Primary germinomas of the central nervous system carry a good prognosis because of their radiosensitivity. Recurrences are rare and extraneural metastases are even more unusual. One of the possible routes of extraneural spread is via ventriculo-peritoneal shunts which may be required to reduce intracranial pressure. One such case of germinoma metastasizing via a ventriculo-peritoneal shunt is reported. Patients with intracranial germinomas and ventriculo-peritoneal shunts should have close surveillance of their abdomens and may require systemic chemotherapy.
Intra-articular haemangioma is a rare and uncommon condition that sometimes presents in infants. The lesion can be a diagnostic challenge, with misdiagnosis often leading to delayed diagnosis and treatment. It is essential to establish and treat the condition early, as intra-articular haemangioma can lead to destruction of the joint and secondary arthrosis. Herein, we report the case of a five-year-old boy who presented with intra-articular haemangioma and discuss the management of his condition.
This study aimed to measure the basal metabolic rate (BMR) of elite athletes and develop a gender specific predictive equation to estimate their energy requirements.
The AdeABC pump of Acinetobacter spp. confers resistance to various antibiotic classes. This pump is composed of the AdeA, AdeB, and AdeC proteins where AdeB is a member of the resistance-nodulation-division efflux pump superfamily. The adeA, adeB, and adeC genes are contiguous and adjacent to adeS and adeR, which are transcribed in the opposite direction and which specify proteins homologous to sensors and regulators of two-component systems, respectively. In this study, an attempt is made to elucidate the role of the AdeABC efflux pump in carbapenem resistance in Acinetobacter spp.
Brain herniation is generally thought to be unlikely to occur in newborns due to the presence of the patent fontanelles and cranial sutures. A review of the literature published from 1993 to 2008 via MEDLINE search revealed no reports on neonatal brain herniation from intracranial tumour. We report a preterm Malay male infant born via elective Caesarean section for antenatally diagnosed intracerebral tumour, which subsequently developed herniation. Cerebral magnetic resonance imaging showed features that were compatible with a large complex intracranial tumour causing mass effect and gross hydrocephalus. Tumour excision was scheduled when the infant was two weeks old. Unfortunately, on the morning of the surgery, he developed signs of brain herniation and had profuse tumour haemorrhage during the attempted excision. Histopathological examination revealed an embryonal tumour, possibly an atypical rhabdoid/teratoid tumour. This case illustrates that intracranial tumours in newborns can herniate and should therefore be closely monitored.
We present two infants whose endovascular lines were accidentally cut or fractured, and had to be retrieved via transcatheter means in the cardiac catheterisation laboratory. The first case was a two-month-old infant with transposition of the great arteries, requiring an emergency balloon atrial septostomy. An indwelling vascular catheter that was placed in the right femoral vein was accidentally cut and had migrated into the inferior vena cava, before being retrieved. The second case was a one-week-old neonate who presented with pneumonia at birth, and had a long intravenous catheter placed in the left saphenous vein, which became fractured, and subsequently migrated into the heart. This case presented as a pulmonary embolus with haemodynamic instability, as the catheter had partially obstructed the right ventricular outflow tract. This was later retrieved via transcatheter means.
Hydroxyzine is a first generation antihistamine widely used in the paediatric population for a variety of conditions. A nine-year-old girl presented with supraventricular tachycardia while on clinical doses of hydroxyzine for pruritus. On arrival at the hospital, she was diaphoretic, with cool peripheries, poor peripheral pulses and a heart rate of 250/minute. There was a history of three palpitation episodes with chest tightness during the five months she was taking hydroxyzine. The supraventricular tachycardia eventually reverted to sinus rhythm with intravenous verapamil. Relevant cardiac examination and investigations had not shown any cardiac abnormalities. After discontinuing hydroxyzine, she had no further episodes of supraventricular tachycardia. To our knowledge, this is the first report of hydroxyzine induced-supraventricular tachycardia in the medical literature.
This is a case report of a 56-year-old Malay male presenting with a giant urethral calculus. The stone measuring 70 X 50 X 40 mm and weighing 45 g was impacted in the posterior urethra. The giant urethral calculus was removed successfully through external urethrotomy.
Cervical spondylotic myelopathy (CSM) represents a spectrum of pathologies with progressive compression of the spinal cord. The clinical signs and symptoms play a key role in diagnosis. The characteristic hand myelopathy signs are of significant clinical importance. The aim of this descriptive study was to report a relatively easy to elicit new hand myelopathy sign. The basis for this is finger and wrist flexor disinhibition, which is used for the spinal specificity of cord compression at or above the C5/6 level.
Two cases of dislocation of total knee arthroplasty presented to us within the same week. The first patient is a 71-year-old woman who underwent bilateral primary total knee arthroplasty. The left knee dislocated three weeks after the surgery. Due to failure of conservative measures, she underwent revision total knee arthroplasty. The other patient is a 72-year-old woman presenting ten years after primary total knee arthroplasty, with a traumatic dislocation of the knee joint. She was treated as an outpatient with closed manipulative reduction.
Diabetes mellitus is a common chronic disease in Singapore. Its occurrence in pregnant women was 1.3% in a previous report. In a survey of 145 consecutive pregnant women registered at Alexandra Hospital the incidence of gestational diabetes was 13.1% when a total screen with 75 gm oral glucose challenge was used. The mean age of this sample was 27 years and the mean gestation at screening 33 weeks. There was an excess of Malay and Indian patients. Fifty percent had traditional risk factors tor gestational diabetes. Whether this higher incidence is a result of more stringent screening and/or increased occurrence remains to be confirmed.
