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  1. Amarpreet, K., Nor Zuraida, Z., Ng, C.G., Aida, S.A.
    MyJurnal
    Pathological laughing or crying (PLC) were recognized after the occurrence of stroke, with a prevalence of 15% to 18%. There is no apparent triggering stimulus, and is often misdiagnosed as a mood disorder as it is a disorder of emotional expression rather than a primary disturbance of feeling. We reported a case of a 32 year old lady, who presented with giddiness and altered consciousness progressing to fever and neck stiffness, who’s CT showed a massive left cerebellar infarct. No risk factors were identified. Psychiatrically, she developed sudden crying spells after one month and a diagnosis of Major Depressive Disorder was made with subsequent commencement of anti-depressants. A week later, she developed continuous inappropriate laughter without the feeling of elation, which was beyond her control. There were no symptoms of mania or psychosis.
    Matched MeSH terms: Tomography, X-Ray Computed
  2. Goh. SY, Ropilah, AR, Othmaliza, O, Mushawiahti, M
    MyJurnal
    Diabetic retinopathy is a disease involving microangiopathic changes in response to chronic hyperglycaemia and pan retinal photocoagulation (PRP) is currently the mainstay of treatment for proliferative retinopathy. In the present study, we evaluated the effect of pan retinal photocoagulation (PRP) on retinal nerve fibre layer (RNFL) thickness in patients with diabetic retinopathy using optical coherence tomography (OCT). This was a prospective longitudinal study. Patients with Type 2 diabetes mellitus with proliferative diabetic retinopathy (PDR) or very severe non-(N)PDR requiring laser treatment were included in the study. PRP was performed by a single trained personnel. Peripapillary RNFL located 3.4 mm around the optic disc was evaluated using time-domain OCT. Examination was performed before treatment, and 2 and 4 months after laser treatment. In total, 39 subjects (39 eyes) were recruited into this study. Twenty-nine patients had PDR and 10 had very severe NPDR. Mean age was 54.97 ± 8.38 years. Male and female genders were almost equally distributed with 18 males and 21 females. Median thickness of average RNFL at baseline was 108.8 um (interquartile range [IQR] 35.3). At two months post-procedure, average RNFL thickness significantly increased to 117.4 (IQR 28.6; P = 0.006). Although, other quadrants revealed a similar trend of increasing thickness at two months but it was not significant. At 4 months post-laser treatment, RNFL thickness in all quadrants reduced to baseline levels with insignificant changes of thickness compared to prior to laser treatment. There was also no significant association between changes in RNFL thickness and HbA1c levels (P = 0.77). In conclusion, PRP causes transient thickening of the RNFL which recovers within 4 months post-laser treatment. At the same time, poor sugar control has no direct influence on the RNFL changes after PRP.
    Matched MeSH terms: Tomography, Optical Coherence
  3. Law, C.W., Ng, C.L.L.
    JUMMEC, 2008;11(2):83-85.
    MyJurnal
    A 65-year-old lady with cholelithiasis underwent an elective laparoscopic cholecystectomy (LC) and was discharged on post-operative day 2. She was re-admitted after five days with right hypochondriac pain and fever. Investigations revealed a drop in hemoglobin. Computed tomography showed a large intrahepatic subcapsular collection without intra-abdominal collection. She was treated with intravenous antibiotics. Percutaneous aspiration of intrahepatic subcapsular collection under ultrasound guidance revealed old blood. Hence diagnosis of intrahepatic subcapsular hematoma (ISH) was made. She improved and was discharged after a two weeks' hospital stay. Follow-up ultrasonography examination two months later revealed complete resolution of the hematoma. We report this case due to its rarity and review the previously documented cases of this complication.
    Matched MeSH terms: Tomography
  4. Tan, E.C., Soon, H.C., Kevin, M., Se To, B.C.
    Malays Orthop J, 2007;1(2):30-32.
    MyJurnal
    Congenital partial aplasia of the atlas with a posterior arch remnant is rare. It may be found as an incidental radiological finding or patients can present with neurological signs and symptoms after head or neck trauma. A 36-year-old female presented with a 3-day history of right sided neck pain radiating down the right arm. Radiographs of the cervical spine showed a radiolucent area in the region of the posterior arch of the atlas. Computed tomography subsequently revealed partial absence of the posterior arch of the atlas with a defect at the anterior ring. Her clinical condition subsequently improved with rest, analgesia and physiotherapy. This case report illustrates a situation where congenital defect of the posterior arch of the atlas was revealed in a patient with neck pain. Awareness of the existence of this condition will help clinicians avoid misdiagnosis and excessive investigations.
    Matched MeSH terms: Tomography, X-Ray Computed
  5. Phon, S.E., Ng, W.Y.L., Ng, B.K., Rahman, R.A., Zainuddin, A.A, Mahdy, Z.A.
    MyJurnal
    Congenital peritoneal band is an extremely rare condition, but may induce small bowel obstruction (SBO) at any age, predominantly in childhood and rarely in adults. We report a case of extensive bowel ischaemia following caesarean section, due to trapping of an intestinal loop between a congenital peritoneal band and the mesentery. A 42-year-old, Gravida 2 Para 1, who has no history of prior abdominal surgery or trauma, presented in spontaneous labour and underwent an uncomplicated emergency lower segment caesarean section, for fetal distress. Postoperatively, she had worsening abdominal distension and pain, followed by vomiting. Computed Tomography Scan of the abdomen showed gross fluid retention with marked small bowel dilatation and fluid filled bowel loops. An emergency exploratory laparotomy was performed which revealed a congenital band, extending between the right fimbrial end and the small bowel mesentery, looping over the small bowel, causing extensive small bowel ischemia. Post-operative course was uneventful. In conclusion, congenital peritoneal band causing small bowel obstruction, although rare, should be considered in the differential, especially for patients with virgin abdomen.
    Matched MeSH terms: Tomography
  6. Johari HH, Mohamad I, Sachlin IS, Aziz ME, Mey TY, Ramli RR
    Auris Nasus Larynx, 2018 Dec;45(6):1183-1190.
    PMID: 29880289 DOI: 10.1016/j.anl.2018.04.010
    OBJECTIVE: This study was done to determine frontal recess anatomy cell variations and its association with frontal sinusitis. The incidence of frontal recess cells in the population, the presence of frontal recess cell variations in chronic rhinosinusitis and non-chronic rhinosinusitis and the association of frontal recess cell variation in the development of frontal sinusitis were also assessed.

