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Chandra Sakaran KR, Tiew T, Kamil K, Habeebullah Khan HA, Idris MA, Safri LS. Bilateral carotid body tumours: a case report from surgeon's perspective. J Surg Case Rep 2024; 2024:rjae011. [PMID: 38487394 PMCID: PMC10937255 DOI: 10.1093/jscr/rjae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/10/2024] [Indexed: 03/17/2024] Open
Abstract
Carotid body tumour (CBT) is the most common paraganglioma of the head and neck and may compromise neurovascular structures such as carotid vessels, and cranial nerves. Intracranial extension from the mass is possible if left untreated. The main treatment for CBT is surgical resection albeit extremely challenging due to tumour hypervascularity and its relationship to the carotid artery. A bilateral CBT, however, is a rare occurrence. Herein, we present a case of a man who presented to us with bilateral painless and palpable neck mass. He underwent staged bilateral CBT excision and it was complicated with left hypoglossal nerve palsy, which recovered over time.
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Affiliation(s)
- Kishen Raj Chandra Sakaran
- Vascular Unit, Department of Surgery, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Cheras 56000, Kuala Lumpur, Malaysia
| | - Toot Tiew
- Vascular Unit, Department of Surgery, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Cheras 56000, Kuala Lumpur, Malaysia
| | - Khidhir Kamil
- Vascular Unit, Department of Surgery, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Cheras 56000, Kuala Lumpur, Malaysia
| | - Hisham Arshad Habeebullah Khan
- Vascular Unit, Department of Surgery, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Cheras 56000, Kuala Lumpur, Malaysia
| | - Mohamad Azim Idris
- Vascular Unit, Department of Surgery, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Cheras 56000, Kuala Lumpur, Malaysia
| | - Lenny Suryani Safri
- Vascular Unit, Department of Surgery, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Cheras 56000, Kuala Lumpur, Malaysia
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M Azmi N, Safri LS, Abdul Rahman N, Dualim DM, Chandrakanthan S. A Rare Incidence of Splenic Artery Aneurysm and Hypersplenism. Cureus 2024; 16:e54280. [PMID: 38371434 PMCID: PMC10870191 DOI: 10.7759/cureus.54280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 02/20/2024] Open
Abstract
A 31-year-old woman with Child's B liver cirrhosis with portal hypertension and splenomegaly presented with a one-month history of abdominal pain. A physical examination confirmed splenomegaly. A blood investigation revealed a low white blood cell (WBC) and platelet count. Computed tomography (CT) revealed a splenic artery aneurysm at the distal splenic artery measuring 3.4 x 3.4 x 4.3 cm (AP x W x CC) with thrombus and splenic infarction. A successful angiographic embolisation was performed without immediate complications. The abdominal pain symptoms resolved, leading to the patient's discharge from the ward on the third day post-embolisation. Follow-up at the surgical outpatient clinic indicated the patient remained asymptomatic, and repeated blood counts showed improvement in both WBC and platelet counts. Furthermore, follow-up CT scans demonstrated a reduction in spleen size, indicating positive outcomes and a favourable response to the intervention.
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Affiliation(s)
- Nabil M Azmi
- Department of Surgery, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, MYS
| | - Lenny Suryani Safri
- Department of Surgery, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, MYS
| | | | - Diana Melissa Dualim
- Department of Surgery, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, MYS
| | - Soma Chandrakanthan
- Department of Surgery, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, MYS
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Safri LS, Lip HTC, Saripan MI, Huei TJ, Krishna K, Md Idris MA, Harunarashid H. Older age and duration of exposure to type 2 diabetes in selective screening of asymptomatic carotid artery stenosis for primary stroke prevention-A single institution experience. Prim Care Diabetes 2020; 14:364-369. [PMID: 31744790 DOI: 10.1016/j.pcd.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 12/19/2022]
Abstract
AIMS To evaluate the incidence and risk factors for carotid artery stenosis amongst asymptomatic type 2 diabetes from a single Malaysian tertiary institution. METHODS This is a prospective cross-sectional study of asymptomatic type 2 diabetics selected from the outpatient ophthalmology and endocrine clinics for carotid duplex ultrasound scanning performed by a single radiologist. The duplex ultrasound criteria were based on the North American Symptomatic Carotid Endarterectomy Trial (NASCET) classification of carotid artery stenosis. Univariate and multivariate analysis was performed to identify possible risk factors of carotid artery stenosis. RESULTS Amongst the 200 patients, the majority were males (56%) and Malay predominance (58.5%). There were 12/200 patients (6%) with mean age of 69.2 years identified to have carotid artery stenosis. Univariate analysis of patients with asymptomatic carotid artery stenosis identified older age of 69.2 years (p=0.027) and duration of exposure to diabetes of 17.9 years (p=0.024) as significant risk factors. CONCLUSION Patients with longer exposure of diabetes and older age were risk factors of carotid artery stenosis in asymptomatic type 2 diabetics. These patients should be considered for selective screening of carotid artery stenosis during primary care visit for early identification and closer surveillance for stroke prevention.
