MyMedR

Fulltext Tuberculous aortic pseudoaneurysm treated with in situ silver-impregnated vascular inlay graft

Hussein H, Azizi ZA

Asian J Surg, 2008 Apr;31(2):87-9.

PMID: 18490221 DOI: 10.1016/S1015-9584(08)60064-0

A 62-year-old man presented with continuous, persistent backache shortly after completion of antituberculosis medication for tuberculosis (TB) of the spine. Computed tomography scan revealed a pseudoaneurysm involving the infrarenal aorta. He was restarted on anti-TB medication and underwent repair of the pseudoaneurysm with an in situ silver-coated bifurcated Dacron graft. His postoperative recovery was uneventful and he remained well up to 12 months of follow up. To our knowledge, this is the first case in the literature where an in situ silver-impregnated vascular graft has been successfully used in treating a tuberculous pseudoaneurysm.

Fulltext Total thyroidectomy: the procedure of choice for toxic goitre

Hussain M, Hisham AN

Asian J Surg, 2008 Apr;31(2):59-62.

PMID: 18490216 DOI: 10.1016/S1015-9584(08)60059-7

Over the years, subtotal thyroidectomy has been the mainstay of treatment for toxic goitre; however, total thyroidectomy is increasingly being considered as the procedure of choice. This study aimed to review our experience with total thyroidectomy in toxic goitre and evaluate the outcome of this procedure.

Laparoscopic appendicectomy: the ideal procedure for laparoscopic skill training for surgical registrars

Tata MD, Singh R, Bakar AA, Selvindoss P, P K, Gurunathan R

Asian J Surg, 2008 Apr;31(2):55-8.

PMID: 18490215

OBJECTIVE: Appendicectomy is a very common surgical procedure performed by registrars. It is mainly carried out by surgical registrars as an open procedure in many government hospitals. We aimed to evaluate laparoscopic appendicectomy as a laparoscopic training skill in a clinical setting for our registrars.

METHODS: A retrospective analysis of all attempted laparoscopic appendicectomies over 12 months by experienced surgeons and registrars was done. Factors evaluated were operating time, conversion rate, postoperative hospital stay, morbidity and mortality.

RESULTS: There was no statistically significant difference in operating time for surgeons and registrars (mean, 53 minutes vs. 60 minutes), conversion rate (10% vs. 11%). Mean hospital stay for patients operated on by surgeons was 3.1 days and 3.2 days for registrars. Morbidity was equal with both surgeons and registrars.

CONCLUSION: We conclude that laparoscopic appendicectomy is a safe laparoscopic training tool for registrars with basic laparoscopic knowledge who have had a proper apprenticeship, and can be done in a clinical setting.

Fulltext Serum lipoprotein(a) levels in patients with atherosclerotic peripheral vascular disease in Hospital Kuala Lumpur

Hakim NA, Hafizan MT, Baizurah MH, Zainal AA

Asian J Surg, 2008 Jan;31(1):11-5.

PMID: 18334463 DOI: 10.1016/S1015-9584(08)60048-2

The objective of this study was to determine the proportion of patients with atherosclerotic peripheral vascular disease (PVD) who had elevated lipoprotein(a) [Lp(a)] levels, as well as to determine the latter's significance as a risk factor for PVD in the local population.

Fulltext Surgical management of juvenile nasopharyngeal angiofibroma without angiographic embolization

Ahmad R, Ishlah W, Azilah N, Rahman JA

Asian J Surg, 2008 Oct;31(4):174-8.

