Authors: Chin Voon Tong, Mohamad Rafie bin Md Kaslan.

ABSTRACT

In pregnancy, the diagnosis of primary hyperparathyroidism (PHP) may be delayed due to physiological changes that occur during this period. The maternal related complications of PHP during pregnancy has been reported to be as high as 67%, whilst fetal complications up to 80% of cases.1 The therapeutic gold standard and definitive treatment for PHP in pregnancy is minimally invasive parathyroidectomy in the second trimester. We report a case of a 22-year old primidgravida who underwent parathyroidectomy in the third trimester of her pregnancy for PHP with persistent hypercalcemia. She was also found to have Vitamin D deficiency which probably led to secondary hyperparathyroidism and made her hypercalcemia more apparent during pregnancy.

Keywords: Primary hyperparathyroidism, hypercalcemia, pregnancy, parathyroidectomy, vitamin D deficiency.

Citation: IeJSME 2015 9(3): 47-51

DOI: https://doi.org/10.56026/imu.9.3.47

Authors: Norly Salleh, Aishah Ibrahim, Ros’aini Paijan.

ABSTRACT

Leiomyosarcoma is a rare cancer and the presence of this type of cancer in the breast is even rarer. Due to its rarity, the management options for leiomyosarcoma of the breast are not well documented. Literature review was done to establish the best treatment options for this type of breast cancer.

Keywords: breast cancer, leiomyosarcoma.

Citation: IeJSME 2015 9(3): 52-54

DOI: https://doi.org/10.56026/imu.9.3.52

Authors: Rafiqahmed Vasiwala, Ismail Burud.

ABSTRACT

Malignant melanoma is a rare malignancy of the external auditory canal. The vast majority of them occur in the areas of the body that are exposed to the sun. Early histological examination may possibly favor better prognosis. We report a case of a 38-year-old female who presented with a small mass in right ear canal, earache and minimum discharge since 4 months. Initially scraping was done in the ENT clinic. Subsequently she had a wide excision done by the end aural approach at a different hospital. A year later the patient presented with a swelling involving the ear canal which extended to the helix and supratemporal region with the histology report as malignant melanoma. A literature review of the disease, radiological findings, immunohistochemical features and treatment options are discussed.

Keywords: ear canal, malignant melanoma, wart.

Citation: IeJSME 2016 10(1): 47-48

DOI: https://doi.org/10.56026/imu.10.1.47

Authors: Ren Yi Kow, Dhiauddin Hai Ismail, Jamaluddin Shafie, Ruben Jaya Kumar, Nor Hafliza Md Salleh, Chooi Leng Low.

ABSTRACT

Marjolin’s ulcer is a malignant cutaneous ulcer that undergoes transformation from a previously traumatized or chronically inflammed skin.1 Causes leading to ulcerations can be burn injury, trauma, chronic osteomyelitis and varicose ulcers.2 It is named after a French surgeon, Jean Nicolas Marjolin, who first described the condition in patients who developed malignant ulcers from burn scars.3 We report a case of a chronic non-healing foot ulcer that has become a Marjolin’s ulcer after 12 years.

Keywords: Marjolin’s ulcer, chronic wound, squamous cell carcinoma, malignancies.

Citation: IeJSME 2016 10(3): 34-36

DOI: https://doi.org/10.56026/imu.10.3.34

Authors: Siew Kim Kwa, Zainab Abdul Majeed, Kah Nian Tan.

ABSTRACT

Myasthenia gravis (MG) is a rare autoimmune disorder characterised by fluctuating and variable combination of muscle weakness and fatigue. Most cases are due to T-cell mediated autoantibodies against post-synaptic acetylcholine receptors (AChR-Ab), thus preventing acetylcholine from binding and signalling skeletal muscle to contract.1

The annual incidence is 7-23 new cases per million.1 It can occur at any age but with two peaks; an earlyonset (20-40 years) female-predominant and a late-onset (60-80 years) male-predominant peak. MG is classified into ocular and generalised (80%). More than half the patients initially present with ptosis and diplopia but half will progress to generalised disease with involvement of bulbar, limb and respiratory weakness. Those presenting as generalised MG can also develop eye signs later.1

It is important to recognise MG early because it is highly treatable. Untreated disease leads to permanent weakness.2 Treatment reduces mortality from lifethreatening myasthenic crisis.1,3 Misdiagnosis leads to potentially harmful interventions and inappropriate management.4,5 Diagnosis in late-onset MG is easily missed2,3,4,5 because of overlapping symptoms with other diseases common in the elderly. We report a case of delay and misdiagnosis in an elderly patient with co-morbidities.

Keywords: Myasthenia gravis, misdiagnosis, delay diagnosis, late-onset, elderly.

