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Fulltext Biliary cystadenoma - computed tomography findings

Ariff A, Hassan H, John G

Malays J Med Sci, 2002 Jan;9(1):49-51.
PMID: 22969318

Biliary cystadenoma is a rare neoplasm of the biliary ductal system. Surgical management yields an excellent result. We present a case of recurrent biliary cystadenoma in the left lobe of the liver. The cyst was successfully treated with hepatic segmentectomy. The lobulated smoothly marginated septated cystic lesion noted on computed tomography (CT) were highlighted and the other imaging studies, differential diagnosis and management were reviewed.
Effective hospital waste classification to overcome occupational health issues and reduce waste disposal cost

Bai VR, Vanitha G, Zainal Ariff AR

Infect Control Hosp Epidemiol, 2013 Nov;34(11):1234-5.
PMID: 24113615 DOI: 10.1086/673461
Fulltext A rare case of bleeding in a cerebellopontine angle epidermoid cyst

Zamzuri I, Abdullah J, Madhavan M, Ariff AR

Med J Malaysia, 2002 Mar;57(1):114-7.
PMID: 14569729

Epidermoid cysts of the central nervous system are described as rare, benign, slow growing lesions with a history of high rate of recurrence even after surgical removal. This lesion is rarely located at the cerebellopontine angle and is found to be composed of solid and cystic components with close adherence to vital neurovascular structures that might complicate its removal. We present a rare case of a twenty-five year old housewife with signs and symptoms of increased intracranial pressure due to the above pathology after multiple episodes of intra-tumoral bleeding. Microneurosurgical techniques were used for tumour dissection and excision. The patient recovered well after a three-year follow-up. This is the fourth example in the index medicus of bleeding seen in a histopathologically proven cerebellopontine angle intraepidermoid cyst.
Stereotactic neuroendoscopic management of hydrocephalus: a three-year follow-up and analysis of Malaysian children with aqueduct stenosis

Abdullah J, Ariff AR, Ghazaime G, Naing NN

Stereotact Funct Neurosurg, 2001;76(3-4):175-80.
PMID: 12378096

The beneficial effects of stereotactic third ventriculostomy versus ventriculoperitoneal shunt were evaluated in 62 paediatric patients and analysed in relation to age, sex, clinical history, presence of meningomyelocele, magnetic resonance imaging measurements of hydrocephalus and third ventricle floor size. The third ventriculostomy were done on 50 patients using the Richard-Wolf Caemaert Endoscope and the Leksell Stereotactic Frame Model G. These patients were operated using the 4-French Fogarty catheter to open the base of the third ventricle. During the same period of study 12 paediatric patients with aqueduct stenosis who were managed by ventriculoperitoneal shunt were included. Both surgical procedures were compared. Statistically univariate analysis revealed that those patient with an age group of more than six months undergoing ventriculostomy had good outcome. Multivariate analysis revealed that past history of haemorrhage and/or meningitis were predictors of poor outcome. Sex, size of lumbar meningocele at birth, abnormal ventricular anatomy or narrow third ventricular floor size were non predictors of bad outcome in these patients. There was no difference in outcome in both the shunt or ventriculostomy group.
Use of bovine xenograft in reconstruction of traumatic anterior cranial fossa bone defects involving the frontal sinus

Abdullah J, Rushdan A, Hamzah M, Ariff AR, Rani A

Ann. Transplant., 1999;4(3-4):28-31.
PMID: 10853777

Four patients underwent reconstruction of anterior cranial fossa of skull defects between November 1997 and January 1998. All of them had traumatic anterior cranial fossa defect and were reconstructed with lyophilised bovine cortical bone graft. There was no cerebrospinal fluid leakage, meningitis, extradural abscess or other infections. This study demonstrates that the use of bovine bone graft in the reconstruction of anterior base defects is safe.
Spontaneous intracerebral hemorrhage in northeast Malaysian patients: a four-year study

