In Malaysia, transbronchial needle aspiration (TBNA) is a relatively new procedure performed only in a handful of respiratory centres. We reviewed TBNA of mediastinal lymph node performed in Hospital Tengku Ampuan Afzan (HTAA) to determine the yield and its complications. Data was retrieved from endoscopy databases and patients' records, CT thorax images and all cytological and histological slides were reviewed. Twenty-five patients had TBNA performed. TBNA was positive in 15 patients (60%). Overall, 80% had confirmed malignancy after bronchoscopy. Only four patients had documented bleeding after TBNA and in two of them, bleeding stopped spontaneously and another two patients required diluted adrenaline to stop the bleed. No mortality was reported from this procedure. Hence, TBNA is a safe procedure.
Tako Tsubo cardiomyopathy is rare, stress related and indistinguishable from acute myocardial infarction clinically. Proper diagnosis is essential to avoid unnecessary thrombolysis and life long management of coronary artery disease.
A review of 45 patients who underwent endoscopic dacryocystorhinostomy (EDCR) from 1998 to 2005 was done. Only patients who had complete notes and had Jones tube removed at least three months before the study were included. Our experience with EDCR concludes it to be an easy, efficient treatment for nasolacrimal duct obstruction with minimal complications.
Shift work is associated with various health problems and there is concern that shift workers are at higher risk to develop dyslipidaemia. A cross-sectional study was conducted from December 2003 to May 2004 to compare the prevalence of dyslipidaemia (hypercholesterolaemia, hypertriglyceridaemia, hyper-LDL and hypo-HDL-cholesterolaemia) and to examine the relationship between shift work and dyslipidaemia among 148 randomly selected male workers from one of the factories in Kota Bharu, Kelantan. Information on psychosocial and life-style factors, anthropometric and blood pressure measurement, fasting blood sugar and lipid profiles analyses were obtained. In multiple variable analysis, the presence of any abnormalities in the lipid profiles was regarded as having dyslipidaemia. The prevalence of hypercholesterolaemia (47.4%) and hypertriglyceridaemia (42.1%) were significantly higher among shift workers compared to day workers with p-value of 0.014 and 0.044 respectively. There was no significant different in the prevalence of hyper-LDL and hypo-HDL-cholesterolaemia and shift work was not significantly associated with dyslipidaemia, OR(adj) = 1.27; 95% CI 0.63-2.57.
Fibrous dysplasia is a benign disease characterized by a progressive replacement of normal bone elements with fibrous tissue and the temporal bone involvement is uncommon. It has a male:female ratio of 2:1 and is seen more commonly in the first two decades of life. Diagnosis is made based on radiological findings and the modality of treatment is mainly conservative. However, surgery is reserved for preserving function and preventing complications. Fibrous dysplasia in the region of craniofacial bones is of particular interest to the otolaryngologist as it causes deformity and dysfunction that can be debilitating. We present a 49 year old Chinese gentleman with complaints of chronic dizziness over the last one year and had no obvious hearing impairment. Computed tomography of the mastoid revealed fibrous dysplasia of the right temporal bone. This case is of particular interest due to the late presentation as it is more commonly seen in the first two decades of life.
Schwannomas are benign tumors. A series of three unusual cases involving the head and neck region at the Department of ENT, Hospital Ipoh from July 2004 to June 2005 is presented. The first case was a pedunculated schwannoma of the tongue base. The second was a schwannoma of the cervical sympathetic chain who developed a transient Horner's Syndrome upon fine needle aspiration cytology. The third case was a bilobed cervical vagal schwannoma which developed immediate vocal cord palsy postoperatively which was evident at six months follow-up. All tumors were removed surgically.
The present study examines the gross anatomical features of anomalous lunate sulcus detected incidentally in a cadaveric brain and discusses its clinical importance. The absence of lunate sulcus was carefully studied in a dissected brain specimen. The absence of lunate sulcus was observed unilaterally on the right side of a cadaveric brain specimen. The lunate sulcus was clearly appreciated on the left side whilst on the right side it was absent. The right hemisphere of the cerebellum was also bigger in size as compared to the left. The absence of lunate sulcus is a rare finding, which may be detected incidentally. The anatomical knowledge of the lunate sulcus may be important for neurosurgeons operating on the occipital lobe and the radiologists interpreting CT scan.
