Obturator hernia: A rare condition with common surgical symptoms

Hernia is a common surgical problem. However, worldwide incidence of obturator hernia is <1% of all hernia cases, occurring more commonly in thin, elderly and multiparous female. An 82 years old lady presented with bowel obstruction sign and symptoms for 4 days duration. Imaging study, computed tomography with enhanced contrast (CECT) of abdomen and pelvis showed small bowel obstruction secondary to left obturator hernia. Emergency abdominal exploration with left transverse transperitoneal approach was performed. Intraoperatively, anti mesenteric part of ileal wall was incarcerated through the left obturator foramen causing small bowel obstruction and it was resected with end to end anastomosis. She recovered well and was discharged on postoperative day 7. The signs and symptoms of obturator hernia are non-specific. Most cases are presented with symptoms of intestinal obstruction, resulting in diagnostic difficulty for this rare condition. Delay in diagnosis and surgical intervention contribute to poorer outcomes

Brain Metastasis from Breast Cancer in a Male Patient

Male breast cancer is a rare disease and has contributed to <1% of all cancers in the male population. Delay in diagnosis is common, due to its rarity and lack of awareness of the disease among the male patient and physicians. Most cases were detected at an advanced stage and up to 30% of them were diagnosed with metastasis on the initial presentation. The authors presented a case of a 60-yearold man who presented with seizure and right hemiparesis. In addition, he also has left breast mass for one year. Computed tomography of the brain showed a left frontal intra-axial brain lesion and biopsy of the breast lesion confirmed triple-negative invasive breast cancer. He was planned for whole-brain radiotherapy, however, he succumbed prior to the treatment

Circulating neonatal Nav1.5 (nNav1.5) antigen and anti-nNav1.5 antibodies as potential biomarkers for breast cancer metastasis

Neonatal Nav1.5 (nNav1.5) has been known to potentiate breast cancer (BCa) metastasis. The detection of anti-nNav1.5 antibodies (anti-nNav1.5-Ab) reflects the immunogenicity of nNav1.5. However, the presences of circulating nNav1.5 antigen and anti-nNav1.5-Ab in the context of BCa metastasis have not been explored yet. Therefore, the study has attempted to conduct such an investigation using both blood samples from 4T1 orthotopic mice and BCa patients. In the preclinical study, forty female BALB/c mice were divided into three groups: 4T1 orthotopic BCa mice (n=17), control mice (n=20) and positive control mice (n=3). After tumour development, the mice were sacrificed to obtain target organs, whole blood, and serum. Histopathology, cytokine analyses, real-time PCR, and indirect ELISA were performed. Histopathology and cytokine analyses showed the establishment of metastasis in 4T1 orthotopic mice. The concentration of vascular endothelial growth factor (VEGF) was significantly higher in the 4T1 orthotopic mice (P<0.0001****). Circulating nNav1.5 antigen and anti-nNav1.5-Ab were detected in 4T1 orthotopic mice, using real-time PCR and indirect ELISA, respectively. Furthermore, there was an inverse relationship between anti-nNav1.5-Ab and the total metastatic foci (P=0.0485*, r=-0.7306). In the clinical study, 32 BCa patients were grouped based on their stages: early-invasive (n=15) and advanced (n=17) stages. Approximately 3 mL of blood was withdrawn, and only indirect ELISA was conducted. The clinical study showed that BCa patients of advanced-stages portrayed higher expression of anti-nNav1.5-Ab compared to early stages of BCa (P =0.0110*). In conclusion, the detection of nNav1.5 antigen and anti-nNav1.5-Ab was consistent with the presence of BCa metastasis

A review of relationship between presenting symptoms and tumour location in colorectal carcinoma in tertiary centre hospital

