Uterine sex cord tumour is a very rare tumour with uncertain management strategies and prognosis. A 61-year-old, nulliparous, who was not on hormone replacement therapy, presented with first episode of postmenopausal bleeding. A transvaginal scan revealed an enlarged uterus with thick endometrial lining and features of multiple degenerated fibroid. Endometrial biopsy was negative for malignancy. Computed tomography of the abdomen and pelvis confirmed the mass, with atrophic ovaries and incidental finding of bilateral hydronephrosis requiring stentings. Otherwise, there were no pelvic lymph nodes enlargement. Our impression was a uterine sarcoma and we decided for total abdominal hysterectomy with bilateral salpingooophorectomy. Surprisingly, the histology report confirmed uterine sex cord tumour. There are less cases of recurrence and there is no general consensus on the management. However, we decided for adjuvant chemotherapy (BEP regime) as the malignant cells infiltrated more than half of myometrial thickness, with good outcome.

Hepatic resection, the only treatment that offers long term survival for patients with Hepatocellular carcinoma (HCC), have shown significant improvement in results over the past decades. The aim of the study was to compare the survival between patients receiving and not receiving surgery. A retrospective co¬hort study measured the survival of newly diagnosed cases of HCC patients who underwent treatment in Selayang Hospital from 1 January 2003 till 31 December 2006. Survival time was measured from the date of diagnosis until the subjects died or until the end of study period (31 December 2007). Overall survival was significantly longer in surgery group in comparison with non-surgery group with a median survival of 43 and 20 months, respectively (p<0.001). The following factors were noted to have improved survival duration with surgical resection; Child Pugh Class B patients, tumor size less or more than 4cm and number of nodules less than 3. Sub¬group analysis showed improved survival duration with surgical resection among patients with Child Pugh Class B with tumor size less than 4cm or with nodule less than 3 and patients who had less than 3 nodules, even with tumor size of less or more than 4cm. Multivariate Cox Re¬gression showed surgical intervention significantly improved survival time for overall patients (Adjusted HR: 1.5) while non-surgery improved survival in patients with tumor size less than 4cm (Adjusted HR: 0.4). Surgical resection significantly improved the survival duration in over¬all patients while non-surgical procedure improved survival if the tumor size was less than 4cm.

Treatment of a complex, wide neck aneurysm sometimes cannot be achieved in a single endovascular session. This case illustrates a planned stage endovascular treatment of a complex aneurysm with remodeling technique aiming to eliminate risk of rebleeding during acute phase in the first stage of treatment, and complete occlusion in the second stage of treatment. After first stage, separation between coil mass and neck remnant was clearly shown indicating presence of neointimal layer. Multiple sessions also provide proper planning and more controlled treatment of difficult aneurysms.

Subcutaneous metastasis of rectal adenocarcinoma is an infrequent event as it occurs in less than 4% of all patients with rectal malignancy. When present, it signifies an advanced disease and carries poor prognosis. We hereby, present the case of a 51-year-old woman with subcutaneous lesion that turned out to be rectal adenocarcinoma metastases. She was then managed as an advanced case.

The urinary bladder can be affected by either congenital or acquired disease leading to small, noncompliant, hypertonic urinary bladder with subsequent transfer of high pressure to upper tract leading to renal function deterioration and renal failure. The aim of urinary bladder reconstruction was to restore normal structure and functions of the urinary bladder. Successful reconstructions should be confirmed by measurement and evaluation of bladder structure and functions. In this study, different modalities such as radiography (CT scan), ultrasonography, and urodynamic were used to assess urinary bladder structure and functions in an animal model. The radiographic (CT scan) and ultrasonography have mostly structural data, while urodynamic studies produce functional parameters. Using these combined modalities we could measure and determine the normal urinary bladder volume, bladder filling pressure, voiding pressure, bladder shape, outline border, three dimension (3D) configurations, locations, and bladder dimensions. Radiography showed bladder as oval, contrast filled hollow organ, localized centrally. Mean bladder volume was 1.42 ml±0.03. Ultrasonography showed bladder as oval, elongated hypo echoic urine filled organ with, wall thickness 1mm at bladder dome and 2mm at bladder base. Mean volume was 1.44 ml±0.05. Urodynamic study showed low intravesical filling pressure with a mean value of 6-5 cm H2O, while the mean voiding pressure was 18-19cmH2O. Mean bladder volume was 1.40 ml±0.02. The acquired data for the normal (control) animals may be used as a reference for further evaluations of our future research on urinary bladder reconstructions using tissue engineering technology.

We hereby report a rare case of a woman who presented with symptoms of urogenital prolapse and menorrhagia. She was erroneously diagnosed to have cervical mass and underwent examination under anesthesia and was found to have only a vaginal leiomyoma. The fibroid was enucleated successfully through a vaginal incision. We discuss the rare case.

