Aim. To validate a radial quantitative ultrasound (QUS) system with dual energy X-ray absorptiometry (DXA), a criterion technique in bone status assessment among children. Methods. Bone health was evaluated using a radial QUS system (Sunlight Omnisense 8000P) to measure the speed of sound (SOS) at one-third distal radius of the nondominant hand and DXA (Hologic QDR) was used to assess whole body bone mineral density (BMD). Results. Some 29.9% of the children were grossly misclassified according to quartiles of BMD and radial SOS. Poor agreement was observed between Z-scores of radial SOS and whole-body BMD (mean difference = 0.6 ± 0.9; 95% limits of agreement = -1.4 to 2.6). With a cut-off value of -1.0, radial SOS yielded satisfactory sensitivity (80%) and specificity (93%) for the detection of children with low BMD. Conclusion. The observed poor agreement in the present study suggests that radial QUS and DXA are not comparable and hence are not interchangeable in evaluating bone status of the children.
Paraesophageal hernia with intrathoracic mesentericoaxial type of gastric volvulus is a rare clinical entity. The rotation occurs because of the idiopathic relaxation of the gastric ligaments and ascent of the stomach adjacent to the oesophagus through the hiatus defect, while the gastroesophageal junction remains in the abdomen. The open approach remains the gold standard therapy for most patients. Here we report the case of a patient with such a condition who underwent a successful laparoscopic surgery. A literature search revealed that this is the first case report from Southeast Asia.
A rare case of bilateral anterior hip dislocation reduced under sedation was reported in this study. A 47-year-old man was knocked down by a car and sustained bilateral anterior hip dislocation which was reduced successfully with sedation using titrated dose of intravenous Midazolam in combination with Pethidine. A modified Lefkowitz maneuver using the manipulator's thigh as a fulcrum was used. Patient started weight bearing in the second month after injury and was walking without any hip pain at the twenty-fourth month follow-up. Thirteen case reports describing bilateral anterior hip dislocations were found while reviewing the literature and it was noticed that only one author had reported the usage of intravenous sedation (Propofol) for the reduction procedure. However, no author reported the use of Lefkowitz maneuver for this purpose. Consequently, reduction of a bilateral anterior hip dislocation is possible with sedation using a modified Lefkowitz maneuver.
A retrospective study was conducted to assess the surgical outcomes of degenerative lumbar spinal stenosis. Twenty-five patients treated with decompressive surgery in Hospital Kuala Lumpur between January 1992 and August 1996 were reviewed. There were seven males and eighteen females. The average age was 51 years old (range 33 to 64 years old). The diagnosis of degenerative spinal stenosis was made based on the clinical features and was confirmed by radiographic findings. Ninety two percent of the patients had moderate to severe symptoms preoperatively. The types of surgery consisted of laminectomy (n = 15), laminotomy (n = 10), and laminoplasty (n = 1). The surgical outcomes were assessed based on patients' own assessment of symptoms relieved and functional returned to daily activities at least six months after the surgery. The average follow-up period was fifteen months (range 6 months to 42 months). Of these twenty-five patients, 4 (16%) claimed to have excellent results, 11 (44%) had good results, 8 (32%) reported fair, and 2 (8%) judged their surgical treatment as poor with little or no use. There was no anaesthetic, cardiovascular, or thromboembolic complications seen in this study. Four patients had recurrent claudication, one demonstrated localised arachnoiditis, and two had lumbar instability which were not documented preoperatively. One patient had L4 nerve root avulsion with dura torn and another patient had superficial wound infection. We concluded in this study that decompressive surgery offers satisfactory results in patients with moderate to severe degenerative spinal stenosis in short term follow-up.
This is a prospective study with the objective of comparing Three Dimensional (3D) Dynamic Subtraction Contrast Enhanced Magnetic Resonance Angiography (3DDSCEMRA) with Conventional Catheter Arteriography (CCA) as the gold standard, in the diagnosis of peripheral occlusive disease. Three patients scheduled for CCA in this hospital in between September and October 2000 were included in this study. Patients underwent 3DDSCEMRA before proceeding to CCA on the same day. The 3DDSCEMRA reader was blinded to the CCA results. The results showed good correlation in iliofemoral segment and poor correlation in the infrapopliteal segment due to artifacts in 3DDSCEMRA images. 3DDSCEMRA is a new, non-invasive and promising technique in the diagnosis of peripheral occlusive disease.
