1.A case report of pyloric intussusception secondary to helicobacter pylori hyperplastic polyps
Wan Najmi Wan Daud ; Noorfizura Ahmad ; Wan Anna Mohd Fahmi
The Medical Journal of Malaysia 2016;71(1):35-36
We report a middle age man who presented with intermittent
vomiting and loss of weight.
Oesophagogastroduodenoscopy showed numerous antral
hyperplastic polyps with inaccessible duodenum. Contrast
enhanced computed topography demonstrated a classical
target sign of intussusception. This finding was later
confirmed at laparotomy. This rare presentation and
management strategy is discussed.
Polyps
2.Predictors for Failure to Mature of Autogenous Arteriovenous Fistulae: Alor Setar Experience
Wan Najmi ; Low Han Tong ; Mohan Nallusamy ; Kamarul Imran Musa
The Medical Journal of Malaysia 2012;67(2):165-168
Renal replacement therapy in Malaysia has changed
dramatically. In 1980 there were only 59 patients on dialysis. Since then the number of patients has increased
exponentially from 4,540 in 1998 to almost 15,000 in 20061.
Autogenous Arteriovenous Fistula (AVF) provides an excellent long term hemodialysis access with low rates of infection, thrombosis and is cost effective.
Hospital Sultanah Bahiyah is a tertiary hospital situated in the northern region of Peninsular Malaysia. Vascular Access creation is one of the main services provided by our surgical unit; with an average of 100 patients seen in the vascular access clinic per month. The number of AVF operations has increased from 30 cases in 2001 to 328 in 2007. The reported rates of Primary Fistula Failure (fistula fail to mature) varies from 8% to 53%2,4. Immature fistulae will lead to prolonged dependence on dialysis catheters. This phenomenon is well known to be associated with the risk of infective complications, central venous thrombosis or stenosis and patients’ inconvenience. Numerous studies have
reported the predictors of successful fistulae, but are varied in their design, definitions, end points and clinical factors considered 2,3 Preoperative imaging also has been proposed, but their widespread use is generally limited in most of the centres4. Knowing the risk factors for failure will help the surgeon to take the necessary precautions and preventive measures more effectively. The information may help to stratify the patients into various risk groups based on their likelihood to develop fistula failure. Thus, the main objective of this study was to identify clinical risk factors that are
related to Failure to Mature (FTM) of autogenous AVF.
3.Descemet Membrane Detachment Post-Phacoemulsification
Muhammad Najmi K ; Logeswary K ; Rona Asnida N ; Wan Haslina WAH ; Umi Kalthum MN ; Aida Zairani MZ
Medicine and Health 2018;13(1):208-214
We report the case series of phacoemulsification-related Descemet membrane detachment (DMD) encountered at a tertiary hospital in Kuala Lumpur. Case 1 was an iatrogenic DMD which was detected intraoperatively and managed early with good outcome. Case 2 and case 3 described unusual presentation of DMD which was initially undiagnosed. This report highlights the use of anterior segment optical coherence tomography (ASOCT) in detecting and confirming the correct diagnosis for DMD. With the aid of an experienced corneal specialist, the higher threshold for suspicious occurrence of DMD was confirmed using ASOCT. Treatment was tailored accordingly, with successful clearance of corneal oedema and visual recovery. This case series highlighted the importance of proper operative documentation and high threshold for suspicion for DMD in focal corneal oedema following an otherwise uneventful cataract surgery. It is concluded that ASOCT is an excellent tool to confirm diagnosis of DMD and success of treatment.
4.Diastolic dysfunction grading, echocardiographic and electrocardiogram findings in 50 patients with apical hypertrophic cardiomyopathy
Aslannif Roslan ; Suraya Hani Kamsani ; Hui Beng Koh ; Yee Sin Tey ; Kin Leong Tan ; Chan Ho Tham ; Mohd Saad Jalaluddin ; Mohamed Nazrul Mohamed Nazeeb ; Nay Thu Win ; Ahmad Tantawi Jauhari Aktifanus ; Malini Kerisnan ; Wan Nabeelah ; Muhd Najmi Hakim Abdul Rani ; Ai Ming Tan ; Amin Ariff Nuruddin
The Medical Journal of Malaysia 2019;74(6):521-526
Introduction: Apical Hypertrophic Cardiomyopathy (Apical
HCM) is an uncommon variant of hypertrophic
cardiomyopathy, but it is relatively more common in Asian
countries. This is a retrospective, non-randomised, single
centre study of patients with Apical HCM focusing on their
diastolic dysfunction grading, echocardiographic
parameters and electrocardiograms (ECG).
Methods: All Apical HCM patients coming for clinic visits at
the Institut Jantung Negara from September 2017 to
September 2018 were included. We assessed their
echocardiography images, grade their diastolic function and
reviewed their ECG on presentation.
Results: Fifty patient were included, 82% (n=41) were males
and 18% (n=9) females. The diastolic function grading of 37
(74%) patients were able to be determined using the updated
2016 American Society of Echocardiography (ASE) diastolic
guidelines. Fifty percent (n=25) had the typical ace-ofspades shape left ventricle (LV) appearance in diastole and
12% (n=6) had apical pouch. All patients had T inversion in
the anterior leads of their ECG, and only 52% (n=26) fulfilled
the ECG left ventricular hypertrophy (LVH) criteria. Majority
of our patients presented with symptoms of chest pain (52%,
n=26) and dyspnoea (42%, n=21).
Conclusion: The updated 2016 ASE guideline makes it easier
to evaluate LV diastolic function in most patients with Apical
HCM. It also helps in elucidating the aetiology of dyspnoea,
based on left atrial pressure. Clinicians should have a high
index of suspicion for Apical HCM when faced with deep T
inversion on ECG, in addition to a thick LV apex with an aceof-spades appearance during diastole.