MyMedR

Fulltext Malignant melanoma of the foot in patients with diabetes mellitus--a trap for the unwary

Hussin P, Loke SC, Noor FM, Mawardi M, Singh VA

Med J Malaysia, 2012 Aug;67(4):422-3.

Melanomas on the foot are difficult to differentiate from diabetic foot ulcers (DFU). In particular, acral lentiginous and amelanotic melanomas have a high chance of being misdiagnosed. We present two patients with diabetes mellitus and malignant melanomas of the foot initially diagnosed as DFU. Both cases were treated with wide excision amputation and local dissection, without adjuvant chemotherapy or radiotherapy. Both patients remain disease-free up to the last follow-up visit. It is important to maintain a high index of suspicion and a skin biopsy should be done in any DFU with atypical features.

Matched MeSH terms: Diagnosis, Differential; Foot Diseases/diagnosis*; Melanoma/diagnosis*; Skin Neoplasms/diagnosis*; Diabetic Foot/diagnosis*

Fulltext Cardiac imaging in valvular heart disease

Choo WS, Steeds RP

Br J Radiol, 2011 Dec;84 Spec No 3:S245-57.

PMID: 22723532 DOI: 10.1259/bjr/54030257

The aim of this article is to provide a perspective on the relative importance and contribution of different imaging modalities in patients with valvular heart disease. Valvular heart disease is increasing in prevalence across Europe, at a time when the clinical ability of physicians to diagnose and assess severity is declining. Increasing reliance is placed on echocardiography, which is the mainstay of cardiac imaging in valvular heart disease. This article outlines the techniques used in this context and their limitations, identifying areas in which dynamic imaging with cardiovascular magnetic resonance and multislice CT are expanding.

Matched MeSH terms: Aortic Valve Insufficiency/diagnosis; Aortic Valve Stenosis/diagnosis; Heart Valve Diseases/diagnosis*; Mitral Valve Insufficiency/diagnosis; Mitral Valve Stenosis/diagnosis

Recurrence of multiple myeloma with soft tissue plasmacytoma presenting as unilateral proptosis

Pan SW, Wan Hitam WH, Mohd Noor RA, Bhavaraju VM

Orbit, 2011 Mar;30(2):105-7.

PMID: 21322793 DOI: 10.3109/01676830.2010.546553

To describe a rare case of soft tissue plasmacytoma of the orbit presenting with proptosis.

Matched MeSH terms: Exophthalmos/diagnosis*; Multiple Myeloma/diagnosis*; Orbital Neoplasms/diagnosis*; Plasmacytoma/diagnosis*; Soft Tissue Neoplasms/diagnosis*

Fulltext Spontaneous bladder perforation: a rare complication of tuberculosis

Kong CH, Ali SA, Singam P, Hong GE, Cheok LB, Zainuddin ZM

Int J Infect Dis, 2010 Sep;14 Suppl 3:e250-2.

PMID: 20117032 DOI: 10.1016/j.ijid.2009.10.006

Spontaneous bladder perforation secondary to tuberculosis (TB) is very rare. Only three cases have been reported so far in the literature. Due to its rarity, the diagnosis of spontaneous bladder perforation is often missed. Confirmation of TB via culture takes a long time and starting empirical treatment for TB is necessary. We relate our experience with a young woman who presented with clinical features of a perforated appendix and was only diagnosed with bladder perforation during laparotomy. She also had distal right ureteral stricture and left infundibular stenosis. The provisional diagnosis of TB was attained via typical histopathological features and a positive Mantoux test. She was started empirically on anti-TB treatment and recovered without any complications. Urine culture after 6 weeks confirmed the diagnosis of TB.

Matched MeSH terms: Appendicitis/diagnosis; Urinary Bladder Diseases/diagnosis; Diagnosis, Differential; Rupture, Spontaneous/diagnosis; Tuberculosis, Urogenital/diagnosis

Cholesterol atheroembolism of the colon can mimic the endoscopic features of pseudomembranous colitis

Lim GH, Roslani AC, Pang B, Bih-Shiou CT

Surg Laparosc Endosc Percutan Tech, 2008 Dec;18(6):616-8.

PMID: 19098673 DOI: 10.1097/SLE.0b013e318180c956

The endoscopic features of cholesterol atheroembolism affecting the colon have not been extensively described in the literature, owing to the rarity of this entity. We report a middle-aged man who presented with hematochezia after recent coronary artery bypass graft surgery. Colonoscopy revealed ulcerative skip lesions with overlying slough resembling pseudomembranes distal to the transverse colon, inconsistent with the initial clinical impression of ischemic colitis. As a consequence of continued bleeding with hemodynamic instability, the patient underwent an extended low anterior resection with end transverse colostomy. Histology revealed cholesterol atheroembolism resulting in patchy ischemic ulceration of the colon. Colonic cholesterol atheroembolism can mimic the endoscopic features of pseudomembranous colitis.

