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Relationship of Anatomical Lengths of Forearm plusHand to the Length of Femur in Healthy Subjects

Mohd Salahuddin A ; Tarun G ; Shobha SA ; Rashmi M

Journal of Surgical Academia.2018;8(1):23-27.

The commonest procedure for adult diaphyseal femoral fractures is intramedullary nailing. A thorough preoperative examination of facture pattern and its morphology are necessary. Previous studies are non-homogenous and with conflicting results. So the study was planned to find out, any relation between femur and forearm plus little finger length and its association with height/ arm span and upper segment/lower segment ratios in an individual, with its statistical validity. The study was carried on 75 male and 75 female students of more than 18 years of age, studying at AIIMS Rishikesh after taking their informed consent and ethical approval. The forearm plus hand length and the length offemur were measured as per protocol, by simple measuring tape. The mean forearm plus hand length and the length of femur were 42.85 (SD, ±1.87) and 45.88 (SD, ±2.95) cm, respectively with the mean difference between these 2 measurements of -3.03 (95% CI, -3.83 to -2.22) cm, in male and 39.56(SD, ±1.68), 40.96 (SD, ± 2.75) cm and -1.400 (95% CI, -1.917 to -0.883) cm in female volunteers. The Pearson correlation co efficient and p value 0.575, 0.0001 and 0.585, 0.0001 in male and female respectively. There was no significant variation with height, upper segment and lower segment ratios. So we conclude that there is extremely significant correlation between the forearm plus hand length and the length of femur of the individuals. The forearm plus hand length represents the maximum length of the nail to be used in femur. The length of the femur nail can be definitely predicted by the forearm plus hand length in both sexes but it has to be different in both, for the same femoral fracture and there is no significant variation in the femur length with height, upper segment and lower segment variation in the same individ

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A Rare Complication of MRSA Lid Abscess and Orbital Abscess Following Strabismus Surgery in a Child

Kenneth Teow KL ; Nor Akmal B ; Jamalia R ; Safinaz MK

Journal of Surgical Academia.2018;8(1):32-35.

Strabismus is one of the most common ocular problems affecting the preschool population and the aim of strabismus surgery is to correct abnormal alignment of the eyes. A 5-year-old girl with strabismus underwent an uneventful surgery and was discharged on the same day with topical medications. Two days later, she returned with a painful right lower eyelid swelling, eye discharge and fever which started 1 day post-surgery. She was admitted for intravenous (IV) antibiotic. Symptoms initially improved after 24 hours of treatment, but later she had worsening eyelid swelling. An urgent CT scan of the orbit showed a right lower lid abscess with orbital cellulitis. Subsequently an examination under anaesthesia (EUA) and incision and drainage (I&D) of the lower lid abscess were performed. Culture from the pus grew Community Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA), sensitive to Vancomycin. At day 2 post I&D she subsequently developed another episode of localised right lower lid swelling. Another EUA was done but showed the lower lid and wound was freeof pus. She was later found to have a toxic reaction to topical Gentamicin and hence this medication was stopped. She responded well to treatment and was discharged after completing her IV antibiotics. At 14 months outpatient follow up, she was well and orthophoric in primary gaze. While treating a disease, we should be opened to all possibilities and not to treat with multiple antibiotics once susceptibility is known.

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A Rare Presentation of Plexiform Neurofibroma

Poh KW ; Syed Osman SIH

Journal of Surgical Academia.2018;8(1):39-42.

We report on a rare case of a child with persistent right upper lid eversion with conjunctival prolapse since birth that failed various attempts in repositioning the right superior fornix at other centre. He was found to have a right supero-temporal orbital mass above the prolapsed area. Computerized tomography (CT) scan of orbit confirmed a right lacrimal gland tumour with thinning of the right lesser wing of sphenoid. An excision biopsy of the tumour via anterior orbitotomy and eyelid reconstruction were performed. Histopathology report reviewed plexiform neurofibroma of the lacrimal gland. Further physical examination confirmed presence ofmultiple café-au-lait spots. He was diagnosed as Neurofibromatosis Type 1

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Atypical Contact Lens Related Corneal Ulcer Caused by Pasteurella Multocida

Fatin Hanisah F ; Umi Kalthum MN ; Rona Asnida N ; Jemaima CH

Journal of Surgical Academia.2018;8(1):43-46.

