1.Factors Affecting the Outcomes in Children Post-Myelomeningocoele Repair in Northeastern Peninsular Malaysia
Malaysian Journal of Medical Sciences 2011;18(1):52-59
Background: The present study aimed to evaluate the impact of multiple factors and
outcomes (ambulatory function and sphincter function) on children with myelomeningocoele
(MMC) following surgical repair.
Method: A retrospective chart review of children that underwent surgery for MMC in the
Hospital Universiti Sains Malaysia from 1 January 1990 to 31 December 2004 was conducted. Only
those children who were followed-up for at least 18 months after the operation were included in the
study.
Results: A total of 42 children with MMC were included in the study. Approximately 79%
of the MMC were located in the lumbosacral and sacral regions. Thirty (71.4%) of the children had
hydrocephalus, and 28 (67.7%) had a cerebrospinal fluid (CSF) shunt inserted. An analysis of the
association between the predictors of ambulatory status revealed that hydrocephalus (P = 0.013),
the presence of a CSF shunt (P = 0.005), intact motor function at L3 and below (P < 0.001), and the
presence of deep tendon reflexes (P < 0.001) were good factors of ambulatory status. Only 16.7% of
the children did not have urinary or faecal incontinence. Hydrocephalus (P = 0.049) and low-level
MMC (P = 0.028) were significantly associated with sphincter control.
Conclusion: Multiple factors contributed to the outcomes in post-MMC repair children in
terms of ambulation and sphincter function following a repair of MMC. The Spina Bifida Neurological
Scale (SBNS) should be applied during the management of these children to identify neurological
deterioration.
2.There are No Differences between Factors Determining Graft Infection in Autologous Bone Flap Replacement and Acrylic Cranioplasty: A Prospective Observational Study at Hospital Kuala Lumpur
Siti Azleen Mohamad ; Mohd Safari Mohd Haspani ; Badrisyah Idris
Malaysian Journal of Medical Sciences 2016;23(5):83-90
Objectives: This study, conducted in 2012, was performed to determine the incidence
of graft infection after cranioplasty procedures and factors affecting the graft infection rate at
Hospital Kuala Lumpur (HKL).
Methodology: This was an observational cross-sectional case study of patients who
have undergone cranioplasty at HKL over a period of one year (2012). One hundred seventytwo
patients were included in the study. A total of 105 (61.8%) cases were autologous bone flap
replacements, and 67 (38.2%) were acrylic cranioplasty.
Result: A total of five infected grafts were identified among the 172 cases included in the
study, resulting in an overall infection rate of 2.9%. Of this infected group, three (4.5%) were
cases of cranioplasty and two (1.9%) were cases of autologous bone flap replacement. There
was high proportion of male patients undergoing cranioplasty (118 [or 68.6%]) and only 54 (or
31.4%) female patients. The primary pathology in the majority of patients (126 [or 73.2%]) was
due to trauma; only 46 cases (or 26.8%) did not result from trauma. Of the patients, 123 (or
71.5%) had undergone a single cranial procedure prior to their cranioplasty, and 43 (or 28.5%)
had undergone multiple cranial procedures. Most of the patients (114 [or 66.3%]) underwent
cranioplasty 90 days after undergoing decompressive craniectomy while 58 (or 33.7%) underwent
cranioplasty less than 90 days after decompressive craniectomy.
3.Case Report: A Rare Case of Pediatric Conus Medularis Glioblastoma Multiforme
Teak Sheng Gee ; Abdul Rahman Izani Ghani ; Badrisyah Idris ; Mohamad Saufi Awang
The Medical Journal of Malaysia 2012;67(4):438-441
CNS malignant astrocytoma has a descending frequency of
occurrence according to site; moving from intracranial to
cervical-medullary, thoracic, lumbar and extremely rare in
the conus medullaris. IMSC glioblastoma are rare and de
novo conus medullaris GBM is an extreme rarity. The
duration of symptoms is short and the neurological & clinical
deterioration are rapid. Despite aggressive treatment via
surgery and radiotherapy IMSC & conus GBM still carry a
grim and fatal prognosis. This is a strong motivation for
developing new treatment strategy. New treatment modality
like Temozolomide & gene therapy is currently in under studyand long term result is under study and review.
4.Brain Metastasis of Atrial Myxoma: Case report
Badrisyah Idris ; Saiful Razman ; Rahmat Harun ; Venkatesh R Naik ; Tan Y C
The Medical Journal of Malaysia 2012;67(6):613-615
Metastasis of an atrial myxoma to the brain is extremely
rare1. Thus far there are only 17 cases reported, including
our present case. Most of the brain metastases manifest
only in 3 to 6 decades, after an average time frame of one to two years after surgical removal of parental tumour. We
present a case of brain metastases of atrial myxoma in a
teenager of the youngest age among all reported cases,
unusually as early as 15 years old 3. The progress of the
metastatic process had been insidious for three years after
heart surgery, The imaging demonstrated a rather sizeable
tumour by the time when the patient is symptomatic. The
location of the metastatic tumour is anyhow superficial to
the cortical surface, enabling complete surgical excision of the tumour easily achievable with favourable outcome.