We describe a rare tumor site in a 46 year old man who presented with a two week history of headache. Physical examination revealed bilateral papilloedema with no other localizing signs. Computed Tomographic Scan as well as Magnetic Resonance Imaging of the brain revealed a lesion with a dura tail located adjacent to the falx cerebri of the right frontal lobe. This lesion was not invading the inner table of the skull base. A tumor blush was seen on angiogram. There were no abnormalities on CT scan of the abdomen and fundoscopy was normal. Intraoperatively a vascular tumor not attached to the dura was noted and removed totally. Histopathological examination was typical of a hemangioblastoma. Analysis revealed no mutations of the VHL gene in 5 regions, exon 5-8 of the p53 gene, exon 1-2 of the p16 gene and exon 5,6 and 8 of the PTEN gene. This is the first case report of a supratentorial hemangioblastoma in a non-Von Hippel Lindau patient with genetic evidence.
The aim of study was to investigate the role of climate on the Malaria Incidence Rates (MIR) in some regions in of Yemen. For such purpose, the monthly (MIR) were calculated from the records of the hospitals' laboratories and centers of the Malaria Rollback centers in the main cities of the governorates Hudeidah, Taiz, Sana'a and Hadramout for the period 1989-1998. The readings of the climatic factors (CF) particularly the average monthly temperature (T), relative humidity (RH), volume of rain fall (RF) and wind speed (WS) for the same period of time were also collected from different weather and climatic information resources. Descriptive statistics, simple linear regression and multiple linear regression techniques were used to analyse the relationship between MIR and CF. The analysis shows highly significant relationship between MIR and the CF in these regions of Yemen (p-value 0.001).
Cervical spine injuries such as subluxation and fracture dislocation have long been known to result in severe consequences, as well as the trauma management itself. The injury to the region has been identified as one of the major causes of death in Malaysian motorcyclists involved in road crashes, besides head and chest injuries (Pang, 1999). Despite this, cervical spine injury in motorcyclists is not a well-studied injury, unlike the whiplash injury in motorcar accidents. The present study is a retrospective study on the mechanisms of injury in cervical spine sustained by Malaysian motorcyclists, who were involved in road crash using an established mechanistic classification system. This will serve as an initial step to look at the cervical injuries pattern. The information obtained gives engineer ideas to facilitate design and safety features to reduce injuries. All cervical spine injured motorcyclists admitted to Hospital Kuala Lumpur between January 1, 2000 and December 31, 2001 were included in the present study. Based on the medical notes and radiological investigations (X-rays, CT and MRI scans), the mechanisms of injuries were formulated using the injury mechanics classification. The result shows that flexion of the cervical vertebrae is the most common vertebral kinematics in causing injury to motorcyclists. This indicates that the cervical vertebrae sustained a high-energy loading at flexion movement in road crash, and exceeded its tolerance level. The high frequency of injury at the C5 vertebra, C6 vertebra and C5-C6 intervertebral space are recorded. Classification based on the Abbreviated Injury Scale (AIS) is made to give a view on injury severity, 9.1% of the study samples have been classified as AIS code 1, 51.5% with AIS 2 and 21.2% with AIS 3.
Chitosan has similar structure to glycosaminoglycans in the tissue, thus may be a good candidates as tissue engineering scaffold. However, to improve their cell attachment ability, we try to incorporate this natural polymer with collagen by combining it via cross-linking process. In this preliminary study we evaluate the cell attachment ability of chitosan-collagen scaffold versus chitosan scaffold alone. Chitosan and collagen were dissolved in 1% acetic acid and then were frozen for 24 hours before the lyophilizing process. Human skin fibroblasts were seeded into both scaffold and were cultured in F12: DMEM (1:1). Metabolic activity assay were used to evaluate cell attachment ability of scaffold for a period of 1, 3, 7 and 14 days. Scanning electron micrographs shows good cell morphology on chitosan-collagen hybrid scaffold. In conclusion, the incorporation of collagen to chitosan will enhance its cell attachment ability and will be a potential scaffold in tissue engineering.
Scanning Electron Microscopy (SEM) and Transmission Electron Microscopy (TEM) evaluation were carried out in the in vivo skin construct using fibrin as biomaterial. To investigate its progressive remodeling, nude mice were grafted and the Extracellular Matrix (ECM) components were studied at four and eight weeks post-grafting. It was discovered that by 4 weeks of remodeling the skin construct acquired its native structure.
The aim of this study was to evaluate bovine pericardium surgical patch in rat model. Bovine pericardial sacs collected from local abattoir were cleaned, disinfected and cut into pieces of 3 by 2.5cm and preserved in 99.5% glycerol. Full thickness abdominal wall defects of 3 by 2.5 cm were created in 30 adult male Sprague Dawley rats and repaired with glycerol preserved pieces. The rats were serially sacrificed in a group of six rats at 1,3,6,9 and 18 weeks post-surgical intervals for morphological and tensometeric study. Macroscopically, no mortality or postoperative surgical complications was encountered except slight adhesions between implanted grafts and some visceral organs in 10% of the rats. Microscopically no calcification or foreign body giant cell formation was found in the explanted grafts. The implanted grafts were replaced gradually with recipient tissue, which made mainly of dense collagenous bundles. The healing strength between the implanted grafts and the recipient abdominal wall was gradually increased with time. The results of this study showed that glycerol preserved bovine pericardium act as scaffold for transformation into living tissue without clinical complications such as that associated with prostheses.
