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  1. Abdul Azih, M.N., Hin, H.S., Kori, A.N., Rahman, A.A., Chunn, K.Y.
    MyJurnal
    We report a 26-year old lady who presented with chronic cough and breathlessness associated with subtle
    TB symptoms for 1 year. Her CT thorax showed multiple cavitating pulmonary nodules with mediastinal and
    cervical lymphadenopathy. Cervical lymph node biopsy and CT-guided pulmonary biopsy at our centre
    confirmed the diagnosis of Hodgkin’s lymphoma with pulmonary infiltrations. She was successfully treated
    with ABVD regime but later developed life-threatening bleomycin-induced pulmonary fibrosis. Sadly, she
    succumbed to respiratory failure due to severe pneumonia with possibility of bleomycin-induced pulmonary
    fibrosis. Multiple cavitating pulmonary nodules secondary to lymphoma is rare and in TB endemic area, it
    may result in delayed diagnosis and treatment.
    Matched MeSH terms: Tomography, X-Ray Computed
  2. Ishak MN, Nik-Abdul-Ghani NM, Mohamad I
    Iran J Otorhinolaryngol, 2018 Mar;30(97):113-116.
    PMID: 29594079
    Introduction: Sudden sensorineural hearing loss (SSNHL) is an important otological emergency. Up to 90% of the cases are idiopathic. Cerebral venous thrombosis (CVT) is an extremely rare identifiable cause as it only represents 0.5% of all strokes.

    Case Report: In this paper, an unusual case of bilateral SSNHL secondary to bilateral CVT with rapid and complete recovery is reported. The patient presented with sudden bilateral hearing loss associated with some neurological symptoms. Initial computed tomography (CT) venography revealed a CVT of bilateral transverse sinuses. The patient was started on an anticoagulant and imaging was repeated after five days, revealing the absence of the thrombosis. Serial pure tone audiometry (PTA) showed complete recovery of bilateral hearing within 10 days.

    Conclusion: Early detection and intervention may fasten hearing recovery and improve the quality of life. The immediate restoration of venous blood flow and intracranial pressure may lead to the complete recovery of bilateral hearing loss.

    Matched MeSH terms: Tomography
  3. Sharudin SN, Govindasamy G, Mohamad NF, Kanesalingam R, Vasudevan SK
    Can J Ophthalmol, 2018 04;53(2):e55-e58.
    PMID: 29631841 DOI: 10.1016/j.jcjo.2017.07.024
    Matched MeSH terms: Tomography, X-Ray Computed
  4. Ahmedy F, Ahmad Fauzi A, Engkasan JP
    PMID: 29844926 DOI: 10.1038/s41394-018-0074-7
    Introduction: Tachycardia, or elevated heart rate is one of the important clinical parameters considered when diagnosing pulmonary embolism (PE) based on Wells' criteria. However, tachycardia is not highly specific and commonly presents in many other conditions.

    Case presentation: A 29-year-old female with incomplete paraplegia secondary to tuberculosis (TB) spondylodiscitis presented with asymptomatic sinus tachycardia. The related medical conditions, including anaemia, acute coronary syndrome, hyperthyroidism and other infective causes had been ruled out. Deep venous thrombosis was not on the list of differentials as she showed improvements in neurological and mobility functions with no clinical signs of calf pain or swelling. She had moderate risk of acute PE based on Wells' criteria with positive D-dimer testing and computed tomography pulmonary angiography (CTPA) showing thrombus formation in the left-ascending pulmonary artery.

    Discussion: Acute PE may present solely with asymptomatic sinus tachycardia in TB spondylodiscitis. This caveat should provide a high index of suspicion to prevent delay in diagnosis and prevention of more sinister complications. Early stratification based on Wells' criteria for a possible diagnosis of acute PE is proven to be a useful approach in conjunction with clinical features.

