No abstract available.

We report two cases of segmental neurofibromatosis that developed in s. 33-year-old female and a 35-years-old female. The skin lesions situated on the right C3 and C4 dermatomes, and on the right C2 dermatome respectively. Biopsy specimen showed collagenous wavy fibrils among which spindle-shaped and round cells were embedded as seen in the typical neurofibroma. These cases were considered to be true segmental neurofibromstosis.
Adult ; Biopsy ; Collagen ; Female ; Humans ; Neurofibroma ; Neurofibromatoses* ; Skin

The authors investigated the antiproliferative effect and expression of HLA-DR an- tigen by recombinant gamma-interferon (r-IFN-y) on cultured human keratinocytes (KC). The results were as follows, 1. From 10l.J/ml of r-1FN-p exposure, the proliferation of KC decreased in a concentration dependent fashion. But there was little difference of antiproliferative effect above 30U/ml of r-IFN-y exposure. 2. The expression of HLA-DR antigen on KC increased in a concentration and time dependent fashion of r-IFN-p exposure. E3ut t,here was little difference of HLA-DR antigen expression on KC above 30tJ/ml and most of HLA-DR antigen were expressed within 48hr. 3. The opt,imal condition for HLA-DR antigen induction on KC by r-IFN-p was likely t,hat HLA-DR KC was observed at 48hr under the our exposure of 30U/ml of r-IFN p. 4. After 4hr exposure of 30U/ml of r-IFN-p, KC expresed HLA-BR. antigen, reaching a maximum intensity at 3 days. At, 7 days, the loss of HI A-DR KC showed over 90% of maximum intensity.
HLA-DR Antigens* ; Humans* ; Interferon-gamma ; Interferons* ; Keratinocytes*

Background & Objective: Posterior reversible encephalopathy syndrome (PRES) is associated with immunosuppressive agents used in children with haemato-oncological diseases. There are no reports to date from the South Asia and South East Asia region. We report a Malaysian tertiary centre case series of children with haemato-oncological disease who developed PRES. Methods: Retrospective study of children seen with haemato-oncology diseases seen at the University Malaya Medical Centre Kuala Lumpur who developed PRES from 2011 – 2013. Clinical details were obtained from medical records and brain neuroimaging was reviewed. Results: Five patients met the inclusion criteria. All 5 patients had significant hypertension acutely or subacutely prior to neurology presentation. Four presented with acute seizures and the remainder 1 presented with encephalopathy.Three patients were on chemotherapy, 1 had renal impairment and 1 had prior immunosupression for bone marrow transplantation. A full recovery was seen in 4 patients and 1 patient had mild residual quadriplegia. Conclusion: Our case series expands the clinico-radiological spectrum of PRES in children with underlying haemato-oncological disorders. It is the first to show that prior cyclosporin intake as long as 2 months is a potential risk factor for PRES. Clinicians need to be vigilant for development of PRES and closely monitor the blood pressure in these children who are receiving or recently had immunosuppressive drugs and present with acute neurological symptoms.
Posterior Leukoencephalopathy Syndrome ; Brain Diseases

Purpose: This study aims to assess the effectiveness of enteral versus parenteral feeding in patients after esophagectomy. Methods: This a prospective cohort study of post-esophagectomy intensive care unit (ICU) patients over 12 months in the National Cancer Institute, Malaysia. Early enteral feeding followed the Enhanced Recovery After Surgery protocol, and parenteral nutrition (PN) was considered if there was a risk for conduit ischemia. It compared the effectiveness of enteral versus PN following esophagectomy, and assessed the correlations between biochemical nutritional markers and hospital lengths of stay or ventilation days. Results: It included two cohorts receiving PN (n=11) or enteral nutrition (EN) (n=11) following elective esophagectomy. Preoperative weight, body mass index, and Subjective Global Assessment were higher in the EN group (P=0.033, P=0.021, P=0.031, respectively). Nutritional interruption occurred more frequently in the EN group (63.7%) compared to the PN group (P=0.001). Mean levels of energy and protein received were 93.1 kcal/kg and 1.4 g/kg for PN versus 92.4 kcal/kg and 1.2 g/kg for EN (P=0.893, P=0.036). The median lengths of ICU stay (P=0.688) and postoperative stay (P=0.947) between groups showed no significant difference. In addition, 30-day mortality (P=0.214) and other postoperative complications (P>0.05) were comparable in the two groups. Conclusion Early initiation of supplementary PN due to significant interruption in EN led to higher protein intake compared to the EN group. However, there were no significant differences in postoperative outcomes, including 30-day mortality, ICU length of stay, and ventilation days. PN ensures adequate nutritional intake, especially in terms of protein delivery, without adversely affecting postoperative recovery and clinical outcomes.