INTRODUCTION:
This study aimed to compare the detection rates of glucose-6-phosphate dehydrogenase (G6PD) deficiency in neonates by fluorescent spot test (FST), enzyme assay and molecular methods, and to identify which method was a significant predictor of severe hyperbilirubinaemia.
METHODS:
74 term infants of Chinese descent admitted with severe hyperbilirubinaemia (total serum bilirubin equal or greater than 300 micromol/L) and 125 healthy term infants born in the hospital without severe hyperbilirubinaemia were recruited into the study. Specimens of blood were collected from each infant for FST, G6PD enzyme assay and TaqMan minor groove binder single nucleotide polymorphism genotyping assay.
RESULTS:
26 (13.1 percent) infants were diagnosed to have G6PD deficiency by FST. They had significantly lower median enzyme levels (0.8 IU/g Hb, interquartile range [IQR] 0.4-4.3) than those diagnosed to be normal (12.0 IU/g Hb, IQR 10.3-15.8) (p-value is less than 0.0001). Based on the enzyme assay, 39 (19.6 percent) infants had G6PD deficiency at an enzyme cut-off level of less than 8.5 IU/g Hb. G6PD mutation was detected in 27 (13.6 percent) infants. Logistic regression analysis showed that the only significant predictors of severe hyperbilirubinaemia were G6PD deficiency based on a cut-off level of less than 8.5 IU/g Hb (adjusted odds ratio [OR] 5.3, 95 percent confidence interval [CI] 2.4-11.4; p-value is less than 0.0001) and exclusive breast-feeding (adjusted OR 11.4, 95 percent CI 3.1-42.4; p-value is less than 0.0001). The gender and birth weight of infants, FST results, G6PD mutation and the actual G6PD enzyme levels were not significant predictors.
CONCLUSION:
A G6PD enzyme level of less than 8.5 IU/g Hb is a significant predictor of severe hyperbilirubinaemia
We describe a 50-year-old Chinese woman who had severe gastrointestinal manifestations from systemic sclerosis complicated by spontaneous pneumoperitoneum in the absence of either visceral perforation or pneumatosis cystoides intestinalis. This is a rare complication of systemic sclerosis; only four other cases have been reported. Recognition of this condition is important so as to avoid unnecessary surgery.
INTRODUCTION: The present study aimed to obtain preliminary tympanometric data of young Malay adults and to compare the results between genders.
METHODS: 96 undergraduate students (49 males and 47 females), aged 19-25 (mean and standard deviation 21.14 +/- 1.31) years, participated in this study. Otoscopic examination, pure tone audiometry, qualitative tympanogram and ipsilateral acoustic reflex were measured to ensure a clear ear canal, normal hearing and normal middle ear function, prior to tympanometric measurement. As a result, a total of 154 ears (80 ears from males and 74 ears from females) were selected for further statistical analyses. The tympanometric parameters measured were peak compensated static acoustic admittance (Peak Y(tm)), tympanometric width (TW) and equivalent ear canal volume (V(ea)).
RESULTS: The results showed that the mean Peak Y(tm), V(ea) and TW for males were 0.81 mmhos, 1.48 cubic cm and 113.67 daPa, respectively. The mean Peak Y(tm), V(ea) and TW for females were 0.63 mmhos, 1.12 cubic cm and 98.04 daPa, respectively. Males were found to have significantly higher mean V(ea) and mean Peak Y(tm) than females. However no significant gender difference was observed in the mean TW.
CONCLUSION: The current study suggests that young Malay adults may require gender-specific Peak Y(tm) and V(ea) values when implementing a quantitative approach in tympanogram interpretation.
We describe here a case of cryptococcal empyema thoracis and periauricular pyogenic abscess in a child with Bruton's agammaglobulinaemia. The cryptococcal empyema thoracis was treated with intravenous amphotericin B and intravenous fluconazole for six weeks followed by oral fluconazole. The pyogenic periauricular abscess was surgically drained and treated with intravenous ceftazidime and cloxacillin for two weeks. He also received monthly intravenous immunoglobulin.
The aim of this study was to identify the prognostic factors that influence the survival of differentiated thyroid cancer patients treated at Hospital Universiti Sains Malaysia (HUSM).
The arterial and muscular variations of the upper limbs are common but important with regard to surgical approaches. Even though anomalies of the coracobrachialis muscle are rare, anatomical variations of the biceps brachii, existence of the accessory muscles in the forearm and persistent median artery are known and well documented. During routine dissection, we observed some important anatomical variations in a 50-year-old male cadaver. The variations were unilateral. The anomalies were: third head for biceps brachii muscle, an accessory belly for coracobrachialis muscle crossing the median nerve and brachial vessels and continuing with the medial head of triceps brachii muscle to be inserted to the olecranon process (coracoulnaris), a persistent median artery and an additional muscle in the anterior compartment of forearm. Although there are individual reports about these variations, the combination of these variations in one cadaver has not previously been described in the literature. Awareness of these variations is necessary to avoid complications during radiodiagnostic procedures or surgeries in the upper limb.
The primary closure of a rectus sheath muscle abscess was performed on an 11-year-old child following evacuation of its contents under antimicrobial cover. Complete healing was achieved in eight days. This method avoids the delays in wound healing and morbidity associated with conventional drainage and shortens convalescence.
A six-year-old boy sustained an accidental penetrating missile injury to his chest. Imaging studies revealed a metallic foreign body lodged between the pulmonary infundibulum and the right atrium of the heart. No cardiovascular compromise was produced. Surgical exploration was not required. The foreign body remained stable and non-migratory over a 16-month follow-up period.