Leiomyosarcoma is a malignant smooth-muscle tumour that has a predilection for the gastrointestinal and female genital tract. It is locally fast-spreading and highly aggressive, and the prognosis is poor. We report a rare case of leiomyosarcoma of the maxilla in a patient who sought treatment for maxillary swelling, nasal obstruction with no epistaxis, orbital involvement or cervical lymph node metastasis. The patient underwent subtotal maxillectomy followed by radiotherapy. At present, he is symptom free with no recurrence and under regular follow up.
Facial nerve palsy with a parotid mass is usually associated with malignant neoplasm of parotid gland. Its occurrence as a complication of parotid abscess is extremely rare. A literature review revealed only 16 cases of facial nerve palsy associated with suppurative parotitis or parotid abscess were reported. We present a case of deep parotid abscess which is complicated by facial nerve dysfunction. Underlying neoplasia was excluded.
Timely identification of specific injuries in a polytrauma case is of paramount importance in order to reduce morbidity and mortality. Unfortunately, some of these injuries are subtle and can be missed on initial primary and secondary assessments. In this paper, we report one such injury in a case of a 16-year old motorcyclist who complained of abdominal pain over the right lumbar region after the motorcycle handlebar hit his abdomen. Although initial assessment was uneventful, he was subsequently diagnosed to have a traumatic abdominal wall herniation on abdominal computed tomography after more than 24 hours of observation in the ward.
Traditional open approaches to the nasopharynx either provide limited access and risk significant morbidity. Here we describe our experience with endoscopic resection of nasopharyngeal tumours. Retrospective chart review was performed for all patients who underwent endoscopic nasopharyngeal resection from September 1993 to January 2007 at a tertiary rhinology centre. Six patients underwent endoscopic nasopharyngectomy for tumours arising from or involving the nasopharynx. The mean age was 49.8 years (range 23 - 70). The sex distribution was five males and one female. Four tumours were malignant and two were benign. The mean disease-free and overall survival for malignant tumors was 90.75 months (range 66 - 120 months). None of the benign tumors recurred. The endoscopic nasopharyngectomy technique may be successfully used for resection of tumors arising from or involving the nasopharynx with good efficacy and a decrease in morbidity when compared to open approaches.
The quality of physician prescribing is suboptimal. Patients are at risk of potentially adverse reaction because of inappropriate or writing error in the drug prescriptions. We assess the effect of "group academic detailing" to reduce writing drug name using brand name and short form in the drug prescriptions in a controlled study at two primary health care clinics in Negeri Sembilan. Five medical officers in Ampangan Health Clinic received an educational intervention consisting of group academic detailing from the resident Family Medicine Specialist, as well as a drug summary list using generic names. The academic detailing focused on appropriate prescribing habit and emphasized on using the full generic drug name when writing the drug prescription. Analyses were based on 3371 prescriptions that were taken from two clinics. The other health clinic was for comparison. The prescribing rates were assessed by reviewing the prescriptions (two months each for pre- and post-intervention phase). Statistically significant reduction in writing prescription using brand name and using short form were observed after the educational intervention. Writing prescription using brand name for pre- and postintervention phase were 33.9% and 19.0% (postintervention vs pre-intervention RR 0.56, 95% CI 0.48 to 0.66) in the intervention clinic. Prescription writing using any short form for pre- and post-intervention phase were 49.2% and 29.2% (post-intervention vs pre-intervention RR 0.59, 95% CI 0.53 to 0.67). This low cost educational intervention focusing on prescribing habit produced an important reduction in writing prescription using brand name and short form. Group detailing appears to be feasible in the public health care system in Malaysia and possibly can be used for other prescribing issues in primary care.
Pleomorphic sarcoma is the most common sarcoma. Reports of outcome as well as evaluation of prognostic factors in the literature show great variation. We looked at our experience in treating this tumour at University Malaya Medical Center. This is a review of patients diagnosed with Pleomorphic Sarcoma from January 1990 to December 2005 at University Malaya Medical Center. Outcome measures studied are the overall survival, disease free survival and local recurrence of disease. Prognostic factors for survival and local recurrence which were studied are the tumour size, depth, stage, type of surgery, adjuvant therapy, and surgical margin. There were fifty four patients available for analysis of demographics. The mean age at presentation was 52.3 +/- 16.7 years. There were thirty male patients (56%) and twenty four female patients (44%) in the study population. The patients were predominantly Malay (44.4%) and Chinese (42.6%). There were two Indian patients (3.7%) and five patients from other races (9.3%). Thirty patients had disease affecting the extremities while six patients had disease affecting the trunk. Patients with tumour affecting the trunk had 100% mortality. In patients with tumour affecting the extremity, 46.7% presented with Stage 3 disease. The overall median survival was 39 months. The overall survival rate at 3 years was 53.3% and the 5 years was 30.0%. The disease free survival rate at five years was 27.6%. However, if patients who presented with metastasis were excluded, the 5 year survival rate was 60% while the disease free survival was 53.3%. Recurrence rate was 33.3%. Factors affecting survival was stage, size and location of tumour. No factors were found to correlate with higher local recurrence rate. In conclusion, Pleomorphic Sarcoma is a heterogenous disease with variable outcome. In our centre, late presentation with advanced disease significantly affects the overall outcome of this condition. Tumour size and location are important prognostic factors. Inherent tumour behavior and aggressiveness probably outweigh current treatment modalities as the most important prognostic factor in the management of Pleomorphic Sarcoma.
