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Chiu CK, Chong KI, Chan TS, Mohamad SM, Hasan MS, Chan CYW, Kwan MK. The anatomical locations of postoperative pain and their recovery trajectories following Posterior Spinal Fusion (PSF) surgery in Adolescent Idiopathic Scoliosis (AIS) patients. Med J Malaysia 2020; 75:12-17. [PMID: 32008013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION This study looked into the different anatomical locations of pain and their trajectories within the first two weeks after Posterior Spinal Fusion (PSF) surgery for Adolescent Idiopathic Scoliosis (AIS). METHODS We prospectively recruited patients with Adolescent Idiopathic Scoliosis (AIS) scheduled for PSF surgery. The anatomical locations of pain were divided into four: (1) surgical wound pain; (2) shoulder pain; (3) neck pain; and (4) low back pain. The anatomical locations of pain were charted using the visual analogue pain score at intervals of 12, 24, 36, 48 hours; and from day-3 to -14. Patient-controlled analgesia (morphine), use of celecoxib capsules, acetaminophen tablets and oxycodone hydrochloride capsule consumption were recorded. RESULTS A total of 40 patients were recruited. Patients complained of surgical wound pain score of 6.2±2.1 after surgery. This subsequently reduced to 4.2±2.0 by day-4, and to 2.4±1.3 by day-7. Shoulder pain scores of symptomatic patients peaked to 4.2±2.7 at 24 hours and 36 hours which then reduced to 1.8±1.1 by day-8. Neck pain scores of symptomatic patients reduced from 4.2±1.9 at 12 hours to 1.8±1.1 by day-4. Low back pain scores of symptomatic patients reduced from 5.3±2.3 at 12 hours to 1.8±1.1 by day- 12. CONCLUSIONS Despite the presence of different anatomical locations of pain after surgery, surgical wound was the most significant pain and other anatomical locations of pain were generally mild. Surgical wound pain reduced to a tolerable level by day-4 when patients can then be comfortably discharged. This finding provides useful information for clinicians, patients and their caregivers.
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Affiliation(s)
- C K Chiu
- University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery (NOCERAL), Kuala Lumpur, Malaysia
| | - K I Chong
- University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery (NOCERAL), Kuala Lumpur, Malaysia
| | - T S Chan
- University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery (NOCERAL), Kuala Lumpur, Malaysia
| | - S M Mohamad
- University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery (NOCERAL), Kuala Lumpur, Malaysia
| | - M S Hasan
- University of Malaya, Faculty of Medicine, Department of Anaesthesiology, Kuala Lumpur, Malaysia
| | - C Y W Chan
- University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery (NOCERAL), Kuala Lumpur, Malaysia.
| | - M K Kwan
- University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery (NOCERAL), Kuala Lumpur, Malaysia
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Poremski D, Loo E, Chan CYW, Li LD, Fung D. Reducing Injury During Restraint by Crisis Intervention in Psychiatric Wards in Singapore. East Asian Arch Psychiatry 2019; 29:129-135. [PMID: 31871310 DOI: 10.12809/eaap1811] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The application of restraints during psychiatric crises is a serious adverse event. We aimed to reduce the number of injuries sustained by patients during the application of restraints. METHODS Structured interviews were conducted with 10 staff to determine six root causes of patient injury during restraint. Three plan-do-study-act cycles were implemented: (1) reorganising shift rosters to pair trained staff with inexperienced staff, (2) holding monthly session for practising de-escalation and restraint techniques as a team in a supervised setting, and (3) rotating the responsibility for leading the de-escalation in real crises. RESULTS Pre-intervention period was from January 2014 to December 2014 (28 251 inpatient bed days). Intervention period was from January 2015 to March 2015 (7121 inpatient bed days). Post-intervention period was from April 2015 to December 2016 (51 735 inpatient bed days). Data extracted included the dates and numbers of crises, activation of the crisis team, use of restraints, and injuries. During pre-intervention and intervention periods, only two minor and three moderate injuries were recorded. During post-intervention period, no injury was recorded and the number of restraints decreased gradually although the number of crisis team activations increased in the early phase. Eventually restraints were used only upon arrival of the crisis team. CONCLUSION Our quality improvement project identified six root causes and implemented three plan-do-study-act cycles to successfully eliminated patient injuries during the use of restraints.
