Correspondence: Ikhwan Sani Mohamad Department of Surgery, Universiti Sains Malaysia, 16150 Kota ... more Correspondence: Ikhwan Sani Mohamad Department of Surgery, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia Tel: +6097676774 [email protected] ABSTRACT Background: Single Incision Laparoscopic Cholecystectomy (SILC) was first introduced about 2 decades ago, as an evolution of the gold standard 3-4 ports laparoscopic cholecystectomy. Objectives: The objective of the study was to assess the safety and feasibility of SILC using a novel Glove Port Technique. Methodology: This is an retrospective cohort study of SILC using a novel glove port technique, carried out at our centre from 1 September 2014 to 31 December 2016. Data on patients’ demographic data, operative time, post-operative pain, length of stay, post-operative intervention were retrieved from patients’ medical records and overall satisfaction were recorded at follow-up. Results : A total of 50 patients, mean age of 58.2 ± 16.5 years, underwent SILC at our centre during the study period and were included i...
Trauma is a major health problem in Malaysia. An understanding of the trauma epidemiology is impo... more Trauma is a major health problem in Malaysia. An understanding of the trauma epidemiology is important in developing a reliable trauma service. The aim of this study is to understand the pattern of trauma in our institution and to highlight the need for a dedicated trauma service. In this database, 142 cases were included. Majority were males (127, 89.4%). Most common injury types are motor vehicle accidents (87.3%) followed by falls (7.7%), and stabs (3.5%). Most Injury Severity Score (ISS) falls under moderate score with 38.7%. Mean Abbreviated Injury Score (AIS) was 3 with most involving the chest and 90% of the patients have injuries involving at least 2 regions. Average hospital length of stay (LOS) was 11.4 days ±11.5 SD; with most patients (71.8%) were discharged without permanent disability. The mortality rate was 9.2% with all having ISS>16. ISS found to be strongly related to longer hospital stay and worse outcome (0.59, p < 0.0001, 0.4, p < 0.0001). This data is...
tumorigenesis in HCC cells were analyzed by flow cytometry, colony formation assays and CCK8 assa... more tumorigenesis in HCC cells were analyzed by flow cytometry, colony formation assays and CCK8 assays. The correlation between XRCC2 expression and long-term outcomes after liver resection, as well as the potential molecular mechanism of XRCC2 in regulating the proliferation in HCC cells were also addressed. Results: The expression of XRCC2 was higher in tumor tissues and HCC cell lines compared to the adjacent liver tissues and normal liver cell lines. The expression level of XRCC2 has a reverse relationship with the long-term outcomes after liver resection. Down-regulating the expression of XRCC2 in HCC cell strains could inhibit the proliferation of HCC cells by inducing S-phase arrest and cell apoptosis in vitro and in vivo. Further study indicates that down-regulating the expression of XRCC2 could induce the up-regulation of p53/p21 signaling pathway. Conclusion: This study provides novel insights into the role of XRCC2 in controlling HCC cell proliferation and tumorigenesis, and identifies XRCC2 as a potential prognostic marker and therapeutic target.
Asian Journal of Pharmaceutical and Clinical Research
Objective: The purpose of this study is to reduce the incidence of post-endoscopic retrograde cho... more Objective: The purpose of this study is to reduce the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) by the administration of intravenous (IV) diclofenac sodium.Methods: This is a prospective, randomized, double-blinded control study. This study was performed in the hepatobiliary unit of general surgery department in University Kebangsaan Malaysia Medical Centre (UKMMC) from May 2015 to May 2016. A total of 128 patients were enrolled in this study. 59 patients were randomized into the treatment arm, while 63 were randomized into the control group. Patients were randomized by envelope system, and patients in the treatment arm received 75 mg of diclofenac sodium intravenously, within 30 min of ERCP commencement. Both groups were observed for PEP post-ERCP and their pain score recorded. Patients’ demographic data were also observed.Results: A total of 122 patients were included in the study, with 59 patients randomized into the treatment arm ...
