MyMedR

Fulltext Migrating foreign body--an unusual presentation

Krishnan G

Med J Malaysia, 1994 Jun;49(2):169-71.

A case report of an ingested fish bone migrating to the subcutaneous tissue in the neck is presented. During its course of migration there was no significant morbidity. The usual management is to locate the foreign body and remove it. A review of the literature indicates that this is evidently a rare case.

Fulltext Comparative study of plain-film radiographs of maxillary sinuses between radiologists and clinicians

Krishnan G

Med J Malaysia, 1992 Sep;47(3):190-3.

PMID: 1491644

Maxillary sinuses plain film radiographs of 59 patients were reviewed and reported by both clinicians or Radiologists at the University Hospital, Kuala Lumpur. There was agreement in 52 reports of the plain film radiographs however there was partial differences in about seven cases. This gave an impression that the ENT specialist and the Radiologist were both capable of reporting plain film radiographs of maxillary sinuses, even though the radiologist has no opportunity of doing detail clinical examination of the patient.

Fulltext A review of the management of 107 dizzy patients at the university hospital

Krishnan G

Med J Malaysia, 1994 Mar;49(1):44-8.

PMID: 8057990

The common investigations done were pure tone audiometry, electronystagmography, X-ray of the internal auditory meatus, CT-scan of the internal auditory meatus and X-ray of the cervical spine. After the examinations and investigations only 52 patients out of the 107 could be given any diagnosis. The most common diagnosis for the vertigo was Meniere's disease.

Frontoethmoid mucocele: one-year follow-up after endoscopic frontoethmoidectomy

Krishnan G, Kumar G

J Otolaryngol, 1996 Feb;25(1):37-40.

PMID: 8816108

Endoscopic sinus surgery for frontal sinus mucocele is gaining popularity. A case study, and the CT scan of a large frontal mucocele with 1-year follow up is presented showing the lining of the sinus cavity well healed and the frontal sinus ostium as patent. Endoscopic sinus surgery, therefore, is a potentially useful method for treating large frontal mucoceles.

Fulltext Endonasal endoscopic dacryocystorhinostomy

Krishnan G, Prepageran N, Muthu K

Med J Malaysia, 2002 Dec;57(4):404-7.

PMID: 12733164

A review of endoscopic dacryocystorhinostomy (EDCR) performed in University Hospital from 1998 till early 2001 were carried out. They were reviewed for indication, functional results, complications and other associated factors. Eleven patients (6 female and 5 male) were reviewed. All had unilateral nasolacrimal duct (NLD) obstruction (6 right, 5 left). Their ages range from 6 to 73 years. All 11 had persistent epiphora while 4 had concurrent recurrent dacryocystitis with purulent discharge. Two patients had history of lacrimal sac abscess that needed drainage. Ten patients had the procedure performed successfully. Functional results were excellent in 8 patients (80%) while two patients still had occasional epiphora although markedly reduced. Complications include synachae (1 patient), premature dislodgement of Jones tube (1 patient) and impacted tube in a child. Our experience with EDCR concludes it to be an easy, efficient treatment for nasolacrimal duct obstruction with minimal complications.

Fulltext Nasal scarring by joss stick burns

Krishnan G, Khanijow VJ

Med J Malaysia, 1994 Mar;49(1):90-2.

PMID: 8057998

Vasomotor rhinitis is a common condition in Malaysia. Patients' dissatisfaction with medical treatment of this recurring condition leads them to seek other forms of traditional cures. This paper highlights the complications in such patients who seek traditional cures for their chronic condition.

Fulltext Endoscopic coagulation of sphenopalatine artery for posterior epistaxis

Prepageran N, Krishnan G

Singapore Med J, 2003 Mar;44(3):123-5.

PMID: 12953724

To present our experience of endoscopic electrocoagulation of sphenopalatine artery for persistent posterior epistaxis despite conservative measures.

Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses: a rare case

Tang IP, Singh S, Krishnan G, Looi LM

J Laryngol Otol, 2012 Dec;126(12):1284-6.

PMID: 23084156 DOI: 10.1017/S0022215112002435

We report a rare case of small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses with intracranial extension, and discuss the management of this rare tumour.

Ocular presentation of sphenoid mucocele

Prepageran N, Subramaniam KN, Krishnan GG, Raman R

Orbit, 2004 Mar;23(1):45-7.

PMID: 15513020

A sphenoid mucocele often presents late due to its deep-seated anatomical site. It has a varied presentation, due to its close relationship to the cavernous sinus and the base of the skull. It can present initially to the ophthalmologist with ocular complaints. In the present paper, the authors present two cases of sphenoid mucocele, one with an isolated third and one with an isolated sixth cranial nerve palsy.

Fulltext Juvenile nasopharyngeal angiofibroma in a tertiary centre: ten-year experience

Tang IP, Shashinder S, Gopala Krishnan G, Narayanan P

Singapore Med J, 2009 Mar;50(3):261-4.

PMID: 19352568

This is a retrospective study that aimed to examine the outcomes of patients presenting with juvenile nasopharyngeal angiofibroma (JNA) at a tertiary centre in Malaysia.

