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Fulltext Initial leucocytosis and other significant indicators of poor outcome in severe traumatic brain injury: an observational study

Vijian K, Teo EG, Kanesen D, Wong ASH

Chinese neurosurgical journal, 2020;6:5.
PMID: 32922934 DOI: 10.1186/s41016-020-0185-4

Background: Globally, severe traumatic brain injury (TBI) has been the principal cause of mortality among individuals aged 45 and below. The incidence of road traffic accidents in Malaysia is one of the highest in the world with thousands of victims sustaining severe disabilities. The aim of this study is to determine the association between leucocytosis and extended Glasgow Outcome Scale (GOSE) scores as well the relationship of other factors and the outcomes of severe TBI.
Methods: This was a retrospective observational study. A total of 44 consecutive patients who were admitted to Sarawak General Hospital from January 1, 2018, to September 30, 2018, with severe TBI were included. Data were collected from discharge summaries and hospital medical records. Chi-square and t test were used. SPSS was employed.
Results: Of a total of 44 patients with severe TBI, 18 patients (41%) died during the same admission. The mean age of patients was 37.1 years with 93.2% of affected patients being male. 56.9% of patients presented with a Glasgow Coma Scale (GCS) of 6 and less. A large percentage (86.3%) were discharged with a GOSE of less than 7. Older age and low admission GCS (6 and less) were significantly associated with poor GOSE scores on discharge and after 6 months (p < 0.05) on multivariate analysis. Leucocytosis on admission was also associated with poor outcomes where patients with higher total white counts on presentation attaining lower GOSE scores (p < 0.05).
Conclusion: We concluded that leucocytosis was significantly associated with poor outcomes in severe TBI patients in addition to other factors such as advanced age and poor GCS on arrival.
Factors affecting diagnostic yield in stereotactic biopsy for brain lesions: a 5-year single-center series

Lau BL, Vijian K, Liew DNS, Wong ASH

Neurosurg Rev, 2021 Oct 10.
PMID: 34628562 DOI: 10.1007/s10143-021-01671-6

The objective of this study is to determine the factors that are associated with the diagnostic yield of stereotactic brain biopsy. A retrospective analysis was performed on 50 consecutive patients who underwent stereotactic brain biopsies in a single institute from 2014 to 2019. Variables including age, gender, lesion topography and characteristics, biopsy methods, and surgeon's experience were analyzed along with diagnostic rate. This study included 31 male and 19 female patients with a mean age of 48.4 (range: 1-76). Of these, 25 underwent frameless brain-suite stereotactic biopsies, 15 were frameless Portable Brain-lab® stereotactic biopsies and 10 were frame-based CRW® stereotactic biopsies. There was no statistical difference between the diagnostic yield of the three methods. The diagnostic yield in our series was 76%. Age, gender, and biopsy methods had no impact on diagnostic yield. Periventricular and pineal lesion biopsies were significantly associated with negative diagnostic yield (p = 0.01) whereas larger lesions were significantly associated with a positive yield (p = 0.01) with the mean volume of lesions in the positive yield group (13.6 cc) being higher than the negative yield group (7 cc). The diagnostic yields seen between senior and junior neurosurgeons in the biopsy procedure were 95% and 63%, respectively (p = 0.02). Anatomical location of the lesion, volume of the lesion, and experience of the surgeon have significant impacts on the diagnostic yield in stereotactic brain biopsy. There was no statistical difference between the diagnostic yield of the three methods, age, gender, and depth of lesion.
Fulltext Improving Diagnostic Yield and Accuracy of Stereotactic Biopsies through Changes in Practice and Techniques: An 8-Year Single-Center Comparative Study

Vijian K, Lau BL, Kanesen D, Lim SS, Ngian DL, Wong ASH

Asian J Neurosurg, 2024 Dec;19(4):701-706.
PMID: 39606292 DOI: 10.1055/s-0044-1789593

