MyMedR

Vaginal vascular malformation mimicking pelvic organ prolapse requiring serial embolizations

Pue LB, Lo TS, Wu PY

Int Urogynecol J, 2013 Nov;24(11):1985-7.

PMID: 23430075 DOI: 10.1007/s00192-013-2060-8

Vaginal vascular malformation (VVM) is rare. There are, in fact, less than ten cases reported to date. VVM often presents as a mass protruding from the vagina, mimicking pelvic organ prolapse (POP). It can coexist with POP, thereby usually exaggerating the severity of POP. We report a case of VVM in a premenopausal woman who presented as severe POP and urinary incontinence. The diagnosis was confirmed with computed tomography (CT) scan and angiography. The patient underwent conservative management with embolization. These procedures had to be repeated three times in 1.5 years due to lesion recurrence. In mitigation, conservative treatment eliminates the risks associated with surgery, e.g. massive hemorrhage and visceral injuries. It does, however, require a long course of treatment and follow-up.

Matched MeSH terms: Vagina/blood supply*

Fulltext Successful revascularisation of near total amputation of the upper limb after ten hours of warm ischaemia

Merican AM, Kwan MK, Cheok CY, Wong ELW, Sara TA

Med J Malaysia, 2005 Jun;60(2):218-21.

PMID: 16114164

Near total amputation of the upper limb if unsalvageable would cause severe disability. However, delayed revascularisation can be life threatening. We report two cases of revascularisation of the upper limb following near total amputation that was successful and functional after a warm ischaemic time of ten hours. The first was a traction avulsion injury of the arm leaving major nerves contused but in continuity. The second was a sharp injury through the mid-forearm attached by only a bridge of skin. Attempting revascularisation of a proximal injury beyond 6 hours, in selected cases is worthwhile.

Matched MeSH terms: Arm/blood supply*

Long-term outcome of free fibula osteocutaneous flap and massive allograft in the reconstruction of long bone defect

Halim AS, Chai SC, Wan Ismail WF, Wan Azman WS, Mat Saad AZ, Wan Z

J Plast Reconstr Aesthet Surg, 2015 Dec;68(12):1755-62.

PMID: 26420474 DOI: 10.1016/j.bjps.2015.08.013

Reconstruction of massive bone defects in bone tumors with allografts has been shown to have significant complications including infection, delayed or nonunion of allograft, and allograft fracture. Resection compounded with soft tissue defects requires skin coverage. A composite osteocutaneous free fibula offers an optimal solution where the allografts can be augmented mechanically and achieve biological incorporation. Following resection, the cutaneous component of the free osteocutaneous fibula flaps covers the massive soft tissue defect. In this retrospective study, the long-term outcome of 12 patients, who underwent single-stage limb reconstruction with massive allograft and free fibula osteocutaneous flaps instead of free fibula osteal flaps only, was evaluated. This study included 12 consecutive patients who had primary bone tumors and had follow-up for a minimum of 24 months. The mean age at the time of surgery was 19.8 years. A total of eight patients had primary malignant bone tumors (five osteosarcomas, two chondrosarcomas and one synovial sarcoma), and four patients had benign bone tumors (two giant-cell tumors, one aneurysmal bone cyst, and one neurofibromatosis). The mean follow-up for the 12 patients was 63 months (range 24-124 months). Out of the 10 patients, nine underwent lower-limb reconstruction and ambulated with partial weight bearing and full weight bearing at an average of 4.2 months and 8.2 months, respectively. In conclusion, augmentation of a massive allograft with free fibula osteocutaneous flap is an excellent alternative for reducing the long-term complication of massive allograft and concurrently addresses the soft tissue coverage.

Matched MeSH terms: Leg/blood supply

Is First-Order Vector Autoregressive Model Optimal for fMRI Data?

Ting CM, Seghouane AK, Khalid MU, Salleh ShH

Neural Comput, 2015 Sep;27(9):1857-71.

PMID: 26161816 DOI: 10.1162/NECO_a_00765

We consider the problem of selecting the optimal orders of vector autoregressive (VAR) models for fMRI data. Many previous studies used model order of one and ignored that it may vary considerably across data sets depending on different data dimensions, subjects, tasks, and experimental designs. In addition, the classical information criteria (IC) used (e.g., the Akaike IC (AIC)) are biased and inappropriate for the high-dimensional fMRI data typically with a small sample size. We examine the mixed results on the optimal VAR orders for fMRI, especially the validity of the order-one hypothesis, by a comprehensive evaluation using different model selection criteria over three typical data types--a resting state, an event-related design, and a block design data set--with varying time series dimensions obtained from distinct functional brain networks. We use a more balanced criterion, Kullback's IC (KIC) based on Kullback's symmetric divergence combining two directed divergences. We also consider the bias-corrected versions (AICc and KICc) to improve VAR model selection in small samples. Simulation results show better small-sample selection performance of the proposed criteria over the classical ones. Both bias-corrected ICs provide more accurate and consistent model order choices than their biased counterparts, which suffer from overfitting, with KICc performing the best. Results on real data show that orders greater than one were selected by all criteria across all data sets for the small to moderate dimensions, particularly from small, specific networks such as the resting-state default mode network and the task-related motor networks, whereas low orders close to one but not necessarily one were chosen for the large dimensions of full-brain networks.