    METHODS: This was an observational, retrospective cross-sectional study of computed tomography (CT) scan of paranasal sinus that had been performed on patients in Hospital Universiti Sains Malaysia and Hospital Sultanah Bahiyah done from January 2009 until December 2016. The presence of frontal recess cells variation was compared with other populations.

    RESULTS: A total of 312 sides from 156 patients' CT scan images were analyzed. Left and right sinuses were considered individually. A total of 63 sides showed evidence of frontal sinusitis, 37 were male and 26 were female, whereas 249 sides were clear from frontal sinus disease. It was not much difference in mean age for frontal sinusitis patient (46.51±14.00) and patients without frontal sinusitis (48.73±16.44). The percentage was almost equal for CRS and non-CRS groups regardless of side and gender. In our study, the frontal recess cell such as agger nasi cell was found in almost all patients 98.1%, frontal ethmoidal cell type 1, type 2, type 3 and type 4 comprised of 28.8%, 31.1%, 14.4% and 0% respectively. Whereas, suprabullar cell can be seen in 40.3%, supraorbital ethmoid cells 16.7%, frontal bullar cell 33.0% and inter-frontal sinus septal cells 10.8%. There was a statistically significant association between the presence of frontal bullar cell and the development of frontal sinusitis (p value<0.001).

    CONCLUSION: The frontal recess cells variation in Malaysian subjects were almost similar to those reported in other Asian populations such as Japanese, Taiwanese, Chinese and Korean. Our study found that frontal bullar cells had a significant association with the development of frontal sinusitis than other frontal recess cells. The understanding of the frontal recess anatomical structures was very important as this would lead to a successful treatment of CRS and at the same time it helped the surgeon to have a better plan of endoscopic sinus surgery to prevent the disease recurrence and surgical complication.

