Pericardial effusion with cardiac tamponade is a rare and life-threatening complication of peripherally inserted central catheter (PICC) in a neonate. We report a 33-week preterm neonate who had sudden clinical deterioration at day seven of total parenteral nutrition regime via PICC. Recognition of pericardial effusion with cardiac tamponade in neonates with a PICC requires a high index of suspicion and steps in prevention include proper catheter tip placement and continuous monitoring of line position and function.
Gram-negative endocarditis is rare and it has high mortality if there is a delay in diagnosis and treatment. Gram-negative organisms should be considered in the differential diagnosis of IE in hemodialysis patients. Central lineassociated bloodstream infections (CLABSIs) can be prevented by following sterile measures during catheter insertion and proper management of catheter site.
Myth, believe in powerful ‘being’ commonly known as jinn and usage of ‘bomoh’ as the medium is still widespread in our community in Kelantan especially among the Malay community. This believe and practice of usin ‘bomoh’ to cure and help with known and unknown disease believe to be caused by the jinn, occasionally poses a significant complication and threat to the management of patient in the hospital. Our case is just one of many cases that happen in our local hospital, and we hope by sharing this case will illustrate how ethical discussion occasionally surpassed the four common ethical pillars.
In 1977, a female patient, aged 31y, presented with histiocytosis X in the right pelvis and was treated with radiotherapy. She presented again in 1999 at the age of 53y with a similar problem at the same location this time also involving the acetabulum. The affected right hip was treated with cemented total hip replacement. Two years postoperatively, the patient was pain free with no evidence of local recurrence or loosening of implant, thus demonstrating that total hip replacement is a viable treatment option for histiocytosis involving the hip.
Blunt trauma to the right proximal subclavian artery is uncommon and tends to be associated with pseudoaneurysm formation. We report a patient with right proximal subclavian artery pseudoaneurysm after blunt chest trauma following a motor vehicle accident. The condition was successfully treated with a combined insertion of a covered stent and carotid-carotid bypass as a hybrid procedure. Duplex scans at 6 month and 1 year follow-up documented good stent-graft positioning and no pseudoaneurysm recurrence.
Foreign body ingestion among children is common and most usually pass through the gastrointestinal tract without requiring any intervention. Magnets, however, pose a greater threat especially when more than one are ingested. We report a case of multiple bowel perforation secondary to ingestion of magnetic beads in a 3-year-old.
Pulmonary toxicity is a rare complication of Rituximab therapy. Although Rituximab is relatively safe and can be administered in an outpatient setting, Rituximab-associated lung disease has been reported and may cause mortality despite early detection. Typically the pulmonary toxicity occurs at around the fourth cycle of Rituximab. High index of suspicion is crucial and other concurrent pathology such as infective causes should be excluded. Radiological imaging and histological confirmation should be obtained and early treatment with corticosteroid should be initiated. Patients should receive counselling regarding respiratory symptoms and possible pulmonary toxicity.
Epithelioid sarcoma (ES) of the small bowel is a rare gastrointestinal tumour. We report a case of gastrointestinal bleeding secondary to small bowel ES in a 55-year-old gentleman. After gastroscopy and colonoscopy failed to identify the source of bleeding, we proceeded with computed tomography angiogram of the mesentery, which revealed intraluminal blood clot in the distal jejunum with features of obstruction. This is a rare cause of obscure gastrointestinal bleeding and emphasises the need for additional evaluation in the presence of negative endoscopic findings.
Accessory muscles are relatively rare anatomic duplications of muscles that may appear anywhere in the muscular system. Though a wide array of accessory and supernumery muscles involving the ankle have been described in the literature, this is the first reported case we are aware of that features two accessory muscles. Accessory muscles are typically asymptomatic and often picked up as incidental findings but are important to be identified in the presence of chronic persistent ankle pain and the absence of other more common aetiologies.
Contact lenses provide an alternative to spectacles for many people. However, the hazard of bacterial corneal ulcers exists. This article describes a soft contact lens wearer who developed a bacterial corneal ulcer. Prompt diagnosis and treatment is essential for eradication of the infection and prevention of loss of vision.
A 7 year-old Malay child with lightning burns is reported. Lightning injuries are rare. Victims who are clinically 'dead' may recover normally if resuscitation is carried out for prolonged periods.
This paper describes a case of invasive arnoebiasis in a 72 year old woman. About 1 week prior to admission she had right iliac fossa pain and physical examination suggested perforated appendix or carcinoma of caecum. Laparotomy revealed perforation of caecum. Histopathology of tissue removed showed abundant trophozoites of Entamoeba histolytica. After surgery treatment was instituted and patient had an uneventful recovery. KEYWORDS: Rupture of caecum, amoebiasis
Spirit possession in an Indian family is described. Its importance as a culture-bound phenomenon is stressed. Its nature as a hysteria, and as a culturally sanctioned and accepted means of expression of emotions and feelings, are discussed.
A case of sarcoidosis is reported in the hope that this seemingly rare disease in Malaysia will be better recognised. A brief review of the literature is made and various points regarding the aetiology, pathology, clinical features and diagnosis are discussed.
Gastrointestinal stromal tumours (GIST) are tumours of gastrointestinal tract and mesentery. The commonest site of its occurrence is the stomach. Patients with GIST are usually asymptomatic but they can present as abdominal pain, bleeding and rarely gastric outlet obstruction. In this particular case, the patient presents with symptoms of anaemia, partial gastric outlet obstruction and intermittent epigastric pain. Laparotomy was performed and a diagnosis of gastroduodenal intussusception secondary to gastrointestinal stromal tumour was made.
In patients with thyroid disease, ocular involvement or thyroid ophthalmopathy is common, irrespective of their thyroid status. A common feature of thyroid eye disease is eyelid retraction, which leads to a classical starry gaze (Kocher sign). Treatment with radioactive iodine (RAI) is a known therapy for hyperthyroidism. However, this treatment may lead to or worsen thyroid ophthalmopathy. We report a case series of two patients with thyrotoxicosis, who presented with an atypical and subtle occurrence of thyroid eye disease (TED) soon after RAI therapy. One of the patients was initially diagnosed and treated for dry eyes; however, over a period of time, the patient's vision progressively deteriorated. Clinical and radiological investigations confirmed thyroid ophthalmopathy with low serum thyroid hormone levels. Both patients recovered well after immediate intensive intravenous steroid treatment. These cases highlight the importance of recognizing partial ptosis as one of the presenting signs of active TED among general practitioners and physicians.