Multiple primary malignancies of the upper aerodigestive tract occurring in the same patient are not commonly reported. The incidence varies from 1% to 20%. Second primary malignancy occurring at the same anatomical location is more common than those that arise from a distant location. We report a case of a 52-year-old Malay man who was previously treated for nasopharyngeal carcinoma with chemoradiotherapy and subsequently developed a basal cell carcinoma complicated by multiple recurrences and squamous cell carcinomas of the temporal region and the nose. Such an occurrence has not been previously reported in the literature.

Papillary thyroid carcinoma is a common thyroid malignancy reported world wide. It affects females more commonly in the 4th to 6th decades of life. The patients usually present with a painless anterior neck mass and occasionally with lymph node involvement. We report a case of an elderly male who presented with hoarseness and hemoptysis, which warranted bronchoscopy. Biopsy of the intraluminal tracheal mass revealed the diagnosis of papillary thyroid carcinoma. Computed tomography scan of the neck confirmed the presence of the primary lesion in the right thyroid lobe with invasion into the adjacent trachea and esophagus.

The unilateral nasal symptom should trigger a treating physician to a certain diagnosis. The differential diagnosis includes foreign body, rhinolith and tumour. The chronicity of symptom helps a lot with the diagnosis. Foreign body for example, tends to present with positive history of insertion, mainly by children or the acute symptom of local infection. In the presence of prolonged symptom, rhinolith should be suspected especially when the patient presents with pathognomonic nasal obstruction with foul smelly discharge. A referral should be made for a nasoendoscopy evaluation whenever a rhinitis-like symptoms remain after a period of medical treatment for allergy. We share a case of a missed diagnosis of a rhinolith after six years of symptoms. Keywords: nose; obstruction; rhinolith; unilateral

Foreign bodies or objects in the ear are one of the most common problems encountered by otorhinolaryngologist (ORL) with attendant complications, removal of which requires expertise. Patients with this problem who sought treatment in the otorhinolaryngology clinic of Hospital Universiti Sains Malaysia (HUSM) were studied for duration of one year from January 2010 to December 2010. Specifically, the clinical presentation, type of foreign body and management outcome were analysed. 72 patients were reviewed - 44 (61.1%) males and 28 (38.9%) females. The age range was one year to 75 years with 59.8% being children below 10 years old. Ear pain (56.9%) was recorded as the most common and persistent symptom and insects (54%) were the commonest foreign body encountered. 95% (69) of the foreign bodies were removed under clinic setting with only three (4.2%) cases requiring general anaesthesia. Post-removal complications were noted in only one patient (1.4%). Repeated attempts by untrained personnel should be avoided and timely referral is vital to avoid undesirable complications.

Jugular phlebectasia has been increasingly recognised with the advent of non-invasive diagnostic methods. Phlebectasia differs from varix, as it is an abnormal outward dilatation of a vein without tortuosity. It presents as a soft, compressible mass, apparent upon straining or execution of the Valsalva maneuver. The differentials for neck masses are broad, but if the swelling appears on the Valsalva maneuver, the type of mass narrows down to a laryngocele, superior mediastinal mass or phlebectasia. A simple non-invasive investigation, such as ultrasonography, is used as a diagnostic tool. We report a case of jugular phlebectasia that was suspected clinically and confirmed via ultrasound to be a vascular lesion which changed its size upon straining.

BACKGROUND: Pyoderma gangrenosum (PG) is an uncommon neutrophilic dermatosis typically characterized by painful cutaneous ulceration's with hermorrhagic and purulent crust. PG has several different variants that often delay correct diagnosis. Clinical appearance and histopathology should suggest the diagnosis and exclude other diseases with similar ulceration's. The course of the disease is variable, often chronic, and occasionally severe and progressive. PG is frequently associated with other inflammatory diseases, most often inflammatory bowel disease and rheumatoid arthritis. Management can be challenging, with immunosuppression as the mainstay of treatment.

This special editorial assessed the recent developments in Malaysian Journal of Medical Sciences (MJMS) and examined the characteristics of the submission, peer review, and publication processes for MJMS. This retrospective analysis used information about the manuscripts submitted to MJMS during the one-year period (from 1 June 2010 to 31 May 2010) since the start of current online submission and review system (ScholarOneTM Manuscripts, Thomson Reuters). In addition, we also discussed the future directions of MJMS. Finally, we would like to recommend an annual internal audit for MJMS, which is very useful to monitor the growth of this journal progressively.