Muiz AJ, Abdullah J, Naing NN, Ghazaime G, Ariff AR

Neuroepidemiology, 2003 May-Jun;22(3):184-95.
PMID: 12711851

The aim of this study was to compare nonsurgical versus stereotactic aspiration of intracerebral hematomas in relation to clinical aspects, computed tomographic imaging features of the brain, laboratory parameters and specific risk factors that may influence the outcome in southeast Asian Malay patients. Fifty-five of the patients with intracerebral hemorrhage (ICH) underwent stereotactic aspiration and 57 did not. Analysis was done on risk factors, locations and treatments of ICH, and the final outcomes measured by the Glasgow Outcome Scale. A total of 112 patients were evaluated. Mean age was 52 years with ages ranging from 12 to 80 years. Hypertension was seen in 60.7% of patients with ICH. The mortality rate was 25% by 3 months. 58.9% had a poor final outcome, while 41.1% had a good outcome. The selected variables were incorporated into models generated by multiple logistic regression method analysis to define the significant predictors of outcome. Significant predictors of outcome were the Glasgow Coma Scale score on admission, the duration of surgery and the total volume of the hematoma. Significant predictors of mortality were high total white blood cell differential count, low plasma protein, and high plasma lactate dehydrogenase and brain edema. The study suggests that stereotactic aspiration of patients with ICH does not offer any definite advantage over conservative treatment.
Fulltext Two-stage management of mega occipito-encephalocele

Mardzuki AI, Abdullah J, Ghazaime G, Ariff AR, Ghazali M

Med J Malaysia, 2003 Mar;58(1):115-9.
PMID: 14556336 MyJurnal

We report three cases of large occipito-encephaloceles that were managed in the Neurosciences Unit, Hospital Universiti Sains Malaysia over the last 5 years. All patients had pre-operative MRI (magnetic resonance imaging) evolution and mapping of the sagittal sinus tract. The cerebrospinal fluid (CSF) of all three patients were initially diverted by means of ventricular shunt two weeks prior to shunt removal. The slow drainage of CSF prevented electrolyte and volume disturbances due to sudden decompression during their definitive occipital encephalocele operations. After 3 years follow-up, all these patients are progressing well.
Unilateral exophthalmos caused by an extramedullary plasmacytoma: a case report

Ashraf M, Abdullah J, Ariff A, Biswal BM, Mokhtar I, Othman N

Malays J Med Sci, 2003 Jan;10(1):95-9.
PMID: 23365508

Solitary plasmacytoma of the head and neck is a rare disease entity. Its description in the literature consist of some case reports. Solitary plasmacytoma presenting with exophthalmos are rare. We report a case of intracranial solitary plasmacytoma in an elderly lady with involvement of the right orbitocranial region presenting with severe exophthalmos. The tumour was debulked and radiotherapy was given.
A study of the factors related to intima-media thickness of the common carotid artery amongst rural middle age individuals in Hospital Universiti Sains Malaysia

Yunus R, Ariff AR, Shuaib IL, Jelani AM, Alias NA, Abdullah J, et al.

Southeast Asian J. Trop. Med. Public Health, 2006 Jul;37(4):806-11.
PMID: 17121310

There is very little data regarding the factors related to intima-media thickness (IMT) of the common carotid artery in normal individuals in those with non-insulin diabetes mellitus and perimenopausal women in Southeast Asian countries. Ultrasound imaging evaluating the carotid artery IMT in those with diabetes and those on hormone replacement therapy (HRT) was performed beginning in August 2000 for a period of nearly two years at the Department of Radiology, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. A total of 153 participants were included. Significant differences between the women on HRT and not on HRT were IMT and systolic blood pressure. When comparing those with non-insulin dependent diabetes mellitus (NIDDM) and normal individuals, the significant differences were IMT, total cholesterol level, systolic blood pressure and diastolic blood pressure. IMT was high in those with NIDDM but not in those on HRT. Both those with NIDDM and those on HRT had associated dyslipidemia and systolic hypertension.
Diagnostic cerebral angiography in spontaneous intracranial haemorrhage: a guide for developing countries

