Jejunal gastrointestinal stromal tumour masquerading as an ovarian cancer: A case report

A 60-year-old lady presented with lower abdominal discomfort and a huge palpable intra-abdominal mass for 4 months, with significant weight loss over half a year. Transvaginal ultrasonography and computed tomography (CT) abdomen showed a large right solid cystic mass likely ovarian in origin. The CA-125 was raised. With the provisional diagnosis of ovarian cancer patient underwent laparotomy at Hospital Umum Sarawak, Malaysia. However intraoperative findings showed that uterus and both ovaries were normal. The tumour was arising from the jejunum and adherent to the dome of the urinary bladder and right broad ligament. The tumour was resected and final diagnosis was jejunal gastrointestinal stromal tumour (GIST). We described this case which was misinterpreted as an ovarian cancer

Right ureteric reconstruction with vascularised interpositional appendix graft in retroperitoneal leiomysarcoma

We present here a case of a 66-year-old lady who was diagnosed with right iliac fossa retroperitoneal leiomyosarcoma at Hospital Umum Sarawak. The challenge in this case was the extension of tumour with the involvement of her right ureter causing proximal hydroureter and hydronephrosis. After resection of tumour en-block with the involved segment of ureter, it was not possible to repair the ureteric defect directly. We used interpositional vascularized appendix graft to repair this large (7 cm) ureteric defect. We describe here this uncommon technique of ureter reconstruction

Revealing Covid 19 Effects on Malaysian Domestic Tourism Acceptance Towards Destination Competitiveness

Tourism destination competitiveness has been demonstrated as one of the significant components to improve the country's travel industry goal. This paper study the relationship of domestic tourism acceptance towards tourism destination competitiveness. The data was drawn from a sample of 227 respondents, and a simple random sampling method was used. The data were analyzed using the Statistical Package for Social Science (SPSS). The questionnaires are distributed by online survey and face to face method. Results showed that natural resources, cultural heritage, and special events had significant relationships between domestic tourism acceptance and tourism destination competitiveness in Malaysia. As an emerging tourist attraction, several measures should be considered to improve destination competitiveness while maintaining the future development of Malaysia as a tourism destination

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The Peridynamic Model of Viscoelastic Creep and Recovery

Purpose – The purpose of this paper is to establish a peridynamic method in predicting viscoelastic creep behaviour with recovery stage and to find the suitable numerical parameters of peridynamic method. Design/methodology/approach – A rheological viscoelastic creep constitutive equation including recovery and an elastic peridynamic equation (with integral basis) are examined and used. The elasticity equation within the peridynamic equation is replaced by the viscoelastic equation. A new peridynamic method with two time parameters, i.e. numerical time and viscoelastic real time is designed. The two parameters of peridynamic method, horizon radius and number of nodes per unit volume are studied to get their optimal values. In validating this peridynamic method, comparisons are made between numerical and analytical result and between numerical and experimental data. Findings – The new peridynamic method for viscoelastic creep behaviour is approved by the good matching in numerical-analytical data comparison with difference of < 0.1 per cent and in numerical-experimental data comparison with difference of 4-6 per cent. It can be used for further creep test which may include non-linear viscoelastic behaviour and creep rupture. From this paper, the variation of constants in Burger’s viscoelastic model is also studied and groups of constants values that can simulate solid, fluid and solid-fluid viscoelastic behaviours were obtained. In addition, the numerical peridynamic parameters were also manipulated and examined to achieve the optimal values of the parameters. Research limitations/implications – The peridynamic model of viscoelastic creep behaviour preferably should have only one time parameter. This can only be done by solving the unstable fluctuation of dynamic results, which is not discussed in this paper. Another limitation is the tertiary region and creep rupture are not included in this paper. Practical implications – The viscoelastic peridynamic model in this paper can serve as an alternative for conventional numerical simulations in viscoelastic area. This model also is the initial step of developing peridynamic model of viscoelastic creep rupture properties (crack initiation, crack propagation, crack branching, etc.), where this future model has high potential in predicting failure behaviours of any components, tools or structures, and hence increase safety and reduce loss. Originality/value – The application of viscoelastic creep constitutive model on peridynamic formulation, effect of peridynamic parameters manipulation on numerical result, and optimization of constants of viscoelastic model in simulating three types of viscoelastic creep behaviours

Single-incision laparoscopic cholecystectomy: The first Malaysian experience

SummaryIntroductionSingle-incision laparoscopic cholecystectomy (SILC) is an evolving concept in minimally invasive surgery. It utilizes the concept of inline viewing and a single incision that accommodates all of the working instruments. Here, we describe a single surgeon's initial experiences of using this technique in a tertiary hospital.MethodsBetween January and September 2010, 21 patients underwent SILC for symptomatic cholelithiasis. The umbilicus was the point of access into abdomen for all patients using a 2.0–2.5-cm incision. The surgeries were performed using the Covidien SILS port with a 30° angled scope and two 5-mm conventional laparoscopic instruments.ResultsNineteen patients successfully underwent surgery (8 males and 11 females; mean age: 43 years). The mean body mass index was 25.9kg/m2 (range: 19.0–38.2kg/m2). The mean operative time was 89 minutes (range: 55–135 minutes). Minimal blood loss was noted in each patient. The mean length of the postoperative stay was 1.1 days (range: 1–3 days). No complications or mortalities were associated with the technique. The visual analogue score for pain at the 1-day and 6-week follow-up examinations was 2 (range: 1–7) and 0.6 (range: 0–3), respectively. At 6 weeks, the mean satisfaction score for the resultant scar was 8.8 (range: 4–10) and the mean overall satisfaction score was 9.2 (range: 7–10). The mean time until returning to work or normal activities was 8.8 days (range: 1–21 days).ConclusionSILC is feasible and demonstrates a good clinical outcome

Intestinal knotting : A case report and brief literature review

Ileo-ileal knotting is a rare cause of intestinal obstruction. In this condition, one bowel loop makes a knot with an adjacent bowel loop, resulting in mechanical obstruction and even gangrene of the bowel. We present a case of a young girl with ileo-ileal knotting resulting in a closed-loop obstruction and gangrene of the small bowel loop. This is a difficult condition to diagnose; a high index of suspicion and early surgical intervention are essential to reduce morbidity and mortality