Recurrent occipital dermatofibrosarcoma protuberans tackled with wide local excision : A case report and current management

Dermatofibrosarcoma protuberans (DFSP) is a slow-growing, locally invasive tumour of the dermis. It commonly presents in the trunks and proximal extremities but is seen to a lesser extent in the head and neck regions. We present a case report of a recurrent DFSP in a 48-year-old Iban woman at the occipital region. The patient underwent wide local excision and removal of outer table of cranium, dressing followed by split thickness skin graft. Histopathological examination confirmed dermatofibrosarcoma protuberans with clear lateral surgical margins and a deep margin of 0.5mm. She is currently undergoing radiotherapy and is planned for 50Grey 25cycles. © 2019, Malaysian Medical Association

Endoscopic sinus surgery training courses: Benefit and problems – a multicenter evaluation

Introduction: Dissection courses are important for trainees and surgeons in mastering the skills required to perform endoscopic sinus surgery (ESS) which is a common surgery in otorhinolaryngology. Aim: To evaluate the benefits of ESS training courses and ways to improve training. Material and methods: In a prospective study using a structured questionnaire, participants of ESS courses in the United Kingdom, Malaysia, India and Thailand were asked on their experiences in these courses and suggestions on improving them. Results and discussion: The majority of the participants have experiences in performing ESS prior to joining the course. Infundibulotomy was considered the easiest dissection step in ESS while frontal sinus surgery was considered the most challenging by the majority of the participants. The motivation for most of the participants in joining the course is to improve their skills with almost all stating that their expectations of the course have been fulfilled with improvement of their surgical techniques, anatomical skills and on patient’s safety. Almost all the participants were satisfied with the course and would recommend attending it. Conclusions: ESS dissection courses are an integral part in the learning process of trainees in becoming a competent surgeon and for surgeons to improve their techniques. Continuous improvement should be made to ensure that the participants will benefit from attending the cours

A Rare Adnexal Tumor of Head & Neck: Eccrine Spiradenoma

Introduction: Eccrine Spiradenoma is a rare connective tissue tumor arising from the dermis of well differentiated eccrine sweat gland. It is considered benign nature, nonetheless, reported malignant cases are extremely rare. The most common presentation symptom is localized intradermal swelling and complete surgical excision is the gold standard in managing these cases. Aim: This case report is undertaken to document a rare case of adnexal tumor of head and neck as well as sharing our experience to peer medical practitioners. Case study: We present a case of a 68-year-old lady, presented to a tertiary medical centre with a localized nodular right posterior neck swelling for the past 10 years, which underwent complete excision. Results and discussion: Following complete surgical excision and thorough surveillance, there is no evidence of recurrence and malignant transformation. Conclusions: Eccrine Spiradenoma is an extremly rare adnexal tumor that could involve head and neck, with reported cases of recurrence and malignant transformation that need to be closely observed and intervened should it present

Endoscopic Endonasal Approach in Clival Chordoma Surgery: Case Series

Abstract Chordomas are rare and slow-growing locally destructive bone tumors that can develop in the craniospinal axis. It is commonly found in the sacrococcygeal region whereas only 25–35% are found in the clival region. Headache with neurological deficits are the most common clinical presentations. Complete surgical resection either via open or endoscopic endonasal approaches are the main mode of treatment. Here, we report a series of 5 cases of clival chordomas which was managed via endoscopic endonasal approaches in our center. A retrospective analysis of patients who had undergone endoscopic endonasal resection of clival chordoma in Sarawak General Hospital from 2014 to 2018. A total of 5 cases were operated on endoscopically via a combine effort of both the otorhinolaryngology team and the neurosurgical team during the study period from year 2013 to 2018. From our patient, 2 were female and 3 were male patients. The main clinical presentation was headache, squinting of eye and nasopharyngeal fullness. All our patient had endoscopic endonasal debulking of clival tumor done, with average of hospital stay from 9 – 23 days. Pos-operatively, patients were discharged back well. Endoscopic endonasal resection of clival chordomas gives good surgical resection results with low morbidity rates and therefore can be considered as a surgical option in centers where the surgical specialties are available

