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Medical Journal of Malaysia

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https://www.readbyqxmd.com/read/28255154/immediate-simultaneous-bilateral-breast-reconstruction-with-deep-inferior-epigastric-diep-free-flap-and-transverse-rectus-abdominis-musculocutaneous-tram-pedicled-flap
#1
E J Roslan, E G Kelly, M A Zain, N H Basiron, F H Imran
Breast reconstructive surgery has evolved tremendously since its inception. Following tumour clearance surgery, physical restoration with breast reconstruction is an important aspect of physical and emotional rehabilitation. Various methods have been described to suit patients demand for the best aesthetic outcome. Surgeon's preference, experience and practicality of differing procedures must be considered. We describe a simultaneous bilateral breast reconstruction with free deep inferior epigastric (DIEP) flap and pedicled transverse rectus abdominis musculocutaneous (TRAM) flap immediately post mastectomies for bilateral breast cancers...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255153/an-unexpected-gangrenous-duplication-of-ileum
#2
C I Chiar, T Elango, L Sivaneswaran, R Umasangar, N Mohan
Alimentary tract duplication is a rare congenital anomaly which may involve any part of the alimentary tract extending from stomach to rectum. Clinical presentation may mimic an inflamed appendix as described in this case. A 9-year-old boy with a clinical diagnosis of perforated appendix was noted to have a normal appendix intra-operatively. On further search for an underlying pathology, a gangrenous ileal duplication was discovered. En-bloc resection with primary bowel anastomosis was done. Histopathology report revealed a gangrenous small bowel duplication...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255152/follicular-thyroid-cancer-with-sternal-metastasis-challenges-and-outcomes
#3
M A Syazni, H S Gendeh, N R Kosai, A R Ramzisham, B S Gendeh, N H Basiron, F H Imran
Sternal metastasis from differentiated thyroid carcinoma (DTC) is rare and presents a conundrum for surgeons. We present a lady diagnosed with follicular thyroid carcinoma and sternal metastasis who underwent thyroidectomy, sternectomy and sternoplasty with titanium mesh and acrylic plate. She developed a surgical site infection, of which multiple conservative approaches were attempted. She eventually required removal of the implant. Closure of sternal defect was completed with bilateral pectoralis major advancement flaps...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255151/abdominal-wall-necrotising-fasciitis-a-rare-but-devastating-complication-of-the-percutaneous-endoscopic-gastrostomy-procedure
#4
M R Mohd Said, R Abdul Rani, R A Raja Ali, C S Ngiu
Percutaneous Endoscopic Gastrostomy (PEG) tubes were often offered to patients requiring long term enteral feeding. Even though the procedure is relatively safe, it is associated with various complications such as peritonitis or even death.1 We presented a case of a 54-year-old gentleman with underlying ischemic stroke and pus discharges from a recently inserted PEG tube. Computed Topography (CT) scan confirmed abdominal wall necrotising fasciitis complicated with hyperosmolar hyperglycaemia state (HHS) and later succumbed after 48 hours of admission...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255150/computed-tomography-of-the-thorax-with-3d-reconstruction-in-penetrating-chest-injury
#5
A Michael, Z O Yahya, I Mdrazali, H Hanif
Penetrating chest wounds is less common but more deadly then blunt trauma. Majority of penetrating chest trauma can be managed conservatively with observation and simple thoracotomy. This case report highlights a bizarre occupational hazard causing a penetrating chest injury and the option of non-invasive management with the aid of computed tomography with 3D reconstruction.
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255149/unusual-presentation-of-severe-dengue-dengue-maculopathy
#6
K H Chuah, C W K Ng, K Zabri, C L Wong
Dengue infection is epidemic but ocular complications of dengue are less reported. We report a case of dengueinfected patient with disturbing ocular symptoms. He was admitted for severe dengue. Subsequently, he presented with symptoms of bilateral central scotoma with metamorphosia. Fundus examination revealed cotton wool spots and flame-shaped haemorrhages at the macula, with dull foveal light reflex. He was diagnosed with bilateral dengue maculopathy. The patient was managed conservatively with surveillance...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255148/bilateral-fracture-of-prostheses-post-hip-replacement
#7
S Surinder, P George
Fracture of hip prostheses is a rare occurrence. A case of bilateral hip prostheses fracture is described here. The need to follow-up and remain vigilant post hip replacement is highlighted.