Medical thoracoscopy has gain its popularity in Malaysia recently. This paper presents our early experience in thoracoscopy using semi-rigid fiberoptic thoracoscope. All thoracoscopy records since October 2006 were retrieved. The patients' records, thoracocentesis investigations results, thoracoscopic findings and all pleural biopsy results were reviewed. Twenty-four thoracoscopic procedures on 22 patients in whom two patients had repeated thoracoscopy. Ten patients were confirmed carcinoma. Eight patients had inconclusive thoracoscopic pleural biopsy results. Three patients underwent pleurodesis for malignant effusion. One patient had adhesiolysis for empyema. There was no procedure-related deaths or intraoperative accidents. Thoracoscopy is a relatively safe procedure.
The importance of universal newborn hearing screening (UNHS) in identifying hearing-impaired infants as early as possible is already well recognized. Transient evoked otoacoustic emissions (TEOAE) have been established as a reliable method for UNHS in full term infants. This is a cross sectional study between April 2003--December 2005. Thirteen thousand five hundred and ninety eight (13,598) newborns were screened for hearing loss with portable otoacoustic emission (OAE) before discharge. The initial coverage rate during the 3 years study period was 85.9% (13,598) with 89.2% (3762), 79.0% (4480) and 90.3% (5356) for 2003, 2004 and 2005 respectively. The mean age when hearing loss was diagnosed using ABR were 3.56 months old, 3.08 months old, and 2.25 months old and 3.01 months old for 2003, 2004, 2005 respectively and it was statistically significant. The defaulter rate at the third stage during the 3 years study period was 35% (21), 15.2% (7) and 18.2% (2) for 2003, 2004 and 2005 respectively. This study showed significant improvement in initial referral rate, coverage rate and age of diagnosis. However, we need to improve on high defaulter rates.
Angiokeratoma is a dark violaceous keratotic papule which can be solitary or multiple. Generalised systemic angiokeratoma constitute angiokeratoma corporis diffusum, a rare X-linked recessive inborn error of glycosphingolipid metabolism due to deficiency of alpha galactosidase A. Patients with this disease have premature death due to the vascular complications. A case of possible Fabry's disease is presented.
Newborn screening for congenital hypothyroidism (CH) was implemented in Hospital UKM in December 2004 using cord blood sample. From the audit over a period of 25 months, a total of 13,875 newborn babies were screened with a coverage of 98.8%. From this cohort, the mean recall rate was 0.32%; unfortunately the mean percentage of recalled babies that came for retesting was only 79.5%. In addition, the mean sample rejection rate was high, i.e. 2.2%. Two babies were diagnosed to have CH. These findings implied that whilst the coverage of screening was good, there is a need for regular surveillance of performance of both clinical and laboratory personnel. In addition, a more concerted effort should be carried out to promote community awareness of such a programme.
Effect of Tai Chi exercise on the level of DNA damage using the comet assay, lymphocyte viability and frequency of sister chromatid exchange (SCE) were determined in adults aged above 45. Tai Chi participants of 7 years (n=35), showed higher level of normal DNA and lower level of mild and severely damaged DNA as compared to the sedentary subjects (n=35). The former are suggested to have effective DNA repair mechanism as their frequency of SCE was markedly lower. Higher lymphocyte apoptosis and proliferation found in the Tai Chi participants also indicated that the exercise promotes renewal and regeneration of lymphocytes.
Penile reconstructive surgeries are performed mainly as radical treatment for conditions associated with congenital abnormalities of the urethra or penis, after penile trauma, penile cancer, short penis, corporal fibrosis and in cases of gender reassignment. We present here a method of penile reconstruction with a pre fabricated radial forearm free flap incorporating the segment of the radius for structural support.
Amyloidosis of the skull base is a rare entity. A patient with localized amyloidosis of the sphenoid sinus presented at our institution with cerebrospinal fluid rhinorrhoea. Endoscopic excision of the lesion and multilayered obliteration of the sphenoid sinus resolved the symptoms.
Basal cell carcinoma (BCC) is an indolent, slow-growing malignant skin tumour. Approximately 70% of the tumours occur in the head and neck region. The nose is a common site for malignant skin tumours, such as basal cell carcinoma and squamous cell carcinoma because it is exposed to the sun. Excision of the BCC will leave the nose with a soft tissue defect which requires reconstruction. This report illustrates a case of BCC of nose whereby a wide excision and reconstruction was performed with a paramedian forehead flap.