Purpose: This study aims to assess the effectiveness of enteral versus parenteral feeding in patients after esophagectomy. Methods: This a prospective cohort study of post-esophagectomy intensive care unit (ICU) patients over 12 months in the National Cancer Institute, Malaysia. Early enteral feeding followed the Enhanced Recovery After Surgery protocol, and parenteral nutrition (PN) was considered if there was a risk for conduit ischemia. It compared the effectiveness of enteral versus PN following esophagectomy, and assessed the correlations between biochemical nutritional markers and hospital lengths of stay or ventilation days. Results: It included two cohorts receiving PN (n=11) or enteral nutrition (EN) (n=11) following elective esophagectomy. Preoperative weight, body mass index, and Subjective Global Assessment were higher in the EN group (P=0.033, P=0.021, P=0.031, respectively). Nutritional interruption occurred more frequently in the EN group (63.7%) compared to the PN group (P=0.001). Mean levels of energy and protein received were 93.1 kcal/kg and 1.4 g/kg for PN versus 92.4 kcal/kg and 1.2 g/kg for EN (P=0.893, P=0.036). The median lengths of ICU stay (P=0.688) and postoperative stay (P=0.947) between groups showed no significant difference. In addition, 30-day mortality (P=0.214) and other postoperative complications (P>0.05) were comparable in the two groups. Conclusion Early initiation of supplementary PN due to significant interruption in EN led to higher protein intake compared to the EN group. However, there were no significant differences in postoperative outcomes, including 30-day mortality, ICU length of stay, and ventilation days. PN ensures adequate nutritional intake, especially in terms of protein delivery, without adversely affecting postoperative recovery and clinical outcomes.

Facet joint arthrosis is a progressive degenerative disease that is frequently associated with other spinal degenerative disorders such as degenerative disc disease or spinal stenosis. Lumbar facet joint arthrosis can induce pain in the proximal lower extremities. However, symptoms and imaging findings of “facet joint syndrome” are not specific as they mimic the pain from herniated discs or nerve root compression. Currently, evidence for therapeutic intra-articular lumbar facet joint injections is still considered low, with a weak recommendation strength. Nevertheless, some studies have reported therapeutic effectiveness of facet joint injections. Moreover, the use of therapeutic facet joint injections in clinical practice has increased. This review article includes opinions based on the authors’ experience with facet joint injections. This review primarily aimed to investigate the efficacy of lumbar facet joint injections and consider their associated safety aspects.

Purpose: This study aims to assess the effectiveness of enteral versus parenteral feeding in patients after esophagectomy. Methods: This a prospective cohort study of post-esophagectomy intensive care unit (ICU) patients over 12 months in the National Cancer Institute, Malaysia. Early enteral feeding followed the Enhanced Recovery After Surgery protocol, and parenteral nutrition (PN) was considered if there was a risk for conduit ischemia. It compared the effectiveness of enteral versus PN following esophagectomy, and assessed the correlations between biochemical nutritional markers and hospital lengths of stay or ventilation days. Results: It included two cohorts receiving PN (n=11) or enteral nutrition (EN) (n=11) following elective esophagectomy. Preoperative weight, body mass index, and Subjective Global Assessment were higher in the EN group (P=0.033, P=0.021, P=0.031, respectively). Nutritional interruption occurred more frequently in the EN group (63.7%) compared to the PN group (P=0.001). Mean levels of energy and protein received were 93.1 kcal/kg and 1.4 g/kg for PN versus 92.4 kcal/kg and 1.2 g/kg for EN (P=0.893, P=0.036). The median lengths of ICU stay (P=0.688) and postoperative stay (P=0.947) between groups showed no significant difference. In addition, 30-day mortality (P=0.214) and other postoperative complications (P>0.05) were comparable in the two groups. Conclusion Early initiation of supplementary PN due to significant interruption in EN led to higher protein intake compared to the EN group. However, there were no significant differences in postoperative outcomes, including 30-day mortality, ICU length of stay, and ventilation days. PN ensures adequate nutritional intake, especially in terms of protein delivery, without adversely affecting postoperative recovery and clinical outcomes.

