE.
Introduction: Good control of glycaemia negates potential maternal and fetal complications. A diet suitable for women with gestational diabetes mellitus (GDM) is a first line approach. However, little is said about suitable exercise in pregnancy that will potentially help control glycaemia. This pilot study seeks to understand the perceived barriers to exercise in women with GDM.
Materials and Methods: This crosssectional study recruited patients with GDM on diet control at the antenatal clinic of Hospital Sultanah Aminah Johor Bahru, Malaysia between October 2017 and January 2018. Those who fulfilled the recruitment criteria were approached and 89 women consented to participate. Data was obtained from antenatal records and a self-administered questionnaire.
Results: The mean age of the participants was 33.3 years. More than 80% were Para 1 and above. 69.6% were either overweight or obese at booking of pregnancy. 80.9% were aware that exercise was necessary for women with GDM. Only 6.7% say that healthcare professionals were their source of information on exercise in pregnancy. 77.3% of the women with low physical activity had full time jobs. Housewives (64.5%) had the highest level of physical activity. Tiredness (43.8%), childcare duties (38.2%) and lack of time (27.0%) were the most common perceived barriers to exercise. Nulliparity was significantly associated with tiredness.
Conclusion: Main barriers to exercise are tiredness and childcare duties. Health care professionals did little in educating women with GDM on suitable exercise.
Total knee arthroplasty represents a major advance in the treatment of
degenerative joint disease. It provides excellent restoration of joint function and pain
relief. The primary indication for total knee arthroplasty is to relieve pain caused by
severe arthritis, with or without significant deformity. This study is to assess
psychological impact pre and post arthroplasty. (Copied from article).
Tetanus is an acute, potentially fatal disease caused by Clostridium tetani. It is characterized by generalized, painful spasms and rigidity of skeletal muscles. We present two fatal cases and discuss the potential causes that lead to mortality in cases of tetanus infection
Qur’anic verses recitations to ill patients are practiced by many Muslims as a form of healing and worship. The effectiveness has been observed in many medical institutions; however, it has never been objectively measured and documented. This pilot study was conducted to construct a methodological approach to evaluate the therapeutic effects of Yasiin recitation on the haemodynamics of critically ill patients. Methods: Ventilated Muslim patients in coronary care unit of a teaching hospital were evaluated. Yasiin was recited twice; by one of the researchers and then by the patients’ relatives. Mean arterial blood pressure, pulse rate, oxygen saturation level and electrocardiographic changes, were observed. The difference of the parameters before and during recitation was analysed. Results: Five patients fulfilling the selection criteria were selected; two acute myocardial infarctions, two congestive cardiac failures, and a third-degree atrioventricular block. Based on a non-parametric two-related-sample test, the haemodynamic parameters were not significantly affected by Yaasiin recitation. At the end of the study, two of the patients passed away, one patient was extubated and survived. Two patients were still on ventilators when the study had been completed. Limitations in the study were observed and highlighted in explaining the equivocal results. Conclusions: The effect of Yasiin recitation on heamodynamics of patients was not proven in this study. Further refinements might be needed based upon the observation on limitations encountered. It is hoped that this humble effort would pave the way for further studies to explore this field.
Introduction: Praying represents a fundamental activity of daily living in Muslim community. Muslims need to adopt several postures that require deep flexion of the knee and hip to perform this daily obligation. This is a preliminary report of the study on hip and knee range of motion conducted to obtain normative passive and functional range of flexion data during Muslim prayers in both weight-bearing joints of normal Muslim adults. Methods: A cohort of Malay men aged between 20 to 30 years was recruited in this cross-sectional study. Passive range of motion and flexion angles of the joints in various postures during prayer were measured using a standard goniometer. The difference against existing normative range of motion database available and the influence of various factors were analysed. Factors analysed include body mass index and other anthropometric measurements. Results: Sixty participants recruited for the preliminary phase of this study. The mean (SD) of passive hip and knee flexions were higher compared to other existing normative range of motion database. A unit increase in body mass index will have 0.782 units lower of knee range of motion. The hip and knee flexion arc were from 74.1° to 119.0° and from 3.3° to 119.7° respectively. Conclusion: The range of motion involved for prayers was more for the knee but less for the hip as compared to the measured passive range of motion. Body mass index has a significant linear negative relationship with the passive range of motion of the knee, but not the hip.
Ewing sarcoma is a primary bone malignancy that rarely occurs in the hand. Resection and reconstruction will usually result in reduced or loss of thumb function. We describe a case of successful transplantation of non- vascularized osteoarticular second metatarsal autograft following wide resection of Ewing sarcoma of first metacarpal in an 11-year-old girl. The capsule of the graft’s metatarso-phalangeal joint was repaired to achieve mobility of the joint. This enabled preservation of thumb function by a relatively simple surgical technique. Detailed surgical procedures and excellence function after 2 years following surgery are described.
