Chyle fistula may be common in the neck and thorax region but it is a rare entity in the inguinal region. The rarity of the incidence of chyle fistula and the tremendous response to conservative management are the important aspects to be remembered. We hereby report a case of iatrogenic inguinal chyle fistula complicating a femoral vein cannulation.
The Bio-ecological Drainage System, or BIOECODS, is an urban drainage system located at the Engineering Campus, Universiti Sains Malaysia. It consists of a constructed wetland as a part of the urban drainage system to carry storm water in a closed system. In this closed system, the constructed wetland was designed particularly for further treatment of storm water. For the purpose of studying the water balance of the constructed wetland, data collection was carried out for two years (2007 and 2009). The results show that the constructed wetland has a consistent volume of water storage compared to the outflow for both years with correlation coefficients (R(2)) of 0.99 in 2007 and 0.86 in 2009.
The photo-degradation of nutrients in stormwater in photocatalytic reactor wet detention pond using nano titanium dioxide (TiO2) in concrete was investigated in a scale model as a new stormwater treatment method. Degradation of phosphate and nitrate in the presence of nano-TiO2 under natural ultra violet (UV) from tropical sunlight was monitored for 3 weeks compared with normal ponds. Two types of cement, including ordinary Portland and white cement mixed with TiO2 nano powder, were used as a thin cover to surround the body of the pond. Experiments with and without the catalyst were carried out for comparison and control. Average Anatase diameter of 25 nm and Rutile 100 nm nano particles were applied at three different mixtures of 3, 10 and 30% weight. The amounts of algae available orthophosphate and nitrate, which cause eutrophication in the ponds, were measured during the tests. Results revealed that the utilization of 3% up to 30% weight nano-TiO2 can improve stormwater outflow quality by up to 25% after 48 h and 57% after 3 weeks compared with the control sample in normal conditions with average nutrient (phosphate and nitrate) removal of 4% after 48 h and 10% after 3 weeks.
Four cases of emphysematous pyelonephritis are reported and the pathogenesis, surgical implications and preferred mode of management are discussed. We have not found percutaneous drainage to be useful, but feel there is an important place for surgical drainage alone because of the potential for renal recovery and the risks of emergency nephrectomy.
We report two patients, who have used Pneumostat to replace the conventional underwater seal drainage system for recurrent pneumothorax. Both patients had required repeated chest tube insertion for recurrent pneumothorax and needed a longer hospital stay. Both patients were able to be discharged with the Pneumostat device and were reviewed in outpatient clinic. Both patients had optimal clinical improvement and chest X-ray showed no residual pneumothorax.
The indwelling pleural catheter (IPC) is a 16-Fr-multifenestrated catheter. It has become an accepted practice in the management of malignant pleural effusion, especially in patients with non-expandable lung. However, IPC blockage or not draining is common. A 53-year-old female with malignant pleural effusion presented to us with blocked IPC and symptomatic pleural loculation one month after IPC insertion. After failing saline flushing and low-pressure wall suction, intrapleural alteplase was instituted through the IPC with a favourable outcome, and she continued to drain daily thereafter. The present case highlights the safety of intrapleural alteplase via IPC in the non-expandable lung.
Neurogenic bladder is one of the negative consequences following a spinal cord injury (SCI). SCI patients who have neurogenic bladder depend on alternative methods to drain urine from their bladder. These include indwelling catheters, reflex voiding , suprapubic tapping and intermittent catheterisation. This review summarizes evidence from the literature of five selected complications (renal failure, urinary tract infections, calculi, urethral stricture, and bladder cancer) that could result from use of the different bladder drainage methods. There is inconsistent evidence to support the superiority of intermittent over indwelling catheterisation on risk of renal impairment, urethral stricture, and renal calculi. Indwelling catheterisations are associated with higher risk of bladder calculi and cancer. Caution needs to be taken when interpreting this review, as many of its findings are from retrospective studies, and more than a decade old. Clinicians need to communicate the evidence to their patients when making the decision on method of bladder drainage.
Re-expansion pulmonary oedema (RPE) is an uncommon complication that occurs when a collapsed lung suddenly re-expands, resulting in an osmotic shift of fluid from the blood vessels into the air spaces within the lungs. This condition can develop following thoracocentesis or intercostal chest drainage. We report two cases of RPE that developed after varying volumes of pleural drainage and at different times. Both patients responded well to non-invasive ventilation and hydrocortisone, making a full recovery. Early detection is crucial as RPE is associated with higher mortality rates, but a positive prognosis is attainable with prompt identification and intervention.
A late preterm newborn baby presented with respiratory distress and increasing cyanosis within 2 hours of birth. Bedside transthroracic echocardiography showed a critically obstructed vertical vein in a supracardiac total anomalous pulmonary venous drainage (TAPVd). Emergency stenting of the vertical vein was successfully performed at 24 hours of life.
This case report describes an unusual case of extrapulmonary tuberculosis of the ischial tuberosity presenting with chronic gluteal pain of 4 years duration. The patient presented when the pain became intolerable; at that time, the ischial tuberosity was debrided and curetted while incision and drainage were used to treat the gluteal abscess. Antituberculosis chemotherapy was administered (for a period of one year) following histopathological confirmation of tuberculosis. At four yearspostoperatively, the patient has no pain and is symptom free. Furthermore, radiographs shows that the right ischial tuberosity osteomyelitis has healed. Prompt diagnosis and treatment resulted in a good clinical outcome in this patient.
Melioidosis is an infectious disease which is associated with high rate of mortality. We reviewed 33 patients treated in our hospital over a period of 14 months. About half (55%) of these patient presented with one focus of infection while the rest had multifocal infections. 81% require drainage of abscess or arthrotomy. Four patients (12%) died as a result of septicaemia and the rate is lower than those reported in literature. We conclude that mortality of melioidosis can reduce with early diagnosis followed by appropriate and prolonged antibiotic therapy.