    Matched MeSH terms: Tomography, X-Ray Computed
  7. Noor Liza Ishak, Primuharsa Putra Sabir Athar Husin, Suria Hayati Md Pauzi, Isa Mohd Rose, Mohd Razif Mohamad Yunus
    MyJurnal
    Solitary fibrous tumours of the head and neck region are
    extremely rare. The clinical diagnosis is often difficult to
    establish, and this lesion may be indistinguishable from other
    soft tissue neoplasms. An 18-year old Chinese gentleman
    presented with a painless right submandibular swelling which
    was increasing in size for eight months. A computed
    tomography scan showed a well-defined solid mass measuring
    about 2.0 x 2.96 cm in the submandibular region. The tumour
    was resected and was confined within its capsule.
    Immunohistochemical staining was strongly positive for CD34,
    CD 99, and vimentin and negative for desmin, smooth muscle
    actin (SMA), cytokeratin, S100 and CD68. The microscopic and
    immunohistochemical profile were compatible with solitary
    fibrous tumour. Distinguishing solitary fibrous tumours from
    various spindle neoplasms can be difficult. In view of the
    resemblance, immunohistochemical staining can help
    differentiate solitary fibrous tumour from spindle neoplasm.
    Matched MeSH terms: Tomography, X-Ray Computed
  8. Hayati F, Mohd Azman ZA, Nasuruddin DN, Mazlan L, Zakaria AD, Sagap I
    Asian Pac J Cancer Prev, 2017 07 27;18(7):1821-1825.
    PMID: 28749112
    Background: Anastomotic leaks in colorectal surgery results in a high morbidity and mortality rate. Serum procalcitonin levels is known as a sensitive and specific marker of sepsis and could be use as a marker for early detection of a leak allowing early intervention. It may help a clinician decide to perform a CT scan even earlier especially when the diagnosis of a leak is uncertain. The aim of this study is to determine whether serum procalcitonin is a good predictor of anastomotic leak in colorectal surgery. Methodology: Between July 2014 until October 2015, 70 patients undergoing colorectal surgery were prospectively analyzed in a single-center tertiary teaching hospital. Demographic and surgical data were obtained. Serum procalcitonin was taken before surgery and at day 3 (72 hours) postoperatively. During the postoperative period, the patients were observed in the ward for features of anastomotic leak and if present, it was managed accordingly. The primary outcome was to prospectively determine an association between serum procalcitonin levels and an anastomotic leak in patients who underwent colorectal surgery with a primary anastomosis. Result: The rate of anastomotic leak was 4.5% (3 patients) with a mortality rate of 4.3% (3 patients). A rise in serum procalcitonin was statistically significant among patients with anastomotic leak. The optimal procalcitonin cut-off level at postoperative day 3 was 5.27 ng/mL, resulting in 100% sensitivity, 85% specificity, 23% positive predictive value and 100% negative predictive value. Nevertheless, none of the variables showed statistical significance with an anastomotic leak. Conclusion: Procalcitonin is a reliable biochemical marker to help diagnose anastomotic leak in colorectal surgery. Our study has shown that a level of 5 times beyond normal is statistically significant and a value of more than 5.27 ng/mL is confirmatory of a leak.
    Matched MeSH terms: Tomography, X-Ray Computed
  9. Hussin S, Yusoff SSM, Zin FM, Ghani ARI
    J Family Med Prim Care, 2018 6 20;7(1):252-254.
    PMID: 29915770 DOI: 10.4103/jfmpc.jfmpc_157_17
    Frontal meningioma is often asymptomatic and patient may present with psychiatric symptoms. We report a case of 45- year-old female patient with no premorbid medical illness presented with 6 months history of depressive symptoms and changes in personality. Her worsening cognitive impairment brought her to psychiatry clinic and led to further investigation with contrast-enhanced computed tomography (CECT) Brain. The result showed well defined markedly enhancing lesion in the frontal region measuring 5.5 cm X5.2 cm X 4.4 cm with mass effect to the adjacent brain parenchyma and associated surrounding edema. Diagnosis of bifrontal tumour-olfactory Groove Meningioma was made. Patient underwent bifrontal craniotomy and tumour excision. The quality of life improved after surgical excision.
    Matched MeSH terms: Tomography
  10. Amin OS, Mahmood MM
    BMJ Case Rep, 2017 Mar 08;2017.
    PMID: 28275028 DOI: 10.1136/bcr-2017-219300
    Matched MeSH terms: Tomography, X-Ray Computed
  11. Chuah YY, Lee YY, Tsai TJ
    Postgrad Med, 2017 May;129(4):488-490.
    PMID: 28335674 DOI: 10.1080/00325481.2017.1311198
    Migration of percutaneous endoscopic gastrostomy (PEG) tube to colon with gastro-colonic-cutaneous fistula formation is a rare complication of the procedure. Transient episodic diarrhea following each PEG tube feeding is typical of this complication. We present a 72-year-old man with cerebrovascular disease and scoliosis who encountered episodes of transient diarrhea after each PEG tube feeding. His diarrhea was refractory to medications. Colonoscopy demonstrated a mal-positioned PEG in the transverse colon. Computed tomogram (CT) of abdomen further confirmed the finding. After removal of the migrated PEG, his diarrhea had ceased completely. The gastro-colonic-cutaneous fistula was further managed with endoscopic clipping method with no complications encountered during follow up.
    Matched MeSH terms: Tomography, X-Ray Computed
  12. Hairol AO, Affirul CA, Azlanudin A, Zamri Z, Razman J, Choi SY
    Clin Ter, 2017 Jan-Feb;168(1):e5-e7.
    PMID: 28240755 DOI: 10.7417/CT.2017.1974
    Radiofrequency ablation (RFA) has evolved to become the treatment of choice for non-resectable recurrent colorectal liver metastasis. It is however, not without complications. Portal vein thrombosis following RFA is rare but can be fatal to the outcome of the patient. Here, we present a case of a 66-year-old man who developed portal vein thrombosis following RFA. CT scan revealed a left portal vein thrombosis. This case report highlights the challenges and multimodal treatment of portal vein thrombosis following Radiofrequency ablation (RFA) in a cirrhotic patient.
    Matched MeSH terms: Tomography, X-Ray Computed
  13. Tengku Shaeran TA, Shaari R, Abdul Rahman S, Alam MK, Muhamad Husin A
    J Oral Biol Craniofac Res, 2017 Jan-Apr;7(1):7-12.
    PMID: 28316914 DOI: 10.1016/j.jobcr.2016.10.007
    BACKGROUND: Bilateral sagittal split osteotomy (BSSO) is the most versatile procedure and adopted by many surgeons to relocate the mandible in patients having mandibular prognathism (MP). Injury to the inferior alveolar nerve (IAN) and unfavorable splits are two surgical complications of BSSO which are associated with mandibular morphology. Uses of cone beam computed tomography (CBCT) in providing 3-D images has gained a wider acceptance in surgical field nowadays. Its advantages are including reduced cost, lesser radiation dose and smaller physical footprint comparing to the conventional computed tomography.