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Affiliation(s)
- Lenny Suryani Safri
- Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, 50603 Kuala Lumpur, Malaysia.
| | - Henry Tan Chor Lip
- Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, 50603 Kuala Lumpur, Malaysia; Department of Surgery, Hospital Sultanah Aminah, Johor Bahru, Malaysia.
| | - M Iqbal Saripan
- Department of Computer and Communication Systems Engineering, Faculty of Engineering, Universiti Putra Malaysia.
| | - Tan Jih Huei
- Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, 50603 Kuala Lumpur, Malaysia; Department of Surgery, Hospital Sultanah Aminah, Johor Bahru, Malaysia.
| | - K Krishna
- Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, 50603 Kuala Lumpur, Malaysia.
| | - Mohamad Azim Md Idris
- Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, 50603 Kuala Lumpur, Malaysia.
| | - Hanafiah Harunarashid
- Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, 50603 Kuala Lumpur, Malaysia.
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Henry TCL, Huei TJ, Yuzaidi M, Safri LS, Krishna K, Rizal IA, Mohamad Azim MI, Harunarashid H. Unexpected complication of arteriovenous fistula of the left common carotid to internal jugular vein following central venous catheterization. Chin J Traumatol 2020; 23:29-31. [PMID: 31744657 PMCID: PMC7049590 DOI: 10.1016/j.cjtee.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/11/2019] [Accepted: 10/03/2019] [Indexed: 02/04/2023] Open
Abstract
Incidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of <1%. This is due to the advancements and wide availability of ultrasound to guide its insertion. Formation of arteriovenous fistula after arterial puncture is an unexpected complication. Till date, only five cases (including this case) of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture. The present case is a 26-year-old man sustained traumatic brain injuries, chest injuries and multiple bony fractures. During resuscitative phase, attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery. Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula. The catheter was removed successfully and common carotid artery was repaired. Postoperatively, the patient recovered and clinic visits revealed no neurological deficits. From our literature review, the safest method for removal is via endovascular and open surgical removal. The pull/push technique (direct removal with compression) is not recommended due to the high risk for stroke, bleeding and hematoma formation.
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Affiliation(s)
- Tan Chor Lip Henry
- Trauma Surgery Unit, Department of Surgery, Hospital Sultanah Aminah, Johor Bahru, Malaysia,Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia,Corresponding author. Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Tan Jih Huei
- Trauma Surgery Unit, Department of Surgery, Hospital Sultanah Aminah, Johor Bahru, Malaysia,Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mohamad Yuzaidi
- Trauma Surgery Unit, Department of Surgery, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Lenny Suryani Safri
- Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - K. Krishna
- Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Imran Alwi Rizal
- Trauma Surgery Unit, Department of Surgery, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Md Idris Mohamad Azim
- Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hanafiah Harunarashid
- Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Safri LS, Idris MA, Harunarashid H. Prevalence and the Risk Factors for Asymptomatic Carotid Artery Stenosis Among Type II Diabetes Mellitus Patients. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kumar A/L S Katheraveloo K, Suryani Safri L, Guo Hou L, Hafiz Maliki A, Md Idris MA, Harunarashid H. Effect of isometric handgrip exercise on the size of cephalic veins in patients with stage 3 and 4 chronic kidney disease: A randomized controlled trial. J Vasc Access 2019; 21:372-378. [DOI: 10.1177/1129729819879314] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Proper vascular access is essential for the long-term survival of chronic haemodialysis patients. The preferred vascular access in terms of long-term function is the native arteriovenous fistula. The success of native arteriovenous fistula depends mainly on a sufficient vein diameter. Thus, any intervention that could increase vein diameter before arteriovenous fistula creation could improve its patency. We conduct a study to investigate the effect of local physical training, namely handgrip exercise, on the distal forearm cephalic vein diameter in patients with chronic renal disease. Material and methods: A total of 34 chronic renal disease patients (stage 3 and 4) were recruited in a randomized controlled trial. Handgrip exercise was performed for 8 weeks in the intervention group. Handgrip-strength measurement and distal forearm cephalic vein diameter of a non-dominant hand with and without tourniquet was recorded (measurement is taken 1 cm proximal to the radial styloid). Results: After 8 weeks, the mean cephalic vein diameter in the intervention group increased from 1.77 and 1.97 mm to 2.15 and 2.43 mm, without and with a tourniquet, respectively ( p < 0.05). There is also a significant change in the mean diameter of distal forearm cephalic vein ( p < 0.05) in the intervention group when measured in both the absence (mean change 0.39 ± 0.06 mm vs 0.01 ± 0.02 mm) and the presence of tourniquet (mean change 0.47 ± 0.07 mm vs 0.01 ± 0.01 mm). Conclusion: These findings suggest that non-invasive handgrip exercise can increase in the diameter of the distal forearm cephalic vein, thereby increasing the rate of successful arteriovenous fistula creation.
