Displaying publications 81 - 100 of 111 in total

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  1. Noor Aniah, A., Bastion, M.L.C., Mushawiahti, M.
    MyJurnal
    Retinal detachment is one of the common complications of pathological myopia due to presence of retinal break.
    However, retinal break commonly occurs in the peripheral retina. This case report illustrates the rare incidence of
    retinal break adjacent to the optic disc, highlights the possible causes of poor visual outcome following surgical
    repair as well as the possible measures to treat the complications.
  2. Tan, J.A., Levin, K.B., Rhani, S.A., Hisam, A.
    MyJurnal
    Schwannomas are benign tumours arising from neurilemmal cells which forms the myelin sheath of peripheral nerves. It usually occurs in the head, but may be found in the brachial plexus and sciatic nerve. Common peroneal nerve schwannoma are rare. We report a case of a middle age gentleman who presented with pain and swelling over the right popliteal fossa with associated right radicular pain of the anterolateral leg and weakness of ankle dorsiflexion. Examination revealed a 3x2 cm lump behind the posterolateral aspect of the right knee with positiveTinel’s sign upon tapping of the lump, sensory deficit over the anterolateral aspect of the leg and the ankle dorsiflexors had a muscle power of grade 3. Magnetic resonance imaging (MRI) of the right leg revealed a well circumscribed, oval lesion located along the pathway of the common peroneal nerve homogenously hypointense on T1-weighted images and heterogeneously hyperintense on T2 weighted images compared to the muscles. The lesion was not surpressed on fat suppression sequences. Intra-operatively, we noted that the schwannoma was in continuity with the common peroneal nerve. The patient underwent excision of the schwannoma. Post operatively, the pain reduced remarkably but patient suffers from numbness and right foot drop as a complication of the tumour. This case highlights the rarity of common peroneal nerve schwannoma which presents with neuropathic symptoms complicated with right foot drop.
  3. Goh, E.H., Tan, G.H., Rozman, Z., Nik Azuan, N.I., Fam, X.I., Mohd Hafidzul, J., et al.
    MyJurnal
    Hematospermia is a distressing disorder in sexually active men resulting in great concern to the patient. We report an unusual case of hematospermia with an atypical presentation, involving a 54-year-old man presented with acute urinary retention after sexual intercourse. Although the causes are widely known, arteriovenous malformation as the cause of this disorder has not much been reported in the literature. Transcatheter embolization of internal pudendal artery is a promising option for hematospermia caused by arterial fistula or bleeding.
  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. Ngo, C.W., Syauki, H., Kumar, M.V.
    MyJurnal
    Rapunzel syndrome, or generically known as trichobezoar, is a rare condition. It usually happens among teenage population. We are presenting a case report of Rapunzel syndrome that happened in a 4-year-old child. She was initially investigated for nephrotic syndrome, as she had high blood pressure and hypoalbuminaemia. However, it was later found out to be a trichobezoar, indirectly causing both hypertension and malnutrition. This condition demanded a combination of surgical and psychiatric discipline for diagnosis and its treatment.
  6. 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.
  7. Ab. Latip, N., Ng, P.Y.
    MyJurnal
    During the study period from January 2008 to December 2012, 177 women had transvaginal sacrospinous ligament fixation (SSF) for vault suspension at General Hospital Kuala Lumpur. Of the 177 women, 133 (75.1%) had severe uterovaginal prolapse while 44 (24.9%) had post-hysterectomy vault prolapse. All patients with severe uterovaginal prolapse and rectocele undergone vaginal hysterectomy and posterior colporrhaphy respectively. A hundred and seventy-four patients (98.3%) had anterior repair whilst 48 (27.1%) received midurethral sling as concomitant procedure to vault suspension (SSF). The mean duration of surgery was 92.1±30.2 minutes and the mean estimated blood loss was 319±199.3mls. There was no surgical mortality. Two patients (1.1%) had rectal injuries. No patient had bladder injury or de novo urinary symptoms. The commonest immediate postoperative complications was fever (98; 55.4%) followed by buttock pain in 18 (10.2%) patients. Both complications were resolved with conservative measures. Seven patients (3.9%) had sutures erosion as late complications. Of the 177 women, 158 (89.3%) and 141 (79.7%) came for the 6 and 12 months follow-up, respectively. The success rate for all three compartments ranged from 92.4% to 98.1% at 6 months and reduced to range from 85.7% to 94.4% at 12 months. The highest success rate was observed in the posterior compartment followed by apical and anterior compartment. Equally, the recurrence rate was lowest in the posterior compartment (1.9%), followed by the central (3.8%) and anterior compartment (7.5%) at 6 months’ review. This increased to 5.7% for rectocele, 7.8% for vault prolapse and 14.2% for cystocele at 12 months’ follow-up. None had repeated surgery for prolapse recurrence during the study period. In conclusion, SSF remains a high priority in our therapeutic regime for the treatment of severe uterovaginal and vault prolapse as it has a reasonably good success rate with lower serious complications in the skillful hands.