Matched MeSH terms: Diagnosis, Differential; Enterocolitis, Pseudomembranous/diagnosis; Proctocolitis/diagnosis; Colitis, Ischemic/diagnosis*; Embolism, Cholesterol/diagnosis*

Fulltext Marjolin's ulcer--a near forgotten entity

Tan BC, Horton TC, Sara Ahmad T

Med J Malaysia, 2006 Feb;61 Suppl A:91-3.

PMID: 17042239

We report a case of a 55-year-old man who presented with a 6-month history of a fungating ulcer on the right hand at the site of a previously healed ulcer that had been present for 40 years. Histopathological examination of four-quadrant biopsy specimens showed a moderately differentiated squamous cell carcinoma (SCC). A transradiocarpal amputation with stump closure using radial flap was performed as it was not possible to achieve a functionally and cosmetically acceptable hand after a wide excision with 2 cm tumour-free margin. It is our intention to highlight this rare condition as reminder to consider this entity as a differential diagnosis of chronic non-healing skin ulcer.

Matched MeSH terms: Carcinoma, Squamous Cell/diagnosis*; Diagnosis, Differential; Skin Neoplasms/diagnosis*; Skin Ulcer/diagnosis*; Acro-Osteolysis/diagnosis

Prenatal detection of birth defects in a Malaysian population: estimation of the influence of termination of pregnancy on birth prevalence in a developing country

Ho JJ, Thong MK, Nurani NK

Aust N Z J Obstet Gynaecol, 2006 Feb;46(1):55-7.

PMID: 16441696

We studied 253 women with a pregnancy complicated by a birth defect and 506 controls to determine the frequency and type of prenatal tests and the types of defects detected antenatally. Most women had at least one ultrasound examination, but the frequency of other screening tests was low. Only 38 (15%) of defects were detected antenatally (37 by ultrasound). Birth prevalence is unlikely to be affected by pregnancy termination.

Matched MeSH terms: Congenital Abnormalities/diagnosis*; Down Syndrome/diagnosis; Neural Tube Defects/diagnosis; Prenatal Diagnosis*

Fulltext An acute pharyngeal-cervical-brachial (PCB) variant of Guillain-Barre syndrome presenting with isolated bulbar palsy

Hamidon BB

Med J Malaysia, 2006 Jun;61(2):245-7.

PMID: 16898323 MyJurnal

Acute Guillain-Barre syndrome (GBS) is characterized by an acute onset of limb weakness and areflexia. There are a few rare variants that have been described and one of them is the pharyngeal-cervical-brachial (PCB) variant (oropharynx, neck, and proximal upper limb muscles). However, in this patient, the only presentation was bulbar involvement with fast recovery within days. This is likely to be the milder form of PCB that has rarely been described before. A 19-year-old Malay lady presented with progressive dysphagia associated with nasal voice for one week duration. There was no limb weakness. Examination showed generalized areflexia. Pharyngeal and palatal muscles were markedly weak. Cerebrospinal fluid (CSF) examination showed raised protein level. Nerve conduction studies revealed generalized demyelinating motor polyneuropathy consistent with GBS. The patient fully recovered within three days and was discharged well.

Matched MeSH terms: Diagnosis, Differential; Bulbar Palsy, Progressive/diagnosis*; Pharyngeal Diseases/diagnosis*; Muscle Weakness/diagnosis*; Guillain-Barre Syndrome/diagnosis*

Fulltext Rapid and cost-effective antenatal diagnosis of haemoglobin Bart's hydrops foetalis syndrome using a duplex-polymerase chain reaction

Wee YC, Tan KL, Tan PC, Yap SF, Tan JAMA

Med J Malaysia, 2005 Oct;60(4):447-53.

PMID: 16570706

Haemoglobin Bart's hydrops foetalis syndrome (--SEA/--SEA) is not compatible with life and contributes to a majority of the hydropic foetuses in the Malaysian Chinese alpha-thalassaemia carriers who possess the 2-alpha-gene deletion in cis (--SEA/alphaalpha). A duplex-PCR which simultaneously amplifies a normal 136 bp sequence between the psialpha-alpha2-globin genes and a 730 bp Southeast Asian deletion-specific sequence (--SEA) between the psialpha2-theta1-globin genes was established. The duplex-PCR which detects the --SEA deletion in both chromosomes serves as a rapid and cost-effective confirmatory test in the antenatal diagnosis of Haemoglobin Bart's hydrops foetalis syndrome in Malaysia. In addition, the duplex-PCR is simple to perform as both the normal and deletion-specific alpha-globin gene sequences are amplified in the same PCR reaction.