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255147/intrapancreatic-accessory-spleen-an-eluding-diagnosis
#8
K H Teoh, S Balraj, S R Navarasi
Intrapancreatic accessory spleen (IPAS) is a benign anomaly of splenic embryology and a rare cause of pancreatic pseudotumour. Here, we report a case of a 70-year-old Malay lady whose IPAS was discovered incidentally during her surveillance computed tomography for her underlying left lower lung fibrosis. Radiologically, the lesion mimicked a neuroendocrine pancreatic tumour and was only diagnosed pathologically as IPAS after surgery. In conclusion, recognising IPAS as a differential for enhancing pancreatic mass allows us to exhaust all non-invasive diagnostic means to diagnose this benign lesion...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255146/large-adrenal-leiomyoma-presented-as-adrenal-incidentaloma-in-an-aids-patient-a-rare-entity
#9
T J Huei, H T Lip, M S Rahman, A Sarojah
The literature on adrenal gland tumour in HIV-infected patients is scarce. We report a 46-year-old Malay man with HIV and Hepatitis C infection presenting with a large nonfunctioning adrenal tumour. Computed tomography showed a large right adrenal tumour with heterogeneous enhancement and central necrosis. A high index of suspicion of a malignant tumour or pheochromocytoma led us to surgical removal of the adrenal gland. In this case report, we highlight important features to look for during pre-op evaluation of a large adrenal mass...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255145/infection-associated-haemophagocytic-syndrome-in-severe-dengue-infection-a-case-series-in-a-district-hospital
#10
Y S Y Jasmine, S L Lee, F K Kan
Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal disorder resulting from uncontrolled hyperinflammatory response. There had been increase in cases of one of the secondary form of HLH, i.e., infectionassociated haemophagocytic syndrome (IAHS) in severe dengue in recent years. However, the condition remains under diagnosed due to lack of awareness compounded by the lack of validated diagnostic criteria. Severe hepatitis with prolonged cytopenias, severe hyperferritinemia, hypofibrinogenemia and persistent fever were evident in all four cases reported...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255144/a-rare-case-of-large-sphenoethmoidal-osteoma
#11
Z Nazli, A W Abdul Fattah
Osteoma is the most common benign tumour of the nose and paranasal sinuses. However, involvement of the sphenoid sinus by osteoma is rare. Most of the time, patients with paranasal sinus osteoma are asymptomatic. However, symptoms may present, depending on the location and extension of the tumour. We report a case of a patient with sphenoethmoidal osteoma found incidentally on imaging, with evidence of impingement onto the optic nerve at the optic canal. However, the patient was asymptomatic. He was surgically treated using the endoscopic transnasal approach...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255143/inferior-vena-cava-and-intra-cardiac-invasion-of-hepatocellular-carcinoma-a-rare-but-catastrophic-complication
#12
C A Peter, U Anand Swaroop, B S Wong
Intra-cardiac extension of hepatocellular carcinoma (HCC) is an uncommon but serious condition related to poor prognosis. We report a 57-year-old male diagnosed with HCC with intra-cardiac extension into the right atrium at presentation. There were no symptoms related to cardiac involvement and intra-cardiac extension was incidentally noted on radiological imaging. He was offered palliative treatment and succumbed to his disease within 50 days of first diagnosis.
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255142/upper-gastrointestinal-haemorrhage-in-severe-dengue-to-scope-or-not-to-scope
#13
C H Lim, N H S Benjamin, F K Kan
Upper gastrointestinal haemorrhage (UGIH) in severe dengue represents a clinical dilemma in term of management. The recommended treatment in dengue with UGIH involves blood product transfusion support and proton pump inhibitor (PPI) infusion. Despite being the mainstay of treatment in non-dengue UGIH, the role of endoscopic haemostatic intervention in severe dengue remains controversial. In the present report, we present a case of severe dengue complicated with upper gastrointestinal haemorrhage successfully underwent early therapeutic endoscopic intervention in a district hospital...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255141/the-modern-implementation-of-patient-blood-management-pbm-in-malaysia-the-use-of-intravenous-iron-in-severe-anaemia-with-iron-deficiency-a-case-report
#14
A Krishnamoorthy, F A Hadi, A Naidu, J Sathar
Anaemia is a common condition in Malaysia, and is mostly due to iron deficiency. In many cases, allogeneic blood transfusion (ABT) is administered unnecessarily to treat anaemia. Patient blood management (PBM) is a concept whereby a patient becomes his or her "own blood bank", instead of receiving ABT. The concept encompasses three pillars namely optimising erythropoiesis, minimising blood loss and harnessing human physiological reserve. We present a safe and fruitful outcome of managing severe anaemia without utilising any ABT, made possible with the PBM approach including administration of intravenous iron...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255140/idiopathic-thrombocytopenic-purpura-in-childhood-langerhans-cell-histiocytosis-in-adulthood-more-than-a-chance-association
