Animal Rights ; Animals ; Humans ; Infertility, Male ; therapy ; Male

Acromioclavicular joint (ACJ) dissociation is one of the common injuries affecting adults. The stability of ACJ largely depends on the integrity of acromioclavicular ligament, coracoclavicular ligament, capsule, trapezius muscle and deltoid muscle. The injury has been classified by Rockwood into six types and treatment options can be guided by the classification. TightRope fixation is one of the many surgical procedures available to address acromioclavicular joint separation. It consists of tensioning of a no. 5 Fibrewire suture secured at both ends to lowprofile metallic buttons. Despite various advantages of using this technique, complications such as suture cut-out, clavicle fracture and suture failure have been documented. The author presents a case of a type III acromioclavicular joint dissociation treated with TightRope which suture cutout was noted intra-operatively. Decision to amend the fixation using a cut one-third tubular plate as an additional anchor for the metallic button on the clavicle was made. Patient’s progress was evaluated using the University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) and significant improvement was noted six months post operatively. We propose this technique as a solution to the encountered problem.
Acromioclavicular Joint

We report a case of a 21 years old female who presented with a history of anterior knee pain for previous 3 months. Pain was localized to the anteromedial aspect of the left knee and aggravated by flexion. Clinical examination revealed a 2x2 cm painful lump on the anteromedial aspect of the left medial condyle with no effusion. Magnetic resonance imaging revealed an anterosuperior tear of the medial collateral ligament. The patient subsequently underwent left knee arthroscopic examination. Two yellowish pe
Orthopaedic

OBJECTIVE: The aim of this study was to determine the prevalence and pattern of Extra-pulmonary Tuberculosis (EPTB) cases that were admitted and diagnosed in a tertiary government hospital from January 2006 to December 2010.

METHODOLOGY: Records of pediatric patients who were admitted in a tertiary government hospital from January 2006 to December 2010 with a diagnosis of Extra-pulmonary Tuberculosis were reviewed. The following information was gathered: demographic profile, clinical profile, results of PPD, complications and mortality rate, and laboratory results.

RESULTS: The sixty-six cases constituted 7.8% of the total pediatric admissions during the same period. There was no significant difference as to sex distribution (53% males vs. 47% females, with 1:1 ratio). Majority of cases involved the meninges (72.7%) followed by lymph node (6.1%), liver (6.1%), bone (6.1%) and genitourinary (3.0%). The three most common symptoms were nonspecific: fever, anorexia and weight loss. The occurrence of fever was universal among all admitted cases of Extrapulmonary TB. With regards to prognosis, the majority (83%) of cases were discharged in improved condition. The case fatality rate was 16.7%.

CONCLUSION: The incidence of new cases of EPTB has remained constant, despite the decline in new cases of active pulmonary TB.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; Tuberculosis-prevalence, epidemiology, incidence, therapy, history, diagnosis ; Tuberculosis, Meningeal ; Tertiary Care Centers ; ;

Abscess ; diagnosis ; etiology ; Adenocarcinoma ; complications ; diagnosis ; Colorectal Neoplasms ; complications ; diagnosis ; Diagnosis, Differential ; Diverticulitis, Colonic ; complications ; diagnosis ; Female ; Follow-Up Studies ; Humans ; Intestinal Perforation ; diagnosis ; etiology ; Laparotomy ; methods ; Male ; Middle Aged ; Sigmoid Neoplasms ; complications ; diagnosis ; Tomography, X-Ray Computed ; methods

AIM: To report the usefulness of a new parameter (maximum cross sectional area) in the measurements of B-scan ultrasonography to evaluate the progress of choroidal metastatic tumour size during the follow-up of patient.METHODS: Case report-the B-scan ultrasonographic measurements of height, base and maximum cross sectional area during the follow-up of the patient are presented.RESULTS: A 62-year-old Chinese lady, known case of non-small cell lung carcinoma, presented with painless blurring of vision in the right eye. She was diagnosed to have bilateral choroidal metastasis (advanced in the right eye and early in the left eye) with good vision in both eyes. The tumour size in the right eye reduced significantly after the first chemotherapy; but increased again 6 weeks after the end of last cycle of chemotherapy. She was given radiotherapy and another course of chemotherapy. The tumour size in the right eye did not respond much later on. However, the tumour size in the left eye was static through out the follow up period of 2years. The patient maintained best corrected visual acuity in both eyes (6/9 in right eye and 6/6 in left eye). The progress of tumour size in right eye was evaluated with serial B-scan ultrasonographic measurements.CONCLUSION: The ultrasonographic measurements were reproducible all through the follow up period and coincided well with clinical appearance of the tumour in right eye. We suggest the use of B-scan ultrasonography in the follow up of patients with elevated choroidal masses for quantitative assessment of progression/regression in their size during the treatment period.

