Browse publications by year: 2016

Fulltext Technical considerations in the surgical management of external laryngotracheal trauma: surgical outcomes

Mohd Sayuti, R., Raja Ahmad, R.L.A., Wan Ishlah, L., Kahairi, A., Asha’ari, Z.A., Norie Azilah, K.

International Medical Journal Malaysia, 2016;15(2):7-12.
MyJurnal

Introduction: External laryngotracheal (ELT) trauma is rarely encountered in clinical practice. In most
circumstances, this injury is overlooked by the primary attending team. Surgical management of ELT trauma
is complicated, because there is no established management approach for this potentially life-altering, high
morbidity injury. It is important for this injury to be identified early, as any delay in surgical intervention
may result in poor airway and phonatory outcomes. The aim of surgical reconstruction is to minimise the
above debilitating morbidities by restoring the main laryngeal functions as much as possible. Methods: We
reviewed the outcomes of six surgical interventions for ELT trauma at Tengku Ampuan Afzan Hospital from
June 2007 to June 2014. Clinical presentations, computed tomography (CT) scans features, intraoperative
findings, and postoperative outcomes were evaluated. Results: All patients made a good recovery in terms of
phonation except for one patient who had reduced speech function. After one year, one patient was still
dependent on a fenestrated tracheostomy. This article describes the surgical reconstruction techniques used
to achieve these positive outcomes. Stenting is helpful to aid healing and re-epithelialisation. Conclusion:
Prompt recognition and non-traumatised airway control are essential for addressing laryngotracheal trauma.
Subcutaneous emphysema is an important hallmark that should alert the attending physician to the
possibility of ELT trauma. Immediate surgical intervention using appropriate techniques can produce
favorable patient outcomes.

MeSH terms: Humans; Larynx; Phonation; Speech; Subcutaneous Emphysema; Tomography; Tomography, X-Ray Computed; Tracheostomy; Wound Healing; Airway Management; Re-Epithelialization
Fulltext Knowledge, attitude and practice towards religious obligations among healthcare workers in hospital Langkawi, Malaysia

Hafiz J., Dzulkhairi, M.R., Shamsir, M.A., Abu, N.

International Medical Journal Malaysia, 2016;15(2):3-6.
MyJurnal

Introduction: Islamic prayers involve certain physical movements and positions. These positions may be
difficult to achieve in Muslim patients who suffer from any illness that limit their physical movements.
Therefore, Islam introduced the concept of Rukhsah or exemptions. The objective of this study was to
assess the knowledge, attitudes and practices of healthcare workers related to performing prayers during
illness. Materials and Methods: A cross sectional study was conducted among 121 healthcare workers in
Hospital Langkawi, between 22nd to 24th April 2014. Simple random sampling method was used to select the
participants among healthcare workers in Hospital Langkawi to attend a workshop on Rukhsah Ibadah. The
participants were given a set of questionnaire to answer and all the data were collected just before the talk
began. Results: The majority of the participants 108 (89.3%) were female and more than half of them 74
(61.2%) were staff nurses. The mean age for the participants was 32.4 (SD: 9.42) years. About 73 (60.3%) of
the participants have good knowledge, 62 (51.2%) have good attitude and 73 (60.3%) have good practice
towards religious obligations and Rukhsah. Bivariate analysis shows no correlation between age and
knowledge, attitude and practice score. There was also no correlation seen between knowledge, attitude
and practice score. Conclusion: Almost half of the participants have good knowledge, attitude and practice
on performing prayers during illness. By conducting proper training and coaching, it is hoped that their level
of understanding towards Rukhsah can be improved.