Primary tumors of the heart are rare. However, among them cardiac myxoma is the most common tumor accounting for half of the primary cardiac neoplasms.  About 75% of cardiac myxomas are located in the left atrium, and 25% are located in the right atrium. These are thought to be arising from remnants of subendocardial vasoformative reserve cells or multipotential primitive mesenchymal cells in the fossa ovalis and surrounding endocardium, which can differentiate along a variety of cell lineages including epithelial, hematopoietic, and muscle cells. Although some cases are discovered incidentally by echocardiographic examination, it was recognized in most of the patients by various symptoms caused by the release of inflammatory cytokines such as interleukin-6 (IL-6), obstruction of intracardiac blood flow, or embolization. Cardiac myxoma has many undetermined interesting issues regarding its origin, nature as a tumor, varying clinical manifestations, and the presence of both sporadic and familial types. Recent evidence revealed that cardiac myxomas are benign neoplasms and slowly proliferating lesions. The existence of its malignant counterpart is controversial. However, recurrence after surgical excision or metastasis has been  reported.  We hereby present a case report of a young gentleman who presented with history of sudden onset of weakness and cerebellar signs. Urgent CT scan revealed hypodensities of bilateral occipital lobes and cerebellum suggestive of infarcts. Urgent echocardiography denoted large left atrial myxoma. The tumor was excised and the patient recovered well.

Coronary artery disease (CAD) is the most common cause of death in the industrialized world. Obesity is one of the risk factor for developing CAD and also postoperative morbidity and mortality. However, in published articles the relationship between body mass index (BMI) and outcome of coronary artery bypass graft surgery depict conflicting results. This study evaluated the relationship between BMI and outcome of isolated coronary artery bypass graft performed in Hospital Universiti Sains Malaysia (HUSM). Cardiothoracic Unit HUSM is a referral centre for east coast of West Malaysia. Data was retrospectively collected from the medical records retrieved from the hospital record office. All patients who underwent isolated CABG in Cardiothoracic Unit, Hospital Universiti Sains Malaysia Kubang Kerian, Kelantan from November 2001 till October 2004 were identified and their demographic and clinical data were collected. Patients were divided into non overweight (BMI= or <25 kg/m2) and overweight (BMI>25 kg/m2) group. Data was then analyzed using SPSS version 12.0. There were 141 patients who underwent isolated CABG over the three year period. There were 80 patients with BMI < or =25 kg/m2 and 61 patients with BMI of >25 kg/m2. The demographic data of the two groups were similar. There was no statistical significant differences in the outcome of isolated coronary artery bypass graft. In conclusion, body mass index does not influence the outcome of isolated coronary artery bypass graft.

Intussusception is the most common cause of intestinal obstruction in the first two years of life. The cause is not apparent in most of the cases. Associated conditions that can result in intussusception include polyps, Meckel’s diverticulum, Henoch-Schonlein purpura, lymphoma, lipoma, parasites, foreign bodies and viral enteritis with hypertrophy of Payer’s patches. We hereby describe a rare case of sand bezoar induced intussusception in a 9-year-old school girl with pica (geophagia). A description of her presentation and management, along with a review of literature is being presented.

The endotracheal tube (ETT) cuff pressure is usually estimated and assumed to be within the appropriate range. However, the estimation of cuff pressure may be influenced by the various estimation techniques used by anaesthesia providers and their different experience level. The main aim of this study was to observe the correlation between the experience of the anaesthesia providers and their ability to estimate endotracheal cuff pressure in a correct manner. One hundred anaesthesia providers were classified into three different groups based on their months of anaesthetic experience: Group I (< 36 months), Group II (36 to 59 months) and Group III (≥ 60 months). Following intubation, the ETT cuff was inflated by the anaesthetic nurse and ETT placement verified by the anaesthesia provider. Using the pilot balloon palpation technique (PBPT), the cuff pressure was estimated to be within the appropriate pressure range, over or under-inflated. The necessary adjustments were made if needed after measurement with a VBM™ Manometer Pressure Gauge. More number of months of anaesthesia experience was not associated with a greater ability to correctly estimate the ETT cuff pressure. However, this correlation was poor (r = - 0.177). The pilot balloon palpation technique was found to be only moderately sensitive (76.5%) but poorly specific (42.9%) for correct estimation of the ETT cuff pressure, whereby PPV and NPV were 58.2% and 63.6%, respectively. The technique was 50% (95% CI 24.04 - 75.95) sensitive while correctly estimating the under-inflated cuff and 60% (95%CI 13.25-37.81) sensitive to correctly estimating the over-inflated cuff. The results depict that the experience of anaesthesia providers did not correlate with the ability to correctly estimate the ETT cuff pressure.

