MyMedR

Fulltext Mucinous adenocarcinoma of the rectum with breast and ocular metastases

Hisham RB, Thuaibah H, Gul YA

Asian J Surg, 2006 Apr;29(2):95-7.

We present the case of a 32-year-old woman who, 10 months after abdominoperineal resection and total mesorectal excision for a locally advanced mucinous adenocarcinoma of the rectum, presented with local recurrence and metastases to the breast, spine, the left eye and orbit. Following surgery, due to the patient's personal reasons, adjuvant chemoradiation was not given. The patient died 2 months later, with disseminated cancer. To the best of our knowledge, breast as well as ocular metastasis in a patient with mucinous adenocarcinoma of the rectum has never been reported and, therefore, needs to be documented.

Intestinal obstruction due to rectal endometriosis: a surgical enigma

Jarmin R, Idris MA, Shaharuddin S, Nadeson S, Rashid LM, Mustaffa WM

Asian J Surg, 2006 Jul;29(3):149-52.

PMID: 16877213

Obstructed rectal endometriosis is an uncommon presentation. The clinical and intraoperative presentation may present as malignant obstruction. The difficulty in making the diagnosis may delay the definitive management of the patient. We report a unique case of rectal endometriosis mimicking malignant rectal mass causing intestinal obstruction and discuss the management of the case.

Association of loss of heterozygosity and PTEN gene abnormalities with paraclinical, clinical modalities and survival time of glioma patients in Malaysia

Abdullah JM, Farizan A, Asmarina K, Zainuddin N, Ghazali MM, Jaafar H, et al.

Asian J Surg, 2006 Oct;29(4):274-82.

PMID: 17098662

The pattern of allelic loss of heterozygosity (LOH) and PTEN mutations appear to be associated with the progression of gliomas leading to a decrement in the survival rate of patients. This present study was carried out to determine the LOH and PTEN mutational status in glioma patients and its association with patients' survival.

Endoscopic drainage of empyema of the gallbladder through a concurrent cholecystoduodenal fistula

Lim MS, Davaraj B, Kandasami P

Asian J Surg, 2006 Jan;29(1):55-7.

PMID: 16428103

The duodenum is the most common site of cholecystoenteric fistulation resulting from cholecystitis or empyema of the gallbladder. This rare condition is usually only diagnosed intraoperatively and managed incidentally. This paper presents the endoscopic diagnosis of a case of cholecystoduodenal fistula arising from the late presentation of empyema of the gallbladder and its subsequent drainage through the fistula. As far as we can determine, this is the only reported case of opportunistic drainage of an empyema of the gallbladder through a concurrent cholecystoduodenal fistula.

Chylous ascites after anterior resection for rectal carcinoma: a rare but significant incident

Chan KY, Teoh CM, Sukumar N

Asian J Surg, 2006 Jan;29(1):46-8.

PMID: 16428100

Chylous ascites specifically after anterior resection for rectal cancer has not been documented in the literature thus far. All previously reported postoperative chylous ascites developed in other types of malignancies and were diagnosed within a few days of surgery. However, the patient we report had symptoms 2 years after surgery. Intraoperatively, chylous ascites was found with multiple lymph node metastasis in the small bowel mesentery and retroperitoneal region. The rarity of chylous ascites after anterior resection in rectal carcinoma is documented and discussed.

Intravenous neck injections in a drug abuser resulting in infection of a laryngocele

Jahendran J, Sani A, Rajan P, Mann GS, Appoo B

Asian J Surg, 2005 Jan;28(1):41-4.

PMID: 15691797

A pyolaryngocele is an uncommon complication of a laryngocele that has become infected. We present a case of a pyolaryngocele that was probably due to repeated injections in the neck veins. The pathogenesis, clinical features and management are discussed in detail.

Diagnostic cerebral angiography in spontaneous intracranial haemorrhage: a guide for developing countries

Abu Bakar I, Shuaib IL, Mohd Ariff AR, Naing NN, Abdullah JM

Asian J Surg, 2005 Jan;28(1):1-6.

PMID: 15691788

OBJECTIVE: Spontaneous intracranial haemorrhage constitutes 18-40% of all stroke cases. Indications for cerebral angiography to find underlying potentially treatable vascular abnormalities are not clear. This study determined which intracranial haemorrhage patients need cerebral angiography by correlating computed tomography (CT) findings, age and hypertension history with cerebral angiography findings.

METHODS: A total of 54 patients (8-79 years) with intracranial haemorrhage who underwent both CT examination and six-vessel cerebral angiography were studied over a 2-year period. Cerebral angiography was repeated within 6 weeks if the first angiogram was negative.

