The diagnosis and management of brain death is discussed in this paper. Criteria recommended by the Conference of Medical Royal Colleges and their Faculties in U.K. were used in the diagnosis of brain death. It is felt that brain death should be considered as death of the individual and a plea is made to draw up guidelines on management of patients with brain death.
Two Malaysian boys of Chinese origin who satisfy the necessary criteria of subacute sclerosing panencephalitis are reported. A brief description of the symptomatology, epidemiology, laboratory finding, pathology, pathogenesis and treatment of the illness was also given.
A 29 year old Chinese female who presented with spontaneous purpura, was found to have gross hepatomegaly and thrombocytopenia. The thrombocytopenia responded to steroid therapy but relapsed when the dose of steroid was tapered down. Subsequent investigations revealed that the hepatomegaly was due to a large haemangioma of her liver. For symptomatic hepatic haemangioma, surgical excision is the treatment of choice; this was refused by the patient.
A 32 year old HIV positive intravenous drug user (IVDU) with a promiscuous lifestyle in the past presented with altered behaviour and was diagnosed to have pulmonary tuberculosis, tuberculous meningitis and tuberculous osteomyelitis. After initial response to anti-tuberculous therapy, his symptoms recurred with the appearance of cerebral mass lesions. A presumptive diagnosis of toxoplasma encephalitis was made based on clinical, serological and radiological evidence. He showed clinical improGement with anti-toxoplasmic therapy.
We report a 33-year-old Malay lady who presented with fever, tonsillitis and pharyngitis a month after initiation of antithyroid therapy (carbimazole 15 mg tds) for thyrotoxicosis by her general practitioner. She was still clinically and biochemically thyrotoxic but not in thyroid storm. At that time, she was also confirmed to be four weeks pregnant. Her full blood count revealed neutropaenia with an absolute neutrophil count of 0.036 × 109/L. Bone marrow aspirate and trephine were compatible with carbimazole-related agranulocytosis. Carbimazole was discontinued and she was given broad spectrum antibiotics and Granulocyte Colony Stimulating Factor (GCSF), to which she responded. Verapamil was used for symptomatic heart rate control instead of beta-blockers as she had a history of bronchial asthma. The patient subsequently opted for termination of pregnancy after which she was given radioactive iodine I131 (10 mCi) for definitive therapy of her thyrotoxicosis. In conclusion, carbimazole-related agranulocytosis is an important entity to recognise and treat early to prevent morbidity and mortality. Termination of pregnancy was carried out as the treatment given during the episode of agranulocytosis may have negative effects on foetal viability and growth.
Stroke is the third leading cause of death, a major cause of disability in adults, and is frequently more disabling than fatal. With a decline in mortality from initial cerebral infarction and an increase in the life expectancy of the population, the number of patients with recurrent stroke and ensuing cardiovascular events will become greater. Thus it is important to find out those patients at high risk of stroke recurrence. This case report illustrates the process of recurrent stroke and the resulting disabilities and morbidities in a 42-year- old man. The role of integrated stroke rehabilitation programme is described.
Hoarseness due to left recurrent laryngeal nerve paralysis was first described in 1897 by Norbert Ortner. Various cardiopulmonary and thoracic arch aorta pathologies associated with left recurrent laryngeal nerve palsy have been described over the last 100 years and is also known as cardio-vocal syndrome. We report our experience with seven cases of Ortners syndrome due to thoracic aortic aneurysm with compression of the left recurrent laryngeal nerve and resultant hoarseness.
This case report illustrates the misdiagnosis of intermittent claudication in an elderly with multiple cardiac risk factors. Careful clinical evaluation and imaging shifts the diagnosis from peripheral vascular disease to spinal stenosis. The decision whether to offer conservative therapy or proceed to spinal surgery requires an accurate assessment of the severity of the symptoms without ignoring the important role of patient preferences.
Osteopoikilosis is a rare bone dysplasia which is inherited as an autosomal dominant trait with a prevalence of less than 0.1 per million.1 It is characterised by dense ovoid or circular spots in cancellous bone which may appear at birth or during skeletal growth. It is usually found in the metaphyseal and epiphyseal regions of long bones, the carpals and tarsals, the end of large turbular bones and around the acetabula. It is clinically asymptomatic and occasionally associated with hereditary multiple exostosis and dermatofibrosis lenticularis disseminata. It is not associated with spontaneous fractures and treatment is unnecessary. However a case of osteosarcoma developing in a man with osteopoikilosis has been reported. The first case of osteopoikilosis was reported in Malaysia four years ago in a 25 years old lady who is also of Indian descent. It would be interesting to know if these two patients are related. Since the bone lesions could easily be mistaken for metastatic disease, it is important that family physicians be aware of the benign nature of this condition.
