Safe Laparoscopic Cholecystectomy

The Potential Danger Of Durians Feast

The Health Effects of Eating Excessive Amounts of Durians

Durians , often referred to as the "king of fruits," are notorious for their distinct odor and unique flavor. While they are beloved by many, indulging in excessive amounts of this rich fruit can have various health implications. This blog post explores both the positive aspects and potential drawbacks of consuming durians in large quantities.

Nutritional Benefits of DurianBefore we dive into the potential drawbacks, it's essential to recognize the nutritional profile of durians:- 

**Rich in Nutrients**: Durians are packed with vitamins and minerals, including vitamin C, B vitamins, potassium, and fiber.- 

**Antioxidant Properties**: The presence of antioxidants in durians can help combat oxidative stress and inflammation in the body.- 

**Energy Source**: Durians are high in carbohydrates, making them a quick energy source, especially for individuals engaged in physical activities.Despite these benefits, moderation is key.

Potential Health Risks of Overconsumption

1. **High Caloric Content**: Durians are calorie-dense, with about357 calories per100 grams. Overeating could lead to an excessive caloric intake, contributing to weight gain and obesity if not balanced with physical activity.

.2. **Digestive Issues**: Consuming large amounts of durian can lead to digestive discomfort, including bloating, gas, and diarrhea. The fruit's high fiber content may overwhelm the digestive system when eaten in excess.

3. **High Sugar Levels**: Durian contains natural sugars, which can spike blood sugar levels. For individuals with diabetes or insulin sensitivity, excessive consumption may lead to complications.

4. **Potential for Allergies**: Some individuals may have allergies or intolerances to durians. Symptoms can include itching, swelling, or gastrointestinal distress.

5. **Interaction with Alcohol**: A common belief in Southeast Asia is that consuming durians alongside alcohol intensifies the effects, potentially leading to nausea or discomfort. It is often advised to avoid pairing these two.

Conclusion

 Durians can be a delicious and nutritious addition to a balanced diet, but like any food, moderation is crucial. Enjoying them in reasonable portions can allow individuals to reap their health benefits without facing adverse effects.For those who are fans of this tropical fruit, keep in mind that while indulging occasionally is perfectly fine, consuming excessive amounts may lead to unwanted health concerns. As with all dietary choices, striking the right balance is the key to overall health and well-being.

 Tips for Enjoying Durians Responsibly-

 **Portion Control**: Limit your intake to one or two segments at a time.- 

**Pair with Other Foods**: Balance your meal with vegetables or lean protein to mitigate the caloric impact.- 

**Stay Hydrated**: Drink plenty of water to aid digestion and overall health.Remember, enjoying durians is a delightful experience, but it’s essential to listen to your body and consume responsibly!

Malaysians Health Myths

 It is a well-known fact that Malaysians patients are still influenced by health myths and unscientific antiquated beliefs. Despite advances in modern medicine and access to reliable healthcare information, many individuals in Malaysia continue to hold on to traditional beliefs and practices that are not based on scientific evidence.

One prevalent health myth that continues to persist in Malaysian society is the belief in the effectiveness of traditional herbal remedies over modern medicine. Many individuals still believe that herbal remedies are a natural and safer alternative to pharmaceutical drugs, despite the lack of empirical evidence to support these claims. This can often lead to delays in seeking proper medical treatment and potentially worsen health conditions. 

Research and modern pharmaceutical manufacturing have confirmed the usefulness of some of these herbs but a large number still remains in the people’s collective myths

Another common health myth in Malaysia is the belief in supernatural causes of illnesses. Many individuals still believe that illnesses are caused by supernatural entities or black magic, leading them to seek treatment from traditional healers or spiritual practitioners instead of trained medical professionals. This can result in further health complications and delay in receiving appropriate medical care.

It is important for healthcare providers and public health authorities in Malaysia to actively combat these health myths and educate the public on the importance of evidence-based medicine. By promoting scientific literacy and debunking unscientific beliefs, we can empower Malaysians to make informed decisions about their health and well-being.

In conclusion, Malaysians patients are still influenced by health myths and unscientific antiquated beliefs. It is crucial for healthcare providers and public health authorities to address these misconceptions and promote evidence-based medicine to ensure the health and safety of the Malaysian population. Let us work together to empower individuals to make informed decisions about their health and break free from the shackles of unscientific beliefs.

Debunking Malaysian Medical Myths:Paving The Way For Modern Medicine’s Success

In the realm of healthcare and medicine, knowledge and information play a crucial role in ensuring positive health outcomes and improved quality of life. However, it is disheartening to realize that many medical myths continue to persist in Malaysian society, hindering the success of modern medicine. These myths, often rooted in cultural beliefs or misinformation, pose significant challenges to healthcare professionals and limit accessibility to evidence-based treatments. This essay aims to shed light on some prevalent medical myths in Malaysian society and emphasize the importance of dispelling these misconceptions.