Human ; Male ; Female ; Infant ; Breast Feeding ; Dermatitis, Atopic ; Milk, Human ; Wound Healing ; Eczema

Myopia studies are notoriously difficult to carry out. Past studies on intervention in myopia progression have given conflicting results. Beside inaccurate and inadequate measurements, the most important cause for this is the very variable nature of myopia, which makes it difficult to achieve baseline comparability between the control and the study group. Although there were inclusion criteria in these studies, for age, sex, race, degree of myopia and stigmatism, the most important variate-- the rate of myopia progression-- was not included. Randomisation can achieve baseline comparability of the myopia progression rate, provided the sample sizes are large enough. Unfortunately, past studies have been limited to 100 to 200 children only. Studies on twins are more reliable than random groups because myopia progression rates are more likely to be the same in a pair of twins. Studies on the same subject, comparing the right eye and the left eye would be even better, but this method is practicable for some studies only (e.g., we cannot have a spectacle lens for one eye and a contact lens on the fellow eye). There is another method of doing an interventional study on myopia. Because myopia progression is linear in its early stage until the early teenage years, it is possible to observe what happens to the linear progression upon intervention. In this way, we avoid the problem of trying to compare "apples with apples" but use the "same apple" instead.
Contact Lenses ; Disease Progression ; Humans ; Myopia ; pathology ; therapy ; Randomized Controlled Trials as Topic ; methods ; Reproducibility of Results ; Research

OBJECTIVE: To describe outcomes of oral propranolol therapy in a series of adult and pediatric patients diagnosed with benign capillary hemangioma of the head and neck.
METHODS:
Design: Prospective Case Series
Setting: Tertiary Government Teaching Hospital
Participants: Ten (10) patients representing all patients clinically diagnosed with benign capillary hemangioma of the head and neck enrolled in the study from 2012 to 2015.
RESULTS: Two (2) adults and eight (8) children were enrolled in the study. Although a decrease in lesion size was observed in half of the participants starting at three months, only one (1) attained complete resolution of the lesion-- a 12-year-old girl with hemangioma of the right parotid gland that attained clinical resolution of symptoms after four months of treatment. The remaining nine out of ten (9/10) participants did not attain complete clinical resolution; but there was a decrease in lesion size in four (4) of these participants. For the remaining five (5) participants, there was neither a decrease nor an increase in lesion size. Altogether, of the two adult participants, only one responded to therapy while only 4 out of 8 pediatric participants responded to therapy. There were no noticeable differences between adult and pediatric patients in terms of resolution and plateau. Aside from mild bradycardia expected with propranolol, no adverse reactions were observed during the course of treatment.
CONCLUSIONS: Although half of our participants responded to oral propranolol therapy whether these observations may be attributable to oral propranolol alone cannot be concluded.

Human ; Male ; Female ; Adult ; Child ; Child Preschool ; Infant ; Propranolol ; Bradycardia ; Parotid Gland ; Hemangioma, Capillary ; Hemangioma ; Neck ; Head

Despite increasing use of bone graft in Malaysia, there was still lack of data to quantify knowledge level on bone banking among orthopaedic community who are involved in transplantation related work. Therefore, a survey on awareness in tissue banking specifically bone banking, usage and choice of bone grafts was conducted. From 80 respondents, 82.5% were aware about tissue banking however only 12.5% knew of the existence of tissue banks in Malaysia. Femoral head was the bone allograft most often used as a substitute to autograft. Only 34.8% respondents preferred irradiated bone grafts whilst 46.9% preferred nonirradiated, indicating the need to educate the importance of radiation for sterilising tissues. Exhibition was the most preferred medium for awareness programme to disseminate information about bone banking in the orthopaedic community. The professional awareness is necessary to increase the knowledge on the use of bone graft, hence to increase bone transplantation for musculoskeletal surgeries in the country.