Purpose: Palliative resection and palliative stenting are established options for managing obstruction in patients with metastatic left-sided colonic cancer. This retrospective study investigated the long-term outcomes and survival associated with each treatment modality. Methods: Patients with left-sided colon cancer complicated by intestinal obstruction and unresectable metastatic lesions were included. Propensity score matching was conducted to balance demographic characteristics. The primary outcome was long-term survival. Secondary outcomes included short-term morbidity, length of hospital stay, clinical success rate, stoma formation rate, and number of readmissions due to tumor-related complications. Results: Initially, 131 patients who underwent palliative resection or stenting between 2015 and 2022 were included. After propensity score matching, 98 patients remained (49 in each group). Survival was significantly better among patients receiving palliative resection compared to stenting (median, 19.6 months vs. 9.6 months; P=0.003). However, subgroup analysis for patients older than 70 years demonstrated no statistically significant survival benefit (median, 11.5 months vs. 10.2 months; P=0.240). The resection group experienced significantly higher rates of stoma formation and longer postoperative hospital stays. Readmission rates were similar. Cox regression analysis identified low carcinoembryonic antigen levels, tumor resection, chemotherapy, and targeted therapy as independent predictors of longer survival. Conclusion For metastatic colon cancer patients presenting with intestinal obstruction, palliative resection may offer a survival advantage. However, this benefit diminishes in patients over 70 years of age. Additionally, resection is associated with a higher rate of stoma formation. Therefore, individualized treatment decisions are warranted when choosing between palliative resection and palliative stenting in metastatic colonic cancer patients.

Introduction: This was a retrospective study aimed to investigate the perioperative outcomes of long construct minimally invasive spinal stabilisation (MISt) using percutaneous pedicle screws (PPS) versus conventional open spinal surgery in the treatment of spinal fracture in ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). Material and Methods: Twenty-one patients with AS and DISH who were surgically treated between 2009 and 2017 were recruited. Outcomes of interest included operative time, intra-operative blood loss, complications, duration of hospital stay and fracture union rate. Results: Mean age was 69.2 ± 9.9 years. Seven patients had AS and 14 patients had DISH. 17 patients sustained AO type B3 fracture and 4 patients had type B1 fracture. Spinal trauma among these patients mostly involved thoracic spine (61.9%), followed by lumbar (28.6%) and cervical spine (9.5%). MISt using PPS was performed in 14 patients (66.7%) whereas open surgery in 7 patients (33.3%). Mean number of instrumentation level was 7.9 ± 1.6. Mean operative time in MISt and open group was 179.3 ± 42.3 minutes and 253.6 ± 98.7 minutes, respectively (p=0.028). Mean intra-operative blood loss in MISt and open group was 185.7 ± 86.4ml and 885.7 ± 338.8ml, respectively (p<0.001). Complications and union rate were comparable between both groups. Conclusion: MISt using PPS lowers the operative time and reduces intra-operative blood loss in vertebral fractures in ankylosed disorders. However, it does not reduce the perioperative complication rate due to the premorbid status of the patients. There was no significant difference in the union rate between MISt and open surgery.

Objective: Employment is important for patients with chronic illness, and to remain employed is a robust support to them. This study aimed to examine the employment rate and to identify factors associated with employment among multiple sclerosis (MS) in Hong Kong. Methods: A cross-sectional study was performed from 2010 to 2011 at five major public hospitals. Fifty-nine clinical definite MS patients with no evidence of dementia (Mini-Mental State Examination ≥ 22) were recruited. Demographic data and neuropsychological test results including memory, visual perception, psychological well-being, motor, executive domain and processing speed were collected. Principal component analysis and logistic regression with multiple imputation were used in data analyses. Results: The employment rate among MS patients was 56%. Patients with better cognitive functions were more likely to be employed (p=0.002). No significant association was found between employment status and age, gender, level of education, types of MS, disease duration, frequency of relapse or use of interferon. Conclusion: MS patients had high unemployment rate (44%) which was 11.5 times higher than the general population in Hong Kong. MS patients with better cognitive functions had higher employment rates.
Multiple Sclerosis

Chondrosarcoma is the third most common primary tumour of the bone, after myeloma and osteosarcoma. Most of the chondrosarcoma grow slowly and rarely metastasize, and they have an excellent prognosis after adequate surgery. However most of them are chemo or radio-resistant. We report a case of primary chondrosarcoma of proximal humerus in a 36-year-old female who presented with a six years history of left shoulder swelling and restricted range of motion. Trucut biopsy showed a well-differentiated chondrosarcoma. The patient underwent forequarter amputation of left upper limb and was started on chemotherapy following operation.
Chondrosarcoma

The aim of this review was to analyze the gender disparities found as well as the life expectancies in Asia. An analysis of the data on gender disparities as well as life expectancies of the different Asian countries was done based on the World Health Organization (WHO) Global Health Observatory Data Repository as well as the regional government databases. Middle Eastern countries have the highest male to female population ratio. The results show that in terms of population pyramid, Asia is moving towards a more geriatric population. Qatar has the highest life expectancy for men and is the only country in Asia where men live longer than women (difference of 2 years). In general, women in Asia live longer than men. High income countries like Hong Kong, Japan and Singapore have higher life expectancies as compared to those on the lower income nations. The life expectancy of Asian men still lags women. Men’s health care needs to be addressed urgently. The disparity in income-status reflecting the lifespan of men is an impetus for us to narrow the gap of health in Asian countries.

This study aims to determine the prevalence of lower urinary tract symptoms (LUTS) and level of awareness among male outpatients in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A questionnaire consisting of demographic data, questions related to knowledge, attitude and practice on BPH and the International Prostate Symptom Score (IPSS) was used for this study. Uroflowmetry and bladder scan were used to evaluate the function of the urinary tract and severity of BPH. Urine dipstick was done for glycosuria, proteinuria and haematuria. A total of 220 respondents were surveyed. The prevalence of moderately and severely symptomatic LUTS was 42.7%. The most commonly reported LUTS were nocturia (78.2%), frequency (58.2%) and incomplete emptying (44.6%). The prevalence of glycosuria, proteinuria and haematuria were 23.6%, 11.4% and 1.8% respectively. There was a significant association between increasing age with the severity of LUTS (p=0.005). Out of 102 respondents with voided urine volume greater than 150 mL, there was a significant decrease in maximum (Qmax) (p=0.039) and average (Qave) urine flow rates with every 10 years increase of age (p=0.001). The majority of respondents (59.5%) have heard of BPH before. Over 78.2% of the respondents would seek medical attention if they have LUTS with 15.9% saying they would seek traditional treatment. In conclusion, the prevalence of LUTS was high and the level of awareness was satisfactory.

A 20 year old female student was involved in a motor vehicle accident. She sustained a severe friction injury to the left knee that resulted in considerable soft tissue and bone loss. There was also damage to the knee extensor mechanism, tibialis anterior muscle, femoral trochlea, the anterior half of the tibial plateau extending distally to the proximal tibia and skin. However, there was no crushing of the limb or resultant neurovascular deficit but cancellous bone and the remainder of the joint were exp
Orthopaedic