Endoscopic transsphenoidal resection of craniopharyngioma

Objectives: To demonstrate, step-by-step, the technique and efficacy of endoscopic transsphenoidal approach in resection of a suprasellar craniopharyngioma. Design The video shows a step-by-step approach to the resection, covering the exposure, access, resection, and confirmation of resection and reconstruction. Setting: The surgery was performed in the University of Malaya Medical Centre, a tertiary referral center in the capital of Malaysia. Participants Surgery was performed jointly by Professor Prepageran from the department of otorhinolaryngology and Professor Vicknes Waran from the division of neurosurgery. Both surgeons are from the University of Malaya. Video compilation, editing, and voice narration was done by Dr. Kong Yew Liew. Main Outcome Measures: Completeness of resection and avoidance of intra- and postoperative complications. Results: Based on intraoperative views and MRI findings, the tumor was completely resected with the patient suffering only transient diabetes insipidus. Conclusion: Central suprasellar tumors can be removed completely via an endoscopic transsphenoidal approach with minimal morbidity to the patient

Migrated guidewire: an unusual cause for recurrent aural polyps

Aural polyps are secondary to multiple ear pathologies, most commonly inflammatory or cholesteatoma related. Here, we present a rare case of recurrent aural polyps caused by guidewire migration into the middle ear with serious systemic complications and our attempts at removal

Dual tongue: the unexpected origin

Laryngeal lipoma is a very rare benign laryngeal tumour. Although it has an indolent growth, laryngeal lipoma can lead to compression and obstruction at upper aero digestive tract which leads to dysphagia, dyspnoea and hoarseness. Case Report: A 26-year-old man who came with presenting complaint that he developed a second tongue recently. His voice has turned muffled. Examination showed an accessory tongue appeared to arise from supraglottic region from nasoendoscopy. A transoral endoscopic excision of the lipoma was done. He has a complete resolution of symptom immediately following surgery with no recurrence on follow up. Conclusion: A complete excision of laryngeal lipoma is important as its location may cause mechanical narrowing of upper aerodigestive tract, giving symptoms of airway obstruction and difficulty swallowing. We highlighted the structures that may involve in laryngeal lipoma and its type

Primary localized amyloidosis in nasopharynx: a case report

Nasopharyngeal amyloidosis is an extremely rare benign tumour. It is divided into localized or systemic amyloidosis. It is more common in men. Clinical presentation includes nasal blockage, epistaxis and reduced hearing. Classical positive Congo red stain and appearance of apple green birefringence on polarized microscopy confirms the diagnosis of amyloidosis. We present a case of nasopharyngeal amyloidosis in a 44-year old lady who presented with acute hearing loss for 1 week with epistaxis mimicking nasopharyngeal carcinoma. Clinical examination showed a nasopharyngeal mass with biopsy proven AA amyloidosis. She is now cured of amyloidosis following endoscopic transnasal excision of tumour. We discuss on the similarity of presentation between nasopharyngeal carcinoma; the commonest malignant tumour in our region and the much rarer nasopharyngeal amyloidosis as well as highlighting the importance in early recognition of the latter in view of its known risk of systemic involvement

Neutrophil–lymphocyte ratios in the prognostication of primary non-metastatic nasopharyngeal carcinoma

Introduction: Nasopharyngeal carcinoma is a geographically and racially variable disease which has a high incidence in Malaysia. Based on current concepts in tumour related inflammation the inflammatory marker, neutrophil–lymphocyte ratio was tested to find its relationship with prognosis in nasopharyngeal carcinoma. Objective: To investigate the effect of the neutrophil–lymphocyte ratio on prognosis in non-metastatic primary nasopharyngeal carcinoma patients and to further refine the cut off between high and low neutrophil–lymphocyte ratio values. Methods: The medical charts of patients with histologically confirmed nasopharyngeal carcinoma from 1st January 2005 until 31st December 2009 were reviewed retrospectively and theneutrophil–lymphocyte ratio was calculated to see if there was any association between their higher values with higher failure rates. Results: Records of 98 patients (n = 98) were retrieved and reviewed. Only neutrophil–lymphocyte ratio (p = 0.004) and tumor node metastasis staging (p = 0.002) were significantly different between recurrent and non-recurrent groups, with the neutrophil–lymphocyte ratio being independent of tumor node metastasis staging (p = 0.007). Treatment failure was significantly higher in the high neutrophil–lymphocyte ratio group (p = 0.001). Disease free survival was also significantly higher in this group (p = 0.000077). Conclusion: High neutrophil–lymphocyte ratio values are associated with higher rates of recurrence and worse disease free survival in non-metastatic nasopharyngeal carcinoma patients undergoing primary curative treatment. Resumo: Introdução: O carcinoma de nasofaringe é uma doença variável geográfica e etnicamente, com alta incidência na Malásia. Baseado em conceitos atuais sobre inflamação relacionada a tumores, o marcador inflamatório relação neutrófilos/linfócitos foi testado para verificar sua relação com o prognóstico dessa condição clínica. Objetivo: Investigar o efeito do marcador neutrófilos/linfócitos no prognóstico de pacientes com primários não metastáticos de nasofaringe e refinar o ponto de corte entre valores altos e baixos da relação neutrófilos/linfócitos. Método: Os prontuários médicos dos pacientes com carcinoma de nasofaringe confirmado histologicamente de 1° de janeiro de 2005 até 31 de dezembro de 2009 foram revisados retrospectivamente e a relação neutrófilos/linfócitos foi calculada para verificar se havia alguma associação entre valores maiores e aumento na taxa de falha de tratamento. Resultados: Os dados de 98 pacientes (n = 98) foram revisados. Apenas a relação neutrófilos/linfócitos (p = 0,004) e o estadiamento TNM (p = 0,002) foram significantemente diferentes entre os grupos recorrentes e os não recorrentes, a relação neutrófilos/linfócitos foi independente do estadiamento TNM (p = 0,007). A falha de tratamento foi significantemente maior no grupo com relação neutrófilos/linfócitos alta (p = 0,001). A sobrevida livre de doença também foi significantemente maior nesse grupo (p = 0,000077). Conclusão: Os altos valores da relação neutrófilos/linfócitos estão associados a maiores taxas de recorrência e menor tempo de sobrevida livre de doença em pacientes com carcinomas não metastáticos de nasofaringe submetidos a tratamento curativo primário. Keywords: Nasopharyngeal carcinoma, Prognosis, Survival, Neutrophil–lymphocyte ratio, Biomarker, Palavras-chave: Carcinoma de nasofaringe, Prognóstico, Sobrevida, Relação linfócitos/neutrófilos, Biomarcado