Migrating foreign body into the common carotid artery and internal jugular vein--a rare case

Tang IP, Singh S, Shoba N, Rahmat O, Shivalingam S, Gopala KG, et al.

Auris Nasus Larynx, 2009 Jun;36(3):380-2.

PMID: 19019597 DOI: 10.1016/j.anl.2008.08.003

Ingested foreign bodies are a fairly common otorhinolaryngological emergencies encountered in Malaysia. The vast majority of these foreign bodies are fish bones which most commonly are impacted at the level of the cricopharynx. Rarely, however, a foreign body may migrate extraluminally and may even extrude subcutaneously. We report a rare occurrence where a fish bone not only migrated extraluminally, it was found to have migrated into the common carotid artery and the internal jugular vein and required surgical removal.

Biophotonic effect of diode laser irradiance on tensile strength of diabetic rats

Lau PS, Bidin N, Krishnan G, Nassir Z, Bahktiar H

J Cosmet Laser Ther, 2015 Apr;17(2):86-9.

PMID: 25260140 DOI: 10.3109/14764172.2014.968587

Low-energy laser irradiance at certain wavelengths is able to stimulate the tissue bio-reaction and enhance the healing process. Collagen deposition is one of the important aspects in healing process because it can increase the strength of the skin. This study was designed to examine the biophotonic effect of irradiance on collagen production of diabetic wound in rat model. The tensile strength of skin was employed as a parameter to describe the wound. Diabetic rat models were induced by streptozotocin via intravenous injection. Skin-breaking strength was measured using an Instron tensile test machine. The experimental animals were treated with 808-nm diode laser at two different powers-0.1 and 0.5 W/cm(2)-and 30, 60, and 120 s for each session. The tensile strength was optimized after treated with high-power diode laser. The photostimulation effect was revealed by accelerated healing process and enhanced tensile strength of wound. Laser photostimulation on tensile strength in diabetic wound suggests that such therapy facilitates collagen production in diabetic wound healing.

Recombinant production of Epstein-Barr virus BZLF1 trans-activator and characterization of its DNA-binding specificity

Lim CS, Goh SL, Krishnan G, Ng CC

Protein Expr. Purif., 2014 Mar;95:8-12.

PMID: 24291446 DOI: 10.1016/j.pep.2013.11.007

This paper describes the recombinant production of a biologically active Epstein-Barr virus BZLF1 trans-activator, i.e., Z-encoded broadly reactive activator (ZEBRA), that recognized specific DNA motifs. We used auto-induction for histidine-tagged BZLF1 expression in Escherichia coli and immobilized cobalt affinity membrane chromatography for protein purification under native conditions. We obtained the purified BZLF1 at a yield of 5.4mg per gram of wet weight cells at 75% purity, in which 27% of the recombinant BZLF1 remained biologically active. The recombinant BZLF1 bound to oligonucleotides containing ZEBRA response elements, either AP-1 or ZIIIB, but not a ZIIIB mutant. The recombinant BZLF1 showed a specific DNA-binding activity which could be useful for functional studies.

Silent sinus syndrome due to a maxillary mucocele

Tan TY, Shashinder S, Subrayan V, Krishnan G

Auris Nasus Larynx, 2008 Jun;35(2):285-7.

PMID: 18024042

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.

Papillary cystic type of acinic cell carcinoma of parotid: fine needle aspiration cytological features of a high grade variant with oncocytic metaplasia

Jayaram G, Othman MA, Kumar M, Krishnan G

Malays J Pathol, 2002 Dec;24(2):107-12.

PMID: 12887170

A 60-year-old female developed a right parotid swelling six months after surgery for intra-oral squamous cell carcinoma. Fine needle aspiration (FNA) cytological smears showed dissociated large and small pleomorphic tumour cells with abundant mitoses and oncocytic features. A cytological diagnosis of parotid acinic cell carcinoma (ACC) was made. Histological study of the subtotal parotidectomy specimen showed a papillary cystic variety of acinic cell carcinoma (ACC-PCV). FNA cytological features in this case of ACC-PCV differs from the two previously reported cases in that it showed prominent oncocytic and high grade features and absence of papillary pattern in the cytological smears. ACC-PCV is an uncommon tumour and knowledge of its varied FNA cytological features is important for the diagnosis of this neoplasm.

Nasopharyngeal carcinoma and nasal allergy: any correlation?

Prepageran N, Lingham OR, Krishnan G, Jalaludin MA, Raman R

Ear Nose Throat J, 2003 Jun;82(6):438-40.

PMID: 12861869

Although it has been observed that nasal allergy is rarely seen in patients who have nasopharyngeal carcinoma, to our knowledge, no actual study of such a lack of association has been previously reported. To fill this void, we conducted a pilot study to investigate any such inverse relationship. We conducted skin-prick allergen tests on 22 patients with newly diagnosed but not-yet-treated nasopharyngeal carcinoma. Combining these test results with findings on the history and clinical examination, we concluded that only one of the 22 cancer patients (4.5%) had allergic rhinitis. Our study also confirmed the validity of using findings on the history, clinical examination, and skin-prick testing as a reliable means of diagnosing allergic rhinitis.