1. The Myth of Traditional Remedies Being Superior:

Throughout history, traditional remedies have been deeply ingrained in Malaysian culture. Many believe that these remedies are more effective and safer than modern medicine. While traditional practices often possess cultural significance and may have anecdotal evidence suggesting their effectiveness, it is important to approach them critically. Modern medicine, backed by rigorous scientific research and clinical trials, provides a level of accuracy and safety that traditional remedies may lack.

2. Misconceptions about Vaccinations:

Vaccines have been a cornerstone of modern medicine, preventing and eradicating numerous diseases worldwide. However, misconceptions regarding vaccinations persist in Malaysian society, leading to increased vaccine hesitancy. Some individuals believe that vaccines can cause autism or infertility, despite ample scientific evidence debunking these claims. Education and awareness programs are vital to address these misconceptions, emphasizing the importance and safety of vaccinations to protect public health.

3. Dietary Myths and Cultural Influences:

Food holds a significant place in Malaysian culture, and popular dietary myths often prevail. One example is the belief that consuming "heaty" or "cooling" foods can impact one's health. These perceptions are based on traditional Chinese medicine principles but lack scientific validity. Educating the public on the importance of a balanced diet, rich in necessary nutrients, rather than adhering to restrictive dietary myths is crucial for promoting overall well-being.

4. Traditional Practices and Obstetric Myths:

The realm of pregnancy and childbirth is surrounded by several misconceptions and myths in Malaysian society. Traditional practices, such as abdominal binding or specific birthing positions, are believed to ensure a healthy pregnancy and ease childbirth. However, expecting parents need information on evidence-based obstetric practices to make informed decisions for the well-being of both mother and child.

5. "Natural" Remedies and the Lack of Critical Evaluation:

The notion of "natural" remedies often gains popularity due to the belief that they are safer and free from adverse effects. However, natural does not always equate to safe or effective. Taking herbal supplements without proper consultation or relying solely on alternative therapies can have negative consequences, including interactions with prescribed medications. Conducting more research, educating the public, and promoting critical evaluation of alternative remedies are essential for appropriate healthcare decision-making.

In conclusion, dispelling prevalent medical myths in Malaysian society is essential to pave the way for the success of modern medicine. The persistence of these myths can lead to suboptimal healthcare choices and prevent individuals from accessing evidence-based treatments that can improve their well-being. By fostering public education, raising awareness, and encouraging critical evaluation, healthcare professionals can challenge these misconceptions and promote a society that embraces the advancements and benefits of modern medicine. Ultimately, a society that embraces evidence-based practices and trusts in the expertise of healthcare professionals is more likely to achieve better health outcomes for its citizens.

The Dynamic Balance: The Current Place of Alternative Medicine In Modern Healthcare

Introduction:

Imagine a world where individuals have access to personalized care that combines the best of conventional medicine with holistic therapies, enhancing not only physical health but also overall well-being. This remarkable transformation is occurring today, as alternative medicine emerges as a complementary approach within the realm of modern healthcare. With a deep-rooted focus on patient-centered care, alternative medicine techniques are gaining recognition and finding their place alongside conventional medical practices. In this essay, we will explore the current position of alternative medicine in the practice of modern medicine, heralding a new era of collaborative and patient-centric care.

1. Bridging the Gap: Complementary Approaches in Patient Care

Alternative medicine has gained considerable recognition in modern medicine due to its ability to bridge gaps in conventional healthcare practices. As patients increasingly seek a holistic approach to healing, parallel advancements in research have taken place, highlighting the effectiveness of complementary therapies. Recognizing this, many medical professionals are incorporating alternative medicine techniques to improve their patients' overall health outcomes.

2. Embracing the Science: Evidentiary Support for Alternative Medicine

An essential factor contributing to the current place of alternative medicine within modern healthcare is the scientific validation of its practices. Researchers worldwide have dedicated significant efforts to evaluate the effectiveness and safety of various alternative treatments. This evidence-based approach gives medical professionals confidence in integrating alternative medicine approaches, such as herbal remedies, acupuncture, and mind-body practices, with conventional treatments. By using both evidence-based medicine and alternative therapies, a more comprehensive and personalized care plan can be devised for patients.

3. Holistic Healthcare: A Prescription for Enhanced Well-being

One of the most significant advantages of alternative medicine is its holistic approach to healthcare. Unlike conventional medicine that primarily focuses on the disease itself, alternative medicine emphasizes the interconnectedness of the body, mind, and spirit. By considering the individual as a whole, alternative medicine addresses not only the physical symptoms but also psychological, emotional, and spiritual aspects of health. This holistic perspective can lead to increased patient satisfaction, improved treatment adherence, and a higher overall quality of life.

4. From Treatment to Prevention: Shifting the Paradigm

While modern medicine often intervenes after the development of disease, alternative medicine places considerable emphasis on prevention. By promoting lifestyle modifications, such as healthy eating, stress reduction, and regular exercise, alternative medicine works to strengthen overall well-being, thereby reducing the risk of illness. Integrating these preventive measures into conventional medical practices serves as a powerful tool to battle the rising burden of chronic diseases, thus contributing to a greater focus on patient-centered healthcare.