    PURPOSE: This study aims to identify the differences in morphology of prognathic and non-prognathic mandible at BSSO sites using cone beam computed tomography images.

    METHODS: This retrospective study involved 51 CBCT images of patients having mandibular prognathism and without mandibular prognathism. The latter group made up from patients with Class I skeletal pattern. Samples were taken using purposive sampling method from two clinical centers.

    RESULT: Prognathic mandible has higher lingula level, superiorly and buccally placed inferior alveolar nerve canal at distal second molar, thinner mediolateral width of ramus at anterior and posterior part and thinner anteroposterior width of the ramus.

    CONCLUSION: Morphology of mandible in patients with mandibular prognathism (MP) was significantly different from patients without mandibular prognathism (WMP) for most of the parameters. The high risk parameters may be highlighted to the patients using cone beam computed tomography images.
    Matched MeSH terms: Cone-Beam Computed Tomography
  14. Ismail NA, Ragab S, Abd El Dayem SM, Baky ANAE, Hamed M, Ahmed Kamel S, et al.
    Med J Malaysia, 2018 10;73(5):286-290.
    PMID: 30350806
    INTRODUCTION: CDKAL1 single-nucleotide polymorphism rs 9465871variant is a risk locus for Type 2 Diabetes (T2DM).The study evaluated the associations of CDKAL1- rs9465871 with glycosylated hemoglobin A1C Level (HbA1c), fasting insulin level, insulin resistance and metabolic syndrome among obese and non- obese Egyptian children.