    Matched MeSH terms: Computed Tomography Angiography
  5. Masni-Azian, Tanaka M
    Comput Biol Med, 2018 07 01;98:26-38.
    PMID: 29758454 DOI: 10.1016/j.compbiomed.2018.05.010
    Intervertebral disc degeneration involves changes in its material properties that affect the mechanical functions of the spinal system. However, the alteration of the biomechanics of a spinal segment through specific material degradation in a specific region is poorly understood. In this study, the influence of the constitutive material degeneration of disc tissues on the mechanics of a lower lumbar spinal unit was examined using a three-dimensional nonlinear finite element model of the L4-L5 functional spinal unit. Different grades of disc degeneration were simulated by introducing a degeneration factor to the corresponding material properties to represent fibrous nucleus, increased fibre and ground substance laxity, increased fibre stiffness and total annular fracture along posterior and posterolateral regions. The model was loaded with an axial compression of 500 N and pure moments of up to 10 Nm to simulate extension, flexion, lateral bending and axial rotation. To validate the model, the spinal motion and intradiscal pressure of healthy and degenerated discs with existing in vitro data were compared. The disc with a fibrous nucleus and the presence of intradiscal pressure increase the spinal instability during flexion and axial rotation, and the absence of intradiscal pressure increases the spinal instability in all directions. Bulging displacement and shear strains in the disc with total fracture and ground substance laxity are high in all of the loading cases. Our study could provide useful information to enhance our understanding of the influence of each constitutive component of the intervertebral disc on the mechanics of the spinal segment.
    Matched MeSH terms: Tomography, X-Ray Computed
  6. Cheng, M.H., Norzila, T.A.B.
    MyJurnal
    Cerebral Venous Thrombosis in patients with Evan’s Syndrome of autoimmune hemolytic anemia is rare. The
    common neurological symptoms are headaches, vision loss, dyslexia without agraphia, motor aphasia,
    unilateral upper limb weakness and papilloedema. We present a case report of a lady with a known case of
    Evan’s Syndrome whom presented with severe anemia and unilateral right sided hemiparesis with right facial
    weakness. Plain and Contrast enhanced CT brain showed bilateral high parietal white matter edema with
    venous thrombosis in the right transverse and superior sagittal venous sinuses. At the time of the diagnosis,
    she was in hematological remission.
    Matched MeSH terms: Tomography, X-Ray Computed
  7. Md Noh MSF, Abdul Rashid AM, Abdul Rahim E
    J Bronchology Interv Pulmonol, 2018 07;25(3):e30-e32.
    PMID: 29944591 DOI: 10.1097/LBR.0000000000000456
    Matched MeSH terms: Tomography, X-Ray Computed
  8. Neoh YL, Neoh PF, Salleh A, Yusof ZB, Gurusamy B, Ahmad Tajudin LS
    Ann Acad Med Singap, 2018 06;47(6):226-229.
    PMID: 30019068
    Matched MeSH terms: Tomography, Optical Coherence
  9. Lorna Ting KN, Liew YT, Abu Bakar Z, Narayanan P
    Auris Nasus Larynx, 2019 Jun;46(3):469-473.
    PMID: 30049634 DOI: 10.1016/j.anl.2018.07.002
    Nasopharyngeal carcinoma is a neoplasm commonly found in population of South East Asia. The mainstay of treatment is high dose irradiation. Complications from radiotherapy are not uncommon especially to those nearby structures such as vertebrae and spinal cord. A 57 year-old gentleman with nasopharyngeal carcinoma (NPC) who was treated with chemo-radiation (total of 35 fractions,70Gy) presented to us 6 months post therapy with bilateral nasal discharge and progressive neck stiffness. Nasoendoscopy showed inflamed nasophayngeal mucosa and Computed Tomography (CT) brain and cervical spine showed retropharyngeal and anterior epidural collection with extension into atlantoaxial bone and spinal cord compression. Histopathological specimen revealed features of chronic inflammations with multiple actinomycetes colonies. Our patient suffered severe neck stiffness and loss of sensations on both upper limbs. He was treated conservatively with Halo vest and intravenous antibiotics for 8 weeks and recovered fully. Irradiation in NPC is known to cause devastating complications to cervical spine such as osteoradionecrosis, osteomyelitis. It also renders tissues hypoxic and risk of getting rare infection like actinomycosis. This report can represent a great diagnostic and therapeutic challenge with differentials of tumor recurrence, osteoradionecrosis or osteomyelitis. Patients must be regularly followed up to look for possible cervical complications as a result from irradiation, to prevent devastating outcome or prognosis.
    Matched MeSH terms: Tomography, X-Ray Computed
  10. Kultida CHY, Ruedeekorn SW, Keerati HS
    Med J Malaysia, 2018 06;73(3):131-136.
    PMID: 29962495
    OBJECTIVE: To evaluate the prevalence of coronary artery anatomic variants and anomalies detected by computed tomography angiography (CTA) MATERIALS AND METHODS: A retrospective study was conducted on all patients undergoing coronary CTA using a 64-detector row CT in the Radiology Department, Songklanagarind Hospital, from January 2010 to January 2013. Data were recorded and analyzed.