RESULTS: Angiography detected vascular lesions in 50% of cases (aneurysm 38.9% and arteriovenous malformation, AVM, 11.1%). In the aneurysm group, angiographic yield was 34.3% whereas in the AVM group, it was 37.9%. Subarachnoid haemorrhage (SAH) combined with other types of haemorrhage (such as intracerebral haemorrhage, ICH) was not significantly correlated with the likelihood of finding a vascular lesion, both aneurysm and AVM (p = 0.157). Age less than 50 years had significant correlation (p = 0.021) in the AVM group as well as in the aneurysm group (p < 0.001). A history of hypertension was associated with both aneurysm (p = 0.039) and AVM (p = 0.008). No patients with deep intracerebral haematoma had vascular lesions. The presence of an intravascular haemorrhage (IVH) had significant correlation with aneurysm (p = 0.008) but not AVM. There was no significant difference in mean age between patients with and without a vascular lesion (p = 0.134).

CONCLUSION: Cerebral angiography is justified in patients with ICH accompanied by pure SAH (p = 0.001). Other factors associated with finding a vascular lesion were a history of hypertension and the presence of IVH. Diagnostic cerebral angiography is indicated for patients with ICH and SAH and IVH with a history of hypertension, regardless of age.

Adult intussusception secondary to inflammatory polyps

Jabar MF, Prasannan S, Gul YA

Asian J Surg, 2005 Jan;28(1):58-61.

PMID: 15691802

Adult intussusception is a rare entity that may present in the acute and subacute setting principally related to the degree of bowel obstruction. Preoperative diagnosis of this condition may be difficult. The intussusception is usually due to a definable intraluminal lesion, most probably neoplasia, unlike intussusception in children. We present the cases of two adult male patients with intussusception. The first presented with acute small-bowel obstruction secondary to a retrograde ileojejunal intussusception with a pseudopolyp as the lead point. This was possibly due to a retrograde ball-valve effect. The intussuscepting segment was resected. The second patient presented with unexplained chronic diarrhoea and an intussusception occurring within the caecum, as demonstrated at colonoscopy, with a terminal ileal pedunculated fibroid polyp as the lead point. A limited right hemicolectomy was performed. Both patients recovered uneventfully and have remained well. A brief literature review of adult intussusception complements the case reports, with an emphasis on the pathogenesis of inflammatory polyps and recommended surgical management.

Fulltext Large fungating thyroid cancers: a unique surgical challenge

Harjit KD, Hisham AN

Asian J Surg, 2005 Jan;28(1):48-51.

PMID: 15691799

Large goitres are common in the developing world, particularly in Asia and Africa. Nonetheless, large fungating goitres are extremely rare and represent a unique challenge to surgeons. Surgery should always be considered, when the general condition of the patient permits, to provide a better quality of life as it offers the only hope of long-term survival. The potential gain with surgery is that it allows maximum benefit for more effective radioactive iodine ablation and radiotherapy treatment. We report two cases of large fungating thyroid cancers complicated by anaemia and foul-smelling discharge.

Benign fibrous tumour of the parotid gland

Sreetharan SS, Prepageran N

Asian J Surg, 2005 Jan;28(1):45-7.

PMID: 15691798

The case of a 44-year-old man with left parotid enlargement that was initially diagnosed as cementifying fibroma is presented. The lesion was found in the deep lobe of the parotid gland and was successfully removed. Postoperatively, the patient recovered well with intact facial nerve function and remained asymptomatic after 1 year. Subsequent histology revealed the mass to be a benign fibrous tumour. The diagnosis and management of this rare entity are discussed.

Common bile duct perforation due to tuberculosis: a case report

Jarmin R, Alwi RI, Shaharuddin S, Salleh KM, Gunn A

Asian J Surg, 2004 Oct;27(4):342-4.

PMID: 15564193

A young man with HIV presented with biliary peritonitis secondary to spontaneous common bile duct perforation. Investigation revealed that the perforation was due to Mycobacterium tuberculosis. Tuberculosis of the bile duct is uncommon and usually presents with obstructive jaundice due to stricture. Bile duct perforation due to tuberculosis is extremely rare. Its management is discussed.

Management of iatrogenic facial nerve palsy and labyrinthine fistula in mastoid surgery

Long YT, bin Sabir Husin Athar PP, Mahmud R, Saim L

Asian J Surg, 2004 Jul;27(3):176-9.

PMID: 15564156

A 6-year review of complications of mastoid surgery between June 1995 and June 2001 revealed five cases with serious iatrogenic complications from mastoid surgery, of which four were facial nerve palsy and two were labyrinthine fistula. One of these patients had concomitant facial nerve palsy and labyrinthine fistula. There were two cases of complete facial nerve palsy (House Brackmann grade VI) and two cases of incomplete palsy (House Brackmann grades IV and V). The second genu was the site of injury in three of the four cases. Of the four cases with facial nerve palsy, two patients had full recovery (House Brackmann grade I), one recovered only to House Brackmann grade III, and one was lost to follow-up. Both patients with labyrinthine fistula had postoperative vertigo and profound sensorineural hearing loss. The site of iatrogenic fenestration was the lateral semicircular canal in both cases.

