Henoch-Schonlein purpura or anaphylactoid purpura is a systemic vasculitis of unknown cause that affects small vessels and mainly involves the skin, joints, gastrointestinal tract and kidneys. Gastrointestinal involvement occurs in more than half of patients and is thought to be related to edema and intramural haemorrhage. Radiologically the gastrointestinal findings are mainly those of bowel ischemia with thumbprinting and bowel wall oedema. Although this disease is usually treated conservatively, aggressive intervention is occasionally performed because of acute abdominal symptoms due to complications, such as perforation, intussusception and obstruction. This report illustrates a case of Henoch-Schonlein purpura with acute abdominal symptoms due to intussusception.
Dural arteriovenous malformation (DAVM) is relatively rare and defined as abnormal connections or shunts between the arterial and the venous side of vascular tree located within the dura mater. Spontaneous closures of DAVM are rare and have been scarcely reported. This case report will describe the neuroimaging findings and classification of DAVM. A 50 year old lady presented with headache. Neuroimaging showed prominent serpinginous flow-void structures, cerebral angiogram confirmed the presence of DAVM at the occipital region. She had defaulted treatment and follow-up for 3 years. On second admission, she had a cerebral angiogram which showed normal findings with no evidence of fistulas or malformation. She was discharged well. Causes of spontaneous closure of DAVM are discussed.
Syringomyelia is a rare neurological disease, which is characterized by the formation of a cyst in the spinal cord. The aetiology of the disease still remains controversial. The damage to the spinal cord results in headache, weakness, stiffness and numbness on both lower and upper limbs. Only few a cases of syringomyelia in pregnancy have been reported thus far. As such, there is no standard management of intrapartum care.1 We present a case of symptomatic syringomyelia in pregnancy, its management and literature review. The mode of delivery with risks for vaginal route is discussed.
Inflammatory pseudotumour (IPT) is a rare benign solid tumor in adults and children. The prevalence, etiology and pathogenesis of this condition are still uncertain. Despite the use of modern laboratory techniques and imaging, it is often difficult to make the diagnosis of IPT. Besides, occasionally the nonspecific morphological appearance and clinical presentation of the mass may mimic other more common primary or secondary neoplasms. IPT is commonly encountered in the lung and mediastinum. Other sites include abdomen (liver, pancreas, stomach, omentum), retroperitoneum, pelvis (bladder) and extremities in children. We report a rare case of gastric inflammatory pseudotumour in a 65-year-old female patient. Clinical presentations and its management along with review of literatures are presented.
Benign gastrojejunocolic fistula is mostly due to Bilroth II operations. It typically presents with a triad of feculent vomiting, weight loss and chronic diarrhoea but sometimes the diagnosis is not straight forward. We discuss a case that presented and was investigated as intestinal obstruction however diagnosed with gastrojejunocolic fistula during surgery.
Metastatic spread of tumors to the skull is quite unusual and often represents diagnostic and therapeutic issues. Skull involvement can be observed in various neoplasms of epithelial origin and are most often due to lung, breast, thyroid, kidney and prostate cancers. However, skull metastases from hepatocellular carcinoma (HCC) have been rarely reported. The prognosis for patients with hepatocellular carcinoma is so poor that treatment of such distant metastatic lesion cannot be achieved before death occurs due to the primary malignancy. Therefore, the clinical manifestations of cranial metastasis prior to that of primary hepatocellular carcinoma have rarely been reported. This case illustrates a rare case of skull metastasis as an initial manifestation of hepatocellular carcinoma. Although a solitary skull metastasis prior to the diagnosis of HCC demonstrates rare metastatic behavior for HCC, especially in Asia, skull metastases from HCC should be included in the differential diagnosis of skull tumors, even if the patient is asymptomatic of liver cirrhosis.
Renal arteriovenous malformation (AVM) is a rare congenital anomaly of the urinary system. We present a patient with bilateral renal AVMs who presented with back pain and microscopic hematuria. This case highlights the importance of careful diagnostic work-up in the evaluation of upper tract hematuria. Renal AVM was found to be the cause of mild back pain and persistent microscopic hematuria in a 45-year-old lady. This case highlights the importance of complete diagnostic work-up in the evaluation of microscopic hematuria in arriving at the correct diagnosis of an uncommon clinical entity.
We report a case of sudden hypoxaemia after intubation in a patient who had smoked a few hours prior to a surgical procedure. The cause of his desaturation was not related to bronchial secretions, bronchospasm or obstruction of the upper airways but most likely due to reduced oxygen saturation in the body prior to surgery. We managed to secure the airway and prevent prolonged desaturation by instituting remedial measures. Our conclusion is that cessation of smoking is very important and need to be emphasized in all patients having surgery under general anaesthesia. This applies to emergency cases as well.