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Affiliation(s)
- D Poremski
- Institute of Mental Health, Buangkok Green Medical Park, Singapore
| | - E Loo
- Institute of Mental Health, Buangkok Green Medical Park, Singapore
| | - C Y W Chan
- Institute of Mental Health, Buangkok Green Medical Park, Singapore
| | - L D Li
- Institute of Mental Health, Buangkok Green Medical Park, Singapore
| | - D Fung
- Institute of Mental Health, Buangkok Green Medical Park, Singapore
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Zubair M, Ravindran T, Chan CYW, Saw LB, Kwan MK. Acute Brown-Séquard Syndrome following Brachial Plexus Avulsion Injury. A Report of Two Cases. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Brown-Séquard syndrome is an unusual sequelae of pre-ganglionic brachial plexus injury. There have been sporadic case reports indicating that the cause of this condition is due to tethering of the cord, vascular ischaemia or direct avulsion injury of the nerve roots. This is a report of two patients with complete pre-ganglionic brachial plexus avulsion injuries who developed acute partial Brown-Séquard syndrome due to haematoma. Cases Two patients developed acute partial Brown-Séquard syndrome associated with complete pre-ganglionic brachial plexus avulsion injuries. In the first case the neurology recovered fully after the evacuation of the large subdural hematoma. Whereas, in the second case the neurology only recovered after 4 weeks closed observation in view of the compression was due to small epidural haematoma. Conclusion Acute Brown-Séquard syndrome occurring in association brachial plexus injury should be investigated with urgent magnetic resonance imaging to exclude any reversible haematoma compression.
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Chan CYW, Kwan MK. Zonal differences in risk and pattern of pedicle screw perforations in adolescent idiopathic scoliosis (AIS): a computerized tomography (CT) review of 1986 screws. Eur Spine J 2017; 27:340-349. [PMID: 29058137 DOI: 10.1007/s00586-017-5350-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the zonal differences in risk and pattern of pedicle screw perforations in adolescent idiopathic scoliosis (AIS) patients. METHODS The scoliosis curves were divided into eight zones. CT scans were used to assess perforations: Grade 0, Grade 1(< 2 mm), Grade 2(2-4 mm) and Grade 3(> 4 mm). Anterior perforations were classified into Grade 0, Grade 1(< 4 mm), Grade 2(4-6 mm) and Grade 3(> 6 mm). Grade 2 and 3 (except lateral grade 2 and 3 perforation over thoracic vertebrae) were considered as 'critical perforations'. RESULTS 1986 screws in 137 patients were analyzed. The overall perforation rate was 8.4% after exclusion of the lateral perforation. The highest medial perforation rate was at the transitional proximal thoracic (PT)/main thoracic (MT) zone (6.9%), followed by concave lumbar (6.7%) and convex main thoracic (MT) zone (6.1%). The overall critical medial perforation rate was 0.9%. 33.3% occurred at convex MT and 22.2% occurred at transitional PT/MT zone. There were 39 anterior perforations (overall perforation rate of 2.0%). 43.6% occurred at transitional PT/MT zone, whereas 23.1% occurred at concave PT zone. The overall critical anterior perforation rate was 0.6%. 5/12 (41.7%) critical perforations occurred at concave PT zone, whereas four perforations occurred at the transitional PT/MT zone. There were only two symptomatic left medial grade 2 perforations (0.1%) resulting radiculopathy, occurring at the transitional main thoracic (MT)/Lumbar (L) zone. CONCLUSION Overall pedicle perforation rate was 8.4%. Highest rate of critical medial perforation was at the convex MT zone and the transitional PT/MT zone, whereas highest rate of critical anterior perforation was at the concave PT zone and the transitional PT/MT zone. The rate of symptomatic perforations was 0.1%.
