We report a case of umbilical necrosis after a unilateral pedicled transverse rectus abdominis myocutaneous flap in a patient post mastectomy. This uncommon complication of breast reconstruction is highlighted.
A 65 year old man presented with a right upper cervical mass. A diagnosis of pleomorphic adenoma was reported on fine needle aspiration cytology (FNAC). CT scan however reported an intramuscular sternocleidomastoid swelling. The tumor was excised and a diagnosis of nodular fasciitis was made. It is important to be aware of this diagnosis and that FNAC reports may mimic that of a pleomorphic adenoma.
Chondrosarcomas are uncommon tumors which originates in the head and neck and accounts for approximately 10 to 15% of all cases. Most chondrosarcomas exhibit an indolent growth pattern. Nasoseptal tumors may mimic common sinonasal conditions, making early diagnosis difficult. We report a case of nasoseptal metastatic chondrosarcoma which was atypical, characterized by an aggressive growth pattern and widely disseminated.
Cystic spinal or ancient schwannoma is a rare form of intradural tumour especially in the conus medullaris region. Due to its indolent behavior and benign course, the diagnosis of schwannoma is always a challenge and the imaging findings can be misleading. Our patient presented with chronic mild sciatica pain without any other neurological symptom. MRI of the spine showed intradural tumour located at the conus medullaris region with nerves compression and was reported as ependymoma. L3-L5 laminectomy and total excision of tumour was performed without any neurological complication. We concluded that ancient schwannoma of the conus medullaris is a rare benign tumour that can present with minimal non-specific neurological symptom that lead to misdiagnosis. Radical tumour excision is safe with an excellent outcome.
Pyoderma Gangrenosum (PG) is a non-infective, necrotising neutrophilic dermatosis. Many diseases may mimic PG. It may be idiopathic or may be associated with a systemic disorder. We report a case of PG in association with ulcerative colitis.
Phaeohyphomycosis consists of a group of mycotic infections characterized by the presence of dematiaceous (dark walled) septate hyphae. Splenic abscess and spontaneous rupture is an infrequent complication in children with haematological malignancies and can be life threatening. To the best of our knowledge this is the first report of a case of splenic rupture following the development of multiple abscesses secondary to infestation by this rare fungal species.
Visceral pentastomiasis in humans is caused by the larval stages (nymphs) of the arthropod-related tongue worms Linguatula serrata, Armillifer armillatus, A. moniliformis, A. grandis, and Porocephalus crotali. The majority of cases has been reported from Africa, Malaysia, and the Middle East, where visceral pentastomiasis may be an incidental finding in autopsies, and less often from China and Latin America. In Europe and North America, the disease is only rarely encountered in immigrants and long-term travelers, and the parasitic lesions may be confused with malignancies, leading to a delay in the correct diagnosis. Since clinical symptoms are variable and serological tests are not readily available, the diagnosis often relies on histopathological examinations. This laboratory symposium focuses on the diagnosis of this unusual parasitic disease and presents its risk factors and epidemiology.
Recurrent glomerular disease is an important cause of late allograft loss in renal transplant recipients. Immunoglobulin A nephropathy (IgAN) is a leading cause of end-stage renal disease (ESRD) worldwide and its recurrence has been reported in allografts. The present study examined outcomes following renal transplantation (RTX) in 101 patients with ESRD due to biopsy-proven IgAN, in comparison to non-IgA patients, and evaluated the incidence of recurrence. The study population (mean age 34.8 +/- 7.7 years; males 62.2%; Chinese 88.3%) underwent RTX under CsA immunosuppression between November 1984 and December 2004; as two patients underwent retransplantation during the study period, 103 allografts (56.3% cadaveric) were included for retrospective analysis. At time of analysis on 1 January 2005, 78 (75.7%) renal allografts (IgAN RTX) were functioning, of which 51 (49.5%) had normal serum creatinine, 27 (26.2%) had chronic allograft dysfunction, while 25 had graft losses, either due to patient death with functioning grafts (5.8%) or withdrawal to dialysis (18.5%). Persistent microscopic haematuria, not attributable to other causes or proteinuria > 1 g/day occurred in 42.7% and 13.6% of allografts respectively. Of 29 allografts biopsied for evaluation of proteinuria and/or renal dysfunction post-RTX, 8 (27.6%) had IgAN (overall histological recurrence, 7.8%). Of these, three had graft loss due to recurrent IgAN, three had elevated serum creatinine, while two had normal serum creatinine. Overall five and ten year patient survivals for IgAN RTX were 95.3% and 82.2%, and five and ten year actuarial graft survivals were 82.3% and 67.8% respectively. Five and ten year patient and graft survivals for IgAN RTX were not significantly different from that for non-IgAN RTX. In summary, RTX patients with IgAN have a low incidence of documented histological recurrence and recurrence contributing to graft loss occurs in only 2.9%. These results suggest that RTX is an excellent modality of renal replacement therapy in this population.
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.
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.
Tonsillectomy in children is performed on a regular basis in ENT. The indications are chronic tonsillitis, sleep apnea to deeper structures. The natural history of tonsillar hyperplasia is regression when a child is six years beyond. In children with bilateral tonsillar hyperplasia we studied the use of laser as an alternative procedure to reduce the bulk of the tonsillar mass. Children with symptoms of bilateral tonsillar hyperplasia underwent laser tonsillotomy. The tonsils were dissected using carbon dioxide (CO2) laser. The tonsillar bed was left untouched. Intraoperative and postoperative conditions were noted.