    RESULTS: The imaging results of 279 patients were reviewed. One hundred and twenty-two females (43.7%) and 157 males (56.3%) [age range, 26-82 years] were reviewed for coronary artery variants and anomalies with post-processing images. The right coronary dominance was the most common dominant type (91.4%). The prevalence of ramus intermedius was 68.8%; those of the absence of the left main coronary artery and left circumflex artery were 0.4%, respectively; and of the high takeoff of the coronary artery was 3.6%. Anomalies of origin and course were detected as the right coronary artery originating from the left coronary sinus in 1.1% of the patients. Myocardial bridging and coronary fistulas were demonstrated in 55.6% and 0.7% of our subjects, respectively.

    CONCLUSION: A coronary CTA can effectively represent the complex anatomy of the coronaries as well as their anatomic variations and anomalies. The prevalence of most coronary variations were in concordance with the data of previous reports.

    Matched MeSH terms: Computed Tomography Angiography
  11. Tan, Ciang Sang, Haiza Hani Hamidon, Zainah Shaikh Hedra
    MyJurnal
    Background: A 9 year old boy presented with history of persistent headache and recurrent vomiting for 1 month post dental extraction. CT brain was performed for the possibility of space occupying lesion but it was normal. Subsequently, he was treated as migraine after exclusion of meningitis and intracranial lesion. Unfortunately, he developed 3rd, 4th and 6th cranial nerve palsy two weeks later. Repeated CT brain showed subtle finding and inconclusive. MRI brain performed at the time showed features suggestive of basal skull osteomyelitis with congestion of right orbit and optic nerve swelling. Case was referred to Paediatric Neurologist and he was diagnosed to have cranial nerve palsy secondary to basal skull osteomyelitis, post dental extraction.

