MyMedR

Fulltext Triple primary cancers of the larynx, lung and thyroid presenting in one patient

Iqbal FR, Sani A, Gendeh BS, Aireen I

Med J Malaysia, 2008 Dec;63(5):417-8.

PMID: 19803306 MyJurnal

Patients with multiple malignant primary tumours are often described, based on their chronology of presentation, as simultaneous, synchronous or metachronous tumours. Lung malignancies presenting in association with head and neck tumours are well documented while there have been small series of thyroid synchronous cancers presenting with laryngeal lesions in literature. No cases, to our knowledge, have been reported in literature of a single patient with all three laryngeal, lung and thyroid malignancies. We report one such case of a 71-year-old Chinese man who had undergone a total laryngectomy for a recurrent cancer of the larynx only to be found to have tumours of the lung and thyroid in the post-operative period and he eventually died of post-operative complications. We also discuss screening for lung and thyroid malignancies in patients with head and neck squamous cell carcinoma (SCC).

Matched MeSH terms: Tomography, X-Ray Computed

Orbital rhabdomyosarcoma in an HIV positive child

Khairy-Shamel ST, Shatriah I, Adil H, Zunaina E, Bakiah S, Rohaizan Y, et al.

Orbit, 2008;27(5):388-90.

PMID: 18836940 DOI: 10.1080/01676830802336629

We reported a case of orbital rhabdomyosarcoma with an intracranial extension in an HIV-infected child. It was an uncommon sarcoma in a retroviral-positive patient that resulted in a diagnostic and therapeutic dilemma. The child is currently asymptomatic following surgery, chemotherapy, and reinstitution of highly active retroviral therapy (HAART).

Matched MeSH terms: Tomography, X-Ray Computed

Pulmonary actinomycosis and skin sinuses

Lee JK

J Paediatr Child Health, 2007 Dec;43(12):854-5.

PMID: 18036023

A 12-year old girl presented with an unusual problem of recurrent discharging multiple skin sinuses on her right anterior and posterior chest wall for a year. There was ipsilateral lower lobe pneumonia and imaging showed multiple abscesses in her lower back muscles bilaterally. A purulent fluid was aspirated from her back muscles and the histology examination showed sulphur granules with gram positive branched filaments. She responded well to the treatment for actinomycosis with penicillin and doxycycline.

Matched MeSH terms: Tomography, X-Ray Computed

Internal auditory canal stenosis in congenital sensorineural hearing loss

Sakina MS, Goh BS, Abdullah A, Zulfiqar MA, Saim L

Int J Pediatr Otorhinolaryngol, 2006 Dec;70(12):2093-7.

PMID: 16996619

Sensorineural hearing loss (SNHL) due to internal auditory canal (IAC) stenosis with hypoplasia of the cochleovestibular nerve is a rare disorder. The diagnosis of the IAC stenosis requires both high resolution computed tomography scan (HRCT) and magnetic resonance imaging (MRI).

Matched MeSH terms: Tomography, X-Ray Computed

The creation and verification of cranial models using three-dimensional rapid prototyping technology in field of transnasal sphenoid endoscopy

Waran V, Menon R, Pancharatnam D, Rathinam AK, Balakrishnan YK, Tung TS, et al.

Am J Rhinol Allergy, 2012 Sep-Oct;26(5):e132-6.

PMID: 23168144 DOI: 10.2500/ajra.2012.26.3808

Surgical navigation systems have been used increasingly in guiding complex ear, nose, and throat surgery. Although these are helpful, they are only beneficial intraoperatively; thus, the novice surgeon will not have the preoperative training or exposure that can be vital in complex procedures. In addition, there is a lack of reliable models to give surgeons hands-on training in performing such procedures.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext Surgical access to parapharyngeal space tumours--the Manipal experience

Hazarika P, Dipak RN, Parul P, Kailesh P

Med J Malaysia, 2004 Aug;59(3):323-9.

PMID: 15727377

A few series of parapharyngeal space tumours have been reported earlier but recently not many series have been published in English literature. It is rare for any medical center, let alone an individual surgeon, to develop sufficient experience in evaluating these tumours. We present our experience in the treatment of 41 cases of parapharyngeal tumours from January 1992 to December 2001. FNAC, ultrasound and CT scan of the presenting mass was done in most of the patients as the main pre-operative work-up. The strategic location and extension of the tumour may occasionally alter the surgical approach for tumour excision.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext Pulmonary metastases of giant cell tumour of the bone

Faisham WI, Zulmi W, Saim AHM, Biswal BM

Med J Malaysia, 2004 Dec;59 Suppl F:78-81.