A 55-year-old healthy lady withhistory of regular contact lens (CL) use presented with 10 days history of progressive left eye blurring of vision, redness and pain. There was good CL hygiene practiced with no history of swimming, trauma or contact with domestic pets. Left eye vision was hand movement and right eye was 1/60, pinhole 6/18. On the left eye, there was a central, oval-shaped corneal infiltrate with an overlying large epithelial defect and stromal oedema, with significant anterior chamber cells and fibrin. B-mode ultrasound showed no vitritis. Intensive topical benzylpenicillin 10000iu/ml and topical gentamycin 1.4% hourly, homatropine 2% three times daily, oral doxycycline and oral ascorbic acid were started. The gram stain results showed gram positive cocci growth. Her ulcerimproved with the treatment and preservative-free dexamethasone 0.1% once daily was commenced to reduce inflammation and scarring. Interestingly, culture was reported as Pasteurella maltocida, a gram negative bacilli sensitive to penicillin, and so treatment was continued until the ulcer completely healed. She had central corneal scarring with best corrected vision of 6/24 in the left eye but was not keen on further surgery to improve her vision. Although it has not been previously reported, Pasteurella multocidacan cause CL related corneal ulcer with severe anterior chamber inflammation. This diagnosis should be considered even if there is trivial contact or no history of exposure to domestic animals.

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Severe Orbital CellulitisSecondary to Chronic Sinusitis: Challenges in Saving the Eye

Diymitra KG ; Mushawiahti M ; Aida Zairani MZ

Journal of Surgical Academia.2018;8(1):47-50.

Orbital cellulitis is a relatively common disease affecting predominantly the paediatric population. Most cases occur as a result of spread from the nearby sinuses. Other causes include penetrating trauma or extension from infected adjacent structures.If left untreated, this condition may result in devastating sequelae such as orbital apex syndrome, cavernous sinus thrombosis, meningitis, cranial nerve palsies, intracranial abscess formation and even death.A 47 year old immunocompetent Burmese lady presented with left eyelid swelling of 2 days duration associated with eye redness, blurring of vision and diplopia. Previously, there was history of right maxillary sinusitis and parapharyngeal abscess 9 months prior to presentation. On examination, she was afebrile with vision of 1/60 for the left eye with positiverelative afferent pupillary defect (RAPD). The eye was proptosed and swollen with restricted extraocular movements in all gazes. Conjunctiva was injected with chemosis and there was corneal epithelial bedewing. Otherwise anterior chamber was quiet and intraocular pressure was 51mmHg. Bilateral fundus examination was normal. Computed tomography (CT) scan of the orbit and paranasal sinus showed dense sinusitis and periosteal abscess at the lateral orbital wall.She was started on intravenous (IV) Cefuroxime and Metronidazole and underwent Functional Endoscopic Sinus Surgery (FESS) and orbital decompression. Intra-operatively there was pus and debris at the left anterior ethmoid, maxillary and sphenoid air sinuses and cultures revealed Klebsiella pneumoniaewhich was sensitive to Cefuroxime. Despite medical and surgical treatment, left orbital swelling only reduced minimally. However after starting intravenous Dexamethasone the swelling dramatically improved. She completed 10 days of intravenous Dexamethasone. Upon discharge, she was given oral Dexamethasone 2mg daily for 2 weeks and completed 2 weeks of oral Cefuroxime and Metronidazole. Intraocular pressure normalised and vision recovered to 6/9. A repeat CT orbit 3 weeks later showed resolving preseptal and periorbital collection.

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A Study of Relationship between Body Mass Index and Short Term Outcome of Isolated Coronary Artery Bypass Graft Surgery

Azhar AH1 ; Zulkarnain H ; Ziyadi G ; Rahman MNG

Journal of Surgical Academia.2011;1(2):41-48.

Coronary artery disease (CAD) is the most common cause of death in the industrialized world. Obesity is one of the risk factor for developing CAD and also postoperative morbidity and mortality. However, in published articles the relationship between body mass index (BMI) and outcome of coronary artery bypass graft surgery depict conflicting results. This study evaluated the relationship between BMI and outcome of isolated coronary artery bypass graft performed in Hospital Universiti Sains Malaysia (HUSM). Cardiothoracic Unit HUSM is a referral centre for east coast of West Malaysia. Data was retrospectively collected from the medical records retrieved from the hospital record office. All patients who underwent isolated CABG in Cardiothoracic Unit, Hospital Universiti Sains Malaysia Kubang Kerian, Kelantan from November 2001 till October 2004 were identified and their demographic and clinical data were collected. Patients were divided into non overweight (BMI= or <25 kg/m2) and overweight (BMI>25 kg/m2) group. Data was then analyzed using SPSS version 12.0. There were 141 patients who underwent isolated CABG over the three year period. There were 80 patients with BMI < or =25 kg/m2 and 61 patients with BMI of >25 kg/m2. The demographic data of the two groups were similar. There was no statistical significant differences in the outcome of isolated coronary artery bypass graft. In conclusion, body mass index does not influence the outcome of isolated coronary artery bypass graft.