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Affiliation(s)
- C Y W Chan
- Department of Orthopaedic Surgery, Faculty of Medicine, NOCERAL, University Malaya, 50603, Kuala Lumpur, Malaysia
| | - M K Kwan
- Department of Orthopaedic Surgery, Faculty of Medicine, NOCERAL, University Malaya, 50603, Kuala Lumpur, Malaysia.
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Kew Y, Tan CY, Ng CJ, Thang SS, Tan LH, Khoo YK, Lim JN, Ng JH, Chan CYW, Kwan MK, Goh KJ. Prevalence and associations of neuropathic pain in a cohort of multi-ethnic Asian low back pain patients. Rheumatol Int 2016; 37:633-639. [PMID: 28013358 DOI: 10.1007/s00296-016-3633-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/09/2016] [Indexed: 12/30/2022]
Abstract
The prevalence of neuropathic low back pain differs in different ethnic populations. The aims of the study are to determine its frequency and associations in a multi-ethnic cohort of Asian low back pain patients. This was a cross-sectional study of low back patients seen at the University of Malaya Medical Centre, Kuala Lumpur, Malaysia. Neuropathic low back pain patients were identified using the painDETECT questionnaire and compared with non-neuropathic (unclear or nociceptive) low back pain patients, in terms of socio-demographic and clinical factors, pain severity (numerical pain rating scale, NPRS), disability (Roland Morris Disability Questionnaire, RMDQ), as well as anxiety and depression (Hospital Anxiety and Depression Scale, HADS). Of 210 patients, 26 (12.4%) have neuropathic low back pain. Neuropathic pain is associated with non-Chinese ethnicity, higher body mass index and pain radiation below the knee. Patients with neuropathic pain have significantly higher NPRS and RMDQ scores, and there are more subjects with anxiety on HADS. However, there are no differences between the groups in age, gender, pain duration or underlying diagnosis of low back pain. The prevalence of neuropathic low back pain in a multi-ethnic Malaysian cohort is lower than previously reported in other populations with possible differences between ethnic groups. It is associated with greater pain severity, disability and anxiety.
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Affiliation(s)
- Yueting Kew
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Cheng-Yin Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chong-Jing Ng
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Sue-Sien Thang
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Leong-Hooi Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yvonne Khaii Khoo
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Jun-Ni Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Jia-Hui Ng
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chris Yin-Wei Chan
- Department of Orthopaedic Surgery, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mun-Keong Kwan
- Department of Orthopaedic Surgery, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Khean-Jin Goh
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Muhammad MT, Kwan MK, Chan CYW, Lim BS, Goh DW. Correction of severe thoracolumbar spondylolisthesis (grade 4) secondary to neurofibromatosis with posterior spinal instrumented fusion alone. A case report. Med J Malaysia 2012; 67:633-635. [PMID: 23770965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 15-year-old teenager with Type 1 Neurofibromatosis presented with grade 4 spondylolisthesis over T12/L1 junction resulting paraparesis (Frankel D). Radiograph showed a Cobb angle of 88 degrees. Computed tomography scan showed dysplastic vertebral bodies, pedicles and facet joints of T11, T12 and L1 vertebra with complete T12/L1 facets dislocation. Magnetic resonance imaging confirmed presence of spinal cord compression. He underwent posterior instrumentation and posterolateral fusion (T8 to L4) using hybrid instrumentation. Extensive corticotomy of the posterior elements was followed by the use of large amount of bone graft. Post operatively, his neurology improved markedly back to normal. Radiographs showed a good correction of the deformity. He was immobilized in a thoracolumbar orthosis for six months. A solid posterior fusion was achieved at six months follow up. At 36-month follow up, he remained asymptomatic. This case report illustrates a successful treatment of a grade 4 thoracolumbar spondylolisthesis secondary to neurofibromatosis with posterior spinal fusion alone.
