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Fulltext An Undiagnosed Non Functioning Retroperitoneum Paraganglioma, Complicating A Gynaecological Surgery; A Case Report

Noraziana, A.W., Hakim, B., Mokhtar, A., Alik, R.

International Medical Journal Malaysia, 2010;9(1):59-61.
MyJurnal

Paragangliomas are uncommon tumors arising from the neuroendocrine elements (chief cells) of the paraganglia and symmetrically distributed along the aorta in close association with the sympathetic chain. Although functional tumors are easier to diagnose due to the clinical fi ndings caused by excess secretion of catecholamines and an elevation of the urinary catecholamine levels, however the diagnosis of nonfunctioning paraganglioma of the retroperitoneum is diffi cult and only few cases have been made before exploratory laparotomy. Although our patient was initially planned and operated by our gynaecological team, the incidental findings had to involve the general surgeons. She is fortunate that the tumour did not show any features of malignancy nor metastasis, however a long time follow up is needed in case of any possible recurrence.

Matched MeSH terms: Surgeons
Fulltext A Computer Navigation System Analysis of the Accuracy of the Extramedullary (Tibial) Alignment Technique in Total Knee Arthroplasty (TKA)

Chee, E.K., Ewe, T.W.

Malays Orthop J, 2010;4(2):0-0.
MyJurnal

In total knee arthroplasty, mechanical alignment guides have improved the accuracy of implant alignment, but errors are not uncommon. In the present study, an image-free computer-assisted navigation system was used to analyse the accuracy of an extramedullary (tibial) alignment system, which is based on predetermined, fixed anatomical landmarks. Comparisons were made between two surgeons, with different levels of competency in order to determine if experience affected the accuracy of extramedullary tibial jig placement, in either the coronal and sagittal planes or both planes. The results showed that the accuracy of the extramedullary tibial alignment system, in the coronal plane (in up to 80-87% of cases) was much better than for posterior slope, and sagittal plane. Surgeon experience was not a significant factor.

Matched MeSH terms: Surgeons
Fulltext Retrospective review of facial nerve schwannomas: the universiti kebangsaan malaysia medical centre experience

Mazita, A., Zahirrudin, Z., Saim, L., Asma, A.

Medicine & Health, 2010;5(2):86-92.
MyJurnal

Facial nerve schwannoma is a rare slow growing benign tumour which arises from the Schwann cell of the neurilemma. A retrospective review of 6 patients who had been diagnosed with facial nerve schwannoma between 1998 and 2008 was conducted. There was equal distribution of male and female patients. The mean age was 42 years (range 19 to 66 years). The tumour originated in the internal auditory canal (2 patients), intra-temporal (3 patients) and intraparotid (1 patient) segments of the facial nerve. All tumours were successfully removed and facial nerve continuity was pre-served in 2 cases. The presenting symptoms of facial nerve schwannoma are non specific and dependent on the site of tumour origin. It is a great mimicker of other lesions that can present at the same location. The surgeon should have a high index of suspicion when patients present with progressive facial nerve palsy. Patients should always be counselled regarding risk of facial paralysis because the diagnosis of facial nerve schwannoma is often confirmed intra-operatively.

Matched MeSH terms: Surgeons
Fulltext Computed tomography of blunt spleen injury: a pictorial review

Hassan R, Abd Aziz A, Md Ralib AR, Saat A

Malays J Med Sci, 2011 Jan;18(1):60-7.
PMID: 22135575 MyJurnal

The spleen is one of the organs most frequently injured in blunt abdominal trauma. Computed tomography (CT) scanning can accurately detect splenic injury and is currently the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. The CT features of spleen injury include lacerations, subcapsular or parenchymal haematomas, active haemorrhage, and vascular injuries. We present a pictorial review of the spectrum of CT findings for blunt splenic injuries. This article will be a useful reference for radiologists and surgeons as CT scan is widely used for the assessment of splenic injuries and contributes to the current trend towards nonsurgical management of this injury.