PMID: 15941172

The clinical presentation and behaviour of giant cell tumour of bone vary. The progression of the disease and metastasis are unpredictable, but the overall prognosis is good. Six patients with pulmonary metastases of giant cell tumour have been treated at our institution since 1998. This represents 15% of all patients treated for giant cell tumour of the bone. Early detection and treatment of this tumour is important as complete resection of this tumour have favourable prognosis. Multiple lung nodules which preclude resection may remain dormant and asymptomatic with systemic chemotherapy.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext An unusual radiographic presentation of posterior cruciate ligament avulsion fracture

Nizlan MNM, Suhail A, Samsudin OC, Masbah O

Med J Malaysia, 2004 Dec;59 Suppl F:65-8.

PMID: 15941168

A case of traumatic posterior cruciate ligament (PCL) avulsion fracture presenting with unusual radiographic findings is described. CT scan of the right knee showed features suggestive of combined ACL and PCL avulsion fractures. Arthroscopic findings showed that the injury was in fact a PCL avulsion fracture that was displaced anteriorly so as to mimic an ACL avulsion fracture on CT scan.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext Versatility of the latissimus dorsi flap in upper limb salvage tumour surgery

Dorai AA, Halim AS, Zulmi W

Med J Malaysia, 2004 Dec;59 Suppl F:42-6.

PMID: 15941160

Reconstructive surgeons often encounter complex soft tissue and skeletal defects following oncological surgery. Soft tissue defects after wide resection in upper extremities posses a difficult challenge to find adequate tissue for reconstructing these defects. Paucity of local tissues dictates the requirement of loco-regional or distant flaps for these complex soft tissue defects which often exposes tendons, bones, nerves and joints. The latissimus dorsi muscle is a near ideal flap for the reconstruction because of the long neurovascular pedicle, ease of mobilization and its expendability. It can be rotated, with or without overlying skin, to cover soft tissue defects of the shoulder arm and elbow. Due to the large size of the muscle, it can be used to resurface the soft tissue defects and cover all major structures. Eleven consecutive cases were reviewed in which latissimus dorsi myocutaneous flap was used to reconstruct soft tissue defects of the upper limb following radical tumor resection. Flap survival was 100% with nominal donor site morbidity.

Matched MeSH terms: Tomography, X-Ray Computed

A negative waveform in the scotopic response in a patient with phosphoglycerate kinase deficiency: a visual electrophysiology report

Mohd Khialdin S, Grigg J, Rowe N, Crofts S, Wilson M, Troedson C

Documenta ophthalmologica. Advances in ophthalmology, 2015 Dec;131(3):215-20.

PMID: 26396085 DOI: 10.1007/s10633-015-9511-0

Phosphoglycerate kinase (PGK) deficiency is an X-linked neurometabolic genetic disorder with variable systemic manifestations. So far, only one patient with retinal anomalies has been reported, but no visual electrophysiology findings were described. We report the first description of visual electrophysiology in a child with PGK deficiency. This provides further information for the site of involvement in the eye.

Matched MeSH terms: Tomography, Optical Coherence

Fulltext Macular retinal sensitivity using MP-1 in healthy Malaysian subjects of different ages

Ismail SA, Sharanjeet-Kaur, Mutalib HA, Ngah NF

J Optom, 2015 Oct-Dec;8(4):266-72.