MeSH terms: Optimism; Adult; Cross-Sectional Studies; Female; Health Personnel; Hospitals; Humans; Islam; Surveys and Questionnaires; Mentoring
Fulltext Exact solutions for unsteady free convection flow over an oscillating plate due to non-coaxial rotation

Mohamad AQ, Khan I, Ismail Z, Shafie S

Springerplus, 2016;5(1):2090.
PMID: 28018798 DOI: 10.1186/s40064-016-3748-2

BACKGROUND: Non-coaxial rotation has wide applications in engineering devices, e.g. in food processing such as mixer machines and stirrers with a two-axis kneader, in cooling turbine blades, jet engines, pumps and vacuum cleaners, in designing thermal syphon tubes, and in geophysical flows. Therefore, this study aims to investigate unsteady free convection flow of viscous fluid due to non-coaxial rotation and fluid at infinity over an oscillating vertical plate with constant wall temperature.
METHODS: The governing equations are modelled by a sudden coincidence of the axes of a disk and the fluid at infinity rotating with uniform angular velocity, together with initial and boundary conditions. Some suitable non-dimensional variables are introduced. The Laplace transform method is used to obtain the exact solutions of the corresponding non-dimensional momentum and energy equations with conditions. Solutions of the velocity for cosine and sine oscillations as well as for temperature fields are obtained and displayed graphically for different values of time (t ), the Grashof number (Gr), the Prandtl number ([Formula: see text]), and the phase angle ([Formula: see text]). Skin friction and the Nusselt number are also evaluated.
RESULTS: The exact solutions are obtained and in limiting cases, the present solutions are found to be identical to the published results. Further, the obtained exact solutions also validated by comparing with results obtained by using Gaver-Stehfest algorithm.
CONCLUSION: The interested physical property such as velocity, temperature, skin friction and Nusselt number are affected by the embedded parameters time (t), the Grashof number (Gr), the Prandtl number ([Formula: see text]), and the phase angle ([Formula: see text]).
Fulltext Cancer Pain Management Insights and Reality in Southeast Asia: Expert Perspectives From Six Countries

Javier FO, Irawan C, Mansor MB, Sriraj W, Tan KH, Thinh DHQ

J Glob Oncol, 2016 Aug;2(4):235-243.
PMID: 28717706 DOI: 10.1200/JGO.2015.001859

This expert opinion report examines the current realities of the cancer pain management landscape and the various factors that hinder optimal pain control in six countries in Southeast Asia, describes ongoing efforts to advance patient care, and discusses approaches for improving cancer pain management. Information was gathered from leading experts in the field of cancer pain management in each country through an initial meeting and subsequent e-mail discussions. Overall, there are vast disparities in cancer pain management practices and access to opioids in the Southeast Asian countries. The experts considered cancer pain as being generally undermanaged. Access to opioids is inadequate in most countries, and opioid use for analgesia remains inadequate in the region. Several system-, physician-, and patient-related barriers to adequate pain relief were identified, including widespread over-regulation of opioid use, shortage of trained health care workers, inadequacies in pain assessment and knowledge about managing pain, and widespread resistance among patients and physicians toward opioid treatment. According to the experts, many of the ongoing initiatives in the Southeast Asian countries are related to educating patients and physicians on cancer pain management and opioid use. Efforts to improve opioid availability and reduce regulatory barriers in the region are limited, and much work is still needed to improve the status of cancer pain management in the region. Enacting necessary change will require recognition of the unique needs and resources of each country and collaboration across interdisciplinary professional teams to improve cancer pain care in this region.
Fulltext A survey on the usage and demand of medical radioisotope and radio pharmaceuticals in Malaysia

Muhammad Fakhrurazi Ahmad Fadzil, Siti Selina Abdul Hamid, Siti Najila Mohd Janib, Azahari Kasbollah, Syed Asraf Fahlawi Wafa

