MyMedR

Fulltext Understanding hyperemesis gravidarum

Loh KY, Sivalingam N

Med J Malaysia, 2005 Aug;60(3):394-9; quiz 400.

Nausea and vomiting are common in early pregnancy affecting 70-80 percent of pregnant mothers. In a majority of women vomiting begins between 4-7 weeks of pregnancy. Nausea and vomiting are usually mild and self-limiting, however some of the mothers have a more profound course which lead to hyperemesis gravidarum. Careful clinical evaluation is necessary to exclude underlying medical illnesses or non pregnancy related causes of severe vomiting. Hyperemesis gravidarum poses health risk to both mother and baby, therefore prompt treatment should be initiated without delay. Non pharmacotherapy such as dietary modification and emotional support are useful. Pharmacotherapy with antiemetics, pyridoxine, methylprednisolone are effective and relatively safe. Severe hyperemesis with dehydration and electrolyte imbalance may need hospitalisation for electrolyte and fluid replacement.

Matched MeSH terms: Diagnosis, Differential

Stone detection in MRCP images using controlled region growing

Logeswaran R, Eswaran C

Comput Biol Med, 2007 Aug;37(8):1084-91.

PMID: 17112496

Stones in the biliary tract are routinely identified using MRCP (magnetic resonance cholangiopancreatography). The noisy nature of the images, as well as varying intensity, size and location of the stones, defeat most automatic detection algorithms, making computer-aided diagnosis difficult. This paper proposes a multi-stage segment-based scheme for semi-automated detection of choledocholithiasis and cholelithiasis in the MRCP images, producing good performance in tests, differentiating them from "normal" MRCP images. With the high success rate of over 90%, refinement of the scheme could be applicable in the clinical environment as a tool in aiding diagnosis, with possible applications in telemedicine.

Matched MeSH terms: Diagnosis, Computer-Assisted/methods*; Gallstones/diagnosis*

Fulltext Third ventricular cavernous angioma

Zakaria MA, Abdullah JM, George JP, Mutum SS, Lee NN

Med J Malaysia, 2006 Jun;61(2):229-32.

PMID: 16898318 MyJurnal

Third ventricular cavernous angiomas are rare vascular malformations of the brain. We report an eight-year old boy with a rare third ventricular cavernous angioma that hemorrhaged presenting with symptoms of acute hydrocephalus. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) showed a heterogenous ill-defined, solid and cystic intraventricular mass in the third ventricle which was mildly enhanced with contrast and there was associated hydrocephalus. The mass was removed with success and follow up after two years revealed no neurological abnormalities.

Matched MeSH terms: Diagnosis, Differential; Central Nervous System Neoplasms/diagnosis*; Hemangioma, Cavernous, Central Nervous System/diagnosis*

A large unilateral submandibular mass

Rajandram RK, Sha PP, Hussaini HM, Jabar NA

Oral Surg Oral Med Oral Pathol Oral Radiol, 2014 Apr;117(4):402-6.

PMID: 23183027 DOI: 10.1016/j.oooo.2012.08.456

Matched MeSH terms: Choristoma/diagnosis*; Diagnosis, Differential; Submandibular Gland Diseases/diagnosis*

Caecal tumour with hepatic metastases?

Rajendra S, Kutty K

Gut, 2005 Feb;54(2):178, 200.

PMID: 15647173

Matched MeSH terms: Cecal Neoplasms/diagnosis*; Diagnosis, Differential; Liver Neoplasms/diagnosis

Vaginal vascular malformation mimicking pelvic organ prolapse requiring serial embolizations

Pue LB, Lo TS, Wu PY

Int Urogynecol J, 2013 Nov;24(11):1985-7.

PMID: 23430075 DOI: 10.1007/s00192-013-2060-8

Vaginal vascular malformation (VVM) is rare. There are, in fact, less than ten cases reported to date. VVM often presents as a mass protruding from the vagina, mimicking pelvic organ prolapse (POP). It can coexist with POP, thereby usually exaggerating the severity of POP. We report a case of VVM in a premenopausal woman who presented as severe POP and urinary incontinence. The diagnosis was confirmed with computed tomography (CT) scan and angiography. The patient underwent conservative management with embolization. These procedures had to be repeated three times in 1.5 years due to lesion recurrence. In mitigation, conservative treatment eliminates the risks associated with surgery, e.g. massive hemorrhage and visceral injuries. It does, however, require a long course of treatment and follow-up.

Matched MeSH terms: Diagnosis, Differential; Vascular Malformations/diagnosis*; Pelvic Organ Prolapse/diagnosis*

Fulltext A rare case of chondrosarcoma of the clavicle

Amalourde A, Vinayaga P, Naveed N, Jamal A, Looi LM, Sengupta S

Med J Malaysia, 2004 Dec;59 Suppl F:60-2.