PMID: 26025808 DOI: 10.1016/j.optom.2015.04.001

PURPOSE: To determine the influence of age and gender on macular sensitivity to light in healthy subjects of 4 age groups using the MP-1 microperimeter.
METHODS: A prospective study was carried out on 50 healthy subjects (age range: 18-60 years) divided into 4 age groups; 18-30 years, 31-40 years, 41-50 years and 51-60 years. Full-threshold microperimetry of the central 10° of retina was performed utilizing 32 points with the MP-1. Macula area was divided into four quadrants, which were superior nasal (SN), inferior nasal (IN), inferior temporal (IT) and superior temporal (ST).
RESULTS: Total mean sensitivity at 10° for age groups 18-30 years, 31-40 years, 41-50 years and 51-60 years were 19.46 ± 0.30, 19.40 ± 0.39, 19.47 ± 0.35 and 18.73 ± 0.75 (dB), respectively. There was a significant difference in total mean retinal sensitivity at 10° and at the four quadrants with age but not for gender. The retinal sensitivity was highest in the IT quadrant and lowest in the SN quadrant for all age groups. The linear regression analysis revealed that there was a 0.019 dB, 0.016 dB, 0.022 dB, 0.029 dB and 0.029 dB per year age-related decline in mean macular sensitivity within the central 10° diameter in the SN, IN, IT and ST quadrants respectively.
CONCLUSION: Among normal healthy subjects, there was a linear decline in retinal light sensitivity with increasing age with the highest reduction in the superior nasal quadrant and lowest in the inferior temporal quadrant.

Matched MeSH terms: Tomography, Optical Coherence

The accuracy and safety of fluoroscopically guided percutaneous pedicle screws in the lumbosacral junction and the lumbar spine: a review of 880 screws

Chiu CK, Kwan MK, Chan CY, Schaefer C, Hansen-Algenstaedt N

Bone Joint J, 2015 Aug;97-B(8):1111-7.

PMID: 26224830 DOI: 10.1302/0301-620X.97B8.35330

We undertook a retrospective study investigating the accuracy and safety of percutaneous pedicle screws placed under fluoroscopic guidance in the lumbosacral junction and lumbar spine. The CT scans of patients were chosen from two centres: European patients from University Medical Center Hamburg-Eppendorf, Germany, and Asian patients from the University of Malaya, Malaysia. Screw perforations were classified into grades 0, 1, 2 and 3. A total of 880 percutaneous pedicle screws from 203 patients were analysed: 614 screws from 144 European patients and 266 screws from 59 Asian patients. The mean age of the patients was 58.8 years (16 to 91) and there were 103 men and 100 women. The total rate of perforation was 9.9% (87 screws) with 7.4% grade 1, 2.0% grade 2 and 0.5% grade 3 perforations. The rate of perforation in Europeans was 10.4% and in Asians was 8.6%, with no significant difference between the two (p = 0.42). The rate of perforation was the highest in S1 (19.4%) followed by L5 (14.9%). The accuracy and safety of percutaneous pedicle screw placement are comparable to those cited in the literature for the open method of pedicle screw placement. Greater caution must be taken during the insertion of L5 and S1 percutaneous pedicle screws owing to their more angulated pedicles, the anatomical variations in their vertebral bodies and the morphology of the spinal canal at this location.

Matched MeSH terms: Tomography, X-Ray Computed

Clinical and Imaging Features of Lacrimal Gland Involvement in Granulomatosis with Polyangiitis

Tan LT, Davagnanam I, Isa H, Rose GE, Verity DH, Pusey CD, et al.

Ophthalmology, 2015 Oct;122(10):2125-9.

PMID: 26233627 DOI: 10.1016/j.ophtha.2015.06.026

Lacrimal gland involvement in granulomatosis with polyangiitis (GPA) commonly accompanies orbital disease, but occasionally may be the sole presentation preceding any other organ manifestation or systemic disease. Diagnosis of orbital GPA, especially in patients with lacrimal involvement as the initial presentation, can be difficult because of nonspecific clinical features and lack of diagnostic specificity on histologic and antineutrophilic cytoplasmic antibody (ANCA) testing. Orbital GPA can be associated with a high morbidity from potential visual loss or rapid progression of latent systemic disease, making early diagnosis important. The purpose of this study was to describe the clinical and imaging features of patients with lacrimal gland involvement secondary to GPA and to compare them with those of other orbital inflammatory conditions in the lacrimal gland fossa.

Matched MeSH terms: Tomography, X-Ray Computed

Malignant transformation of mesenchymal hamartoma of the liver: case report and review of the literature

Ramanujam TM, Ramesh JC, Goh DW, Wong KT, Ariffin WA, Kumar G, et al.

J Pediatr Surg, 1999 Nov;34(11):1684-6.

