MyMedR

Fulltext Iatrogenic ureter injuries: eleven years experience in a tertiary hospital

Mahendran HA, Singam P, Ho C, Goh EH, Tan GH, Zuklifli MZ

Med J Malaysia, 2012 Apr;67(2):169-72.

Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity from infection and possible loss of renal function. A successful repair is related to the timing of diagnosis, site of injury and method of repair. This study was a retrospective review of outcomes of iatrogenic ureteric injury and factors contributing to successful operative repair. Twenty consecutive cases referred to the Urology Unit of the UKM Medical Center during an 11-year period from 1998 to 2009 were reviewed. Thirteen patients were diagnosed intraoperatively and underwent immediate repair. Seven patients had delayed diagnosis but also underwent immediate repair. In our series, there was no significant difference in outcome between injuries diagnosed intraoperatively versus injuries with delayed diagnosis. There was significant difference in the outcomes between methods of ureteric repair where ureter reimplantation via psoas hitch or Boari flap yielded better results than primary end-to-end anastomosis Three patients suffered loss of renal function from unsuccessful ureter repair. We conclude that all iatrogenic ureteric injury should be repaired immediately in the absence of overt sepsis. Ureter reimplantation using a Boari flap or psoas hitch is preferred to the end-to-end anastomosis especially when there is delayed diagnosis

Matched MeSH terms: Stents

Fulltext Update on the management of peripheral arterial disease (PAD)

Liew NC, Moissinac K, Lee L, Gee T, Zezeman RB

Med J Malaysia, 2011 Oct;66(4):386-8; quiz 389.

PMID: 22299571 MyJurnal

There has been much progress made in the management of peripheral arterial disease (PAD) in the past two decades. Progress in the understanding of the endothelial-platelet interaction during health and disease state have resulted in better antiplatelet drugs that can prevent platelet aggregation, activation and thrombosis during angioplasty and stenting. Collaborative effort by different international societies has resulted in a consensus guideline that recommends the modality of intervention in certain disease states. Progress in perioperative care has reduced the morbidity and mortality associated with peripheral vascular reconstruction surgery. Nevertheless, the advances in percutaneous peripheral intervention (PPI) have made a paradigm shift in the current management of patients. The procedure is safe and effective and is emerging as the first choice revascularization procedure.

Matched MeSH terms: Stents

Fulltext Tracheobronchial stenting is safe and effective in relieving upper airway obstruction

Pang YK, Liam CK, Leow CH, Shyamala P, Zal AR

Med J Malaysia, 2006 Jun;61(2):147-50.

PMID: 16898303 MyJurnal

Many studies have shown that tracheobronchial stenting is effective in relieving respiratory distress secondary to major airway obstruction due to lung or oesophageal cancer. A retrospective review on the benefits and complications of self-expandable metallic stent (SEMS) insertion through flexible bronchoscopy for the palliative treatment of upper airway obstruction in University Malaya Medical Centre was performed. Ten patients underwent this procedure. Relief of dyspnoea was immediate following stent insertion in all patients. Stent migration occurred in one patient and three patients had restenosis of the central airway. We conclude that tracheobronchial stenting via flexible bronchoscopy is feasible and safe.

Matched MeSH terms: Stents*

Fulltext Informed consent in clinical trials with reference to information disclosure to patient-subjects

Yuhanif Yusof, Anisah Che Ngah, Zaki Morad Mohamad Zaher

Int J Public Health Res, 2014;4(1):384-390.

MyJurnal

Introduction The aim of this study was to examine the aspect of information disclosure by doctor-investigator during the process of obtaining informed consent in clinical trials.
Methods This research employed a mixed-method data collection that is library research and interview. A qualitative methodology and analysis were used in an open-ended, face-to-face interviews with 17 patient-subjects. The interview questions were based on information that needed to be disclosed to patient-subjects during the process of obtaining informed consent. Each interview took place in Kajang Hospital and National Heart Institute and lasted 25-30 minutes. Interviews were conducted in Bahasa Melayu and English. The interviews were tape-recorded, and the main points from the interviews were jotted down to ensure that all information was adequately gathered. Interviewed occurred in Kajang Hospital and National Heart Institute. The participants were patients who had been referred to the Kajang Hospital and National Heart Institute. They were recruited (8 from Kajang Hospital and 9 from National Heart Institute) by their own doctors to participate in a study to evaluate the safety and effectiveness of the investigational stent after been diagnosed with coronary artery disease and also in a study to investigate drug for antidepressant. respectively.
Results The study revealed that doctor-investigators fail to disclose full information to patient-subjects. Instead, doctor-investigators only disclosed information which they thought were necessary for the patient-subjects to know. The study also showed that there were doctor-investigators who did not disclose information at all to the patient-subjects.
Conclusions This study implies that the aspect of information disclosure in the process of obtaining informed consent in clinical trials is rather poor and did not fulfill the criterion of good medical practice. A random monitoring task to be conducted by the research ethics commitees during the informed consent process is suggested.

Matched MeSH terms: Stents

Intravesical stent position as a predictor of quality of life in patients with indwelling ureteral stent

Inn FX, Ahmed N, Hou LG, Abidin ZAZ, Yi LL, Zainuddin ZM

Int Urol Nephrol, 2019 Nov;51(11):1949-1953.