Matched MeSH terms: Surgeons
Fulltext Retrocaval ureter: the importance of intravenous urography

Hassan R, Aziz AA, Mohamed SK

Malays J Med Sci, 2011 Oct;18(4):84-7.
PMID: 22589677

Retrocaval ureter is a rare cause of hydronephrosis. Its rarity and non-specific presentation pose a challenge to surgeons and radiologists in making the correct diagnosis. Differentiation from other causes of urinary tract obstruction, especially the more common urolithiasis, is important for successful surgical management. Current practice has seen multislice computed tomography (MSCT) rapidly replaces intravenous urography (IVU) in the assessment of patients with hydronephrosis due to suspected urolithiasis, especially ureterolithiasis. However, MSCT, without adequate opacification of the entire ureter, may allow the physician to overlook a retrocaval ureter as the cause of hydronephrosis. High-resolution IVU images can demonstrate the typical appearance that leads to the accurate diagnosis of a retrocaval ureter. We reported a case that illustrates this scenario and highlights the importance of IVU in the assessment of a complex congenital disorder involving the urinary tract.

Matched MeSH terms: Surgeons
Fulltext A technique of distal clavicle fracture fixation using the tightrope procedure

Soh C, Sivapathasundaram N, Parthiban R, Ramanand A

Malays Orthop J, 2011 Nov;5(3):20-3.
PMID: 25279031 MyJurnal DOI: 10.5704/MOJ.1111.002

We present here a technique of fracture stabilization using the Tightrope procedure in a patient with a widely displaced Neer type IIB distal clavicle fracture. The Tightrope system, typically used for stabilization of acromioclavicular joint dislocation, has not been widely described for distal clavicle fractures. The patient achieved satisfactory results after surgery; we feel that this technique is appealing as it is simple, reproducible and avoids the complications associated with extensive metalwork. This technique may also appeal to the arthroscopic surgeon.

Matched MeSH terms: Surgeons
Fulltext Separate Belly and Tendon of Flexor Digitorum Superficialis to the Fifth Digit

Rao M, Ashwini LS, Somayaji SN, Mishra S, Guru A, Rao A

Oman Med J, 2011 Nov;26(6):e027.
PMID: 28861181 DOI: 10.5001/omj.2011.120

Variation in the origin of long flexor tendons in the anterior compartment of forearm is common. During routine cadaveric dissection at Melaka Manipal Medical College (Manipal Campus), we observed a separate muscle belly and tendon of flexor digitorum superficialis (FDS) to the fifth digit in the right upper limb of a 60 year-old male cadaver. The anomalous muscle belly originated from the common flexor tendon from the medial epicondyle of the humerus and continued as a thin tendon at the middle of the forearm to get inserted into the middle phalanx of the fifth digit. This can be considered as a case of split flexor digitorum superficialis. Such muscle variations and knowledge of their frequency, appearance, and location can be helpful for surgeons.

Matched MeSH terms: Surgeons
Fulltext Sub acromial debridement surgery with acromioplasty for chronic shoulder pain - biomechanical challenges in physical rehabilitation

Leonar, J.H., Siti Salmiah, M.D., Das, S., Ayiesah, H.R.

Journal of Surgical Academia, 2011;1(1):76-80.
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.

Matched MeSH terms: Surgeons
Fulltext Anesthesia for massive retrosternal goiter with severe intrathoracic tracheal narrowing: the challenges imposed -A case report-

Tan PC, Esa N

Korean J Anesthesiol, 2012 May;62(5):474-8.
PMID: 22679546 DOI: 10.4097/kjae.2012.62.5.474

Anesthetic management of patients with mediastinal masses remains challenging as acute cardiorespiratory decompensation may follow induction of anesthesia. We describe a 57 year old lady with massive retrosternal goiter and severe intrathoracic tracheal compression who had a total thyroidectomy. Comprehensive contingency plans were an essential prerequisite for successful management of difficult airway, including multidisciplinary involvement of otorhinolaryngologic and cardiothoracic surgeons preparing for rigid bronchoscopy and cardiopulmonary bypass. Awake oral fiberoptic intubation was performed under dexmedetomidine sedation. Severe tracheal narrowing necessitated usage of a 5.0 mm uncuffed flexometallic endotracheal tube. Anesthesia was maintained with sevoflurane and dexmedetomidine infusion with target controlled infusion of remifentanil as analgesia. No muscle relaxant was given. Surgical manipulation led to intermittent total tracheal compression and inadequate ventilation. The tumor was successfully removed via the cervical approach. A close working relationship between anesthesiologists and surgeons was the key to the safe use of anesthesia and uneventful recovery of this patient.