PMID: 15941166 MyJurnal

Although all types of tumour and tumour-like conditions have been described to occur in the clavicle, they only contribute to less then 0.5% of all skeletal tumours. The incidence of primary chondrosarcoma of the clavicle is extremely rare. To our knowledge it has not been reported in Malaysia. We would like to highlight the possibility of chondrosarcoma as a differential diagnosis for a clavicular lesion.

Matched MeSH terms: Diagnosis, Differential

Fulltext Right internal carotid pseudoaneurysm mimicking a retropharyngeal abscess in a child

Lee NNA, Long G, Ngai S, Sahrir S, Parker A, Lamont AC

Med J Malaysia, 2004 Dec;59(5):685-7.

PMID: 15889576

A 7-year-old girl with tonsillar infection with antibiotics. Two weeks later, there was a right sided neck lump. Computed tomography scans demonstrated a predominantly hypodense right retropharyngeal area with peripheral enhancement and mass effect. There was intense enhancement within the postero-superior aspect of the lesion which was continuous with the right internal carotid artery. Ultrasound demonstrated tapering of the right internal carotid artery. Magnetic resonance imaging and magnetic resonance arteriography showed a right internal carotid artery pseudoaneurysm. Surgical exploration confirmed the finding. This case highlights an unusual presentation of an internal carotid pseudoaneurysm and how imaging provided the diagnosis.

Matched MeSH terms: Diagnosis, Differential; Retropharyngeal Abscess/diagnosis*; Carotid-Cavernous Sinus Fistula/diagnosis*

Heterotopic neuroglial tissue presenting as oral cavity mass with intracranial extension

Marina MB, Zurin AR, Muhaizan WM, Primuharsa Putra SH, Azizi AB, Kenali MS

Int J Pediatr Otorhinolaryngol, 2005 Nov;69(11):1587-90.

PMID: 15935483

Heterotopic neuroglial tissue is a rare congenital lesion with predilection in head and neck region. We report a case of a newborn who presented with an oral cavity mass with intracranial extension and later respiratory distress that was successfully excised via transcranial and transcervical approach.

Matched MeSH terms: Brain Diseases/diagnosis*; Choristoma/diagnosis*; Mouth Diseases/diagnosis*

Fulltext Beyond Critical Congenital Heart Disease: Newborn Screening Using Pulse Oximetry for Neonatal Sepsis and Respiratory Diseases in a Middle-Income Country

Jawin V, Ang HL, Omar A, Thong MK

PLoS One, 2015;10(9):e0137580.

PMID: 26360420 DOI: 10.1371/journal.pone.0137580

Studies on pulse oximetry screening for neonatal sepsis and respiratory disease in a middle-income country are lacking. Newborn screening for critical congenital heart disease (CCHD) using pulse oximetry is an effective and life-saving strategy in developed countries. While most studies have reported false-positive results during CCHD screening, they have not elaborated on the detected disease types. We studied the effectiveness and outcomes of pulse oximetry newborn screening for non-cardiac hypoxemic diseases such as neonatal sepsis, respiratory diseases, and CCHD in a middle-income country.

Matched MeSH terms: Anoxia/diagnosis*; Heart Defects, Congenital/diagnosis*; Sepsis/diagnosis*

Unicystic Ameloblastoma: A Perception for the Cautious Interpretation of Radiographic and Histological Findings

Arora S

J Coll Physicians Surg Pak, 2015 Oct;25(10):761764-764.

PMID: 26454399 DOI: 10.2015/JCPSP.761764

The term Unicystic Ameloblastoma (UA) refers to those cystic lesions that show clinical and radiological characteristics of an odontogenic cyst but on histological examination show a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor growth. Till date, lot of controversies exist among oral surgeons and oral pathologists regarding this entity. An attempt is being made here to discuss all the diagnostic dilemmas associated with UA.

Matched MeSH terms: Ameloblastoma/diagnosis*; Mandibular Neoplasms/diagnosis*; Odontogenic Cysts/diagnosis

Fulltext Practical way of creating differential diagnoses through an expanded VITAMINSABCDEK mnemonic

Zabidi-Hussin ZA

Adv Med Educ Pract, 2016;7:247-8.

PMID: 27217805 DOI: 10.2147/AMEP.S106507

Having an organized, structured thinking process is critical in medicine. It is through this thinking process that enables one to go through the method of history-taking, which will eventually lead to making a definitive diagnosis and all other processes that follow. The use of mnemonic has been found to be useful for this purpose. The mnemonic VITAMINSABCDEK, is a convenient and practical way to assist in expanding the differential diagnoses and covers all possible causes of an illness. It is also easy to remember, as the vitamins whose letters are represented in this mnemonic cover the entire range of vitamins known.