Splenic artery aneurysms (SAAs) account for more than half of all visceral artery aneurysms. SAAs... more Splenic artery aneurysms (SAAs) account for more than half of all visceral artery aneurysms. SAAs are the third most common intraabdominal aneurysm. Although SAAs is rare but are potentially life threatening [1]. It can cause complications, such as spontaneous intraperitoneal rupture, into the neighbouring hollow organs, and fistulisation into the pancreatic duct.
Background: Internal fi stula with adjacent viscera during acute pancreatitis is a rare complicat... more Background: Internal fi stula with adjacent viscera during acute pancreatitis is a rare complication. Due to their anatomic localization, colon, duodenum or stomach may be involved. Pancreatico-colonic fi stula is associated with a higher septic risk and surgery is usually mandatory. Results and main fi ndings: We report a new case in 71-year-old man diagnosed by CT with rectal water soluble contrast media and managed conservatively. To our knowledge, this is the second case in the literature treated in this way. Conclusion: Conservative treatment may be offered to selected patients who have a rapid improvement of symptoms associated with a signifi cant regression of the collection.
ABSTRACT Introduction: Pancreatic ascites was first reported in 1953. It is commonly affected in ... more ABSTRACT Introduction: Pancreatic ascites was first reported in 1953. It is commonly affected in male between age 20-50 years old. We reported a case of progressing abdominal ascites in a young healthy man. Method: This is a case of 22 year old gentleman with a complaint of progressive abdominal distention for the past 1 month. It was associated with intermittent epigastric discomfort, loss of weight and steatorrhoea. He had a history of recurrent pancreatitis attack for the past 2 months. On examination he was cachexic with a BMI of 21, dehydrated with a gross distended abdomen suggestive of ascites. Abdominal ultrasound revealed gross ascites fluid intraperitoneal with a normal liver and pancreas. Peritoneal tapping was done and the fluid was sent for cytology and the result come back as negative. Only the body fluid amylase was 64000U/L. Therefore CT scan of the abdomen was done for further investigation. CT scan abdomen showed a well defined cystic lesion at the body of the pancreas measuring 4.7 x 4.9 x 5 with a continuity of this lesion with the main pancreatic duct. There is also a soft tissue density lesion within the pancreatic duct at the region of the head of pancreas. Endoscopic retrograde pancreatogram was performed, however it was unable to cannulate the pancreatic duct. Patient was underwent laparotomy with Frey Procedure. Intraoperatively there was a stone at the pancreatic head that obstructing the pancreatic duct with distal pancreatic duct dilatation. Postoperatively he was uneventful. The was no ascites fluid and he was discharge well. Results: - Conclusion: Pancreatic ascites is an uncommon sequalae of chronic pancreatitis. Its required CT scan imaging to determine the causes for the chronic pancreatitis. ERCP is recommend as a first line treatment however Frey Procedure is an option if failure in managing endoscopically.
Introduction Primary liver tuberculoma is a rare entity within healthy immuno-competent individua... more Introduction Primary liver tuberculoma is a rare entity within healthy immuno-competent individuals. Conversely, most of cases are secondary and are associated with miliary tuberculosis(TB). We report a case of primary hepatic TB which was misdiagnosed and treated initially as a primary liver tumour 1-3 Case A 56-year-old lady presented with epigastric pain, loss of weight and appetite of 3 weeks duration. Clinical examination revealed jaundiced patient with upper quadrant tenderness. Initial blood work-up revealed anaemia, a deranged liver profile and an elevated CA-19-9 (562 U/ml). Computed tomography(CT) demonstrated an ill-defined 3.5 x 4.0 cm heterogeneously enhancing mass at the liver hilum with peri-portal lymphadenopathy. She was diagnosed with cholangiocarcinoma. Biliary decompression via ERCP was performed and she was then subjected for a central hepatectomy. Intra-operatively, we noted yellowish nodules over the entire liver with mesenteric and omental lymphadenopathy dis...
