Massive dissecting intramural duodenal haematoma following endoscopic haemostasis of a bleeding duodenal ulcer

Intramural duodenal haematoma is a rare injury of the duodenum. Most reported cases are secondary to blunt trauma to the abdomen. Such injury following endoscopic intervention is even rarer, and there are no definite guidelines for its management. We report a case where endoscopic haemostasis of a bleeding duodenal ulcer resulted in a massive dissecting intramural duodenal haematoma with gastric outlet obstruction and obstructive jaundice.     

Pre-ablative diagnostic whole-body scan following total thyroidectomy for well-differentiated thyroid cancer: is it necessary?

OBJECTIVE: This study reviewed the incidence of positive pre-ablative diagnostic scan after total thyroidectomy and the efficacy of the current ablative dose. The predictive factors for outcome using a standard ablative dose and postoperative complications of total thyroidectomy were also examined. METHODS: This was a retrospective review of patients referred for radioiodine ablation after total thyroidectomy between September 1997 and September 2001. RESULTS: Forty patients were included in this study, of whom 95% had a positive scan after total thyroidectomy. Of the 30 patients who underwent standard 80-mCi radioiodine ablation, 21 (70%) had successful single ablation while the remaining nine patients needed a higher ablative dose. There were no significant differences between patients who had successful ablation with the standard dose and those who did not in terms of tumour size, patient age, lymph node status and extra-thyroidal extension. Fifteen percent suffered from permanent hypoparathyroidism requiring calcium supplementation. Three patients had documented recurrent laryngeal nerve paralysis. CONCLUSION: Bypassing the pre-ablative diagnostic scan is feasible. The present ablation dose of 80 mCi of radioiodine is effective. The relatively high postoperative morbidity after difficult total thyroidectomy suggests less aggressive excision and postoperative radioiodine ablation of the remnant tissue.     

两性霉素B角膜基质内注射成功治疗真菌性角膜炎1例

目的:报告1例使用5mg/L两性霉素成功治疗难治性真菌性角膜炎的病例。方法:病例报告。结果:女性患者1例,48岁,以右眼红1wk,伴视力下降和角膜混浊2d入院。否认有外伤或异物史。检查发现:右眼视力:6/12,针孔视力:6/18。注射结膜前使眼分泌物保持最少。角膜旁中央区有一全层基质脓肿-形态不规则且伴有卫星病灶及羽状边缘,不伴有上皮缺损,有前房积脓液平。左眼正常。诊断为真菌性角膜炎。尽管在此前患者经历了3wk的局部两性霉素B点眼(1次/2h),那他霉素眼液点眼(1次/4h),但并无病情恢复的迹象。相反12点出现了一个新的更大的基质脓肿病灶。我们应用5mg/L两性霉素B角膜基质注射联合穿透性角膜移植术治疗后溃疡面积明显减少,前房积脓完全消失,没有毒性反应发生。患者干预后2mo视力恢复了正常视力(6/6)。结论:使用两性霉素B5mg/L基质内注射,使用过程安全有效,是一种治疗难治性真菌性角膜炎的理想方法。     

Modified Bahasa Malaysia version of VF-14 questionnaire: assessing the impact of glaucoma in rural area of Malaysia

