3.Carbimazole-induced aplastic anaemia - a case report
Vijay AP ; Lim SS ; Tan ATB ; Rokiah P ; Chan SP
Journal of University of Malaya Medical Centre 2009;12(2):92-95
Antithyroid drugs have been used for more than 50 years for the management of hyperthyroidism.
Most patients tolerate treatment well, but some may develop rare life threatening side effects such
as agranulocytosis and aplastic anaemia. Clinical experience with the latter condition is extremely
limited. We report on a case of carbimazole-induced aplastic anaemia caused by hypocellular bone
marrow and associated plasmacytosis in a thyrotoxic patient chronically treated with carbimazole.
This resolved after substitution with propylthiouracil. The clinical course was complicated by
neutropaenic septicaemia and atrial fibrillation.
Thyrotoxicosis
5.Evaluation of imaging performance of major image guidance systems
Chan MF* ; Yang J ; Song Y ; Burman C ; Chan P ; Li S
Biomedical Imaging and Intervention Journal 2011;7(2):1-7
Purpose: The imaging characteristics of two popular kV cone-beam CT (CBCT) and two MVCT systems utilised in
image-guided radiation therapy (IGRT) were evaluated.
Materials and methods: The study was performed on Varian Clinac iX, Elekta Synergy S, Siemens Oncor, and
Tomotherapy. A CT phantom (Catphan-504, Phantom Laboratory, Salem, NY) was scanned for measurements of image
quality including image noise, uniformity, density accuracy, spatial resolution, contrast linearity, and contrast resolution.
The measurement results were analysed using in-house image analysis software. Reproducibility, position correction,
and geometric accuracy were also evaluated with markers in a smaller alignment phantom. The performance evaluation
compared volumetric image properties from these four systems with those from a conventional diagnostic CT (CCT).
Results: It was shown that the linearity of the two kV CBCT was fairly consistent with CCT. The Elekta CBCT
with half-circle 27-cm FOV had higher CT numbers than the other three systems. The image noises of the Elekta kV
CBCT, Siemens MV CBCT, and Tomotherapy fan-beam CT (FBCT) are about 2-4 times higher than that of the Varian
CBCT. The spatial resolutions of two kV CBCTs and two MV CBCTs were 8-11 lp/cm and 3-5 lp/cm, respectively.
Conclusion: Elekta CBCT provided a faster image reconstruction and low dose per scan for half-circle scanning.
Varian CBCT had relatively lower image noise. Tomotherapy FBCT had the best uniformity.
6.A Case of Combined Nervus Showing Features of Common Blue Nervus and Dysplastic Nervus.
You Chan KIM ; Daniel P VANDERSTEEN ; Hyang Joon PARK ; Yong Woo CINN
Korean Journal of Dermatology 2000;38(5):674-676
No Abstract Available.
7.Carbimazole-related agranulocytosis in pregnancy - A case report
Lim SS ; Shireene V ; Vijay A ; Tan TBA ; Rokiah P ; Chan SP
Journal of University of Malaya Medical Centre 2007;10(1):34-38
We report a 33-year-old Malay lady who presented with fever, tonsillitis and pharyngitis
a month after initiation of antithyroid therapy (carbimazole 15 mg tds) for thyrotoxicosis by her general
practitioner. She was still clinically and biochemically thyrotoxic but not in thyroid storm. At that
time, she was also confirmed to be four weeks pregnant. Her full blood count revealed neutropaenia
with an absolute neutrophil count of 0.036 × 109/L. Bone marrow aspirate and trephine were compatible
with carbimazole-related agranulocytosis. Carbimazole was discontinued and she was given broad
spectrum antibiotics and Granulocyte Colony Stimulating Factor (GCSF), to which she responded.
Verapamil was used for symptomatic heart rate control instead of beta-blockers as she had a history of
bronchial asthma. The patient subsequently opted for termination of pregnancy after which she was
given radioactive iodine I131 (10 mCi) for definitive therapy of her thyrotoxicosis. In conclusion,
carbimazole-related agranulocytosis is an important entity to recognise and treat early to prevent
morbidity and mortality. Termination of pregnancy was carried out as the treatment given during the
episode of agranulocytosis may have negative effects on foetal viability and growth.
8.Metabolic syndrome amongst patients with psoriasis in a tertiary dermatology centre, Malaysia
Lee YY ; Lim SS ; Lee CK ; Tan ATB ; Ananda V ; Rokiah P ; Chan SP
Malaysian Journal of Dermatology 2011;27(-):6-6
Background: Psoriasis has been shown to be associated with a higher risk of metabolic syndrome and cardiovascular disease.
Objective: To investigate the prevalence of metabolic syndrome among patients with psoriasis and study the association between psoriasis and cardiovascular risk factors.
Methods: This was a hospital based case-control study conducted at the Dermatology Clinic, University Malaya Medical Centre (UMMC) from May 2010 to March 2011. A total of 131 adult patients with psoriasis and 129 age-, gender- and race-matched controls were recruited. All subjects answered a standardised cardiovascular risks questionnaire and had anthropometric measurements recorded. Laboratory investigations included fasting glucose / lipid profile, erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), urine microalbumin:creatinine ratio and an electrocardiogram. The diagnosis of metabolic
syndrome was made using the harmonised criteria for metabolic syndrome in South East Asians. Statistical analysis was performed using statistical processing software (SPSS-17).
Results: Metabolic syndrome was significantly higher among patients with psoriasis (64.9% versus 51.9%) (p = 0.034). The presence of metabolic syndrome was associated with low high density lipoprotein (HDL) (p=0.002) and high triglyceride (TG) levels (p = 0.014). The prevalence of diabetes mellitus was also significantly higher among patients with psoriasis (46.6% versus
27.1%) (p = 0.001). Hypertension, ischaemic heart disease, low density lipoprotein (LDL) levels, smoking and obesity were not significantly higher among patients with psoriasis.
Conclusion: Our results demonstrate an association between psoriasis and metabolic syndrome which was primarily due to diabetes mellitus and dyslipidaemia.
9.Large Volume Osteosarcomas of the Femur Treated with Total Femoral Replacement
Pan KL ; Chan WH ; Shanmugam P ; Ong GB ; Kamaruddin F ; Tan S
Malaysian Orthopaedic Journal 2014;8(1):32-36
Patients with extensive malignancies involving the femur
often require total femoral replacement when their limbs can
be salvaged. Reported series are small and involve
heterogeneity of tumours. We present nine patients with
osteosarcomas of the femur treated at our institution between
2003 and 2010 with a mean follow-up of 27 (6 to 56)
months. Their ages ranged from 9 to 17 (mean 14 years).
They had large volume tumours (mean 911 cm3
) and
presented late with a mean of 5.5 months from the onset of
symptoms to definitive treatment. All patients underwent
resection and total femur replacement. Six patients have
died and two are alive with good function at the time of this
report. One was lost to follow-up. These patients require a
high level of treatment care and have a guarded prognosis
Osteosarcoma
10.Uncertainty and Its Consequences in Clinical Practice.
Journal of Korean Medical Science 2015;30(11):1710-1712
No abstract available.
Clinical Decision-Making/*methods
;
*Evidence-Based Medicine
;
*Practice Patterns, Physicians'
;
*Uncertainty