Matched MeSH terms: Brain/blood supply*

Fulltext Psychosis post corona radiata and lentiform nucleus infarction

Abdullah KH, Saini SM, Sharip S, Rahman AH

BMJ Case Rep, 2015 Apr 02;2015.

PMID: 25837653 DOI: 10.1136/bcr-2014-208954

Complications of stroke can include neuropsychiatric symptoms. However, post-stroke psychosis is rare. We report a case where an acute presentation of psychosis, depression and fluctuating cognitive impairment in a middle-aged man turned out to be related to a silent brain infarction. The patient had a background of poorly controlled type 2 diabetes mellitus with glycated haemoglobin level of 9.0-11.0%, hypertension and ischaemic heart disease. His CT brain results showed multifocal infarct with hypodensities at bilateral lentiform nucleus and bilateral corona radiata. His strong genetic predisposition of psychosis and a history of brief psychotic disorder with complete remission 3 years prior to the current presentation might possibly contribute to his post-stroke atypical neuropsychiatric presentation, and posed diagnostic challenges. He showed marked improvement with risperidone 6 mg nocte, chlorpromazine 50 mg nocte and fluvoxamine of 200 mg nocte. The need of comprehensive treatments to modify his stroke risk factors was addressed.

Matched MeSH terms: Corpus Striatum/blood supply*

Primary torsion of the greater omentum

Gul YA, Jabbar MF, Moissinac K

Acta Chir. Belg., 2001 Nov-Dec;101(6):312-4.

PMID: 11868511

Primary or idiopathic greater omental torsion remains a rare cause of acute surgical abdomen in adults and children. The aetiology is as yet unknown and the treatment of choice, once diagnosis is established, is resection of the torted omentum. We report our experience with three such cases encountered over the last five years, two of which were diagnosed and subsequently managed laparoscopically. The performance of diagnostic laparoscopy for acute abdominal pain of an undetermined origin may lead to an increased detection of this condition and subsequent therapeutic intervention.

Matched MeSH terms: Omentum/blood supply*

Fulltext Revascularization for foot salvage in diabetic critical foot ischaemia

Yii MK, Liew NC

Med J Malaysia, 1999 Sep;54(3):325-8.

PMID: 11045058

A consecutive series of 32 diabetic patients, 16 male and 16 female, who presented to the authors with critical limb ischaemia was reviewed over a two-year period. Atherosclerotic risk factors and co-morbidities were present in 56% of these patients. Diagnostic angiography was performed in all patients. Revascularization was achieved in 91% of the cases with three perioperative deaths. Ten bypasses were anastomosed distally to one of the crural or ankle arteries at the foot. Major amputations were required in five patients who had had revascularization and in 4 of these gross sepsis was the main factor responsible for limb loss despite patent grafts. The primary graft patency rates at one month and one year were 96% and 90% respectively. Surgical reconstruction was possible in the majority of diabetic patients with critical ischaemia and should be offered to patients preferably before the establishment of gross sepsis to improve limb salvage.

Matched MeSH terms: Foot/blood supply*

Fulltext Hand replantation and revascularization--six years experience in Hospital Kuala Lumpur 1990-1995

Razana A, Hyzan MY, Pathmanathan V, Gill RS

Med J Malaysia, 1998 Sep;53 Suppl A:121-30.

PMID: 10968194

A retrospective study was conducted in 130 patients who underwent replantation or revascularization of 195 amputations in Hand and Microsurgery Unit Hospital Kuala Lumpur from 1990 to 1995. There were 130 patients with 195 amputations in the duration of 6 years study, which were mainly males (111 patients, 85.4%). The commonest age group involved was 19-25 years old (49 cases, 63.7%). There were 146 complete amputations replanted and 49 cases of incomplete amputations were revascularized. The commonest part involved was thumb and index finger (23% of cases each) and majority was caused by industrial accident (60.8%). However in pediatric age group home accident was the leading cause of the amputation (93.8%). The overall survival rate for the amputation was 65.6%. Revascularization had a better survival rate (77.6%) than replantation (61.6%). A clean cut wound and ischaemic time less than 12 hours gave better survival rate. However, there was no significant different chance of survival on distribution of injured parts and ischaemic time (< 12 hours).

