Tuesday, December 30, 2008

TB Peritoneum

A man (one of the many foreign workers in Malaysia) was referred to me with ascites (fluid in the peritoneal cavity) and weight loss. The working diagnosis was tuberculosis. Mantoux test was negative, PCR and ESR were not suggestive. Chest X-ray was clear. The peritoneal fluid was tapped but the cytology was negative. I did a laparoscopy recently; and this is what I saw. Thousands of small 'soft' nodules (which I prefer to call tubercles) studded the surface of the peritoneum, intestines and other intraperitoneal organs. These were biopsied and the diagnosis of tuberculosis confirmed. He was sent back to the referring physician to recieve anti-tuberculosis treatment.

The prevalence of tuberculosis mainly PTB was high in Malaysia previously. With good public health programme and vaccination, it was brought under control. Unfortunately, lately it has resurged. One of the reasons given was HIV; low immunity. But I believe the influx of immigrant workers from countries which don't have efficient anti-TB programme is the main reason.

The authority should look seriously into this. Now, we have new diseases that we never heard about before: Chikungunya, Yellow Fever, Kala Azar and what not !!!!

Globalisation doesn't come without a price .....

Sebaceous Cyst
A sebaceous cyst is a closed sac below the surface of the skin that has a lining that resembles the uppermost part of a hair follicle and fills with a fatty white, semi-solid material called sebum. Sebum is produced by sebaceous glands of the epidermis. Usually patients present with a lump (most often painless) on the body or limb. Not unusual, the cyst gets infected and patients present with and abscess, and this is painful.

This is one of the few huge sebaceous cysts that I have removed. The patient was a man who had kept the lump for more than 10 years, and he came only when he couldn't sit properly.

He was lucky; this is a benign disease, not a cancer. If this were cancerous, then he would be in deep trouble !

SUSAH SANGATKAH NAK DATANG AWAL ???(Is it difficult to come for treatment early ??)