Aim: This study aims to evaluate the demographics, to analyze the clinical and pathological findings, treatment and the outcome of oral cavity squamous cell carcinomas (OSCC) in patients aged 40-years old and below in our centre. Methods: Records of patients who were diagnosed with OSCC in the Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, from 1998 to 2003 were analyzed. Their socioeconomic data such as their age, gender and race, risk factors, family history and genetic predisposition were assessed. Other data examined included the sites and stage of the tumor, histopathology results, treatment modality and outcome of OSCC. Results: There were 19 patients with no gender predilection. Malays made up most patients diagnosed with OSCC, followed by Chinese and Indians. There was no significant high-risk habit in this group. Most of the sites involved were the tongue (73.7%), buccal mucosa (15.8%) and alveolus (10.5%). Most of the patients (57.9%) were diagnosed with stage IV disease. Eighteen patients underwent treatment consisting of surgery or radiotherapy or in combination. A 5-year follow up revealed that nine patients (47.3%) survived and remain well, four patients (21.1%) had a recurrence, two patients (10.5%) died of the disease. Conclusion: The majority of patients presented with stage IV disease without any significant high-risk habit. Surgery remains the mainstay of treatment, however, 5-year follow-up showed a less than 50% survival rate.
Objective: Rhinoliths in adult are rare and uncommon. Clinical Presentation and Intervention:We present two cases of rhinoliths in adult. The first case reports an interesting case of a healthy adult male who presented with symptoms of foul-smelling nasal discharge and nasal block. The second case report merely shows an adult with the same clinical symptoms in which a rhinolith was diagnosed. Both cases report incidental findings of huge rhinoliths in the right nasal cavity. Conclusion:Management of the rhinolith and possible genesis of the rhinolith are discussed.
Introduction: Ortner’s syndrome, or cardio-vocal syndrome, is a clinical entity characterised by hoarseness (secondary to left-sided recurrent laryngeal nerve palsy) caused by cardiovascular disease. The incidence of Ortner’s syndrome ranges from 0.25 percent to 0.5 percent of all cases of recurrent laryngeal nerve paralysis. Case Report: A 44-year-old Malay gentleman presented with hoarseness and shortness of breath for 4 days. It was associated with mild orthopnea and aspiration symptoms. He denied history of dysphagia, chronic cough, sore throat, chest pain, palpitation and decreased effort tolerance. There was no history of hypertension, diabetes and asthma. He also gave no history of recurrent fever with sore throat during childhood. Results: On examination, the patient appeared tachypnoeic. There was no peripheral oedema, cyanosis or clubbing. His blood pressure was 100/60 mm Hg and his pulse was irregular with a rate of 78/min. Neck examination was normal. Apex beat was not displaced. On auscultation the first heart sound was loud. A grade 3/6 long rumbling diastolic murmur was heard at the mitral area and he had bilateral basal crepitations. Laryngoscopy using 700 scope showed left vocal cord palsy in paramedian position with phonatory gap. Computed tomography (CT) of the thorax showed left atrial enlargement with prominent pulmonary veins. Echochardiography showed left atrial dilatation with thickened mitral valve. Left ventricular systolic function was good with ejection fraction of 70% and coronary angiogram showed normal coronary artery. A diagnosis of severe mitral stenosis with heart failure was made. Preoperatively the patient was stabilized and was referred for dental clearance. Then he underwent surgery for mitral and aortic valve replacement. Post-operatively patient recovered uneventfully. His hoarseness recovered completely after 3 months. Conclusion: Cardiovascular disease should be considered as a differential diagnosis in a patient with hoarseness.
Introduction: Falls may result in injuries, prolonged hospitalization, increase in morbidity and mortality, incur cost to the individual and the healthcare system and increase potential litigation. Various hospital fall prevention programs such as Morse Fall Scale Assessment Tool have been implemented in the last decade; however most of the program had no sustained effects on falls reduction over extended period of time. Benchmarking from private hospitals showed patients fall increased by 27% in 2008 as compared to 2007 (MPC report, 2008). There were 25 cases of falls in 2008 at KPJ Seremban Specialist Hospital. The objective of this program is to comply with The Joint Commission’s National Patient Safety Goals 9, “reduce the risk of patient harm resulting from falls” and to formulate evidence based best clinical practice recommendations on assessment and prevention of falls in the hospital for all inpatients, outpatients, customers and staffs within hospital premises. Materials and Methods: Contributing factors were identified based on the retrospective analysis of falls from 1st.January 2008 to 30th September 2008. A fall risk assessment tool identified as KPJ FRAT (KPJ Fall Risk Assessment Tool) for inpatient was developed and various other strategies to reduce the risk of falls throughout the hospital premises were identified. Points of engagement for inpatient assessment using KPJ FRAT were on admission, transfer in or when there is a change in patients’ condition. A prospective descriptive study was done and data was collected from 1st January 2009 till 31st December 2009 through interview with patients, healthcare providers and review of adverse event reports and medical records. Results: No of inpatients during this study were 37058 and there were 13 falls. The post implementation data reflects for every 1000 inpatient days the fall rate decreased to 4.3 falls. Conclusion: The use of KPJ FRAT and Fall Prevention program implemented throughout KPJ SSH has reduced the incidence of falls significantly by 48%. This might be due to increase awareness among the staff, hospital wide policy to report all cases and the formation of patient safety committee to formulate policy and reinforce the implementation processes. Limitation of the study include under reporting and heavy workload.
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