Surgical biopsies of lymphnodes of 315 patients (273 adult and 42 children) were reviewed microscopically and analysed. The sex ratio was similar in adults but in children males were twice than female (2:1). Ethnically Malay patients predominated in both the groups. The commonest cause of biopsied lymphadenopathy in adults were malignancy (47%) followed by chronic nonspecific lymphadenitis (20%) and granulomatous lymphadenitis (9%) while in children chronic nonspecific lymphadenitis was the commonest (46%) followed by granulomatous lymphadentitis (21%) and malignancy (14%). Twenty percent of adults and 4% of children had normal lymphnodes. Secondary deposits in adult males and females were of squamous cell carcinoma and adenocarcinoma type respectively. In our study 100% of clildren and 96% of adults with granulomatous lymphadenitis had tubercular lesions.
Patellar thickness is an important consideration for resurfacing in total knee arthroplasty. A patella of 25 mm in thickness is not suitable for resurfacing using the currently available total knee systems. A cross sectional study on patellar thickness using plain radiographs was undertaken on 56 patients. It was observed that the average thickness of the bony part of the patella was 20.05 mm (range 17-23 mm). The actual thickness of cartilage varies from 2.0 to 5.5 mm (mean 3.2 mm). Thus the mean thickness of the patella was 23.2 mm (range 20.2-26.2 mm). The majority of our patients (73%) had patellar thickness of 24 mm or less. The patellar thickness had a significant correlation with the patient's height (R=0.5). Since the majority of our patients have thin patella, we are of the opinion that majority of our patients are not suitable for patellar resurfacing.
A study was undertaken to 1) determine the effects of tobacco smoke exposure on maternal and neonatal weight and body mass index (BMI) and placental weight, volume and surface area and 2) establish any correlations between the placental surface area, volume and weight with maternal and neonatal body weight and BMI in mothers exposed to cigarette smoke. A total of 154 full-term placentae, 65 from mothers exposed to tobacco smoke and 89 from non-exposed mothers were collected from Kuala Lumpur Maternity Hospital. The placental surface area was determined using a stereological grid, the volume by Scherle's method and the weight by using an electronic weighing machine. In general there were no differences in maternal, placental and neonatal parameters between the exposed and non-exposed groups. However, there were significant correlations between placental weight with maternal weight and maternal BMI in both exposed (r = 0.315; p = 0.013) and (r = 0.265; p = 0.038), and non-exposed (r = 0.224; p = 0.035) and (r = 0.241; p = 0.023) mothers. It was also found that the maternal weight on admission correlated significantly with placental weight in both Malay (r = 0.405; p = 0.020) and Indian (r = 0.553; p = 0.050) passive smokers. Correcting the placental parameters for the maternal weight had no effect on the results.
Background: There has been no published study of biopsy proven childhood glomerulonephritis in Malaysia.
Objectives: To determine the pattern of childhood glomerulonephritis in Johor, Malaysia from a histopathological perspective and the various indications used for renal biopsy in children.
Materials and methods: Retrospective study was done of all renal biopsies from children under 16 years of age, received in Sultanah Aminah Hospital, Johor between 1994 and 2001. The histopathological findings were reviewed to determine the pattern of biopsy proven glomerulonephritis. The indications of biopsy, mode of therapy given after biopsy and the clinical outcome were studied.
Results: 123 adequate biopsies were received, 9 children had repeated biopsies. Of the 113 biopsies, minimal change disease formed the most common histopathological diagnosis (40.7%) while lupus nephritis formed the most common secondary glomerulonephritis (23.0%). The main indications for biopsy were nephrotic syndrome (50.8%), lupus nephritis (25.4%) and renal impairment (13.1%). The mode of therapy was changed in 59.8% of the children. Of 106 patients followed up, 84 children were found to have normal renal function in remission or on treatment. 4 patients developed chronic renal impairment and 16 reached end stage renal disease. Five of the 16 children with end stage disease had since died while 11 were on renal replacement therapy. another 2 patients died of other complications.
Conclusions: The pattern of childhood GN in our study tended to reflect the more severe renal parenchymal diseases in children and those requiring more aggressive treatment. This was because of our criteria of selection (indication) for renal biopsy. Renal biopsy where performed appropriately in selected children may not only be a useful investigative tool for histological diagnosis and prognosis but may help clinicians plan the optimal therapy for these children.
The management of pulmonary metastasis from breast carcinoma is challenging and often consists of palliation of symptoms. Surgical resection of pulmonary metastasis is considered inappropriate in view of the disseminated nature of the disease and limited life expectancy. It can however be a worthwhile option if imaging, including bone scans rule out metastatic disease in other part of the body. We report a patient with pulmonary metastasis from breast carcinoma who was successfully treated with pulmonary wedge resection of the metastatic lesion.
Bone is unique in its ability to adapt structure to functional requirements, but as is all too obvious in an ever-ageing population it is susceptible to a number of degenerative diseases. Therefore there is an increasing need for materials for bone replacement. Clearly, the ideal material with which to replace bone, would be bone itself, but the major problem now facing us is that there is an insufficient supply of the natural bone to satisfy the clinical requirements. Hence, there is a need for the development of chemically synthesised bone graft substitutes