MyMedR

A case of chronic subdural hematoma following lumbar drainage for the management of iatrogenic cerebrospinal fluid rhinorrhea: pitfalls and lessons

Tan VE, Liew D

Ear Nose Throat J, 2013 Oct-Nov;92(10-11):513-5.

PMID: 24170465

Chronic subdural hematoma as a complication of lumbar drain placement for the management of iatrogenic cerebrospinal fluid (CSF) leak has not been previously documented in the literature. We describe such a case in a 69-year-old man who presented with right nasal obstruction secondary to an inverted papilloma involving the paranasal sinuses. The patient underwent endoscopic sinus surgery, which included a medial maxillectomy. Surgery was complicated by a small CSF leak, which was repaired intraoperatively. Five days later, the patient experienced CSF rhinorrhea, and a lumbar drain was inserted. He developed overdrainage symptoms but was well when he was discharged. However, 22 days later he returned with right hemiparesis. Computed tomography of the brain showed a left frontoparietal subdural hematoma with a mass effect. The neurosurgical team performed an emergency drainage procedure, and the patient experienced a complete neurologic recovery. We discuss the pitfalls of lumbar drainage, the possible pathophysiology of overdrainage, and the lessons learned from this case.

Matched MeSH terms: Paranasal Sinus Neoplasms/surgery*

Fulltext Parathyroid carcinoma in a 30-year-old man: a diagnostic and management challenge

Ng SH, Lang BH

World J Surg Oncol, 2013;11:83.

PMID: 23566353 DOI: 10.1186/1477-7819-11-83

Parathyroid carcinoma is a rare endocrine malignancy, accounting for less than 1% of cases of primary hyperparathyroidism. Patient-related factors such as age and sex, as well as the biological features and management of the cancer, influence mid-term and long-term survival. We report a case of a young man with an unusual presentation of parathyroid carcinoma. The patient presented with left thigh swelling, which had been present for 6 months without other symptoms of hypercalcemia. On computed tomography scan a hypodense lesion, 30 × 20 × 20 mm in size, was seen in the posterior thyroid. There was no evidence of cervical lymphadenopathy or local infiltration. On a Sestamibi scan, a hot spot was seen in the lower pole of left thyroid lobe. Cervical neck exploration was performed. The patient subsequently underwent surgery and a parathyroid tumor was excised. The tumor was adherent to the thyroid capsule, but there was no evidence of invasion. After surgery, the patient's calcium and parathyroid hormone levels normalized, but histology confirmed parathyroid carcinoma with capsular and vascular invasion. The patient was offered reoperation, but declined, and developed recurrent parathyroid carcinoma 2 years later. In this report, we aim to present the challenges in managing parathyroid carcinoma and discuss factors that might contribute to future locoregional recurrences. This case also highlighted several issues, including the challenge of ascertaining the diagnosis before surgery and the dilemma of reoperation after simple excision.

Matched MeSH terms: Parathyroid Neoplasms/surgery*

Hook wire localization for testis sparing surgery

Ong TA, Yaakup NA, Sivalingam S, Razack AH

Urology, 2013 Apr;81(4):904-7.

PMID: 23537760 DOI: 10.1016/j.urology.2012.10.077

To describe a novel technique for localizing small testicular mass during testicular-sparing surgery (TSS).

Matched MeSH terms: Testicular Neoplasms/surgery*

Education and imaging. Hepatobiliary and pancreatic: A huge liver paraganglioma

Koh PS, Koong JK, Westerhout CJ, Yoong BK

J Gastroenterol Hepatol, 2013 Jul;28(7):1075.

PMID: 23782121 DOI: 10.1111/jgh.12254

Matched MeSH terms: Liver Neoplasms/surgery

Estimating the five-year survival of cervical cancer patients treated in hospital universiti sains malaysia

Razak NA, Mn K, Zubairi YZ, Naing NN, Zaki NM

Asian Pac J Cancer Prev, 2013;14(2):825-8.

PMID: 23621246

OBJECTIVE: The objective of this study was to determine the five-year survival among patients with cervical cancer treated in Hospital Universiti Sains Malaysia.

