MyMedR

Fulltext Repair of thoracic oesophageal perforation with latissimus dorsi flap

Yap CM

Med J Malaysia, 1994 Mar;49(1):100-1.

Thoracic oesophageal perforation, a life-threatening condition, is a therapeutic challenge. A 20 year old male developed a lower oesophageal perforation following an abdominal cardiomyotomy for achalasia of the lower oesophagus. The resulting suppurative mediastinitis and left empyema thoracis were treated by decortication. The oesophageal perforation was closed using a transposition pedicle left latissimus dorsi muscle flap.

Matched MeSH terms: Empyema/etiology; Esophageal Perforation/etiology; Intraoperative Complications/etiology; Mediastinitis/etiology

Pigbel in Papua New Guinea: an ancient disease rediscovered

Murrell TG

Int J Epidemiol, 1983 Jun;12(2):211-4.

PMID: 6307898

A hypothesis suggested in this paper is that pigbel, or enteritis necroticans was a common disease in mediaeval Europe when human habitats, food hygiene, protein deficiency and periodic meat feasting formed the basics of village life as they do in many Third World cultures today. Based on the Papua New Guinea experience with pigbel, it is suggested that health authorities should look closely at the epidemiology of the acute surgical abdomen in such communities. Enteritis necroticans may be the important predisposing lesion to mid-gut volvulus, jejunal and ileal ileus and other forms of small bowel strangulation in communities where protein deprivation, poor food hygiene, epochal meat feasting and staple diets containing trypsin inhibitors co-exist. Such human habitats occur in Central South America, Western Pacific, Asian and South-East Asian cultures. Isolated outbreaks of necrotising enteritis have been reported from Uganda, Malaysia and Indonesia but as yet no systematic epidemiological studies of the prevalence of small bowel strangulations have been described in the surgical literature of Third World countries. Now that enteritis necroticans is preventable by vaccination such studies should be undertaken.

Matched MeSH terms: Abdomen, Acute/etiology*; Clostridium Infections/etiology*; Enteritis/etiology*; Intestinal Obstruction/etiology*

The tampered implant. Intra-medullary nailing of the femur for fracture of the shaft-unusual difficulty in extraction: case report

Subramanian N

Med J Malaysia, 1973 Dec;28(2):123-4.

PMID: 4276229

Matched MeSH terms: Bone Diseases/etiology; Fistula/etiology; Osteomyelitis/etiology; Skin Diseases/etiology

Right hydronephrosis and vesicocolic fistula complicating sigmoid colonic diverticulitis: report of a case

Ng KK, Tan KM, Lim KT

Dis Colon Rectum, 1975 Oct;18(7):623-5.

PMID: 1181168

Matched MeSH terms: Urinary Bladder Fistula/etiology*; Colonic Diseases/etiology*; Hydronephrosis/etiology*; Intestinal Fistula/etiology*

Fulltext Syndrome of inappropriate antidiuretic hormone secretion and Leser-Trélat syndrome as uncommon paraneoplastic manifestations of renal malignancy - a geriatric experience: a case report

Nyanti L, Samsudin A, Tiong IK

J Med Case Rep, 2019 Jun 21;13(1):188.

PMID: 31221202 DOI: 10.1186/s13256-019-2122-8

BACKGROUND: Leser-Trélat syndrome, which manifests as eruptive multiple seborrheic keratoses, is a rare paraneoplastic sign. Hyponatremia in the elderly population is an often overlooked but potentially sinister biochemical abnormality. Cancer-related causes of hyponatremia include syndrome of inappropriate antidiuretic hormone secretion, cerebral or renal salt wasting, and adrenal dysfunction. We report a case of an elderly man who presented with both syndrome of inappropriate antidiuretic hormone secretion and Leser-Trélat syndrome, and was eventually found to have renal malignancy.

