Displaying publications 1 - 20 of 111 in total

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  1. Azizan, N., Hayati, F., Madatang, A., Abu Seman, F.
    MyJurnal
    Endometrial stromal sarcoma (ESS) is a rare malignant tumour of the endometrium, accounts for less than 1% of all
    uterine malignancies. Routinely, it is diagnosed morphologically, supported by immunomarkers of CD10 and
    vimentin. CD56 is used widely in neuroendocrine tumour. In our current practice, CD56 is not used to support the
    diagnosis of ESS. We present a case of a postmenopausal lady with advanced ESS who had expression of CD56
    upon immunohistochemical study
  2. Diymitra, K. G., Mushawiahti, M., Aida Zairani, M. Z.
    MyJurnal
    Orbital cellulitis is a relatively common disease affecting predominantly the paediatric population. Most cases occur as a result of spread from the nearby sinuses. Other causes include penetrating trauma or extension from infected adjacent structures.If left untreated, this condition may result in devastating sequelae such as orbital apex syndrome, cavernous sinus thrombosis, meningitis, cranial nerve palsies, intracranial abscess formation and even death. A 47 year old immunocompetent Burmese lady presented with left eyelid swelling of 2 days duration associated with eye redness, blurring of vision and diplopia. Previously, there was history of right maxillary sinusitis and parapharyngeal abscess 9 months prior to presentation. On examination, she was afebrile with vision of 1/60 for the left eye with positiverelative afferent pupillary defect (RAPD). The eye was proptosed and swollen with restricted extraocular movements in all gazes. Conjunctiva was injected with chemosis and there was corneal epithelial bedewing. Otherwise anterior chamber was quiet and intraocular pressure was 51mmHg. Bilateral fundus examination was normal. Computed tomography (CT) scan of the orbit and paranasal sinus showed dense sinusitis and periosteal abscess at the lateral orbital wall.She was started on intravenous (IV) Cefuroxime and Metronidazole and underwent Functional Endoscopic Sinus Surgery (FESS) and orbital decompression. Intra-operatively there was pus and debris at the left anterior ethmoid, maxillary and sphenoid air sinuses and cultures revealed Klebsiella pneumoniae which was sensitive to Cefuroxime. Despite medical and surgical treatment, left orbital swelling only reduced minimally. However after starting intravenous Dexamethasone the swelling dramatically improved. She completed 10 days of intravenous Dexamethasone. Upon discharge, she was given oral Dexamethasone 2mg daily for 2 weeks and completed 2 weeks of oral Cefuroxime and Metronidazole. Intraocular pressure normalised and vision recovered to 6/9. A repeat CT orbit 3 weeks later showed resolving preseptal and periorbital collection.
  3. Logeswary, K., Jemaima Che-Hamzah, Aida Zairani, M.Z.
    MyJurnal
    A 47-year-old healthy Indonesian gentleman, presented with blurring of vision on the left eye associated with pain
    and redness after history of foreign body entering the eye. A general practitioner prescribed him some eye drops;
    however, his symptoms worsened. A corneal laceration wound measuring 0.5 x 3.5mm with a large stromal abscess
    measuring 9.0 x 5.0mm with flat anterior chamber was seen on the left eye. Emergency corneal T&S revealed a large
    descemetocele and cyanoacrylate corneal glue was applied on the area. C&S showed Pseudomonas aeruginosa.
    Patient was subsequently undergone penetrating keratoplasty as a definitive measure. This case highlights the rapid
    progression of pseudomonas keratitis, presented with a large descemetocele, which can be mistaken as an infected
    corneal laceration wound. Corneal cyanoacrylate glueing together with corneal suturing is a viable temporary method
    for large descemetoceles awaiting definitive surgery.
  4. Muhammad Najmi, K., Aida Zairani, M.Z., Mushawiahti, M., Bastion, M.L.C., Amin, A.
    MyJurnal
    Pneumatic retinopexy is known as one of the treatment options for a specific type of retinal detachment. It is done in
    an office setting and may be the most cost-effective means of retinal reattachment surgery. Location and size of the
    retinal break remain as the major criteria for a successful outcome. We describe a case that fulfilled all except one
    major criteria for pneumatic retinopexy and underwent multiple procedures but failed. Fluctuation in the resolution
    of the retinal detachment such as in this particular case suggested possibility of early treatment failure.