Primary sinonasal mucosal melanoma – a diagnostic and histological conundrum

Primary sinonasal mucosal melanomas (PSMM), a rare subtype of melanomas offers significant diagnostic challenge clinically and histologically especially when amelanotic, as they can show many histologic mimics that require immunohistochemical and molecular studies to confirm the diagnosis. We report the case of a 50-year-old male presented with persistent left nasal blockage and epistaxis secondary to a fleshy and friable lobulated mass occupying the left nasal cavity and nasopharynx. The tumour was excised endoscopically and histology confirmed a malignant tumour consisting of small round blue cells with hyperchromatic nuclei, in solid sheets with areas of angiocentric pattern (H & E staining). The cells were positive for S100 protein and focally positive for HMB-45 and Melan A and a diagnosis of PSMM was made. However, he defaulted the subsequent radiotherapy and presented back a few months later with tumour recurrence locally and nodes metastasis. Despite undergoing radiotherapy, he died after two cycles due to an episode of acute coronary syndrome

Dengue in Malaysia: Factors Associated with Dengue Mortality from a National Registry.

BACKGROUND:The increasing incidence and geographical distribution of dengue has had significant impact on global healthcare services and resources. This study aimed to determine the factors associated with dengue-related mortality in a cohort of Malaysian patients. METHODS:This was a retrospective cohort study of patients in the Malaysian National Dengue Registry of 2013. The outcome measure was dengue-related mortality. Associations between sociodemographic and clinical variables with the outcome were analysed using multivariate analysis. RESULTS:There were 43 347 cases of which 13081 were serologically confirmed. The mean age was 30.0 years (SD 15.7); 60.2% were male. The incidence of dengue increased towards the later part of the calendar year. There were 92 probable dengue mortalities, of which 41 were serologically confirmed. Multivariate analysis in those with positive serology showed that increasing age (OR 1.03; CI:1.01-1.05), persistent vomiting (OR 13.34; CI: 1.92-92.95), bleeding (OR 5.84; CI 2.17-15.70) and severe plasma leakage (OR 66.68; CI: 9.13-487.23) were associated with mortality. Factors associated with probable dengue mortality were increasing age (OR 1.04; CI:1.03-1.06), female gender (OR 1.53; CI:1.01-2.33), nausea and/or vomiting (OR 1.80; CI:1.17-2.77), bleeding (OR 3.01; CI:1.29-7.04), lethargy and/or restlessness (OR 5.97; CI:2.26-15.78), severe plasma leakage (OR 14.72; CI:1.54-140.70), and shock (OR 1805.37; CI:125.44-25982.98), in the overall study population. CONCLUSIONS:Older persons and those with persistent vomiting, bleeding or severe plasma leakage, which were associated with mortality, at notification should be monitored closely and referred early if indicated. Doctors and primary care practitioners need to detect patients with dengue early before they develop these severe signs and symptoms

Clinical manifestations at notification (n = 43347).

<p>Clinical manifestations at notification (n = 43347).</p

Univariate and multivariate analysis (n = 37021) of probable dengue-related mortality in Adults (≥15 years old).

<p>Univariate and multivariate analysis (n = 37021) of probable dengue-related mortality in Adults (≥15 years old).</p

Univariate and multivariate analysis (n = 43343) of probable dengue-related mortality.

<p>Univariate and multivariate analysis (n = 43343) of probable dengue-related mortality.</p