CASE PRESENTATION: A 74-year-old indigenous Malaysian man with underlying chronic kidney disease presented with recurrent admissions for hyponatremia with parameters indicative of syndrome of inappropriate antidiuretic hormone secretion, constitutional symptoms, and diffuse skin lesions suggestive of multiple seborrheic keratoses. A radiological workup revealed metastatic renal cell carcinoma with evidence of metastasis to the brain, adrenal glands, bone, and lungs.

CONCLUSIONS: To the best of our knowledge, renal malignancy presenting as syndrome of inappropriate antidiuretic hormone secretion and Leser-Trélat concurrently is rare. The causes of hyponatremia in the elderly, approach to investigation, and value as a poor prognostic marker in malignancy are highlighted. We also discuss Leser-Trélat syndrome, its pathophysiology, and its possible implications on clinical practice.

Matched MeSH terms: Hyponatremia/etiology; Inappropriate ADH Syndrome/etiology*; Paraneoplastic Syndromes/etiology*; Keratosis, Seborrheic/etiology*

Fulltext Acquired immunodeficiency syndrome presenting as childhood non-Hodgkin's lymphoma

Lee WS, Chan TL, Koh MT, Ariffin WA, Lin HP

Singapore Med J, 2001 Nov;42(11):530-3.

PMID: 11876380

Two children with non-Hodgkin's lymphoma (NHL) as the presenting illness of acquired immunodeficiency syndrome (AIDS) are described. There was a delay in diagnosing the underlying AIDS in both cases. In the first case, an 18-month-old boy with stage IV, high-grade,T-cell NHL, the diagnosis of underlying AIDS was suspected only when he developed recurrent and profound opportunistic infection during chemotherapy. The second case, an eight-month-old female infant presented initially with hepatosplenomegaly and thrombocytopenia of undetermined cause. She had progressive abdominal distension and swelling of her right eye one year later due to high grade B-cell NHL. She was later found to be sero-positive for HIV during pre-chemotherapy screening. As the prevalence of HIV infection continues to increase, HIV infection should be considered in the differential diagnoses of childhood hepatosplenomegaly and thrombocytopenia, and as a possible underlying cause of childhood cancer, especially NHL.

Matched MeSH terms: Lymphoma, Non-Hodgkin/etiology*; Lymphoma, B-Cell/etiology*; Lymphoma, T-Cell/etiology*; Lymphoma, AIDS-Related/etiology*

Fulltext Liver biopsy--past, present and future

Chuah SY

Singapore Med J, 1996 Feb;37(1):86-90.

PMID: 8783921

Percutaneous liver biopsy is widely used for the diagnosis and management of liver diseases. With the advancement in medical technology, there are now different approaches to performing liver biopsy, using various biopsy needles. This review highlights the differences between these various techniques. It re-examines in detail, the contraindications and complications of liver biopsy. Haemorrhage accounts for about 50% of all major complications and is the main cause of mortality. About 25% of complications are pulmonary in nature. The rest consists mainly of infective complications. Day case liver biopsy has been repeatedly shown to be safe in selected patients, but is underpracticed. Routine practice of image-guided biopsy is advocated, even in the absence of discrete lesion. Medicine is constantly evolving. New indications for liver biopsy, eg of transplanted liver, are to be expected. Conversely, with the advent in other less invasive modalities of investigation, some indications will disappear from the list.

Matched MeSH terms: Hemorrhage/etiology; Peritonitis/etiology; Pneumothorax/etiology; Sepsis/etiology

Fulltext Systemic lupus erythematosus presenting as parotitis and secondary Sjogren's syndrome

Azarisman Shah MS, Heselynn H

Singapore Med J, 2007 Feb;48(2):e60-1.

PMID: 17304382

A 38-year-old woman presented with right-sided parotid swelling, dry mouth and dry eyes of one year duration. Her Schirmer's test and sialometry were positive and histopathology showed lymphoplasmacytic infiltration. She also had concomitant normochromic , normocytic anaemia and mild haematuria. Her anti-nuclear antibody titre was also positive, 1:640, with a speckled pattern on immunofluorescence. We discuss the atypical presentation of systemic lupus erythematosus, particularly parotitis and secondary Sjogren's syndrome.

