Search

Arteriovenous fistula (AVF) is an abnormal direct communication between an artery and the venous drainage without a capillary component. Although renal AVF is rare, detecting the disease is important to assist in management and, thus, help reverse the sequelae of the disease such as hypertension and heart failure. The clinical presentation and radiological features are important parameters that can help in the diagnosis and decision of treatment. We would like to share our successful approach to a 52-year-old female with idiopathic high-flow left renal AVF with concomitant renal artery aneurysm using a single Amplatzer vascular plug in the limit of our setting. [ABSTRACT FROM AUTHOR]

Segmental bone allografts are widely used in managing large cortical bone defects. To improve host-graft union, the effect of allograft on a large cortical tibial bone defect augmented with a non-vascularized periosteal flap was studied. Twelve mature Australian white rabbits (Oryctolagus cuniculus) were divided into intervention groups and a control group. Bone defects in the intervention groups were treated with segmental allografts wrapped with a non-vascularized periosteal flap. The control group was treated with allograft transplantation alone. Healing was evaluated at the end of the 2nd, 4th, and 6th weeks with plain radiographs, CT scan, and histology. In the intervention groups, the bony union was achieved at both ends of the allografts at the 4th to 6th weeks. Solid callus encasing the whole allograft segments at the end of the 6th week. In the control group, the union did not occur at both ends of the allograft segments even up to the end of the 6th week. No callus formation surrounding the allograft segments. Fragmentation and telescoping of the allograft segment into the medullary cavity of the host were observed. The use of autogenous, non-vascularized periosteal flap modified the healing process of allograft and maintained the integrity of the allograft. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Ewing sarcoma and primitive neuroectodermal tumor are rare tumors grouped under the spectrum of the Ewing sarcoma family of tumors. These highly malignant tumors involve the bones and commonly occur in children. Ewing sarcoma of the skull bone accounts for only 1% of all Ewing sarcomas, with primary skull base Ewing sarcoma occurring in less than 1% of cases. We present a case of skull base Ewing sarcoma with complete symptom recovery and near-total radiological resolution. Case Report: A 4-year-old girl initially presented with a 2-month history of vomiting, poor oral intake, weight loss, and gradual visual deterioration followed by acute symptoms of fever, breathing difficulties, and seizure. Initial computed tomography and magnetic resonance imaging of the brain displayed a large sinonasal mass with extensive regional infiltration and bony destruction and no evidence of distant metastasis. A transnasal biopsy was taken. The histopathology result revealed features of skull base Ewing sarcoma. The child was given a combination of radiotherapy and chemotherapy, to which she responded well, with a minimal residual tumor. Conclusions: Skull base Ewing sarcoma is a rare entity, presenting a challenge to the reporting radiologists. Differential diagnoses of esthesioneuroblastoma, olfactory neuroepithelioma, and, more commonly, sinonasal carcinoma can be misleading since they have similar radiological appearances to skull base Ewing sarcoma, which differs in treatment regimen and prognosis. Therefore, a combination of histopathological appearance, radiographic findings, and clinical correlation is important to determine the correct diagnosis, establish the appropriate treatment regime, and improve the patient's survival. [ABSTRACT FROM AUTHOR]