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Affiliation(s)
- M T Muhammad
- University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
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Low TH,,,,, Saw LB, Kwan MK, Chan CYW, Deepak AS. Extensive Brown Tumors of Spine, Distal femur and Patella Presenting with Acute Cord Compression. A Case Report. Malays Orthop J 2011. [DOI: 10.5704/moj.1103.014] [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: 11/05/2022] Open
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Lee CK, Chan CYW, Saw LB, Kwan MK. Double Level Extension-Distraction Thoracic Spine Injuries with Concomitant Double Level Sternal Fractures: A Case Report. Malays Orthop J 2011. [DOI: 10.5704/moj.1103.012] [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: 11/05/2022] Open
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Norazian K, Saw LB, Chan CYW, Amin R, Kwan MK. Chondrosarcoma of T2 Vertebrae Treated by Combined Anterior and Posterior Approach: A Case Report. Malays Orthop J 2010. [DOI: 10.5704/moj.1011.006] [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: 11/05/2022] Open
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Kwan MK, Chan CYW, Kwan TCC, Gashi YN, Saw LB. Safety Issues and Neurological Improvement following C1-C2 Fusion using C1 Lateral Mass and C2 Pedicle Screw in Atlantoaxial Instability. Malays Orthop J 2010. [DOI: 10.5704/moj.1007.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
U-shaped sacral fracture is a very rare injury. This injury is easily missed and the diagnosis is often delayed as it is difficult to detect on the anteroposterior view of the pelvic radiograph. It is highly unstable and neurological injury is common. Two cases of U-shaped sacral fractures are reported here in which the diagnosis was delayed resulting in the late development of cauda equina syndrome. In these two cases, full recoveries were achieved following surgical decompression. A high index of suspicion with proper clinical and radiographic assessments will decrease the incidence of missed diagnosis and prevent the occurrence of delayed neurological deficits.
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Affiliation(s)
- P Hussin
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Chiu CK, Yin-Wei Chan C, Saw LB, Kwan MK. Scarf-Related Hangman’s Fracture: A Case Report. Eur J Trauma Emerg Surg 2009; 36:180-2. [PMID: 26815695 DOI: 10.1007/s00068-009-8212-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Accepted: 02/05/2009] [Indexed: 11/24/2022]
Affiliation(s)
- Chee-Kidd Chiu
- Orthopedic Surgery, Clinical School, International Medical University, Seremban, Malaysia.
- Orthopedic Surgery, Clinical School, International Medical University Seremban, Negeri Sembilan, 70300, Malaysia.
| | - Chris Yin-Wei Chan
- Orthopedic Surgery, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Lim-Beng Saw
- Orthopedic Surgery, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Mun-Keong Kwan
- Orthopedic Surgery, University of Malaya Medical Center, Kuala Lumpur, Malaysia
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Chan CYW, Saw LB, Kwan MK. Comparison of Srs-24 And Srs-22 Scores in Thirty Eight Adolescent Idiopathic Scoliosis Patients Who Had Undergone Surgical Correction. Malays Orthop J 2009. [DOI: 10.5704/moj.0905.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Chiu CK, Chan CYW, Singh VA. Is the femoral neck geometry adequate for placement of the proximal femoral nail in the Malaysian population? A review of 100 cases. Med J Malaysia 2009; 64:22-26. [PMID: 19852315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Issues that had been encountered during proximal femoral fracture fixation using proximal femoral nail include (i) the adequacy of the femoral neck width in the local population and (ii) the potential difficulty encountered during fixation in certain prefixed angles as determined by the implant. This was a retrospective, descriptive study evaluating the anterior-posterior pelvic radiographs of 100 consecutive patients, from January to August 2007, managed at University Malaya Medical Centre, Kuala Lumpur. The femoral neck width in the population studied was adequate for placement of femoral neck screw and anti-rotation pin or hip pin using the proximal femoral nail implant. (mean = 34.0 +/- 3.7 mm, min = 24.6 mm). There was no significant difference between the working area using an implant angled at 130 degrees or 135 degrees (P = 0.91). Both femoral neck width and neck shaft angle of the Malaysian population studied were not a factor influencing the placement of femoral neck lag screws and anti-rotation pin.