Matched MeSH terms: Parotitis/etiology*; Sjogren's Syndrome/etiology*; Xerostomia/etiology; Dry Eye Syndromes/etiology

Fulltext Left ventricular outflow tract (LVOT) vegetations and spontaneous obliteration of a large ruptured intracranial mycotic aneurysm in a case of infective endocarditis

Quah BS, Selladurai BM, Jayakumar CR, Mahendra Raj S

Singapore Med J, 1993 Apr;34(2):172-4.

PMID: 8266164

A 10-year-old girl with mild aortic regurgitation presented with cerebral infarction. Two-dimensional echocardiography showed vegetations on the septal wall of the left ventricular outflow tract without involvement of the aortic valve itself. After successful antibiotic treatment the patient developed an intra-cranial haemorrhage due to rupture of a large intracranial mycotic aneurysm. Consent for surgical treatment of the mycotic aneurysm was not obtained. Twelve months later repeat angiography showed that the aneurysm had undergone spontaneous obliteration.

Matched MeSH terms: Aneurysm, Infected/etiology*; Intracranial Aneurysm/etiology*; Cerebral Infarction/etiology; Aneurysm, Ruptured/etiology*

Pancreatobiliary and pancreatoduodenal fistulae in intraductal papillary mucinous neoplasm of the pancreas: report of a case

Bong JJ, Wang J, Spalding DR

Surg Today, 2011 Feb;41(2):281-4.

PMID: 21264770 DOI: 10.1007/s00595-009-4217-0

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas present more commonly in the elderly. This report describes a case of IPMN in a 36-year-old man who presented with obstructive jaundice and weight loss. The initial investigation by computed tomography scan revealed a cystic lesion in the head of pancreas fistulating into the duodenum and the common bile duct (CBD). Subsequent endoscopic retrograde cholangiopancreatography revealed a low CBD stricture with proximal filling defects. Mucin was observed extruding from the biliary orifice following an endoscopic sphincterotomy. A classic Whipple's pancreatoduodenectomy was performed to excise the lesion. A histological examination of the lesion confirmed the presence of a malignant IPMN of the pancreas complicated by pancreatobiliary and pancreatoduodenal fistulae.

Matched MeSH terms: Biliary Fistula/etiology*; Duodenal Diseases/etiology*; Intestinal Fistula/etiology*; Pancreatic Fistula/etiology*

Fulltext A Review of Risk Factors for Cognitive Impairment in Stroke Survivors

Mohd Zulkifly MF, Ghazali SE, Che Din N, Singh DK, Subramaniam P

ScientificWorldJournal, 2016;2016:3456943.

PMID: 27340686 DOI: 10.1155/2016/3456943

In this review, we aimed to identify the risk factors that may influence cognitive impairment among stroke survivors, namely, demographic, clinical, psychological, and physical determinants. A search from Medline, Scopus, and ISI Web of Science databases was conducted for papers published from year 2004 to 2015 related to risk factors of cognitive impairment among adult stroke survivors. A total of 1931 articles were retrieved, but only 27 articles met the criteria and were reviewed. In more than half of the articles it was found that demographical variables that include age, education level, and history of stroke were significant risk factors of cognitive impairment among stroke survivors. The review also indicated that diabetes mellitus, hypertension, types of stroke and affected region of brain, and stroke characteristics (e.g., size and location of infarctions) were clinical determinants that affected cognitive status. In addition, the presence of emotional disturbances mainly depressive symptoms showed significant effects on cognition. Independent relationships between cognition and functional impairment were also identified as determinants in a few studies. This review provided information on the possible risk factors of cognitive impairment in stroke survivors. This information may be beneficial in the prevention and management strategy of cognitive impairments among stroke survivors.