Matched MeSH terms: Surgeons
Fulltext Surgeons' adherence to guidelines for surgical antimicrobial prophylaxis - a review

Ng RS, Chong CP

Australas Med J, 2012;5(10):534-40.
PMID: 23173017 DOI: 10.4066/AMJ.2012.1312

Surgical site infections are the most common nosocomial infection among surgical patients. Patients who experience surgical site infections are associated with prolonged hospital stay, rehospitalisation, increased morbidity and mortality, and costs. Consequently, surgical antimicrobial prophylaxis (SAP), which is a very brief course of antibiotic given just before the surgery, has been introduced to prevent the occurrence of surgical site infections. The efficacy of SAP depends on several factors, including selection of appropriate antibiotic, timing of administration, dosage, duration of prophylaxis and route of administration. In many institutions around the globe, evidence-based guidelines have been developed to advance the proper use of SAP. This paper aims to review the studies on surgeons' adherence to SAP guidelines and factors influencing their adherence. A wide variation of overall compliance towards SAP guidelines was noted, ranging from 0% to 71.9%. The misuses of prophylactic antibiotics are commonly seen, particularly inappropriate choice and prolonged duration of administration. Lack of awareness of the available SAP guidelines, influence of initial training, personal preference and influence from colleagues were among the factors which hindered the surgeons' adherence to SAP guidelines. Immediate actions are needed to improve the adherence rate as inappropriate use of SAP can lead to the emergence of a strain of resistant bacteria resulting in a number of costs to the healthcare system. Corrective measures to improve SAP adherence include development of guidelines, education and effective dissemination of guidelines to targeted surgeons and routine audit of antibiotic utilisation by a dedicated infection control team.

Matched MeSH terms: Surgeons
Fulltext Pediatric laryngotracheal cases in Hospital Universiti Sains Malaysia

Irfan, M., Izani S.M., Adil, S.A.R., Suzina, S.A.H.

Malaysian Journal of Medicine and Health Sciences, 2012;8(1):55-59.
MyJurnal

There are many inherent challenges in the evaluation and management of children with laryngotracheal disorders, and it differs widely from one institution to another. The main challenges include access to suitable equipment, fully trained surgeon and, cooperation with the anesthetist and pediatrician. Material & Methods: The aim of the study was to analyze the pediatric laryngotracheal cases undergoing endoscopic examination in Hospital Universiti Sains Malaysia. A retrospective review of 73 cases undergoing microlaryngoscopy and bronchoscopy from 2004 to 2008 was done. Results: Laryngomalacia was the commonest diagnosis. The majority of the cases (45.2 %) were referred because of noisy respiration. Other reasons for referral were foreign body inhalation, unresolved lung disease, failed extubation, examination prior to decannulation and hoarseness. Conclusion: Management of pediatric laryngotracheal cases were varied and tailored to each problem. The endoscopic examination must be meticulous. The management include observation, medical treatment, closed (endoscopic)
techniques and open surgery.

Matched MeSH terms: Surgeons
Fulltext The anatomy of anatomy

Judson, John Paul

International e-Journal of Science, Medicine & Education, 2012;6(10):0-0.
MyJurnal

The relationship between anatomy and surgery has been historic and epic, spanning many centuries, complementing each other in medical education and being independent as well as interdependent in many ways. However, curricular changes that have happened globally in recent years with the introduction of several contemporary styles of medical teaching have subtly downplayed the importance of anatomy in medicine, allowing young doctors with poor knowledge of anatomy to become surgeons. With a whimsical introduction that metaphorically hints at the strained relationship that exists between anatomy and surgery, the article attempts to explore the ‘anatomy’ of anatomy itself, examining its origins in recorded ancient history, evolution along the centuries in tandem with surgery and its current status in medical education.