PMID: 10591570

Here the first case in the literature of both mesenchymal hamartoma and malignant mesenchymoma occurring in a 6-year-old male child, at different times and at different sites in the liver, and also the possible malignant transformation of a mesenchymal hamartoma is reported. The tumor developed from a lesion in the right lobe that was overlooked initially during a left lateral segmentectomy at 18 months of age for a mesenchymal hamartoma. Malignant mesenchymoma is a rare and aggressive tumor. The origin of this tumor is not well understood. There has been no direct support to the hypothesis that malignant mesenchymoma may be the malignant counterpart of mesenchymal hamartoma. The authors provide clinical and histopathologic evidence in our case that suggests the possibility of malignant mesenchymoma arising from a mesenchymal hamartoma. This case emphasizes the need for complete removal of mesenchymal hamartoma and the need for long-term follow-up to detect multifocal lesion or malignant transformation.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext Neurological manifestations of children with systemic lupus erythematosus

Loh WF, Hussain IMI, Soffiah A, Lim YN

Med J Malaysia, 2000 Dec;55(4):459-63.

PMID: 11221157

In a cross-sectional study of 21 children with Systemic Lupus Erythematosus, 15 (71%) were found to have neuropsychiatric manifestations. The most common finding was generalised seizures (42.8%) followed by encephalopathy (19%) and hallucinations (19%). One child (4.76%) had hemichorea. In 3 children neurological manifestations were the first symptom of SLE. Computerised Axial Tomograms (CAT scans) showed cerebral atrophy in 7 of 12 scans available for review. Ten children had abnormal EEGs. Although none of the children had clinical evidence of a peripheral neuropathy, 8 had neurophysiological evidence of a neuropathy. One child died of intracranial haemorrhage. Six children had residual neuropsychiatric sequalae.

Matched MeSH terms: Tomography, X-Ray Computed

Refractory seizures in a young army cohort

Loh NK, Lee WL, Yew WW, Tjia TL

Ann Acad Med Singap, 1997 Jul;26(4):471-4.

PMID: 9395813

This survey covered male Singapore citizens born in 1974 who were medically screened at the age of 18 years before enlistment for compulsory military service. Suspected epileptics were referred to government hospitals for further management. Out of 20,542 men, there were 121 epileptics, giving a cumulative incidence of 5 per 1000 by age 18 years. We had information on 106 (87%) of these individuals and were able to interview them and review their hospital records. Seventy-three of the 106 (69%) epileptics had generalised seizures while 14 (13%) had refractory seizures. There was no statistically significant racial bias amongst these epileptics. Unprovoked afebrile seizures occurred early in these patients, half of whom had seizures onset before 7 years of age. Nine refractory epileptics had a history of febrile seizures, 4 of which were complex febrile seizures. Magnetic resonance imaging identified mesial temporal sclerosis in 2 patients and a hypothalamic lesion in 1 patient. Computed tomographic scans revealed focal cortical atrophy in 2 patients. Nine other patients had normal imaging studies. Nine out of 14 (64%) patients with refractory epilepsy had partial seizures; 4 (29%) had generalised seizures and 1 (7%) was unclassified. This is in contrast to the distribution of the entire cohort of epileptics studied. Two out of 9 patients with refractory partial seizures (gelastic epilepsy and mesial temporal sclerosis) had undergone surgery while 6 of the other 7 patients refused to consider surgery.

Matched MeSH terms: Tomography, X-Ray Computed

Multifocal mucus secreting papillary adenocarcinoma of the bile duct causing obstructive jaundice

Khan TF, Sherazi ZA, Alias NA, Mahmood Z

Ann Acad Med Singap, 1993 Mar;22(2):251-3.

PMID: 8363342

We present a 64-year-old Malay lady who had undergone a choledochoduodenostomy (CDD) two years ago for obstructive jaundice. She was admitted with jaundice and underwent ultrasonography, percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangio pancreatography (ERCP) and computed tomographic (CT) scanning of the liver and biliary tree. All the investigations confirmed a type IVa choledochal cyst. At operation, the grossly dilated biliary system was packed with a thick mucoid material and the mucosa of the bile ducts was visibly abnormal with scattered nodules. This mucoid material had caused occlusion of the entire biliary tree resulting in obstructive jaundice. To the best of our knowledge, this is probably the first report of obstructive jaundice caused by thick mucus. The peculiar management problems of this case and the risk of malignant change in choledochal cysts are discussed.

Matched MeSH terms: Tomography, X-Ray Computed

Role of Angiography in Systemic Lupus Erythematosus-Induced Choroiditis

Lee KR, Peng LY, Iqbal TB, Subrayan V

Ocul Immunol Inflamm, 2018;26(8):1146-1149.