Matched MeSH terms: Cognition Disorders/etiology*; Mild Cognitive Impairment/etiology*

Fulltext Gangrenous small bowel obstruction secondary to congenital internal herniation: a case report

Tan YL, Alhagi MV

Med J Malaysia, 2012 Feb;67(1):118-20.

PMID: 22582563 MyJurnal

Congenital internal herniation is a rare condition presenting as recurrent abdominal pain or acute intestinal obstruction. In cases in which bowel incarceration or strangulation develop, rapid progression to bowel ischemia, necrosis or perforation is inevitable. Mortality in such cases has been reported to be as high as 50%. Despite advances in imaging modalities, arriving at a pre-operative diagnosis of a congenital internal herniation remains a challenge. We report such a case where imaging was unsuccessful in determining the cause of intestinal obstruction in a 3 year old child. Congenital internal herniation may result in disastrous consequences if not addressed in a timely fashion due to its rarity. Hence a high index of clinical suspicion is needed to avoid missing this diagnosis in a child presenting with recurrent abdominal pain or acute intestinal obstruction.

Matched MeSH terms: Gangrene/etiology*; Intestinal Obstruction/etiology*

Fulltext Trilateral retinoblastoma

Limn YS, Juraida E, Alagaratnam J, Menon BS

Med J Malaysia, 2011 Jun;66(2):156-7.

PMID: 22106703 MyJurnal

Trilateral retinoblastoma is the association of hereditary bilateral or unilateral retinoblastoma with a pineal neuroblastic tumour. We describe two cases of trilateral retinoblastoma from a total of 141 cases of retinoblastoma seen over an 8.5 year period. Both had a fatal outcome, with survival times of only 4 and 8 months respectively.

Matched MeSH terms: Retinoblastoma/etiology; Retinal Neoplasms/etiology

Compression neuropathy of the common peroneal nerve secondary to a ganglion cyst

Yazid Bajuri M, Tan BC, Das S, Hassan S, Subanesh S

Clin Ter, 2011;162(6):549-52.

PMID: 22262327

There are various causes of the common peroneal nerve palsy. However, common peroneal nerve palsy caused by ganglia are uncommon. We hereby present a case of a 55-year-old man with a 1 week history of foot drop and swelling in the region of the right leg. Physical examination and nerve conduction study studies confirmed a diagnosis of common peroneal nerve palsy. Magnetic resonance imaging (MRI) revealed a lobulated, elongated cystic-appearing mass anterior to the head of fibula. Surgical decompression of the nerve with removal of the mass was performed. Surgical pathology reports confirmed the diagnosis of a ganglion cyst. Findings on physical examination, nerve conduction study and MRI results of this interesting case are being discussed. We wish to highlight that even a tumour which is benign and within the nerve sheath can cause compression.

Matched MeSH terms: Nerve Compression Syndromes/etiology*; Peroneal Neuropathies/etiology*

Motor vehicle-assisted ligature strangulation causing complete decapitation: an autopsy report

Samberkar PN

Am J Forensic Med Pathol, 2012 Mar;33(1):86-7.

PMID: 21455053 DOI: 10.1097/PAF.0b013e3182186d72

The victim, a 63-year-old prosperous businessman from Labasa, of the Northern Island (Vanua Levu) of Fiji Islands, was found completely decapitated in the early hours of morning in 2004. Initial police investigation did not reveal any history of any medical or family calamity. Further inquiry by the police revealed that on the previous day the deceased had visited all his friends and relatives, and his behavior was not out of the ordinary. The police suspected it to be a case of homicide. On visit to the scene, a completely decapitated body was found in a van on a downhill road. Tire marks were found on the road. A nylon rope was used for ligature strangulation. At autopsy, the decapitation wound of the head and the torso articulated well. The face was congested, and there was tongue bite. Wound margins were clear-cut, with well-demarcated abrasion and multiple imprints of the nylon rope on the neck. The upper one third of the larynx was attached to the head. No other injuries were found on the body. From the findings, it was obvious that asphyxiation was involved in the death before decapitation.