Matched MeSH terms: Surgeons
Fulltext Profile of patients referred to a specialist oral medicine and oral pathology unit

Suraya Hani Mohd Sinon, Nur Syazwani Che Husin, NurulJannah Yusof

Int J Public Health Res, 2013;3(2):325-333.
MyJurnal

The aim of this study was to determine the profile of patients referred to a specialist oral medicine and oral pathology unit in Kuala Lumpur by reviewing clinical dental records received in Oral Pathology Diagnostic Service (OPDS) in Faculty of Dentistry, UKM from 2001 until 2010. A total of 547 archival biopsy clinical dental records were reviewed and analysed using SPSS version 17.0. Oral and maxillofacial diseases were frequently seen in female (1.3:1), young adults (30.0%) of Malay ethnicity (64.6%). Most of the acquired specimens were from dental specialists (n=451, 84.8%), particularly from oral and maxillofacial surgeons (OMFS) (n=349, 63.8%) compared to general dental practitioners (GDPs) (n=81, 14.8%). Almost all of the biopsy specimens were of soft tissue origin (n=462, 84.4%), derived from lining mucosa (n=197, 36.0%) and were biopsied excisionally (n=325, 59.4%) more often than by incisional biopsy (n=207, 37.8%). A large proportion of the oral and maxillofacial diseases were of reactive (n=188, 34.4%) and inflammatory (n=121, 22.1%) cause. Tumours are mainly benign (n=69, 12.6%) with only small cases are malignant (n=34, 6.2%). The most common histological diagnoses were accounted by mucocele (n=56, 10.2%), pyogenic granuloma (n=47, 8.6%), fibroepithelial polyp (n=38, 6.9%), radicular cyst (n=33, 6.0%) and periapical granuloma (n=29, 5.3%). This study characterizes the clinical profile of patients seen in our oral medicine and oral pathology unit. Present findings can be used as a reference to the clinicians and pathologists in effective patient management and organization in the future.

Matched MeSH terms: Oral and Maxillofacial Surgeons
Fulltext Sequelae of neglected senile cataract

Azhany Y, Hemalatha C, Nani D, Rosediani M, Liza-Sharmini A

Malays Fam Physician, 2013;8(1):33-7.
PMID: 25606266 MyJurnal

Cataract is the most common cause of blindness in the world. An attack of phacolytic and phacomorphic glaucoma as a result of neglected cataract constitutes a medical emergency that must be addressed immediately. Ocular emergencies such as these is challenging for the surgeon with guarded or poor prognosis. We describe the presentation, management and prognosis of three cases of phacomorphic and phacolytic glaucoma. All three patients underwent aggressive management of intraocular pressure. Despite successful cataract operation with implantation of intraocular lens, there was only mild improvement of the vision. Optic nerve and pupil functions were permanently affected following the insult. Phacomorphic and phacolytic glaucoma present a very challenging problem to the surgeon with poor visual outcome. Public health education and awareness are important and health workers should encourage patients with cataract to seek early treatment for better prognosis.

Matched MeSH terms: Surgeons
Fulltext Coblation tonsillectomy versus dissection tonsillectomy: a comparison of intraoperative time, intraoperative blood loss and post-operative pain