Matched MeSH terms: Fetal Diseases/diagnosis; Prenatal Diagnosis/economics; Prenatal Diagnosis/methods*; Hydrops Fetalis/diagnosis*

Fulltext Awareness and knowledge of common eye diseases among the academic staff (non-medical faculties) of University of Malaya

Chew YK, Reddy SC, Karina R

Med J Malaysia, 2004 Aug;59(3):305-11.

PMID: 15727374 MyJurnal

A cross sectional study was conducted to assess the level of awareness and knowledge of common eye diseases (cataract, glaucoma, diabetic retinopathy and refractive errors) among 473 academic staff (non-medical faculties) of University Malaya. The awareness of cataract was in 88.2%, diabetic retinopathy in 83.5%, refractive errors in 75.3% and glaucoma in 71.5% of the study population. The knowledge about all the above common eye diseases was moderate, except presbyopia which was poor. Multivariate analysis revealed that females, older people, and those having family history of eye diseases were significantly more aware and more knowledgeable about the eye diseases. Health education about eye diseases would be beneficial to seek early treatment and prevent visual impairment in the society.

Matched MeSH terms: Cataract/diagnosis; Diabetic Retinopathy/diagnosis; Eye Diseases/diagnosis*; Glaucoma/diagnosis; Refractive Errors/diagnosis

Cannon's disease: clinical and diagnostic implications: a case report

Ram S, Siar CH

Dent Update, 2004 Nov;31(9):557-9.

PMID: 15612463

Cannon's disease or white sponge naevus is a relatively rare genetically determined skin disorder. It is inherited as an autosomal dominant trait that displays a high degree of penetrance and expressivity. This article describes cases of Cannon's disease in a mother and her son.

Matched MeSH terms: Burns, Chemical/diagnosis; Candidiasis, Oral/diagnosis; Diagnosis, Differential; Keratosis/diagnosis; Leukoplakia, Oral/diagnosis

Fulltext Aerodigestive amyloidosis presenting as acute asthma

Sreetharan SS, Prepageran N, Razak A, Valuyeetham KA

Med J Malaysia, 2003 Jun;58(2):290-3.

PMID: 14569753

Aerodigestive amyloidosis is a rare disorder characterized by fibrillar protein deposition in the aerodigestive tree. We present a case of a 19-year-old Chinese gentleman whose diagnosis was initially missed as he presented with features suggestive of severe bronchial asthma and was intubated and ventilated. He subsequently presented 2 years later with severe stridor and required emergency tracheostomy. Current literature is reviewed for the histopathology, common clinical features, radiological findings and treatment options for aerodigestive amyloidosis.

Matched MeSH terms: Amyloidosis/diagnosis*; Asthma/diagnosis; Diagnosis, Differential; Digestive System Diseases/diagnosis*; Respiratory Tract Diseases/diagnosis*

Dermoid cyst simulating recurrent dacryocystitis in a toddler

Tengku-Fatishah A, Abdullah B, Sanjeevan N, Nurul-Shuhada AH, Sharifah-Emilia TS, Haron J, et al.

Can J Ophthalmol, 2019 08;54(4):e196-e199.

PMID: 31358169 DOI: 10.1016/j.jcjo.2018.10.006

Matched MeSH terms: Dacryocystitis/diagnosis*; Dermoid Cyst/diagnosis*; Diagnosis, Differential; Eye Neoplasms/diagnosis*; Lacrimal Apparatus Diseases/diagnosis*

Trisomy 21 and hydrops fetalis: parvovirus B19 or transient abnormal myelopoiesis?

Tan LN, Cheung KW, Kilby MD

J Obstet Gynaecol, 2019 May;39(4):556-557.

PMID: 30634881 DOI: 10.1080/01443615.2018.1530740

Matched MeSH terms: Diagnosis, Differential; Down Syndrome/diagnosis*; Parvoviridae Infections/diagnosis; Pregnancy Complications, Infectious/diagnosis*; Hydrops Fetalis/diagnosis*

Simultaneous non-Hodgkin lymphoma of the external auditory canal and thyroid gland: A case report

Khaw B, Sivalingam S, Pathamanathan SS, Tan TS, Naicker M

Ear Nose Throat J, 2014 12;93(12):508-11.