Synthesis of Au-Ag Alloy Nanoparticles in Deionized Water by Pulsed Laser Ablation Technique

Norsyuhada W, Shukri WM, Bidin N, Islam S, Krishnan G

J Nanosci Nanotechnol, 2018 Jul 01;18(7):4841-4851.

PMID: 29442664 DOI: 10.1166/jnn.2018.15358

Au-Ag alloy nanoparticles are physically synthesized using rapid, simple and efficient Q-switched Nd:YAG pulsed laser ablation in liquid technique (PLAL). Au and Ag colloidal solutions are separately prepared by 1064 nm laser ablation of metallic target (gold and silver) which is immersed in deionized water. Au-Ag alloy nanoparticles are prepared by irradiating the mixture of Au and Ag colloidal solutions with 532 nm of second harmonic wavelength of Nd:YAG laser at three different ratio, 3:1, 1:1 and 1:3 within different exposure times. The three of plasmon absorption bands of Au-Ag nanoparticles are shifted linearly to the lower wavelength [499.67 nm (3:1), 481.25 nm (1:1), 467.91 nm (1:3)], as compared to plasmon absorption spectra of pure Au (520 nm) and Ag (400 nm). Moreover, the change in colors are also observed from red (Au) and yellow (Ag) to orange, brown and green color due to the Au-Ag alloy formations, respectively. Transmission electron microscopy shows the Ag shell around the inner core of Au spherical metal with broad size distribution due to the three different volume ratio, respectively (1.7 nm, 0.7 nm, 1.4 nm). Energy-dispersive X-ray spectroscopy analysis confirms the presence of Au and Ag elements in Au-Ag alloy nanoparticles without any contaminations. Attenuated total reflectance fourier transform infrared spectroscopy analysis also confirms the homogenous Au-Ag alloys chemical bonding.

On optimizing the blocking step of indirect enzyme-linked immunosorbent assay for Epstein-Barr virus serology

Lim CS, Krishnan G, Sam CK, Ng CC

Clin Chim Acta, 2013 Jan 16;415:158-61.

PMID: 23043757 DOI: 10.1016/j.cca.2012.08.031

Because blocking agent occupies most binding surface of a solid phase, its ability to prevent nonspecific binding determines the signal-to-noise ratio (SNR) and reliability of an enzyme-linked immunosorbent assay (ELISA).

Fulltext Primary pituitary tuberculoma with a pituitary apoplexy-like presentation

Krishnan G, Mohd Makhatar NH, Ching TH, Khoo S

Endocrinol Diabetes Metab Case Rep, 2024 Jan 01;2024(1).

PMID: 38290212 DOI: 10.1530/EDM-23-0092

SUMMARY: Pituitary tuberculoma is extremely rare and may pose as a diagnostic challenge especially when encountered as an isolated lesion without other systemic manifestation of tuberculosis. A 21-year-old female was admitted for diabetic ketoacidosis. On the third day of admission following the resolution of diabetic ketoacidosis she developed a sudden onset of headache and blurring of vision suggestive of pituitary apoplexy. An urgent MRI brain revealed a large sellar mass with erosion into the sphenoid sinus and intracranial vasculitis. Transphenoidal surgery was done for tumour debulking which allowed histopathological examination of the sellar mass. Immunohistochemical examination of the sellar mass was positive for Gene Xpert MTB/Rif suggesting a tuberculoma. Anti-tuberculous therapy was commenced with full recovery of pituitary hormonal profile seen 7 months post-treatment. In regions with a high incidence of tuberculosis, a tuberculoma should be a considered in a diagnostic evaluation of a sellar lesion.

LEARNING POINTS: In an endemic area of tuberculosis, tuberculoma should be considered as a differential diagnosis when evaluating sellar lesions. Pituitary tuberculoma can present with pituitary apoplexy-like symptoms. Prompt diagnosis and treatment may lead to recovery of pituitary function.

Fulltext Nasopharyngeal Carcinoma Database

Pua KC, Khoo AS, Yap YY, Subramaniam SK, Ong CA, Gopala Krishnan G, et al.

Med J Malaysia, 2008 Sep;63 Suppl C:59-62.

PMID: 19230249

Nasopharyngeal carcinoma (NPC) is a cancer which is common in Asia. We report the establishment and early results of a multi-institutional prospective study of nasopharyngeal carcinoma, which seeks to systematically collect data as well as blood and tumour tissue samples from patients diagnosed with nasopharyngeal cancer at six centres in Malaysia. A total of 484 confirmed NPC cases were reported from the six participating centres between 1st July 2007 and 29th February 2008. Of these, 225 were newly diagnosed cases, 53 were recurrent cases and 206 were in remission at the time of reporting. Amongst the newly diagnosed cases, the most common presenting symptom was the presence of neck lumps (42%). Ophthalmo-neurologic symptoms were the presenting symptoms of 11% of the new cases. The majority of cases (75%) presented at stage III/IV.

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