We reviewed 116 chest radiographs done in 70 adult asthmatic patients who were admitted to the Hospital Universiti Sains Malaysia from January to December 1989. The chest radiographs were abnormal in 23% of cases. Twelve percent showed hyperinflation and 7% had pneumonia. Eight patients diagnosed clinically to have pneumonia had normal chest radiographs. Seven patients had radiographic findings of conditions which were unsuspected clinically. These included two cases of pneumonia, one case each of fibrosing alveolitis, pneumothorax, pneumomediastinum, mitral stenosis with left ventricular failure and right pleural effusion. In conclusion, we found that significant chest radiograph abnormalities in adult patients admitted for asthma were uncommon although chest radiographs were helpful in detecting complications or coincidental conditions. Chest radiograph is therefore an important investigation in adult asthmatic patients who are admitted. However, considering the cost and the risk of radiation, it should be done only in selective cases rather than as a routine procedure.
Study site: Hospital Universiti Sains Malaysia, Kelantan, Malaysia
Impaction of food usually occurs in patients having obstructive lesions of the oesophagus. The food bolus impaction normally occurs in patients older than 60 years of age. Though food bolus impaction in the oesophagus is not uncommon, food bolus in the oesophagus causing complete obstruction resulting in total dysphagia is rare. This is a case report of a woman who had complete obstruction of the oesophagus following impaction by a piece of meat. The various treatment modalities available for such a condition are discussed.
A case of an intracerebral bleed in a young man with a rare combination of arteriovenous malformation (AVM) and unilateral moyamoya disease is presented. The location of the bleed in the left basal ganglia corresponded to the area supplied by the basal moyamoya vessels. The AVM which received supply from collateral moyamoya vessels as well as normal cerebral arteries was located in the ipsilateral parieto-occipital region posterior to the basal ganglia bleed. This is the first reported cerebral AVM co-existing with a unilateral moyamoya disease in the English literature. Unusual features of the case such as the unilaterality of the angiographic abnormalities, their coexistence and hypotheses as to their development are discussed.
A 35 year old diabetic presented with features of septicaemia and developed cardiac tamponade. He was found to have pulmonary, acute septicaemic and pericardial melioidosis. Some initial improvement was achieved with medical therapy but only with surgical intervention was a successful outcome achieved.
Adult onset still's disease usually presents with high grade intermittent fever, polyarthritis, salmon pink evanescent rash and hepatosplenomegaly. Pulmonary involvement in the form of pneumonitis, as a presenting feature is very rare. We report a case of a young lady who presented with fever, cough and respiratory distress. Chest X-ray revealed patchy infiltration in left upper lung zone. She was subsequently diagnosed as Adult onset Still's disease. There was no improvement in clinical condition despite five days of antibiotics. On trans-bronchial lung biopsy (TBLB) proved she had interstitial pneumonitis and responded dramatically to steroid treatment.
Computed tomography (CT) is widely used in assessing clinically stable patients with blunt abdominal trauma. In these patients, liver is one of the commonest organs being injured and CT can accurately identify and assess the extent of the injury. The CT features of blunt liver trauma include laceration, subcapsular or parenchymal haematomas, active haemorrhage and vascular injuries. Widespread use of CT has notably influenced the management of blunt liver injury from routine surgical to nonsurgical management. We present pictorial illustrations of various liver injuries depicted on CT in patients with blunt trauma.
This study is aimed to evaluate the accuracy of Demirjian method in estimating the chronological age of male and female Kelantanese Malay children between 6 and 16 years of age and to establish a new dental age (DA) curve if the Demirjian method was not found to be accurate. About 905 panoramic radiographs of healthy Malay children between 6 and 16 years of age were collected from the radiographic unit in the Hospital Universiti Sains Malaysia (HUSM) and the orthodontic clinic in Hospital Kota Bharu (HKB). Children who had any disease affecting the dental development, or have agenesis in the lower arch and poor quality radiographic images were excluded. The results showed that Demirjian method overestimated the chronological age (CA) by 1.23 years for boys and 1.20 years for girls and it was less accurate for the Kelantanese Malay children. Thus new standard curve were produced and tested on external samples. Results showed that the mean difference between the chronological age and DA is about 0.17 years for boys and 0.11 years for girls. DA was more advanced in the Kelantanese Malay boys and girls as compared to French-Canadian children in all age groups. It is concluded that the Demirjian method tends to be less accurate in estimating the chronological age in Malay children. The new curve that was produced is more applicable to the Kelantanese Malay children.
Pedicle screw instrumentation has superior biomechanical as well as clinical outcome. Thoracic pedicles show great variation in different population groups, particularly in Asians who have been shown to have smaller pedicle dimensions. Although plain radiographs are widely performed prior to spine surgery, no studies have been done so far to investigate whether the thoracic pedicle profile on plain radiographs affect thoracic pedicle screw insertion. Therefore, this is a cadaveric study aimed to determine the relationship between plain radiographic thoracic pedicle profile in Asians and the outcome of pedicle screw insertion in the thoracic spine.
The articular facets on the inferior aspect of the occipital condyles, articulate with the superior articular facets of the first cervical (atlas) vertebra, to form the atlanto-occipital joint. The present case, reports the asymmetrical dimensions of the facets on the occipital condyles of a human dried skull. The anatomico-radiological study of asymmetrical articular facets on the occipital condyles, may be helpful for academicians, neuro-surgeons, clinicians and radiologists in day to day clinical practice.