Jurnal Sains Nuklear Malaysia, 2016;28(2):37-53.
MyJurnal

Medical radioisotope is a small quantity of radioactive substance used for the purpose of diagnostic and therapy of various diseases. In Malaysia, the emerging of new nuclear medicine centers or institutions in both government and private sectors rose abruptly for the past few years. Currently, there are no data available on the usage and demand of these medical radioisotope or radiopharmaceuticals. The aim of this study is to assess current medical radioisotopes and radiopharmaceuticals usage and also to provide data on current medical radioisotope and radiopharmaceuticals demand for both private and government hospitals or institutions in Malaysia. A survey for a period of 3 months was conducted across Malaysia. The survey was divided into five (5) main parts and it was distributed among healthcare professionalsinvolved working with medical radioisotope and radiopharmaceuticals in private, government and university based hospitals or institutions and was distributed manually either by hand, mail ore-mail.Data is presented in either pie chart or bar chart. Survey results found out that the highest demand and the highest usage among all radioisotopes are Technetium-99m and radioiodine isotopes such as the iodine-131, iodine-131 MIBG, iodine-123 and iodine-123 MIBG. Technetium-99m is the backbone of nuclear medicine whereby more than 80% of Nuclear Medicine services utilize this radioisotope. Technetium-99m supply chain is unstable globally and in coming future, two main reactors that produce 60% of world Molybdenum-99 will shut down and the supply of molybdenum-99 will be disrupted. In radioiodine services, currently, Iodine-123 can’t be obtained in Malaysia and neighboring countries due to its short half-life. Iodine-123 is useful in diagnostic of thyroid related diseases. As for PET services, the highest demands are F-18 FDG and gallium-68 Generator. It is important for Malaysia to self-produced medical radioisotope and radiopharmaceuticals to meet the local market demand.
Fulltext Residence time distribution (RTD) in operating plant:a review

Noraishah Othman, Nor Pa’iza Mohamad Hasan, Nazrul Hizam Yusoff, Mohd Amirul Syafiq Mohd Yunos, Engku Mohd Fahmi Engku Chik

Jurnal Sains Nuklear Malaysia, 2016;28(2):30-36.
MyJurnal

Radiotracer technology is a technique of radioactive injection into the systemand the detection is done using radiationdetector.It is alsoa tool for investigating and solving plant process problems namely process malfunctions andmechanical damages. Radiotracer is the most preferred stimulus response techniques in the industries due to its non-invasive application and on line monitoring capabilities, which avoid shut down of the plant. Radiotracer techniques have many advantages, such as high detection sensitivity, in-situ detection, availability of a wide range of compatible radiotracers for different phases, rapid response and high reliability and accuracy of the results. The residence time distribution (RTD) is one of the important parameters that can provide information on the characteristics or hydrodynamics of the nuclear reactor. In this paper, the overall review is presented in brief regarding radiotracer technology in plant operation.
Fulltext A review on microbial mutagenesis through gamma irradiation for agricultural applications

Phua Choo Kwai Hoe, Halimi Mohd Saud, Khairuddin Abdul Rahim

Jurnal Sains Nuklear Malaysia, 2016;28(2):20-29.
MyJurnal

Gamma irradiation is widely used in sterilizationand mutagenesis,especially for plant breeding and crop protection. Microbial mutagenesisthrough gamma irradiation is mainly applied in fermentation industry. In agriculture, gamma irradiation is mostlyapplied in cropimprovement. Microbial mutagenesis is mainly applied against fungus and spore-forming bacteria,which are resistant to gamma irradiation.Response of microbes to gamma irradiation varies and depends on various factors. Reviewof previous works on gamma irradiation for microbial mutagenesis in agriculture may provide some information for the use of this method. Thegeneral view ongamma irradiation, its application,and mutagenesis are discussedin this paper. Further investigation onmicrobial mutagenesis should consider molecular changes,information on which is lacking in previous works.Moreover, studies on microbial mutagenesis are still lacking in Malaysiadespite having severalgamma irradiation facilities.Therefore, further studies on microbial mutagenesis should be conducted.
Fulltext Intercomparison programme of absorbed dose for megavoltage X-ray teletherapy units in Malaysia

Norhayati Abdullah, Ng, Kwan Hoong, Wong, Jeannie Hsiu Ding, Ngie Min Ung, Taiman Kadni, Siti Sara Deraman

