Although the diagnosis of thymolipoma has improved with the introduction of computerized tomography (CT), variations in CT appearance are still being described; this paper describes a case which resembled a lipoma. The CT features of thymolipoma are discussed with special reference to the differential diagnosis. Surgical excision should be considered for patients who are found to exhibit a fatty intrathoracic mass on CT.
A 30-year-old female entered the emergency room for medical advice because of progressive deterioration of general health with headache, arthralgias, myalgias and fever after a vacation of three weeks in Malaysia and Hong Kong. Because of persistent fever, lymphadenopathy, slight leuco- and thrombocytopenia and only insignificantly elevated humoral signs of an inflammatory process, the patient was treated symptomatically after exclusion of malaria. A viral disease was suspected. Two days later, an exanthema erupted suddenly on the trunk. Pinhead-sized livid, flat macules, increasing in size within hours and spreading to the extremities, were observed. Further investigations revealed a significantly elevated titer of IgG directed against rickettsia conorii, leading to the diagnosis of Mediterranean spotted fever. Under antibiotic treatment with tetracycline, the aforementioned findings regressed within few days, and the patient recovered completely.
The use of maternal age alone to identify pregnant mothers at risk of a fetus with Down's syndrome has recently been supplemented by maternal serum screening using biochemical markers such as alpha-protein, human chorionic gonadotrophin and oestriol. These tests have been reported to increase the sensitivity of antenatal detection of such fetuses from 35% to 67% with a false positive rate of 5%. However, these maternal serum markers may be affected by maternal weight, the smoking history of mothers and diabetes mellitus. Furthermore, such sensitivities are achieved only when gestational age is assessed accurately by ultrasound. Many further studies need to be carried out before the introduction of maternal serum screening into routine obstetric practice in Singapore. These include studies on the incidence of Down's syndrome in the local population, studies on the distribution of these serum markers in the second trimester of pregnancy, sensitivities and positive predictive values of such a test in the local population as well as the socio-economic implications of implementing such a screening test in the local obstetric population.
Matched MeSH terms: Down Syndrome/diagnosis*; Prenatal Diagnosis*
A total of 165 children from a school for the deaf in Malaysia were screened to find out the prevalence of additional conductive hearing loss. Otological examination, tympanometry and pure tone audiometry were performed in all these children. Fifty-one children (30.9%) had additional conductive hearing loss. Middle ear disorders were present in 15 children (9.09%). The deaf children seldom complain about the change in their hearing sensitivity, so there is a need for regular otological examination in deaf children to detect the additional conductive hearing loss.
Pharyngeal involvement in tuberculosis is rare and is usually secondary to pulmonary tuberculosis. We report a very rare case of chronic granulomatous pharyngitis, which later turned out to be due to primary tuberculosis of the pharynx. The clinical presentation, diagnosis, treatment and complications of this rare clinical entity are presented.
The gold standard for the diagnosis and evaluation of sleep apnoea is overnight polysomnography. However, full polysomnography is an expensive and labour intensive procedure which requires the patient to sleep overnight in a hospital sleep laboratory. This paper describes the use of a commercial ambulatory microprocessor based system (Edentrace II) for the evaluation of fifteen patients aged 24 to 68 years with clinical features suggestive of sleep apnoea syndrome. With this portable recording system, sleep studies can be carried out unattended in a hospital ward and computer-assisted scoring of respiratory events can be performed.
Study site: Chest clinic, wards, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
This paper outlines our approach to the diagnosis of Idiopathic Oedema. The patient presented illustrates some of the pertinent clinical and laboratory pointers one has to take into consideration before labelling a person as suffering from idiopathic oedema. The discussion also includes a brief review of the literature on the patho-physiology and management of this benign disorder.
The general lack of specialist obstetricians in a developing country such as Malaysia prompted us to develop a computer expert system for the management of fetal distress in rural hospitals. It was based on accepted production rules and implemented on a microcomputer. The clinical prototype was evaluated by 8 specialist obstetricians and 21 non-specialist doctors involved in obstetric care. The initial impression was that this type of expert system may help in diagnosis, decision-making and teaching.
A case of endometrial infection by Entamoeba histolytica is described in an elderly lady who presented with profuse vaginal discharge and was clinically misdiagnosed as endometrial carcinoma.
The study concerned the identification of the beta-thalassaemia mutations that were present in 24 patients with beta-thalassaemia major who were transfusion dependent. The application of a modified polymerase chain reaction, the amplification refractory system (ARMS) was found to be an effective and rapid method for the identification of the beta-thalassaemia mutations. Six different mutations were detected. Seventy five percent of the patients were Chinese-Malaysians and showed the commonly occurring anomalies: 1. frameshift codon 41 and 42 (-TCTT); 2. the C to T substitution at position 654 of intron 2 (IVS-2); 3. the mutation at position -28(A to G); and the nonsense mutation A to T at codon 17. In the Malays, the common mutations seen were: 1. the G to C mutation at position 5 of IVS-1; 2. the G to T mutation at position 1 of intron 1 (IVS-1); and the A to T at codon 17. The delineation of the specific mutations present will enable effective prenatal diagnosis for beta-thalassaemia to be instituted.
The distribution of restriction fragment length polymorphism (RFLP) at the BamH1 site of the beta-globin gene was investigated in the Chinese, Indian, and Malay race in Singapore. The sample comprised of 183 normal individuals and 35 beta-thalassemia carriers in which 13 were couples with at least one beta-major child. The results from this study indicate that BamH1 polymorphism will be informative in 22% of pregnancies at risk for beta-thalassemia major in Chinese, 19% in Malays and 7% in Indians. In prenatal diagnosis using BamH1 polymorphism for one beta-major affected family, the fetus was diagnosed to be normal or beta-carrier. The validity of BamH1 polymorphism in the exclusion of beta-thalassemia major was subsequently confirmed at birth by globin chain biosynthesis.
In the University Hospital, Kuala Lumpur, from 1984 to 1990, 184 patients with acute conjunctivitis were examined for chlamydial infection by direct immunofluorescence. Overall, 52 (28.3%) were found to be positive for chlamydial antigen. There was no significant difference in the detection rate between men and women and among the 3 major ethnic groups. The detection rate was highest among sexually active adults. Epidemiological and clinical features suggest that most of the chlamydial ocular infections seen were inclusion conjunctivitis and not classical trachoma.
Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia