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Fulltext Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: a case report

Siow SL, Tee SC, Wong CM

J Med Case Rep, 2015;9:49.
PMID: 25890166 DOI: 10.1186/s13256-015-0519-6

Paraesophageal hernia with intrathoracic mesentericoaxial type of gastric volvulus is a rare clinical entity. The rotation occurs because of the idiopathic relaxation of the gastric ligaments and ascent of the stomach adjacent to the oesophagus through the hiatus defect, while the gastroesophageal junction remains in the abdomen. The open approach remains the gold standard therapy for most patients. Here we report the case of a patient with such a condition who underwent a successful laparoscopic surgery. A literature search revealed that this is the first case report from Southeast Asia.
The prevalence of diastolic dysfunction in patients with hypertension referred for echocardiographic assessment of left ventricular function

Mohamed AL, Yong J, Masiyati J, Lim L, Tee SC

Malays J Med Sci, 2004 Jan;11(1):66-74.
PMID: 22977362

Hypertension is the major cause of congestive cardiac failure all over the world. It is under diagnosed and achievement of optimal therapy is difficult and costly. Diastolic dysfunction is an early poor prognostic factor in hypertension and is a reversible condition. Early detection and treatment is necessary to avoid cardiac complications. The objective of this study was to assess the occurrence of diastolic dysfunction in hypertensive patients referred for echocardiograph assessment of left ventricular function in a secondary hospital. It was also designed to determine whether contributing factors such as age, gender, systolic and diastolic pressure, duration of hypertension, previous myocardial infarct or ischemic heart disease and choice of anti-hypertensive drugs influence the development of diastolic dysfunction in these hypertensive patients. The analysis of diastolic dysfunction was based on the E/A ratio using Doppler echocardiogram. All of the patients were recruited from the Echocardiography Unit, Department of Medicine, Seremban General Hospital. Fifty patients with history of hypertension were selected for the study. Out of These 22 patients (44%) were found to have diastolic dysfunction; 39.1% of male patients (9 out of 23) and 48.1% of female patients (13 out of 27). Other contributing factors of diastolic dysfunction were found in patients : (a) with more than 8 years history of hypertension (12%) (b) with history of preexisting IHD/AMI (20%), (c) stages II - III of systolic hypertension based on 6th Joint National Committee recommendation (73%) (d) on ACE-inhibitor (18%) and (e) on Beta-blocker (28%) In conclusion, the study had demonstrated that the duration of hypertension, both systolic and diastolic blood pressure and age of patients are important prognostic indicators in predicting the development of diastolic dysfunction in hypertensive patients.
Our experience in using the brachial venae comitantes as a native vascular access for hemodialysis

Sha HL, Luk TL, Tee SC, Hardin R, Seak CK

Hemodial Int, 2016 Apr;20(2):293-7.
PMID: 26415761 DOI: 10.1111/hdi.12370

A native arteriovenous fistula is the preferred vascular access for patients on long-term hemodialysis. In the absence of suitable superficial veins, the deep venous system can be used. We intend to present our experience in using the brachial venae comitantes (VC) to create a native arteriovenous fistula. From January 2012 to December 2014, we utilized the brachial vena comitantes to create 12 arteriovenous fistulae. Data from these 12 subjects were analyzed retrospectively to produce this case series. The average age of our subjects was 55.6 years. Forty-two percent of the subjects were women. Fifty percent of the subjects had diabetes mellitus and 58% had hypertension. We achieved a functional patency rate of 58% at 1 month's follow up after maturation. The brachio-brachial vena comitans fistula is a safe and plausible option in patients with no other suitable veins for a native fistula, more so in the hands of experienced surgeons. The longer time to cannulation has to be taken into consideration when creating a VC fistula. In suitable patients with end-stage renal disease, it can delay the use of an arteriovenous graft or a tunneled central venous catheter.
The impact of prehabilitation in upper gastrointestinal cancer underwent major surgery