Jurnal Sains Nuklear Malaysia, 2016;28(2):11-19.
MyJurnal

The objective of this study is to perform a thermoluminescent dosimetry (TLD) postal dose quality audit for megavoltage X-ray teletherapy units in Malaysia. This audit is essential to be carried out to ensure adequate precision in the dosimetry of clinical beams before being delivered to the patients. Through this work, participating centres were requested to irradiate three capsules of TLD-100 powder with an absorbed dose to water of 2 Gy for 6MV and10MV photon beams. The International Atomic Energy Agency (IAEA)’s Technical Report Series No. 398 is used as a reference standard for TLD irradiation. Atotal of 22photon beamsfrom ten radiotherapy centres comprising onegovernment hospital and nineprivate medical centres were evaluated. The percentage deviation of user’s measured absorbed dose relative to Secondary Standard Dosimetry Laboratory (SSDL) mean absorbed dose was calculated. The results showed that all photon beams are within the IAEA’s acceptance limit of ± 5% except six photon beams. These centres were followed up with a second round of TLD irradiation which resulted in a better compliance.As a conclusion, regular audits should be performed to ensure consistency of radiotherapy treatment unit performances thus maintaining the accuracy of dose delivered to patients inall radiotherapy centres in Malaysia.
Fulltext Dose assessment in Anabas testudineus affected from exposure of waterborne Th-232

Zal U'yun Wan Mahmood, Nita Salina Abu Bakar, Mohamad Noh Sawon, Khairul Nizam Razali, Mohd Tarmizi Ishak, Norfaizal Mohamed, et al.

Jurnal Sains Nuklear Malaysia, 2016;28(2):1-10.
MyJurnal

Results ofthe bioaccumulation study anddose assessmentof Th-232 in whole-body Anabas testudineus are presented. The objective of this study was to evaluate the effect of Th-232 concentration activity on the laboratory bioaccumulation and total dose rate in Anabas testudineus. Anabas testudineus adults were exposed to different waterborne Th-232 levels: 0 Bq/L (control), 50 Bq/L and 100 Bq/L for 30 day (uptake phase). Whole-body uptakesof Th-232 in Anabas testudineuswere calculated and total dose ratesusing ERICA Assessment Tool were also estimated. The results showed the increase of waterborne Th-232 concentration corresponded to a progressive increase of Th-232accumulation and total dose rate (internal and external) in whole-body Anabas testudineus.Considering the ERICA dose rate screening value of 10 μGy/h, the findings can be concluded the estimated of total dose rate (0.38 –1.29μGy/h) in Anabas testudineuswasin orderof small magnitude. Nevertheless, these results showed that the Anabas testudineushas a potential to accumulate thorium.
Fulltext Application of stable isotope signatures in food traceability

Nazaratul Ashifa Abdullah Salim, Roslanzairi Mostapha, Zainon Othman, Nor Afiqah Harun, Mohd Suhaimi Hamzah, Shamsiah Abdul Rahman, et al.

Jurnal Sains Nuklear Malaysia, 2016;28(1):34-38.
MyJurnal

Stable isotope analysis has widely been used to trace the origin of organic materials in various fields, such as geochemistry, biochemistry, archeology and petroleum. In past a decade, it has also become an important tool for food traceability study. The globalisation of food markets and the relative ease which food commodities are transported through and between countries and continentsmeans that consumers are increasingly concerned about the origin of the foods they eat. The natural abundance of stable isotope variation such as carbon, nitrogen, hydrogen and oxygen are usedas geographic tracersor marker to determine the geographic origin of fruits, crop, vegetables and food products from animal. The isotopic compositions of plant materials reflect various factors such as isotopic compositions of source materials and their assimilation processes as well as growth environments. This paper will discuss on stable carbon and nitrogen isotopic compositions inricethat been determined by Isotope Ratio Mass Spectromety, advantages, limitations and potential of other analysis applicationsthat can be incorporated in food traceability system.
Fulltext Plasma focus device as a X ray source for radiography applications in nuclear Malaysia

Rokiah Mohd Sabri, Abd Halim Baijan, Siti A’iasah Hashim, Mohd Rizal Md Chulan, Leo, Kwee Wah, Mukhlis Mokhtar, et al.