  5. Nurhayati, A., Aida Hani, M.K., Nik Muhd Aslan, A., Reena Rahayu, M.Z., Ani Amelia, Z.
    MyJurnal
    Gastrointestinal stromal tumour (GIST) is extremely rare with reported incidence of 20 per million per year. It is the most common mesenchymal tumour of the gastrointestinal tract. When it occurs at the pelvis in a female patient, it can be misleading to a gynaecological diagnosis. Non gynaecological diagnosis such as GIST must be considered in patients with pelvic mass presenting with atypical symptoms.
  6. Vijayakumar, P., Leonard, H.J., Ayiesah, H.R.
    MyJurnal
    Traumatic knee crush injuries of degloving nature carries a greater risk for the multitude of complications rendering emergency surgical intervention the treatment of choice in the majority of such injuries. These types of injuries commonly result in a unique post- operative complication such as arthrofibrosis and it presents overly challenge for Physiotherapists managing it. In this retrospective single-case report, we describe the challenges of in – and out- patient physiotherapy treatment planning for a 16-year old boy throughout the continuum of care for his knee arthrofibrosis following a series of surgical procedures. As result of his complex medical situation, the time-specific physiotherapy intervention during the immediate post-operative period failed to improve our patient’s knee function. The knee function with regard to range of motion ( especially extension), muscle strength(quadriceps) improved considerably with the adoption of an aggressive physiotherapy intervention approach that included specific quadriceps muscle strengthening, joint mobilization (rotation/traction) in sitting position with legs over the edge of table and contract-relax quadriceps stretching in prone position using theraband.
  7. Leonar, J.H., Siti Salmiah, M.D., Das, S., Ayiesah, H.R.
    MyJurnal
    Arthroscopic sub acromial debridement surgery with acromioplasty is one of the shoulder surgeries performed to treat chronic shoulder pain. This surgical procedure is usually indicated in sub acromial impingement syndrome of shoulder, degenerative rotator cuff tears, severe functional limitation of shoulder joint and often surgery was performed in cases where all the conservative management had failed in the treatment of chronic shoulder pain. Even though the patient would be referred for early rehabilitation, post operative management of this surgical condition is highly challenging. Movement of the shoulder joint is often related with scapulo-thoracic joint, acromio-clavicular joint and sternoclavicular joint and the shoulder movements are governed by various different muscular forces from these joints. Failure to understand this biomechanical complexity of shoulder joint during post operative rehabilitation results in failure of the surgical outcome and might cause severe functional limitation with recurrent shoulder pain. Often in clinical practice, greater emphasis is given to achieve and regain movements in shoulder joint at the expense of the joint stability. However, inadequate scapular stability might further predispose the shoulder joint to excessive loading and results in repetitive injuries leading to chronic shoulder pain. This might affect the surgical and clinical outcome of the acromioplasty and result in surgical failure. Hence, surgeons and clinicians need to understand the biomechanical contributions in the post operative rehabilitation of the shoulder joint. The present case report emphasises the biomechanical model of post operative rehabilitation of a patient who had arthroscopic sub acromial debridement with acromioplasty.
  8. Christopher, C.K.H., Praveen, S., Goh, E.H., Tan, G.H., Rozman, Z., Zulkifli, M.Z., et al.
    MyJurnal
    Dermoid cyst in a kidney is rarely seen. We report a case of intrarenal dermoid cyst which mimics malignant renal tumour and discuss the dilemma in managing this disease.
  9. Norshamsiah, M.D., Muhaya, M., Bastion, M.L.C.
    MyJurnal
    A 24-year-old Chinese gentleman presented with two weeks history of sudden floaters in his right temporal visual field associated with blurring of vision. This ex-smoker also reported chronic, bloody cough for two years and recent pleuritic chest pain. Examination revealed a thin patient with right eye visual acuity of 6/18 associated with optic nerve dysfunction, optic disc swelling and macula star, retinal vasculitis and retinitis. Despite anti-tuberculosis medication and corticosteroids, he developed neovascularisation. Subsequent vitreous haemorrhage necessitated trans pars plana vitrectomy, membrane peeling, endolaser and silicone oil injection. Final visual acuity was 6/9 with quiescent retinopathy.
