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Article in English | WPRIM | ID: wpr-875928


@#Oesophageal perforation is a not uncommon condition, yet it carries a high mortality rate and has been observed as the most grievous trauma to the digestive tract. Common causes include iatrogenic instrumentation, foreign-body swallowing, and physical injury. This report highlighted a case of oesophageal perforation complicated by formation of proximal descending aorta pseudoaneurysm as a result of okra ingestion. The patient was successfully treated with conservative treatment. The possible mechanism of oesophageal rupture, diagnosis, treatment, and other complication will be further discussed.

Article in English | WPRIM | ID: wpr-875927


@#Spontaneous pneumothorax and pneumomediastinum is defined as presence of free air or gas in the pleural cavity and mediastinal structures respectively. Spontaneous pneumothorax seems to be associated with anatomical abnormalities such as subpleural blebs or bullae, however not for spontaneous pneumomediastinum which may developed without an apparent precipitating cause. Both usually may occur in young healthy adults without serious underlying lung disease. We report a case of spontaneous pneumothorax and pneumomediastinum after a trivial injury. He was initially presented with dyspnea after two weeks of initial trivial trauma. Chest radiograph showed left apical pneumothorax with pneumomediastinum with no evidence of rib fracture. His condition was deemed non-traumatic by surgical colleague, thus admitted to medical ward for observation and eventually discharged well.

Article in English | WPRIM | ID: wpr-875926


@#Sarcoidosis is characterized by formation of inflammatory granulomas affecting all over the body, with pulmonary predilection (1). Neurosarcoidosis is a rare but potentially dangerous manifestation of sarcoidosis. We report a case of disseminated sarcoidosis presenting with a neurological diagnostic dilemma. Worsening mediastinal lymphadenopathy, together formation of lung and liver nodules making a sarcoidosis diagnosis favourable. Histology from these lesions showed non-caseating granulomatous inflammation. She was treated as a rare case of disseminated sarcoidosis. To date, there is no specific or clear guideline on the management of disseminated sarcoidosis.

Article in English | WPRIM | ID: wpr-875925


@#Necrotizing autoimmune myopathy (NAM) is considered a new subgroup of a rare autoimmune idiopathic inflammatory myopathies. Classically, NAM presented with sub-acute onset of proximal muscle loss of power with raised creatinine kinase and characteristic muscle biopsy showing muscle necrosis and regeneration with little inflammation. Statin use, connective tissue diseases, malignancy and HIV infection are the identified risk factors for NAM. The autoantibodies expected to be presented in NAM are anti-signal recognition particle (SRP) and anti-hydroxymethylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies. In this article, we present three cases of NAM with different risk factors and autoantibodies which we believe to have impact on the clinical course and outcome of our patients

Article in English | WPRIM | ID: wpr-875924


@#Sarcomas usually frequented in the head and neck region of young adults. Trachea is a rare site, and due to scarce clinical data, its clinical outcome is unclear. We reported a case of 60-year old patient presented with progressive worsening shortness of breath, cough, and progressive worsening dysphagia. Computer tomography scan revealed extensive 2 lobulated soft tissue lesions within and surrounding the trachea at the T4 level. Rigid bronchoscopy with mass cryo-debulking was performed and ultimately synovial sarcoma was diagnosed. Shortness of breath was completely relieved post-procedure.

Article in English | WPRIM | ID: wpr-875920


@#Introduction: Malaysia is an intermediate tuberculosis burdened country as classified by WHO. There was a recent rise in TB incidence. Healthcare providers, especially in secondary or tertiary centers, were constantly exposed to TB infected patients, which is a hazard source for TB infection. Thus, assessment of behavior towards TB is paramount through knowledge, attitude, health-seeking practice, and stigma domains. Method: A cross-sectional survey was carried out between November 2014 and February 2015 among healthcare providers in Medical Department, Hospital Ampang. Data were analyzed using SPSS ver 21. Results: Despite overall good knowledge on TB, only 20% of the correspondence knew which patient’s population is at risk of TB infection. Almost all perceived TB as a health threat and willing to seek medical care if they developed TB symptoms. However, a small proportion (5.3%) will keep it a secret if they contracted TB. This is contrasted by the majority that perceived TB patients will not be accepted by the community. Conclusion: Knowledge and attitude towards TB was adequate within the healthcare providers in Medical Department, Hospital Ampang despite the presence of some knowledge gaps. However, there was high perceived stigma that needed to be addressed in order for them to deliver the best medical care.