Jurnal Sains Nuklear Malaysia, 2016;28(1):30-33.
MyJurnal

A 3.375 kJ plasma focus is designed to operate at 13.5 kV for studying X-ray source in Argon discharge. X-rays are detected by a film from the mammography radiographic plate using radiography technique. The feasibility of plasma focus as a high intensity flash X-ray radiation for a good contrast in radiography image is presented.
Fulltext Mammographic breast density in Malaysian women with breast cancer

Noriah Jamal, Humairah Samad Cheung

Jurnal Sains Nuklear Malaysia, 2016;28(1):22-29.
MyJurnal

The objective of this study was to examine the mammographic breast density of women with breast cancer detected on voluntary mammographic screening at two selected screening centersin Malaysia.This was a retrospective study of Full-Field Digital Mammography(FFDM) images of150 Malaysian women with biopsy-proven breast cancer. The study population comprised 73 Malays(37.7%), 59 Chinese (39.3%) and 18 Indians (12.0%). The Tabár breast density Patterns(I -V) wereused to evaluate mammographic breast density. Data were analyzed using descriptive statistics. The results were compared with findings from a similar study on a group of 668 women who did not have breast cancer.The results showed that 44.7% of the study populationhad dense breasts (Patterns IV and V), 14.7% had predominantly fatty breasts (Patterns II and III) while 40.7% had Pattern I. The proportion of study populationwith dense breasts decreased with age. In conclusion, the proportion of women with dense breasts decreased with age. Majority of the women with cancer (44.7%) had dense breasts of Tabár Patterns IV and V, which has been associated with increased risk of breast cancer detected by voluntary mammographic screening. The results support the notion that increased breast density is a risk factor of breast cancer.
Fulltext Radioactivity concentrations of soils from the vicinity of Lynas plant at Gebeng, Kuantan and its potential radiation risk

Mei-Wo Yii, Zal U'yun Wan Mahmood

Jurnal Sains Nuklear Malaysia, 2016;28(1):9-21.
MyJurnal

Natural radioactivityin thesurface soil from thevicinity of Lynas Rare-earth plantin Kuantan, Pahanghad been studied with aim of evaluating environmental radioacitivityof thatarea. The radioactivities of the samples have been measured usinga low-background HPGe gamma detector. The concentration of 226Ra ranged found to be between 8.7 –76.9 Bq/kg (mean 33.7 Bq/kg); activity of 238U from 8.7 to 80.5 Bq/kg (mean 36.9 Bq/kg); as for 232Th, it ranged from 6.2 to 121.5 Bq/kg(mean 58.2 Bq/kg)and that of 40K,the values was from 19.1 to 778.9 Bq/kg (mean of 221.3 Bq/kg). Activity standard deviation for226Ra, 238U, 232Th and 40K were 14.2 Bq/kg, 14.7 Bq/kg, 26.1 Bq/kg and 185.6 Bq/kg, respectively. To evaluate the risk of radiation hazard to human, several parameters, i.e. the radium equivalent activity, External hazard index, Representative level index and dose rate in air from the terrestrial natural gamma radiation were calculatedwith the mean valuesfound to be136.7 Bq/kg, 0.4, 1.0, 65 nGy/h, respectively. The data were discussed and compared with those obtained from the previous studies given in the literatures. Thisstudy found that themean dose equivalent received by an individual at the vicinity area (outdoor) of Lynas plant was estimated to be 82.0 Sv/yr, whichis far below the annual dose limitof1,000 Sv/yrfor general public as stipulated in the national act.
Fulltext 10Po, 210Pb and 210Po/210Pb in sediment core from surrounding Sungai Linggi estuary