A review of clinical and surgical outcomes of endoscopic endonasal skull base surgery in a Tertiary Center in Sarawak

Background: Endoscopic endonasal approach (EEA) for skull base tumor has been extensively developed in recent years. Objectives: To review the demographic data, indications, clinical presentations and surgical outcomes of endoscopic endonasal skull base surgeries performed. Methods: A retrospective analysis on all patients who had undergone endoscopic endonasal skull base surgery at the Skull Base Unit (ENT & Neurosurgery) from December 2013 to December 2015. Results: A total 34 cases were operated on during the study period. Female patients account for 44% of patients while 56% were male patients, with ages ranging from 8 to 77 years, with the mean age of 51.88 years. Majority of the cases were pituitary tumors (41%), followed by sinonasal tumors (15%), meningioma (12%), clival tumor (8%), cerebrospinal fluid (CSF) leak repair (8%) and frontal mucocoele (6%). Transsellar approach was the commonest approach (41%) followed by the transclival, transplanum, transfrontal approaches. In about 80% of cases, CSF leak was encountered intraoperatively and was successfully repaired endoscopically with the Hadad-Bassagasteguy flap and with the insertion of a lumbar drain. Only one case (3%) of CSF leak was noted postoperatively which was then successful repaired endoscopically with a nasoseptal flap. Systemic complications and intracranial infections were seen in 3 cases (8%) and were managed accordingly. No cases of epitaxis requiring surgical intervention were noted post operatively

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Adenoid Cystic Carcinoma of the Nasopharynx : A Case Series

Adenoid cystic carcinomas are tumors that are more commonly seen in the salivary glands than in the nasopharynx. Nasopharyngeal adenoid cystic carcinomas are rare and cases that are reported in the literatures are few. Treatment is mainly by surgical resection. Here, we report 2 cases of nasopharyngeal adenoid cystic carcinoma

Endoscopic Repair of Recurrent Congenital H-Type Tracheoesophageal Fistula with Electrocautery and Tissue Adhesive: A Case Report with Endoscopic Pictures to Illustrate Technique.

Recurrent tracheoesophageal fistula (TOF) is a known complication that follows a primary operative repair of a TOF. It is a diagnostic and therapeutic challenge as the management is difficult due to its significant morbidity. Treatment options include open surgical repair or an endoscopic repair of the fistula. We present a case of a recurrent tracheoesophageal fistula in a 11-month-old girl that was treated successfully via endoscopy approach with electrocautery and tissue adhesive

Endoscopic endonasal orbital and optic nerve decompression for traumatic orbital injuries: A review of outcome

I n t r o d u c t i o n : Orbital and optic nerve decompression has evolved over the years from an open surgery initially, to the current endoscopic approach. The current endoscopic approach is popularized on the idea of a safer surgery with better or similar outcome compared to open surgery. A i m : To review the outcomes of endoscopic endonasal orbital and optic nerve decompression for traumatic orbital injuries in the Otorhinolaryngology-Head and Neck Surgery Department of a tertiary referral centre. M a t e r i a l a n d m e t h o d s : A retrospective review of data on orbital and optic nerve decompression which was done on a total of 10 eyes involving 9 patients from July 2015 to December 2017 were collected. Data that were collected inclu- des demographic data, visual assessment, time to surgery and surgical outcomes with review of patients’ status within three months postoperatively. R e s u l t s a n d d i s c u s s i o n : Among the 9 patients operated, four presented with diplopia, another four with blurring of vision (BOV) and one with both the symptoms. Our review shows complete resolution of diplopia in 2 patients with another 3 reporting improvement in the symptom. Among the 5 patients with visual acuity impairment, 3 patients reported improvement while another 2 sho- wed no worsening. There were no surgical complications reported throughout the study. C o n c l u s i o n s : Endoscopic endonasal orbital and optic nerve decompression continues to evolve with increasing application in our surgical practice. Excellent outcomes in patients’ status postoperatively should encourage us to consider endo-scopic endonasal orbital and optic nerve decompression as the surgical approach of choice for such cases