Post operative morbidity and 3 years survival rate in diabetic and non diabetic patients undergoing coronary artery bypass grafting in Hospital Universiti Sains Malaysia

Diabetes mellitus is a risk factor for development of coronary artery disease and also being linked to worse outcomes after coronary artery bypass grafting (CABG). The purpose of the study is to evaluate the post operative morbidity and survival rate at 3 years following CABG in patients with diabetes mellitus compared to non diabetics. This study was done on 205 patients who underwent elective isolated CABG in Cardiothoracic Uni4 Hospital Universiti Sains Malaysi~ Kubang Kerian from January 2002 to December 2005. Our study group were divided into diabetes and non diabetes. 90 patients (43.9%) were diabetics and 115 (56.1%) were non diabetics. There were 169 (82.4%) male patients and 36 (17.6%) female patients. Patients' age ranged from 39 to 77 years old. The data showed that diabetic patients had poorer ejection fraction (59% vs 62%, p= 0.03) and preoperative renal failure (25.6% vs 16.6%, p=0.02). There were no significant difference in term of other comorbidities between diabetes and non diabetes group , which were hypertension, chronic obstructive airway disease (COAD), smoking status, cerebrovascular accident (CV A), and hyperlipidaemia (HPL). Intraoperative findings showed no significant findings between both groups which include cardiopulmonary bypass (CPB) time, amount of cardioplegia, aortic cross clamped time and number of bypass performed. Post operative outcome revealed that diabetic patients had higher risk of developing harvested site infection (61.1% vs 23.5%, p<O.OOI) and post operative renal failure (27.7% vs 7.8%, p<O.OO I). However, no significant differences were noted in other post operative complications, which were sternal wound infection, pneumonia, post operative bleeding, arrythmias and CV A. During follow up until 3 years post operatively, we found that diabetic patients were more frequently being readmitted due to cardiac causes (42.2% vs 27.8%, p=0.03). No differences in term of reoperation rate and recurrent angina post CABO. OveraJI mortality until 3 years post CABO was 15 patients where 10 patients died within 30 days. We reported that no significant outcome between both groups in term of 30 days mortality and 3 years survival rate. As conclusion, this study supported the evidence that diabetes mellitus were the significant prognostic factors for some post CABO complications especiaJiy harvested site infection and post operative renal failure. However, it is difficult to really determine either the disease contribute to post operative death or not in view of smaJJ overall number of mortality

Anterior abdominal wall abscess as a complication of appendicular mass in elderly

Appendicitis in the elderly continues to be a challenging surgical problem. Patients usually present late with atypical presentations. The diagnosis of appendicitis is often difficult to establish and there are increased rate of perforation and mortality. Abscess formation with extension to anterior abdominal wall as reported in this case is rather rare. Older patients also tend to undergo more complicated operative procedures and higher rate of postoperative morbidity and mortality. We reported a case of atypical presentation of appendicitis as anterior abdominal abscess and postoperative challenges in geriatric surgery

Delayed presentation of traumatic diaphragmatic hernia: a case report

Traumatic diaphragmatic hernias are an unusual presentation of trauma. The diagnosis is often missed because of non-specific clinical signs, and the absence of additional intra-abdominal and thoracic injuries. Thus, a delay in diagnosis may occur which, in the presence of obstruction and/or strangulation, is associated with a high mortality and morbidity

The unusual presentation of ceacal cancer with synchronous tumor at descending colon: a case report

Synchronous primary colorectal cancer is rare and only occurs in 2% to 11% of all colorectal cancers. Thus, preoperative or intraoperative detection of synchronous tumor is vital because if they are not recognized, they may present at an advanced stage, thereby reduce the probability of cure. Early identification of synchronous tumor may alter the extensiveness of the surgical procedure in order to decide for strategic therapeutic management

A rare case of hepatic flexure Gastroenteropancreatic neuroendocrine carcinoma (GEP-NEC)