Condom-murder is term used to describe a homicide where a person has been killed due to his recreational sexual behaviour and the killing has strong links with the recovered condom/contraceptive material on the scene or was in personal possession of victim. It can provide immediate clue about perpetrator. We present six cases of a similar nature. Four males and two females had condoms in their vicinity at crime scene. All incidents occurred at different timings and different places but there was striking similarity in method of killing. In four cases hands were tied on the back in three cases; similarly legs were also tied in three cases. In three cases strong electric cords were used. The presence of condoms give clue for investigation, possibility of DNA identification, about type of sexual behaviour as recreational and commercial method in these cases.
We tried to understand whether there are significant cut off values simply determining body mass index (BMI). The study was performed in Internal Medicine Polyclinics on consecutive check up patients aged between 15 and 70 years to see possible consequences of excess weight on health and to avoid debility induced weight loss in elders. Insulin using diabetics and patients with devastating illnesses were excluded to avoid their possible effects on weight. Cases were subdivided into three groups according to their body weights as under 65, between 65 and 85, and above 85 kg groups and prevalences of underweight, normal weight, overweight, and obesity were determined. Sensitivity, specificity, and positive and negative predictive values of body weights to determine BMI were calculated. The study included 954 cases (566 females). Sensitivity of 65 kg as a cut off value to detect normal weight was 61.0%, specificity 94.3%, positive predictive value 82.9%, and negative predictive value was 97.6%. Similarly, sensitivity, specificity, and positive and negative predictive values of 65 and 85 kg to detect overweight cases were 71.5%, 63.3%, 56.2%, and 77.1% respectively. So both values were statistically significant to detect normal weight, overweight and obese individuals (p = 0.000 for both). Although BMI is probably a more valuable parameter to show weight status, the cut off values of 65 and 85 kg, as an easier way, have significant places, too.
OBJECTIVES: To design a valid and reliable questionnaire, the Malaysian Osteoporosis Knowledge Tool (MOKT), to assess the knowledge of postmenopausal osteoporotic women in Malaysia, on osteoporosis and its treatment.
METHODS: A 40-item instrument was designed and tested in this study. The scores ranged from 1 to 40, which were then converted into percentage. This was administered to 88 postmenopausal osteoporotic women who were taking alendronate (patient group) and 43 pharmacists (professional group). The MOKT was administered again to the patient group after 1 month.
RESULTS: Flesch reading ease was 57, which is satisfactory, while the mean difficulty factor+/-S.D. was 0.73+/-0.25, indicating that the MOKT is moderately easy. Internal consistency of the instrument was good with Cronbach's alpha=0.82. The test and retest scores showed no significant difference for 38 out of the 40 items, indicating that the questionnaire has achieved a stable reliability. Level of knowledge on osteoporosis and its treatment was good with a mean score+/-S.D. of 69.0+/-13.9 and 81.6+/-9.5 in the patient and professional group, respectively. The difference in knowledge scores between the two groups was statistically significant (p<0.001).
CONCLUSIONS: In conclusion, the 40-item questionnaire (MOKT) is a reliable and valid instrument for measuring knowledge on osteoporosis in the Malaysian setting. Therefore, it can be used to identify individuals in need of educational interventions and to assess the effectiveness of education efforts as part of osteoporosis management.
Traditionally peritoneal dialysis (PD) catheter was implanted by surgeons using mini-laparotomy or open technique in Malaysia. We introduced peritoneoscopic Tenckhoff catheter insertion technique since the beginning of our PD program. Data were collected from the start of our PD program in February 2006 until April 2008. All Tenckhoff catheters were inserted by nephrologists using the peritoneoscope technique. We also compare the penetration rate of PD versus hemodialysis (HD) in our center, as well as comparing to national PD penetration rate. There were 83 patients who underwent 91 peritoneoscope Tenckhoff catheter insertion procedures from March 2006 until April 2008. The patients were mostly female (66%) with the mean age of 51.99 +/- 1.78 years and the majority (67%) of them were diabetics. All together there were 749.7 patient-months at risk and the overall peritonitis rate was 1 in 93.7 patient-months. The 1-year catheter survival was 86.5%. Primary catheter failure (defined as failure of the catheter within 1 month of insertion) occurred in 16 procedures (17.6%). The main cause of catheter malfunction was catheter tip migration and omentum wrap. The penetration ratio of PD when compared with HD in our center is 44.8%, which is about 4.5 times the national average. With our integrated care approach where nephrologist was heavily involved from the outset of renal replacement therapy discussion, PD access implantation to the assistance of spoke person to whom new patient can identify with, we were able to achieve PD penetration rate which far exceeds that of the national average.
