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Fulltext A rare case of fulminant hemobilia resulting from gallstone erosion of the right hepatic artery

Jee SL, Lim KF, Krishnan R

Med J Malaysia, 2014 Aug;69(4):191-2.
PMID: 25500850 MyJurnal

Hemobilia is a rare but potentially lethal condition. The commonest cause of hemobilia is trauma, accounting up to 85% of all cases. Hemobilia caused by gallstones is very rare. Most of the cases of hemobilia are either managed conservatively or treated by embolization. Surgery is indicated only when there is an associated surgical condition or when embolization fails. We report a case of a 72-year-old patient with massive hemobilia caused by gallstone erosion to the adjacent artery, diagnosed intraoperatively. The complication was successfully managed by cholecystectomy and repair of the bleeding vessel. This case highlights the importance that hemobilia should be suspected in patients presenting with upper gastrointestinal bleeding. Although rare, massive hemobilia can be life threatening, leading to significant morbidity and mortality. Therefore, a high index of suspicion and timely intervention are important.
Fulltext Diagnosis and management of ruptured hepatoma: single center experience over 10 years

Letchumanan VP, Lim KF, Mohamad AB

Med J Malaysia, 2013 Oct;68(5):405-9.
PMID: 24632870 MyJurnal

INTRODUCTION: Spontaneous rupture is a dramatic presentation of HCC and it carries high mortality rate. To study the outcomes of ruptured HCC patients managed at a tertiary referral centre in Malaysia.
METHODS: A retrospective review of all ruptured HCC patients managed as inpatient at the Department of Hepatobiliary Surgery, Hospital Selayang between January 2001 and December 2010. Data was retrieved from the hospital electronic medical records, Powerchart (Cerner Corporation Inc., USA) and supplemented with registry from Interventional Radiology record of chemoembolization and registry from hepatobiliary operative surgery records.
RESULTS: There were 22 patients admitted with confirmed diagnosis of ruptured HCC over 10 years period. The common clinical findings on presentation were abdominal pain and presence of shock (36.4%). The mortality rate was 81.8% with only four patients noted to be alive during the follow up. One year overall survival for ER and DR are 40.0% and 72.7% respectively and the median survival in patients treated with DR was 433.3 days whereas it was 212.5 days in ER group.
CONCLUSIONS: This study supports the clinical practice of TAE should be the first line treatment followed by staged surgery in suitable candidates with ruptured HCC.
Ofloxacin, a new quinolone for the treatment of gonorrhea

Rajakumar MK, Ngeow YF, Khor BS, Lim KF

Sex Transm Dis, 1988 1 1;15(1):25-6.
PMID: 3162781

Forty-three patients with uncomplicated gonorrhea were treated with 400 mg of ofloxacin. All had cultures negative for Neisseria gonorrhoeae at follow-up within two weeks of treatment. Minimal side effects were reported. Ofloxacin appears to be satisfactory as a single-dose oral drug for the treatment of gonococcal urethritis, including those cases caused by penicillinase-producing strains of N. gonorrhoeae.
Fulltext Hepatitis B markers in heterosexuals involved in promiscuous sexual activity

Rajakumar MK, Ton SH, Lim KF, Oorloff KH

Med J Malaysia, 1984 Mar;39(1):65-8.
PMID: 6513842

179 heterosexuals, selected for VDRL testing on the basis of a history of involvement in promiscuous sexual activity, mainly prostitution, had their serum also tested for hepatitis B infection markers, HBsAg, HBeAg and anti-HBe. 51 samples (29%) were found to be positive for at least one of the three markers, at levels higher than the already high levels in voluntary random blood donors in Malaysia.
Fulltext Outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis: A randomized prospective study

Jee SL, Jarmin R, Lim KF, Raman K

Asian J Surg, 2018 Jan;41(1):47-54.
PMID: 27530927 DOI: 10.1016/j.asjsur.2016.07.010