Non-contrast computed tomography (NCCT) remains a widely used imaging technique and plays an important role in the evaluation of patients with acute ischaemic stroke. However, the task of identifying the signs of acute ischaemia and quantifying areas of brain involvement on NCCT scan is not easy due to its subtle findings. The reliability of early ischemic sign detection can be improved with experience, clinical history and the use of stroke window width and level on viewing the images. The Alberta Stroke Program Early CT Score (ASPECTS) was developed to overcome the difficulty of volume estimation in patients eligible for thrombolysis. It is a systematic, robust and practical method that can standardized the detection and reporting of the extent of acute ischaemic stroke. This article serves as an educational material that illustrates those findings which are important for all clinicians involved in acute stroke care.
A study of nerve regeneration through a 1cm defect in the peroneal component of the sciatic nerve was performed on sixteen rabbits. Either silicone or polytetrafluoroethylene (PTFE) tubes or nerve graft were used to bridge the defect and the opposite limb was not operated upon. The rabbits that underwent nerve grafting had favourable findings. In the PTFE group, a nerve-like structure was seen at the former gap site and histology confirmed viable axons within the tubes and distal to the repair site. In the silicone tube group, there were no myelinated axons demonstrated. The axonal count for the grafted nerves and the nerves repaired with PTFE tube are on average 80.4% and 38.2% of that of the unoperated nerve, respectively. On average, the percentage anterior compartment muscle weight (expressed as a percentage of the unoperated limb) for the silicone, PTFE and nerve graft groups are 42.3%, 42.1%, and 72.7% respectively. The results show that although, PTFE conduits can bridge a nerve defect of 1cm, nerve grafting provides a superior and more predictable outcome.
"Cauliflower Ears" describes the appearance of swelling of the auricular cartilage resulting in gross distortion of the auricle. The underlying pathology is inflammation of the auricular cartilage. We report a case of a patient who presented to the ophthalmology clinic with an ocular inflammation, whose subsequent diagnosis of replapsing polychondritis was clinched with the finding of "Cauliflower Ears". This case emphasizes the importance of an appropriate general examination of ophthalmic patients for early diagnosis and prompt institution of medical treatment, which may prevent life-threatening complications to the patient.
Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
We review 81 cases of acute haematogenous osteomyelitis from 1983 to 1990 to establish current pattern of clinical presentation, modes of treatment and success of therapy. Majority of the patient (70%) presented within a week of symptom and significant number of them came with fever and swelling of the affected limb. Sedimentation rate was found to be raised in all of them. Fifty-four (55%) of them were treated surgically. The average antibiotic time was one week by intravenous administration followed by additional oral therapy for period up to four weeks. Average follow-up was 9 months. Six of them (7.5%) end up with various complication which was believed to be due to delay in getting medical treatment.
Tibial fractures are common and complications occur more frequently than any other long bone fractures. The effect of fibula and location of fracture on union of Tibia fracture remain controversial. A retrospective study of unilateral closed tibial shaft fractures without any associated injury was done. From 1988 to 1992, 74 out of 103 patients were available for the study. There were 60 males and 14 females with the age ranges from 3 to 75 years with an average of 29.7 years. The differences of fractures healing were analyses with respect to the status of the fibula and the location of the tibial fracture. This study concludes that the location of the fracture and the status of the fibula have no significant influence on healing (p > 0.05).
We report a case of tuberculosis of the thyroid gland associated with mediastinal lymphadenitis in a 30 years-old male, who presented with dysphagia and a mid line anterior neck swelling. Fine needle aspiration was positive for acid fast bacilli. He made an uneventful recovery with antituberculous drugs. Although seldom observed, tuberculosis should be kept in mind in te differential diagnisis of nodular lesions of the thyroid.
We report a rare tumour of the nasopharynx- papillary adenocarcinoma. This is usually of low grade and certainly in out patient it behaved so. It is even rarer to have this tumour in a patient with Turner's syndrome in whom there is a high incidence of gynaecological malignancy. It has not previously been documented and the occurrence in this patient is probably coincidental.
Lower limb injuries are the main cause of temporary and permanent disability among motorcyclists in Malaysia. They cause non-fatal but serious injuries requiring hospitalisation. Detailed studies on factors influencing lower limb injuries are justified in an attempt to reduce the occurrence of these injuries. This study presents a computer simulation of the crash behaviour of the basket of a small-engined motorcycle with the lower limb using finite element (FE) methods. The results suggest that the extensive deformation of the motorcycle basket may reduce the risk of injury to the lower limb. The behaviour of the basket during collision is analogous to the crumple zone of automobiles.
A 25 year old woman developed a right pleural effusion 6 weeks after commencement of short course chemotherapy for left sided tuberculous pleural effusion. Since the patient improved following continuation of the same treatment, it is presumed to be a case of paradoxical response to anti-tuberculosis treatment.
Tuberculosis and malignancy are two common causes of exudative pleural effusions. In this retrospective study of 52 patients with tuberculous pleural effusions and 32 patients with malignant effusions, the median age of patients with malignant effusions (68.5 years) was older than that of patients with tuberculous effusions (34.5 years) (p < 0.001). Both types of effusion occurred more frequently on the right side and there was no difference between them in terms of right-sided dominance. A higher percentage of patients with malignant pleural effusions (44%) presented with large effusions than patients with tuberculous effusions (12%) (x2 = 11.33, p = 0.001). A higher proportion of patients with tuberculous effusion had lymphocyte predominant effusions and tuberculous effusions had higher lymphocyte percentage, lower red cell count, and higher protein content. However, there was considerable overlap of these characteristics of both types of effusions.
An asymptomatic subject with radiographic changes due to welders' siderosis is described. This condition has not been well recognized and described in our community. Siderosis of the lung is generally considered to be a benign condition not associated with respiratory symptoms. However, recent reports have associated welding with various disorders of pulmonary function as well as lung cancer. There is a need for future epidemiological studies to better define the risk of long term welding.