#15
Y C Kuan, M N Nurain
Described herein, a case of Langerhans cell histiocytosis (LCH) in an adult with Idiopathic Thrombocytopenic Purpura (ITP) diagnosed at age ten. She presented with cranial diabetes insipidus, later developed hypogonadotrophic hypogonadism and multiple cervical lympadenopathy from which histopathology of excisional biopsy confirmed LCH. Magnetic resonance imaging showed thickened pituitary stalk. Association of ITP and LCH is unknown but the question of LCH presenting as isolated thrombocytopenia in childhood only to be discovered in adulthood when there was pituitary and bone involvement remains...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255139/effectiveness-of-selective-risk-based-screening-for-gestational-diabetes-gdm-in-malaysia-a-retrospective-cohort-study-based-on-the-national-obstetric-registry-nor-of-malaysia
#16
G Muniswaran, S A Soelar, S D Karalasingam, M A Bujang, R Jeganathan, H Suharjono
INTRODUCTION: Gestational diabetes (GDM) has significant maternal and foetal implications. screening allows active interventions which significantly improves pregnancy outcomes. Despite World Health Organization (WHO), FIGO and National Institute of clinical Excellence (NIcE) recommendations for universal screening especially among high risk population; Malaysia currently adopts a selective risk based screening for GDM. OBJECTIVE: the objective is to audit the effectiveness of the current practice of selective risk based screening in detection of GDM in Malaysia...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255138/towards-developing-high-fidelity-simulated-learning-environment-training-modules-in-audiology
#17
A A Dzulkarnain, S Rahmat, N A F Mohd Puzi, M Badzis
INTRODUCTION: This discussion paper reviews and synthesises the literature on simulated learning environment (SLE) from allied health sciences, medical and nursing in general and audiology specifically. The focus of the paper is on discussing the use of high-fidelity (HF) SLE and describing the challenges for developing a HF SLE for clinical audiology training. METHODS: Through the review of the literature, this paper discusses seven questions, (i) What is SLE? (ii) What are the types of SLEs? (iii) How is SLE classified? (iv) What is HF SLE? (v) What types of SLEs are available in audiology and their level of fidelity? (vi) What are the components needed for developing HF SLE? (vii) What are the possible types of HF SLEs that are suitable for audiology training? Publications were identified by structured searches from three major databases PubMed, Web of Knowledge and PsychInfo and from the reference lists of relevant articles...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255137/clinical-spectrum-of-children-receiving-palliative-care-in-malaysian-hospitals
#18
L A Chong, F Khalid, T B Khoo, S H Teh, G L Kuan, A M Aina Mariana, E Alias, C H Chieng, H Razali, G B Ong, S H Zainah, I N C Shukor, J J Wong
INTRODUCTION: Awareness for paediatric palliative care has resulted in the impetus for paediatrician-led palliative care services across Malaysia. However, there is paucity of local data on patients receiving hospital-based paediatric palliative care. We aim to review the clinical spectrum of patients referred to these services. METHODS: An observational study of children aged between 0-18 years receiving palliative care at 13 hospitals between 1st January and 31st December 2014 was carried out...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255136/attitudes-barriers-and-facilitators-to-the-conduct-of-research-in-government-hospitals-a-cross-sectional-study-among-specialists-in-government-hospitals-northern-states-of-malaysia
#19
L C Teh, M Prema, M P Choy, G R Letchuman
INTRODUCTION: Specialists constitute a major 'driving force' and catalyst for growth of research in their speciality. A clearer understanding is required as to what motivates their participation in research as well as the barriers they faced. This research aims to study the attitudes, barriers and facilitators faced by specialists and to identify strategies to promote and sustain research activities in their hospitals. METHODOLOGY: A cross-sectional survey using selfadministered questionnaires was conducted among all specialists working in government specialist hospitals in the northern states of Malaysia...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28255135/patients-blood-pressure-control-and-doctors-adherence-to-hypertension-clinical-practice-guideline-in-managing-patients-at-health-clinics-in-kuala-muda-district-kedah
#20
S H Teoh, A R Razlina, D Norwati, M Y Siti Suhaila
BACKGROUND: blood pressure (bP) control among Malaysian is poor and doctor's adherence to clinical practice guideline (cPG) has been a well-known factor that may improve it. this study was designed to evaluate patients' bP control, doctors' adherence to the latest hypertension cPG and their association. Factors associated with bP control and cPG adherence was also examined. METHODS: A cross-sectional study was conducted in Kuala Muda district's health clinics. 331 medical records were selected using stratified random sampling and standard proforma was used for data collection...
February 2017: Medical Journal of Malaysia
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