Endovascular Treatment of Intracranial Aneurysms: Diversity in Treatment Techniques of Varying Anatomical Presentations

We discuss and illustrate various endovascular treatment options for intracranial aneurysms, to reflect common technique used in endovascular treatment of brain aneurysm. We select five cases of various aneurysm types to show assortments of endovascular treatment (EVT) are performed. Selective catheterization of the intracranial aneurysms and endovascular treatments are technically feasible, offering a viable alternative to the surgical approach. We discuss the radiographic features, clinical presentation, and strategies of endovascular treatment of intracranial aneurysms. Key words: endovascular treatment, intracranial aneurysm, intracranial stent, balloon assisted

A PRELIMINARY STUDY OF SEXUAL DIMORPHISM OF SCAPULA BY COMPUTED TOMOGRAPHY IN THE MALAYSIAN POPULATION

Objective: Sex estimation is one of the crucial steps for human identification, which is evident in cases of commingled, eroded, and/or missing remains. When pelvis or skull are unavailable, scapula has been used as an alternative bone for determining sex. Besides, the scapula was shown to be population-specific in several studies. Limited dry bone collections in Malaysia have led to various recommendations of virtual anthropology studies of bone in human identification. The aims of this study were to investigate the sexual dimorphism of the scapula using three-dimensional (3D) computed tomography (CT) imaging and to generate population-specific equations for sex determination in the Malaysian population.Methods: A total of 66 CT thorax images of 33 males and 33 females were taken. Morphological breadth (MB) and morphological length (ML) on bilateral scapulae were measured on 3D CT reconstructed images. Independent t-test and discriminant function analysis (DFA) were performed for analysis.Results: Results revealed that both parameters showed sexual dimorphism of scapula but displayed no difference between the right and left scapulae. DFA showed that MB and ML had high accuracy for sex estimation. The equations were highly accurate when both parameters were used in combination, followed by MB only and ML only, in that sequence.Conclusion: In brief, scapula measurements may be useful for forensic assessment of sex in the Malaysian population

Academics as decision makers: what style do they adopt?

Many studies have focused on the decision-making styles (DMS) of managers, but very few have studied the DMS among academicians. Using the Rowe Decision Style Inventory, this study investigates the DMS of the academics in a public university in Malaysia. The objectives are to identify the common styles adopted by the academics and to determine their dominant styles in relation to their gender, age, faculty, qualifications, and years of service. This study employed a quantitative-questionnaire design that was distributed to 163 academics during an in-house training program. Four types of DMS—directive, analytical, conceptual, and behavioural styles—were identified with regard to gender, age, faculty, qualifications, and years of service. The results revealed that while the majority of the respondents have more than one dominant DMS, the conceptual and analytical styles predominate. Additionally, empirical evidence of variations in the types of DMS across demographic characteristics was found. These findings provide important implications for academics in making the most effective decisions within their professio

Embolization in Haemorrhage-associated Transurethral Resection of Prostate: An Advancement of Endovascular Technique

Benign prostatic hyperplasia is common in the elderly. The surgery of choice in those who failed medical treatment is transurethral resection of the prostate (TURP). Post- TURP haematuria can be distressing and difficult to manage. The physiological changes in the elderly have led to inability to withhold hypovolaemic states especially in inoperable patients. Using endovascular modalities, this complication can be managed efficiently without endangering patients’ well-being. Herein, we present a case of a successful prostatic artery embolization in a patient with a post-TURP hemorrhagic complication ineligible for surgery

"IMMOLIMB™" penyelesaian masalah kepada imej prosedur angiografi anggota bawah yang kurang optimum / Halmi Shamsudin … [et al.]

Prosedur angiografi adalah salah satu daripada prosedur pengimejan diagnostik untuk mengkaji saluran darah di dalam arteri dan vena. Pemeriksaan angiografi ini dilakukan dengan menyuntik cecair likat yang dipanggil media kontras ke dalam salur darah bagi mengenal pasti dengan jelas kawasan salur darah yang tersumbat. Prosedur ini melibatkan pendedahan sinar-x di kawasan salur darah tertentu dan dilakukan oleh pakar intervensi yang terpilih. Terdapat beberapa jenis pemeriksaan angiografi di antaranya ialah angiografi serebral/karotid, angiografi koronari, angiografipulmonari, angiografiperiferal dan angiografi renal. Permasalahan utama berlaku apabila pemeriksaan angiografi anggota bawah dilakukan kepada pesakit warga tua berumur 60 tahun dan ke atas yang menghidap diabetes tahap kritikal pada saluran darah keduadua belah kaki. Permasalahan yang berlaku ialah tiadanya alat cegah gerak khas sesuai untuk menyokong pergerakan kaki pesakit dan pesakit berada dalam keadaan yang kurang selesa untuk tempoh 2-3 jam ketika pemeriksaan. Ini mengakibatkan pakar-pakar sukar menganalisis dengan tepat salur darah kaki yang tersumbat disebabkan imej yang dihasilkan adalah kurang optimum. Daripadaprojekyang telah dilaksanakan, terdapat beberapa impak telah berjaya diperoleh iaitu penurunan imej sinar-x anggota kaki daripada 40.18% kepada 7.95%, penjimatan kos pembelian alat cegah gerak kaki sebanyak RM23,316.00, kos perubatan telah berjaya dikurangkan sebanyak RM630,000.00, dos radiasi telah dikurangkan sebanyak 72.72%, penjimatan masa pemeriksaan sebanyak 67.74%, alam sekitar telah berjaya dipulihara dan projek ini telah menepati Strategi Lautan Biru Kebangsaan (NBOS).Secara rumusannya, IMMOLIMB™ adalah ciptaan inovasi yang tercipta daripada bahan buangan terpakai bagi mengatasi masalah pergerakan kaki pesakit, memberikan keselesaan dan meningkatkan imej diagnostikpada tahapyang optimum

The Use Of Hybrid Technique: Thresholding And Edge Detection For Identifying River From Aerial Photo

The Field Of Image Processing Is A Broad Field With Many Applications In Science And Industry. Image Processing Is Used To Manipulate And Enhance An Image, Which Ease The Next Process. This Research Involves The Use Of A Hybrid Techniques, Which Is A Combination Of Thresholding And Sobel Edge Detection Technique, To Recognize A River From A Grey Scale Image. Thresholding Technique Is Used To Reduce Non-Maxima Pixels, Weak Edges And Noise, Whilst The Edge Detection Technique Is Used To Detect Location Of The Edges. The Output From This Hybrid Technique Is Compared To The Existing Techniques Such As Sobel, Prewitt, Laplacian, And Robert Cross Technique

Embozene loaded prostatic artery embolization

Herein is a case report of a 70 years old man with a tenacious benign prostatic hyperplasia (BPH). The aim of this manuscript is to briefly discuss the usage and advantage of EmbozeneTM Microsphere in embolization of the prostate arteries in the treatment of failed medical and surgical therapy for BPH

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London