Acute suppurative thyroiditis is a rare disorder. We saw a 24 year old man with this condition that present atypically. The patient had a non-tender thyroid enlargement associated with fever and leukocytosis. FNA cytology clinched the diagnosis. The abscess was associated with Klebsiella pneumoniae septicemia and required surgical drainage after failing antibiotic therapy.
A 45-year-old Malay housewife was seen at a health clinic with the chief complain of recurrent lower abdominal pain for 9 months. The pain was colicky in nature and occasionally it radiated to the back. There was no history of fever, vaginal discharge or any urinary or bowel symptoms. She had been using an intrauterine contraceptive device (IUCD Cu250) for the past 5 years. The last change of the IUCD was 2 years ago. Her annual pap smear results were normal. She had been to many primary care clinics and was reassured by the doctors that her symptom was due to her IUCD. She was prescribed mefenamic acid repeatedly for the past 9 months. However her symptoms worsen and she was worried because prior to this she did not have similar problems. Her physical examination was unremarkable. On pelvic examination, the IUCD string was visualised, indicating that her IUCD was still in-situ. Her cervix was pink and healthy. There was no abnormal vaginal discharge.
Diagnosis and management of orofacial pain of non-odontogenic origin has always been a challenge to dentists. Inaccurate diagnosis would result in delay of treatment and in cases of orofacial pain, affects patient’s quality of life. Temporomandibular pain dysfunction syndrome is the most common temporomandibular disorder that presents to dental clinics. Trigeminal neuralgia, also known as ticdouloureux is a relatively rare condition that causes electric shock-like pain when the trigger zone is stimulated by triggering factor. Case report: A case of temporomandibular pain dysfunction syndrome in a 52 years old Indian lady that was managed as trigeminal neuralgia for 7 years is presented. Conclusion: The aim of this case report is to make dentists aware of the signs and symptoms of different orofacial pain, so that early and accurate diagnosis can be made and appropriate treatment instituted.
Porphyrias are uncommon disorders of haem metabolism and we report the first documented case of acute intermittent porphyria in Malaysia. The biochemical, clinical features and the management of this order are discussed.
Two Malaysian Chinese male children are described with Wiskoll-Aldrich syndrome, which has rarely been reported in the East. Classical features were found, with bleeding and infections, low titres of isohaemagglutinins and IgM, but variable IgG and IgA. The immune response was broadly disturbed. Survival of one child was sufficiently long for a Iymphoreticular malignancy or appear.
Kawasaki disease is primarily a condition that affects young children and it is associated with cardiac morbidity and mortality. This disease has been known to cause coronary artery aneurysms which occurs as a sequelae of vasculitis. The progression of triple vessel disease in adult which results from cardiac complications from Kawasaki disease is rare. We report a case of a young man with history of Kawasaki disease at infancy presenting with triple vessel disease requiring cardiac bypass surgery at the age of 20 years old.
While electrocardiogram (ECG) changes are common during viral dengue infection, atrial fibrillation (AF) is a very rare manifestation. It has previously been highlighted that cardiac complications during dengue infection are invariably transient and will spontaneously resolve following recovery from the illness. We present the case of a young patient with IgM- and IgG-positive dengue hemorrhagic fever complicated by AF. ECG revealed a structurally normal heart. The patient remained in AF despite resolution of the illness. Reversion to normal sinus rhythm was achieved after loading of oral amiodarone.
Optic neuropathy, an uncommon manifestation occurs in 5% of patients with Graves' ophthalmopathy. Its outcome is good if early and proper treatment given. We reported a 49 years old male patient of Graves' disease with bilateral optic neuropathy. He underwent bilateral transnasal endoscopic orbital decompression with marked improvement of visual acuity bilaterally. The preoperative visual acuity was 6/36 in his right eye and 6/60 in his left eye. Two days after operation, his visual acuity was 6/12 in his right eye and 6/24 in his left eye. Transnasal endoscopic orbital decompression is a choice of treatment in optic neuropathy in thyroid ophthalmopathy after trial of corticosteroids.