    Conclusion: Dental procedure is common among children, however basal skull osteomyelitis with cranial nerve palsy is a rare complication. Adequate treatment of dental infection post dental procedure is important to prevent this complication.
    Matched MeSH terms: Tomography, X-Ray Computed
  12. Zulfakar MH, Porter RM, Heard CM
    FEBS Open Bio, 2016 08;6(8):827-34.
    PMID: 27516961 DOI: 10.1002/2211-5463.12095
    Psoriasis is an incurable autoimmune disease characterized by patches of abnormal red, itchy and scaly skin. This work examined the modulation of inflammation, hyperproliferation and immune cell markers following topical application of fish oil (FO) in comparison to the antipsoriatic agents, betamethasone dipropionate (BD) and salicylic acid (SA), to GsdmA3(Dfl)/+ mice, a hair loss mutant which also exhibits epidermal hyperproliferation akin to psoriasis. The mice were dosed with 100 mg of the test formulation and after 10 days, the mice were sacrificed, skin sections excised and subjected to immunohistochemical determination of COX-2, K17 and MAC-1; and immunofluorescence of Ki-67. Unchanged expression of the proinflammatory enzyme COX-2 was observed in all treatments, suggesting the noninvolvement of COX-2 in the aetiology of cutaneous aberration seen in GsdmA3(Dfl)/+ mice. Intense staining of K17 and MAC-1 in the FO-treated group mirrored the epidermal thickening seen observed in live mice by optical coherence tomography (OCT). The ratio of Ki-67-positive nuclei per 100 basal cells indicated that hyperproliferation of keratinocytes occurred in FO-treated mice and the opposite was true for BD-treated mice. There was a positive correlation (R (2) 0.995) between Ki-67 and the epidermal thickness data observed previously. In all immunochemical procedures, the combined BD, SA and FO formulation did not show any significant difference with the control group, reflecting observations seen previously. In conclusion, the epidermal changes observed following topical FO treatment on GsdmA3(Dfl)/+ mice involves an increase in cellular proliferation and macrophages, although COX-2 does not appear to play an important role.
    Matched MeSH terms: Tomography, Optical Coherence
  13. Huei TJ, Lip HTC, Rahmat O
    Med J Malaysia, 2018 06;73(3):177-179.
    PMID: 29962504 MyJurnal
    Tracheobronchial injuries are uncommon and a high level of suspicion is needed for immediate diagnosis and prompt treatment. In this case series, two rare cases of tracheobronchial injuries is described showing variable clinical presentations with different levels of injury. Our first case was seen in a 20 years old male whom had a direct impact on the neck and presented with upper tracheal injury. On arrival, this patient was in respiratory distress and had bilateral pneumothorax. Bilateral chest tube was inserted with subsequent neck exploration. During the neck exploration, anastomosis of the injured trachea was performed. The second case was represented by a 35 years old man with right main bronchial injury. Upon initial presentation, this patient appeared well and was comfortable under room air. However he gradually deteriorated one week after the trauma requiring surgical intervention. Eventually a thoracotomy with primary anastomosis of the bronchial tear was performed. Details of both cases including clinical presentation, imaging and procedures done will be discussed in this article.
    Matched MeSH terms: Tomography, X-Ray Computed
  14. Md Noh MS, Abdul Aziz AF, Mohd Ghani KA, Lee Kheng Siang C, Yunus R, Mohd Yusof M
    Am J Case Rep, 2017 Mar 01;18:212-216.
    PMID: 28246375
    BACKGROUND Intradiverticular bladder tumors are rare. This renders diagnosis of an intradiverticular bladder tumor difficult. Imaging plays a vital role in achieving the diagnosis, and subsequently staging of the disease. CASE REPORT A 74-year-old male presented to our center with a few months history of constitutional symptoms. Upon further history, he reported hematuria two months prior to presentation, which stopped temporarily, only to recur a few days prior to coming to the hospital. The patient admitted to having lower urinary tract symptoms. However, there was no dysuria, no sandy urine, and no fever. Palpation of his abdomen revealed a vague mass at the suprapubic region, which was non tender. In view of his history and the clinical examination findings, an ultrasound of the abdomen and computed tomography (CT) was arranged. These investigations revealed a giant tumor that seemed to be arising from a bladder diverticulum, with a mass effect and hydronephrosis. He later underwent operative intervention. CONCLUSIONS Intradiverticular bladder tumors may present a challenge to the treating physician in an atypical presentation; thus requiring a high index of suspicion and knowledge of tumor pathophysiology. As illustrated in our case, CT with its wide availability and multiplanar imaging capabilities offers a useful means for diagnosis, disease staging, operative planning, and follow-up.
    Matched MeSH terms: Tomography, X-Ray Computed
  15. Yew YC, Hor JY, Lim TT, Kanesalingam R, Ching YM, Arip M, et al.
    Mult Scler Relat Disord, 2016 Nov;10:22-25.
    PMID: 27919493 DOI: 10.1016/j.msard.2016.08.009
