Mohd Nizam Md Hashim

Solid variant of papillary thyroid carcinoma in a 14-year-old girl

Solid variant of papillary thyroid carcinoma (PTC) is a rare, poorly characterised variant and predominantly reported in children with a history of radiation exposure. This variant has a high propensity for extra-thyroidal extension and cervical lymph node metastases. A 14-year-old Malay girl who had no history of radiation exposure, presented with multiple cervical lymphadenopathy and it was clinically suspicious for tuberculosis or lymphoma. An incisional biopsy revealed a metastatic PTC. The patient underwent total thyroidectomy with bilateral lateral neck dissection and histopathology report was solid variant of PTC. Whole-body I131 scan was performed which revealed an intense tracer uptake in the neck. She was planned for radioactive iodine ablation and now on regular follow-up for monitoring of possible tumour metastasis.

Prospective diagnostic study on the use of narrow-band imaging on suspicious lesions during colonoscopy examination: Narrow band imaging

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.

MANAGEMENT OF HYPERTENSION - RELATED INTRACEREBRAL HEMORRHAGE

Intra cerebr al hemorrhage (ICH) is a devastating disease with high rates of mortality and morbidity. ICH occurs as a result from rupture of blood vessels in the brain. This health problem has been increasing in hospital admission since the past 10 years . Patient is a 64 years old male with complain of sudden onset of right sided body weakness and slurred speech in the morning of the day he was admitted to HUSM. Patient presented with drooling saliva, mild tachypneic, aphasia and unable to move right sided limb. He had no history of headache, no chest pain, no blurred vision and no palpitation. Patient was alert and conscious during admission. ICH is a medical emergency, and delays in treatment result in worse outcome. Initial management should focus on urgent stabilizat ion of cardio respiratory variables and treatment of intracranial complications.

MANAGEMENT OF LEFT FRONTAL CAVERNOMA

Cavernoma is blood vessels abnormalities where the blood vessels dilated. It may happen in various locations throughout the brain. Seizure, focal neurological deficit, haemorrhage and headache are most common symptoms of cavernoma. Cavernoma can be diagnosed using MRI, while its treatment options can either be observation, surgical excision or radio surgical depending on the natural course of the lesion, its location relative to eloquent areas of the brain, surgical accessibility and availability of surgeon skills. A 50 years old male patient having seizures was suspected to have low grade glioma after CT scan was done. However, after MRI was done, the patient was diagnosed with cavernoma on left frontal lobe. The treatment course in the hospital was mainly to treat the low grade glioma. However after low grade glioma was rule out, the treatment was stopped and treatment for cavernoma started. The treatment option to treat the patient is surgery excision. The most preferred diagnostic tool for cavernoma is MRI. The selections of treatment in management of cavernoma are observation, surgical excision or radiosurgery depending on the natural of the lesion, its location relative to eloquent areas of the brain, surgical accessibility and finally the neurosurgeon skills.

The Control of Haemostasis of Presacral Venous Haemorrhage with Sterile Thumbtacks and Roller Gauze—Experience in Managing a Case of Recurrent Ovarian Cancer

Decision of relaparotomy is usually become a surgical dilemma as one may encounter dense adhesion before reaching the target site. This may end up with unwanted complication such as iatrogenic injury to adjacent structures as well as bleeding. This is a case of a 46-year-old lady with underlying history of ovarian carcinoma who needed to go for relaparotomy and debulking of recurrent tumour. The attempt to release adhesions was complicated with bleeding at presacral venous plexus. Due to difficulty in achieving haemostasis, bilateral internal iliac artery ligation was done. This procedure did not completely solve the bleeding, so the subsequent step to apply thumbtacks and roller gauze packing were done to create tamponade. The gauzes were removed piece by piece starting from day 8 through small incisional wound without needing to go for another laparotomy.