  8. Farhana, K., Lee, Choon Yee, Thohiroh, A.R.
    MyJurnal
    This was a prospective observational study to identify the incidence and possible risk factors for maternal desaturation following neuraxial blockade for elective caesarean section (CS). Patients with body mass index (BMI) ≥ 30 kg/m2 at the first antenatal consultation were identified and classified into the obese group. Neuraxial blockade in the form of subarachnoid block (SAB) or combined spinal-epidural (CSE) was performed. Mean arterial pressure (MAP) and oxygen saturation (SpO2) were recorded at baseline and at 5-minute intervals following neuraxial blockade. Desaturation, defined as SpO2 < 94% for more than 30 seconds without artifacts, was managed with oxygen therapy and other appropriate measures. Newborn Apgar score and umbilical cord blood gases were analysed. Among a total of 254 recruited patients, 69 (27.2%) were obese and were associated with significantly higher age, parity, previous CS and pre-existing diabetes mellitus. The incidence of oxygen desaturation was 1.2%, involving three patients in the non obese group. These desaturation episodes were short-lived and associated with intraoperative hypotension. Six patients, two of whom in the obese group, received rescue oxygen therapy following intraoperative events such as deteriorating SpO2 or hypotension. The mean MAP was significantly lower at baseline and at 5 minutes post neuraxial blockade in the non obese group, which could account for the occurrence of desaturation in this group only. There were no significant inter-group differences in terms of neonatal outcome, umbilical cord blood gases and changes in mean SpO2 post neuraxial blockade. In conclusion, the current practice of not routinely giving supplementary oxygen to patient during elective CS at our institution is deemed to be safe, provided continuous SpO2 monitoring is available throughout the surgery. Further randomised clinical trials are indicated to investigate the impact of maternal obesity and of labouring patients presenting for urgent or emergency CS on intraoperative oxygen desaturation.
  9. Adlin Dasima, A.K., Nadia Hanom, I., Siti Aznida, A.K., Rusnaini, M.K., Mohd Fahmi, Z., Mohd Nazir, M.S., et al.
    MyJurnal
    This is our first experience in providing general anaesthesia for robotic-assisted thyroidectomy (RAT). It is rather a
    new experience for our anaesthetic team and few issues should be addressed. The conduct of RAT must be fully
    understood and familiarized as it may present with few challenges for the anaesthesiologists. The key point of
    success during this learning curve period is the importance of teamwork between the anaesthesiologists and the
    operating surgeons. The specific anaesthetic challenges include limited access to the patient post-docking of the
    robot, the need of extra precautions of the anaesthetic circuit and IV line connections, a vigilant anaesthesiologists
    and options for postoperative pain relief.
  10. 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.
  11. 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.
  12. Ikhwan Sani, M., Boo, H.S., Affirul, C., Zamri, Z., Razman, J.
    MyJurnal
    Frantz’ tumour of the pancreas is also known as solid pseudopapillary tumour (SPT) of the pancreas. It is a rare pancreatic neoplasm and represents about 3% of all the pancreatic cystic neoplasm.It occurs predominantly in young woman in 2nd to 3rd decade of life. These tumours exhibit indolent behaviour and very often reach considerable size before the first symptoms appear. Despite this presentation these tumours have low malignant potential and complete surgical resection render excellent prognosis. We reported a case of a 16-year-old girl who presented with upper abdominal mass with symptoms of gastric outlet obstruction for 7 months duration. Clinical examination revealed a huge epigastric mass measuring 10 x 12 cm in size. CT scan showed presence of mass arising from the body of the pancreas which was hypervascular, well-encapsulated with mixed cystic and solid components. She then underwent successful distal pancreatectomy and splenectomy and recovered uneventfully.
  13. Nur Zaiti, M.A., Mohd Rushdan, M.N., Lee, S.J.
    MyJurnal
    Desmoplastic small round cell tumour (DSRCT) is a very rare malignant tumour which commonly presented as an
    intraabdominal tumour. It has a distinct histological and immunophenotypic characteristic which differentiates it
    from other types of small blue cell tumour such as Ewing’s sarcoma, primitive neuroectodermal tumour,
    neuroblastoma and malignant mesothelioma. Apart from the abdomen, it may also originate from other region of the
    body including the reproductive organs.
  14. Rima Anggrena, D., Yulianty, A., Nor Azlin, M.I.
    MyJurnal
    Placenta previa is a condition when the placental tissue extends over the internal cervical os. It is associated with
    maternal and fetal morbidity and mortality. With intrauterine death, the mode of delivery will be more difficult to
    decide. Here, we report a case of 30 years old G3P2 with placenta previa major diagnosed with intrauterine death at
    29 weeks gestation who was managed conservatively and delivered vaginally with minimal complication. A good
    patient selection and thorough counseling, patient with placenta previa major and intrauterine death still can be safely
    delivered vaginally.