Matched MeSH terms: Asphyxia/etiology*; Decapitation/etiology*

Fulltext Granulomatous prostatitis: a reminder to clinicians

Shanggar K, Zulkifli MZ, Razack AH, Dublin N

Med J Malaysia, 2010 Mar;65(1):21-2.

PMID: 21265242 MyJurnal

Granulomatous Prostatitis (GnP) is a heterogenous entity classified into specific infections, non-specific infections, post surgical i.e. post-transurethral resection of prostate (TURP) and rare secondary (systemic) causes. A total of 1388 reports of prostatic biopsy and prostatic chips from TURP were reviewed from 1995 and 2007. The results which showed granulomatous prostatitis were analyzed and retrospective data collected from the patient's records. A total of 9 cases with granulomatous prostatitis were identified. There are 3 types of entities which are the non-specific (NSGnP), post-TURP and the specific type. The incidence of GnP in our center is lower than reported by Stillwell et al. The majority of the patients were Malays.

Matched MeSH terms: Granuloma/etiology; Prostatitis/etiology

Fulltext Adult pyloric stenosis masquerading as acute renal failure

Siow SL, Wong CM, Sohail M

Med J Malaysia, 2009 Jun;64(2):168-9.

PMID: 20058581 MyJurnal

Gastric outlet obstruction and in particular, pyloric stenosis, is relatively common in developing countries. Acute clinical presentation is often the manifestation of biochemical and electrolyte changes. The presence of metabolic alkalosis in combination with acute renal failure should alarm us to the possibility of adult pyloric stenosis. We report a case of adult pyloric stenosis that presented as acute renal failure and discuss its pathophysiology.

Matched MeSH terms: Acidosis/etiology; Acute Kidney Injury/etiology*

Fulltext A tile factory worker presenting with breathlessness and dry cough

Khajotia R, Gupta ED

Aust Fam Physician, 2009 Oct;38(10):803-4.

PMID: 19893821

Jenny, a nonsmoker, 54 years of age, presents with 3 years of dry cough, progressive breathlessness and reducing exercise tolerance. Two years ago she was diagnosed with asthma and treated with inhaled bronchodilators (which have been marginally effective). Jenny has worked in a tile factory for 22 years; 15 years in the grinding department, transferring to the chipping department 7 years ago. On examination she is tachypnoeic with a prolonged expiratory phase. There are bilateral rhonchi and a few fine crepitations at the left infrascapular region. Jenny's full blood count and electrocardiogram are normal. Arterial blood gas show mild hypoxia with respiratory alkalosis. Spirometry demonstrates mixed moderate obstructive and restrictive impairment. The diffusion capacity for carbon monoxide is reduced. Mantoux is negative and erythrocyte sedimentation rate is 10 mm/hour. A chest X-ray is taken.

Matched MeSH terms: Cough/etiology*; Respiratory Insufficiency/etiology*

Fulltext Images in clinical medicine. Retinal detachment in malignant hypertension

Tajunisah I, Patel DK

N Engl J Med, 2009 Aug 27;361(9):899.

PMID: 19710488 DOI: 10.1056/NEJMicm0802683

Matched MeSH terms: Retinal Detachment/etiology*; Renal Insufficiency/etiology

Fulltext Typhoid fever presenting as acute cerebellar ataxia and severe thrombocytopenia

Cheong BM

Med J Malaysia, 2008 Mar;63(1):77-8.

PMID: 18935745 MyJurnal

Typhoid fever being a systemic infection can present in a multitude of ways, involving various systems. Here we describe a case of typhoid fever presenting with acute cerebellar ataxia and marked thrombocytopenia. This atypical presentation is not common in typhoid fever and can lead to misdiagnosis as well as a delay in the initiation of appropriate therapy. Prompt clinical improvement and the return of platelet counts to normal were noted after the patient was started on IV Ceftriaxone.

Matched MeSH terms: Cerebellar Ataxia/etiology*; Thrombocytopenia/etiology*

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