    It is difficult to predict whether a particular attack of neuromyelitis optica spectrum disorder (NMOSD) will affect the optic nerve [optic neuritis (ON): unilateral or bilateral], spinal cord (myelitis), brain or brainstem, or a combination of the above. We report an interesting case of recurrent ON of the same eye for a total of 11 episodes in a Chinese woman. Over a period of 22 years, the attacks only involved the left eye, and never the right eye and also no myelitis. For a prolonged duration, she was diagnosed as recurrent idiopathic ON. Only until she was tested positive for aquaporin 4 antibody that her diagnosis was revised to NMOSD. Optical coherence tomography revealed thinning of the retinal nerve fibre layer (RNFL) for the affected left eye, while the RNFL thickness was within normal range for the unaffected right eye. The disability accrual in NMOSD is generally considered to be attack-related - without a clinical attack of ON, there shall be no visual impairment, and no significant subclinical thinning of RNFL. Our case is in agreement with this notion. This is in contrast to multiple sclerosis where subclinical RNFL thinning does occur. This case highlights the importance of revisiting and questioning a diagnosis of recurrent idiopathic ON particularly when new diagnostic tools are available.
    Matched MeSH terms: Tomography, Optical Coherence
  16. Mohd Said MR, Abdul Rani R, Raja Ali RA, Ngiu CS
    Med J Malaysia, 2017 02;72(1):77-79.
    PMID: 28255151 MyJurnal
    Percutaneous Endoscopic Gastrostomy (PEG) tubes were often offered to patients requiring long term enteral feeding. Even though the procedure is relatively safe, it is associated with various complications such as peritonitis or even death.1 We presented a case of a 54-year-old gentleman with underlying ischemic stroke and pus discharges from a recently inserted PEG tube. Computed Topography (CT) scan confirmed abdominal wall necrotising fasciitis complicated with hyperosmolar hyperglycaemia state (HHS) and later succumbed after 48 hours of admission. Our case illustrated the rare complication related to the insertion of PEG tube; abdominal wall necrotising fasciitis that was associated with mortality.
    Matched MeSH terms: Tomography, X-Ray Computed
  17. Kenneth Teow, K. L., Nor Akmal, B., Jamalia, R., Safinaz, M. K.
    MyJurnal
    Strabismus is one of the most common ocular problems affecting the preschool population and the aim of strabismus surgery is to correct abnormal alignment of the eyes. A 5-year-old girl with strabismus underwent an uneventful surgery and was discharged on the same day with topical medications. Two days later, she returned with a painful right lower eyelid swelling, eye discharge and fever which started 1 day post-surgery. She was admitted for intravenous (IV) antibiotic. Symptoms initially improved after 24 hours of treatment, but later she had worsening eyelid swelling. An urgent CT scan of the orbit showed a right lower lid abscess with orbital cellulitis. Subsequently an examination under anaesthesia (EUA) and incision and drainage (I&D) of the lower lid abscess were performed. Culture from the pus grew Community Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA), sensitive to Vancomycin. At day 2 post I&D she subsequently developed another episode of localised right lower lid swelling. Another EUA was done but showed the lower lid and wound was free of pus. She was later found to have a toxic reaction to topical Gentamicin and hence this medication was stopped. She responded well to treatment and was discharged after completing her IV antibiotics. At 14 months outpatient follow up, she was well and orthophoric in primary gaze. While treating a disease, we should be opened to all possibilities and not to treat with multiple antibiotics once susceptibility is known
    Matched MeSH terms: Tomography, X-Ray Computed
  18. Mustafar R, Kamaruzaman L, Chien BH, Yahaya A, Mohd Nasir N, Mohd R, et al.
    Case Rep Med, 2018;2018:8425985.
    PMID: 30186328 DOI: 10.1155/2018/8425985
    We reported a case of primary renal lymphoma (PRL) presented with non-oliguric acute kidney injury and bilateral kidney infiltrates in an individual with human immunodeficiency virus (HIV) disease. Acute kidney injury secondary to lymphoma infiltrates is very rare (less than 1% of hematological malignancy). A 37-year-old gentleman with underlying human immunodeficiency virus (HIV) disease was on combined antiretroviral therapy since diagnosis. He presented to our center with uremic symptoms and gross hematuria. Clinically, bilateral kidneys massively enlarged and were ballotable. Blood investigations showed hemoglobin of 3.7 g/L, urea of 65.6 mmol/L, and serum creatinine of 1630 µmol/L with hyperkalemia and metabolic acidosis. An urgent hemodialysis was initiated, and he was dependent on regular hemodialysis subsequently. Computed tomography renal scan showed diffuse nonenhancing hypodense lesion in both renal parenchyma. Diagnosis of diffuse large B cell lymphoma with germinal center type, CD20 positive, and proliferative index 95% was confirmed via renal biopsy, and there was no bone marrow infiltrates. Unfortunately, the patient succumbs prior to initiation of chemotherapy.
    Matched MeSH terms: Tomography
  19. Alsrouji MS, Ahmad R, Rajali A, Mustafa NWNA, Ibrahim N, Baba NZ
    J Prosthodont, 2019 Feb;28(2):131-137.
    PMID: 30427557 DOI: 10.1111/jopr.12999
    PURPOSE: To compare the residual ridge resorption (RRR) of the anterior maxillary bone beneath complete dentures when opposed by mandibular complete dentures (CD) and implant-retained overdentures (IRO).