  15. 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.
  16. Norfaidhi Akram, M.N., Samuel, T., Norly, S., Ros’aini, P.
    MyJurnal
    Breast carcinoma to the colon and rectum is rare type of metastatic spread. We report a case of colonic metastasis
    from a lobular carcinoma of the breast twelve years after the initial diagnosis. Accurate diagnosis and early treatment
    of systemic therapy can be done if awareness is increased.
  17. Ng, B.K., Wang, P.Y., Mohammed, F., Lim, P.S., Mahdy, Z.A., Ng, W.Y.L.
    MyJurnal
    First trimester placenta accreta is a rare occurrence but potential life threatening and catastrophic. Most of these
    cases ended up with emergency hysterectomy. We report a case of incidental finding of placental accreta during
    evacuation of retained product of conception (ERPOC) for missed miscarriage. A 33-year-old, Gravida 4 Para 2 + 1
    at 15 weeks’ gestation admitted for missed miscarriage, failed medical evacuation requiring ERPOC. There was
    excessive bleeding during the procedure and required hysterectomy and bilateral internal iliac artery ligation.
    Histopathological examination confirmed products of conception with evidence of placenta accreta. This case
    highlighted the diagnostic dilemma and importance of early accurate diagnosis of placental accreta prior to any
    surgical intervention for miscarriage.
  18. Nor Amirawati, A., Anizah, A., Shafiee, M,N.
    MyJurnal
    Myomectomy is rarely performed in pregnancy due to risk of miscarriage or pregnancy loss, bleeding and possible
    hysterectomy. Myomectomy is mainly reserved for unavoidable indications such as rapidly growing fibroid or severe
    pain with possiblity of red degeneration for which medical treatment failed. However, good outcome had been
    reported in selective second trimester myomectomies.
  19. Norhuzaimah, J., Liu, C. Y., Muhammad, M., Joanna Ooi ,S. M.
    MyJurnal
    During induction of general anaesthesia, the act of laryngoscopy and tracheal intubation stimulates the sympathetic
    nervous system resulting in an increase in blood pressure and heart rate which may be harmful especially in elderly
    patients with pre-existing ischaemic heart disease. Several drugs have therefore been used to obtund this increase
    including esmolol, nicardipine, magnesium sulphate and lignocaine. This prospective, double blind randomised
    clinical trial compared the efficacy of magnesium sulphate and esmolol in attenuating haemodynamic responses to
    laryngoscopy and tracheal intubation. One hundred and twenty six ASA I-II patients scheduled for elective surgery
    requiring general anaesthesia with tracheal intubation were enrolled and randomised into two groups: Group 1 (n =
    67) received MgSO4 40 mg/kg diluted in 100 ml normal saline administered over ten minutes, whereas Group 2 (n =
    59) received a bolus of esmolol 1.0 mg/kg diluted to 10 ml. Systolic and diastolic blood pressures and heart rate were
    recorded every minute for subsequent 10 minutes following laryngoscopy and tracheal intubation. Attenuation of the
    mean systolic and diastolic blood pressures following laryngoscopy and tracheal intubation was significantly larger
    in Group 2 compared to Group 1. Patients in Group 2 had significantly better suppression of heart rate response
    compared to Group 1 during the first four minutes after laryngoscopy and tracheal intubation (p
  20. Fatin Hanisah, F., Umi Kalthum, M. N., Rona Asnida, N., Jemaima, C. H.
    MyJurnal
    A 55-year-old healthy lady with history of regular contact lens (CL) use presented with 10 days history of
    progressive left eye blurring of vision, redness and pain. There was good CL hygiene practiced with no history of
    swimming, trauma or contact with domestic pets. Left eye vision was hand movement and right eye was 1/60,
    pinhole 6/18. On the left eye, there was a central, oval-shaped corneal infiltrate with an overlying large epithelial
    defect and stromal oedema, with significant anterior chamber cells and fibrin. B-mode ultrasound showed no vitritis.
    Intensive topical benzylpenicillin 10000iu/ml and topical gentamycin 1.4% hourly, homatropine 2% three times
    daily, oral doxycycline and oral ascorbic acid were started. The gram stain results showed gram positive cocci
    growth. Her ulcer improved with the treatment and preservative-free dexamethasone 0.1% once daily was
    commenced to reduce inflammation and scarring. Interestingly, culture was reported as Pasteurella maltocida, a
    gram negative bacilli sensitive to penicillin, and so treatment was continued until the ulcer completely healed. She
    had central corneal scarring with best corrected vision of 6/24 in the left eye but was not keen on further surgery to
    improve her vision. Although it has not been previously reported, Pasteurella multocida can cause CL related
    corneal ulcer with severe anterior chamber inflammation. This diagnosis should be considered even if there is trivial
    contact or no history of exposure to domestic animals.
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