Zal U’yun Wan Mahmood, Mei, Wo Yii, Abdul Kadir Ishak

Jurnal Sains Nuklear Malaysia, 2016;28(1):1-8.
MyJurnal

This study was performed to observe the variation in the distribution of 210Po,210Pb and 210Po/210Pb activity ratio throughtheir vertical profile of the sediment cores takenat surrounding Sungai Linggi estuary. Five sediment cores were takenin February 2011 and were cutto an intervalof 2 cm layer. Activity concentrations of 210Po and 210Pb were determined using alpha radiochemical analysis and gamma direct measurement, respectively. Generally, the measured activity of 210Po, 210Pb and 210Po/210Pbwere in the ranges of 22.73 –139.06 Bqkg-1dw., 37.88 –176.24 Bqkg-1dw.and 0.23 –1.34, respectively. The variation in the distribution profile for the radionuclides are believed to be influencedby human activities such as agriculture, fertilizer, vehicles, burned fuel fossil and forest, industrialand others via river input from land-base.Other factor is due to organic mattercontent played importantrole as the geochemical carrier to transportthose radionuclides at study area. It was provedthat hasa strong correlation between the radionuclide distribution and the sedimentcomposition of organic matter.Furthermore, in those rangesreflectedthat 210Pb activities were higher than210Po with an activity ratio average of 0.79. This is probably due to dramatic increase of excess 210Pb supplied from atmospheric deposition, in situ decay of 226Ra and as a result of diagenetic remolibilazationof 210Pbin deeper layesof the sediment column. Thus, thosefactors are majorcontributions on thevariation of 210Po and 210Pb in the sediment core at surrounding Sungai Linggi estuary.

MeSH terms: Agriculture; Fertilizers; Fibrinogen; Fossil Fuels; Fossils; Humans; Human Activities; Lead Radioisotopes; Rivers; Estuaries; Forests
Fulltext A review of stroke research in Malaysia from 2000 – 2014

Cheah Wee Kooi, Hor, Chee Peng, Zariah Abdul Aziz, Irene Looi

Medical Journal of Malaysia, 2016;71(11):58-69.
MyJurnal

Over 100 articles related to stroke were found in a search
through a database dedicated to indexing all literature with
original data involving the Malaysian population between
years 2000 and 2014. Stroke is emerging as a major public
health problem. The development of the National Stroke
Registry in the year 2009 aims to coordinate and improve
stroke care, as well as to generate more data on various
aspects of stroke in the country. Studies on predictors of
survival after strokes have shown potential to improve the
overall management of stroke, both during acute event and
long term care. Stroke units were shown to be effective
locally in stroke outcomes and prevention of stroke-related
complications. The limited data looking at direct cost of
stroke management suggests that the health economic
burden in stroke management may be even higher.
Innovative rehabilitation programmes including braincomputer
interface technology were studied with
encouraging results. Studies in traditional complementary
medicine for strokes such as acupuncture, Urut Melayu and
herbal medicine were still limited.
Fulltext Popliteal artery pseudoaneurysm successfully treated with amplatzer vascular plug

Leong, Benjamin Dak Keung, Liew, Kah Weng

Medical Journal of Malaysia, 2016;71(5):302-303.
MyJurnal

Popliteal artery pseudoaneurysm is uncommon. They
usually result from penetrating or blunt trauma, arterial
reconstructive surgery, invasive diagnostic or surgical
orthopedic procedures. They can cause arterial thrombosis
and limb ischeamia. We report a 53 year old Chinese
gentleman with popliteal artery pseudoaneurysm who
presented with right lower limb numbness and paralysis in
toes extension. He gave a history of acupuncture treatment
around the popliteal fossa of the affected limb. Clinical
examination revealed a pulsatile mass in the popliteal fossa.
Computed tomography angiography showed a large, 5 cm,
pseudoaneurysm arising from the popliteal artery. A
diagnostic angiogram was performed and revealed that
there is no run off from the popliteal artery and the tibial
vessels were reconstructed from collaterals. Endovascular
intervention was carried out with an Amplatzer Vascular
Plug to embolise the pseudoaneurysm. The
pseudoaneurysm was successfully excluded and post-op
follow up revealed no more pulsatile mass and improving
lower limb function. To the best of our knowledge this is first
reported case of pseudoaneurysm of the popliteal artery
secondary to acupuncture in Malaysia.