Matched MeSH terms: Diagnosis, Differential

Fulltext Non-invasive prenatal diagnosis using fetal DNA in maternal plasma: a preliminary study for identification of paternally-inherited alleles using single nucleotide polymorphisms

Chen JJ, Tan JA, Chua KH, Tan PC, George E

BMJ Open, 2015 Jul 22;5(7):e007648.

PMID: 26201722 DOI: 10.1136/bmjopen-2015-007648

OBJECTIVES: Single nucleotide polymorphism (SNP) with a mutation can be used to identify the presence of the paternally-inherited wild-type or mutant allele as result of the inheritance of either allele in the fetus and allows the prediction of the fetal genotype. This study aims to identify paternal SNPs located at the flanking regions upstream or downstream from the β-globin gene mutations at CD41/42 (HBB:c.127_130delCTTT), IVS1-5 (HBB:c.92+5G>C) and IVS2-654 (HBB:c.316-197C>T) using free-circulating fetal DNA.

SETTING: Haematology Lab, Department of Biomedical Science, University of Malaya.

PARTICIPANTS: Eight couples characterised as β-thalassaemia carriers where both partners posed the same β-globin gene mutations at CD41/42, IVS1-5 and IVS2-654, were recruited in this study.

OUTCOME MEASURES: Genotyping was performed by allele specific-PCR and the locations of SNPs were identified after sequencing alignment.

RESULTS: Genotype analysis revealed that at least one paternal SNP was present for each of the couples. Amplification on free-circulating DNA revealed that the paternal mutant allele of SNP was present in three fcDNA. Thus, the fetuses may be β-thalassaemia carriers or β-thalassaemia major. Paternal wild-type alleles of SNP were present in the remaining five fcDNA samples, thus indicating that the fetal genotypes would not be homozygous mutants.

CONCLUSIONS: This preliminary research demonstrates that paternal allele of SNP can be used as a non-invasive prenatal diagnosis approach for at-risk couples to determine the β-thalassaemia status of the fetus.

Matched MeSH terms: Prenatal Diagnosis/methods*; beta-Thalassemia/diagnosis*

Tonic Pupil, a Paraneoplastic Neuro-Ophtalmological Disease Associated with Occult Breast Cancer

Peyman A, Kabiri M, Peyman M

Breast J, 2015 Sep-Oct;21(5):543-4.

PMID: 26174775 DOI: 10.1111/tbj.12451

Here, we present a case of tonic pupil associated with occult breast cancer as a paraneoplastic neuro-ophthalmology syndrome. A 45-year-old woman developed progressive photophobia and blurred vision due to unilateral Adie's tonic pupil. Magnetic resonance image of her brain and neurological examination (including deep tendon reflexes) were normal at first visit. Follow-up examinations performed by ophthalmologist every 6 month without any change in her condition. After 2 years, patient discovered a mass in her breast which identified to be malignant after diagnostic procedures. Despite surgical and medical treatment for cancer, no change in the ocular condition was happened.

Matched MeSH terms: Breast Neoplasms/diagnosis; Tonic Pupil/diagnosis; Paraneoplastic Syndromes, Nervous System/diagnosis

Association of Knowledge and Cultural Perceptions of Malaysian Women with Delay in Diagnosis and Treatment of Breast Cancer: a Systematic Review

Khan TM, Leong JP, Ming LC, Khan AH

Asian Pac J Cancer Prev, 2015;16(13):5349-57.

PMID: 26225677

BACKGROUND: Breast cancer is the most common cancer and the leading cause of cancer mortality among women of all ethnic and age groups in Malaysia. Delay in seeking help for breast cancer symptoms is preventable and by identifying possible factors for delayed diagnosis, patient prognosis and survival rates could be improved.

OBJECTIVES: This narrative review aimed to understand and evaluate the level of in-depth breast cancer knowledge in terms of clinical breast examination and breast self-examination, and other important aspects such as side-effects and risk factors in Malaysian females. Since Malaysia is multicultural, this review assessed social perceptions, cultural beliefs and help-seeking behaviour in respect to breast cancer among different ethnic groups, since these may impinge on efforts to 'avoid' the disease.

MATERIALS AND METHODS: A comprehensive literature search of seven databases was performed from December 2015 to January 2015. Screening of relevant published journals was also undertaken to identify available information related to the knowledge, perception and help-seeking behaviour of Malaysian women in relation to breast cancer.