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Affiliation(s)
- C K Chiu
- Department of Orthopaedic Surgery, University of Malaya Medical Centre, 50603 Kuala Lumpur, Malaysia
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Chan CYW, Janarthan N, Vivek AS, Jayalakshmi P. The outcome of pleomorphic sarcoma at University Malaya Medical Center--a fifteen-year review. Med J Malaysia 2008; 63:311-314. [PMID: 19385491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Pleomorphic sarcoma is the most common sarcoma. Reports of outcome as well as evaluation of prognostic factors in the literature show great variation. We looked at our experience in treating this tumour at University Malaya Medical Center. This is a review of patients diagnosed with Pleomorphic Sarcoma from January 1990 to December 2005 at University Malaya Medical Center. Outcome measures studied are the overall survival, disease free survival and local recurrence of disease. Prognostic factors for survival and local recurrence which were studied are the tumour size, depth, stage, type of surgery, adjuvant therapy, and surgical margin. There were fifty four patients available for analysis of demographics. The mean age at presentation was 52.3 +/- 16.7 years. There were thirty male patients (56%) and twenty four female patients (44%) in the study population. The patients were predominantly Malay (44.4%) and Chinese (42.6%). There were two Indian patients (3.7%) and five patients from other races (9.3%). Thirty patients had disease affecting the extremities while six patients had disease affecting the trunk. Patients with tumour affecting the trunk had 100% mortality. In patients with tumour affecting the extremity, 46.7% presented with Stage 3 disease. The overall median survival was 39 months. The overall survival rate at 3 years was 53.3% and the 5 years was 30.0%. The disease free survival rate at five years was 27.6%. However, if patients who presented with metastasis were excluded, the 5 year survival rate was 60% while the disease free survival was 53.3%. Recurrence rate was 33.3%. Factors affecting survival was stage, size and location of tumour. No factors were found to correlate with higher local recurrence rate. In conclusion, Pleomorphic Sarcoma is a heterogenous disease with variable outcome. In our centre, late presentation with advanced disease significantly affects the overall outcome of this condition. Tumour size and location are important prognostic factors. Inherent tumour behavior and aggressiveness probably outweigh current treatment modalities as the most important prognostic factor in the management of Pleomorphic Sarcoma.
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Affiliation(s)
- C Y W Chan
- Department of Orthopaedic Surgery, University Malaya Medical Center, 50603 Kuala Lumpur, Malaysia
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Chan CYW, Kwan MK, Saw LB, Deepak AS, Chong CS, Liew TM, Lee CS. Post-operative health related quality of life assessment in scoliosis patients. Med J Malaysia 2008; 63:137-139. [PMID: 18942300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Adolescent Idiopathic Scoliosis is a spinal deformity which affects patients' self image and confidence. Surgery is offered when the curve is more than 50 degrees based on its likelihood of progression. Studies on the radiological outcome of scoliosis correction are abundant. Therefore, it is the objective of this study to evaluate the health related quality of life in scoliosis patients who had undergone surgical correction in University Malaya Medical Center, Kuala Lumpur, Malaysia using Scoliosis Research Society-22 (SRS-22) patient questionnaire. This is a prospective evaluation of SRS-22 scores of thirty eight patients operated in our center over the past five years with a minimum follow up of one year. There were thirty two females and six males. Twenty six (68.4%) were Chinese, eight (21.1%) Malay and four (10.5%) Indian patients. The age of the patients ranged from twelve to twenty eight years, with a mean age of 18.4 +/- 3.5. Based on the King and Moe's classification, sixteen patients had King's 3 curve. The mean pre-operative Cobb angle was 68.6 degree and post-operative Cobb angle was 35.8 degree. The average curve correction was 48.5%. The overall score for SRS-22 was 4.2. The SRS-22 scores were highest for the pain domains and lowest for the functional domains. Satisfaction domain scored 4.3. The function domain scored significantly higher in those who have twenty four months or less follow up duration. Curve magnitude and the amount of correction did not significantly alter the SRS scores. In conclusion, patients were satisfied with the outcome of their operation. Although pain was common, the intensity of the pain was minimal. The amount of curve correction did not correlate with the quality of life after operation.