MeSH terms: Aneurysm; Angiography; Follow-Up Studies; Hypesthesia; Malaysia; Male; Popliteal Artery; Thrombosis; Tibia; Toes; Acupuncture Therapy; Aneurysm, False; Orthopedic Procedures; Reconstructive Surgical Procedures; Lower Extremity; Computed Tomography Angiography
Fulltext Congenital epulis: a rare benign tumour

Kit, Danny Chung Wong, Roszalina Ramli, Muhaizan Wan Mustaffa, Primuharsa Putra Sabir Husin Athar

Medical Journal of Malaysia, 2016;71(5):300-301.
MyJurnal

Congenital epulis is a rare benign pedunculated tumour of
the oral cavity arising from the alveolar ridges. It is usually
detected in newborns and can be successfully resected
surgically. We report a case of a newborn baby who had a
5x3x3cm pedunculated lobar mass arising from the upper
alveolar ridge.
Fulltext Primary cutaneous T cell lymphoma (gamma delta subtype)

Guan, Yong Khee, Gan, Chye Chung

Medical Journal of Malaysia, 2016;71(5):296-297.
MyJurnal

Primary cutaneous T-cell lymphoma gamma-delta subtype is
an extremely rare entity of all the cutaneous T-cell
lymphomas. Our case provides an insight on clinical
behavior and treatment response with feasible effective
combination chemotherapy. We believe this will be of great
interest to clinicians when facing this difficult clinical entity.
We present a case of a 66-year-old Malay man with a threeweek
history of rapidly growing skin nodules and plaques
which spread throughout his body. He was commenced on
combination chemotherapy gemcitabine, etoposide, and
carboplatin with near complete remission on completion of
second cycle but he defaulted. He relapsed within a month
and he progressed despite treatment with the same regime.
He was salvaged with fludarabine, cytarabine, and
vinblastine combination chemotherapy but progressed with
brain metastasis and died. However, more investigations
and studies need to be done in this relatively unknown rare
entity. A rare lymphoma registry might be of help to better
understand and treat similar conditions.
Fulltext Idiopathic duodenal varix presenting as a massive upper gastrointestinal bleeding: a case report

Zubaidah Nor Hanipah, Asraf Haslam Jasmani, Lee Limi, Tikfu Gee

Medical Journal of Malaysia, 2016;71(5):294-295.
MyJurnal

Ectopic variceal bleeding is both a diagnostic dilemma and
a therapeutic challenge, especially when it is located in the
third part of the duodenum. Varix is rare in the absence of
cirrhosis or portal hypertension. Because the diagnosis of
this condition is usually delayed, treatment is administered
late resulting in high morbidity and mortality rate. We report
a case of a 61-year-old lady with an idiopathic duodenal
varix presenting as an upper gastrointestinal bleeding.
Fulltext Case report of a chest wall cystic hygroma in a teenager

Karthigesu Aimanan, Putera Mas Pian, Ramesh R. Thangrathnam, Balaji Padmanaban, Guan, Chew Loon, Muhamad Azim Mohd Idris

Medical Journal of Malaysia, 2016;71(5):292-293.
MyJurnal

Cystic hygroma or cystic lymphangioma is a congenital
malformation of lymphatic origin. Their occurrence on the
chest wall is very rare, and they progressively grow with age
infiltrating into the local tissues, around muscle fibers and
nerves, making them difficult and hazardous to remove.
There are various treatment modalities of such lesion.
Based on the literature surgical excision is the preferred
treatment of choice in cystic hygroma because it gives a
better cure rate compared to other modalities. We report a
case successful excision of anterolateral chest wall cystic
hygroma in a teenager in Hospital Serdang.

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