Purpose: This study aims to assess the effectiveness of enteral versus parenteral feeding in patients after esophagectomy. Methods: This a prospective cohort study of post-esophagectomy intensive care unit (ICU) patients over 12 months in the National Cancer Institute, Malaysia. Early enteral feeding followed the Enhanced Recovery After Surgery protocol, and parenteral nutrition (PN) was considered if there was a risk for conduit ischemia. It compared the effectiveness of enteral versus PN following esophagectomy, and assessed the correlations between biochemical nutritional markers and hospital lengths of stay or ventilation days. Results: It included two cohorts receiving PN (n=11) or enteral nutrition (EN) (n=11) following elective esophagectomy. Preoperative weight, body mass index, and Subjective Global Assessment were higher in the EN group (P=0.033, P=0.021, P=0.031, respectively). Nutritional interruption occurred more frequently in the EN group (63.7%) compared to the PN group (P=0.001). Mean levels of energy and protein received were 93.1 kcal/kg and 1.4 g/kg for PN versus 92.4 kcal/kg and 1.2 g/kg for EN (P=0.893, P=0.036). The median lengths of ICU stay (P=0.688) and postoperative stay (P=0.947) between groups showed no significant difference. In addition, 30-day mortality (P=0.214) and other postoperative complications (P>0.05) were comparable in the two groups. Conclusion Early initiation of supplementary PN due to significant interruption in EN led to higher protein intake compared to the EN group. However, there were no significant differences in postoperative outcomes, including 30-day mortality, ICU length of stay, and ventilation days. PN ensures adequate nutritional intake, especially in terms of protein delivery, without adversely affecting postoperative recovery and clinical outcomes.

Purpose: This study aims to assess the effectiveness of enteral versus parenteral feeding in patients after esophagectomy. Methods: This a prospective cohort study of post-esophagectomy intensive care unit (ICU) patients over 12 months in the National Cancer Institute, Malaysia. Early enteral feeding followed the Enhanced Recovery After Surgery protocol, and parenteral nutrition (PN) was considered if there was a risk for conduit ischemia. It compared the effectiveness of enteral versus PN following esophagectomy, and assessed the correlations between biochemical nutritional markers and hospital lengths of stay or ventilation days. Results: It included two cohorts receiving PN (n=11) or enteral nutrition (EN) (n=11) following elective esophagectomy. Preoperative weight, body mass index, and Subjective Global Assessment were higher in the EN group (P=0.033, P=0.021, P=0.031, respectively). Nutritional interruption occurred more frequently in the EN group (63.7%) compared to the PN group (P=0.001). Mean levels of energy and protein received were 93.1 kcal/kg and 1.4 g/kg for PN versus 92.4 kcal/kg and 1.2 g/kg for EN (P=0.893, P=0.036). The median lengths of ICU stay (P=0.688) and postoperative stay (P=0.947) between groups showed no significant difference. In addition, 30-day mortality (P=0.214) and other postoperative complications (P>0.05) were comparable in the two groups. Conclusion Early initiation of supplementary PN due to significant interruption in EN led to higher protein intake compared to the EN group. However, there were no significant differences in postoperative outcomes, including 30-day mortality, ICU length of stay, and ventilation days. PN ensures adequate nutritional intake, especially in terms of protein delivery, without adversely affecting postoperative recovery and clinical outcomes.