Colorectal cancer is ranked as the most common cancer for men and the second most common cancer for women according to the Malaysian National Cancer Registry Report (MNCR) 2007-2011. However, delay in the diagnosis of colorectal cancer is still common partly attributable due to late presentation and incorrect diagnosis by the general practitioners. The aim of this study is to determine the relationship between presenting symptoms of colorectal cancer to the location of the tumour in order to prevent delay in diagnosis of colorectal cancer. Between 1996 until 2009, a total of 212 patient data from Hospital Universiti Sains Malaysia were retrospectively analyzed. The demographic and surgical data were obtained. We studied the relationship of the presenting symptoms of colorectal cancer to the location of the tumour. The age of candidate included in this study range from 16 to 93 years old with mean age was 56 and male predominance. In this study, there is a strong relationship between presenting symptoms and the location of the colorectal cancer but no significant relationship between age and sex to the anatomical location of the tumour. The study showed the presenting symptoms of rectal bleeding, change in bowel habit and tenesmus were significantly associated with rectal tumor, intestinal obstruction with left sided tumors and anemia and abdominal mass with right sided tumors (p-value <0.05). However abdominal pain does not follow this role as it is mostly associated with other presenting symptoms and it has no significant relation to the anatomical location of the tumor

Empyema thoracis presented as giant back abscess

Empyema thoracis (ET) is defined as pus in the pleural space, either localized or involving the entire pleural cavity, due to diverse etiologies. In severe form, it may infiltrate the extra pulmonary region. Clinical guideline describes 3 stages of parapneumonic effusion before developing into an ET, namely the exudative stage, the fibrinopurulent stage, and the orga nizing/late stage.We highlight a 59-year-old gentleman who presented a back swelling mas querading as a deep-seated abscess, in which the diagnosis of ET had not been established early. The principles of treatment are treating the underlying condition such as pneumonia, pleural drainage and debridement, full re-expansion of the collapsed lung by performing chest physiotherapy, and improving nutrition. ET is a condition with a dynamic process due to diverse etiologies, either localized or involving the entire pleural cavity. The gold stan dard in diagnosing ET is the pleural aspiration of fluid from the pleural space, whereas the management of ET may include non-surgical and/or surgical treatments based on the basic principles of ET treatment

Empyema thoracis presented as giant back abscess

Empyema thoracis (ET) is defined as pus in the pleural space, either localized or involving the entire pleural cavity, due to diverse etiologies. In severe form, it may infiltrate the extra- pulmonary region. Clinical guideline describes 3 stages of parapneumonic effusion before developing into an ET, namely the exudative stage, the fibrinopurulent stage, and the orga- nizing/late stage. We highlight a 59-year-old gentleman who presented a back swelling masquerading as a deep-seated abscess, in which the diagnosis of ET had not been established early. The principles of treatment are treating the underlying condition such as pneumonia, pleural drainage and debridement, full re-expansion of the collapsed lung by performing chest physiotherapy, and improving nutrition. ET is a condition with a dynamic process due to diverse etiologies, either localized or involving the entire pleural cavity. The gold standard in diagnosing ET is the pleural aspiration of fluid from the pleural space, whereas the management of ET may include non-surgical and/or surgical treatments based on the basic principles of ET treatment

Risk factors associated with low anterior resection syndrome: a cross-sectional study

Purpose Oncological outcomes following rectal cancer surgery have improved significantly over recent decades with lower recurrences and longer overall survival. However, many of the patients experienced low anterior resection syndrome (LARS). This study identified the prevalence and risk factors associated with the development of LARS. Methods This cross-sectional study involved patients who were diagnosed with rectal cancer and had undergone sphincter-preserving low anterior resection from January 2011 to December 2020. Upon clinic follow-up, patients were asked to complete an interviewed based questionnaire (LARS score) designed to assess bowel dysfunction after rectal cancer surgery. Results Out of 76 patients, 25 patients (32.9%) had major LARS, 10 patients (13.2%) had minor LARS, and 41 patients (53.9%) had no LARS. The height of tumor from anal verge showed an association with the development of major LARS (P=0.039). Those patients with less than 8 cm tumor from anal verge had an increased risk of LARS by 3 times compared to those with 8 cm and above (adjusted odds ratio, 3.11; 95% confidence interval, 1.06–9.13). Conclusion Results from our study show that low tumor height was a significant risk factor that has a negative impact on bowel function after surgery. The high prevalence of LARS emphasizes the need for study regarding risk factors and the importance of understanding the pathophysiology of LARS, in order for us to improve patient bowel function and quality of life after rectal cancer surgery