Study Design: This is an observational study of computed tomography (CT) data. Purpose: The C1 and C2 laminas in the Malaysian Malay population were analyzed for the feasibility of fitting 3.5-mm laminar screws in a cross configuration. Overview of Literature: Morphometric analysis of the C1 and C2 laminas has been performed for various populations but not for the Malaysian Malay population. Methods: A total of 330 CT cervical images were measured to establish the bicortical diameter of the C1 and C2 laminas as well as their height and length. The C1 posterior tubercle bicortical diameter and height were also determined from these images. All parameters were measured up to 0.1 mm, and statistical analysis was performed using IBM SPSS Statistics ver. 24.0 (IBM Corp., Armonk, NY, USA). An independent t-test and the Pearson chi-square test were used to determine the mean difference and screw acceptance. Results: The means of the C1 lamina measurements were 5.79±1.19 mm in diameter, 9.76±1.51 mm in height, and 20.70±1.86 mm in length. The means of the measurements of the posterior tubercle were 7.20±1.88 mm in diameter and 10.51±1.68 mm in height. The means of the C2 lamina measurements were 5.74±1.31 mm in diameter, 11.76±1.69 mm in height, and 24.96±2.56 mm in length. Overall 65.5% of C1 and 80.3% of C2 laminas are able to accept 3.5-mm screws in a cross configuration. Screw acceptability is similar between the right and left sides ( p>0.05). However, males have a higher screw acceptability compared with females ( p<0.05), except for the C2 left lamina. Conclusions: It is feasible to insert a 3.5-mm screw in a cross configuration in the C1 and C2 laminas of the Malaysian Malay population, especially in males. However, a CT scan should be performed prior to the operation to determine screw acceptability and to estimate screw sizes. [ABSTRACT FROM AUTHOR]

Purpose: We sought to present our preliminary experience on the effectiveness and safety of magnetic resonance imaging (MRI)-guided, high-intensity focused ultrasound (HIFU) therapy using a volumetric ablation technique in the treatment of Association of Asian Nations (ASEAN) patients with symptomatic uterine leiomyomas.Methods: This study included 33 women who underwent HIFU treatment. Tissue characteristics of leiomyomas were assessed based on T2- and T1-weighted MRI. The immediate nonperfused volume (NPV) ratio and the treatment effectiveness of MRI-guided HIFU on the basis of the degrees of volume reduction and improvement in transformed symptom severity score (SSS) were assessed.Results: The median immediate NPV ratio was 89.8%. Additionally, the median acoustic sonication power and HIFU treatment durations were 150 W and 125 min, respectively. At six-month follow-up, the median leiomyoma volume had decreased from 139 mL at baseline to 84 mL and the median transformed SSS had decreased from 56.2 at baseline to 18.8. No major adverse events were observed.Conclusion: The preliminary results demonstrated that volumetric MRI-guided HIFU therapy for the treatment of symptomatic leiomyomas in ASEAN patients appears to be clinically acceptable with regard to treatment effectiveness and safety. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to estimate the annual proportion of positive computed tomography pulmonary angiography (CTPA) in diagnosing pulmonary embolism and determine its socio-demographic and clinical determinants. Materials and Methods: CTPA datasets of 431 patients from 2014 to 2017 were analysed retrospectively to estimate the annual proportion of cases with pulmonary embolism in Kelantan, a northeast state of peninsular Malaysia. Comparative cross-sectional study between positive and negative CTPA cases among 388 randomly selected patients that fulfilled the inclusion criteria was conducted to determine associated factors for positive CTPA finding. Descriptive statistics, simple and multiple logistic regressions were used for data analysis. Result: The annual proportion of positive CTPA cases ranged from 25.2% to 33.3%. The mean age of patients with positive CTPA finding was 50.32 years old and majority of positive CTPA patients were male (67.0 %), cigarette smoker (67.0 %), non-hypertensive (58.9%) and had high Well’s score (74.5%). Older age, male gender and high Wells score were the significant determinants for positive CTPA findings with an adjusted odds ratio (aOR) of 1.03 (95% confidence interval (CI): 1.01-1.05; p = 0.004), 5.42 (95% CI: 2.31-12.68; p < 0.001), and 13.45 (95% CI: 6.93-26.11; p < 0.001), respectively. Conclusion: Patients with older age, male gender and high Wells score were more likely to get positive CTPA finding. These significant determinants might help clinicians in preventing unnecessary CTPA examination, thus unjustified radiation to the patient can be avoided. [ABSTRACT FROM AUTHOR]