A 62-year-old man presented with a 2-month history of right occipito-parietal headache and worsening ipsilateral ptosis. CT scan and cerebral angiography revealed a large fusiform aneurysm of the P2 segment of the right posterior cerebral artery (PCA). The aneurysm was successfully trapped and subsequently excised via sub temporal approach leaving no additional neurological deficits to our patient.
A research that tested the methods suitable for comparing ante- and post-mortem radiographic patterns of frontal sinuses concluded that superimposition should be followed as a stringent method for establishing individual identification. We verified the practical relevance of prescribing superimposition by superimposing ante- and post-mortem frontal sinus patterns recorded in case situations as well as simulated ante- and post-mortem of frontal sinus patterns recorded using archived skulls. For superimposition, the wipe facility available in the vision mixer was employed in addition to the mix mode. Ante- and post-mortem radiographic patterns that were available in two earlier cases were not superimposable. Related simulated ante- and post-mortem radiographic patterns of frontal sinuses are superimposable only when the skull that is initially oriented for recording the ante-mortem radiograph is retained in the same posture for recording the post-mortem radiograph also. Once the skull has been removed from the X-ray table, after recording the simulated ante-mortem radiograph, and repositioned for the simulated post-mortem radiograph, even when the intervening time is 1min, the sinus patterns in these radiographs are not superimposable. Superimposition cannot be used as a conditional requirement for side-by-side comparison of radiographic patterns of frontal sinuses.
OBJECTIVE: 1.To evaluates and recognizes findings in chest radiograph in patients with laboratory-confirmed S-OIV (H1N1) infection treated at UKMMC. 2. To evaluate whether the findings on initial chest radiographs of influenza A (H1N1) patients can help to predict the prognosis.
MATERIAL AND METHODS: Total of 109 adult patients presenting to the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) with flu-like symptoms who were positive for influenza A and these patients had underwent chest radiographs (CXR). The initial CXRs were evaluated for the pattern (consolidation, ground-glass, and reticulation), distribution, and extend of abnormality. The disease is classifies by the clinical severity (mild, moderate or severe illness) and adverse outcome (ventilated, death or recovered well).
RESULTS: The initial CXRs were normal in 56% of cases. The predominant radiographic finding was consolidation, most commonly involving the middle and lower zones (35% of cases). There is no significant association between initial CXR findings with the patient clinical outcome either fully recovered or death/ ventilated.
CONCLUSION: Normal chest radiographs is the most common radiographic finding in S-OIV (H1N1) infection and the most common abnormal lung finding is consolidation. Initial chest radiographs did not determine the patient clinical outcome and a normal initial radiograph could not exclude adverse outcome.
This is a review of the positive biopsy rate of nonpalpable breast lesions detected on mammography. The histology of 130 hookwire excision biopsy from 1990 to 1995 and the cytology of 39 stereotactic fine needle aspiration cytology in 1995 were reviewed. The yearly positive biopsy rate of each procedure was determined. In 1990, the positive biopsy rate for hookwire excision biopsy was 15%, in 1991 20%, in 1992 11%, in 1993 17%, in 1994 33% and in 1995 39%. In 1995, the positive biopsy rate for stereotactic fine needle aspiration cytology was 21%. The positive biopsy rate for hookwire excision biopsy had improved from 15% in 1990 to 39% in 1995.
A collaborative national survey initiated by the University of Malaya and the Ministry of Health was conducted from 1993 to 1995 to establish baseline patient dose data for seven common types (12 projections) of X-ray examinations in Malaysia. A total of 12 randomly selected public hospitals and 867 patients were included in this survey. The entrance surface doses (ESD) received by the patients were measured using thermoluminescent dosemeters (TLDs) attached to the patient's skin. Histograms are presented showing wide, positively skewed distributions of measured entrance surface doses for each examination. Mean, median, first and third quartile values of ESD and median effective dose are reported. Survey results are generally comparable with those reported in the UK, USA and by the International Atomic Energy Agency (IAEA). The results also provide information on dose level for a lower weight population (mean weight 60 kg) compared with the international reference dose values based on a 70 kg standard. The findings support the importance of the on-going national quality assurance programme to ensure doses are kept to a level consistent with optimum image quality. The data will also be useful for the formulation of national guidance levels as recommended by the IAEA. Furthermore, this study provides patient dosimetry information on healthcare level II countries.
The results of radiological investigations performed on 81 children with urinary tract infection (UTI) were reviewed. Investigations included 91 voiding cystourethrograms (VCU), 59 intravenous urograms (IVU) and 36 ultrasonograms (US). The aim was to study the local spectrum of renal tract abnormalities in childhood UTI and to compare the diagnostic yield of combining US and VCU against IVU and VCU. Renal tract abnormalities were detected in 37%. Vesico-ureteric reflux (VUR) was the commonest, detected in 26%, with renal scarring found in 9% of refluxing units. Ultrasound should replace IVU in the initial diagnostic work-up of these children.
A preterm baby was born to a multiparous mother by emergency caesarean section at 36 weeks of gestation. Apart from a depression on the right temporo-parietal region measuring 3 cm x 3 cm x 0.5 cm, no other abnormality was noted. A CT scan of the brain excluded the presence of intracranial haematoma and pressure effect on the brain. Spontaneous reduction of the fracture without any adverse neurological sequelae suggests that these fractures can be managed conservatively in some instances.