Hoarseness due to left recurrent laryngeal nerve paralysis was first described in 1897 by Norbert Ortner. Various cardiopulmonary and thoracic arch aorta pathologies associated with left recurrent laryngeal nerve palsy have been described over the last 100 years and is also known as cardio-vocal syndrome. We report our experience with seven cases of Ortners syndrome due to thoracic aortic aneurysm with compression of the left recurrent laryngeal nerve and resultant hoarseness.
ortic Aneurysm, Thoracic

Objective:To investigate the short and long term efficacy of a commercial air ionizer in killing Dermatophagoides pteronyssinus (D. pteronyssinus) and Dermatophagoides farinae (D. farinae) mites. Methods: The effect of a commercial ionizer on D. pteronyssinus and D. farinae was evaluated in the laboratory, using a specially designed test. Mortality was assessed after 6, 16 and 24 hours for direct exposure and after 24, 36, 48, 60 and 72 hours for exposure in simulated mattress. New batches of mites were used for each exposure time. Results: LT50 for direct exposure of ionizer was 10 hours for D. pteronyssinus and 18 hours for D. farinae. The LT50 for exposure in simulated mattress was 132 hours or 5.5 days for D. pteronyssinus and 72 hours or 3 days for D. farinae. LT95 for direct exposure of ionizer was 36 hours for D. pteronyssinus and D. farinae. Meanwhile, the LT95 for exposure in simulated mattress was 956 hours or 39.8 days for D. pteronyssinus and 403 hours or 16.8 days for D. farinae. Conclusions:This study demonstrates the increasing mite mortalities with increasing exposure time of a commercial ionizer and suggests that negative ions produced by an ionizer kill dust mites and can be used to reduce natural mite populations on exposed surfaces such as floors, clothes, curtains, etc. However, there is reduced efficacy on mites inside stuffed materials as in mattresses and furniture.

Background: Vertical jump is an index representing leg/kick power. The explosive movement of the kick is the key to scoring in martial arts competitions. It is important to determine factors that influence the vertical jump to help athletes improve their leg power. The objective of the present study is to identify anthropometric factors that influence vertical jump height for male and female martial arts athletes. Methods: Twenty-nine male and 25 female athletes participated in this study. Participants were Malaysian undergraduate students whose ages ranged from 18 to 24 years old. Their heights were measured using a stadiometer. The subjects were weighted using digital scale. Body mass index was calculated by kg/m2. Waist–hip ratio was measured from the ratio of waist to hip circumferences. Body fat % was obtained from the sum of four skinfold thickness using Harpenden callipers. The highest vertical jump from a stationary standing position was recorded. The maximum grip was recorded using a dynamometer. For standing back strength, the maximum pull upwards using a handle bar was recorded. Multiple linear regression was used to obtain the relationship between vertical jump height and explanatory variables with gender effect. Results: Body fat % has a significant negative relationship with vertical jump height (P < 0.001). The effect of gender is significant (P < 0.001): on average, males jumped 26% higher than females did. Conclusion: Vertical jump height of martial arts athletes can be predicted by body fat %. The vertical jump for male is higher than for their female counterparts. Reducing body fat by proper dietary planning will help to improve leg power.

Laryngeal amyloidosis is a rare cause of stridor in a healthy young adult. We report a case of localised laryngeal amyloidosis, including our MRI findings, which included a necrotic centre that has not previously been described. This case also highlights the need for a high index of clinical suspicion to achieve the correct histopathological interpretation

Introduction: Cancer chemopreventive agents from natural sources have been actively investigated over the years to seek prevention against cancer. In this study, cocoa polyphenols extract (CPE) was examined to explore its antioxidant and cytotoxicity activities. Methods: CPE was analysed for total phenolic content (TPC) and antioxidant activity (DPPH radical scavenging activity and FRAP ferric-reducing antioxidant power assays). In vitro cytotoxicity effect of CPE against HepG2, HT-29, HeLa, MCF-7, MDA-MB-231 and WRL-68 cell lines after 48 h exposure was measured by MTT assay. Results: The study showed that CPE had higher total phenolic content (13560.0±420.1 mg GAE/100g dry weight of sample) than vitamin E (p<0.05). CPE exhibited strong antioxidant activity comparable with ascorbic acid in both DPPH (IC50 = 14.73±1.47 􀂗g/ml) and FRAP (2130.33±2.33 μM of FE/1 mg of dry weight of sample). The cytotoxicity study showed that CPE exhibited the highest cytotoxicity effect against MCF-7 with lowest IC50 value (3.00±0.29 mg/ml) compared to other cancer cell lines after 48 h treatment (p<0.05). Conclusion: Our results indicate that CPE demonstrated high total phenolic content, free radical scavenging activity, ferric reducing ability and cytotoxicity activity towards HepG2, HT-29, HeLa, A549, MDA-MB- 231 and MCF-7 cancer cell lines. Further isolation of bioactive constituents from CPE should be done to characterise its potential chemopreventive activity as well as to elucidate the mechanism of cancer cell death induced by CPE.

