MyMedR

Fulltext Fulminant necrotising amoebic colitis: A diagnostic conundrum

Michael A, Jasjit SN, Prabhu R

Med J Malaysia, 2015 Dec;70(6):365-6.

Fulminant necrotising amoebic colitis is a complication of untreated amoebiasis. This is seen in mainly low-income countries. It has a high mortality rate and is difficult to diagnose. We present an extremely rare case of fulminant necrotising amoebic colitis that caused diagnostic confusion in mimicking an acute abdomen, presumably caused by a perforated duodenal ulcer.

Fulltext Anti N-Methyl-D-Aspartate receptor encephalitis: An under-recognised cause of encephalitis

Rajahram GS, Nadarajah R, Lim KS, Menon J

Med J Malaysia, 2015 Dec;70(6):363-4.

PMID: 26988212 MyJurnal

Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is an immune mediated condition with characteristic clinical presentation. We report the first case from Borneo, Sabah and the use of electroconvulsive therapy (ECT) in treating recalcitrant psychiatrist symptoms associated with this condition.

Fulltext Early central nervous system involvement in a young patient with dengue encephalitis

Alice V, Cheong BM

Med J Malaysia, 2016 02;71(1):41-3.

PMID: 27130747

A previously well 13-year-old boy presented with a short history of fever and altered mental status. His mother was admitted for dengue fever and there had been a recent dengue outbreak in their neighbourhood. He was diagnosed with dengue encephalitis as both his dengue non-structural protein 1 (NS-1) antigen and cerebrospinal fluid (CSF) dengue polymerase chain reaction (PCR) were positive. He did not have haemoconcentration, thrombocytopenia or any warning signs associated with severe dengue. He recovered fully with supportive treatment. This case highlights the importance of considering the diagnosis of dengue encephalitis in patients from dengue endemic areas presenting with an acute febrile illness and neurological symptoms.

Uncontrolled hypertension, palpitation and sweating in young female - A rare cause

Sandeep HV, Sarat KS, Ng LT

Med J Malaysia, 2016 02;71(1):39-40.

PMID: 27130746

Extra-adrenal /retroperitoneal paraganglioma is a rare cause of hypertension in young with increased incidence of metastasis as compared to adrenal pheochromocytoma. We present a case of a young female with history of headache, nausea/vomiting, palpitations, uncontrolled hypertension, heat intolerance and diaphoresis. The 24-hour urine catecholamine levels were elevated. Clinical diagnosis of pheochromocytoma was made and further evaluation with Computed Tomography (CT) scan of the adrenals revealed extradrenal para-aortic retroperitoneal mass in keeping with paraganglioma. Gallium-68 DOTATE positron emission tomography-CT scan (PET-CT) confirmed the diagnosis without evidence of metastatic foci.

Polyps! Polyps! And More Polyps! - The First Case of Cronkhite-Canada Syndrome in Malaysia

Abdul Rani R, Hussin FR, Hamzaini AH, Isa MR, Raja Ali RA

Med J Malaysia, 2016 02;71(1):37-8.

PMID: 27130745

Cronkhite-Canada Syndrome (CCS) is a syndrome characterised by a constellation of signs including but not limited to onychodystrophy of the finger and toe nails, skin hyperpigmentation and alopecia. Endoscopic features showed hamartomatous polyps involving all segments of the gastrointestinal tract with the characteristic exception of being oesophageal sparring. These polyps show confirmation by the presence of eosinophils and mast cells at the lamina propria upon histological studies.

A case report of pyloric intussusception secondary to helicobacter pylori hyperplastic polyps

Wan Najmi WD, Noorfizura A, Wan Anna MA

Med J Malaysia, 2016 02;71(1):35-6.

PMID: 27130744

We report a middle age man who presented with intermittent vomiting and loss of weight. Oesophagogastroduodenoscopy showed numerous antral hyperplastic polyps with inaccessible duodenum. Contrast enhanced computed topography demonstrated a classical target sign of intussusception. This finding was later confirmed at laparotomy. This rare presentation and management strategy is discussed.

Fulltext Arterial stiffness during acute and recovery phases of children with rheumatic fever

Ibrahim NN, Jaafar H, Rasool AH, Wong AR

Med J Malaysia, 2016 02;71(1):23-5.