PMID: 25531844

Approximately 25% of all cases of extranodal non-Hodgkin lymphoma (NHL) occur in the head and neck region; NHL of the external auditory canal (EAC) and thyroid gland are rare. Specific immunohistochemical staining of the excised tissue is required to confirm the final pathologic diagnosis. We report the case of a 53-year-old woman with underlying systemic lupus erythematosus and autoimmune hemolytic anemia that were in remission. She presented with chronic left ear pain, a mass in the left EAC, and rapid growth of an anterior neck swelling that had led to left vocal fold palsy. High-resolution computed tomography (CT) of the temporal bone and CT of the neck detected a mass lateral to the left tympanic membrane and another mass in the anterior neck that had infiltrated the thyroid gland. The patient was diagnosed with simultaneous B-cell lymphoma of the left EAC and thyroid gland. She was treated with chemotherapy. She responded well to treatment and was lost to follow-up after 1 year. To the best of our knowledge, the simultaneous occurrence of a lymphoma in the EAC and the thyroid has not been previously described in the literature.

Matched MeSH terms: Ear Neoplasms/diagnosis*; Neoplasms, Multiple Primary/diagnosis*; Thyroid Neoplasms/diagnosis*; Lymphoma, B-Cell/diagnosis*; Lymphoma, B-Cell, Marginal Zone/diagnosis*

Uncovering the sleep disorders among young doctors

Yasin R, Muntham D, Chirakalwasan N

Sleep Breath, 2016 Dec;20(4):1137-1144.

PMID: 27535070 DOI: 10.1007/s11325-016-1380-6

PURPOSE: Sleepiness and tiredness are common complaints among young doctors. Sleep deprivation is believed to be the main culprit. However, we believe that there may be other sleep disorders which may contribute to these symptoms such as occult obstructive sleep apnea (OSA).

METHODS: A prospective cross-sectional study was performed among young doctors less than 40 years old, working at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, and Hospital Kuala Lumpur, Kuala Lumpur, Malaysia, using questionnaires and home sleep apnea testing (Apnealink™Plus). The primary objective of this study was to evaluate the prevalence of OSA (apnea-hypopnea index (AHI) ≥5). The secondary objectives were to evaluate the prevalence of obstructive sleep apnea syndrome (OSAS) defined by AHI ≥5 + excessive daytime sleepiness (EDS), sleep deprivation (the difference of weekend (non-workdays) and weekday (workdays) wake-up time of at least 2 h), EDS (Epworth Sleepiness Scale score ≥10), tiredness, and perception of inadequate sleep as well as to identify their predictors.

RESULTS: Total of 52 subjects completed the study. Mean age and mean body mass index (BMI) were 31.3 ± 4 and 23.3 ± 3.6, respectively. The prevalence of OSA and OSAS were 40.4 and 5.8 %, respectively. One third of OSA subjects were at least moderate OSA. Prevalence of sleep deprivation, EDS, tiredness, and perception of inadequate sleep were 44.2, 15.4, 65.4, and 61.5 %, respectively. History of snoring, being male, and perception of inadequate sleep were significant predictors for OSA with the odds ratio of 34.5 (p = 0.016, 95 % CI = 1.92-619.15), 18.8 (p = 0.001, 95 % CI = 3.10-113.41), and 7.4 (p = 0.037, 95 % CI = 1.13-48.30), respectively. Only observed apnea was a significant predictor for OSAS with odds ratio of 30.7 (p = 0.012, 95 % CI = 2.12-442.6). Number of naps per week was a significant predictor for EDS with the odds ratio of 1.78 (p = 0.007, 95 % CI = 1.17-2.71). OSA and total number of call days per month were significant predictors for tiredness with the odds ratio of 4.8 (p = 0.036, 95 % CI = 1.11-20.72) and 1.3 (p = 0.050, 95 % CI = 1.0004-1.61), respectively. OSA was the only significant predictor for perception of inadequate sleep with the odd ratios of 4.5 (p = 0.022, 95 % CI = 1.24-16.59).

CONCLUSIONS: Our results demonstrated relatively high prevalence of OSA and OSAS among young doctors. Snoring, being male, and perception of inadequate sleep were significant predictors for OSA. Observed apnea was a significant predictor for OSAS. OSA was a significant predictor for tiredness and perception of inadequate sleep.

Matched MeSH terms: Diagnosis, Differential; Disorders of Excessive Somnolence/diagnosis*; Occupational Diseases/diagnosis*; Sleep Deprivation/diagnosis; Sleep Apnea, Obstructive/diagnosis*

Fulltext Treatment response in osmotic demyelination syndrome presenting as severe parkinsonism, ptosis and gaze palsy

Abdul Halim S, Mohd Amin NA

BMJ Case Rep, 2018 Oct 21;2018.