Izny Hafiz Z, Rosdan S, Mohd Khairi MD

Med J Malaysia, 2014 Apr;69(2):74-8.
PMID: 25241816 MyJurnal

The objective of this study was to compare the intraoperative time, intraoperative blood loss and post operative pain between coblation tonsillectomy and cold tonsillectomy in the same patient. A prospective single blind control trial was carried out on 34 patients whom underwent tonsillectomy. The patients with known bleeding disorder, history of unilateral peritonsillar abscess and unilateral tonsillar hypertrophy were excluded. Operations were done by a single surgeon using cold dissection tonsillectomy in one side while coblation tonsillectomy in the other. Intraoperative time, intraoperative blood loss and post operative pain during the first 3 days were compared between the two methods. Results showed that the intraoperative time was significantly shorter (p<0.001) and intraoperative blood loss was significantly lesser (p<0.001) in coblation tonsillectomy as compared to cold tonsillectomy. Post operative pain score was significantly less at 6 hours post operation (p<0.001) in coblation tonsillectomy as compared to cold tonsillectomy. However, there were no differences in the post operative pain scores on day 1, 2 and 3. In conclusion, coblation tonsillectomy does have superiority in improving intraoperative efficiency in term of intraoperative time and bleeding compared to cold dissection tonsillectomy. The patient will benefit with minimal post operative pain in the immediate post surgery duration.

Matched MeSH terms: Surgeons
Fulltext A ten-year retrospective analysis of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) in Malaysia

Gunavathy M, Rohana AG, Norlela S, Nor Azmi K

Med J Malaysia, 2014 Jun;69(3):133-7.
PMID: 25326355 MyJurnal

Gastroenteropancreatic neuroendocrine tumours (GEP- nETs) are rare neoplasms with a complex spectrum of presentation. The study cohort (n=64) included the diagnoses of carcinoid, (n=26, 41%), insulinoma, (n=25, 39%), undetermined (n=10, 16%), VIPoma, glucagonoma and multiple endocrine neoplasia (MEn-1) (n= 3). Almost half of the patients (n=31) had distant metastasis at diagnosis, the commonest being carcinoid tumours. Presenting symptoms were due to either hormonal expressions or mass effects. diagnoses in all patients were made based on positive immunohistochemical staining for chromogranin and synaptophysin. Less than half (n=30) had either serum chromogranin A, urinary 5-hydroxyindole acetic acid (5-hIAA), serum insulin or C-peptide levels performed. Commonest diagnostic imaging modalities were computed tomography (CT) scan (94%) and abdominal ultrasound (15%). Curative or palliative surgery was performed in 58 patients. Systemic therapy included long acting somatostatin analogues (n=14), chemotherapy (n=7) and interferon-α2b (n=1). nine patients died, all of who had metastatic disease at diagnosis. All patients with insulinoma (n=25) were assessed by endocrinologists whilst carcinoid tumours were mainly managed by surgeons (n=16/26). Involvements of oncologists and gastroenterologists were minimal. This study showed that patients with GEP-nETs in Malaysia commonly presented late in the disease with presence of distant metastases. Less than half had adequate hormonal and biochemical examinations performed for diagnostic as well as prognostic purposes, and only a third received systemic therapy. Lack of institutionalbased database, clinical expertise and multi-disciplinary involvement contributed to the inadequate surveillance and management of the disease.

Matched MeSH terms: Surgeons
Fulltext Two-incision three-port laparoscopic cholecystectomy. A feasible and safe technique

Leow VM, Faizah MS, Mohd Sharifudin S, Letchumanan VP, Yang KF, Manisekar KS

Med J Malaysia, 2014 Jun;69(3):129-32.
PMID: 25326354 MyJurnal

OBJECTIVE: Conventional laparoscopic cholecystectomy (LC) involves the use of four ports, but the number of ports has gradually been reduced to one for cosmetic reasons. however, single-incision LC is technically demanding, and there is a substantial learning curve associated with its successful application. The aim of this clinical study was to evaluate the safety and feasibility of a less demanding alternative LC technique with a faster learning curve.

METHODS: This prospective descriptive study was performed from September 2009 to February 2011 at Sultanah Bahiyah hospital in Kedah, Malaysia. A total of 58 patients underwent two-incision threeport laparoscopic cholecystectomy (TILC), which was performed by the senior consultant hepato-pancreato-biliary surgeon and two hepato-pancreato-biliary trainees. Study end points included operative time, postoperative pain, length of hospital stay and early postoperative complications. The follow-up period was 4 weeks.