    MATERIALS AND METHODS: The study included 43 obese children and 40 normal weight children. Anthropometric body measurements, bio-specimen and biochemistry assays were done. Genotyping of rs9465871 (CDKAL1) was conducted.

    RESULTS: The percentages of the CC, CT, and TT genotypes of rs9465871in the lean children were 15%, 42.5%, and 42.5%, respectively. Regarding obese children, the frequencies were 18.6%, 58.1% and 23.3% respectively with no significant statistical difference. Comparison between the CDKAL1 rs 9465871 polymorphism showed that the highest value of fasting insulin was recorded in CC genotype (22.80± 15.18 [uIU/mL] P

    Matched MeSH terms: Tomography, X-Ray Computed
  15. Ikhwan Sani Mohamad, Sivabalan Nadarajan, Azim Idris, Hairol Othman, Affirul Chairil, Razman Jarmin
    MyJurnal
    Leiomyosarcoma of the Inferior Vena Cava (IVC) is a rare soft tissue tumour which accounts for only 0.5% of all soft tissue sarcomas. The patients usually presented with non specific clinical signs and often diagnosed at advanced stage. We reported a case of a 58-year-old lady who presented with right sided abdominal pain for 6 months. CT scan showed large Level 2 IVC tumour which encased the right renal vein and had no clear plane of demarcation with the caudate lobe of the liver. She underwent radical resection of the IVC tumour with the right kidney removed en bloc. Vascular reconstruction was not performed as established collateral veins present. She was nursed in Intensive Care Unit for 2 days and discharged well at day 5 post operatively. Histopathological examination results revealed leiomyosarcoma of IVC.
    Matched MeSH terms: Tomography, X-Ray Computed
  16. Ng RL
    Med J Malaysia, 2018 10;73(5):328-329.
    PMID: 30350815
    A 5-year-old girl presented with three brief episodes of afebrile seizure within 24 hours. There was no significant past medical history but she had symptoms of acute gastroenteritis for the past 2 days. She was mildly dehydrated with no neurological signs. Serum electrolytes and blood sugar were normal and cerebrospinal fluid examination was negative for meningoencephalitis. Contrast-enhanced CT Brain showed no evidence of intracranial lesion, haemorrhage or meningeal enhancement. Only stool investigation was positive for Rotavirus. The conclusion of Benign Afebrile Convulsion with gastroenteritis (CwG) was established after excluding other serious causes of afebrile seizure in children.
    Matched MeSH terms: Tomography, X-Ray Computed
  17. Low, Qin Jia, Huan, Nai Chien, Tan, Wei Lun
    MyJurnal
    Dandy-Walker syndrome is a rare congenital malformation of the brain that involves the cerebellum and the fourth ventricle. It is characterised by a classical triad of hydrocephalus, cystic dilatation of the fourth ventricle and complete or partial agenesis of the vermis. Majority of cases are diagnosed during neonatal or early infantile period. In this case report, a seven-year-old boy complained of recurrent headaches for the past one year. Physical examination was unremarkable. Examination of the fundus on the same day revealed bilateral papilloedema. His subsequent computed tomography scan of the brain done at a major district hospital demonstrated features in keeping with Dandy-Walker malformation. Our case highlighted the importance of embarking on a detailed and thorough approach when dealing with a child with chronic headache, especially in rural settings where advanced medical equipment is not readily available.
    Matched MeSH terms: Tomography
  18. Deng PU, Halim MS, Masudi SM, Al-Shehadat S, Ahmad B
    Eur J Dent, 2018 8 28;12(3):410-416.
    PMID: 30147408 DOI: 10.4103/ejd.ejd_82_18
    Objective: The aim of this study is to investigate the variations in the number of root and canal in the mandibular first permanent molars (MFPMs) teeth in East Coast Malaysian population using cone-beam computed tomography (CBCT).