Pediatric subdural empyema are frequently seen in developing Asean countries secondary to rinosinusogenic origins. A cross sectional analysis on the surgical treatment of intracranial subdural empyema (PISDE) in Hospital Kuala Lumpur (HKL), a major referral center, was done in the period of 2004. A total number of 44 children who fulfilled the inclusion criteria were included into this study. The methods of first surgery, volume of empyema on contrasted CT brain, improvement of neurological status, re-surgery, mortality and morbidity, as well as the demographic data such as age, gender, sex, duration of illness, clinical presentation, probable origin of empyema, cultures and follow-up were studied. Chi-square test was performed to determine the association between surgical methods and the survival of the patients, neurological improvement, clearance of empyema on CT brain, re-surgery and long morbidity among the survivors. If the 20% or more of the cells were having expected frequency less than five, then Fisher's Exact test was applied. The level of significance was set at 0.05. SPSS version 12.0 was used for data entry and data analysis. There were 44 patients who were less than 18 years. Their mean age was 5.90 ± 6.01 years. There were 30 males (68.2%) and 14 females (31.8%) involved in the study. Malays were majority with 28 (63.6%) followed by Indian 8 (18.2%), Chinese 5 (11.4%) and others 3 (6.8%). The variables which were under interest were gender, race, headache, vomiting, seizures, sign of meningism, cranial nerve palsy, thickness site of abscess, first surgical treatment, improvement in neurological deficit, clearance of CT and whether re-surgery was necessary. All variables were found not to be associated with Henk W Mauser Score for PISDE grading. Comparison between this urban study and a rural setting study by the same corresponding author in the same period on subdural empyema was done. Common parameters were compared and it was found out that seizures was more prevalent in urban study where the patients were more than one year old (p=0.005). Mortality was much higher in urban study than the rural one (p=0.040). The larger proportion of urban group had volume of abscess less than or equal to 50 ml (p=< 0.001). [ABSTRACT FROM AUTHOR]

A letter to the editor about a study which examines the role of intra-arterial digital subtraction angiography (IADSA) in the development of cerebral vasospasm (CVS) in patients who are diagnosed with spontaneous subarachnoid haemorrhage (SAH) is presented.

Background: Hippocampal volume is affected by several psychiatric illnesses of old age, as well as by normal aging. It is important to have a normal data in a population to assist in diagnosis. The aim of this study is to determine hippocampal volume in normal Malay people aged 50 years old and older. Methods: This was a cross-sectional study of the normal Malay population aged 50 to 77 years. We included 43 participants, representing 19 men and 24 women. Magnetic resonance imaging (MRI) was performed using a GE Signa Horizon LX 1.0 Tesla. Oblique coronal images of temporal lobes were obtained and hippocampal volumetry was done manually and normalised with intracranial volume. Results: Mean right and left hippocampal volumes (HCVs) were 3.43 cm3 (SD 0.32) and 3.26 cm3 (SD 0.34), with a significant difference between them (P < 0.001). Total mean HCVs exhibited no significant difference between men and women (P = 0.234). The means of the normalised right and left HCVs were 3.42 cm3 (SD 0.31) and 3.26 cm3 (SD 0.32). Conclusion: The mean right and left hippocampal volumes were significantly different in this study. Men had slightly larger mean HCVs but the difference was not statistically significant. It was found that normalisation further reduces the mean volume difference between the genders. [ABSTRACT FROM AUTHOR]