  10. Lam, C.S., Mushawiahti, M., Bastion, M.L.C.
    MyJurnal
    Subluxation or dislocation of PCIOL is one of the complications of cataract operation in RP patients. This paper reports the presentation of PCIOL dislocation and subluxation and the management and outcome in 3 eyes of 2 RP patients. Two medical records of patients with RP who developed dislocated or subluxated PCIOL and subsequently underwent explantation of the dropped IOL were evaluated. Two patients had bilateral eye cataract operation done and had PCIOL implanted. Patient 1 developed left eye subluxated PCIOL inferiorly after 2 years of the cataract operation and right eye dislocated PCIOL anteriorly 4 years after cataract operation. Patient 2 develop right eye subluxated PCIOL inferiorly after 12 years of the cataract operation. Patient 1 with right eye dislocated PCIOL underwent intraocular lens (IOL) explantation and was left aphakic as her visual prognosis was poor due to advanced RP. The left IOL remained within the visual axis despite subluxation and no intervention has been done. Patient 2 with right eye subluxated PCIOL underwent IOL explantation and anterior chamber intraocular lens (ACIOL) implantation. ACIOL remained stable and visual acuity improved post-operation. Both the operations were uneventful. Post-operatively, there was no elevated intraocular pressure and no prolonged ocular inflammation, which required prolonged anti-inflammatory and no retinal detachment was seen. Both patient and surgeon should be aware of potential PCIOL subluxation or dislocation in RP. The presentation may be as late as more than a decade after the cataract operation.
  11. Hor, S.M., Noor Aniah, A., Mushawiahti, M., Mushawiahti, M., Bastion, M.L.C.
    MyJurnal
    Scleral buckle placement is a well-established technique for the treatment of primary rhegmatogenous retinal
    detachment. Complications associated with scleral buckle are uncommon and its presentations can be vary. We
    report a case of recurrent orbital cellulitis with anterior segment ischemia following a forgotten episode of previous
    scleral buckling surgery, presenting with blurring of vision, redness and swelling of the lids. The presence of scleral
    buckle was detected by detailed examination and confirmed by orbital imaging. Orbital infection and rubeosis iridis
    were successfully treated with scleral buckle removal, intravenous antibiotics and intracameral ranibizumab.
    However, the retinal detachment recurred and the visual acuity deteriorated to light perception. There was no further
    intervention as the family declined in view of her old age. In cases of recurrent orbital infection, detailed clinical
    examination is important to look for evidence of ocular prostheses as a source of infection. Orbital imaging is an
    adjunct for making the diagnosis especially in cases where history is unreliable. Anterior segment ischemia due to
    scleral buckle responds well to buckle removal with ranibizumab injection.
  12. Tan, G.H., Nor Faezan, A.R., Hairol, A.O., Bong, J.J.
    MyJurnal
    Pseudohyperkalemia is a spuriously high serum potassium measurement in a patient with no clinical evidence of hyperkalemia. It has been reported to occur in patients with leukocytosis and thrombocytosis. Only a few cases of pseudohyperkalemia have been reported in patients after splenectomy. Two cases of pseudohyperkalemia occurring after emergency splenectomy for abdominal trauma are presented to highlight their clinical presentation and sequalae. Consecutive patients who underwent emergency splenectomy for trauma and subsequently developed pseudohyperkalemia were monitored in Universiti Kebangsaan Malaysia Medical Centre for their clinical sequalae. Both the patients developed leukocytosis, thrombocytosis and high serum potassium level within 2-weeks of their splenectomies. They did not demonstrate any symptoms and signs of hyperkalemia. Their conditions resolved spontaneously without any specific treatment. Pseudohyperkalemia should be suspected in a similar clinical scenario to avoid unnecessary treatment that could lead to severe hypokalemia.