Prospective diagnostic study on the use of narrow‐band imaging on suspicious lesions during colonoscopy examination

Introduction: Colonoscopy is the gold standard to detect colorectal neoplasm. Narrow-band imaging (NBI) has a good diagnostic accuracy to differentiate between neoplastic and non-neoplastic colorectal lesions. This study explores the diagnostic validity of NBI colonoscopy as well as its associated factors related to neoplastic and non-neoplastic colorectal lesions. Methods: This study enrolled 100 patients in a single-center tertiary teaching hospital. Patients presented for screening colonoscopy, and those with suspicious colorectal lesions were included in this study. During colonoscopy, the most suspicious lesion in each patient was analyzed using the NBI system based on Sano’s classification. Each lesion was biopsied for histopathological analysis, the gold standard. Endoscopic images were captured electronically. The sensitivity, specificity, and diagnostic accuracy of NBI colonoscopy were assessed. Other associated factors related to neoplastic and non-neoplastic lesions were analyzed accordingly. Results: The sensitivity and specificity of the NBI were 88.2% and 71.9%, respectively. The area under the receiver–operator curve was 0.801, indicating that NBI has a good ability to differentiate between disease and non-disease. There are significant associations between histopathological examination outcomes and both presenting symptoms, especially weight loss, and lesion site, even after other variables were controlled (P < 0.05). Conclusion: The NBI system in colonoscopy was capable of distinguishing neoplastic from non-neoplastic colorectal lesions. It indicates an acceptable level of agreement with histopathology, the gold standard. However, the role of NBI in screening and surveillance in Malaysia still needs further evaluation and exploration

Study of short term outcome and incidence of recurrence of inguinal hernia rep air in Hospital Universiti Sains malaysia

The purposes of this study are to evaluate the complications arise from the inguinal hernia repair and their correlations with the patients' factors and surgical procedure's factors. The aim is to improve our service. Surgical Unit in Hospital Sains Malaysia offers the surgery for inguinal hernia repair. This retrospective study was done on 600 patients who undergone the hernia repair. This study started from January 2000 until January 2005. About 580 male patients and 18 female patients had undergone hernia repair within the time frame. Mean age was 52 years old with standard deviation of 18.2 years. We found patients more than 50 years old tend to develop short term complications and overall complications after the surgery (p<0.05). 364 patients have right sided hernia, 200 patients have left sided hernia and 36 have bilateral hernia. 494 patients have indirect hernia, 93 patients have direct hernia, 7 patients have both direct and indirect hernia and 6 patients have sliding hernia Indirect hernia have higher risk to develop recurrent hernia (0<0.05). Majority of patients came to hospital for the treatment after 1 to 6 years of symptoms. 460 had undergone Lichteinstein repair, 121 had undergone Darning repair, 10 had Bassini and 9 had Iaparoscopic hernioplasty. Type of surgery does not alter the incidence of complications and recurrence after the surgery. 537 patients had elective surgery and 63 patients had emergency surgery. Duration of operation was longer in emergency surgery in which the duration of more than 2 hours were 17.7% in elective cases comparing to 49.2% in the emergency cases (p<O.OS) and emergency cases stayed longer in hospital comparing to elective cases (p<O.OS). 87 patients had COAD (chronic obstructive airway disease), 45 had chronic constipation and 39 had BPH ( benign prostatic hypertrophy ). Patients who had COAD tend to come as emergency and develop short term complication after the surgery (p<O.OS). There were 23 wound infections. Our wound infection rate was at 3.8%. The less experienced surgeons had shown to have higher early infection rate comparing to the more experienced surgeons (p<O.OS). There were I9 recurrent cases. 6 patients recurred as early as less than 6 months. 6 recurred after 6 month but less than I year, 7 recurred after I year to 5 years after the surgery. The indirect hernia have higher recurrent rate. Similarly with patients who develop post operative complication, the recurrent rate was higher in this group (p<O.OS) In summary, the commonest complications post hernia repair were wound infection, scrotal hematoma and recurrence. Patients age of more than 50 years old, patients who have COAD and less experienced surgeons had increased the risk of post operative complications. Patients who have indirect hernia and who developed post operative complications have higher risk to develop recurrence