METHODS: One hundred and twenty cervical cancer patients diagnosed between 1st July 1995 and 30th June 2007 were identified. Data were obtained from medical records. The survival probability was determined using the Kaplan-Meier method and the log-rank test was applied to compare the survival distribution between groups.

RESULTS: The overall five-year survival was 39.7% [95%CI (Confidence Interval): 30.7, 51.3] with a median survival time of 40.8 (95%CI: 34.0, 62.0) months. The log-rank test showed that there were survival differences between the groups for the following variables: stage at diagnosis (p=0.005); and primary treatment (p=0.0242). Patients who were diagnosed at the latest stage (III-IV) were found to have the lowest survival, 18.4% (95%CI: 6.75, 50.1), compared to stage I and II where the five-year survival was 54.7% (95%CI: 38.7, 77.2) and 40.8% (95%CI: 27.7, 60.3), respectively. The five-year survival was higher in patients who received surgery [52.6% (95%CI: 37.5, 73.6)] as a primary treatment compared to the non-surgical group [33.3% (95%CI: 22.9, 48.4)].

CONCLUSION: The five-year survival of cervical cancer patients in this study was low. The survival of those diagnosed at an advanced stage was low compared to early stages. In addition, those who underwent surgery had higher survival than those who had no surgery for primary treatment.

Matched MeSH terms: Uterine Cervical Neoplasms/surgery

Adenoid cystic carcinoma of the sinonasal tract: outcome of endonasal endoscopic surgery at five-year follow up

Gendeh BS, Zahedi FD, Ahmad H, Kew TY

J Laryngol Otol, 2013 May;127(5):511-5.

PMID: 23570560 DOI: 10.1017/S0022215113000480

To study the outcome of endonasal endoscopic surgery for adenoid cystic carcinoma of the sinonasal tract over a five-year follow-up period.

Matched MeSH terms: Paranasal Sinus Neoplasms/surgery*

Fulltext Intramedullary cervical spine germinoma: a case report

Ashraf S

Med J Malaysia, 2012 Apr;67(2):207-9.

PMID: 22822645 MyJurnal

Primary intramedullary germinoma arising in the cervical spinal cord is a very rare entity. We present one such case arising in a young man who presented with radiculopathy and myelopathy, which was partially excised. Upon histological confirmation, he was treated successfully with radiotherapy alone. To our knowledge, this is only the second reported case worldwide which is histologically confirmed. Although extremely rare, differential diagnosis for intramedullary spinal cord tumor should include germinoma.

Matched MeSH terms: Spinal Cord Neoplasms/surgery*

Fulltext LINAC based radiosurgery and radiotherapy for neurosurgical diseases: what have we learnt so far

Zamzuri I, Badrisyah I, Rahman GI, Pal HK, Muzaimi M, Jafri AM, et al.

Med J Malaysia, 2011 Oct;66(4):346-9.

PMID: 22299555 MyJurnal

Stereotactic radiosurgery uses a single fraction high dose radiation while stereotactic radiotherapy uses multifractionated lower dose focused radiation.

Matched MeSH terms: Brain Neoplasms/surgery*

Fulltext Complete paraparesis following resection of parasagittal meningioma: recovering function with an early intensive neurorehabilitation program

Mazlan M, Fauzi AA

Med J Malaysia, 2011 Oct;66(4):371-3.

PMID: 22299564 MyJurnal

Paraparesis can occur as a primary presentation of brain pathology at the motor strip along the parasagittal region. It could also occur as a neurological complication especially following resection of parasagittal meningioma with infiltration of the superior sagittal sinus (SSS). We report a case of a complete paraparesis immediately following resection of bilateral parasagittal meningioma with infiltration of the middle third of the SSS. A gradual improvement in neurological recovery and functional outcome was observed over a period of one year after undergoing an intensive neurorehabilitation program beginning from the acute inpatient phase post surgery.

Matched MeSH terms: Meningeal Neoplasms/surgery*

Stomal recurrence after total laryngectomy: a 10-year review in Universiti Kebangsaan Malaysia Medical Center

bte Abdul Rashid NH, Yunus MR, bte Baki MM, bte Ami M, Athar PP

J Pak Med Assoc, 2012 May;62(5):466-9.

PMID: 22755311

To determine the frequency of stomal recurrence in patients following total laryngectomy in our center and to compare the frequency of previously reported risk factors such as preoperative tracheostomy, subglottic invasion and the level of lymph node metastases, with the rest of the world.