Introduction: Primary care management of knee osteoarthritis OA has received little attention in the scientific literature and the main reason of this survey is to study and explore the variations and patterns of primary care management and assess both conventional and complementary therapy usage in knee OA in the primary care setting. Materials and Methods: A cross sectional survey of 100 randomly selected general practitioners (GPs) in the northern states of Malaysia (Kedah, Perlis, Pulau Pinang) was undertaken using questionnaires. The GPs involved were asked about basic knowledge of OA in terms of diagnosis, investigation, and treatment of OA. They were also asked their usage of conventional and complementary medication. Results: 80 (80%) GPs responded to the questionnaires sent. 85% of GPs were in solo practice and 15% in group practice. Most of the GPs surveyed (69%) were in practice for more than 10 years, 21% in 5- 10 years and 10% were in practice for less than 5 years. 65% GPs surveyed see an average of more than 20 patients per week, 25% see about 10- 20 patients and 10% see less than 10 patients per week. 75% of GPs surveyed would arrange an X-ray. 65% of GPs surveyed will arrange a blood test, mostly serum uric acid, rheumatoid factor and ESR. Pharmacological management consists of first line treatment with analgesics (32%), NSAIDs (59%) or a combination of the two (4%). Non-pharmacological management consist of advise an exercise (37%), weight reduction (23%) and referral to physiotherapy (8%). 89% of GPs surveyed prescribed some form of complementary medications. 68% prescribed glucosamine sulphate, 29% chondroitin sulphate, 18% cod liver oil, 12% evening primrose oil. Only 5% of GPs surveyed perform intra- articular injection. Conclusion: The data suggest that in the primary care, majority of GP over investigate the diagnosis of OA. Pharmacological interventions largely concentrate on analgesic and NSAIDs. The use of physiotherapy and non drug approach were enormously under-utilized. There is a need to further educate GPs in the management of OA.
Tornwaldt's (Thornwaldt's) or nasopharyngeal cyst is an uncommon developmental
benign cyst located in the midline postero-superior wall of nasopharynx. Incidence reported in
general population is 0.06%. It occurred in the potential space due to outpouching of ectoderm into
the pharyngobasilar fascia at the site where notochord attached to pharyngeal ectoderm. (Copied from article).
Pilomatrixoma is a benign tumour that originates from the matrix of the hair root. This rare tumour is usually managed by the dermatologists. The commonest location of this tumour is in the head and neck region; hence, it can be encountered by any doctors with interest in this area. When presented in the neck, this hard tumour may pose a diagnostic challenge. A case report of pilomatrixoma misdiagnosed as a metastatic neck disease from fine-needle aspiration cytology is presented. The mistake in the diagnosis has led to a more aggressive and high morbidity surgery than necessary. It is important that head and neck doctors be aware of this condition and includes it in the differential diagnosis of hard masses presenting in the neck.
We report two paediatric patients with massive head and neck plexiform neurofibromas who underwent surgical excision. We wish to highlight issues and implications pertaining to the surgery, in particular, the management of intraoperative bleeding often encountered in these cases.
Introduction: In dental schools, the clinical students are closely supervised to ensure a good quality of care delivery. However, little is known about the relation between the patients' satisfaction and the quality of care they received, therefore the aim of this study was to assess the relation between parents' satisfaction and the quality of dental care provided by dental students at IIUM students' polyclinic during paediatric clinical session.
Materials and Methods: A self-administered questionnaire on service quality, interpersonal communication, and efficacy and treatment outcome dimensions were distributed to parents who attended their children dental treatment from September 2016 until December 2016. Meanwhile, the students' performances were assessed for their clinical and soft skills by the allocated paediatric dentistry lecturer. Data collected were analysed by using X² test.
Results: 42 questionnaires and assessment forms were completed and analysed. The result showed 71.1% of the parents were satisfied with the quality of dental care provided despite the students' performance outcomes were moderate (84.2%). There is no significant difference between parents' satisfaction and the quality of dental care provided by the dental students (p>0.05). Mother showed higher percentage of satisfaction (60%) compared to father (36.4%). However, there is no significant relation between parents' satisfaction and the gender of the parents (p=0.076).
Conclusion(s): Generally, parents are satisfied with the dental care provided by the dental students at IIUM Paediatric Dental Clinic regardless of the quality. Hence, parents' satisfaction could not be the best tool to assess the quality of care provided by the operators.
KEYWORDS: parental's satisfaction, dental students, quality of dental care