PMID: 27130739

Acute rheumatic fever (ARF) is associated with systemic inflammation and arterial stiffness during the acute stage. It has not been reported if arterial stiffness remains after recovery. The aim of this study was to determine the arterial stiffness during acute stage and 6 months after recovery from ARF. Arterial stiffness was assessed by carotid femoral pulse wave velocity (PWV) in 23 ARF patients during the acute stage of ARF and 6 months later. Simultaneously, erythrocyte sedimentation rate (ESR) and other anthropometric measurements were taken during both stages. There was a significant reduction in PWV; 6.5 (6.0, 7.45) m/s to 5.9 (5.38, 6.48) m/s, p=0.003 6 months after the acute stage of ARF. Similarly, ESR was also significantly reduced from 92.0 (37.5, 110.50) mm/hr to 7.0 (5.0, 16.0) mm/hr, p=0.001. In conclusion, arterial stiffness improved 6 months after the acute stage with routine aspirin treatment; this correlates well with the reduction in systemic inflammation.

Fulltext Endovascular stent graft repair of aorto-iliac pseudoaneurysms - Hospital Kuala Lumpur experience

Khang NC, Zainal AA

Med J Malaysia, 2016 02;71(1):17-22.

PMID: 27130738

BACKGROUND: This is a single institutional review of aortoiliac pseudoaneurysm of various aetiologies managed with endovascular stent graft repair.

METHODS: From 2009 to 2014, 16 patients had endovascular stent graft inserted for pseudoaneurysm of the thoracic aorta, abdominal aorta and iliac arteries in Hospital Kuala Lumpur. Co-morbidity, causative agents, in-hospital mortality, complications and outcomes were examined.

RESULTS: The average age was 59.1 years (range 36-77). Comorbidities include hypertension, diabetes mellitus, tuberculosis, prior infection and previous open aneurysmal repair. All patients had raised WBC (>10.0x10(9) /L), ESR or Creactive protein on admission while 50% of patients had fever. Blood cultures were positive in 4 patients. All patients were given antibiotics. Only one in-hospital mortality was noted at day-47 post-procedure. Two patients died of aortoenteric fistula at district hospital eight and 16 months later. One patient died of chronic graft infection two years later. One died of unrelated cause. One patient developed type IB endoleak from internal iliac artery two years later and surgical ligation was performed. The average follow up was 15.8 months.

CONCLUSION: Endovascular stent graft repair for pseudoaneurysm is a viable option compared to open surgery. It is less invasive, has lower operative morbidity and fair outcomes. However, some cases may be due to inflammatory aortitis instead of infective pseudoaneurysm, given the frequent culture-negative results. In order to obtain high yield of bacteria culture for infected pseudoaneurysm, open repair with tissue culture is still the main mode of treatment especially for patients with low comorbidity.

Comparison of features and outcomes of perforated peptic ulcer between Malaysians and foreigners

Kugan V, Mahadevan DT, Kandasami P

Med J Malaysia, 2016 02;71(1):12-6.

PMID: 27130737

BACKGROUND: Perforated peptic ulcers (PPU) present as serious surgical emergencies that carry high mortality and morbidity. Foreigners with PPU are also managed in our hospital setting. Their inclusion significantly alters the trend and pattern of PPU seen in Malaysia.

AIM: To compare per-operative and post-operative features and outcomes of perforated peptic ulcers between Malaysians and foreigners.

MATERIAL AND METHODS: This was an analytical crosssectional study. All patients who underwent repair of perforated peptic ulcer disease during a 6-year period were included. 50 consecutive patients' records with perforated peptic ulcer were analysed. Data were collected from operation theatre database and hospital medical records. Chi square and t test were performed using SPSS statistical software.

RESULTS: Total of 50 patients, of which 30 were Malaysians and 20 were foreigners. The mean age of Malaysian patients was 58.3 ± 15.2 years whereas the mean age for foreign patients was 30.3 ± 6.7 years, with foreign patients being significantly younger than local patients. Foreigners had significantly smaller ulcers with only 5% of them having ulcers more than 1cm while 36.7% of Malaysian patients had ulcers more than 1cm. Post-operative complications are significantly higher in Malaysian patients (p<0.05) with 40% of Malaysian patients and 10% of foreign patients developing post-operative complications.

CONCLUSION: Foreign patients are younger with significantly smaller perforated ulcers and better post-operative outcomes.

Fulltext Stress perceived by houseman in a hospital in northern Malaysia

Gopalakrishnan V, Umabalan T, Affan M, Zamri AA, Kamal A, Sandheep S

Med J Malaysia, 2016 02;71(1):8-11.

PMID: 27130736

INTRODUCTION: Being a houseman in Malaysian hospitals can be very stressful. Stress can affect decision making to a great extent while addressing the needs of the patient in an emergency setting. This necessitated a study to find out the main sources of stress among housemen.
METHODS: This was a cross-sectional descriptive study carried out among 55 housemen using a questionnaire on sources of stress. The data was analysed using SPSS version 17.
RESULTS: A total of 16 factors leading to stress were studied among the housemen. Poor work and social life balance, annoying non-clinical personnel and medico-legal threats were among the top causes of stress.
CONCLUSION: The factors leading to stress among housemen should be considered for effective working of the hospital and improving the workplace atmosphere for the housemen.