Matched MeSH terms: Laryngeal Neoplasms/surgery*

Fulltext Soft tissue reconstruction following hemipelvectomy: eight-year experience and literature review

Mat Saad AZ, Halim AS, Faisham WI, Azman WS, Zulmi W

ScientificWorldJournal, 2012;2012:702904.

PMID: 22629187 DOI: 10.1100/2012/702904

Hemipelvectomy is a major surgical procedure that associates with significant morbidity, functional impairment, and psychological and body image problem. Reconstruction of the defect is a challenged since a large amount of composite tissues are needed. We would like to share our eight-year experience with massive pelvic resection and reconstruction.

Matched MeSH terms: Bone Neoplasms/surgery*

Fulltext Endonasal endoscopic transsphenoidal pituitary surgery for pituitary adenoma: a retrospective analysis of surgical outcome

Sand MS, Gendeh BS, Husain S

Med J Malaysia, 2011 Dec;66(5):443-6.

PMID: 22390098 MyJurnal

The purpose of this retrospective joint rhino-neurosurgical study from January 1998 until September 2009 is to document the demographic data, clinical presentations, radiological findings, approaches and incidence of residual tumour. Forty-seven patients with pituitary adenoma underwent trans-sphenoidal hypophysectomy of which 25 patients with complete medical and radiological data were included in the study. The medical and radiological data were analyzed. There were 12 males and 13 females with age ranging from 17 to 76 years old (mean 49.2). Fourteen of the patients were Chinese, eight Malays and three Indians. Twelve of the patients had functioning tumour of which five each presented with acromegaly and Cushing disease respectively and two with amenorrhoea. The rest of 13 patients had non functioning tumour presenting with visual disturbances. Sixteen of the patients had pituitary macroadenomas and the rest 9 microadenomas. Eighteen patients had undergone transcollumellar trans-sphenoidal hypophysectomy and the rest 7 patients had undergone transnasal transsphenoidal hypophysectomy. About 68.8% of pituitary macroadenomas had residual tumour, compared to only 22.2% of patient with pituitary microadenomas. Radiologically, about 45.5% of residual macroadenoma had suprasellar extension and the majority had spread to suprasellar cistern and carvenous sinus (54.5%). About 16.6% of patients had undergone post operative radiotherapy. In conclusion, this study showed that patient with pituitary macroadenomas had higher incidence of residual tumour compared to pituitary microadenomas.

Matched MeSH terms: Pituitary Neoplasms/surgery*

Fulltext The health seeking trajectories of Malaysian women and their husbands in delay cases of breast cancer: a qualitative study

Yusoff N, Taib NA, Ahmad A

Asian Pac J Cancer Prev, 2011;12(10):2563-70.

PMID: 22320956

The aim of this study was to assess why women delay in getting treatment (i.e. surgery) for breast cancer, as well as to explore on what type of issues are involved in such delay cases. Basic interpretative of qualitative methodology was applied to construct the reality of delay phenomena, and its interaction with social worlds. Six themes were identified: new conception of breast cancer treatment, psychological defenses, health support system, symtomatology experience, model and barriers. The delay issue in breast cancer requires attention as a multidimensional problem as this will facilitate more comprehensive and effective intervention to reduce delay.

Matched MeSH terms: Breast Neoplasms/surgery

Fulltext Cholangiocarcinoma: a 10-year experience of a single tertiary centre in the multi ethnicity-Malaysia

Yusoff AR, Siti ZM, Muzammil ARM, Yoong BK, Vijeyasingam R

Med J Malaysia, 2012 Feb;67(1):45-51.

PMID: 22582548 MyJurnal

Cholangiocarcinoma (CCA) is a rare biliary tract epithelial malignancy. We described the clinical features of CCA patients in our institution. A 10-year retrospective study of patients with cholangiocarcinoma in University Malaya Medical Centre was conducted. Clinical data and outcomes in relation to the three anatomical groups of CCA were collected and analysed. Of the 69 patients that were included 55% were male. Mean age was 61 years. Twelve (17%) had intrahepatic, 38 (55%) perihilar and 19 (28%) distal tumour. Mean age (p=0.043), median duration of symptoms (p=0.011), jaundice (p<0.001), total bilirubin level (p=0.003), INR (p=0.005) and mean tumour size (p=0.048) were significantly related to the site of tumour. Only 12 patients had curative resection with seven R0 resections. Cholangiocarcinoma is increasingly diagnosed in our population. Despite that, the diagnosis is still often late. Age, jaundice and tumour size may predict anatomical location of CCA.