Mucoceles are expansile masses originating in the sinuses. They are relatively unusual, occurring most frequently at fronto-ethmoidal region. They are locally destructive. This expansile lesion caused bony erosion and displaces the adjacent structures. We report a case of a patient who presented to our clinic with bulging of his left eye and worsening of the left vision. This was preceded by history of sport injury to his left supraorbital ridge. CT scan revealed that there was an extraconal lesion at the superolateral part of the left orbital cavity which pushed the orbit inferomedially, which consistent with left frontomucocele. He underwent enucleation of the lesion via 3 windows created namely at the left supraorbital ridge, anterior table of left frontal sinus and through the septum separating the frontal sinuses.
Cervical vertebral osteomyelitis is rare. While an early and correct diagnosis is critical to prevent catastrophic neurological injury, the diagnosis of cervical vertebral osteomyelitis is often difficult because of its rarity and variable symptoms. We present a case of C1 and C2 vertebrae osteomyelitis with a misleading presentation and its fatal outcome.
Introduction: Honey has potent bactericidal activity against many pathogenic organisms, including various Gram-negative and Gram-positive bacteria. This study aimed to determine the antimicrobial effect of Malaysian honey against different species of human pathogens using optimized honey broth media. Materials and Methods: The antimicrobial activity of honey against standard strains of Gram-negative and Grampositive bacteria and yeast was tested in vitro by the broth dilution method using 10%-100% w/v concentrations prepared in tryptic soy broth. Results: Streptococcus pyogenes was the most sensitive pathogen, it was completely inhibited by 30% honey broth medium. The most resistant were E. faecalis, S. aureus and MRSA, but they were all completely inhibited by 80% honey broth medium. Conclusion: Honey is shown to possess antimicrobial activity against human Gram-positive and negative medically important bacteria.
Introduction: Each year, more than 20 million people are injured and 1.17 million are killed due to road
traffi c accidents. Developing countries account for over 85% of the deaths, and close to 90% of the disability caused by road traffi c crashes worldwide. The objectives of this study were to determine the knowledge, attitudes and practice and the factors infl uencing university students in Malaysia concerning road traffic accident. Materials and Methods: This study was conducted among the students of Management and Science University, Malaysia. The questionnaire was distributed randomly to the students of the Faculty of Health and Life Sciences. Data was analyzed using SPSS version 13, T-test and ANOVA. Results: The total number of 109 students with the mean age of 20.94±1.89 years participated in this study. Approximately 39 (35.7%) of the participant had been involved in one or more than one road traffi c accident. About 93.6% of them were very strongly/strongly convinced of seat belts importance. Multivariate analysis using the multiple linear regression method showed that age and attitude were signifi cantly associated with the exposure to the accident. Conclusion: The study participants had moderate knowledge about road traffic regulations and most of them mentioned that high speed, drivers’ lack of awareness about traffi c regulation and laws, and drivers’ non-compliance with traffi c rules and regulation were the most important cause of road traffic accidents. Almost all students were very strongly/strongly convinced of seatbelts importance. Age and attitude were signifi cantly associated with the exposure to the accident.
High frequency oscillating ventilation (HFOV) provides a rescue therapy for patients with refractory hypoxaemia in severe acute respiratory distress syndrome (ARDS). HFOV utilizes high mean airway pressures to maintain an open lung and low tidal volumes at a high frequency that allows for adequate ventilation while at the same time preventing alveolar overdistension. This seems to be an ideal lung protective ventilation strategies to prevent ventilator-induced lung injury (VILI)2. We reported a case of severe extrapulmonary ARDS secondary to acute lymphoblastic leukaemia responding to the use of HFOV.
Patient with thyroid mass rarely presents in emergency situation. It is because the nature of the mass is that it usually increases slowly in size. Thus, any surgical intervention can be planned electively. The most common condition that necessitates urgent intervention, is upper airway compromise due to sudden rapid increase in size of the swelling. This can be due to intralesional bleeding or superimposed infection on the enlarged gland. We report a case of urgent completion thyroidectomy performed to a patient with fungating recurrent papillary carcinoma who present with bleeding from the mass externally.
Paragangliomas are uncommon tumors arising from the neuroendocrine elements (chief cells) of the paraganglia and symmetrically distributed along the aorta in close association with the sympathetic chain. Although functional tumors are easier to diagnose due to the clinical fi ndings caused by excess secretion of catecholamines and an elevation of the urinary catecholamine levels, however the diagnosis of nonfunctioning paraganglioma of the retroperitoneum is diffi cult and only few cases have been made before exploratory laparotomy. Although our patient was initially planned and operated by our gynaecological team, the incidental findings had to involve the general surgeons. She is fortunate that the tumour did not show any features of malignancy nor metastasis, however a long time follow up is needed in case of any possible recurrence.