The sensitivity, specificity and predictive values of post mortem computed tomography in detecting liver and splenic injury due to road traffic accident

Norzailin AB, Noor Azman S, Mohd Helmee MN, Khairul Anuar Z

Med J Malaysia, 2016 02;71(1):1-7.

PMID: 27130735

OBJECTIVE: The purpose of the study was to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of post mortem computed tomography (PMCT) in detecting liver and splenic injuries due to road traffic accidents.

MATERIAL & METHOD: 61 road traffic accidental death cases underwent both PMCT and conventional autopsy. The imaging findings were compared to the conventional autopsy findings.

RESULT: The sensitivity, specificity, PPV and NPV for liver injuries in PMCT was 71%, 82%, 68% and 85% while that of splenic injuries was 73%, 80%, 55% and 90% respectively. The accuracy of PMCT scan was 79% for both liver and splenic injuries. There is strong association between lower left ribs fracture and splenic injury (p=0.005) and significant association between positive liver and splenic PMCT finding and intraabdominal fatal injury (p=0.037).

CONCLUSION: In conclusion PMCT has high specificity and NPV for liver and splenic injuries; however the sensitivity and PPV are low. The overall accuracy is not high enough to enable PMCT to be used as a replacement for conventional autopsy; however it is a useful complementary examination and has potential to be used as decision making tool for selective internal autopsy.

Mediastinal mature teratoma in a child- A case report

Liew WX, Lam HY, Narasimman S, Navarasi S, Mohd Hamzah K

Med J Malaysia, 2016 02;71(1):32-4.

PMID: 27130743

Mediastinal teratoma is an infrequent germ cell tumour and comprises of 1 to 5% of all mediastinal tumours. We report a case of mediastinal mature teratoma in a 12 year old boy who presented to us with persistent non-productive cough, fever and dyspnoea for the past 7 months. Computed tomographic scan of thorax revealed a large anterior mediastinal mass measuring 11.2x9.9x14cm with calcification within. He subsequently underwent a median sternotomy with left subcostal extension (L-incision) and excision of tumour. Histopathology of the tumour revealed a mature cystic teratoma. We would like to report a case of successful surgical management of a large mediastinal mature teratoma in a child.

An unusual cause of chest pain in army trainee - spontaneous pneumomediastinum

Lee SS

Med J Malaysia, 2016 02;71(1):30-1.

PMID: 27130742

This is a case report of spontaneous pneumomediastinum that occurred in a 19-year-old army trainee during his 2.4km run. Spontaneous pneumomediastinum is a rare disorder. It is usually precipitated by activities related to Valsalva manoeuvres such as strenuous physical activities, retching and vomiting. Treatment is expectant and the disorder usually resolves spontaneously within a few days. However, one must be aware of the disorder so that additional advice such as avoiding activities that involve Valsalva manoeuvres can be given.

A four-point clinical criteria distinguishes immune thrombocytopenia from acute lymphoblastic leukaemia

Lum SH, How SJ, Ariffin H, Krishnan S

Med J Malaysia, 2016 02;71(1):28-9.

PMID: 27130741

Immune thrombocytopenia is the most common diagnosis of isolated thrombocytopenia. The dilemma encountered by paediatricians is missing diagnosis of acute leukaemia in children with isolated thrombocytopenia. We demonstrated childhood ITP could be diagnosed using a four point clinical criteria without missing a diagnosis of acute leukaemia. Hence, bone marrow examination is not necessary in children with typical features compatible with ITP prior to steroid therapy. This can encourage paediatricians to choose steroid therapy, which is cheaper and non-blood product, as first line platelet elevating therapy in children with significant haemorrhage.

Breaking Bad News: An essential skill for doctors

Abdul Hafidz MI, Zainudin LD

Med J Malaysia, 2016 02;71(1):26-7.

PMID: 27130740

Breaking bad news is a process of delivering news, which may negatively affect a patient's view of the future, however is an essential skill for doctors. There are a multitude of benefits if doctors can execute this task well, and will improve the disease journey for the patient. There are several published models including the SPIKES and ABCDE models to help guide the doctor to break bad news effectively. This important skill can be taught through various methods but the most effective may be actually observing a session by senior clinicians.

Fulltext A case of chronic myeloid leukaemia in blast transformation with leukemic ascites

Mohd Ridzuan MS, Yap E, Wan Fariza WJ, Fadilah SA, Salwati S

Med J Malaysia, 2016 04;71(2):85-7.