Fulltext Prevertebral soft tissue measurements in thyroid enlargement: the value of lateral neck radiographs

Hisham AN, Sarojah A, Mastura T, Lim TO

Asian J Surg, 2004 Jul;27(3):172-5.

PMID: 15564155

Measurement of prevertebral soft tissue is commonly used to assess prevertebral abnormalities, such as retropharyngeal abscess or injury to the cervical spine. In the presence of goitres, the widened prevertebral tissue seen on plain lateral neck radiograph may be diagnostic of an enlarged tubercle of Zuckerkandl (ZT), which may be responsible for most pressure symptoms. The aim of this study was to substantiate the value of plain lateral neck radiographs in preoperative demonstration of enlarged ZT.

Three-layer technique to close a persistent tracheo-oesophageal fistula

Lee LM, Razi A

Asian J Surg, 2004 Oct;27(4):336-8.

PMID: 15564191

This report of a patient with a persistent tracheo-oesophageal (TE) fistula after removal of a speech valve describes a modification of the technique described by Rosen et al for closing TE. Under local anaesthesia, an incision was made above the stoma edge from 9 o'clock to 3 o'clock. The trachea was separated from the oesophagus to beyond the fistula, and the fistula tract was excised. The oesophageal opening was closed in layers and a local flap rotated from the adjacent sternocleidomastoid muscle and sutured over the oesophageal closure. The trachea was then closed separately.

Fulltext Inguinal hernia repair by surgical trainees at a Malaysian teaching hospital

Chan KY, Rohaizak M, Sukumar N, Shaharuddin S, Jasmi AY

Asian J Surg, 2004 Oct;27(4):306-12.

PMID: 15564185

To assess the outcome of inguinal hernia repaired by surgical trainees at Universiti Kebangsaan Malaysia Hospital.

Melioidosis and the vascular surgeon: Hospital Kuala Lumpur experience

Azizi ZA, Yahya M, Lee SK

Asian J Surg, 2005 Oct;28(4):309-11.

PMID: 16234087

Bacterial arteritis is relatively uncommon and management of this condition, which carries high morbidity and mortality, is difficult and time-consuming. Common organisms implicated include Salmonella and Staphylococcus. Arteritis as a result of infection by Burkholderia pseudomallei (formerly Pseudomonas pseudomallei) has been rarely reported in the English literature. This organism, which is endemic in our part of the world, is well known to cause a wide spectrum of septic conditions. A review of cases managed at Hospital Kuala Lumpur revealed that bacterial arteritis due to melioidosis is not such a rare entity. We share our experience in the management of this condition using three cases as examples.

Diagnostic value of plain abdominal radiographs in patients with acute abdominal pain

Prasannan S, Zhueng TJ, Gul YA

Asian J Surg, 2005 Oct;28(4):246-51.

PMID: 16234073

A prospective study was performed over a 3-month period in a tertiary referral centre to evaluate the appropriateness and contribution of plain abdominal radiographs (PAR) in the diagnosis and management of adult patients presenting with acute abdominal pain.

Prospective randomized clinical trial on suction elastic band ligator versus forceps ligator in the treatment of haemorrhoids

Ramzisham AR, Sagap I, Nadeson S, Ali IM, Hasni MJ

Asian J Surg, 2005 Oct;28(4):241-5.

PMID: 16234072

This prospective randomized clinical trial was undertaken to compare the use of a single-operator vacuum suction ligator and the traditional forceps ligator in terms of pain perception following the procedure, intra-procedure bleeding and other complications.

Malignant cervical teratoma in an adult presenting with impending airway obstruction

Lukman MR, Jasmi AY, Sarinah B, Nurismah MI, Aishah MA

Asian J Surg, 2005 Jul;28(3):227-9.

PMID: 16024322

Extragonadal teratomas and germ cell tumours are uncommon. Most teratomas of the head and neck present in the paediatric age group. Occurrence of such tumours in an adult is extremely rare and, to date, less than 40 cases have been reported in the literature. We report a case of a young man presenting with impending airway obstruction secondary to a malignant teratoma of the neck.

Fulltext Early results of a rotation flap to treat chronic anal fissures

Singh M, Sharma A, Duthie G, Balasingh D, Kandasamy P

Asian J Surg, 2005 Jul;28(3):189-91.

PMID: 16024313

Treatment of anal fissures has changed dramatically in the past decade. This is primarily due to a better understanding of its pathophysiology and the implications of the various available options. Only a few anal fissures fail to respond to medical therapy. Sphincterotomy and anal dilatation have fallen out of favour due to the risk of incontinence. Island flaps have been proposed to address this, but 60-70% of the flap donor sites break down with complications. We propose using a rotation flap to overcome this problem.

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