Background: This present study sought to review the feasibility and patients’ satisfaction of lap... more Background: This present study sought to review the feasibility and patients’ satisfaction of laparoscopic cholecystectomy to be perform as daycare procedure. Materials and Methods. Sixty-two patients with symptomatic gallstones were recruited within a year. They were randomized into overnight stay and daycare groups. The outcomes and post-operative complications were analyzed. Results. Fifty-eight patients were eligible for analysis and four patients were excluded because of conversion to open cholecystectomy. All patients in daycare group reported no fever but two patients in the overnight stay group complaint of post-operative fever (p=0.150). The mean pain score using Visual Analogue Score (VAS) in daycare group was 2.93 but in the overnight stay was recorded as 3.59 (p=0.98). Five patients had post-operative nausea and vomiting (PONV) in daycare group compared to 2 patients in the overnight stay group (p=0.227). Patient’s satisfaction were higher in the daycare group (p=0.160)....
Introduction: Pancreatic ascites was first reported in 1953. It is commonly affected in male betw... more Introduction: Pancreatic ascites was first reported in 1953. It is commonly affected in male between age 20-50 years old. We reported a case of progressing abdominal ascites in a young healthy man. Method: This is a case of 22 year old gentleman with a complaint of progressive abdominal distention for the past 1 month. It was associated with intermittent epigastric discomfort, loss of weight and steatorrhoea. He had a history of recurrent pancreatitis attack for the past 2 months. On examination he was cachexic with a BMI of 21, dehydrated with a gross distended abdomen suggestive of ascites. Abdominal ultrasound revealed gross ascites fluid intraperitoneal with a normal liver and pancreas. Peritoneal tapping was done and the fluid was sent for cytology and the result come back as negative. Only the body fluid amylase was 64000U/L. Therefore CT scan of the abdomen was done for further investigation. CT scan abdomen showed a well defined cystic lesion at the body of the pancreas meas...
Introduction: Hepatocellular carcinoma (HCC) is the commonest primary tumor in the liver. It has ... more Introduction: Hepatocellular carcinoma (HCC) is the commonest primary tumor in the liver. It has been shown to have a strong association with hepatitis B and C. HCC not only commonly metastases to the other part of the liver but also commonly metastases to the lung. Involvements of upper gastrointestinal organs are rare. We report a case of hepatocellular carcinoma with duodenal metastases. Method: A 58 years old Chinese man with a background history of hepatitis B presented with right hypochondrium pain. No jaundice or any constitutional symptoms noted. Physical exams revealed irregular right hypochondrium mass. No ascites palpable. Most blood investigation was unremarkable except for a raised Alpha fetoprotein of 2920. Imaging studies confirmed a diagnosis of a segment 4B HCC with enlarged portal nodes and left portal vein thrombosis. Despite his Child’s score A, he was deemed inoperable and subjected to chemoembolization. During a subsequent follow up, he developed symptomatic an...
A 56-year-old woman presented with epigastric pain and loss of appetite and weight for the preced... more A 56-year-old woman presented with epigastric pain and loss of appetite and weight for the preceding 3 weeks. Clinically, she was jaundiced with upper quadrant abdominal tenderness. Initial blood tests and imaging scans suggested cholangiocarcinoma. Intraoperatively, no malignancy was observed. A frozen section biopsy suggested tuberculosis (TB). However, subsequent serological examination showed that the patient was nonreactive for human immunodeficiency virus, hepatitis B, hepatitis C, and acid-fast bacilli. A chest radiograph also showed no evidence of pulmonary TB. The patient was then placed on antitubercular therapy and her condition improved. Primary hepatic TB was not initially considered during diagnosis because of its low prevalence, but this led to performing an unnecessary surgery on this patient. We review the literature on this rare condition and discuss potential strategies for diagnosing and managing patients with primary hepatic TB.
