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  1. Loh, Li Loong, Raffael B. Ismail, Goh, Kian Liang, Kamarul Ariffin Khalid
    MyJurnal
    Giant cell tumour (GCT) of the metacarpal bone is rare, and it behaves more aggressively with a higher recurrence rate as compared to other long bones. Modalities such as bone curettage with or without bone grafting, ray amputation, or wide resection and reconstruction have been described as surgical management for this condition. Wide resection (en block) is often preferred as it has a lower recurrence rate among the rests. Reconstruction techniques options available include vascularised or non-vascularised fibular graft, iliac crest strut graft with loss of metacarpophalangeal joint function or with metatarsal substitution resulting in a more preserved function of the hand. This case report is about a 15-year-old teenager girl with a giant cell tumor of her left second metacarpal bone, which was confirmed with a plain radiograph and magnetic resonance imaging. This case report focuses the operative technique of the metacarpal reconstruction using the third metatarsal bone. The aim was to preserve hand function and cosmesis while achieving good local control of the disease without compromising the lower limb function. The transfer of osteoarticular ligamentous complex of the third metatarsal bone for the reconstruction of the second metacarpal bone defects is a possible operative procedure that provides good cosmetic and excellent functional outcomes while not compromising the donor’s foot function.
  2. Goh Kian Liang, Mohd Shahidan Noor Rahin, Ardilla Hanim Abdul Razak, Mohd Shukrimi Awang
    IIUM Medical Journal Malaysia, 2019;18(102):64-0.
    MyJurnal
    Smartphone and mobile apps have become an indispensable companion in our modern-day living and working environment. In the medical field, web browsers and medical apps have transformed the medical practice as the most current knowledge, best practices, medical references, and calculators are available instantaneously at our fingertips. However, these functionality and usage are limited by the creativity and imagination of the app developers. To overcome these limitations, doctors should think out-of-the-box and educate themselves to be appdevelopers to create functional and useful apps in their field. Our aim was to create medical apps from ground-up independently without formal software development training. Material and method: Hybrid app technology is a popular method for creating apps for newbies due to the familiarity with web browsers. We explore the Ionic© Framework which is a free and open-source front-end with good resources and documentation. This programming technology assumes that everyone has experience with web browsers and the modern browsers essentially run on three technology stacks which are Hypertext Markup Language (HTML), JavaScript and Cascading Style Sheets (CSS). The HTML is a standard markup language for web browser while JavaScript is a scripting language for running commands and functions. The CSS is used for describing how HTML elements should be displayed. Results: We successfully published three apps on the Apple AppStore and Google Play, namely, OrthoBoard©, OpList and OOLH. Based on our experience of designing, coding, testing and deploying the apps, it is not impossible for medical doctors to achieve this goal and utilizing the app-development skills as an armamentarium for teaching, learning, and medical practice tools. Conclusions: App development is an essential skill especially for medical educators to leverage the technological advancement in their teaching and learning as well as medical practice in tandem with our nations’ aspiration towards Education 4.0.
  3. Ardilla Hanim Abdul Razak, Ahmad Hafiz Zulkifly, Ramli Musa, Mohd Shukrimi Awang, Goh, Kian Liang
    MyJurnal
    Total knee arthroplasty represents a major advance in the treatment of
    degenerative joint disease. It provides excellent restoration of joint function and pain
    relief. The primary indication for total knee arthroplasty is to relieve pain caused by
    severe arthritis, with or without significant deformity. This study is to assess
    psychological impact pre and post arthroplasty. (Copied from article).
  4. Kow Ren Yi, Saiful Azlan Kamisan, Goh Kian Liang, Asmah Hanim Hamdan, Ahmad Razali Md Ralib@Md Raghib
    IIUM Medical Journal Malaysia, 2019;18(102):60-0.
    MyJurnal
    Sacral chordomas are rare, low-grade and slow growing malignant bone tumours arising from the sacral bone. They are locally aggressive with the tendency to metastasize to the lungs. Surgical resection remains the mainstay of treatment of sacral chordomas. However, most patients presented late with large tumours and intra-abdominal extension making en bloc resection highly challenging. Besides that, surgical resection poses risk of injury to the surrounding structures such as major blood vessels, bladder, ureters and rectum due to their proximity to the tumour. Therefore, multidisciplinary team approach is vital in ancipitating possible complications and preventing surgical morbidity. We present a case of advanced sacral chordoma which has been successfully resected with the assistance of pre-operative selective arterial embolization as a pre-emptive therapy. Case report: A 58-year-old lady presented with a large sacral chordoma (17.17 cm x 27.3 cm x 30.5 cm) with sacral erosion, infiltration to gluteus maximus, medius and minimus muscles and lung metastasis. A decision to perform a surgical resection was made to alleviate the pain secondary to sacral nerve compression. Anticipating massive bleeding intra-operatively, pre-operative arterial embolization was performed involving one branch of right internal iliac artery as well as five branches of left internal and external iliac arteries using endovascular coils. The tumour was resected with partial sacrectomy from S2 and below. Intra-operatively, 6 pints of packed cells were transfused with estimated blood loss of 4 litres. The patient recovered well after the surgery. She was pain-free post-operatively with no lower limb neurological deficit. Conclusion: Surgical resection remains the treatment of choice for sacral chordoma. Pre-operative selective arterial embolization can reduce intra-operative bleeding and avoid a potentially convoluted surgery.
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