Background Stereotactic biopsies are used to aid neurosurgeons in clinching the diagnosis of intracranial lesions that are difficult to access surgically. A published study of stereotactic biopsies in our center demonstrated a diagnostic yield of only 76% for biopsies from the year 2014 to 2019. A set of criteria/prerequisites was applied to increase yield. Objective The aim of the study was to identify the improvement in accuracy and yield after implementation of a set of criteria/prerequisites. Materials and Methods This was a retrospective and prospective analysis of all patients who underwent stereotactic biopsies from the year 2014 to 2022. This study was conducted at Sarawak General Hospital, Malaysia. A set of stereotactic criteria/prerequisites was introduced since 2020, which include preoperative careful, meticulous trajectory planning and target selection, regular checking and maintenance of equipment, larger burr holes, and good sampling techniques. Results A total of 83 patients underwent stereotactic biopsies from the year 2014 to 2022. Frameless and frame-based methods were used for 45 (54%) and 38 (46%) patients, respectively. The overall diagnostic yield of all biopsies was 84%. Fifty patients underwent stereotactic biopsies prior to implementation of good practice guidelines in 2020 with a positive histopathological yield and accuracy of 76 and 88%, respectively. Thirty-three biopsies done postimplementation demonstrated a yield and accuracy of 97% ( p
Fulltext Manual Muscle Testing of the Scapula and the Upper Limb through Bedside Examination

Vijian K, Cheng YT, Idris Z, Izaini Ghani AR, Abdul Halim S, Abdullah JM

Malays J Med Sci, 2023 Feb;30(1):198-212.
PMID: 36875200 DOI: 10.21315/mjms2023.30.1.17

Neurological examination is an important tool in diagnosing patients with neurological and neurosurgical conditions. As the complexity and knowledge of neurological and neurosurgical conditions increases, we are now required to learn and indoctrinate our peers and students with the correct skills and methods of examination. Emphasis on the correct techniques of testing muscle strength is essential to avoid errors in recording muscle power and in testing specific muscles which may have overlapping functions. The manual muscle testing of muscles of scapula and upper limbs was performed as to mimic a bedside clinical examination and involved an examiner, a patient and a videographer. The manual muscle testing has been performed in rostrocaudal manner starting from the scapula and ending with the thumbs. A reliable and consistent method of manual muscle testing is lacking among students and clinicians. By adhering to the methods delineated in our text and accompanying video, we hope to reduce inter-examiner variability and increase the reliability and validity of this important examination.
Fulltext Effect of peritoneal and wound lavage with super-oxidized solution on surgical-site infection after open appendicectomy in perforated appendicitis (PLaSSo): randomized clinical trial

Sellappan H, Alagoo D, Loo C, Vijian K, Sibin R, Chuah JA

BJS Open, 2024 Sep 03;8(5).
PMID: 39413050 DOI: 10.1093/bjsopen/zrae121

BACKGROUND: Surgical-site infection following open appendicectomy for perforated appendicitis increases length of hospital stay and treatment costs while compromising patients' quality of life. Data from randomized clinical trials (RCTs) evaluating the role of super-oxidized solution in perforated appendicitis are lacking. The study objective was to determine the effect of peritoneal and wound lavage with super-oxidized solution in reducing risk of surgical-site infection following open appendicectomy for perforated appendicitis.
METHODS: In this multicentre RCT conducted between September 2020 and March 2022, patients aged 13 years and older with perforated appendicitis undergoing open appendicectomy were randomly assigned to receive peritoneal and wound lavage with either super-oxidized solution or normal saline. The primary outcome was surgical-site infection within 30 days after surgery. Randomization was computer-generated, with allocation concealment by opaque, sequentially numbered, sealed envelope. The patients, surgeons, outcome assessors and statisticians performing the analysis were blinded to treatment assigned.
RESULTS: A total of 102 consecutive patients (51 in the super-oxidized solution group and 51 in the normal saline group) were randomized and included in the intention-to-treat analysis. The super-oxidized solution group showed a significant reduction in overall surgical-site infection (8 (15.6%) versus 19 (37.2%); relative risk (RR) 0.42; 95% c.i. 0.20 to 0.87; P = 0.014), and superficial surgical-site infection (5 (9.8%) versus 18 (35.3%); RR 0.28; 95% c.i. 0.11 to 0.69; P = 0.002), with a number-needed-to-treat of four patients. There were no adverse events in either group.
CONCLUSIONS: Peritoneal and wound lavage with super-oxidized solution is superior to normal saline in preventing surgical-site infection after open appendicectomy for perforated appendicitis.
TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT04512196.