Introduction: Hemoptysis is a common condition that is seen in cases of pulmonary disease. Arterial embolization is the preferred treatment for this disease entity. In cases of hemoptysis, the bronchial arteries from the systemic circulation are the primary cause of bleeding. There are also systemic nonbronchial arteries that contribute to hemoptysis. Case report: 38 y old malay male with history of uncontrolled recurrent hemoptysis since 1990. Recently, had bouts of hemoptysis amounting to about 1/2 cup of fresh blood daily in the last two weeks before admission. No fever, LOA, LOW, or night sweating. No history of exposure to TB patients. Sputum culture: normal URT flora. Direct smear microscopy: Negative. ESR: 24.4 mm/hr. WBC: 8.1x10_/mm_. Chest radiograph showed cavitating lesion in the left upper zone, which has thin, smooth wall. An intracavitory lesion, which is fairly homogenous and well defined. CT thorax showed multiple cavitating lesion with intracavitory lesion in left upper lobe of the lung. Medical treatment with fluconazole 200-400 mg daily for 3 months has failed to control the hemoptysis. Bronchial arteriography KIV embolization was decided. Arteriography was performed and Bronchial Arteries were not demonstrated suggesting the presence of a variant of origin of the bronchial artery or systemic non bronchial arteries. After a repeat arteriography was performed,the left internal mammary artery (LIMA)was enlarged and blush seen.Selective arteriography of the branches of the LIMA was carried out and embolization performed using Polyvinyl Alcohol PVA (150-250 µm). Subsequently coiling of branches from left internal mammary using fiber platinum coil-18 (2mm). Conclusion: Interventional radiologists should be aware of the possible presence of arterial variants during initial angiography. Conclusion: Interventional radiologists should be aware of the possible presence of arterial variants during initial angiography. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) is a noninvasive method for determining brain morphology and volumetry. Hippocampal volume changes are observed in conjunction with several diseases. This study aimed to determine the normalised volume of the hippocampus in normal Malay children and adolescents., Methods: This was a cross-sectional study performed from January 2009 to June 2010. Brain and temporal lobe MRI was performed for 81 healthy normal Malay individuals aged 7-18 years. Manual volumetry was performed. The hippocampal volumes were normalised with the total intracranial volume., Results: The original right, left, and total hippocampal volumes (mean and standard deviation) were 3.05 (0.48) cm(3), 2.89 (0.44) cm(3), and 5.94 (0.90) cm(3), respectively. Normalised hippocampal volumes for the right, left, and total volume were 3.05 (0.41) cm(3), 2.89 (0.41) cm(3), and 5.94 (0.79) cm(3), respectively. Pearson's correlation coefficient for the right and left hippocampal volumes with intracranial volume were 0.514 and 0.413, respectively (P < 0.001). Both the original and normalised hippocampal volumes of the right hippocampus were significantly larger than those of the left (P < 0.001)., Conclusion: This is a data set for the local Malay paediatric population. There was no significant difference between the actual and normalised values of hippocampal volume in our study.

Background: Central nervous system arteriovenous malformation (AVM) is a vascular malformation of the brain and involves entanglement of veins and arteries without an intervening capillary bed. Affecting predominantly young male patients, AVM presents with different clinical manifestations namely headache, seizures, neurological deficit and intracranial haemorrhage. The patients who present acutely with intracranial bleeding have a significant morbidity and mortality. The aim is to study the angioarchitecture of brain AVM (BAVM) and determine the risk factors for intracranial bleeding. Ultimately, the goal of the study is to look for the association between volume of haematoma and architecture of BAVM., Methods: A cross-sectional study of 58 patients was conducted at the Hospital Universiti Sains Malaysia. Data were collected over a period of seven years (2000 to 2007) to look for the association between the angioarchitecture of brain arteriovenous malformations (BAVM), haemodynamics and the natural history and risk of intracranial haemorrhage., Results: BAVM was predominantly found in young male patients in 65.5%. Small nidal size (P-value=0.004), deep location (P-value=0.003) and deep venous drainage (P-value=0.006) were found to be significant factors contributing to intracranial haemorrhage. All patients with coexisting intranidal or prenidal aneurysms presented with intracranial haematoma., Conclusion: The angioarchitecture of BAVM like nidal size, deep location and deep venous drainage can predict the risk of intracranial bleeding and can help in the management of high risk patients without any delay. Small sized and deep seated lesions have a diffuse type of intracranial bleed which eventually need more attention to the managing team as diffuse haematoma indicates more insult to brain.