PMID: 19010758 DOI: 10.1016/S1015-9584(08)60081-0

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign neoplasm that occurs almost exclusively in the nasopharynx of adolescent males. Surgery remains the primary treatment of choice. JNA has always presented a management challenge to surgeons because of its vascular nature, site of occurrence, and local tissue destruction. The surgical approaches are either standard open method which include external or intraoral incisions, or the recent advanced approach, i.e. via using the endonasal endoscope. It is widely accepted that the use of preoperative angiographic embolization reduces the occurrence of intraoperative bleeding and facilitates tumour removal. However, angiographic embolization is not available at all centres. The purpose of this article is to present our experience with five patients diagnosed with JNA who were resected without embolization, using various surgical approaches. Two tumours were removed via endonasal endoscopic surgery. None of the tumours were embolized prior to surgery. We highlight the preoperative evaluation of tumour extent, using both computed tomography (CT) and magnetic resonance angiography, and the importance of temporary clamping of the external carotid artery intraoperatively. Our results suggest that the latter procedure is a safe and effective means of facilitating surgery and reducing intraoperative bleeding.

Large retrosternal parathyroid carcinoma with primary hyperparathyroidism

Tan GC, Shiran MS, Swaminathan M, Phang KS, Rohaizak M

Asian J Surg, 2007 Oct;30(4):286-9.

PMID: 17962134

Parathyroid carcinoma is an uncommon cause of parathyroid hormone (PTH)-dependent hypercalcaemia, accounting for less than 1% of all cases of hyperparathyroidism. Parathyroid carcinoma is an indolent tumour with rather low malignant potential. Consideration of parathyroid carcinoma in the differential diagnosis of hypercalcaemic disorders is important because the morbidity and mortality are substantial and the best prognosis is associated with early recognition and surgical resection. Clinical indicators favouring parathyroid carcinoma over benign disease include markedly raised serum calcium levels, PTH and alkaline phosphatase. A palpable neck mass with both kidney and skeletal manifestations also give a high index of suspicion of parathyroid carcinoma. Histopathology alone is not sufficient to diagnose parathyroid cancer; it has to be correlated with the clinical findings. The initial and most effective treatment for parathyroid carcinoma is complete resection of the primary lesion, and repeated operations for recurrence are useful. The prognosis of parathyroid carcinomas is quite variable; 5-year survival rates vary from 40% to 86%, while the 10-year survival rate is approximately 49%. We report a case of parathyroid carcinoma occurring in a 55-year-old woman who presented with bone pain and hypercalcaemia.

Fulltext Cost effectiveness analysis of using multiple neuromodalities in treating severe traumatic brain injury in a developing country like Malaysia

Ibrahim MI, Abdullah M, Naing L, Abdullah JM, Idris Z, Aljunid SM

Asian J Surg, 2007 Oct;30(4):261-6.

PMID: 17962129

The aim of this study was to determine the cost-effectiveness of using baseline neuromonitoring (BNM) compared with multimodality monitoring (M3) for severe traumatic brain injury (TBI).

Fulltext Bacillus Calmette-Guerin and bladder cancer

Razack AH

Asian J Surg, 2007 Oct;30(4):302-9.

PMID: 17962138 DOI: 10.1016/S1015-9584(08)60045-7

Bladder cancer is the second most common cancer of the urinary tract, and overall it is among the top 10 cancers in men. Transitional cell carcinoma (TCC) is the most common type, with the majority being superficial disease, i.e. the tumour has not gone beyond the lamina propria. The main problem with superficial TCC is the high recurrence rate. Various forms of treatment methods have been attempted to reduce the recurrence rate, with intravesical bacillus Calmette-Guerin (BCG) being the most successful to date. In fact, intravesical BCG is one of the most successful forms of immunotherapy in the treatment of any form of cancer. This article is a general review of BCG in bladder cancer with an emphasis on the indication and mechanism of action in reducing recurrence and progression.

Specimen shrinkage and its influence on margin assessment in breast cancer

Yeap BH, Muniandy S, Lee SK, Sabaratnam S, Singh M

Asian J Surg, 2007 Jul;30(3):183-7.