PMID: 31441009 DOI: 10.1007/s11255-019-02262-7

PURPOSE: The internal drainage provided by a ureteral stent helps with the relief and prevention of ureteral obstruction. By definition, correct stent placement is one with a complete loop in both the renal pelvis and bladder. This prevents stent migration proximally or distally despite urinary flow, patient movement, and ureteral peristalsis.

METHODS: We performed a comparative prospective cross-sectional study assessing the impact of intravesical stent position on the quality of life in 46 patients with a ureteral stent. This is done using the Ureteral Stent Symptom Questionnaire (USSQ).

RESULTS: 52.5% of patients had an ipsilateral positioned intravesical stent, while the remaining had their stent positioned contralaterally. Intravesical stent position significantly influenced the quality of life. The USSQ score was worse for the contralateral group. Subscore analysis found that urinary symptoms and body pain index contribute significantly to the morbidity. Majority of patients in the ipsilateral group reported no discomfort as compared to the contralateral group.

CONCLUSIONS: To the best of our knowledge, this is the first study assessing the impact of intravesical stent position on the quality of life in the Asian population. Intravesical stent position has a significant influence on patient's morbidity and quality of life in particular towards their urinary irritative symptoms and body pain. It is imperative to ensure correct distal placement of ureteric stent that does not cross the midline to the contralateral site. We believe that the USSQ should be used in daily clinical practice in assessing the symptoms related to indwelling ureteric stents.

Matched MeSH terms: Stents*

Fulltext Endovascular stent graft repair of aorto-iliac pseudoaneurysms - Hospital Kuala Lumpur experience

Khang NC, Zainal AA

Med J Malaysia, 2016 02;71(1):17-22.

PMID: 27130738

BACKGROUND: This is a single institutional review of aortoiliac pseudoaneurysm of various aetiologies managed with endovascular stent graft repair.

METHODS: From 2009 to 2014, 16 patients had endovascular stent graft inserted for pseudoaneurysm of the thoracic aorta, abdominal aorta and iliac arteries in Hospital Kuala Lumpur. Co-morbidity, causative agents, in-hospital mortality, complications and outcomes were examined.

RESULTS: The average age was 59.1 years (range 36-77). Comorbidities include hypertension, diabetes mellitus, tuberculosis, prior infection and previous open aneurysmal repair. All patients had raised WBC (>10.0x10(9) /L), ESR or Creactive protein on admission while 50% of patients had fever. Blood cultures were positive in 4 patients. All patients were given antibiotics. Only one in-hospital mortality was noted at day-47 post-procedure. Two patients died of aortoenteric fistula at district hospital eight and 16 months later. One patient died of chronic graft infection two years later. One died of unrelated cause. One patient developed type IB endoleak from internal iliac artery two years later and surgical ligation was performed. The average follow up was 15.8 months.

CONCLUSION: Endovascular stent graft repair for pseudoaneurysm is a viable option compared to open surgery. It is less invasive, has lower operative morbidity and fair outcomes. However, some cases may be due to inflammatory aortitis instead of infective pseudoaneurysm, given the frequent culture-negative results. In order to obtain high yield of bacteria culture for infected pseudoaneurysm, open repair with tissue culture is still the main mode of treatment especially for patients with low comorbidity.

Matched MeSH terms: Stents*

Extra-anatomical veno-venous surgical bypass for central vein occlusion in patients with ipsilateral arterio-venous fistula (AVF) for haemodialysis - A single centre experience

Saravana KS, Zainal AA

Med J Malaysia, 2017 02;72(1):3-6.

PMID: 28255132 MyJurnal

OBJECTIVE: Central vein occlusion is a common complication related to central vein catheter insertion for haemodialysis which can be unmasked by an ipsilateral fistula creation, leading to a dysfunctional arteriovenous fistula (AVF). We describe an extra-anatomical venous bypass surgical procedure performed to maintain vascular access and reduce the symptoms of swelling of the ipsilateral upper limb, neck and face.

MATERIALS AND METHODS: We report 20 consecutive patients with end-stage renal failure (ESRF) who had central vein occlusion and were not amenable to endovascular intervention. They underwent extra-anatomical vein to vein surgical bypass. The axillary and iliac or femoral veins were approached via infraclavicular and extraperitoneal groin incisions respectively. In all the patients, an externally supported 6 or 8 mm polytetrafluoroethylene (PTFE) graft was used as a conduit and was tunnelled extra-anatomical. All patients had double antiplatelet (Aspirin and Clopidogrel) therapy post-operatively.

RESULTS: Substantial improvement in the facial, neck and upper limb swelling was noticed following this diversion surgery. The vein to vein bypass was patent at 12 months in 10 out of 20 patients. Graft infection occurred in two (10%) cases. Re-thrombectomy or assisted patency procedure (stent/plasty) was done in four (20%) cases. The patients with preoperative fistula flow rate of more than 1500 ml/min and post-operative graft flow rate of more than a 1000 ml/min were patent at 12 months (P=0.025 and p=0.034 respectively).

