Near-miss Thoracic Spine Solitary Plasmacytoma with Neurological Deficit during Pregnancy: A Case Report.

Solitary plasmacytoma (SPC) account for only 5% of plasma cell neoplasms, and the literature hardly reports spinal SPC with a neurological deficit. Furthermore, spinal surgical intervention during pregnancy is rarely encountered and often requires multidisciplinary collaboration and management. The objective of this case report is to highlight this near-miss diagnosis and spinal surgical intervention during pregnancy. A 31-year-old woman with 24 weeks gestation presented with sudden paralysis and incontinence, with an underlying history of chronic backpain over a two-month period. Initially, she was treated for musculoskeletal back pain by obstetric colleagues during an antenatal visit, and no radiograph was performed. A non-contrasted spinal MRI was eventually requested when she started to show bilateral lower limb weakness, numbness and incontinence. The MRI highlighted thoracic vertebrae T11 vertebra plana with kyphotic deformity and a paraspinal soft tissue mass compressing the spinal cord causing spinal cord oedema. Our initial working diagnosis was spinal tuberculosis (TB), considering TB is highly endemic in Malaysia. However, TB workup was negative, and we proceeded with spinal surgery and transpedicular biopsy. Neurology improved significantly after surgery. Eventually, serum protein electrophoresis reported plasma dyscrasia, and HPE confirmed plasmacytoma. The patient was referred to a haematologist for steroidal and chemotherapy treatment.

Femoral Neck Non-Union - A Biomechanical Solution with Valgus Sliding Subtrochanteric Osteotomy: A Case Report.

Avascular necrosis and non-union are two most dreaded complications of femoral neck fracture fixations. Hip replacement seems to be a simple solution for this complex problem. However, the long-term efficacy of prosthetic replacement in the young population with higher functional demand is still questionable. Femoral head preserving valgus subtrochanteric osteotomies in properly selected cases have strong support from literature. The conventional technique of valgus subtrochanteric osteotomy involves lateral based wedge resection. Alternatively, a simpler sliding oblique subtrochanteric osteotomy without any wedge removal can also be performed. We hereby describe a successful case of sliding subtrochanteric osteotomy with 135° dynamic hip screw (DHS) plate fixation in treating non-union neck of femur fracture in a young gentleman.

Infantile myofibromatosis.

Infantile myofibromatosis (IMF) is a rare tumour with a wide spectrum of disease activity ranging from a solitary cutaneous nodule through to a multicentric form with widespread visceral involvement. It is characterised by its unique ability to spontaneously regress and has a typical histological appearance of actin-positive fibroblasts arranged in whorls or fascicles and vessels in a pericytomatous pattern. A male infant with multiple lesions involving the subcutaneous tissue and bone from birth is described and followed-up for two years. Treatment of IMF is dependent on the location of the tumour/s with surgery or chemotherapy reserved for rapidly progressive or symptomatic disease. However, due to the low rate of recurrence and the possibility of spontaneous tumoral regression, therapeutic abstention, as practised in our patient, is justified.

Haemophilus influenzae meningitis in Malaysia.

OBJECTIVE: To determine the pattern of postneonatal childhood meningitis in Malaysia. METHODS: Retrospective cross-sectional study involving five pediatric departments in Malaysia. RESULTS: There were 435 cases of clinical meningitis admitted to the five centers. More than 90% of the patients were <5 years old, and one-half were <6 months of age. The estimated overall incidence of childhood meningitis in the first 5 years of life was 76.7 per 100000 per year. However, of the 435 cases only 71 (16.3%) fulfilled laboratory diagnostic criteria and in only 58 of these was an organism isolated. Nearly one-half (48%) of all bacteriologically proved cases were caused by Haemophilus influenzae type b (Hib). The mortality rate was 12.5% and 21 patients (30%) suffered neurologic sequelae. CONCLUSIONS: More than one-half of all cases of culture-positive childhood bacterial meningitis were caused by Hib, although successful isolation of a pathogen occurred in only a small proportion of cases. For this reason the true incidence of Hib meningitis in Malaysia remains unknown. These findings are consistent with previous studies in Malaysia.

Management of gastroschisis in a peripheral hospital setting.

Ten patients (5 males and 5 females) with gastroschisis were treated in Alor Setar Hospital from January 1989 to December 1993. Two patients had associated congenital anomalies. Primary closure was possible in 9 patient while the other patient had stage closure. All patients received prophylactic antibiotics, 9 patients were ventilated electively in the post-operative period and 7 patients received parenteral nutrition. There were 9 survivors. Complications especially wound infection and breakdown were seen in 7 patients. The average hospital stay was 36 days.

Sulfur dioxide inhibition of translocation in bean plants.

Exposure of the source leaf of bean (Phaseolus vulgaris L. cv. Black Valentine) for 2 hours to 2.9 microliters per liter SO(2) inhibited the net photosynthetic rate an average of 75% and, simultaneously, the translocation rate an average of 45%. Calculations indicated that the experimentally determined translocation rates from SO(2)-stressed leaves were lower than were the rates expected on the basis of the observed reductions in photosynthesis. It is inferred that, under SO(2) stress, the phloem-loading system becomes a major limiting step in controlling the translocation rate.Following removal of SO(2), photosynthesis recovered quite rapidly (to about 60% of its preexposure rate within 2 hours), but the translocation rate failed to increase during this time interval. This delayed response of translocation to removal of SO(2) does not appear to be due to an injury effect of SO(2), inasmuch as a similar effect was obtained by exposing the source leaf to a short (2-hour) interval of dark.