EXIT Llyod Davies

The EXIT (Ex utero intrapartum treatment) procedures have been, with a high degree of success, employed to treat a myriad types of fetal airway obstruction most commonly neck masses such as cystic hygroma and lymphangioma with ample plan including prenatal diagnosis by ultrasound scan or MRI. Before the advent of EXIT, formal documentations had been published with descriptions of intubation during intrapartum period and fetal airway protection either during normal or operative delivery. We report a 28-year-old gravida 2 para 1 who was referred to our Maternal Fetal Medicine (MFM) unit at 26 weeks and 3 days gestation with a foetal neck mass. We present a case of an successful EXIT procedure performed in the Lloyd Davies position with the hips abducted and flexed at 15 degrees as is employed during gynecologic laparoscopy surgery minus the Trendelenburg tilt. Both mother and baby are well. The benefits of this position are discussed.

A Pure Nongestational Choriocarcinoma of Ovary: Sharing Experience in Sabah

A pure ovarian choriocarcinoma is a very rare disease which can be either pregnancy related (gestational), may not be related (non-gestational), or commonly correlated with different type of germ cell; teratocarcinoma, dysgerminoma or undifferentiated carcinoma. A pure non-gestational primary ovarian choriocarcinoma is astronomically uncommon and we recorded such condition in 14-year-old teenage girl’s ovary. An abdominal operative procedure with the help of a careful histopathology examination revealed choriocarcinoma in absence of other type of germ cell element. Multiple courses of Etoposide/Methotrexate/Actinomycin-D (EMA) regime of chemotherapy were shown to be effective in this case.

Improving door-to-doctor and door-to-analgesia time in a tertiary teaching hospital emergency department through a novel 'Red Box' system

To evaluate the effectiveness of a new patient flow system, 'The Red Box' on the quality of patient care in respect of the time taken for the care to be delivered to the patient. A pre-post study was conducted looking at the door-to-doctor [DTD] and door-to-analgesia [DTA] times for cases presenting to the Emergency Department [ED] of a tertiary teaching hospital 'The National University of Malaysia Medical Center' between the periods of July and September 2005 against July and September 2008. Demographic data, ED presentation time, time seen by first doctor, and time first analgesia given were collected in both periods and analyzed. A total of 1,000 cases were enrolled. Group A [pre-Red Box] and group B [post-Red Box] comprised 500 cases each. The mean DTD time for group A was 29 minutes [SD +/- 3 minutes] and for group B was 3 minutes [SD +/- 1 minute], with a 98.8% reduction [p<0.001]. For DTA time, group A recorded a mean of 46 minutes [SD +/- 3 minutes], and group B recorded a mean of 9 minutes [SD +/- 2 minutes], an 80.4% reduction [p<0.001]. The implementation of a red box system improved the quality of emergency patient care in the ED of a tertiary teaching hospital as evidenced by significant reductions in DTD and DTA time

Management of Extensive Surgical Wounds of the Extremity after Tumour Resections Using Two Simultaneous Composite Flaps: Two Case Reports

Tumour surgery for locally extensive malignant neoplasms of the extremity will sometimes result in extensive composite soft tissue defect. Local flaps are usually inadequate to cover these large defects. More than one tissue flap might be required to cover any exposed neurovascular structures, bone or prosthesis. We present two cases where two composite flaps were simultaneously used to cover extensive surgical defects after ablative tumour resections in the extremity. These resulted in uncomplicated wound healing and limb salvage.

Intermediate-term follow-up after transmyocardial laser revascularisation.

Transmyocardial laser revascularisation has emerged as a new therapeutic option for patients with severe diffuse coronary artery disease refractory to conventional modes of therapy. One hundred and two patients underwent isolated transmyocardial laser revascularisation between December 1994 and November 1997. After transmyocardial laser revascularisation, angina class improved from 2.56 +/- 0.8 to 0.8 +/- 0.9 by the end of one year and 54 percent patients were angina-free. Treadmill test workload increased from 3.6 +/- 1.7 METS pre-operatively to 6.0 +/- 3.4 METS (p < 0.005) at the end of one year's follow-up. However, left ventricle ejection fraction by MUGA slightly decreased (p = NS) at the end of one year. We conclude that transmyocardial laser revascularisation provides symptomatic benefit, improves quality of life and objectively improves the exercise tolerance at 12 months post-procedure.