Purpose: To evaluate the functional impairment of glaucoma patients, using a modified Bahasa Malaysia version of VF‐14 questionnaire, and to correlate the score with the severity of the disease. Methods: One‐to‐one interview by trained interviewers was conducted on glaucoma patients seen in the eye clinic of Hospital Universiti Sains Malaysia, using a modified validated Bahasa Malaysia version of VF‐14 questionnaire. The severity of glaucoma was determined based on the better‐eye Advanced Glaucoma Intervention Study Scale (AGIS) score of visual field analysis on the latest most reliable visual field. The literacy rate, living situation, better‐eye visual acuity and lens status were also documented. Results: A total of 110 glaucoma patients were recruited (54.5% primary open‐angle glaucoma, 21.8% primary angle‐closure glaucoma, 19.2% normotensive glaucoma and 4.5% pseudoexfoliative glaucoma) and majority with bilateral involvement. Based on the better‐eye AGIS score, 41.5% were in advanced stage, 29.1% moderate and 29.1% mild. There was a significant association between VF‐14 scoring with the better‐eye AGIS score (r =?0. 579, P < 0.001), age (r = ?0.313, P = 0.000) and better‐eye visual acuity (r = ?0.752, P = 0.000). Based on the multivariate analysis, there was a significant association of the questionnaire score and better‐eye AGIS score (P < 0.001). Conclusion: The Bahasa Malaysia version of modified VF‐14 questionnaire is a useful tool in quantifying quality of life among glaucoma patients in rural area with high illiteracy rate and provides moderate correlation with severity of the disease. Customization of quality of life questionnaire according to custom and culture of the community will provide better insight to the functional impairment of glaucoma patients.     

纤维蛋白胶封闭早期滤过泡漏1例

患者,男,63岁,以“左眼突发视力下降,眼部不适,眼红,流泪”主诉就诊。1wk前因继发性青光眼行青光眼阀植入术。同一眼1a前曾行扩大的小梁切除术,手术失效。眼科检查结果：最佳矫正视力为6／18,有滤过泡漏,前房浅,眼压6mmHg。应用纤维蛋白胶成功封闭滤过泡漏,前房加深,眼压升至13mmHg。此病例说明纤维蛋白胶是治疗早期滤过泡漏的有效方法。     

Inguinal hernia repair by surgical trainees at a Malaysian teaching hospital

OBJECTIVE: To assess the outcome of inguinal hernia repaired by surgical trainees at Universiti Kebangsaan Malaysia Hospital. METHODS: Retrospective review of 103 patients who underwent surgery between November 2001 and October 2002. RESULTS: The mean age of patients was 50 years and the male-to-female ratio was 20:1. Most hernias (60%) were right-sided inguinal hernias. Admissions consisted of 60% elective, 31% day-case and 9% emergency. General anaesthesia was administered in 66% of cases, spinal anaesthesia in 33% and local anaesthesia in 1%. Ten inguinal hernia repairs were performed by first-year trainees, 61 by third-year trainees and 19 by fourth-year trainees. First-year trainees did more darning (60%) and fewer mesh (40%) repairs. Third-year trainees still used darning (57%) but also performed more mesh repairs (43%). Fourth-year trainees performed 68% darning (mainly to teach the first-year trainees) and 32% mesh repairs. Senior surgeons assisted in 13 difficult cases where mesh repair was preferred (92%) to darning repairs (8%). Prophylactic antibiotic was more frequently used in patients undergoing mesh repair (p < 0.001). The mean operative time was the same for both types of repair. There were no significant differences in complications between the two types of repair. One hernia recurred after darning repair but none after mesh repair. CONCLUSIONS: Mesh repair of inguinal hernia is effective. Trainees easily acquire this skill and it becomes their preferred method of repair.     

Dengue related maculopathy and foveolitis

A 24 year-old Malay lady presented with high grade fever, myalgia, generalized rashes, severe headache and was positive for dengue serology test. Her lowest platelet count was 45 × 10⁹ cells/L. She complained of sudden onset of painlessness, profound loss of vision bilaterally 7 days after the onset of fever. On examination, her right eye best corrected vision was 6/30 and left eye was 6/120. Her anterior segment examination was unremarkable. Funduscopy revealed there were multiple retinal haemorrhages found at posterior pole of both fundi and elevation at fovea area with subretinal fluid. Systemic examination revealed normal findings except for residual petechial rashes. She was managed conservatively. Her vision improved tremendously after 2 months. The retinal hemorrhages and foveal elevation showed sign of resolving. Ocular manifestations following dengue fever is rare. However, bilateral visual loss can occur if both fovea are involved.