Pneumomediastinum and pneumopericardium following blunt chest trauma are rare. Diagnosis is by chest radiograph and CT Scan. They have to be identified and treated accordingly. Usually, pneumomediastinum and pneumopericardium are self-limiting requiring no specific therapy. However, vigilance and a continuous monitoring of the vital signs are necessary.
Silent sinus syndrome is a rare clinical condition in which patients present with spontaneous enophthalmos and hypoglobus secondary to collapse of orbital floor due to chronic subclinical maxillary sinusitis. It is postulated that obstruction of the osteomeatal complex lead to negative antrum pressure which causes the maxillary sinus atelectasis.
This is a case report of an environmental accident due to lightning where one school boy sustained current, blast, and flame effects of it. A bolt of lightning directly struck the pole of a football ground and the scatter struck the child. In addition to burn injuries, he showed an exit wound of lightning in left foot. The exit wound of lightning current is a very rare finding. The body of victim had flame and heat effect of atmospheric electricity on head and neck, face, and trunk. In this incidence of lightning other team mates of the victim were safe. The patient survived the attack.
Death by hanging is believed to be a painless method of committing suicide. In most cases the noose has a knot and on this basis only it can be labeled as atypical or typical hanging. A 35 year Chinese man committed suicide by hanging with a ligature material made of electric wire where there was no knot present on the noose.
A descriptive prospective study of 16 children with injuries inflicted by bicycle spokes and chain was undertaken to identify the demographic profiles of such injuries. Aspects of preventive measures are proposed.
Adult intussusception is a rare entity that may present in the acute and subacute setting principally related to the degree of bowel obstruction. Preoperative diagnosis of this condition may be difficult. The intussusception is usually due to a definable intraluminal lesion, most probably neoplasia, unlike intussusception in children. We present the cases of two adult male patients with intussusception. The first presented with acute small-bowel obstruction secondary to a retrograde ileojejunal intussusception with a pseudopolyp as the lead point. This was possibly due to a retrograde ball-valve effect. The intussuscepting segment was resected. The second patient presented with unexplained chronic diarrhoea and an intussusception occurring within the caecum, as demonstrated at colonoscopy, with a terminal ileal pedunculated fibroid polyp as the lead point. A limited right hemicolectomy was performed. Both patients recovered uneventfully and have remained well. A brief literature review of adult intussusception complements the case reports, with an emphasis on the pathogenesis of inflammatory polyps and recommended surgical management.
A 62-year-old man presented with a 3-month history of chronic non-productive cough and unexplained fever. Further questioning revealed that he had headaches and myalgia. Bilateral thickened temporal arteries were noted on physical examination. The erythrocyte sedimentation rate was 96 mm in 1 h. A biopsy specimen of the left temporal artery showed inflammatory changes consistent with the diagnosis of giant cell arteritis. Commencement of prednisolone resulted in rapid and dramatic resolution of his symptoms. Physicians should be aware of respiratory symptoms in patients with giant cell arteritis in order to avoid delay in diagnosis and therapy of this condition.
A 45 years old Chinese housewife presented with menorrhagia and dysmenorrhoea due to adenomyosis failed to respond to various medical treatments. She was treated with balloon thermoablation. The total menstrual blood loss (MBL) decreased from 96.94 ml before to 37.57 ml, six months after thermoablation. The pictorial blood loss chart (PBLC) showed similar decrease in blood loss. Dysmenorrhoea was also cured. At three year follow up, there was no recurrence. This is the first report which shows thermoablation decreases MBL objectively and can be tried to treat adenomyosis.
The formation of Kenyir Lake as part of a hydroelectric project in the 1980s caused much forest area to be submerged. From 1991, underwater divers were employed to log these sunken trees at depths of up to 100 meters. At least 6 mishaps involving underwater logging personnel were recorded from March 1994 to August 1996. We retrospectively reviewed 5 cases who were managed in Hospital Kuala Terengganu. The patients presented with marked cardiorespiratory and neurological disturbances. One diver died in the Hospital while another died at the recompression chamber. Three divers were treated with recompression and improved. Average delay before the start of recompression was 14 hours. Underwater logging has definite dangers and steps must be taken to ensure that both the divers and the equipment are appropriate for the task. Availability of a nearby recompression facility would greatly enhance the management of diving accidents, not only for commercial divers but also for recreational divers who frequent the islands nearby.