PMID: 17638637

The determination of tumour-free margin in breast cancer is crucial in deciding subsequent patient management. To exemplify the phenomenon of margin contraction during specimen preparation for histopathological analysis, we quantified the shrinkage of breast specimens as a result of formalin fixation.

Hypercalcaemic crisis: immediate parathyroidectomy and intraoperative intravenous calcium infusion improves outcome

Harjit K, Zanariah H, Hisham AN

Asian J Surg, 2007 Jul;30(3):173-7.

PMID: 17638635

The hypercalcaemic crisis of hyperparathyroidism is an endocrine emergency that is invariably fatal if untreated. Despite emergency parathyroidectomies to treat hypercalcaemic crisis, mortality rates remain high. The rapid decline of serum calcium levels after removal of an adenoma and its adverse effect on the heart contributes to the development of postoperative complications and death. The cornerstone of surgical treatment for hypercalcaemic crisis is to begin infusion of high doses of calcium immediately after successful removal of parathyroid adenomas to allow gradual and well-controlled decline of serum calcium to avoid fatal myocardial complications.

Aspiration of breast abscess under ultrasound guidance: outcome obtained and factors affecting success

Elagili F, Abdullah N, Fong L, Pei T

Asian J Surg, 2007 Jan;30(1):40-4.

PMID: 17337370

To assess ultrasonographically (US) guided needle aspiration of breast abscesses as an alternative to surgical incision and drainage.

Fulltext Preemptive ropivacaine local anaesthetic infiltration versus postoperative ropivacaine wound infiltration in mastectomy: postoperative pain and drain outputs

Rica MA, Norlia A, Rohaizak M, Naqiyah I

Asian J Surg, 2007 Jan;30(1):34-9.

PMID: 17337369

OBJECTIVE: The aim of this study was to investigate if preemptive local infiltration (PLA) with ropivacaine could improve postoperative pain and determine its effect on drain output postmastectomy with axillary dissection.
METHODS: This was a prospective, randomized trial comprising 30 women allocated to two groups: one to receive postoperative wound infiltration (POW) of 20 mL of 0.2% (40 mg) ropivacaine (Naropin) versus PLA with 20 mL of 0.2% ropivacaine (Naropin) diluted with 80 mL of 0.9% saline, total volume 100 mL. A visual analogue scale (0-100 mm) and angle of shoulder abduction were used for evaluation of pain. Postoperatively, all patients received oral ibuprofen 400 mg tds.
RESULTS: There was no significant difference in postoperative pain for the first 3 days between the two groups. There were wider shoulder abduction angles in the 1st and 3rd postoperative days in the PLA group, but this was not significant. Operative time was significantly shorter in the PLA group than in the POW group (69.34+/-59.37 minutes vs. 109.67+/-26.96 minutes; p=0.02). The axillary drain was removed earlier in the preemptive group, 5.4+/-1.55 days versus 6.8+/-2.04 days in the postoperative group (p=0.04).
CONCLUSION: We found no difference in postoperative pain between preemptive tumescent ropivacaine infiltration and postoperative ropivacaine wound infiltration.

Fulltext Acute anuric renal failure following jering bean ingestion

Wong JS, Ong TA, Chua HH, Tan C

Asian J Surg, 2007 Jan;30(1):80-1.

PMID: 17337378

Djenkol beans or jering (Pithecellobium jeringa) is a traditional delicacy consumed by the local population in Malaysia. Jering poisoning or djenkolism is characterized by spasmodic pain, urinary obstruction and acute renal failure. The underlying pathology is an obstructive nephropathy, which is usually responsive to aggressive hydration and diuretic therapy. We present a case of djenkolism following ingestion of jering. The patient required urgent bilateral ureteric stenting following the failure of conservative therapy. Healthcare providers need to recognize djenkolism as a cause of acute renal failure and the public educated on this potential health hazard.

Epithelial migration in open mastoidectomy cavities

Ong CA, Prepageran N, Godbole S, Raman R

Asian J Surg, 2007 Jan;30(1):57-9.