    MATERIALS AND METHODS: 18 patients were rehabilitated with maxillary CD opposing mandibular IRO, and 4 patients were prescribed with conventional CD. Cone beam computed tomography (CBCT) scans of the maxilla were acquired before and 1 year post-treatment and converted into 3D models using Mimics research software. RRR was quantified by measuring the changes in bone volume following superimpositioning and sectioning of these models at the anterior maxillary region. Subsequently, the sectioned 3D models of the anterior maxilla were exported to 3-Matic software to reveal the predominant region and depth of RRR.

    RESULTS: The mean reduction in bone volume of the anterior maxilla in the CD group was 2.60% (SD = 1.71%, range = -4.89 % to -0.92%, median = -2.30%), while the mean reduction in the IRO group was almost three times higher at 7.25% (SD = 3.16%, range = -13.25 to -1.50, median = -7.15%). The predominant areas of RRR were on the buccal and occlusal ridge of the anterior maxilla.

    CONCLUSION: Within the limits of this study, it may be concluded that an IRO caused significantly higher RRR of the anterior maxilla than a CD.

    Matched MeSH terms: Cone-Beam Computed Tomography
  20. Alias A, Ibrahim A, Abu Bakar SN, Swarhib Shafie M, Das S, Abdullah N, et al.
    Clin Ter, 2018 11 6;169(5):e217-e223.
    PMID: 30393808 DOI: 10.7417/CT.2018.2082
    INTRODUCTION: The first step in the forensic identification is sex determination followed by age and stature estimation, as both are sex-dependent. The mandible is the largest, strongest and most durable bone in the face. Mandible is important for sex confirmation in absence of a complete pelvis and skull.

    AIM: The aim of the present study was to determine sex of human mandible from morphology, morphometric measurements as well as discriminant function analysis from the CT scan.

    MATERIALS AND METHODS: The present retrospective study comprised 79 subjects (48 males, 31 females), with age group between 18 and 74 years, and were obtained from the post mortem computed tomography data in the Hospital Kuala Lumpur. The parameters were divided into three morphologic and nine morphometric parameters, which were measured by using Osirix MD Software 3D Volume Rendering.

    RESULTS: The Chi-square test showed that men were significantly association with square-shaped chin (92%), prominent muscle marking (85%) and everted gonial glare, whereas women had pointed chin (84%), less prominent muscle marking (90%) and inverted gonial glare (80%). All parameter measurements showed significantly greater values in males than in females by independent t-test (p< 0.01). By discriminant analysis, the classification accuracy was 78.5%, the sensitivity was 79.2% and the specificity was 77.4%. The discriminant function equation was formulated based on bigonial breath and condylar height, which were the best predictors.

    CONCLUSION: In conclusion, the mandible could be distinguished according to the sex. The results of the study can be used for identification of damaged and/or unknown mandible in the Malaysian population.

    Matched MeSH terms: Tomography, X-Ray Computed
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