Abu Bakar I, Shuaib IL, Mohd Ariff AR, Naing NN, Abdullah JM

Asian J Surg, 2005 Jan;28(1):1-6.
PMID: 15691788

OBJECTIVE: Spontaneous intracranial haemorrhage constitutes 18-40% of all stroke cases. Indications for cerebral angiography to find underlying potentially treatable vascular abnormalities are not clear. This study determined which intracranial haemorrhage patients need cerebral angiography by correlating computed tomography (CT) findings, age and hypertension history with cerebral angiography findings.
METHODS: A total of 54 patients (8-79 years) with intracranial haemorrhage who underwent both CT examination and six-vessel cerebral angiography were studied over a 2-year period. Cerebral angiography was repeated within 6 weeks if the first angiogram was negative.
RESULTS: Angiography detected vascular lesions in 50% of cases (aneurysm 38.9% and arteriovenous malformation, AVM, 11.1%). In the aneurysm group, angiographic yield was 34.3% whereas in the AVM group, it was 37.9%. Subarachnoid haemorrhage (SAH) combined with other types of haemorrhage (such as intracerebral haemorrhage, ICH) was not significantly correlated with the likelihood of finding a vascular lesion, both aneurysm and AVM (p = 0.157). Age less than 50 years had significant correlation (p = 0.021) in the AVM group as well as in the aneurysm group (p < 0.001). A history of hypertension was associated with both aneurysm (p = 0.039) and AVM (p = 0.008). No patients with deep intracerebral haematoma had vascular lesions. The presence of an intravascular haemorrhage (IVH) had significant correlation with aneurysm (p = 0.008) but not AVM. There was no significant difference in mean age between patients with and without a vascular lesion (p = 0.134).
CONCLUSION: Cerebral angiography is justified in patients with ICH accompanied by pure SAH (p = 0.001). Other factors associated with finding a vascular lesion were a history of hypertension and the presence of IVH. Diagnostic cerebral angiography is indicated for patients with ICH and SAH and IVH with a history of hypertension, regardless of age.
Analysis of pediatric subdural empyema outcome in relation to computerized tomography brain scan

Md Ralib AR, Ariff AR, Shuaib IL, Naing NN, George PJ, Abdullah JM

Southeast Asian J. Trop. Med. Public Health, 2004 Jun;35(2):434-44.
PMID: 15691152

A cross-sectional study was conducted to predict the outcome in patients with subdural empyema, using initial and post-treatment CT scan brain parameters. Data collection was done on those children who were diagnosed to have subdural empyema by CT scan of the brain with contrast, who underwent burrhole evacuation, from February 2000 until April 2002. Numerous factors, such as coma or loss of unconsciousness at diagnosis, age, types of antibiotic, microbiology, extension of empyema, associated cerebral infarction and ventriculitis, were analyzed. Poor prognosis was associated with loss of consciousness, and hypodensity by CT scan at presentation (p < 0.005). Patients with an extensive subdural empyema will have a good outcome if they are treated early and aggressively with antibiotics and burrhole evacuation.
CT scan in minor head injury: a guide for rural doctors

Abdul Latip LS, Ahmad Alias NA, Ariff AR, Shuaib IL, Abdullah J, Naing NN

J Clin Neurosci, 2004 Nov;11(8):835-9.
PMID: 15519858 DOI: 10.1016/j.jocn.2003.12.017

Minor head injury in a developing country like Malaysia is managed by primary care physicians and/or medical assistants in district hospitals. These patients are seen initially in their local hospitals, which have at least an X-ray machine for the purpose of screening. This study aimed to guide these physicians to manage these patients at a primary care level. A cross-sectional study was conducted and the study revealed significant predictors of significant computed tomographic (CT) findings. The presence of a Glasgow coma scale (GCS) score of 14 or 13 was associated with the risk of developing significant CT findings compared to patients with a GCS of 15 (p<0.001). Thirty-seven out of 50 patients with GCS of 14 or 13 developed clinically significant brain injury on CT scan. Similarly, the presence of skull fracture was associated with the risk of developing CT abnormalities (p<0.001). Forty-two out of 51 patients with skull fracture developed clinically significant CT findings. Vomiting was associated with developing CT abnormalities (p=0.017). Twenty-seven out of 40 patients with vomiting showed significant CT findings. Soft tissue injury was also found to be associated with developing CT abnormalities (p=0.007). Therefore, we propose reclassifying minor head injury based on the GCS score. Patients with a GCS score of 15 were classified as having mild head injury, while patients with a GCS score of 13 or 14 were at higher risk of developing brain injury and therefore categorized as high risk mild head injury. This group requires emergency CT scan examination, especially when associated with non-motor vehicle accidents, abnormal central nervous system (CNS) examination, craniofacial injuries or skull fractures. They should be referred to a general surgical unit which can treat head injuries or a neurosurgical tertiary centre.
Giant nerve sheath tumour: report of six cases

Ghani AR, Ariff AR, Romzi AR, Sayuthi S, Hasnan J, Kaur G, et al.