PMID: 28362518 DOI: 10.1080/09273948.2017.1298821

PURPOSE: To report a case of systemic lupus erythematosus-induced choroidal vasculitis.

METHODS: A 34-year-old woman with a long-standing history of systemic lupus erythematosus had a sudden painless loss of vision in the right eye over 12 hours. Ocular examination revealed a visual acuity of counting fingers of 1 foot on the right eye and 20/20 on the left. There was a relative afferent pupillary defect on the right side with a pink, distinct optic disk margin.

RESULTS: Optical coherence tomography of the macula and fundus fluorescein angiogram for the eyes were normal. The MRI brain and orbit with the cerebral MRA did not show signs of optic neuritis or occipital vasculitic changes. However, the indocyanine green angiography revealed patches of ill-defined areas of choroidal hypofluorescence in the early- to mid-phase in the macula region.

CONCLUSION: ICGA becomes the crucial tool in unmasking the presence of choroidal vasculitis.

Matched MeSH terms: Tomography, Optical Coherence

Malignant obstruction of superior vena cava: Endovascular stenting using Y-configuration stent in stent technique

Noor Khairiah AK, Mohamad Nazrulhisham MN, Hazman MN

Med J Malaysia, 2018 12;73(6):407-409.

PMID: 30647215

Malignant intrathoracic disease is the commonest cause of superior vena cava (SVC) obstruction. Life threatening SVC obstruction with intense dyspnoea requires urgent treatment. SVC stenting has been developed in recent years which results in rapid relief of the obstruction. The Yconfiguration technique has been reported to provide support for all three limbs of the bifurcation to prevent restenosis. At present, there are limited reports on the use of Y-configuration stent in stent techniques for endovascular stenting in malignant SVC obstruction. We share our clinical experience of two patients who received balloon-mounted stents using this technique.

Matched MeSH terms: Computed Tomography Angiography

Brain imaging abnormalities and outcome after acute ischaemic stroke: the ENCHANTED trial

Delcourt C, Wang X, Zhou Z, Wardlaw JM, Mair G, Robinson TG, et al.

J Neurol Neurosurg Psychiatry, 2020 12;91(12):1290-1296.

PMID: 33055145 DOI: 10.1136/jnnp-2020-323015

OBJECTIVE: To test the hypothesis that imaging signs of 'brain frailty' and acute ischaemia predict clinical outcomes and symptomatic intracranial haemorrhage (sICH) after thrombolysis for acute ischaemic stroke (AIS) in the alteplase dose arm of ENhanced Control of Hypertension ANd Thrombolysis strokE stuDy (ENCHANTED).

METHODS: Blinded assessors coded baseline images for acute ischaemic signs (presence, extent, swelling and attenuation of acute lesions; and hyperattenuated arteries) and pre-existing changes (atrophy, leucoaraiosis and old ischaemic lesions). Logistic regression models assessed associations between imaging features and death at 7 and 90 days; good recovery (modified Rankin Scale scores 0-2 at 90 days) and sICH. Data are reported with adjusted ORs and 95% CIs.

RESULTS: 2916 patients (67±13 years, National Institutes of Health Stroke Scale 8 (5-14)) were included. Visible ischaemic lesions, severe hypoattenuation, large ischaemic lesion, swelling and hyperattenuated arteries were associated with 7-day death (OR (95% CI): 1.52 (1.06 to 2.18); 1.51 (1.01 to 2.18); 2.67 (1.52 to 4.71); 1.49 (1.03 to 2.14) and 2.17 (1.48 to 3.18)) and inversely with good outcome. Severe atrophy was inversely associated with 7-day death (0.52 (0.29 to 0.96)). Atrophy (1.52 (1.08 to 2.15)) and severe leucoaraiosis (1.74 (1.20 to 2.54)) were associated with 90-day death. Hyperattenuated arteries were associated with sICH (1.71 (1.01 to 2.89)). No imaging features modified the effect of alteplase dose.

CONCLUSIONS: Non-expert-defined brain imaging signs of brain frailty and acute ischaemia contribute to the prognosis of thrombolysis-treated AIS patients for sICH and mortality. However, these imaging features showed no interaction with alteplase dose.

Matched MeSH terms: Tomography, X-Ray Computed

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