A Colorectal neuroendocrine carcinoma (CRNEC) is a rare malignancy of the colon. It is a tumour with a heterogeneous presentation, further complicated by its disunified nomenclature, which imposed a challenge in detection and management. We present a rare case of hepatic flexure neuroendocrine carcinoma in a 47-year-old lady who complained of 5 months history of progressively worsening, intermittent colicky central abdominal pain, altered bowel habit, vomiting, and significant weight loss. She presented with lethargy, distended abdomen and fullness at its centre. The abdominal x-ray showed generalised bowel dilatation, with the subsequent CT scan abdomen showing obstructed hepatic flexure tumour. She underwent emergency exploratory laparotomy and right hemicolectomy with a double-barrel stoma. Intraoperatively, a hepatic flexure tumour, an engorged and nodular appendix with multiple mesenteric lymph nodes. Her recovery was unremarkable. Histopathology examination showed neuroendocrine tumour Grade 3 arising from hepatic flexure with no appendiceal involvement

Frantz’ tumour: a rare pancreatic neoplasm

Frantz’ tumour of the pancreas is also known as solid pseudopapillary tumour (SPT) of the pancreas. It is a rare pancreatic neoplasm and represents about 3% of all the pancreatic cystic neoplasm. It occurs predominantly in young woman in 2nd to 3rd decade of life. These tumours exhibit indolent behaviour and very often reach considerable size before the first symptoms appear. Despite this presentation these tumours have low malignant potential and complete surgical resection render excellent prognosis. We reported a case of a 16-year-old girl who presented with upper abdominal mass with symptoms of gastric outlet obstruction for 7 months duration. Clinical examination revealed a huge epigastric mass measuring 10 x 12 cm in size. CT scan showed presence of mass arising from the body of the pancreas which was hypervascular, well-encapsulated with mixed cystic and solid components. She then underwent successful distal pancreatectomy and splenectomy and recovered uneventfully

Back pain as first presentation of Hepatocellular Carcinoma

Hepatocellular Carcinoma (HCC) is known to be one of the leading causes of deaths globally. In Malaysia HCC is known to be the eight most common cancer in both genders and the fifth most common cancer for males. The etiological factors associated with HCC are chronic Hepatitis B or C viral infection, liver cirrhosis and nonalcoholic fatty liver disease. Patients with HCC usually present with right upper quadrant pain, jaundice, loss of weight, and a palpable mass over the right hypochondrium. This case report will describe and discuss about the diagnosis of HCC in a patient with an atypical presentation of back pain which was confirmed with supportive findings of CT scan and MRI liver.peer-reviewe

Spontaneous esophageal cancer perforation managed with Fully Covered Self Expandable Metallic Stent (FCSEMS)

Esophageal cancer is one of the 7 most common cancers in the world. It usually presents with dysphagia, persistent vomiting, weight loss, loss of appetite and anorexia. However, 1% of esophageal cancer might perforate causing severe abdominal pain. We present the case of a 30-year- old man with sudden onset of epigastric pain for one day duration. He had a history of progressive dysphagia, vomiting, weight loss and loss of appetite for the past three months. CT thorax and abdomen revealed a circumferential mass at the lower esophagus with the presence of pneumomediastinum and pneumoperitoneum suggestive of esophageal perforation. The patient was successfully treated endoscopically by using a Fully Covered Self-Expandable Metallic Stent (FCSEMS) to maintain lumen patency and cover the area of the perforation.peer-reviewe

Small bowel perforation secondary to intestinal tuberculosis in patient with chronic idiopathic myelofibrosis

Idiopathic myelofibrosis is a clonal hematopoetic stem cell disorder due to a mutation in the signaling regulator gene Janus Kinase 2 (JAK2).The condition is widely treated with Ruxolitinib which is a JAK2 inhibitor along with prednisolone. However, these treatment despite promising has been linked with the risk of opportunistic infections and reactivation of tuberculosis.We reported a patient with chronic idiopathic myelofibrosis who developed small bowel perforations secondary to flare up of gut tuberculosis. The perforation sites were resected and double barrel stoma was created.peer-reviewe