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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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Factors Associated with the Recurrence of Complicated Diverticular Disease

Azlanudin Azman ; Ismail Sagap

Journal of Surgical Academia.2011;1(1):6-14.

Colonic diverticula is observed in over 60% of the western population aged over 80 where up to 30% will eventually be symptomatic and may develop complications. The natural history and etiology of colonic diverticula have been well described. However, predictive indicators of complicated diverticular disease are not known thus preventing the prophylactic treatment of this subset of patients,. The aim of this study was to observe patients with complicated diverticular disease in order to identify common factors associated with recurrent complications. All hospital admissions from January 2005 to December 2008 for complications of diverticular disease were recruited. Using logistic regression, demographic data and factors such as clinical presentation, nature of complication, lifestyle, concomitant medical illness and medications that may be associated with recurrent episodes of complications were analyzed. A total of 121 patients were diagnosed with complicated diverticular disease during the study period with 24 patients having recurrent complications. Logistic regression analysis performed after controlling for confounders found active smoking (p=0.006) and alcohol consumption (p=0.036) along with underlying diabetes (p=0.031) and dyslipidemia (p=0.039) significantly associated with an increased risk of recurrent complications. We therefore concluded that smoking, alcohol consumption, diabetes mellitus and dyslipidemia are associated with recurrent complicated colonic diverticular disease. As these are modifiable risk factors, they should be sought for during the presentation of the first attack. Aggressive control of these factors will help in reducing the risk of recurrent complications.

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The relationship between Alvarado Score and Pain Score in Managing Adult Acute Appendicitis in the Emergency Department

Ahmad KI1 ; Shamsul AS2 ; Ismail MS

Journal of Surgical Academia.2011;1(1):15-24.

Acute appendicitis is one of the most common differential diagnoses for acute abdominal pain made by emergency doctors. Suspected cases require surgical referral for observation or definitive intervention to prevent complications. A high index of suspicion and good clinical skills with the aid of scoring systems allows early decision making, which includes optimal pain control. The objective of this study was to identify the pain score and is relationship to the cut-off points of the Alvarado scoring system so that justifies early surgical referral or discharge for suspected acute appendicitis from the Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a cross sectional study of acute abdominal pain from June 2007 to September 2008. All patients who fulfilled the criteria and consented to the study were assessed for Alvarado score, verbal numerical pain score (VNRS) and their subsequent management. Patients with an Alvarado score of ≥7 were likely to have acute appendicitis (80.1% sensitivity and 52.63% specificity) and those with the score of ≤3 were unlikely to have acute appendicitis. The median pain score was 7.00 (IQR: 5.00-8.50) but 72.5% did not receive any analgesia. There was no direct relationship between the pain score with Alvarado score. Oligoanalgesia in patients with acute appendicitis still exist in Emergency Department of UKMMC.

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Nephrectomy for a Case of Intrarenal Dermoid Cyst: Was it an Appropriate Decision?

Goh EH1 ; Christopher CKH1 ; Praveen S1 ; Tan GH1 ; Rozman Z2 ; Zulkifli MZ1 ; Badrulhisham B

Journal of Surgical Academia.2011;1(1):25-27.

Dermoid cyst in a kidney is rarely seen. We report a case of intrarenal dermoid cyst which mimics malignant renal tumour and discuss the dilemma in managing this disease.

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CT-Guidance Combined with Fluoroscopy for Tunnelled Translumbar Catheterization of Inferior Vena Cava: A Technical Case Report

Nik Rizal NY1 ; Shahrina MH1 ; Abdullah M2 ; Rozman Z2 ; Sobri M2

Journal of Surgical Academia.2011;1(1):65-67.

Patients with end-stage renal disease typically require catheter hemodialysis during the time required for fistula or graft maturation or after other methods of hemodialysis are exhausted. When patients requiring indwelling catheters develop central venous occlusions, unconventional routes to the central veins are used. Translumbar catheterization of inferior vena cava is considered as one of the options for central venous access. We highlight a case of Translumbar central venous tunelled catheterization performed under Computed Tomography (CT) guidance combined with fluroscopy in a 40-year-old lady with end-stage renal failure.

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Extra-gonadal Germ Cell Tumour – What About the Testis!

Johann FK ; Praveen S ; Christopher CKH ; Goh EH ; Razman J ; Zulkifli MZ.

Journal of Surgical Academia.2011;1(1):28-31.

Extra-gonadal germ cell tumours (EGGCT) are rare. Therefore further investigations of the testis is aimed at sourcing a possible primary origin of gonadal tumour. Over the years, various case series on EGGCT have been reported questioning its true nature as in a majority of them, a primary source is found in the testis, thus representing a metastatic gonadal tumour. The testis pathology could be either a true germ cell foci, an intra-tubular epithelial neoplasia or an area of fibrosis, indicating a ‘burnt out tumour’. We report a 39-year-old male who underwent laparotomy and excision of a retroperitoneal tumour. Histopathological examination revealed retroperitoneal lymph node of mixed germ cell tumour origin. Clinical and ultrasound examination of bilateral testis was normal. The patient refused orchidectomy or a testicular biopsy. He underwent four cycles of bleomycin, cisplatin, and etoposide with no evidence of tumour recurrence on follow up and remains disease free after 12 months of diagnosis. A literature review of EGGCT, its relation and factors relating with future testicular tumour is presented.

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