Clin Neurol Neurosurg, 2005 Jun;107(4):318-24.
PMID: 15885392

Giant nerve sheath tumour is a rare tumour originating from the nerve sheath. It differs from the conventional nerve sheath tumour only by the size these tumours can reach. There are two main type of tumours that occur in the nerve sheath which include neurofibroma and schwannoma. The current views are that schwannomas arise from the progenitor of the schwann cell. Whereas the neurofibroma series probably arise from a mesenchymal origin closer to a fibroblast. We report on six cases of nerve sheath tumour that occur in the spinal and paraspinal region that presented to us over a 5 year period.
Intramedullary spindle cell hemangioendothelioma of the thoracic spinal cord--case report

Abdullah JM, Mutum SS, Nasuha NA, Biswal BM, Ariff AR

Neurol. Med. Chir. (Tokyo), 2002 Jun;42(6):259-63.
PMID: 12116532

A 28-year-old Malay man presented with progressive paraparesis over a period of 6 months. Magnetic resonance imaging of the spine revealed a thoracic intramedullary spinal cord tumor at the T-7 level with homogeneous enhancement following intravenous gadolinium administration. Laminectomy and partial decompression of the tumor was performed. Histological examination of the tumor revealed features of spindle cell hemangioendothelioma. The patient was managed with limited field radiotherapy followed by systemic interferon therapy. Good neurological improvement was seen subsequently. The patient has survived 48 months with growth restraint at the primary site, although residual neurological deficit persists. Immunotherapy should be considered as a treatment modality for intramedullary hemangioendothelioma of the spinal cord after surgery and radiotherapy.
Computed tomography of the brain in predicting outcome of traumatic intracranial haemorrhage in Malaysian patients

Azian AA, Nurulazman AA, Shuaib L, Mahayidin M, Ariff AR, Naing NN, et al.

Acta Neurochir (Wien), 2001;143(7):711-20.
PMID: 11534693

Head injury is a significant economic, social and medical problem all over the world. Road accidents are the most frequent cause of head injury in Malaysia with highest risk in the young (15 to 24 years old). The associated outcomes include good recovery, possibility of death for the severely injured, which may cause disruption of the lives of their family members. It is important to predict the outcome as it will provide sound information to assist clinicians in Malaysia in providing prognostic information to patients and their families, to assess the effectiveness of different modes of treatment in promoting recovery and to document the significance of head injury as a public health problem.
RESULTS: A total of 103 cases with intracranial haemorrhage i.e. intracerebral haemorrhage, extradural haemorrhage, subdural haemorrhage, intraventricular haemorrhage, haemorrhagic contusion and subarachnoid haemorrhage, following motor vehicle accidents was undertaken to study factors contributing to either good or poor outcome according to the Glasgow Outcome Scale. Patients below 12 years of age were excluded. The end point of the study was taken at 24 months post injury. The selected variables were incorporated into models generated by logistic regression techniques of multivariate analysis to see the significant predictors of outcome as well as the correlation between the CT findings with GCS.
CONCLUSION: Significant predictors of outcome were GCS on arrival in the accident emergency department, pupillary reflex and the CT scan findings. The CT predictors of outcome include ICH, EDH, IVH, present of SAH, site of ICH, volumes of EDH and SDH as well as midline shift.
Association of p53 tumor suppressor gene with paraclinical and clinical modalities of gliomas patients in Malaysia

Yusoff AA, Abdullah J, Abdullah MR, Mohd Ariff AR, Isa MN

Acta Neurochir (Wien), 2004 Jun;146(6):595-601.
PMID: 15168228

Alteration of the tumor suppressor gene p53 is considered to be a critical step in the development of human cancer. Changes in this gene have been detected in a wide range of human tumours, including gliomas. In glioma, the presence of p53 gene alterations has been associated with worse prognosis.
Fulltext Malignant rhabdoid tumour of the brain