PMID: 30344146 DOI: 10.1136/bcr-2018-225751

Osmotic demyelination syndrome commonly affects the pons and infrequently involves the extrapontine region. We report a patient with severe hyponatraemia who developed osmotic demyelination syndrome as a consequence of rapid sodium correction. The condition manifested as acute severe parkinsonism, bilateral ptosis and gaze impairment. MRI revealed typical features of central pontine and extrapontine myelinolysis. The patient improved gradually after treatment with a combination of levodopa, intravenous immunoglobulin and dexamethasone. However, it is important to emphasise that the improvement of neurological symptoms is not necessarily causal with these experimental therapies.

Matched MeSH terms: Blepharoptosis/diagnosis*; Diagnosis, Differential; Hyponatremia/diagnosis*; Myelinolysis, Central Pontine/diagnosis*; Parkinsonian Disorders/diagnosis*

Fulltext Glypican-3 is useful but not superior to Hep Par 1 in differentiating hepatocellular carcinoma from other liver tumours

Pour AM, Masir N, Rose IM

Malays J Pathol, 2016 Dec;38(3):229-233.

PMID: 28028292 MyJurnal

To assess the diagnostic utility of glypican-3 (GPC-3) in comparison to Hep Par 1 in the diagnosis of liver tumours, a cross-sectional study involving 66 resected liver tumours were tested for the protein expression of these markers by immunohistochemistry using monoclonal antibodies. Of the 66 cases, 26 (39.4%) were hepatocellular carcinoma (HCC), 4 (6.1%) were intrahepatic cholangiocarcinoma and 36 (54.5%) were metastatic tumours. Hep Par 1 and GPC-3 expressions in HCC were 24/26 (92.3%) and 19/26 (73.1%) respectively. In contrast, of non-HCC cases, only 2/40 cases (5.0%) expressed Hep Par 1, including a metastatic colorectal adenocarcinoma and a metastatic gastric adenocarcinoma. GPC-3 was expressed in 3/40 cases (7.5%), i.e. a metastatic adenocarcinoma of unknown origin, a metastatic gastric adenocarcinoma and an intrahepatic cholangiocarcinoma. The sensitivity and specificity for Hep Par 1 were 92.3% and 95% respectively while that of GPC-3 was 73.1% and 92.5% respectively. GPC-3 is a useful marker in the diagnosis of HCC. However it is not superior to Hep Par 1 in its sensitivity and specificity. We recommend that it is utilized together with Hep Par 1 as a panel in the diagnosis of HCC.

Matched MeSH terms: Adenocarcinoma/diagnosis; Diagnosis, Differential; Carcinoma, Hepatocellular/diagnosis*; Liver Neoplasms/diagnosis*; Cholangiocarcinoma/diagnosis

Fulltext Oesophageal tuberculosis: rare but not to be forgotten

Momin RN, Chong VH

Singapore Med J, 2012 Sep;53(9):e192-4.

PMID: 23023913

Tuberculosis remains an important cause of morbidity and mortality, especially in underdeveloped and developing nations. Manifestations could be nonspecific and may mimic many other conditions, including malignancies. Oesophageal involvement is surprisingly rare despite the high prevalence of pulmonary tuberculosis and the close proximity of these two structures. We report two cases of oesophageal tuberculosis; a 73-year-old man with simultaneous oesophageal, stomach and duodenal involvement, and a 45-year-old man with isolated oesophageal involvement. Underlying malignancies were initially suspected in both cases, but they were eventually diagnosed as tuberculosis.

Matched MeSH terms: Diagnosis, Differential; Esophageal Diseases/diagnosis*; Esophageal Neoplasms/diagnosis; Granuloma/diagnosis*; Tuberculosis, Gastrointestinal/diagnosis*

Fulltext Comparison of fracture patterns between rural and urban populations in a developing country

Saw A, Sallehuddin AY, Chuah UC, Ismail MS, Yoga R, Hossain MG

Singapore Med J, 2010 Sep;51(9):702-8.

PMID: 20938610

The pattern of fracture, including the anatomical location and age distribution, may differ among urban and rural populations due to various factors such as the inhabitants' occupation and living environment.

Matched MeSH terms: Femoral Fractures/diagnosis; Radius Fractures/diagnosis; Tibial Fractures/diagnosis; Ulna Fractures/diagnosis; Fractures, Bone/diagnosis*

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