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Fulltext A pilot study of enhance recovery after surgery (ERAS) for liver resection

Jarmin, R., Othman, H., Zuhdi, Z., Mohamad, I.S., Ahmad, A.W., Ariffin, A.C.

International Medical Journal Malaysia, 2017;16(2):41-45.
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Background: Morbidity post hepatectomy still remain persistent throughout decades compared to other
surgery. Modern approach have been introduced to improve safety and reduce morbidity whilst at the same
time enhance patient recovery. Thus, enhanced recovery after surgery or fast track recovery program for
liver resection was initiated.

Objective: The aim of this study was to achieve discharge by postoperative
day 3 for minor resection and day 5 for major resection.

Design and Setting: This is a prospective study
conducted in Hospital Universiti Kebangsaan Malaysia (HUKM) from September 2014 till April 2015.

Material
and Methods: All patients undergoing open liver resection were included in the study. They were then
managed post operatively according to ERAS protocol that was drawn up based on previous studies. Patient’s
demographics data, intra operative parameters, postoperative complications and adherence to
postoperative recovery protocol were recorded.

Results: Seventeen patients (7 major and 10 minor
resection) were recruited. The mean length of hospital stay for minor resection was 5.9 and major resection
was 9.6 .With regards to the targets, 4 out of 10 (40%)patients in minor resection group and 4 out 7 (57.1%)
in the major group were discharged on time. 9 patients had postoperative complications with no mortality
recorded. In terms of the ERAS protocol targets, the PCA morphine discontinuation target was achieved in
15 patients (88.3%) ,nasogastric tube removal (13 patients -76.5%) , urinary cathether removal (6 patients -
35.3%), abdominal drains removal (9 patients-52.9%) and resumption of full diet was achieved by 82.4% (14
patients).

Conclusion: From these overall achievement, most of our targets have been met and this shows
that our ERAS protocol is safe to be applied to patient undergoing hepatectomy.

Limitations: Some patients
had achieved their target but not discharged for unknown reason.
A case of an undifferentiated embryonal sarcoma of the liver mimicking a liver abscess

Hanafiah M, Yahya A, Zuhdi Z, Yaacob Y

Sultan Qaboos Univ Med J, 2014 Nov;14(4):e578-81.
PMID: 25364566

An undifferentiated embryonal sarcoma of the liver is a rare malignant tumour. We highlight the diagnostic dilemma and differential diagnosis of a case involving a large cystic liver lesion in a young adult. A 20-year-old man presented with a large liver lesion to the Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia, in February 2012. The initial clinico-radiological presentations were suggestive of a liver abscess. A total tumour resection was performed and the final histopathological results of the resected specimen indicated an undifferentiated embryonal sarcoma of the liver. The ultrasound and computed tomographic images of the tumour were reviewed and found to be contradictory in appearance, as the tumour seemed predominantly solid in the ultrasound image and predominantly cystic in the computed tomographic image. Familiarisation with the imaging appearance of this tumour and a high index of suspicion is therefore crucial in making a successful diagnosis.
Cost analysis of utilising wound edge protector in open appendicectomy to prevent surgical site infection

Muniandy J, Azman A, Murugasan V, Alwi RI, Zuhdi Z, Jarmin R, et al.

Ann Med Surg (Lond), 2021 Aug;68:102573.
PMID: 34354831 DOI: 10.1016/j.amsu.2021.102573

Background: The rate of surgical site infection (SSI) differ with variable nature with appendicitis with a global incidence of up to 11%. Several randomised trials describe a significant reduction in incisional SSI using wound edge protectors (WEP), mainly in elective procedures. This study was designed to analyse WEP use in emergency open appendicectomy.
Method: This randomised controlled trial enrolled 200 patients who underwent emergency open appendicectomy. Permuted block randomisation was used to assign subjects to either mechanical retraction or double ring WEP. The primary endpoints were SSI rates and cost analysis between the methods.
Results: The incidence of SSI was similar, n = 7 (7.4%) in the control group and n = 8 (8.4%) in the WEP group, and demonstrates no statistically significant difference (p > 0.05). Cost analysis showed a statistically significant (p
EtOH-LN cryoembedding workflow to minimize freezing artifact in frozen tissues: A pilot study in preparing tissues compatible with mass spectrometry-based spatial proteomics application

Tan YC, Mustangin M, Rosli N, Wan Ahmad Kammal WSE, Md Isa N, Low TY, et al.

Cryobiology, 2024 Mar;114:104843.
PMID: 38158171 DOI: 10.1016/j.cryobiol.2023.104843

Coolant-assisted liquid nitrogen (LN) flash freezing of frozen tissues has been widely adopted to preserve tissue morphology for histopathological annotations in mass spectrometry-based spatial proteomics techniques. However, existing coolants pose health risks upon inhalation and are expensive. To overcome this challenge, we present our pilot study by introducing the EtOH-LN workflow, which demonstrates the feasibility of using 95 % ethanol as a safer and easily accessible alternative to existing coolants for LN-based cryoembedding of frozen tissues. Our study reveals that both the EtOH-LN and LN-only cryoembedding workflows exhibit significantly reduced freezing artifacts compared to cryoembedding in cryostat (p
The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

De Simone B, Abu-Zidan FM, Chouillard E, Di Saverio S, Sartelli M, Podda M, et al.

World J Emerg Surg, 2022 Dec 16;17(1):61.
PMID: 36527038 DOI: 10.1186/s13017-022-00466-4

BACKGROUND: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not.
METHODS: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not.
RESULTS: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p