Ramizah MS, Tee SC, Muhammad SJ, Abdul AH, Shahabuddin NH, Saiyidah Adila A

Med J Malaysia, 2023 Jan;78(1):39-45.
PMID: 36715190

INTRODUCTION: Several risk factors found to be associated with postoperative complications and cancer surgery, which carry a significant morbidity risk to cancer patients. Therefore, prehabilitation is necessary to improve the functional capability and nutritional status of a patient prior to surgery, so that the patient can withstand any postoperative activity and associated deterioration. Thus, this study aims to assess the effectiveness of prehabilitation interventions on the functional status of patients with gastric and oesophageal cancer who underwent esophagectomy and gastrectomy.
MATERIAL AND METHODS: An interventional study was carried out among oesophageal and gastric cancer patients who had undergone surgery at the National Cancer Institute of Malaysia. The prehabilitation process took a maximum of two weeks, depending on the patient's optimisation before surgery. The prehabilitation is based on functional capacity (ECOG performance status), muscle function (handgrip strength), cardio-respiratory function (peak flow meter) and nutritional status (calorie and protein). Postoperative outcomes are measured based on the length of hospital stay, complications, and Clavien-Dindo Classification.
RESULTS: Thirty-one patients were recruited to undergo a prehabilitation intervention prior to gastrectomy (n=21) and esophagectomy (n=10). Demographically, most of the cancer patients were males (67.7%) with an ideal mean of BMI (23.5±6.0). Physically, the majority of them had physical class (ASA grade) Grade 2 (67.7%), ECOG performance status of 1 (61.3%) and SGA grade B (51.6%). The functional capacity and nutritional status showed a significant improvement after one week of prehabilitation interventions: peak expiratory flow meter (p<0.001), handgrip (p<0.001), ECOG performance (p<0.001), walking distance (p<0.001), incentive spirometry (p<0.001), total body calorie (p<0.001) and total body protein (p=0.004). However, those patients who required two weeks of prehabilitation for optimization showed only significant improvement in peak expiratory flow meter (p<0.001), handgrip (p<0.001), and incentive spirometry (p<0.001). Prehabilitation is significantly associated postoperatively with the length of hospital stay (p=0.028), complications (p=0.011) and Clavien-Dindo Classification (p=0.029).
CONCLUSION: Prehabilitation interventions significantly increase the functional capacity and nutritional status of cancer patients preoperatively; concurrently reducing hospital stays and complications postoperatively. However, certain cancer patients might require over two weeks of prehabilitation to improve the patient's functional capacity and reduce complications postoperatively.
Malaysian joint societies' consensus recommendations on diagnosis and management of disorders of esophagogastric junction outflow

Chuah KH, Ramasami N, Mahendran HA, Shanmuganathan G, Koleth GG, Voon K, et al.

J Gastroenterol Hepatol, 2024 Mar;39(3):431-445.
PMID: 38087846 DOI: 10.1111/jgh.16403

Disorders of esophagogastric junction (EGJ) outflow, including achalasia and EGJ outflow obstruction, are motility disorders characterized by inadequate relaxation of lower esophageal sphincter with or without impaired esophageal peristalsis. Current guidelines are technical and less practical in the Asia-Pacific region, and there are still massive challenges in timely diagnosis and managing these disorders effectively. Therefore, a Malaysian joint societies' task force has developed a consensus on disorders of EGJ outflow based on the latest evidence, while taking into consideration the practical relevance of local and regional context and resources. Twenty-one statements were established after a series of meetings and extensive review of literatures. The Delphi method was used in the consensus voting process. This consensus focuses on the definition, diagnostic investigations, the aims of treatment outcome, non-surgical or surgical treatment options, management of treatment failure or relapse, and the management of complications. This consensus advocates the use of high-resolution esophageal manometry for diagnosis of disorders of EGJ outflow. Myotomy, via either endoscopy or laparoscopy, is the preferred treatment option, while pneumatic dilatation can serve as a secondary option. Evaluation and management of complications including post-procedural reflux and cancer surveillance are recommended.