PMID: 17337373

To study the rate and pattern of epithelial migration in 18 dry, open mastoidectomy cavities.

Efficacy of relocation of submandibular duct in cerebral palsy patients with drooling

Puraviappan P, Dass DB, Narayanan P

Asian J Surg, 2007 Jul;30(3):209-15.

PMID: 17638641

The efficacy of relocating the submandibular duct to treat drooling in children with cerebral palsy was studied.

Prognostic study of using different monitoring modalities in treating severe traumatic brain injury

Idris Z, Ghani RI, Musa KI, Ibrahim MI, Abdullah M, Nyi NN, et al.

Asian J Surg, 2007 Jul;30(3):200-8.

PMID: 17638640

To determine whether or not multimodality monitoring technique would result in a better outcome score than single modality monitoring in severely head injured patients.

Follicular thyroid carcinoma with direct tumour extension into the great cervical veins and right atrium: is transcervical thrombectomy a safe option?

Taib NA, Hisham AN

Asian J Surg, 2007 Jul;30(3):216-9.

PMID: 17638642

Direct tumour extension into the internal jugular veins (IJV) and right atrium in thyroid cancer is extremely uncommon. We report three cases of advanced thyroid cancer invading into the IJV and right atrium. All three patients had well-differentiated thyroid cancer and presented with typical clinical picture of the superior cava syndrome coupled with significant compressive symptoms. Two patients had obvious tumour thrombus extending to the superior vena cava (SVC) and right atrium, whilst in one patient, the thrombus extended to the SVC close to the edge of the right atrium. In all three patients, the intraluminal tumour thrombus was clinically palpable. Involvement of the IJV, SVC and right atrium was confirmed with computed tomography (CT) scan and echocardiography. The decision to extract the thrombus transcervically was made on the basis of the positive "ring sign", which is a thin rim of contrast surrounding the tumour thrombus documented on CT. All three patients underwent total thyroidectomy with segmental resection and ligation of the IJV. The tumour thrombus was successfully extracted transcervically. The histopathology report confirmed follicular carcinoma in all three patients. Two patients had radioiodine ablation therapy postoperatively, and were well 18 months after operation. One patient who had lung metastases documented on chest CT succumbed to the disease due to massive haemoptysis 3 weeks after operation.

Swordfish attack--death by penetrating head injury

Gooi BH, Khamizar W, Suhani MN

Asian J Surg, 2007 Apr;30(2):158-9.

PMID: 17475591

There have been very few reports of swordfish attacks on humans and none have resulted in death. Although there are no reports of unprovoked attacks on humans, swordfish can be very dangerous when provoked and they can jump and use their swords to pierce their target. We describe here an unusual case of death that resulted from intracranial penetrating injury caused by a swordfish.

Liver abscess caused by tuberculosis and melioidosis

Azali HY, Norly S, Wong LM, Tan KS, Safian NM

Asian J Surg, 2007 Apr;30(2):138-40.

PMID: 17475585

We report an unusual co-existence of Burkholderia pseudomallei and acid fast bacilli in a young Malay gentleman with liver abscess. He was treated with antibiotics and surgical drainage. This phenomenon has not been reported in previous literature and the dilemma of its management is discussed.

Massive dissecting intramural duodenal haematoma following endoscopic haemostasis of a bleeding duodenal ulcer

Lukman MR, Jasmi AY, Niza SS

Asian J Surg, 2006 Apr;29(2):98-100.

PMID: 16644511

Intramural duodenal haematoma is a rare injury of the duodenum. Most reported cases are secondary to blunt trauma to the abdomen. Such injury following endoscopic intervention is even rarer, and there are no definite guidelines for its management. We report a case where endoscopic haemostasis of a bleeding duodenal ulcer resulted in a massive dissecting intramural duodenal haematoma with gastric outlet obstruction and obstructive jaundice.

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