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Medical Journal of Malaysia

W M Chung, Y Y Chian, A Azmir
Datura plants contain anticholinergic properties. Consumers may present with a spectrum of anticholinergic symptoms, including hallucination, agitation, tachycardia, delirium, hyperthermia, and dilated pupils. Prompt identification of the symptoms with appropriate treatment can be life-saving. Some patients might not be able to provide history and therefore recognition of toxidromes is imperative. Awareness should be built among the public who may be exposed to such fruits or plants.
December 2018: Medical Journal of Malaysia
C Y G Ong, H M Low, D Chinchure
Acute scrotal pain is a common complaint in emergency or primary care practice. A myriad of pathologies need to be considered, and while the clinical history often leads the clinician to the correct diagnosis, radiologists are often called upon to provide further diagnostic information through ultrasonography. Here, we present the sonographic features of various scrotal emergencies, as well as a few pitfalls. Through this, we explore the breadth of urgent pathologies that may be encountered, both traumatic and non-traumatic...
December 2018: Medical Journal of Malaysia
R Vignesh, S S Ganesh, M Vengata Subramani, M Ravindran, R H Abdul Karim
No abstract provided.
December 2018: Medical Journal of Malaysia
D R Navin Kumar
No abstract provided.
December 2018: Medical Journal of Malaysia
S Nahdiya, C Syukri
Bipolar mood disorder is an established psychiatric disorder affecting 1% of the population and it is a highly disabling disease. As of today, its aetiology is still a confounding question. This case is interesting as the patient presented with a full-blown mania after suffering from electrical injury. The persistent syndrome in this case could point to a unique diagnostic entity and offer possible explanation of the pathophysiology of manic depressive as well as a consideration for caution when prescribing electroconvulsive therapy (ECT)...
December 2018: Medical Journal of Malaysia
L Y Tan, A P Tan
Meningiomas are neoplasm arising from meningoepithelial cells, most commonly in the fifth to sixth decade of life. Meningiomas are rare in paediatric population, accounting for 0.4-4.1% of all paediatric tumours and less than 3% of paediatric brain tumours. However, meningiomas represent the most common dural based tumours in children. We describe a rare case of paediatric fibroblastic meningioma within the left middle cranial fossa masquerading as an intra-axial mass lesion. Our discussion will be centred on atypical features of paediatric meningiomas and differential diagnosis of extra-axial mass lesion in the paediatric population...
December 2018: Medical Journal of Malaysia
R Rao, J Naidu, K N Muhammad Nawawi, Z Q Wong, C S Ngiu, F Mohammed, R A Raja Ali, N Y Yaacob
Hepatic haemangioma is a solitary liver lesion and prevalent among the female patients. We report a case of diffuse hepatic haemangiomatosis in a 62-year-old man, who was referred for an incidental finding of multiple liver nodules. History and physical examinations were unremarkable. Computed tomography and magnetic resonance imaging of the liver were performed and showed multiple haemangiomatosis. In view of the rarity of this condition in men, a liver biopsy was done and confirmed haemangiomas. Available published literature on diffuse hepatic haemangiomatosis was reviewed...
December 2018: Medical Journal of Malaysia
S R Mugilan, J P Joseph
The diagnosis of Creutzfeldt-Jakob disease (CJD) can be challenging as findings are non-specific and there is low awareness of the disease. We present a case of an 83-yearold man with a two months history of rapidly progressive dementia. After a series of extensive diagnostic examinations, he was diagnosed with probable sporadic CJD with key findings of rapidly progressive dementia, myoclonus, pyramidal signs, abnormal hyperintensity signals on diffusion-weighted magnetic resonance imaging (DW-MRI) and typical electroencephalograph (EEG)...
December 2018: Medical Journal of Malaysia
W F Wan Jamaludin, W H Kok, L Loong, S K Palaniappan, M Z Zakaria, T C Ong, S F Abdul Wahid
Immune Thrombocytopenia Purpura (ITP) secondary to vaccinations is rare, especially after autologous hematopoietic stem cell transplantation (HSCT). A 31-yearold female received autologous HSCT for relapsed Hodgkin Disease, with platelet engraftment at Day+14. One week after receiving second scheduled vaccinations, she developed severe thrombocytopenia (3x109 /L) associated with pharyngeal hematoma. Bone marrow (BM) examinations were consistent with ITP, possibly secondary to Influenza vaccine. Platelet increment was poor despite high dose corticosteroids, intravenous immunoglobulin (IVIG), Danazol and Eltrombopag...
December 2018: Medical Journal of Malaysia
T L Tan, L Y Lee, W C Lim
The occurrence of Leptospirosis and Escherichia coli coinfection in the post-partum period is a novel case. This report illustrated a previously well woman from a suburban area presented with acute neurological deterioration following a two days history of fever during her puerperal period. Early interventions with fluids, broad spectrum antibiotics and intensive supportive care were given. Despite that, she deteriorated rapidly and developed pulmonary hemorrhage, disseminated intravascular coagulopathy, and multi-organ failure...