Citation: IeJSME 2016 10(3): 37-39

DOI: https://doi.org/10.56026/imu.10.3.37

Authors: Mohd Razaleigh Yusof, Tony Yong Yee Kong, Andee Dzulkarnaen Zakaria.

ABSTRACT

There has been an increase in the number of Motor Vehicle Accidents (MVA) in Malaysia throughout the years. Although blunt neck injury is uncommon, it is associated with severe, permanent neurological deficit with risk of mortality. This case is a classical presentation of a young male involved in a MVA who sustained head and neck injuries of varying severity. After a short symptom free interval, the patient started to develop neurological signs. Presenting signs and symptoms include Horner’s syndrome, dysphasia, hemiparesis, obtundation or monoparesis. A computed tomography (CT) scan of brain must be done and if the findings showed that there is no intracranial bleeding (ICB), high suspicions with further evaluation should be done. Confirmation can be obtained by Doppler ultrasonography, magnetic resonance imaging, magnetic resonance angiography (MRA), CT angiography (CTA) or catheter angiography to rule out carotid artery injury.

Keywords: Carotid artery dissection, blunt neck trauma.

Citation: IeJSME 2017 11(2): 24-29

DOI: https://doi.org/10.56026/imu.11.2.24

Authors: Yong-Ting Tai, Chin-Voon Tong.

ABSTRACT

We report a case of occult primary spontaneous pneumothorax in a 30 years-old woman. She developed symptoms and signs that were suggestive of pneumothorax. However, chest radiograph failed to reveal pneumothorax. Therefore, we proceeded with computed tomography (CT) thorax which revealed significantly moderate right pneumothorax. The diagnostic approach and the management of this case are discussed.

Keywords: Spontaneous pneumothorax, occult pneumothorax, chest radiograph, CT thorax.

Citation: IeJSME 2017 11(2): 30-33

DOI: https://doi.org/10.56026/imu.11.2.30

Authors: Ren Yi Kow, Zamri Ab Rahman, Ruben Jaya Kumar, Zaharul Azri Mustapha@Zakaria, Chooi Leng Low.

ABSTRACT

Femoral nailing is the overall “gold standard” in treating femoral shaft fractures. However, plate osteosynthesis at the femoral shaft is still being done in selected patients. We report a case of right femoral implant failure after a broad limited contact dynamic compression plate (LC-DCP) insertion and its subsequent management using our minimally invasive technique. Our technique is biologically compliant as well as cosmetically friendly. We converted a load-bearing implant into a load-sharing implant in view that obesity is a significant predictive factor of non-union in a femoral fracture treated with locking plate. The patient subsequently recovered well with no complication.

Keywords: Implant failure, intramedullary nail, dynamic compression plate, femur fracture, obesity, minimally invasive.

Citation: IeJSME 2017 11(1): 39-42

DOI: https://doi.org/10.56026/imu.11.1.39

Authors: Saiful Azlan Bin Kamisan, Ren Yi Kow, Ed Simor Khan Mor Japar Khan, Sa’adon Bin Ibrahim.

ABSTRACT

Dengue fever, a common mosquito-borne disease in Malaysia, has a wide range of clinical presentations. Dengue shock syndrome, a potentially fatal complication of dengue, is associated with derangement of numerous haematologic markers. A compromised coagulation profile, coupled with a traumatic incident may lead to a serious haemorrhagic complication. We present a rare complication of acute compartment syndrome of the right upper limb in a 17- year-old gentleman who was admitted for decompensated dengue shock syndrome after an unsuccessful attempt of venous cannulation. An emergency fasciotomy was performed and the right upper limb was salvaged albeit with ulnar nerve and radial nerve palsy.

Citation: IeJSME 2018 12(3): 30-32

DOI: https://doi.org/10.56026/imu.12.3.30

Authors: Sangeetha Poovaneswaran, Justin Zon Ern Lee, Whei Ying Lim, Navarasi S Raja Gopal, Fauziah Mohd Dali, Ibtisam Mohamad.

ABSTRACT

Solitary adrenal metastasis is a rare presentation in breast cancer and it presents the clinician with a difficult therapeutic dilemma as there are no existing guidelines for optimal management. On literature review, we only found one published case report of solitary adrenal metastasis from infiltrating ductal carcinoma of the breast. Here we present a case of a 75 year-old lady who presented with a right breast lump which was subsequently confirmed to be infiltrating ductal carcinoma. She underwent a right mastectomy and axillary clearance. Computerised tomography (CT) staging revealed a solitary adrenal metastasis. She was treated with aromatase inhibitors and her tumour markers which were initially raised has now normalised.

Keywords: adrenal metastases, infiltrating ductal carcinoma, breast cancer.

Citation: IeJSME 2013 7(1): 33-36

DOI: https://doi.org/10.56026/imu.7.1.33