Correspondence: Ikhwan Sani Mohamad Department of Surgery, Universiti Sains Malaysia, 16150 Kota ... more Correspondence: Ikhwan Sani Mohamad Department of Surgery, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia Tel: +6097676774 [email protected] ABSTRACT Background: Single Incision Laparoscopic Cholecystectomy (SILC) was first introduced about 2 decades ago, as an evolution of the gold standard 3-4 ports laparoscopic cholecystectomy. Objectives: The objective of the study was to assess the safety and feasibility of SILC using a novel Glove Port Technique. Methodology: This is an retrospective cohort study of SILC using a novel glove port technique, carried out at our centre from 1 September 2014 to 31 December 2016. Data on patients’ demographic data, operative time, post-operative pain, length of stay, post-operative intervention were retrieved from patients’ medical records and overall satisfaction were recorded at follow-up. Results : A total of 50 patients, mean age of 58.2 ± 16.5 years, underwent SILC at our centre during the study period and were included i...
Trauma is a major health problem in Malaysia. An understanding of the trauma epidemiology is impo... more Trauma is a major health problem in Malaysia. An understanding of the trauma epidemiology is important in developing a reliable trauma service. The aim of this study is to understand the pattern of trauma in our institution and to highlight the need for a dedicated trauma service. In this database, 142 cases were included. Majority were males (127, 89.4%). Most common injury types are motor vehicle accidents (87.3%) followed by falls (7.7%), and stabs (3.5%). Most Injury Severity Score (ISS) falls under moderate score with 38.7%. Mean Abbreviated Injury Score (AIS) was 3 with most involving the chest and 90% of the patients have injuries involving at least 2 regions. Average hospital length of stay (LOS) was 11.4 days ±11.5 SD; with most patients (71.8%) were discharged without permanent disability. The mortality rate was 9.2% with all having ISS>16. ISS found to be strongly related to longer hospital stay and worse outcome (0.59, p < 0.0001, 0.4, p < 0.0001). This data is...
tumorigenesis in HCC cells were analyzed by flow cytometry, colony formation assays and CCK8 assa... more tumorigenesis in HCC cells were analyzed by flow cytometry, colony formation assays and CCK8 assays. The correlation between XRCC2 expression and long-term outcomes after liver resection, as well as the potential molecular mechanism of XRCC2 in regulating the proliferation in HCC cells were also addressed. Results: The expression of XRCC2 was higher in tumor tissues and HCC cell lines compared to the adjacent liver tissues and normal liver cell lines. The expression level of XRCC2 has a reverse relationship with the long-term outcomes after liver resection. Down-regulating the expression of XRCC2 in HCC cell strains could inhibit the proliferation of HCC cells by inducing S-phase arrest and cell apoptosis in vitro and in vivo. Further study indicates that down-regulating the expression of XRCC2 could induce the up-regulation of p53/p21 signaling pathway. Conclusion: This study provides novel insights into the role of XRCC2 in controlling HCC cell proliferation and tumorigenesis, and identifies XRCC2 as a potential prognostic marker and therapeutic target.
Asian Journal of Pharmaceutical and Clinical Research
Objective: The purpose of this study is to reduce the incidence of post-endoscopic retrograde cho... more Objective: The purpose of this study is to reduce the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) by the administration of intravenous (IV) diclofenac sodium.Methods: This is a prospective, randomized, double-blinded control study. This study was performed in the hepatobiliary unit of general surgery department in University Kebangsaan Malaysia Medical Centre (UKMMC) from May 2015 to May 2016. A total of 128 patients were enrolled in this study. 59 patients were randomized into the treatment arm, while 63 were randomized into the control group. Patients were randomized by envelope system, and patients in the treatment arm received 75 mg of diclofenac sodium intravenously, within 30 min of ERCP commencement. Both groups were observed for PEP post-ERCP and their pain score recorded. Patients’ demographic data were also observed.Results: A total of 122 patients were included in the study, with 59 patients randomized into the treatment arm ...
