paradigm ; seconds ; Injury inflicted to the body by an external force ; therapeutic aspects ; Capital

Spinal fusion surgery ; Homologous Grafts ; Skeletal bone ; Future

Secondary metastases to the hand are rare, accounting for 0.1% of all metastases, and commonly involve bones 1,2. Soft tissue involvement is extremely unusual although it is significantly more common in carcinoma than sarcoma. Metastatic lesions of adenocarcinoma of the rectum to the liver, lung and vertebrae are well known. Here we report an unusual site of metastatic deposit of primary adenocarcinoma of the rectum to the soft tissues of the wrist causing carpal tunnel syndrome, which if correctly diagnos
Orthopaedic

Epidermoid cyst is a common benign cutaneous swelling frequently encountered in surgical practice. It usually presents as a painless lump frequently occurring in hairbearing areas of the body particularly the scalp, scrotum, neck, shoulder and back. Giant epidermoid cysts commonly occur in hairy areas such as the scalp. We present here the case of a rare occurrence of a giant epidermoid cyst in the less hairy area of the right upper thigh mimicking a soft tissue sarcoma. Steps are highlighted for the management of this unusual cyst.

Introduction: The aims of this study are to define the coracoid process anatomy in a Malaysian population, carried out on patients in Hospital Serdang with specific emphasis on the dimension of the base of coracoid process which is important in coraco-acromial (CC) ligament reconstruction, to define the average amount of bone available for use in coracoid transfer, and to compare the size of coracoid process based on gender and race, and with findings in previous studies. Materials and Methods: Fifteen pairs of computed tomography (CT) based 3-dimensional models of shoulders of patients aged between 20 to 60 years old were examined. The mean dimensions of coracoid were measured and compared with regards to gender and race. The data were also compared to previously published studies. Results: The mean length of the coracoid process was 37.94 ± 4.30 mm. Male subjects were found to have larger-sized coracoids in all dimensions as compared to female subjects. The mean tip of coracoid dimension overall was 19.99 + 1.93mm length x 10.03 + 1.48mm height x 11.63 + 2.12mm width. The mean base of coracoid dimension was 18.96 + 3.71mm length x 13.84 + 1.76mm width. No significant differences were observed with regards to racial denomination. The overall coracoid size measurements were found to be smaller compared to previous studies done on the Western population. Conclusion: This study may suggest that Malaysians have smaller coracoid dimension compared to Caucasians. The findings further suggest that the incidence of coracoid fracture and implants pull out in Malaysian subjects may be higher.

Introduction: Positron Emission Tomography-Computed Tomography (PET-CT) was introduced over four decades ago as an imaging tool to evaluate functional and anatomical aspects of disease such as malignancy. Besides pathological uptake, PET-CT also shows physiological uptake, especially in the gastrointestinal system, thus impacting diagnostic accuracy in these cases. There are many conditions that can attribute to increasing physiological uptake in PET-CT including microbial activity and drugs. Therefore, certain anti-spasmodic agents have been introduced to help reduce physiological uptake during scanning such as Hyoscine-n-butylbromide (Buscopan). This study aims to establish its effectiveness in reducing physiological bowel uptake on 18F-FDG PET-CT scan. Methods: 133 subjects were recruited in random for this study and divided into hyoscine (68 subjects) and control groups (65 subjects), respectively. Subjects in control group not given any anti-spasmodic medications and both groups received intravenous 18F-FDG according to body weight. PET-CT scan and images were interpreted by experienced nuclear medicine physician who scored the images according to the degree of bowel uptake and difficulty of image interpretation. Results: There were no statistical difference in bowel uptake based on SUV mean of the bowel and bowel-to-liver ratio between hyoscine and control groups. Conclusion: There was no significant effect of Hyoscine-n-butylbromide in reducing physiological bowel uptake in PET-CT scan.
malignancy

Introduction: Anterior cruciate ligament (ACL) tear is a frequent injury and its reconstruction is among the most commonly performed orthopaedic surgical procedures. ACL reconstruction generally yields good results. However, its recovery can be hampered by the development of postoperative complications. The aim of this study was to review complications following arthroscopic ACL reconstruction done in Hospital Raja Permaisuri Bainun, Ipoh and Hospital Teluk Intan, Perak with the emphasis on arthrofibrosis. Arthrofibrosis is defined as a loss of 15 degrees extension or more, with or without flexion loss compared to the contralateral knee. Materials and Methods: The study is based on a series of retrospective cases, on which medical records of 200 patients who underwent ACL reconstruction surgeries between March 2007 and December 2014 were reviewed. Follow-up treatment records were available for 166 patients (83%). The data was analysed to identify the risk factors for developing complications with an emphasis on arthrofibrosis. Results: Eight patients (5%) developed arthrofibrosis in the post-operative period. Early surgical intervention, preoperative limited range of motion and female gender are the risk factors correlate with arthrofibrosis. However, the type of graft used and meniscal procedure do not have a significant correlation with the development of arthrofibrosis. Other complications encountered are local infections, hypertrophic scar and chronic regional pain syndromes. Conclusion: The 5% incidence of arthrofibrosis following an ACL reconstruction in our centres can be reduced with proper preventive measures which include thorough preoperative evaluation, proper patient selection, restoration of ROM prior to surgery and proper timing of surgery.