Matched MeSH terms: Hand/blood supply*

Fulltext Uterine artery bleeding and haemoperitoneum during the second trimester in pregnancy

Achanna KS, Goh CS

Med J Malaysia, 2003 Mar;58(1):128-30.

PMID: 14556339

A case of spontaneous rupture of uterine artery in the second trimester of pregnancy is described. Haemorrhage from rupture of uterine artery during pregnancy was discovered at laparotomy. This was an unusual but serious complication of pregnancy. This condition is extremely rare and one must consider it in cases of incomprehensible abdominal pain with or without haemodynamic collapse. A review of the literature revealed only four similar cases so far. This pregnancy continued till 37 weeks pregnancy and had a spontaneous vaginal delivery. Immediate institution of effective resuscitative measures and early surgical intervention were essential to both foetal and maternal survival.

Matched MeSH terms: Uterus/blood supply*

Fulltext Case of a non-pulsatile groin swelling

Razif MA, Rajasingam V, Abdullah BJJ

Med J Malaysia, 2002 Dec;57(4):499-502.

PMID: 12733179

We report a case of a non-pulsatile groin swelling in a 38 years old male drug addict without the typical clinical signs of an aneurysm. Ultrasound revealed a left femoral artery pseudo-aneurysm. He was surgically treated and the vessels were ligated without revascularisation.

Matched MeSH terms: Groin/blood supply

Fulltext Spontaneous intra-partum rupture of uterine vein--an uncommon cause of intra-abdominal haemorrhage

Kuppuvelumani P, Rachagan SP, Khin MS

Med J Malaysia, 1994 Jun;49(2):185-6.

PMID: 8090103

A rare case of spontaneous rupture of a branch of the uterine vein in a primigravida is discussed. The patient with an uncomplicated pregnancy presented with signs and symptoms suggestive of abruptio placenta with foetal distress. Lower segment Caesarean section was performed. The cause of acute pain was identified to be intra-abdominal bleeding secondary to the rupture of a branch of the uterine vein. The pathophysiology of the problem is discussed.

Matched MeSH terms: Uterus/blood supply*

Fulltext Unilateral superior ophthalmic vein thrombosis in a user of oral contraceptives

Jaais F, Habib ZA

Med J Malaysia, 1994 Dec;49(4):416-8.

PMID: 7674980

A patient on oral contraceptives over several years developed unilateral proptosis, haemorrhagic retinopathy and increase in intraocular pressure. An orbital vein venogram confirmed the diagnosis of right superior ophthalmic vein thrombosis. There was complete resolution of thrombosis and eye signs and symptoms with discontinuation of the oral contraceptive.

Matched MeSH terms: Orbit/blood supply*

Fulltext Peripheral arterial embolism: a prospective study of 40 consecutive cases

Pung LY, Mohamed SR

Med J Malaysia, 1990 Jun;45(2):131-5.

PMID: 2152017

A prospective study was made of 40 consecutive patients who presented with peripheral arterial embolism to the Vascular Surgical Service in UKM. Atrial fibrillation was the most common source of the embolus. Twelve patients did not present until the affected limb(s) were in established gangrene. Thirty-two embolectomies were performed on 25 patients. Only 10 of these patients were discharged well with their limbs intact. Four patients required amputation because embolectomy did not restore viability of the limbs. Eleven patients died following embolectomy. The overall mortality for arterial embolism was 50%. Among the survival (n = 20), only 11 patients were discharged with their limbs intact. The cause of the poor result was related to the delay in definitive treatment and the poor general state of the patients. It was concluded that the prognosis for arterial embolism was very poor. This result needs to be improved and recommendations are made to achieve this.

Matched MeSH terms: Leg/blood supply

Anomalous arterial supply to the muscles in a combined latissimus dorsi and serratus anterior flap

Halim AS, Wan Z

Clin Anat, 2004 May;17(4):358-9.

PMID: 15108344

The combined latissimus dorsi and serratus anterior flap has been employed for large defect reconstruction and has been shown to be reliable. These flaps are based on the subscapular-thoracodorsal vascular pedicle that usually supplies both muscles. In the case reported, serratus anterior possessed an anomalous arterial supply totally independent of the subscapular pedicle. The latissimus dorsi and serratus anterior muscles were used as a combined flap to reconstruct a massive thigh defect. The combined flap required two arterial anastomoses.

Matched MeSH terms: Surgical Flaps/blood supply*

Fulltext Acute haematogenous osteomyelitis: an unusual complication following a closed fracture of the femur in a child

Baharuddin M, Sharaf I

Med J Malaysia, 2001 Dec;56 Suppl D:54-6.