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Affiliation(s)
| | - Lenny Suryani Safri
- Vascular Surgery Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Loo Guo Hou
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Mohamad Azim Md Idris
- Vascular Surgery Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Caunter G, Faeez Md Noh MS, Safri LS, Kumar K, Md Idris MA, Harunarashid H, Yahaya A. Delayed Presentation of Metastatic Renal Cell Carcinoma as an Arteriovenous Malformation Mimicking Vascular Tumour of the Forearm. EJVES Short Rep 2019; 44:19-22. [PMID: 31453386 PMCID: PMC6704251 DOI: 10.1016/j.ejvssr.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/13/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022] Open
Abstract
Introduction The development of metastatic renal cell carcinoma (RCC) many years after a nephrectomy is not common but has been reported. A metastasis appearing as a hypervascular tumour, mimicking an arteriovenous malformation (AVM), is a highly unusual phenomenon, with a biopsy required for diagnostic confirmation. Surgery is an option for a solitary metastatic lesion amenable to complete excision, with proven survival benefits. However, widespread metastatic disease carries a very poor prognosis, and is best treated with systemic agents such as anti-angiogenic drugs or tyrosine kinase inhibitors. Report A 58 year old man developed an AVM mimicking a vascular tumour within his left brachioradialis muscle 10 years after a nephrectomy for RCC. Ultrasound and magnetic resonance imaging did not reveal any suspicious features of the vascular lesion.The lesion was successfully removed surgically, and was later proven histopathologically to be metastatic RCC. Further imaging showed widespread metastatic disease, and the patient survived only 15 months after receiving tyrosine kinase inhibitor therapy. Discussion This case report aims to highlight a few important points: RCC metastases may be hypervascular, mimicking an AVM. A long disease free interval does not necessarily exclude recurrence or metastasis, as in this case, therefore long term surveillance is recommended. A high index of suspicion must be maintained to avoid delay in treatment, and biopsy of any suspicious lesion for histological examination is mandatory, albeit after many years of cancer remission. Whole body imaging with computed tomography or positron emission tomography computed tomography may detect clinically occult recurrence or metastases, and is important to guide further treatment.
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Affiliation(s)
- Gillian Caunter
- Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Lenny Suryani Safri
- Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Krishna Kumar
- Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mohamad Azim Md Idris
- Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hanafiah Harunarashid
- Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Azyani Yahaya
- Department of Pathology, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Safri LS, Md Noh MSF, Hariz Ramli AR, Md Pauzi SH, Md Idris MA, Harunarashid H. A case of metastatic adenocarcinoma from an unknown primary involving the aortic bifurcation. J Vasc Surg Cases Innov Tech 2018; 4:160-162. [PMID: 29942910 PMCID: PMC6012993 DOI: 10.1016/j.jvscit.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/08/2018] [Indexed: 11/26/2022]
Abstract
Aortic malignant neoplasms are rare; these may be primary or secondary (metastatic). Increasing use of cross-sectional imaging has allowed better detection and diagnosis of these conditions. We encountered a young woman presenting with acute abdomen who was found on cross-sectional imaging to have a malignant tumor involving the aortic bifurcation. An en bloc excision of the tumor was performed, with distal aorta reconstruction using an aortoiliac Dacron graft; this was complicated with infection and graft occlusion, necessitating total removal and extra-anatomic bypass. A pathologic diagnosis of metastatic adenocarcinoma involving the aortic bifurcation, with an unknown primary, was made.
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Affiliation(s)
- Lenny Suryani Safri
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Malaysia
| | | | - Ahmad Rafizi Hariz Ramli
- Department of Surgery, Faculty of Medicine, Universiti Malaya Medical Center, Petaling Jaya, Malaysia
| | - Suria Hayati Md Pauzi
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Malaysia
| | - Mohamad Azim Md Idris
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Malaysia
| | - Hanafiah Harunarashid
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Malaysia
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