Pain is infl uenced by multiple factors including personal experience, psychological, sociocultural and situational factors. Failure to recognise pain will lead to poor patient management and deleterious effect on the patients wellbeing. Assessing pain in paediatric and cognitively compromised patients remains a challenge. Pain assessment in these groups of patients depends on the observers assessment and studies have shown the discrepancy between the observers assessment and patients verbal report. A specifi c and accurate tool is required to assist in the pain assessment. Although there are assessment tools available using behaviour scoring system and physiological indicators, none of the tool demonstrates its superiority than the others. Biochemical indicators such as stress hormones are frequently measured and used in con-junction with verbal reports; however they are non specifi c to pain and are increased in infl ammation, haemodynamic and emotional changes. The association between immunological indicators e.g. IL-1 , IL-6, IL- 8 and clinical pain has been shown, however; the defi nite correlation of the changes in the indicators and the level of pain is still unclear and may require further investigation.
Introduction: Dengue is one of the commonest infections in Malaysia and it is a notifi able disease. Even
though the diagnosis of classical dengue fever and dengue haemorrhagic fever can be recognized clinically, the diagnosis remains a challenge in areas where it could not be differentiated with other febrile illnesses. The aim of this study was to focus on the specifi c and consistent morphological features observed in blood fi lms of dengue infection. Materials and Methods: In all 400 cases of dengue infection serologically diagnosed in the Tengku Ampuan Afzan Hospital (HTAA) during May to October 2007, only a total of 27 cases had blood fi lms examined, and thus were included in this study. These blood fi lms were re-examined by two pathologists from HTAA. The full blood count parameters were also retrieved and studied. Results: We consistently found typical reactive lymphocytes [n= 23 (85%)] and thrombocytopenia [n=21, (77.8%)] in the cases. However, leucopenia was present only in 9 cases (33%). Conclusion: The presence of typical reactive lymphocyte is a consistent fi nding in dengue fever and thus could have a signifi cant role in supporting the diagnosis of dengue infection.
Introduction: The Malay Version of EORTC-QLQ C30 was validated among Malaysian women who had undergone breast cancer surgery. Materials and Methods: Test-retest evaluation (i.e. three weeks and ten weeks following surgery) was carried out to examine the validity and reliability of the scale. The Cronbach’s alpha value was used to determine the internal consistency, meanwhile, test-retest Intraclass Correlation Coeffi cients (ICC) indicates the reliability of the scale. Effect Size Index and Mean Differences interpret the sensitivity of the scale. Discriminant validity was evaluated by comparing two groups i.e. women who had mastectomy and women who had lumpectomy. Results: Internal consistencies are acceptable for Global Health Status (0.91), Functional domains (ranging from 0.50-0.89) and Symptomatology domains (ranging from 0.75-0.99). Intraclass Correlation Coeffi cient (ICC) ranged from 0.05 to 0.99 for Global Health Status and Functional domains, and ranged from 0.13 to 1.00 for Symptomatology domains. Sensitivity of the scale was observed in nearly all of the domains. Conclusion: The Malay Version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ C30) is a suitable tool to measure the quality of life of women with breast cancer.
Introduction: Exposure to excessive noise is the major avoidable cause of permanent hearing impairment. Sawmill is one of the workplaces where workers are exposed to hazardous noise level. This study was conducted to determine the reliability and validity of noise-induced hearing loss questionnaire among sawmill workers. Materials and Methods: This cross sectional study was conducted in March 2007 among 35 consented sawmill workers. A total of 40 items; 10 items for knowledge (8 areas), 20 items for attitude (7 areas) and 10 items for practice (2 areas) were assessed. Statistical analysis for reliability analysis was test by internal consistency and construct validity by exploratory factor analysis using principal components and Varimax rotation method. Results: Cronbach’s alpha coeffi cients were acceptable for attitude (0.90) and practice
(0.75). However, it was low for knowledge (0.67). Exploratory factor analysis showed three meaningful exploratory factors that could explain the three dimensions in the questionnaire. Conclusion: The results of the validation study suggested that the noise-induced hearing loss questionnaire is reliable and valid tool for assessing knowledge, attitude and practice among sawmill workers.
Monoamniotic twin pregnancy is a rare type of twin pregnancy which poses risk of cord entanglement and
sudden death of either one or both fetuses. The role of antenatal surveillance by Ultrasound Doppler for
umbilical cord and ultrasonic evidence of cord entanglement or knotting may predict the pregnancy outcome
but yet unavoidable. The discussion will include antenatal surveillance in this rare type of pregnancy.