PMID: 27326952 MyJurnal

Chronic Myeloid Leukaemia (CML) is a disease characterised by a distinctive marker that is the Philadelphia Chromosome and an ability to transform into blast phase, which confers a poor prognosis. The median survival was reported to be between three to six months in correlation to blast phase. Extramedullary involvement with CML to sites such as pleural, meningeal and bones have been reported. We report a case of 41-year-old man who was diagnosed with CML in blast phase and presented with ascites. Ultrasound of abdomen showed coarse echotexture of liver suggestive leukaemic infiltration to the liver. The liver profile was severely deranged and associated with coagulopathy. Flow cytometry analysis of the peritoneal fluid revealed presence of myeloblasts consistent with CML in blast crisis with leukaemic ascites. Bone marrow biopsy also confirmed disease transformation. He received standard induction chemotherapy for acute myeloid leukaemia with dose modifications based on liver enzymes performance. Our case highlights an unusual presentation of CML in blast crisis with leukaemic ascites and the challenges in managing cytotoxic treatments due to the liver infiltration.

Fulltext Appendicular mass complicating acute appendicitis in a patient with dengue fever

Low YN, Cheong BM

Med J Malaysia, 2016 04;71(2):83-4.

PMID: 27326951 MyJurnal

Abdominal pain with dengue fever can be a diagnostic challenge. Typically, pain is localised to the epigastric region or associated with hepatomegaly. Patients can also present with acute abdomen. We report a case of a girl with dengue fever and right iliac fossa pain. The diagnosis of acute appendicitis was made only after four days of admission. An appendicular mass and a perforated appendix was noted during appendectomy. The patient recovered subsequently. Features suggestive of acute appendicitis are persistent right iliac fossa pain, localised peritonism, persistent fever and leucocytosis. Repeated clinical assessment is important to avoid missing a concurrent diagnosis like acute appendicitis.

Fulltext Case report: Leiomyoma of the anterior abdominal wall

Ernest Ong CW, Siow SL

Med J Malaysia, 2016 04;71(2):81-2.

PMID: 27326950 MyJurnal

Leiomyomas are benign soft tissue swellings of smooth muscle origin, most commonly found in the uterus. Extra uterine leiomyomas presenting as an abdominal mass is often a diagnostic challenge as such occurrence is rare. We present a rare case of primary abdominal wall leiomyoma, and highlight the importance of laparoscopic approach in the diagnosis and treatment of such tumour.

Fulltext Dialysis disequilibrium syndrome: A preventable fatal acute complication

Mah DY, Yia HJ, Cheong WS

Med J Malaysia, 2016 04;71(2):91-2.

PMID: 27326954 MyJurnal

Dialysis disequilibrium syndrome (DDS) is a neurological disorder with varying severity that is postulated to be associated with cerebral oedema. We described a case of DDS resulting in irreversible brain injury and death following acute haemodialysis. A 13-year-old male with no past medical history and weighing 30kg, presented to hospital with severe urosepsis complicated by acute kidney injury (Creatinine 1422mmol/L; Urea 74.2mmol/L, Potassium 6.3mmol/L, Sodium 137mmol/L) and severe metabolic acidosis (pH 6.99, HC03 1.7mmol/L). Chest radiograph was normal. Elective intubation was done for respiratory distress. Acute haemodialysis performed due to refractory metabolic acidosis. Following haemodialysis, he became hypotensive which required inotropes. His Riker's score was low with absence of brainstem reflexes after withholding sedation. CT Brain showed generalised cerebral oedema consistent with global hypoxic changes involving the brainstem. The symptoms of DDS are caused by water movement into the brain causing cerebral oedema. Two theories have been proposed: reverse osmotic shift induced by urea removal and a fall in cerebral intracellular pH. Prevention is the key to the management of DDS. It is important to identify high risk patients and haemodialysis with reduced dialysis efficacy and gradual urea reduction is recommended. Patients who are vulnerable to DDS should be monitored closely. Low efficiency haemodialysis is recommended. Acute peritoneal dialysis might be an alternative option, but further studies are needed.

Fulltext Enteropathy-associated T-cell lymphoma: An extremely rare cause of chronic diarrhoea

Liong CC, Ravindran S, Gnana Kumar G, Chin EF, Koh PS, Chan WK

Med J Malaysia, 2016 04;71(2):88-90.

PMID: 27326953 MyJurnal

Chronic diarrhoea in tropical countries may be due to a myriad of causes from infective to non-infective. This case report illustrates the challenges faced in the investigation of a middle-age Chinese gentleman who presented with chronic diarrhoea and weight loss. The diagnosis of type II enteropathy-associated T-cell lymphoma (EATL) was finally made. The diagnosis of EATL was least suspected as the condition is almost unheard of in this part of the world. The epidemiology, presentation, diagnosis, management and prognosis of this rare condition are discussed.

Displaying publications 1721 - 1740 of 5664 in total