Splenic artery aneurysms (SAAs) account for more than half of all visceral artery aneurysms. SAAs... more Splenic artery aneurysms (SAAs) account for more than half of all visceral artery aneurysms. SAAs are the third most common intraabdominal aneurysm. Although SAAs is rare but are potentially life threatening [1]. It can cause complications, such as spontaneous intraperitoneal rupture, into the neighbouring hollow organs, and fistulisation into the pancreatic duct.
Background: Internal fi stula with adjacent viscera during acute pancreatitis is a rare complicat... more Background: Internal fi stula with adjacent viscera during acute pancreatitis is a rare complication. Due to their anatomic localization, colon, duodenum or stomach may be involved. Pancreatico-colonic fi stula is associated with a higher septic risk and surgery is usually mandatory. Results and main fi ndings: We report a new case in 71-year-old man diagnosed by CT with rectal water soluble contrast media and managed conservatively. To our knowledge, this is the second case in the literature treated in this way. Conclusion: Conservative treatment may be offered to selected patients who have a rapid improvement of symptoms associated with a signifi cant regression of the collection.
ABSTRACT Introduction: Pancreatic ascites was first reported in 1953. It is commonly affected in ... more ABSTRACT Introduction: Pancreatic ascites was first reported in 1953. It is commonly affected in male between age 20-50 years old. We reported a case of progressing abdominal ascites in a young healthy man. Method: This is a case of 22 year old gentleman with a complaint of progressive abdominal distention for the past 1 month. It was associated with intermittent epigastric discomfort, loss of weight and steatorrhoea. He had a history of recurrent pancreatitis attack for the past 2 months. On examination he was cachexic with a BMI of 21, dehydrated with a gross distended abdomen suggestive of ascites. Abdominal ultrasound revealed gross ascites fluid intraperitoneal with a normal liver and pancreas. Peritoneal tapping was done and the fluid was sent for cytology and the result come back as negative. Only the body fluid amylase was 64000U/L. Therefore CT scan of the abdomen was done for further investigation. CT scan abdomen showed a well defined cystic lesion at the body of the pancreas measuring 4.7 x 4.9 x 5 with a continuity of this lesion with the main pancreatic duct. There is also a soft tissue density lesion within the pancreatic duct at the region of the head of pancreas. Endoscopic retrograde pancreatogram was performed, however it was unable to cannulate the pancreatic duct. Patient was underwent laparotomy with Frey Procedure. Intraoperatively there was a stone at the pancreatic head that obstructing the pancreatic duct with distal pancreatic duct dilatation. Postoperatively he was uneventful. The was no ascites fluid and he was discharge well. Results: - Conclusion: Pancreatic ascites is an uncommon sequalae of chronic pancreatitis. Its required CT scan imaging to determine the causes for the chronic pancreatitis. ERCP is recommend as a first line treatment however Frey Procedure is an option if failure in managing endoscopically.
Introduction Primary liver tuberculoma is a rare entity within healthy immuno-competent individua... more Introduction Primary liver tuberculoma is a rare entity within healthy immuno-competent individuals. Conversely, most of cases are secondary and are associated with miliary tuberculosis(TB). We report a case of primary hepatic TB which was misdiagnosed and treated initially as a primary liver tumour 1-3 Case A 56-year-old lady presented with epigastric pain, loss of weight and appetite of 3 weeks duration. Clinical examination revealed jaundiced patient with upper quadrant tenderness. Initial blood work-up revealed anaemia, a deranged liver profile and an elevated CA-19-9 (562 U/ml). Computed tomography(CT) demonstrated an ill-defined 3.5 x 4.0 cm heterogeneously enhancing mass at the liver hilum with peri-portal lymphadenopathy. She was diagnosed with cholangiocarcinoma. Biliary decompression via ERCP was performed and she was then subjected for a central hepatectomy. Intra-operatively, we noted yellowish nodules over the entire liver with mesenteric and omental lymphadenopathy dis...