RESULTS: The overall operative time taken was 44 ± 18 minutes. none of the patients had major complication or incisional hernia postoperatively. All but one of the patients were discharged within 24 h. nonsteroidal anti-inflammatory drugs were the main postoperative analgesic used.

CONCLUSION: TILC is feasible and safe cholecystectomy technique.

Matched MeSH terms: Surgeons
Fulltext Trapezius Rotational Flap for Cervico-thoracic Wound Breakdown in Post-radiotherapy Necrosis : A Case Report

Ariffin M, Lloyd S, Rhani S, Kamalnizat, Baharudin A

Malays Orthop J, 2014 Jul;8(2):40-2.
PMID: 25279091 DOI: 10.5704/MOJ.1407.001

The management of post-radiation wound breakdown over the posterior cervico thoracic region can be a challenging task for a surgeon. The aim of the treatment is to produce a well vascularized and a low tensile flap which will close a large defect. We describe the use of the lower trapezius flap to reconstruct the wound breakdown and to obtain stable tissue coverage in a patient with postradiation necrosis. This flap minimizes the disruption of the scapula-thoracic function while preserving the range of movement over the shoulder. From the literature review, it was noted that the dorsal scapular artery (DSA) and transverse cervical artery (TCA) aid in the blood supply to the trapezius muscle and prevent local necrosis during rotation of the flap. The trapezius flap is widely accepted because of the minor donor site morbidity, large arc of rotation and adequate blood supply.

Matched MeSH terms: Surgeons
Fulltext Iatrogenic aspiration of custom-made keel: a case report

Sharouny H, Omar RB

Iran Red Crescent Med J, 2014 Dec;16(12):e17066.
PMID: 25763237 DOI: 10.5812/ircmj.17066

INTRODUCTION: Laryngeal stenosis has various causes and treatment options. Endoscopic resection of the stenotic part with CO2 laser is one of the treatment options of laryngotracheal stenosis. Keels are useful for preventing adhesion formation, restenosis and web formation, which may happen during the later stage. They can be put in place either via the endoscopic approach or through a micro thyroidotomy and are held in place with a heavy suture through cricothyroid and thyrohyoid membranes. They are left in place for two to four weeks, and then removed through the endoscopic approach under general anesthetics.
CASE PRESENTATION: We report on a case of anterior glottis stenosis with keel aspiration for two weeks, after endoscopic CO2 laser resection of the stenotic section and keel placement. The patient was admitted to our center, where bronchoscopy was performed and the keel was removed. A new custom-made silastic keel was properly placed in raw areas and fixed to the skin with suture through the cricothyroid and thyrohyoid membranes. The keel was removed three weeks later.
CONCLUSIONS: Endoscopic keel placement should be done with heavy suture through cricothyroid and thyrohyoid membranes. Surgeons should suture the keel to the anterior laryngeal wall with specially designed Lichtenberger's needle-carriers to prevent complications such as keel aspiration, adhesion formation and imposing a second trip under general anesthetics, which put the patient at increased risk. The false vocal cord microflaps, as biological keels and a relatively new method may replace silastic keel placement in the future.

Matched MeSH terms: Surgeons
Fulltext Full thickness macular hole: Early intervention is an important factor in visual prognosis

Ng HK, Yaakub A, Ong LB

Malays Fam Physician, 2014;9(3):42-8.
PMID: 26425305 MyJurnal

Full thickness macular hole is an eye disease, which can cause permanent visual impairment. Current advancement in vitreoretinal surgery has high success rates in repairing them, leading to a significant visual improvement, especially if patient presents early. In this article, three cases of idiopathic full thickness macular hole with different visual outcomes have been presented. All cases were referred by the primary care practitioners and had undergone macular hole surgery with the same vitreoretinal surgeon. The visual outcome was best in the patient who had the earliest presentation and referral. Early detection and referral of these patients is vital so that early surgical intervention can be carried out to improve their vision.

Matched MeSH terms: Surgeons

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