Background: This is a single institutional review of aortoiliac pseudoaneurysm of various aetiologies managed with endovascular stent graft repair. Methods: From 2009 to 2014, 16 patients had endovascular stent graft inserted for pseudoaneurysm of the thoracic aorta, abdominal aorta and iliac arteries in Hospital Kuala Lumpur. Co-morbidity, causative agents, in-hospital mortality, complications and outcomes were examined. Results: The average age was 59.1 years (range 36-77). Comorbidities include hypertension, diabetes mellitus, tuberculosis, prior infection and previous open aneurysmal repair. All patients had raised WBC (>10.0x109 /L), ESR or Creactive protein on admission while 50% of patients had fever. Blood cultures were positive in 4 patients. All patients were given antibiotics. Only one in-hospital mortality was noted at day-47 post-procedure. Two patients died of aortoenteric fistula at district hospital eight and 16 months later. One patient died of chronic graft infection two years later. One died of unrelated cause. One patient developed type IB endoleak from internal iliac artery two years later and surgical ligation was performed. The average follow up was 15.8 months. Conclusion: Endovascular stent graft repair for pseudoaneurysm is a viable option compared to open surgery. It is less invasive, has lower operative morbidity and fair outcomes. However, some cases may be due to inflammatory aortitis instead of infective pseudoaneurysm, given the frequent culture-negative results. In order to obtain high yield of bacteria culture for infected pseudoaneurysm, open repair with tissue culture is still the main mode of treatment especially for patients with low comorbidity.
Aneurysm, False

Blunt trauma to the right proximal subclavian artery is uncommon and tends to be associated with pseudoaneurysm formation. We report a patient with right proximal subclavian artery pseudoaneurysm after blunt chest trauma following a motor vehicle accident. The condition was successfully treated with a combined insertion of a covered stent and carotid-carotid bypass as a hybrid procedure. Duplex scans at 6 month and 1 year follow-up documented good stent-graft positioning and no pseudoaneurysm recurrence.
Aneurysm, False ; Subclavian Artery

Objective: Central vein occlusion is a common complication related to central vein catheter insertion for haemodialysis which can be unmasked by an ipsilateral fistula creation, leading to a dysfunctional arteriovenous fistula (AVF). We describe an extra-anatomical venous bypass surgical procedure performed to maintain vascular access and reduce the symptoms of swelling of the ipsilateral upper limb, neck and face. Materials and Methods: We report 20 consecutive patients with end-stage renal failure (ESRF) who had central vein occlusion and were not amenable to endovascular intervention. They underwent extra-anatomical vein to vein surgical bypass. The axillary and iliac or femoral veins were approached via infraclavicular and extraperitoneal groin incisions respectively. In all the patients, an externally supported 6 or 8 mm polytetrafluoroethylene (PTFE) graft was used as a conduit and was tunnelled extra-anatomical. All patients had double antiplatelet (Aspirin and Clopidogrel) therapy post-operatively. Results: Substantial improvement in the facial, neck and upper limb swelling was noticed following this diversion surgery. The vein to vein bypass was patent at 12 months in 10 out of 20 patients. Graft infection occurred in two (10%) cases. Re-thrombectomy or assisted patency procedure (stent/plasty) was done in four (20%) cases. The patients with preoperative fistula flow rate of more than 1500 ml/min and post-operative graft flow rate of more than a 1000 ml/min were patent at 12 months (P=0.025 and p=0.034 respectively). Conclusion. Axillary to iliac/femoral vein bypass can salvage functioning ipsilateral fistula threatened by occluded upper central vein and relieve their upper limb obstructive venous symptoms.