CONCLUSION: Axillary to iliac/femoral vein bypass can salvage functioning ipsilateral fistula threatened by occluded upper central vein.

Matched MeSH terms: Stents

Optimization of Stentys Xposition S self-apposing sirolimus eluting stent expansion and apposition with coronary lesion debulking strategy utilizing cutting balloon

Yew KL

Int J Cardiol, 2016 Jan 15;203:1007-8.

PMID: 26630622 DOI: 10.1016/j.ijcard.2015.11.124

Matched MeSH terms: Drug-Eluting Stents*

Overlapping technique for hybrid percutaneous coronary intervention strategy utilising drug eluting stent and ABSORB bioresorbable vascular scaffold

Yew KL

Int J Cardiol, 2015 Jan 15;178:e8-e10.

PMID: 25205484 DOI: 10.1016/j.ijcard.2014.08.085

Matched MeSH terms: Drug-Eluting Stents/utilization*

Novel use of absorb bioresorbable vascular scaffold and STENTYS self-apposing coronary stent for complex saphenous vein grafts intervention

Yew KL

Int J Cardiol, 2014 Dec 20;177(3):e184-5.

PMID: 25156853 DOI: 10.1016/j.ijcard.2014.08.043

Matched MeSH terms: Drug-Eluting Stents*

Successful treatment of fractional flow reserve wire induced coronary dissection and other coronary de novo lesion with paclitaxel coated balloon only

Yew KL

Int J Cardiol, 2014 Dec 20;177(3):1127-8.

PMID: 25150482 DOI: 10.1016/j.ijcard.2014.08.056

Matched MeSH terms: Drug-Eluting Stents*

Fulltext Successful treatment of perioperative very late stent thrombosis with thromboaspiration device

Yew KL

Med J Malaysia, 2012 Jun;67(3):351.

PMID: 23082437

Matched MeSH terms: Drug-Eluting Stents/adverse effects*

Further elucidation on "Hybrid ABSORB bioresorbable vascular scaffold and drug eluting stent or hybrid BVS-DES percutaneous coronary intervention: Method and rationale for hybrid overlapping PCI"

Yew KL

Int J Cardiol, 2015 Jul 15;191:170-1.

PMID: 25965626 DOI: 10.1016/j.ijcard.2015.05.018

Matched MeSH terms: Drug-Eluting Stents*

Bailout left main bioresorbable vascular scaffolding for the treatment of iatrogenic coronary dissection induced by guiding catheter and sticky ABSORB bioresorbable vascular scaffold balloon

Yew KL

Int J Cardiol, 2015;187:527-9.

PMID: 25846666 DOI: 10.1016/j.ijcard.2015.03.432

Matched MeSH terms: Drug-Eluting Stents*

Hybrid ABSORB bioresorbable vascular scaffold and drug eluting stent or hybrid BVS-DES percutaneous coronary intervention: Method and rationale for hybrid overlapping PCI

Yew KL

Int J Cardiol, 2015;186:74-6.

PMID: 25814348 DOI: 10.1016/j.ijcard.2015.02.092

Matched MeSH terms: Drug-Eluting Stents*

Early experience of transradial multivessel percutaneous coronary intervention with new generation STENTYS sirolimus eluting self-apposing stents for ectatic coronary arteries

Yew KL

Int J Cardiol, 2015 Apr 15;185:155-6.

PMID: 25795209 DOI: 10.1016/j.ijcard.2015.03.003

Matched MeSH terms: Drug-Eluting Stents*

Extreme vessel size variance with concomitant chronic total occlusion: Meeting the unmet needs with self-apposing Xposition S sirolimus-eluting stents

Yew KL

Int J Cardiol, 2016 Oct 15;221:847-9.

PMID: 27434358 DOI: 10.1016/j.ijcard.2016.07.097

Matched MeSH terms: Drug-Eluting Stents*

Guidezilla guide extension catheter enhances the delivery of bioresorbable vascular scaffold in an anomalous coronary artery

Yew KL

Int J Cardiol, 2016 Nov 15;223:239-241.

PMID: 27541663 DOI: 10.1016/j.ijcard.2016.07.299

Matched MeSH terms: Stents*

Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, et al.

J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):87-95.

PMID: 28888080 DOI: 10.1002/jhbp.504

Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound-guided gallbladder drainage can be considered in high-volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso-gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound-guided gallbladder drainage studies. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

Matched MeSH terms: Stents*

Fulltext It's aneurysmal, it's stenotic, it's tuberculosis

Guru K, Yahya M

Med J Malaysia, 2011 Dec;66(5):515-6.

PMID: 22390117 MyJurnal

Tuberculous vasculitis is a very rare presentation of tuberculosis. So far this is the second reported case in the literature. The diagnosis of this disorder is based on the clinical presentation as well as blood investigation results. With the ever improvement in modern medicine and improvement in endovascular treatment of such diseases, the morbidity and mortality of these patients have been dramatically reduced with better clinical and survival results. We present a case of endovascular stenting of a stenotic subclavian artery with good results.

Matched MeSH terms: Stents

Displaying publications 1 - 20 of 148 in total