A 17 year old Malay student who is a known case of synovial sarcoma of left elbow (treated with an above elbow amputation) presented with duodenal obstruction. We report an unusual case of gastrointestinal tract metastases from synovial sarcoma. To our knowledge, there is no previous such report in the literature. The computed tomography (CT) and magnetic resonance imaging (MRI) features are described.
Most patients presenting with acute right sided peritonitic pain are diagnosed and managed as acute appendicitis. In a series of 336 patients, eight were found to have caecal diverticulitis. The occurrence of such diverticula appears to be more frequent in Asian populations. The diagnosis can be established at operation on the basis of surgical findings. The aim of this retrospective review is to discuss the management of such patients when acute diverticulitis is found at the time of appendicectomy. It is advocated that management be conservative where possible, with appendicectomy and antibiotics. Where the possibility of a carcinoma remains, investigation after surgery by colonoscopy may be undertaken.
From 10th September 1998 till 5th June 1999, the Paediatric and Cardiothoracic Surgery Units of Sultanah Aminah Hospital Johor Bahru managed three children with lung collapse secondary to pneumonia. The dominant initial clinical presentation in all three cases was acute abdominal pain. Basal pneumonia was diagnosed in two cases post-operatively after surgical contributory causes were excluded intra-operatively. Thoracotomy, evacuation of infected debris and decortication of the collapsed lung was done in all three cases. In children presenting with acute abdominal pain, basal pneumonia should be considered as a possible contributory cause.
Pregnancy following idiopathic aplastic anaemia is rare and is difficult to manage because of life-threatening episodes of bleeding and infections. Only a handful of cases has been reported in the literature. The pregnancies were unsuccessful in the majority. The present report describes a patient with moderately severe idiopathic aplastic anaemia who was managed with intensive haematological support leading to delivery of a healthy infant by caesarean section. Despite platelet transfusion refractoriness as a result of transfusions prior to pregnancy, adequate platelet transfusions prevented excessive bleeding. The literature is reviewed and management with platelet transfusions is discussed.
The aim of this study was to examine the relationship between the level of stress experienced by rescue workers after the collapse of a 13 story condominium in Kuala Lumpur, and other probable risk factors. Within a month of the incident, 123 firefighters filled up the Impact of Life Event score (Horowitz) and the General Health Questionnaire (GHQ). The results indicated that 7 (6%) firemen could be classified as possible 'cases' on the GHQ, and significantly 5 from this group also scored highly on the impact of events score. No other risk factors were identified in the firemen. On conclusion, the GHQ can be used to screen those with high impact scores to pick up possible cases early enough, so that intervention can be successful.
We report a case of left pulmonary artery sling in a child who also had duodenal atresia. He was admitted for respiratory failure requiring prolonged respiratory support due to a bronchiolitis-like illness at two months of age. Diagnostic procedures confirmed the presence of left pulmonary artery sling. He had a corrective procedure which relieved the compression. However postoperatively he had intermittent episodes of severe bronchospasm in addition to a persistent airway obstruction. Finally one such episode of severe bronchospasm did not respond to medical and resuscitative therapy and the baby succumbed. To our knowledge no case of left pulmonary artery sling has been described previously in a Malaysian child. This case also highlights the postoperative airway problems that may be encountered.
A young patient presenting with splenomegaly and hypersplenism was inadvertently found to have selective IgA deficiency. There were no symptoms of immunodeficiency and the patient responded well to splenectomy, with return of blood counts to normal without adverse effects. No other cause for the hypersplenism was found. We postulate selective IgA deficiency as a cause of splenomegaly and hypersplenism.