Cubitus Valgus with Tardy Ulnar Nerve Palsy - Is Anterior Transposition of the Ulnar Nerve Always Necessary? A Case Report.

Tardy ulnar nerve palsy is a known complication of cubitus valgus. The options for treating the ulnar neuropathy include anterior nerve transposition or neurolysis. We report on an 11-year-old boy who had a tardy ulnar nerve palsy due to cubitus valgus resulting from a non-union of a lateral condyle fracture of the humerus. Anterior transposition of the ulnar nerve was not done after the closing wedge osteotomy of the distal humerus. The close wedge osteotomy relieved the tension on the nerve and not transposing the ulnar nerve anteriorly prevented an iatrogenic nerve injury. The patient had no restriction with activities of daily living at the six years follow-up although neurological recovery was incomplete.

Concurrent stroke and ST-elevation myocardial infarction: Is it a contraindication for intravenous tenecteplase?

Acute ischemic stroke (AIS) and acute ST-elevation myocardial infarction (STEMI) are leading causes of mortality worldwide. Concurrent AIS presentation with STEMI is rare and potentially fatal. Most importantly to date many centres in Malaysia are still not aware on how to treat this condition. We report a case of AIS, which was treated with intravenous tenecteplase (TNK) according to ischemic stroke dosage and lead to improvement of neurological deficit.

Cubitus Valgus with Tardy Ulnar Nerve Palsy - Is Anterior Transposition of the Ulnar Nerve Necessary?: A Case Report

@#Tardy ulnar nerve palsy is a known complication of cubitus valgus. The options for treating the ulnar neuropathy include anterior nerve transposition or neurolysis. We report on an 11-year-old boy who had a tardy ulnar nerve palsy due to cubitus valgus resulting from a non-union of a lateral condyle fracture of the humerus. Anterior transposition of the ulnar nerve was not done after the closing wedge osteotomy of the distal humerus. The close wedge osteotomy relieved the tension on the nerve and not transposing the ulnar nerve anteriorly prevented an iatrogenic nerve injury. The patient had no restriction with activities of daily living at the six years follow-up although neurological recovery was incomplete.

POEMS syndrome.

POEMS syndrome is the syndrome of Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and typical Skin changes. A 65-year-old lady presented with the 2-day-history of inability to walk, 4-month-history of progressive worsening of muscle weakness of both lower limbs and 1-year-history of progressive worsening of bilateral numbness of lower limbs. Nerve conduction study revealed generalized sensorimotor demyelinating polyneuropathy. She was initially treated as chronic inflammatory demyelinating polyradiculoneuropathy with intravenous immunoglobulin (IVIG) and high-dose prednisolone. However, she had no significant neurological improvement despite getting standard therapy. In addition to peripheral neuropathy, the presence of hepatosplenomegaly, skin changes, polycythaemia and thrombocytosis prompted for further investigations. She was diagnosed as POEMS syndrome based on the presence of two mandatory major criteria [polyneuropathy, monoclonal plasma cell proliferative disorder (lambda)], one major criterion (sclerotic bone lesions) and three minor criteria (organomegaly, skin changes and thrombocytosis/polycythaemia). She received treatment with melphalan and prednisolone. She achieved clinical improvement and partial response (haematologic and radiological) after six cycles of therapy. We highlight the awareness of this rare syndrome, for patients presenting with peripheral neuropathy and not responding to its standard therapy, by recognizing other associated clinical manifestations and proceeding further diagnostic work-up.

Posterior reversible encephalopathy syndrome in systemic lupus erythematosus: pooled analysis of the literature reviews and report of six new cases.

INTRODUCTION: Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder which is increasingly recognized to occur in systemic lupus erythematosus (SLE). OBJECTIVE: The purpose of this study was to identify the characteristics of SLE patients with PRES and the associated factors of the poor outcome among them. METHODS: We investigated SLE patients who developed PRES between 2005-2011 at the Universiti Kebangsaan Malaysia Medical Centre. A comprehensive literature search was done to find all published cases of PRES in SLE. Pooled analysis was conducted to identify the factors associated with poor outcome. RESULTS: There were 103 cases of PRES in SLE published in the literature but only 87 cases were included in the analysis in view of incomplete individual data in the remaining cases. The majority of the cases were Asians (74.2%), female (95.4%) with mean age of 26.3 ± 8.8 years. PRES was highly associated with active disease (97.5%), hypertension (91.7%) and renal involvement (85.1%). We found that 79 patients had a full recovery (90.8%) with a mean onset of full clinical recovery in 5.6 ± 4.1 days. On univariate analysis and logistic regression analysis the predictors of poor outcome, defined as incomplete clinical recovery or death, were intracranial hemorrhage, odds ratio (OR) 14 (1.1-187.2), p=0.04 and brainstem involvement in PRES, OR 10.9 (1.3-90.6), p=0.003. CONCLUSION: Intracranial hemorrhage and brainstem involvement were the two important predictors of poor outcome of PRES. Larger prospective studies are needed to further delineate the risk of poor outcome among them.

Use of complementary medicine amongst diabetic patients in a public primary care clinic in Ipoh.

The use of Complementary Medicine (CM) amongst diabetic patients attending the Diabetes/Hypertension, Clinic. Out Patient Department, Ipoh Hospital was studied: Forty-three patients were selected by systematic random sampling (1:5) over a one-week period starting 5/12/01. Data were collected by patient interview, from medical records and through a questionnaire. 56% were using CM together with conventional therapy. Most commonly used were herbal therapy, homeopathy and reflexology. The majority took CM daily with a mean duration of 7 years. Over half had subjective relief of pain with increased energy. Patients on CM or conventional therapy both showed poorly controlled FBS levels. There is a need to assess the effect of these therapies on diabetic outcome.