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Kota Bharu, Malaysia

Boutasta T.,Orthopedic Surgery Unit | Nekhla A.,Cardiothoracic Surgery Unit
Injury Extra | Year: 2013

The posterior variety of sternoclavicular joint dislocation is an uncommon condition accounting for 0.06% of all shoulder injuries, the diagnosis is often missed, but frequently associated to a high morbidity by compromising the great vessels, trachea, oesophagus, or lungs. Although the majority of these complications are observed in acute presentation, few reports noted late complications with chronic unreduced dislocation. © 2013.

Tennyson C.,Ulster Hospital | Lee R.,Cardiothoracic Surgery Unit | Attia R.,Guys and St Thomas Hospital London
Interactive Cardiovascular and Thoracic Surgery | Year: 2013

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was is there a role for HbAlc in predicting morbidity and mortality outcomes after coronary artery bypass surgery? Eleven studies presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The studies presented analyse the relationship between preoperative HbAlc levels and postoperative outcomes following coronary artery bypass graft (CABG) in diabetic, non-diabetic or mixed patient groups. Four studies found significant increases in early and late mortality at higher HbAl c levels, regardless of a preoperative diagnosis of diabetes. One study demonstrated that 30-day survival outcomes were significantly worse in patients with previously undiagnosed diabetes and elevated HbAlc compared with those with good control [HbAl c > 6%; odds ratio 1.53, confidence interval (CI) (1.24-1.91); P = 0.0005]. However, four studies of early mortality outcomes in diabetic patients only showed no significant differences between patients with normal and those with deranged HbAlc levels (P= 0.99). There were mixed reports on morbidity outcomes. Three studies identified a significant increase in infectious complications in patients with poorly controlled HbAlc, two of which were irrespective of previous diabetic status [deep sternal wound infection (P = 0.014); superficial sternal wound infection (P = 0.007) and minor infections (P = 0.006) in poorly controlled diabetics only]. Four studies presented outcomes for total length of stay (LOS). Three of these papers looked specifically at diabetic patients, of which two found no significant differences in length of stay between good and poor preoperative glycaemic control [LOS: P= 0.59 and 0.86 vs P < 0.001]. However, elevated HbAlc vs normal HbAlc was associated with prolonged stay in hospital and in intensive care unit (ICU) in patients irrespective of previous diabetic status [total LOS (P< 0.001)]. Elevated HbAlc levels were also a significant predictor of reduced intraoperative insulin sensitivity in diabetic patients (R =-0.527; P< 0.001). Furthermore, higher HbAlc levels were associated with a reduced incidence of postoperative atrial fibrillation (P = 0.001). We conclude that elevated HbA1 c is a strong predictor of mortality and morbidity irrespective of previous diabetic status. In particular, the mortality risk for CABG is quadrupled at HbAl c levels > 8.6%. Some studies have called into question the predictive value of HbAl c on short-term outcomes in well-controlled diabetics; however, long-term outcomes in this population have not been reported.

Wong D.W.-S.,University of Hong Kong | Leung E.L.-H.,University of Hong Kong | Wong S.K.-M.,University of Hong Kong | Tin V.P.-C.,University of Hong Kong | And 5 more authors.
Cancer | Year: 2011

BACKGROUND: The anaplastic lymphoma kinase (ALK) gene is involved frequently in chromosomal translocations, resulting in fusion genes with different partners found in various lymphoproliferative conditions. It was recently reported in nonsmall cell lung cancer (NSCLC) that the fusion protein encoded by echinoderm microtubule-associated protein-like 4-ALK (EML4-ALK) fusion gene conferred oncogenic properties. The objective of the current study was to identify other possible ALK fusion genes in NSCLC. METHODS: Immunohistochemical analysis was used to screen for aberrant ALK expression in primary NSCLC. The authors used 5′ rapid amplification of complementary DNA ends to screen for potential, novel 5′ fusion partners of ALK other than EML4-ALK. Reverse transcriptase-polymerase chain reaction and fluorescence in situ hybridization analyses were used to confirm the identity of 5′ fusion partners. The genomic breakpoint was verified using genomic sequencing. Overexpression of the novel ALK fusion gene and variants 3a and 3b of EML4-ALK was performed to assess downstream signaling and functional effects. RESULTS: The authors identified a novel gene resulting from the fusion of kinesin family member 5B (KIF5B) exon 15 to ALK exon 20 in a primary lung adenocarcinoma. Western blot analysis of clinical tumor tissues revealed the expression of a protein whose size correlated with that of the predicted KIF5B-ALK. Overexpression of KIF5B-ALK in mammalian cells led to the activation of signal transducer and activator of transcription 3 and protein kinase B and to enhanced cell proliferation, migration, and invasion. CONCLUSIONS: The discovery of the novel KIF5B-ALK variant further consolidated the role of aberrant ALK signaling in lung carcinogenesis. Copyright © 2011 American Cancer Society.

Yap K.H.,Cardiothoracic Surgery Unit | Jones M.,Cardiothoracic Surgery Unit
Journal of Cardiothoracic Surgery | Year: 2013

The authors report a rare case of 17-year-old lady with late presentation of congenital diaphragmatic hernia. She presented with vague abdominal pain and was thought to have urinary tract infection, ruptured ovarian cyst, and appendicitis by different medical teams in the first few days. She eventually underwent a diagnostic laparoscopy with no significant findings. In the early postoperative recovery period, she suffered from severe cardiorespiratory distress and a large intestinal left diaphragmatic hernia was diagnosed subsequently. At further operation a strangulated loop of large bowel herniating through a left antero-lateral congenital diaphragmatic hernia was discovered, which was reduced and repaired with a prolene mesh through thoracotomy. She made an excellent recovery and was discharged a few days after the operation. The authors postulate a mechanism of positive pressure from laparoscopic surgery causing herniation of large bowel through a pre-existing diaphragmatic defect. This case highlights the diagnostic challenge of this disease due to its diverse clinical presentation, the importance of prompt diagnosis and intervention. © 2013 Yap and Jones; licensee BioMed Central Ltd.

Azhar I.O.,Cardiothoracic Surgery Unit | Anas R.,Cardiothoracic Surgery Unit
Medical Journal of Malaysia | Year: 2013

We report a case of two babies with absence of pericardium and patent ductus arteriosus (PDA). The absence of pericardium was found coincidentally during PDA ligation. The PDA was successfully ligated but the pericardium was not reconstructed. Postoperatively, the agenesis of the pericardium did not interfere with cardiac function.

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