PMID: 14569768

We report a rare case of an acute haematogenous osteomyelitis of the femur in a five-year-old boy following a closed fracture of the femur. Because of its rare occurrence, the diagnosis of osteomyelitis was missed initially. He presented with a groin abscess seven weeks after injury. He was treated with external fixation, repeated debridements and intravenous antibiotics. Culture grew Staphylococcus aureus. The latest follow-up one-year after the injury showed resolution of the infection and union of the fracture. The range of knee movement is limited from 0-90 degrees due to quadriceps contracture.

Matched MeSH terms: Femur/blood supply

A rare presentation of chronic myeloid leukaemia with priapism treated with corporoglandular shunting

Huei TJ, Lip HT, Shamsuddin O

Med J Malaysia, 2018 12;73(6):420-422.

PMID: 30647220

Priapism is a rare clinical presentation of a patient with chronic myeloid leukaemia (CML). Herein, we present a young Nepalese man that presented to the emergency department with an acute and painful penile erection for two days. Clinically, he was pale and abdominal examination revealed hepatomegaly. Combined oncologic and initial urological intervention with carvernosal aspiration and intracavernosal phenylephrine failed to achieve detumescence. The patient underwent an emergency corporoglandular shunting eventually. In this case report, we discuss the management compared with previously reported cases.

Matched MeSH terms: Penis/blood supply

Characterization of a novel tetrandrine-induced contraction in rat tail artery

Achike FI, Kwan CY

Acta Pharmacol Sin, 2002 Aug;23(8):698-704.

PMID: 12147191

In an attempt to pharmacologically characterize the Chinese antihypertensive drug, tetrandrine, we observed in rat-tail arteries, an unusual contraction in tissues that were stimulated with high [KCl] and not those stimulated with phenylephrine. The characteristics of this contraction were studied.

Matched MeSH terms: Tail/blood supply

Spontaneous massive haemothorax in the peri-partum period of an undiagnosed neurofibromatosis type 1 patient - A surgical perspective

Narasimman S, Govindasamy H, Seevalingam KK, Paramasvaran G, Ramasamy U

Med J Malaysia, 2019 02;74(1):99-101.

PMID: 30846675

Acute massive haemothorax is a life-threatening situation, which is often associated with a preceding trauma. However, spontaneous haemothorax is a rare occurrence, especially in pregnancy. Spontaneous haemothorax in the immediate post-partum period secondary to a ruptured intercostal AVM is extremely rare more so in the background of an undiagnosed neurofibromatosis. This is a report of a young lady presenting with pleuritis and breathlessness after the delivery of her 1st child. Her management is discussed.

Matched MeSH terms: Intercostal Muscles/blood supply

Epidemiology of surgically treated patient in road traffic accident with lower extremity vascular injury from a single centre in Kelantan

Koh SC, Wan Faisham Nu'man WI, Siti Fatimah NMJ, Wan Azman WS, Mohammad P, Arman Zaharil MS

Med J Malaysia, 2020 05;75(3):292-294.

PMID: 32467547

INTRODUCTION: Lower extremity vascular injury can result in either temporary or permanent disability.

METHODS: This is a clinical audit involving all patients admitted to our institution from January 2008 to June 2018 of those who had undergone revascularization surgery for lower limb trauma.

RESULTS: Fifty-nine patients were in this study with a mean age of 28.1 years. Most of the patients were motorcyclist involved in road traffic accidents with cars (n=30, 50.8%). The popliteal artery was most commonly seen injury (n=41, 69.5%). The mean duration of ischaemia was 14.1 hours. The limb salvage rate was 89.8%.

CONCLUSION: Lower extremity vascular injury caused by RTA treated in our institution predominantly involved young patients aged between 18-30 years associated with long bone fractures causing contusion and thrombosis of the popliteal artery.

Matched MeSH terms: Lower Extremity/blood supply*

An interconnected duplicated femoral vein and its clinical significance

Khan AA, Asari MA, Hassan A, Aiman N

Folia Morphol (Warsz), 2013 Feb;72(1):82-5.

PMID: 23749717

Anatomical variations in the femoral vein are of great clinical importance especially in cases of deep vein thrombosis (DVT). Knowledge of the variable anatomy of the femoral vein is important to minimise false-negative findings on ultrasound examination in patients with DVT and help to explain the 'silent' DVT. Furthermore, the presence of a duplicated femoral vein itself is associated with higher incidence of DVT. These venous anomalies are usually due to the truncular venous malformation. In the present study, while dissecting the right lower limb, we found a case of variation of the femoral vein. In this case, besides a duplicated femoral vein, we also noticed a 3rd interconnecting channel near the apex of the femoral triangle joining the two veins. This variation has not been reported previously by other authors. Considering its uniqueness and clinical importance, we decided to report this case.

Matched MeSH terms: Leg/blood supply

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