Abdullah JM, Rahman ZA, Ariff AR, Jaafar H, Phang KS

Singapore Med J, 2004 Jun;45(6):286-8.
PMID: 15181525

Rhabdoid tumour is a rare childhood tumour with poor prognosis. We report a 13-month-old Malay girl suffering from this tumour that was located at the left fronto-temporo-parietal region of the brain. Computed tomography showed a large irregular enhancing mass that caused obstructive hydrocephalus. The tumour did not reduce in size after three operations and finally the patient succumbed to the disease four months after diagnosis.
Cavernous sinus thrombosis secondary to sinusitis

Amran M, Sidek DS, Hamzah M, Abdullah JM, Halim AS, Johari MR, et al.

J Otolaryngol, 2002 Jun;31(3):165-9.
PMID: 12121021
Molecular genetic analysis of anaplastic pleomorphic xanthoastrocytoma

Nasuha NA, Daud AH, Ghazali MM, Yusoff AA, Zainuddin N, Abdullah JM, et al.

Asian J Surg, 2003 Apr;26(2):120-5.
PMID: 12732498

A case of pleomorphic xanthoastrocytoma in a 10-year-old Malay boy is reported. The patient presented with headache and epilepsy. On computed tomography, a ring-enhancing low-density lesion was observed in the left fronto-temporal area. During surgery, a cystic tumour containing serous fluid was found and almost totally removed. Histologically, the tumour exhibited marked pleomorphism of oval and spindle-shaped cells intermixed with uni- and multinucleated giant cells, and xanthomatous cells with foamy cytoplasm. The tumour displayed pericellular reticulin and periodic acid-Schiff positive granules. Focally, six mitotic characters per 10 high-power fields were seen, and necrosis was confined only to the inner lining of the cyst. Mutational analysis showed that a frameshift mutation (a 4-bp deletion) in the p53 gene had occurred in codons 273 and 274 of exon 8. No mutation was detected in the p16 gene. No allelic loss and/or loss of heterozygosity were observed on chromosome 10 using microsatellite marker D105532. The patient was treated with postoperative radiotherapy because of histological anaplasia and the presence of residual tumour. The patient showed marked neurological recovery after a follow-up period of 2 years.
Absence of Ras, c-myc and Epidermal Growth Factor Receptor (EGFR) Mutations in Human Gliomas and its Clinical Factors Associated with Pathological Grading After Six Years of Diagnosis in North East Malaysian Patients

Ghazali MM, Mohd Zan MS, Yusof AA, Abdullah JM, Jaffar H, Ariff AR, et al.

Malays J Med Sci, 2005 Jul;12(2):27-33.
PMID: 22605955 MyJurnal

Neoplastic transformation appears to be a multi-step process in which the normal controls of cell proliferation and cell-cell interaction are lost, thus transforming normal cells into cancer. The tumorigenic process involves the interplay between oncogenes and tumour suppressor genes. In this study, we have selected the ras family, c-myc and epidermal growth factor receptor (EGFR) genes to detect whether their abnormalities are associated with the expression and progression of glioma cases in Malay patients. We have used the polymerase chain reaction-single stranded conformation polymorphism followed by direct sequencing for the study. For the ras gene family, we screened the point mutations in codons 12 and 61 of the H-, K-, and N-ras gene; for EGFR and c-myc, we analyzed only the exon 1 in glioma samples. In mutational screening analyses of the ras family, c-myc and EGFR gene, there was no mobility shift observed in any tumour analyzed. All patterns of single stranded conformation polymorphism (SSCP) band observed in tumour samples were normal compared to those in normal samples. The DNA sequencing results in all high-grade tumours showed that all base sequences were normal. All 48 patients survived after five years of treatment. In simple logistic regression analysis, variables which were found to be significant were hemiplegia (p=0.047) and response radiotherapy (p=0.003). Hemiplegics were 25 times more likely to have high pathological grade compared to those without. Patients with vascular involvement were 5.5 times more likely to have higher pathological grade. However, these findings were not significant in multivariate analysis. Patients who had radiotherapy were nearly 14 times more likely to have higher pathological grade. Multivariate analysis revealed that patients with hemiplegia were more likely to have higher pathological grade (p= 0.008). Those with higher pathological grading were 80 times more likely to have radiotherapy (p=0.004).

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