The purpose of this retrospective study is to determine whether there is a correlation among overweight, gender and the risk of development of spontaneous cerebrospinal fluid (CSF) rhinorrhoea. The clinical data of eight patients diagnosed with spontaneous cerebrospinal fluid rhinorrhoea who had been treated at our tertiary referral centre between 1998 and 2007 were assessed. Demographically, seven patients were female and one male with ages ranging from 14 to 53 years with a mean age of 43.6 years. This observation revealed that all patients were overweight with a mean body mass index (BMI) of 32.5 kg/m2. This study suggests that there is a trend of increasing BMI to the risk of developing a spontaneous CSF rhinorrhoea.
This is a cross-sectional study design aimed to determine the prevalence of Chorda Tympani Nerve (CTN) injury and related symptoms following myringoplasty. Thirty patients were included in this study. The methods used were measuring taste thresholds using electrogustometer to map taste threshold on the anterior two-third of the tongue on the operated side with the non operated side as the control. Reading is taken when the subject experiences sour/metallic taste. All corresponding threshold values and findings were recorded and compared to control. Results showed 50% of patients had elevated threshold levels suggestive of CTN injury. However, none of the patients reported subjective taste loss. This study concludes that the prevelance rate of CTN injury in post myringoplasty patients is about 50% but this is not associated with altered taste sensation.
A 58 year-old man presented with a large aneurysm of the aortic arch and severe coronary artery disease. He underwent combined repair of the aortic arch aneurysm and coronary artery bypass grafting via a modified clamshell incision using deep hypothermic circulatory arrest and retrograde cerebral perfusion. He made an uncomplicated postoperative recovery. The operative techniques are discussed with a review of the relevant literature.
The differential diagnoses of an abscess deep in the neck are retropharyngeal abscess and parapharyngeal abscess. We report a case each of these deep neck space abscesses to highlight their difference with emphasis on its anatomy and possible etiologies.
Atypical mycobacterium is rarely seen as a cause of chronic mastoiditis but has been increasingly recognized over the past few years. Mycobacterium abscessus is the most pathogenic and chemotherapy-resistant, rapid-growing mycobacterium of all the four groups. This paper presents a case of a 57-year-old woman who had chronic mastoiditis with recurrent exacerbations. The initial computed tomography (CT) findings showed the presence of an inflammatory process and she was treated with the appropriate antibiotics. The patient subsequently underwent a tissue biopsy when she presented with another exacerbation. At this time, the CT scan did not identify the ongoing exacerbation, but the Gallium-67 scintigraphy did.
This study was carried out to determine the association between body mass index and age related cataract among patients attending eye clinic. We conducted a case control study. The outcome of clinical eye assessment determined the patient's status. Mean body mass index among the cases was shown to be higher (25.4 +/- 4.5) than the control group (24.4 +/- 3.9) (p < 0.01). Crude analysis showed that only obese respondents were 2.4 times more likely to develop age related cataract, however this association was not seen in the multivariate analysis after adjusting for other determinants (aOR 1.81; 95% CI 0.91 - 3.62). We conclude that there is no association between body mass index and age related cataract.
Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
An open biopsy has minimal sampling error, but is a major procedure, with its inherent complications and morbidity. The complications of paraspinal needle biopsy of vertebral lesions are well known. Needle biopsies have a high incidence of false negatives, especially for tumors. Percutaneous transpedicular bopsy is efficacious, safe, and cost effective, and mostly performed under local anesthesia. Fluoroscopic monitoring enables real time positioning of the needle. Serious needle complications from percutaneous needle biopsy are uncommon. More than 50% of vertebral body tissue, including the disc is accessible via a unilateral transpedicular approach and amenable for biopsy.
In 1985, when HIV testing first became available, the main goal of such testing was to ensure blood safety. Hemophiliacs and other patients who were transfusion-dependent were the initial patients that needed to be protected as they were exposed to iatrogenic risk. It dawned very quickly to health authorities even then that alternative testing sites had to be quickly established to deter persons from using blood bank facilities for HIV testing purposes. At that time, professional opinion was divided regarding the value of HIV testing and whether HIV testing should be encouraged because no consensus existed regarding whether a positive test predicted transmission to sex partners or from mother to infant. No effective treatment existed then and stigma and discrimination faced by those who were found positive was rampant in many parts of the world. Counseling was designed, in part, to ensure that persons tested were aware of the implications of a positive result and in part, to address the person’s risk behavior to reduce transmission to others.