  13. Lai, S.C., Choy, Y.C.
    MyJurnal
    This was a prospective, randomized, double-blind study comparing the effect of remifentanil and fentanyl on cardiovascular responses from laryngoscopy and tracheal intubation. Forty-four ASA I or II patients aged between 18-65 yrs scheduled for elective surgery under general anaesthesia, were recruited and randomized into two groups. Each patient in Group R received remifentanil of 0.5 mcg/kg bolus over 30 seconds followed by an infusion of 0.25 mcg/kg/min and each patient in Group F received fentanyl of 2 mcg/kg bolus over 30 seconds followed by an infusion of normal saline. Anaesthesia was then induced with propofol, rocuronium and 2% sevoflurane with 100% oxygen. Cardiovascular changes were recorded every minute for 3 minutes after induction and 5 minutes after tracheal intubation. The heart rate remained stable throughout the induction and intubation period in both groups. None of the patients in the remifentanil group develop bradycardia. Systolic blood pressure (SBP) and mean arterial pressure (MAP) were significantly lower in the fentanyl group at the 3rd minute post-induction and 5th minute post- intubation (p < 0.05). Diastolic blood pressure (DBP) in the fentanyl group was significantly lower at the 2nd and 3rd minute post-induction and 4th and 5th minute post-intubation (p < 0.05). The blood pressure remained stable for the remifentanil group throughout the induction and intubation period. Six patients (27.2%) in the fentanyl group and one patient (4.5%) in the remifentanil group experienced hypertension. Three patients (13.7%) from each group experienced hypotensive episodes. In conclusion, remifentanil 0.5 mcg/kg bolus followed by 0.25 mcg/kg/min infusion resulted in SBP, MAP and DBP remained slightly lower than baseline throughout the whole period but still consider stable, as these changes were not statistically significant.
  14. Niew, Y.L., Chee, Magdalene M.X., Juanita, J., Nurul Ezzati, A.K., Mohd Sharol, A.W., Azarinah, I., et al.
    MyJurnal
    Anaesthesiology is a specialty which is less well known and the public usually have little knowledge regarding anaesthesia and the roles of Anaesthesiologist. Many hospitals now use a single dedicated consent for anaesthesia. This study was conducted to compare the effectiveness of a single consent for anaesthesia with the combined surgical and anaesthetic consent. A total of 109 patients, scheduled for elective surgery requiring anaesthesia were interviewed with a standardised questionnaire. Patients were divided into two groups, where one group used a single anaesthetic consent while the other used a combined surgical and anaesthetic consent. A single consent for anaesthesia was found to be more effective than the current combined surgical and anaesthetic consent (p
  15. Levin, K.B, Das, S.
    MyJurnal
    In this article, we speculate the reasons behind the death of Achilles during the Trojan war. Roots of Medicine can be traced to ancient Greek history. From the Hippocrates Oath to the Achilles tendon, it all has a long story to tell. In the history of ancient Greece, Gods played an important role in their lives and the immortals existed.
  16. Nazarudin, B., Khairulamir, Z., Azarinah, I., Jaafarm, M.Z., Karis, M., Esa, K.
    MyJurnal
    This was a prospective randomised study comparing carboxyhaemoglobin concentrations between low-flow anaesthesia (fresh gas flow 1.0 L/min) and minimal-flow anaesthesia (0.5 L/min) using desflurane. Sixty (ASA 1 or 2) adult patients undergoing elective surgery under general anaesthesia were randomly allocated to receive either low-flow (Group 1) or minimal flow anaesthesia (Group 2). Venous blood samples for carboxyhaemoglobin levels were taken at baseline and at 10 mins intervals for 40 mins. Both groups showed significant increase in carboxyhaemoglobin concentrations within the first 10 mins when fresh gas flow of 4.0 L/min was used. Reduction in carboxyhemoglobin levels was seen after 20 mins of minimal or low flow anaesthesia. However, there was no significant difference in the magnitude of reduction of carboxyhemoglobin concentrations between the groups. The fractional inspired of oxygen (FiO2) showed no significant changes in either group. In conclusion, desflurane usage in anaesthesia with either low-flow or minimal-flow was not associated with increased carboxyhaemoglobin concentrations.