RESULTS: A total of 42 articles were appraised and included in this review. Generally, women in Malaysia had good awareness of breast cancer and its screening tools, particularly breast self-examination, but only superficial in-depth knowledge about the disease. Women in rural areas had lower levels of knowledge than those in urban areas. It was also shown that books, magazines, brochures and television were among the most common sources of breast cancer information. Delay in presentation was attributed mainly to a negative social perception of the disease, poverty, cultural and religion practices, and a strong influence of complementary and alternative medicine, rather than a lack of knowledge.

CONCLUSIONS: This review highlighted the need for an intensive and in-depth breast cancer education campaigns using media and community health programmes, even with the existing good awareness of breast cancer. This is essential in order to avoid misconceptions and to frame the correct mind-set about breast cancer among women in Malaysia. Socio-cultural differences and religious practices should be taken into account by health care professionals when advising on breast cancer. Women need to be aware of the risk factors and symptoms of breast cancer so that early diagnosis can take place and the chances of survival improved.

Matched MeSH terms: Breast Neoplasms/diagnosis*; Delayed Diagnosis*

Rupture of the lateral ventricle secondary to a fourth ventricle tumour resulting in an indirect nontraumatic cerebrospinal fluid fistula

Tan SP, Abdullah BJ, Waran V, Liew WF

Neuroradiology, 2003 Jan;45(1):53-5.

PMID: 12525956

We present a rare indirect nontraumatic cerebrospinal fluid (CSF) fistula secondary to a fourth ventricle ependymoma. The fistula resulted from rupture of the left temporal horn, distant from the tumour. The fistula was well demonstrated by MRI. High-resolution CT demonstrated a defect in the roof of the sphenoid sinus, but no leakage of CSF was seen on CT cisternography.

Matched MeSH terms: Cerebral Ventricle Neoplasms/diagnosis; Cerebrospinal Fluid Rhinorrhea/diagnosis; Ependymoma/diagnosis

Fulltext The pale and limping child

S Fadilah SAW, Cheong SK, Shahdan S

Postgrad Med J, 2000 Nov;76(901):717, 725-6.

PMID: 11060153 DOI: 10.1136/pmj.76.901.717

Matched MeSH terms: Arthritis, Juvenile/diagnosis*; Burkitt Lymphoma/diagnosis*; Diagnosis, Differential

Fulltext A rare case of bleeding in a cerebellopontine angle epidermoid cyst

Zamzuri I, Abdullah J, Madhavan M, Ariff AR

Med J Malaysia, 2002 Mar;57(1):114-7.

PMID: 14569729

Epidermoid cysts of the central nervous system are described as rare, benign, slow growing lesions with a history of high rate of recurrence even after surgical removal. This lesion is rarely located at the cerebellopontine angle and is found to be composed of solid and cystic components with close adherence to vital neurovascular structures that might complicate its removal. We present a rare case of a twenty-five year old housewife with signs and symptoms of increased intracranial pressure due to the above pathology after multiple episodes of intra-tumoral bleeding. Microneurosurgical techniques were used for tumour dissection and excision. The patient recovered well after a three-year follow-up. This is the fourth example in the index medicus of bleeding seen in a histopathologically proven cerebellopontine angle intraepidermoid cyst.

Matched MeSH terms: Cerebellar Diseases/diagnosis; Epidermal Cyst/diagnosis; Intracranial Hemorrhages/diagnosis

Use of capnography delaying the diagnosis of tracheal intubation

Chan YK, Zuraidah S, Tan PS

Anaesthesia, 1998 Dec;53(12):1207-8.

PMID: 10193227

There was a delay in making the correct diagnosis of tracheal intubation in a parturient who developed severe bronchospasm after intubation because we relied on the capnogram.

Matched MeSH terms: Bronchial Spasm/diagnosis*; Diagnosis, Differential; Foreign Bodies/diagnosis*

Fulltext Eagle's syndrome

Subramaniam S, Abd Majid MD

Med J Malaysia, 2003 Mar;58(1):139-41.

PMID: 14556342

Eagle's syndrome is an uncommon condition resulting from an elongated styloid process, which causes cervico facial pain, tinnitus and otalgia. A 48-year-old female presented to the clinic with bilateral upper neck pain radiating to the ears with tinnitus for almost one-year duration. Examination of the oral cavity revealed atrophic tonsils and palpable bony projection deep in the tonsillar fossa. Plain lateral neck X-ray and CT scan confirmed the presence of bilateral elongated styloid processes, which were subsequently resected surgically through an oropharyngeal approach. The patient was asymptomatic at follow up at 2 years.

Matched MeSH terms: Earache/diagnosis*; Facial Pain/diagnosis*; Tinnitus/diagnosis*

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