    Materials and Methods: CBCT images which show MFPMs recorded in HUSM Dental Clinic between January 2015 and June 2016 was obtained and analyzed for their number of roots and canals. A total of 208 CBCT images of MFPMs were collected; 118 patients had unilateral molars and 90 patients had bilateral molars. The following observations were made: (1) root number; (2) number of canals per root; and (3) comparisons of number of roots and canals according to gender, ethnicity, and position.

    Results: The majority of cases of bilateral MFPM had the same number of roots (95.6%, 95% confidence interval [CI]: 89.01%, 98.78%) on both the right and left side and only 4 cases (4.4%, 95% CI: 1.22%, 10.99%) had 3 roots on the right and 2 roots on the left sides. The majority of cases had the same number of canals on both sides (66.7%, 95% CI: 55.95, 76.26%) and 33.3% (95% CI: 23.74%, 44.05%) with unequal number of canals. The occurrence of the number of canals was not independent of the sides of the arch (P < 0.001) and there was statistically significantly greater proportion of cases who had greater number of canals on the right side than the left (P = 0.03). The prevalence of right single-rooted MFPM was very small at 0.3% (n = 1) in a Malay male (95% CI: 0.00, 1.83) and the most prevalent was two roots first molar (88.4%). The number of roots was not associated with sex or ethnic group (P > 0.05). The MFPM with a single root was found to have only one mesial canal. For two rooted MFPM, the most prevalent occurrence was two canals at the mesial and one canal at the distal roots (59%); followed by single canals in each mesial and distal (21%) and double canals per root (18%). Three roots MFPM have either single or double canals in the mesial root and double canals in the distal root.

    Conclusions: The majority of population in the East Coast region of Malaysia has two roots and three root canals in their MFPMs. There was no difference in the number of roots between gender and ethnic and canals between ethnic.

    Matched MeSH terms: Cone-Beam Computed Tomography
  19. Tan KS, Jalaluddin WMS
    BJR Case Rep, 2016;2(3):20150460.
    PMID: 30459991 DOI: 10.1259/bjrcr.20150460
    Lipomas of the larynx, oropharynx and hypopharynx are rare, accounting for approximately 1% of benign laryngeal neoplasms. We present a rare case of a simple lipoma arising from the right vallecula. A 55-year-old male presented with worsening dysphagia for 1 week. CT scan revealed a lesion of fat attenuation in the right vallecula. The patient underwent surgical excision and recovered uneventfully. To our knowledge, there are only two cases of vallecular lipoma that have been reported and they are both of spindle cell subtype and located on the left side. This is the first reported case of a simple lipoma arising from the right vallecula and causing obstructive symptoms. CT scan or MRI is essential in confirming the diagnosis and assessing the extent, thus allowing prompt excision, especially when the patient is symptomatic.
    Matched MeSH terms: Tomography, X-Ray Computed
  20. Chan PL, Tan FHS
    Clin Hypertens, 2018;24:15.
    PMID: 30410790 DOI: 10.1186/s40885-018-0100-x
    Background: Hypokalemia in the presence of hypertension is often attributed to primary hyperaldosteronism as a cause of secondary hypertension, however secondary hyperaldosteronism may present similarly. Accessory renal arteries are variants in the vascular anatomy which are often thought to be innocuous but in some circumstances can cause renovascular hypertension leading to secondary hyperaldosteronism.

    Case presentation: We report 2 cases of hypertension with secondary hyperaldosteronism associated with accessory renal arteries. Both patients presented with hypokalemia and further investigations revealed hyperaldosteronism with unsuppressed renin levels. Imaging studies showed the presence of accessory renal artery.

    Conclusion: Accessory renal arteries are a potential cause renovascular hypertension which can be detected via CT angiography or magnetic resonance angiography. Hormonal evaluation should be undertaken to determine whether its presence contributes to hypertension in the patient as targeted treatment such as aldosterone antagonist can be initiated. Surgical intervention or renal denervation may be considered in resistant cases.

    Matched MeSH terms: Computed Tomography Angiography
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