BACKGROUND: In patients with acute biliary pancreatitis (ABP), cholecystectomy is mandatory to prevent further biliary events, but the precise timing of cholecystectomy for mild to moderate disease remain a subject of ongoing debate. The aim of this study is to assess the outcomes of early versus delayed cholecystectomy. We hypothesize that early cholecystectomy as compared to delayed cholecystectomy reduces recurrent biliary events without a higher peri-operative complication rate.
METHODS: Patients with mild to moderate ABP were prospectively randomized to either an early cholecystectomy versus a delayed cholecystectomy group. Recurrent biliary events, peri-operative complications, conversion rate, length of surgery and total hospital length of stay between the two groups were evaluated.
RESULTS: A total of 72 patients were enrolled at a single public hospital. Of them, 38 were randomized to the early group and 34 patients to the delayed group. There were no differences regarding peri-operative complications (7.78% vs 11.76%; p = 0.700), conversion rate to open surgery (10.53% vs 11.76%; p = 1.000) and duration of surgery performed (80 vs 85 minutes, p = 0.752). Nevertheless, a greater rate of recurrent biliary events was found in the delayed group (44.12% vs 0%; p ≤ 0.0001) and the hospital length of stay was longer in the delayed group (9 vs 8 days, p = 0.002).
CONCLUSION: In mild to moderate ABP, early laparoscopic cholecystectomy reduces the risk of recurrent biliary events without an increase in operative difficulty or perioperative morbidity.
Pancreatic angiosarcoma: A case report

Supandi FN, Singh B, Thamutaram H, Lim KF, Yusoff AR

Ann Hepatobiliary Pancreat Surg, 2021 Jun 30;25(Suppl 1):S388.
PMID: 34230285 DOI: 10.14701/ahbps.EP-189

Introduction: Pancreatic cancer has a relative 5-year survival of less than 10%. The most common neoplasm of the pancreas is ductal adenocarcinoma, which comprises 85% of all malignant pancreatic tumours. Primary pancreatic sarcomas are extremely rare which account for less than 0.1% of all pancreatic malignancies and pancreatic angiosarcomas attribute to 1% of all tissue sarcomas. Sarcomas of the pancreas are more aggressive and have a dismal prognosis.
Methods: A 69-year-old lady presented with obstructive jaundice, abdominal discomfort and associated constitutional symptoms. She was investigated and found to have obstructive jaundice with normal tumor marker assays. An endoscopic ultrasound was done followed by a needle biopsy which confirmed a pancreatic head angiosarcoma followed by an ERCP and a stent placement. A CT abdomen done revealed a pancreatic head and uncinate tumor with a stent in the common bile duct.
Results: Patient underwent a pylorus preserving pancreaticoduodenectomy with an uneventful post-operative recovery. She defaulted her oncology appointments and was followed up with serial imaging. She developed a local recurrence 18 months after surgery and succumbed to her disease after 3 years.
Conclusions: Pancreatic angiosarcoma is an aggressive tumor compared to other pancreatic malignancies. For a definite diagnosis of angiosarcoma, histopathologic and immunohistochemical analysis are necessary. Surgical resection offers the only possible cure, while oncological treatment has variable outcome. Currently, there are no treatment protocols available due to the small number of cases present in literature.
Fulltext Digitization of natural history collections: A guideline and nationwide capacity building workshop in Malaysia

Ong SQ, Mat Jalaluddin NS, Yong KT, Ong SP, Lim KF, Azhar S

Ecol Evol, 2023 Jun;13(6):e10212.
PMID: 37325726 DOI: 10.1002/ece3.10212

Natural history museum collections are the most important sources of information on the present and past biodiversity of our planet. Most of the information is primarily stored in analogue form, and digitization of the collections can provide further open access to the images and specimen data to address the many global challenges. However, many museums do not digitize their collections because of constraints on budgets, human resources, and technologies. To encourage the digitization process, we present a guideline that offers low-cost and technical knowledge solutions yet balances the quality of the work and outcomes. The guideline describes three phases of digitization, namely preproduction, production, and postproduction. The preproduction phase includes human resource planning and selecting the highest priority collections for digitization. In the preproduction phase, a worksheet is provided for the digitizer to document the metadata, as well as a list of equipment needed to set up a digitizer station to image the specimens and associated labels. In the production phase, we place special emphasis on the light and color calibrations, as well as the guidelines for ISO/shutter speed/aperture to ensure a satisfactory quality of the digitized output. Once the specimen and labels have been imaged in the production phase, we demonstrate an end-to-end pipeline that uses optical character recognition (OCR) to transfer the physical text on the labels into a digital form and document it in a worksheet cell. A nationwide capacity workshop is then conducted to impart the guideline, and pre- and postcourse surveys were conducted to assess the confidence and skills acquired by the participants. This paper also discusses the challenges and future work that need to be taken forward for proper digital biodiversity data management.