We experienced the case of a patient who had a foreign body in the maxillary sinus. The foreign body was an arrow accidentally triggered by the patient while fishing. The foreign body was removed via the Caldwell-Luc approach.
Despite being a common skin dermatosis in the tropics, physicians in the tropics may miss the diagnosis of cutaneous larva migrans for other pruritic skin manifestation. This is especially in those who live in urban housing with no history of travel. Cutaneous larva migrans, an intensely pruritic skin pathology is mainly contracted by people with history of beach holiday or contact with moist soft sand which had been contaminated with dog or cat faeces. This article reports a patient who presented with intensely itchy papular spots over the dorsum of his foot after walking barefooted in an urban toilet soiled with cat faeces. The patient had initially seen an urban general practitioner who diagnosed the papular skin lesion as an allergic reaction, and prescribed antihistamines. The patient subsequently developed creeping skin lesions and was seen by the author who prescribed albendazole 400 mg twice daily for three days. The patient reported reduction in itching after two days of albendazole treatment and a follow up at ten days revealed a healed infection.
This study aimed to identify the risk factors which were significantly associated with low birth weight (LBW, <2500 g) infants among the Malaysian population. This was a case-control study carried out at the Tuanku Jaafar Hospital, Seremban, Malaysia over a five-month period. Cases were all infants born with birth weight less than 2500 g. Control infant were selected with the help a random sampling table from among infants with birth weight of > or =2500 g born on the same day in the hospital. Of 3341 livebirths delivered in the hospital, 422 (12.6%) were LBW infants. Logistic regression analysis showed that, after controlling for various potential confounders, the only significant risk factors associated with infants of LBW were gestational age (adjusted odds ratio (OR)=0.6, 95% C.I.: 0.5, 0.6; < 0.0001), maternal pre-pregnancy weight (adjusted OR = 0.97, 95% C.I.: 0.95, 0.99; p < 0.0001), nulliparity (adjusted OR = 3.4, 95% C.I.: 2.2, 5.1; p < 0.0001), previous history of LBW infants (adjusted OR = 2.3, 95% C.I.: 1.4, 3.8; p=0.001) and PIH during current pregnancy (adjusted OR=3.3, 95% C.I.: 1.6, 6.6; p = 0.001). A number of potentially preventable or treatable risk factors were identified to be associated with LBW infants in Malaysia.
The Ex-Gratia Compensation Scheme was introduced by the Government of Malaysia in 1994 to provide compensation, which is not covered by any prior legislation, for all its workers suffering from injuries and illnesses due to work. Despite more than ten years of implementation, the submission for claims is still minimal and there is an impression that awareness on the provision of Ex-Gratia benefit among government employees, especially health care staff, is poor. A cross sectional survey was conducted at a medical department of a government hospital in Kuala Lumpur to assess the knowledge and awareness level on Ex-Gratia among a representative group of front line health care workers. The results show that the respondents' knowledge on Ex-Gratia is generally poor as compared to knowledge on the Social Security (SOCSO) Schemes. Majority of the respondents are unsure whether they will be compensated in case of occupational illness and injuries. They also do not know what kind of compensation scheme they are currently eligible. There is an urgent need for the Treasury and health care managers to expand the knowledge and awareness on Ex-Gratia among health care workers.
Recent research in bio-medical science has shown an integral role of endocannabinoid system (ECS) in determining cardio-metabolic risk of human body. The mechanism is mediated through binding of endocannabinoids at the CB1 receptors. The stimulation of CB1 receptor in the brain is believed to control and mediate the effects on appetite. In normal physiology, CB1 receptors activation is responsible for energy homeostasis, govern emotions and behaviors such as anxiety, fear, appetite, food and water intake. CB1 receptors also found in peripheral tissues like liver, pancreas, skeletal muscles and adipose tissues, which play an important role in lipid and glucose metabolism. Over-activation of ECS is associated with various metabolic diseases such as dyslipidemia, insulin resistance, lipogenesis, excessive weight gain and increasing intra-abdominal obesity. All these events lead to increased cardiovascular risk. Use of selective CB1 receptor blocker such as rimonabant has shown to reduced waist circumference, better glycemic control, lower triglyceride levels, raise HDL cholesterol and over all reduction in total body fat. This drug has been recommended for patients with metabolic syndrome.
We report a rare case of recurrent infection of Chromobacterium violaceum in an immunocompromised patient. Despite the high mortality rate associated with this infection as reported in the literature, this patient survived three episodes of recurrent infection. We believe that with high clinical suspicion, prompt treatment and appropriate antimicrobial agents, it is possible for clinicians to treat this infection effectively and reduce the mortality rate.