Four patients underwent reconstruction of anterior cranial fossa of skull defects between November 1997 and January 1998. All of them had traumatic anterior cranial fossa defect and were reconstructed with lyophilised bovine cortical bone graft. There was no cerebrospinal fluid leakage, meningitis, extradural abscess or other infections. This study demonstrates that the use of bovine bone graft in the reconstruction of anterior base defects is safe.
We report a full-term baby boy who presented soon after birth with severe congenital rickets. Maternal and neonatal vitamin D levels were very low and the infant responded well to oral vitamin D. Transient secondary hyperparathyroidism normalised on treatment. The mother's vitamin D deficiency was attributed to the region's cultural dress code which prevents exposure to sunlight. There has not been a previous report of severe congenital rickets from this region.
We report two cases of x-linked dominant hypophosphatemic rickets involving a man and his daughter. The family tree consists of 44 members with 13 of them having short stature and bowing of the lower limbs. The study of this family tree strongly suggests an x-linked dominant inheritance.
Bleeding into the rectus sheath is an uncommon but a well-recognised condition that mimics several other diagnoses of acute abdomen. A wide range of etiology has been proposed in association with this condition. It is often self-limiting, but can lead to unnecessary laparotomy if the diagnosis is not recognised.
We describe a 7-year-old child who presented with a soft fluctuant swelling on the neck which became more prominent during the Valsalva manoeuvre. He underwent adeno-tonsillectomy based on a mistaken diagnosis of ballooning of the pharynx secondary to enlarged adenoids and tonsils obstructing the nasopharyngeal and oropharyngeal airways. Investigations revealed the swelling to be a markedly dilated internal jugular vein. We discuss the diagnostic features and mode of treatment of this condition so as to avoid unnecessary and dangerous surgical intervention.
Tracheoesophageal fistula (TEF) without atresia is rare and usually presents with symptoms from birth. In this report, a 9-year-old boy presented with productive cough of 4 month's duration and was shown to have a right lung abscess seen on chest radiograph. His parents denied earlier respiratory symptoms or illnesses. Rigid bronchoscopy showed a fistulous opening of about 1 mm in diameter in the posterior wall of the trachea about 16 cm from the upper incisor teeth. Cannulation with a ureteral catheter demonstrated that the fistulous opening communicated with the esophageal lumen. The tracheoesophageal fistula was 1 cm long and was divided through a right supraclavicular incision. The postoperative period was uneventful, and the patient was discharged on the third postoperative day. This case demonstrated that TEF should be considered in any patient presenting with chronic respiratory problems even after a prolonged symptom-free period.
Tracheobronchial foreign bodies, which are common in children, are a leading cause of accidental deaths in children under four years of age. Three cases of tracheobronchial foreign bodies in children less than two years old are described. One of the foreign bodies was unsuspected; the other two were probably related to food habits. All three cases improved without sequelae following prompt bronchoscopic intervention. Young children should not be given food containing bones or hard chitinous shells.
Spinal vascular malformation is an uncommon but potentially treatable cause of myelopathy. We describe two cases of angiographically proven spinal vascular malformation in Malaysia. The first case is a 47-year-old man who had a progressive myelopathy and the second a 60-year-old man with intermittent attacks of transient paraparesis leading to paraplegia. As the clinical presentation of spinal vascular malformation is variable, it should be considered as a cause of patients with myelopathy.
Teeth are the most durable structures in the human body. The pattern of their development has been used as a credible technique of age determination of unidentified bodies. Dental age estimation is by comparison of the dental status of an individual with published dental surveys. The third molars are the last teeth to erupt and are regarded as the most variable in the dentition. Nevertheless, radiographs depicting their growth have been used to determine the chronological age. A case for actual need for age estimation using a developing third molar is presented here.
A patient on oral contraceptives over several years developed unilateral proptosis, haemorrhagic retinopathy and increase in intraocular pressure. An orbital vein venogram confirmed the diagnosis of right superior ophthalmic vein thrombosis. There was complete resolution of thrombosis and eye signs and symptoms with discontinuation of the oral contraceptive.
A retrospective study of 34 patients with supracondylar-condylar fractures of the femur admitted to the Alexandra Hospital, Singapore, from January 1979 to December 1983 was carried out. These fractures were surgically treated by AO principles and fixation, and the surgery performed mainly by the two authors. Using strict criteria adopted from Schatzker of Toronto, 1 it was found that 62% of patients had excellent/ good results. The importance of treating supracondylar-condylar fractures by AO principles and fixation is emphasised.