Universiti Kebangsaan Malaysia Medical Center (UKMMC) started neurointerventional service in August 2008. In this study, we aimed to evaluate the immediate and short term outcome of endovascular treatment (EVT) of cerebral aneurysm during early period of the services. A retrospective study for cerebral aneurysm treated by endovascular technique, from the Neurosurgical and Radiology Department from September 2008 till February 2010 was performed. Patient’s demographic data, initial clinical presentation and assessment of the aneurysm were performed. The immediate results and short term assessment post EVT were evaluated based on standard criteria. Recurrence and complications during and following EVT procedures, were recorded. Twenty one patients with total of 22 aneurysms were treated. The mean age was 54.52 years with 57% being males and 43% females. The majority (81%) had single aneurysm. The most common site was anterior communicating artery (28 %). Mean aneurysm sac size was 6.19 mm and 2.55 mm for aneurysm neck. At follow-up, 3 (27.2%) had a small residual neck. Four patients (37.2%) had residual aneurysm filling, but three of them were treated with stent aiming to achieve flow diversion effect instead of complete occlusion during initial treatment. There was no rebleed or rupture from the immediate to follow-up. Significant complications up to 30-days was observed in 4 patients (20%) whereby 2 patients showed improvement and 2 patients died (10 % mortality rate). Endovascular treatment of cerebral aneurysms performed in our centre had early outcome, morbidity and mortality compared to other higher volume centres. Longer term follow up is needed to evaluate the long term outcome/occlusion rate, morbidity and mortality.

Venous thromboembolism has a strong association with pelvic malignancy, whereby a failure in recognizing this event will lead to mortality. The best intervention depends on the individual basis with the availability of supporting service. We illustrate a case of gynaecological malignancy with concurrent deep vein thrombosis undergoing staging laparotomy and debulking surgery. Inferior vena cava filter was inserted after initial thrombolytic therapy and subsequently a long term treatment. Death from massive pulmonary embolism and major bleeding was prevented and synchronous primary ovarian and endometrial cancer prognosis was reassured in this case.

A case of variations in the ventral and lateral and dorsal branches of abdominal aorta were observed in a 50-year-old male cadaver during routine dissection for medical undergraduate students. The common hepatic artery was arising directly from abdominal aorta.  Right inferior phrenic artery originated directly from the abdominal aorta along with upper right renal artery about 0.4cm below the origin of superior mesenteric artery. Triple renal arteries were seen on the right side, all arising from abdominal aorta whereas on the left side, a single renal artery was seen entering the kidney. The upper right renal artery was present behind the inferior vena cava whereas the middle and inferior right renal arteries were present in front of the inferior vena cava. On the right side, ureter was placed anterior to renal vessels.  Knowledge of the above variations in the branches of abdominal aorta have clinical importance not only for surgeons but also for interventional radiologists.

Patients with Falciparum malaria may present with peripheral gangrene as a rare complication. In this report we describe two adult Sudanese patients with high grade fever for 10 days, jaundice, alteration consciousness and hypovolaemic shock. Both patients had blackish discolouration of the fore foot and the toes, bilaterally. Blood smears showed hyperparacitaemia with Plasmodium falciparum. They were diagnosed as having severe malaria with peripheral gangrene; they were treated with quinine infusion and the foot lesions recovered spontaneously without surgical intervention.

Anatomical knowledge of variations of lobes of lung is important for accurately identification of broncho-pulmonary segments. It is of great significance for radiologists during interpretation of X-ray and CT scans. Such studies are of utmost importance during lobectomies and surgical resection of individual segments of lung. The present paper highlights the abnormal sinuous pattern of oblique fissure and incomplete horizontal fissure in right lung. It also describes in detail the morphology of an abnormal pyriform lobe present between these two fissures. We as anatomists wish to draw attention to abnormal morphological patterns of fissures of lungs which may be of utmost importance for radiologists and surgeons and add to the already existing knowledge of lobar anatomy.

Refractory ascites is difficult to treat by restriction of salt and repeated paracentesis which have been the mainstay of treating it for a long time. Sapheno-peritoneal shunts have been performed in patients with refractory ascites . Here, we evaluated the use of saphenous vein to be anastomosed to the peritoneam to drain the refractory ascites. Nine  patients (7 male, median age 45 years, range 17 - 69) with tense refractory ascites associated with  liver cirrhosis, perioprtal fibrosis and end stage renal diseases underwent sapheno-peritoneal anastomosis by mobilizing and rotating  the proximal vein in order to be anastomosed to peritoneum in the lower abdomen . All procedures were performed under local anaesthesia. Thirty-day mortality was 22% (2) patient. Morbidity included fluid leakage in 1 (11%), and wound infection in 1 (11%). Hospital stay (median) was 16 days (range 11 to 23). In the short term (median of 2 months) significant reduction in body weight and abdominal girth was seen in 9 (90%), 6 (60%) were not on diuretics while 3 (30%) continued to remain on reduced doses of diuretic. Furthermore, 7 (70%) did not require paracentesis. At 2-year follow-up, 5 (45%) patients died and 3 succumbed during follow-up. The remaining 3 were all in active employment, 1 was off diuretics, and 2 were on reduced doses. All 3 patients maintained reduced body weights and abdominal girths compared with preoperative values. Saphenous-peritoneal shunt appears a simple, safe, and cost effective method of achieving long-term control of refractory ascites. The use of autogenous shunt is an added advantage over prosthetic shunts for drainage of ascitic fluid.