Background: This present study sought to review the feasibility and patients’ satisfaction of lap... more Background: This present study sought to review the feasibility and patients’ satisfaction of laparoscopic cholecystectomy to be perform as daycare procedure. Materials and Methods. Sixty-two patients with symptomatic gallstones were recruited within a year. They were randomized into overnight stay and daycare groups. The outcomes and post-operative complications were analyzed. Results. Fifty-eight patients were eligible for analysis and four patients were excluded because of conversion to open cholecystectomy. All patients in daycare group reported no fever but two patients in the overnight stay group complaint of post-operative fever (p=0.150). The mean pain score using Visual Analogue Score (VAS) in daycare group was 2.93 but in the overnight stay was recorded as 3.59 (p=0.98). Five patients had post-operative nausea and vomiting (PONV) in daycare group compared to 2 patients in the overnight stay group (p=0.227). Patient’s satisfaction were higher in the daycare group (p=0.160)....
Introduction: Pancreatic ascites was first reported in 1953. It is commonly affected in male betw... more Introduction: Pancreatic ascites was first reported in 1953. It is commonly affected in male between age 20-50 years old. We reported a case of progressing abdominal ascites in a young healthy man. Method: This is a case of 22 year old gentleman with a complaint of progressive abdominal distention for the past 1 month. It was associated with intermittent epigastric discomfort, loss of weight and steatorrhoea. He had a history of recurrent pancreatitis attack for the past 2 months. On examination he was cachexic with a BMI of 21, dehydrated with a gross distended abdomen suggestive of ascites. Abdominal ultrasound revealed gross ascites fluid intraperitoneal with a normal liver and pancreas. Peritoneal tapping was done and the fluid was sent for cytology and the result come back as negative. Only the body fluid amylase was 64000U/L. Therefore CT scan of the abdomen was done for further investigation. CT scan abdomen showed a well defined cystic lesion at the body of the pancreas meas...
Introduction: Hepatocellular carcinoma (HCC) is the commonest primary tumor in the liver. It has ... more Introduction: Hepatocellular carcinoma (HCC) is the commonest primary tumor in the liver. It has been shown to have a strong association with hepatitis B and C. HCC not only commonly metastases to the other part of the liver but also commonly metastases to the lung. Involvements of upper gastrointestinal organs are rare. We report a case of hepatocellular carcinoma with duodenal metastases. Method: A 58 years old Chinese man with a background history of hepatitis B presented with right hypochondrium pain. No jaundice or any constitutional symptoms noted. Physical exams revealed irregular right hypochondrium mass. No ascites palpable. Most blood investigation was unremarkable except for a raised Alpha fetoprotein of 2920. Imaging studies confirmed a diagnosis of a segment 4B HCC with enlarged portal nodes and left portal vein thrombosis. Despite his Child’s score A, he was deemed inoperable and subjected to chemoembolization. During a subsequent follow up, he developed symptomatic an...
A 56-year-old woman presented with epigastric pain and loss of appetite and weight for the preced... more A 56-year-old woman presented with epigastric pain and loss of appetite and weight for the preceding 3 weeks. Clinically, she was jaundiced with upper quadrant abdominal tenderness. Initial blood tests and imaging scans suggested cholangiocarcinoma. Intraoperatively, no malignancy was observed. A frozen section biopsy suggested tuberculosis (TB). However, subsequent serological examination showed that the patient was nonreactive for human immunodeficiency virus, hepatitis B, hepatitis C, and acid-fast bacilli. A chest radiograph also showed no evidence of pulmonary TB. The patient was then placed on antitubercular therapy and her condition improved. Primary hepatic TB was not initially considered during diagnosis because of its low prevalence, but this led to performing an unnecessary surgery on this patient. We review the literature on this rare condition and discuss potential strategies for diagnosing and managing patients with primary hepatic TB.
Uploads
Papers by Hairol Othman