This study presents a theoretical framework based on power law distribution to identify the vulnerable regions to soil loss in Susu river basin at Cameron Highlands, Malaysia by using the geomorphologic factors from Digital Elevation Model (DEM). Drainage area is used to describe the runoff aggregation structure of the watershed which represents the magnitude of discharge. Stream power is also used to describe the energy expenditure pattern of the watershed. They are fitted to power law distribution by means of the maximum likelihood to estimate the threshold for soil loss. The landscape stability condition is assessed through the mechanism of channel initiation. Two regions in the slope area plot are recognized as the regimes susceptible to soil loss, in that discharge, local slope and energy are sufficient for the initiation of soil movement. The result is further improved by incorporating the Topographic Wetness Index (TWI) aiming to locate vulnerable regions to soil loss under the dynamic saturation process. The final result indicates that the vulnerable regions expand from perennial reaches to ephemeral reaches as saturation process develops. It implies the transition of runoff generation from groundwater in perennial reaches to surface runoff in ephemeral reaches. Identification of soil loss vulnerable regions under the dynamic saturation process helps in planning of the mitigation measures for soil erosion.
Spatial and temporal variations in silica concentration were determined at various rivers and tributaries in the Linggi River Basin, which has been highly polluted due to urban, industrial and agricultural wastes. The silica content measured as reactive silicate in the whole Linggi River Basin ranged from 1.4 to 26.3 mg/L. A clear seasonal variation in silica was noted especially in the major rivers with higher concentration during dry months and lower concentration during the wet months. The concentration was found to decrease as the water flooded downstream. The large drainage area with granite dominated lithology and high denudation especially in the upper catchment is attributed for high silica content in the water of Linggi River Basin.
Merbok river catchment situated in the Kedah State receives its input from Bongkok River
and Puntar River flowing down and joining Lalang River to flow down to the Merbok
Estuary. The Merbok catchment (440 km2) is experiencing several degrees of complex
land uses activities that poses some impact on the suspended sediment production of
the Merbok river. A study was conducted to investigate the suspended sediment loading
of rivers draining the Merbok catchment from January to December 2013. Suspended
sediment budget of the Merbok catchment were estimated. The river suspended sediment
concentrations (SSC) and suspended sediment (SS) load increased during wet season
compared to dry season. The SS loads increases from upper catchment to river mouth. The
sediment loadings were divided into three segments- the upstream, middle segment and
lower segment. The SS loads increased from 10 t yr-1 in the upper part of Bongkok river
to 3336 t yr-1 in upper segment. The sediment loading then increase to 4299 t yr-1 in the
middle segment of the catchment (at Bongkok 4), and then exiting the Merbok Estuary, as
the lower segment, with a total amount of sediment output estimated at 7156 t yr-1. From this
total sediment output, most of the sediment
source came from the tributaries; the
Bongkok River at B3 (3337 t yr-1), Puntar
River (2924 t yr-1) and Lalang River (1370
t yr-1), which were much higher than its
proportion in terms of its length and drainage
area. As a conclusion, the inconsistence in
SSC in the river were influenced by the
various anthropogenic activities (especially
agriculture and urbanization activities) in the catchment area which necessitate future land use and sediment control to avoid sediment
and possible nutrient loading into the estuary.
Tuberculous pleural effusion (TBE) is a common encounter in our region. Up to 50% of patients with TBE will develop residual pleural thickening (RPT) which can lead to functional impairment. However, the need of drainage remains controversial. We report a case of end-stage renal failure patient who presented with right multiloculated tuberculous pleural effusion which was drained via a medical thoracoscope. Patient reports immediate relief of breathlessness post procedure and one month follow up shown significant improvement of RPT. We also discussed the current perspective on the rationale of TBE drainage and the role of medical thoracoscope in TBE management.
The PleurX catheter was developed to facilitate long-term intermittent drainage of malignant pleural effusion or ascites. For palliation, it is important that the process of insertion is safe and that this catheter remains complicationfree so as to improve end-of-life quality. We show that this catheter can be safely inserted and discuss methods to reduce infection, which was the most common complication. Our article hopes to enlighten clinicians, patients and their caregivers of this device as a treatment option in palliative patients. Proper case selection and caregiver training are essential in ensuring a successful outcome.
STUDY DESIGN: Qualitative study using individual in-depth interviews.
OBJECTIVE: To explore the roles of patients, their caregivers and doctors when making decisions on the method of bladder drainage after spinal cord injury (SCI).
SETTING: Five public hospitals in Malaysia.
METHODS: Semistructured (one-to-one) interviews with 17 male patients with SCI, 4 caregivers and 10 rehabilitation professionals.
RESULTS: Eight themes describing the respective decisional roles of patients, their caregivers and doctors emerged from the analysis: patient's right and responsibilities, patient as an informed decision maker, forced to accept decision; surrogate decision maker, silent partner; doctor knows best, over-ride patient's decision, or reluctant decision maker. Both patients and doctors acknowledged the importance of patient autonomy but not all patients had the chance to practice it. Some felt that they were forced to accept the doctor's decision and even alleged that the doctor refused to accept their decision. Doctors considered the caregiver as the decision maker in cases that involved minors, elderly and those with tetraplegia. Some patients considered bladder problems an embarrassing subject to discuss with their caregivers and did not want their involvement. Doctors were described as knowledgeable and were trusted by patients and their caregivers to make the most appropriate option. Some doctors were happy to assume this role whereas some others saw themselves only as information providers.
CONCLUSIONS: A paternalistic model is prevalent in this decision-making process and there is a discrepancy between patients' preferred and actual decisional roles.