  17. Farrah-Hani Imran, Muthukumaran, Guhan, Enda, Kelly, Jegan Thanabalan, Farizal Fadzil, Faridah Hanum
    MyJurnal
    This was a case of a young lady presenting with 10 year history of a mass in the right eye. It was found to be an adenocarcinoma of the lacrimal gland from histopathological biopsy. She underwent wide excision, orbital exenteration and reconstruction with a free rectus abdominis flap. Unfortunately, she had a tumour recurrence which was not controlled by radiotherapy and a second excision. The behavior of the tumour was aggressive, resulting in widespread metastases. She passed away within a year of her presentation. Of note, the histopathology report from the second excision turned out to be sarcomatoid carcinoma. This is described in the literature as dedifferentiation, or high grade transformation (HGT). Occurrence of dedifferentiation in salivary gland tumours is well-established, but not as well-described in lacrimal gland tumours. In this case, there was a severely delayed presentation of a lacrimal gland adenocarcinoma in a young person, which underwent dedifferentiation into a sarcomatoid carcinoma. This phenomena is associated with aggressive tumour biology behavior and poor prognosis, despite surgery and radiotherapy.
  18. Umi Kalthum, M.N., Amin, A., Syazarina, S.O., Faridah, H.A.
    MyJurnal
    A 42-year-old Malay gentleman presented with progressive painless blurring of vision on his left eye associated with ocular ache, redness and increasing proptosis. Examination revealed presence of relative afferent papillary defect with visual acuity of counting finger, and 6/6 on the right eye. Extraocular muscle movement of the left eye was restricted to ten percent in all directions. Computed tomography (CT) and magnetic resonance imaging (MRI) showed enhancing mass occupying the left orbital apex. Diagnosis of optic nerve sheath meningioma was made, and patient subsequently went for radiotherapy. His symptoms subsided completely, until he presented with similar visual complains, and fullness of the upper lid two years later. A repeated MRI showed enlargement of superior and lateral recti muscles with extension to lacrimal gland region. Biopsy of the lacrimal gland revealed inflammatory cells consistent of inflammatory pseudotumor. High dose systemic steroid was instituted, followed by slow tapering of oral steroid. His symptoms completely resolved, and latest visual acuity was 6/9, with no recurrence, to date.
  19. Haizul, I.M., Umi Kalthum, M.N., Mae-Lynn, C.B., Faridah, H.A.
    MyJurnal
    A 50-year-old Chinese man presented with sudden onset of painful right eye, diplopia, and redness associated with headache and deteriorating vision. Examination revealed obvious proptosis with elevated intraocular pressure. Computed tomography (CT) scan showed presence of retrobulbar haemmorhage. Emergency lateral canthotomy and cantholysis was performed followed by medical orbital decompression, resulting in improvements in visual acuity, and other ocular symptoms. The diagnosis of thrombosed orbital varices involving inferior ophthalmic vein was confirmed on radiological- angiographic study. To date, he is symptoms-free with good visual acuity. Immediate surgical decompression with lateral cantholysis for retrobulbar haemorrhage was effective in the treatment of retrobulbar haemorrhage.
  20. Khoo, Hau Chun, Enda Gerard, Kelly, Mohd Ali Mat Zain, Farrah-Hani Imran
    MyJurnal
    Basal cell carcinoma is the commonest skin malignancy diagnosed in Malaysia. Surgery is the recommended treatment of choice with the lowest failure rate provided a clear margin is obtained. However, the defect may be too large to be repaired primarily. Formal reconstruction using grafts and flaps should be done to achieve the optimal aim of maintaining the integrity, function and cosmetic patient outcome. Three reconstructive methods are described in this series to restore the facial defect following the wide local excision. The procedures described were peri-alar crescentic advancement flap, nasolabial rotational flap and full thickness skin graft using supraclavicular skin. This series highlights the usage of the procedures based on solid foundation and principles, without compromising the desired outcomes for the patient.
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