Matched MeSH terms: Bile Duct Neoplasms/surgery*

Fulltext eComment. Computed tomography surveillance of lung cancer survivors: the jury is still out

Sachithanandan A

Interact Cardiovasc Thorac Surg, 2012 Nov;15(5):898-9.

PMID: 23100555 DOI: 10.1093/icvts/ivs384

Matched MeSH terms: Lung Neoplasms/surgery*

Robotic single-incision anterior resection for sigmoid colon cancer: access port creation and operative technique

Lim MS, Melich G, Min BS

Surg Endosc, 2013 Mar;27(3):1021.

PMID: 23052525 DOI: 10.1007/s00464-012-2549-0

Potential morbidities related to multiport laparoscopic surgeries have led to the current excitement about single-incision laparoscopic techniques. However, multiport laparoscopy is technically demanding and ergonomically challenging. We present our technique of using the Alexis wound retractor and a surgical glove to fashion an access port and the da Vinci surgical robot to perform single-incision anterior resection.

Matched MeSH terms: Sigmoid Neoplasms/surgery*

Surgical management of tympanojugular paragangliomas with intradural extension, with a proposed revision of the Fisch classification

Sivalingam S, Konishi M, Shin SH, Lope Ahmed RA, Piazza P, Sanna M

Audiol. Neurootol., 2012;17(4):243-55.

PMID: 22584244 DOI: 10.1159/000338418

Tympanojugular paragangliomas (TJPs) with intradural extension can be successfully treated by a single or staged procedure with low surgical morbidity.

Matched MeSH terms: Skull Base Neoplasms/surgery*

Fulltext Mucosal malignant melanoma of the maxillary sinus

Norhafizah M, Mustafa WM, Sabariah AR, Shiran MS, Pathmanathan R

Med J Malaysia, 2010 Sep;65(3):218-20.

PMID: 21939172

Mucosal malignant melanoma (MMM) is an aggressive tumour occurring in the upper respiratory tract. It is rare compared to malignant melanoma of the skin. We report a case of a 53-year-old man with left paranasal swelling. A biopsy showed high-grade spindle cell tumour. Subsequently a subtotal maxillectomy was performed. Histopathological examination revealed a hypercellular tumour composed of mixed spindle and epitheloid cells with very occasional intracytoplasmic melanin pigment. The malignant cells were immunopositive for vimentin, S-100 protein and HMB-45. It was diagnosed as mucosal malignant melanoma (MMM). This article illustrates a rare case of MMM where the diagnosis may be missed or delayed without proper histopathological examination that include meticulous search for melanin pigment and appropriate immunohistochemical stains to confirm the diagnosis. Malignant melanoma can mimic many other types of high-grade malignancy and should be considered as a differential diagnosis in many of these instances.

Matched MeSH terms: Maxillary Sinus Neoplasms/surgery

Fulltext Retinoblastoma Registry report--Hospital Kuala Lumpur experience

Jamalia R, Sunder R, Alagaratnam J, Goh PP

Med J Malaysia, 2010 Jun;65 Suppl A:128-30.

PMID: 21488473

Retinoblastoma is a childhood ocular cancer. The aim of this paper is to describe the clinical and epidemiological characteristics of patients with retinoblastoma in a major paediatric ophthalmology center in the country. Retrospective information was collected through the retinoblastoma registry. Late presentation with advanced staging is a major problem.

Matched MeSH terms: Retinal Neoplasms/surgery

Diabetes insipidus and syndrome of inappropriate antidiuretic hormone complicating pituitary surgery

Aboud SK, Yunus MR, Gendeh BS

Otolaryngol Head Neck Surg, 2011 Jun;144(6):1005-6.

PMID: 21493376 DOI: 10.1177/0194599810390899

Matched MeSH terms: Pituitary Neoplasms/surgery*