December 2018: Medical Journal of Malaysia
K Vincent, S D Cheah
Traumatic abdominal wall hernia (TAWH) after blunt injury is uncommon. Diagnosis requires careful examination and high index of suspicion. We report a case of a 12-year-old boy who complained of painful abdominal swelling over the left iliac fossa after a bicycle-handlebar hit his abdomen. TAWH was diagnosed clinically and confirmed with ultrasound and computed tomography (CT) scan. He developed incarceration after 12 hours of admission and subsequently underwent primary repair without mesh. As TAWH is usually associated with other concomitant injuries, it is important that we are meticulous to rule out other serious concomitant injuries...
December 2018: Medical Journal of Malaysia
K W Khoo, M S Arman Zaharil, M Z Mohd Ali
Craniosynostosis is a premature pathologic fusion of one or more cranial vault sutures leading to abnormally-shaped skull. It can occur in isolated event (non-syndromic), or it can occur in conjunction with other anomalies in welldefined patterns (syndromic). The diagnosis rests on clinical examination and confirmation is generally on the computed tomography scan. The need for surgery is both for cosmetic and functional reasons. Here we describe a case of nonsyndromic craniosynostosis that was treated with frontal orbital advancement (FOA)...
December 2018: Medical Journal of Malaysia
T J Huei, H T Lip, O Shamsuddin
Priapism is a rare clinical presentation of a patient with chronic myeloid leukaemia (CML). Herein, we present a young Nepalese man that presented to the emergency department with an acute and painful penile erection for two days. Clinically, he was pale and abdominal examination revealed hepatomegaly. Combined oncologic and initial urological intervention with carvernosal aspiration and intracavernosal phenylephrine failed to achieve detumescence. The patient underwent an emergency corporoglandular shunting eventually...
December 2018: Medical Journal of Malaysia
K Muhd Yusairi, L Vasu Pillai, M L Voon, K S Manisekar
No abstract provided.
December 2018: Medical Journal of Malaysia
V A Chidambaram, C Robert, C S Y Anita, C Garry
IgG4-related disease is a newly described systemic autoimmune and allergic disease, characterized histologically by a fibroinflammatory response with IgG4 plasma cells. It was initially described as affecting the pancreas, but commonly involves the head and neck region as well. While a biopsy is essential for definitive diagnosis, cross sectional imaging may be the initial modality which may suggest this entity. We describe a case of pathologically proven IgG4 related disease which highlights some key radiologic features seen in this entity...
December 2018: Medical Journal of Malaysia
H S Koay, M Anis, S A Mokhtar
We report a rare case of persistent left superior vena cava (PLSVC) with direct drainage into the left atrium in a 3-yearsold boy who had been electively admitted for hypospadias repair, when he was noticed to have finger clubbing and mild hypoxia but was otherwise asymptomatic. The diagnosis of PLSVC can be made without an invasive tool as direct drainage of PLSVC into the left atrium be visualised using transthoracic echocardiography (TTE) by injecting agitated saline into the left arm.
December 2018: Medical Journal of Malaysia
S H Ng, S Roshan
Kawasaki disease is an autoimmune disease that commonly affects children below the age of 5 years. It is a vasculitic disease of unknown aetiology effecting the skin, eyes, lymph nodes and mucosal layer. Intravenous Immunoglobulin (IVIG) and aspirin therapy are the mainstay treatment however a number of cases have been shown to be refractory to this treatment. Evidence regarding approach and treatment for such cases is limited. This case report is to share our experience in the management of Refractive Kawasaki disease at a district level...
December 2018: Medical Journal of Malaysia
A K Noor Khairiah, M N Mohamad Nazrulhisham, M N Hazman
Malignant intrathoracic disease is the commonest cause of superior vena cava (SVC) obstruction. Life threatening SVC obstruction with intense dyspnoea requires urgent treatment. SVC stenting has been developed in recent years which results in rapid relief of the obstruction. The Yconfiguration technique has been reported to provide support for all three limbs of the bifurcation to prevent restenosis. At present, there are limited reports on the use of Y-configuration stent in stent techniques for endovascular stenting in malignant SVC obstruction...
December 2018: Medical Journal of Malaysia
M F Mohamad Isa, J M Tan, M F Abdul Aziz, C L Leong
Influenza outbreaks in tropical countries are rarely reported. This article reports four cases of influenza within a psychiatric ward of a tertiary hospital in Malaysia. These were patients with severe mental illness who were involuntarily admitted and did not show the classical triad of influenza-like-illness (ILI) at the beginning. However, severe respiratory complications developed requiring intubation. Referral and cooperation with the infectious disease team was initiated to help manage the outbreak while continuing psychiatric treatment...
December 2018: Medical Journal of Malaysia
S S Kho, M C Yong, S K Chan, S T Tie, P J Voon
Malignant central airway obstruction (CAO) with ball valve effect (BVE) in the lung is rare. We discuss a case of metastatic colon cancer who presented with asthma like symptoms which thoracic computed tomography and bronchoscopy revealed an intraluminal tumour obstructing the left main bronchus in a ball valve manner. Airway patency was restored urgently with immediate alleviation of symptoms. This illustrates the importance of recognizing subtle features of central airway obstruction to allow expedition of appropriate investigations and therapy...
December 2018: Medical Journal of Malaysia
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