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Role of Saphenoperitoneal Shunt in Management of Refractory Ascites

Ibrahim SMA1 & Harunarashid H2

Journal of Surgical Academia.2011;1(2):77-80.

Refractory ascites is difficult to treat by restriction of salt and repeated paracentesis which have been the mainstay of treating it for a long time. Sapheno-peritoneal shunts have been performed in patients with refractory ascites . Here, we evaluated the use of saphenous vein to be anastomosed to the peritoneam to drain the refractory ascites. Nine patients (7 male, median age 45 years, range 17 - 69) with tense refractory ascites associated with liver cirrhosis, perioprtal fibrosis and end stage renal diseases underwent sapheno-peritoneal anastomosis by mobilizing and rotating the proximal vein in order to be anastomosed to peritoneum in the lower abdomen . All procedures were performed under local anaesthesia. Thirty-day mortality was 22% (2) patient. Morbidity included fluid leakage in 1 (11%), and wound infection in 1 (11%). Hospital stay (median) was 16 days (range 11 to 23). In the short term (median of 2 months) significant reduction in body weight and abdominal girth was seen in 9 (90%), 6 (60%) were not on diuretics while 3 (30%) continued to remain on reduced doses of diuretic. Furthermore, 7 (70%) did not require paracentesis. At 2-year follow-up, 5 (45%) patients died and 3 succumbed during follow-up. The remaining 3 were all in active employment, 1 was off diuretics, and 2 were on reduced doses. All 3 patients maintained reduced body weights and abdominal girths compared with preoperative values. Saphenous-peritoneal shunt appears a simple, safe, and cost effective method of achieving long-term control of refractory ascites. The use of autogenous shunt is an added advantage over prosthetic shunts for drainage of ascitic fluid.

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Atrial Myxoma Presenting As a Cerebellar Stroke

Azhar AH1 ; Ziyadi G2 ; Zulkarnain H2 ; Rahman MNG1

Journal of Surgical Academia.2011;1(2):36-40.

Primary tumors of the heart are rare. However, among them cardiac myxoma is the most common tumor accounting for half of the primary cardiac neoplasms. About 75% of cardiac myxomas are located in the left atrium, and 25% are located in the right atrium. These are thought to be arising from remnants of subendocardial vasoformative reserve cells or multipotential primitive mesenchymal cells in the fossa ovalis and surrounding endocardium, which can differentiate along a variety of cell lineages including epithelial, hematopoietic, and muscle cells. Although some cases are discovered incidentally by echocardiographic examination, it was recognized in most of the patients by various symptoms caused by the release of inflammatory cytokines such as interleukin-6 (IL-6), obstruction of intracardiac blood flow, or embolization. Cardiac myxoma has many undetermined interesting issues regarding its origin, nature as a tumor, varying clinical manifestations, and the presence of both sporadic and familial types. Recent evidence revealed that cardiac myxomas are benign neoplasms and slowly proliferating lesions. The existence of its malignant counterpart is controversial. However, recurrence after surgical excision or metastasis has been reported. We hereby present a case report of a young gentleman who presented with history of sudden onset of weakness and cerebellar signs. Urgent CT scan revealed hypodensities of bilateral occipital lobes and cerebellum suggestive of infarcts. Urgent echocardiography denoted large left atrial myxoma. The tumor was excised and the patient recovered well.

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Characteristics of Native Arteriovenous Shunt

Muqodriyanto ; Suhartono R

Journal of Surgical Academia.2012;2(2):1-1.

This study is quite representative. Most patients older men in accordance with previous studies. The left side is dominant according to the literature. The elbow side is dominant, after hemodialysis performed and double lumen catheter improvement requires further research.

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Sand Bezoar: A Very Rare Cause of Intussusception

Azhar AH 1 ; Tarmizi MNM4 ; A. Rashidi2 ; H. Mastura3 ; MNG Rahman1

Journal of Surgical Academia.2011;1(2):49-52.

Intussusception is the most common cause of intestinal obstruction in the first two years of life. The cause is not apparent in most of the cases. Associated conditions that can result in intussusception include polyps, Meckel‟s diverticulum, Henoch-Schonlein purpura, lymphoma, lipoma, parasites, foreign bodies and viral enteritis with hypertrophy of Payer‟s patches. We hereby describe a rare case of sand bezoar induced intussusception in a 9-year-old school girl with pica (geophagia). A description of her presentation and management, along with a review of literature is being presented.

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