• Kaufman Dejesus posted an update 1 week, 1 day ago

    We report a 13-year-old Japanese female with ovarian teratoma due to anti-NMDAR encephalitis. The patient was admitted with psychiatric symptoms, including memory impairment, insomnia, binge eating and mouth and hand twisting, associated with constipation. Serum alphafetoprotein and neopterin levels were elevated 102 ng/mL and 19 pmol/mL, respectively. Electroencephalography showed epileptic spikes in frontal and temporal regions. Cerebrospinal fluid (CSF) examination exhibited a pleocytosis. Thereafter, her consciousness level immediately worsened. Brain magnetic resonance imaging (MRI) noted hyper intense lesions in bilateral hippocampi, she was diagnosed with limbic encephalitis. Abdominal echogram showed a solid right ovarian tumour. and also confirmed as a tumour by abdominal MRI. The next day, right ovariectomy was performed and she treated two courses of methyl-prednisolone steroid pulse with high-dose immunoglobulins. Later days, CSF analysis revealed anti- NMDAR antibodies. Pathological diagnosis of the tumour was immature round shaped grade 3 ovarian teratoma, measuring 11cm. Two years follow up after admission, she completely recovered and no neurological sequelae.We present here a case of a 66-year-old lady who was diagnosed with right iliac fossa retroperitoneal leiomyosarcoma at Hospital Umum Sarawak. The challenge in this case was the extension of tumour with the involvement of her right ureter causing proximal hydroureter and hydronephrosis. After resection of tumour en-block with the involved segment of ureter, it was not possible to repair the ureteric defect directly. We used interpositional vascularized appendix graft to repair this large (7 cm) ureteric defect. We describe here this uncommon technique of ureter reconstruction.A pseudoaneurysm, or false aneurysm, is a haematoma that is formed secondary to a leaking hole in an artery. This haematoma is contained by surrounding fascia. In contrast, a true aneurysm contains all three layers of vessel wall, namely intima. Pseudoaneurysms are scarce and can arise consequential of numerous iatrogenic influences, including but not limited to, blunt or penetrating trauma, orthopedic procedures like tibial nailing or ankle arthroscopy, and sports injury. A thorough history taking focusing on the recent history of trauma or instrumentation and clinical examination should raise the suspicion of a pseudoaneurysm. In doubtful cases, imaging modalities such as an ultrasound and doppler examination of the lower limb can be utilized to confirm the diagnosis. Our case was a 37-year-old gentleman presented with progressive swelling in the anterior aspect of his left leg for the past two weeks. The patient had a atypical presentation, with absence of classic signs of a pseudoaneurysm such as a pulsatile mass, absence distal pulses or a thrill or bruit. However, these injuries albeit rare can be sinister and prompt diagnosis is critical, so that pertinent treatment can be delivered. Our case highlights the importance of sonographic approaches for suspected vascular injuries.Acute mesenteric ischemia (AMI) is an emergency associated with a high mortality rate. A high index of clinical suspicion, prompt diagnosis and treatment is necessary to improve the patient outcome. The principle of damage control surgery should be adopted in the management of critically ill surgical patients with AMI. BSOinhibitor Strategic planning by resecting the ischemic bowel, physiological restoration and planned reassessment of remnant bowel with a definitive procedure is recommended. The resection of a long segment ischemic bowel may result in morbidity such as that of short bowel syndrome. We report here a case of decompensated cardiac failure in a 56-year-old lady, presented with one-day history of severe acute epigastric pain and abdominal distension. She presented with extensive bowel ischemia involving most of the superior mesenteric artery distribution. Damage control surgery followed by entero-colic anastomosis was performed 48 hours later. The patient recovered with remarkable intestinal adaptation without exhibiting short bowel syndrome symptoms despite the postulated theory of altered intestinal permeability in decompensated cardiac failure.Childhood severe asthma is different from adult asthma and little is known about the use of biologics in children in Malaysia. Uncontrolled severe asthma has significant morbidity and impact on the quality of life of the children and their families as well as increase healthcare burden. Anti-IgE therapy is known for its efficacy and safety for severe allergic asthma phenotype, both in adults and children. We describe our experience using omalizumab therapy in two pediatric cases of severe allergic asthma and the journey of these patients before and after omalizumab therapy.A 35-year-old lady presented at the Klinik Kesihatan Bandar 32 Bera, Pahang with a one-month history of multiple cervical swelling and ulcers over her neck area. The lesions began as papules and later progressively developed into nodules and pustules. She also had low grade fever associated with weight loss for one month duration. Chest xray revealed normal findings and sputum direct smear for acid fast bacilli was noted to be negative. Histopathologic finding of skin biopsy revealed central epidermal necrosis surrounded by granulomatous tissue forming an abscess and histiocyte infiltrates, confirming the diagnosis of Scrofuloderma. In view of the report of the fine needle aspiration cytology (FNAC) of the cervical lymph nodes suggestive for tuberculous lymphadenitis, the patient was given anti-tuberculosis therapy. Fortunately, six months later, the ulcers began to solve and heal gradually.Fertility preservation is significant for oncology patients to maintain their ability to start a family when they are ready. Onco-fertility, as a discipline, exists at the intersection of oncology and reproductive medicine that safeguards and expands the fertility options for cancer survivors, by facilitating early intervention and suitable treatment with favourable outcomes. Successful fertility preservation requires a comprehensive networking among the gynaecologists, oncologists, pathologists, imaging and other specialists, involved in diagnosing and treating cancer in the reproductive age group. There are several ways in which fertility can be preserved, like role of gonadotrophin releasing hormone analogues, in vitro maturation, and cryopreservation.