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Affiliation(s)
- C Y W Chan
- Department of Orthopaedic Surgery, University Malaya Medical Centre, 50603 Kuala Lumpur.
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Chan CYW, Nam HY, Raveenthiran R, Choon SK, Tai CC. Outpatient pre-operative assessment in joint replacement surgery. Med J Malaysia 2008; 63:100-103. [PMID: 18942292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
An anaesthetist-led outpatient pre-operative assessment (OPA) clinic was introduced in our unit in an effort to improve patient care and cost-effectiveness. To assess the efficiency of the clinic, 112 patients who attended the OPA clinic (attendance rate 98%) during the first year were assessed prospectively and compared with 118 patients who did not undergo OPA the year before. There were fewer cancellations among those who attended the OPA clinic (13.6% compared to 3.6%), and the hospital stay was shortened from an average of 10.7 days to 7.0 days. This has resulted in more efficient utilization of operating theatre, reduced hospital costs and improved patient satisfaction. More extensive use of the pre-admission clinic is recommended and should be explored in other clinical settings.
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Affiliation(s)
- C Y W Chan
- Department of Orthopaedic Surgery, University Malaya Medical Centre, 50603 Kuala Lumpur, Malaysia
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Chan CYW, Kwan MK, Saravanan S, Saw LB, Deepak AS. The assessment of immediate post-operative scoliosis correction using pedicle screw system by utilising the fulcrum bending technique. Med J Malaysia 2007; 62:33-5. [PMID: 17682567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Assessment of the curve flexibility is a crucial step in a surgeon's pre-operative planning for scoliosis surgery. Many techniques have been described. These include traction films, supine side bending films, push prone techniques, traction under general anaesthesia as well as fulcrum bending film. In this study, we studied the pre- and immediate post-operative radiographs of twenty eight adolescent idiopathic scoliosis (AIS) patients who were corrected using pedicle screw systems between January 2004 and August 2006. There were twenty two females and six male patients. The mean age of the patients were 17.5 years with a range of 12 to 38 years. Skeletal maturity of the patients was assessed by Risser's score. The majority was Risser 4 (15 cases, 53.6%). Based on King and Moe's classification, the most common curve was type 3 curve (15 cases, 53.6%). Among the twenty eight patients, twenty three patients underwent only posterior correction, while 5 patients underwent additional anterior release surgery. The mean pre-operative Cobb's angle for the posterior surgery group was 65.5 +/- 13.9 degrees and the mean post-operative Cobb's angle was 32.9 +/- 12.6 degrees. There was no difference between the mean correction estimated by fulcrum bending films (Fulcrum Flexibility) and the post- operative Correction Rate figures (44.2% vs. 49.9%). The mean Fulcrum Bending Correction Index (FBCI) in this group of patients is 112.8%. In the group of patients who underwent additional anterior release, their curves were noted to be larger and less flexible with the mean pre-operative Cobb's angle and Fulcrum Flexibility of 90.4 degrees +/- 9.3 degrees and 23.4% respectively. The Fulcrum Bending Correction Index (FBCI) for this group of patients was significantly higher than the posterior surgery group: i.e. 164.0% vs 112.8%. Thus, anterior release does help to improve the correction significantly. The fulcrum bending films give good pre-operative estimation of the amount of correction to be expected post-operatively. The fulcrum bending films can help to identify the curve types which might require anterior release in order to improve the scoliosis correction. Using the Fulcrum Bending Correction Index (FBCI) will also enable surgeons to quantify more accurately the amount of correction achieved by taking into account the inherent flexibility of the spine.
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Affiliation(s)
- C Y W Chan
- Department of Orthopaedic Surgery, University Malaya Medical Centre, 50603 Kuala Lumpur
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