5. Collaboration and Integration: A Shared Vision for Optimal Health

The current place of alternative medicine in modern healthcare is not about choosing one over the other but rather fostering collaboration and integration. Numerous medical institutions across the globe are now introducing integrative medicine departments, where conventional medicine and alternative therapies coexist harmoniously, offering patients an array of options for their treatment journey. By fostering this collaborative model, healthcare professionals can tap into the vast potential of alternative medicine, ultimately providing patients with safer, more effective, and comprehensive care.

In  conclusion, the incorporation of alternative medicine practices within mainstream healthcare represents an evolution in medical practice and a shift towards more patient-centered care. By amalgamating the wisdom of traditional healing methods with scientific discoveries, modern medicine acknowledges the significance of holistic and personalized approaches. As we move forward, the current place of alternative medicine in the practice of modern medicine holds immense promise, fostering collaboration, promoting overall well-being, and revolutionizing healthcare for the benefit of patients worldwide.

In this dynamic era, where every patient deserves the best possible care, the harmonious blending of alternative and modern medicine paves the way for a brighter, holistic, and patient-centric future.

Whipple Operation

 https://pie.med.utoronto.ca/TVASurg/project/pe-whipple-eng/

Internal View at Choledochoscopy

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18062022 Management of gallstones Dr Hamid

ERCP and Removal of Biliary Stent

complicated gallstones may present with dual problems of gallstones and bile duct stones with associated clinical syndromes in both... calculous cholangitis with bile duct stones will require ERCP and stone removal.. after the stones are removed, a biliary stent is frequently inserted to ensure bile drainage in any possible event of retained duct stones.. calculous cholecystitis will require laparoscopic cholecystectomy... following cholecystectomy, ERCP is repeated for the removal of the stent

Laparoscopic Appendectomy performed during Laparoscopic Cholecystectomy

This latest video on the conduct of Laparoscopic Appendectomy.

Laparoscopic Appendectomy is done selectively in patients that will benefit from a laparoscopic approach as compared to the open conventional approach.

This patient has concomitant Cholecystitis and Appendicitis, hence after the performance of Laparoscopic Cholecystectomy, the inflammed Appendix was next removed laparoscopically using the same port sites without additional port.

Are Your Sure Its Appendix Doc?

 Acute Appendicitis is perhaps one of the commonest surgical conditions that present to any busy Emergency Dept. that open a 24-Hr services anywhere in the world.

Most patients are easily suspected from the history of the pain and the typical physical findings. Doctors then will perform some tests to support this suspected diagnosis in order to embark on definitive treatment namely Appendectomy(removal of appendix).

Quite often patients will pose a really good question to the Surgeons;..Doc, are you sure its Appendix? After operating on so many similar cases before, the most likely answer from the surgeons would be "most probably its appendix". That means you are not so sure?

This typical surgeon-patient conversation is so typical when a diagnosis of Appendicitis is made and the consent for Appendectomy is required.

The surgeon's little doubt is not without reason. The clinical pattern of many other possible conditions may mimic Acute Appendicitis especially in female patients. The many pelvic organs like the right ovary, right fallopian tube, right side of the uterus may give rise to many disease states that may present much like Appendicitis. Any experienced surgeon would have come across unsuspected normal pregnancy and the ectopic ones after ultrasonography of patients with a suspected diagnosis of Appendicitis. Very seldom ultrasound will make a positive diagnosis especially in early appendicitis when the appendicular swelling is minimal.

In fact, thats exactly the main purpose of ultrasound in patients with suspected appendicitis, that is to rule out other diagnoses. In philosophical terms, applying the falsifications principle of Karl Popper in sustaining a theory is to falsify the theory. If the theory stands up to the falsification test, then the theory survives. Many surgeons apply this philosophical of science principle without even realising it. Many patients find difficult to grasp that the test(namely the ultrasound) is done for a negative purpose.

This philosophical mismatch between the surgeon and the patient explains the scepticism of both in managing Appendicitis.

Despite these doubts on both parties, consent from patients are usually obtained and the final diganosis of Appendicitis turn out to be correct at operation.

Based in this empirical and historical experience, many surgeons would remove the patient's doubt by quoting the previous similar successful cases.

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Laparoscopic Cholecystectomy for Gangrenous and Perforated Gallbladder w...

Laparoscopic Cholecystectomy has been a gold standard for removal of a diseased gallbladder. Conversion to Open Cholecystectomy is indicated for gross gallbladder pathology that makes laparoscopic approach significantly hazardous. Gangrenous gallbladder, Perforated gall bladder and Empyema gallbladder are three such extreme pathologies that usually warrant a conversion. This video shows how successful laparoscopic cholecystectomy may still be successful in such hazardous conditions.

DuodenalPolyp

A small Duodenal Polyp is being removed with a Thermal Forceps at Endoscopy.

Laparoscopic Cholecystectomy - Aberrant Structures

Laparoscopic cholecystectomy is a common surgical procedure. Theoritically, there can be up to 25% of structures variations to the biliary tree. Surgeons will always have to keep in mind this brute anatomical fact in order to avoid biliary tree injury

Why Patients With Haemorrhoids Bleed in Their Stools

The above picture shows a view of the lower rectum at colonoscopy. It is obvious the prominent dilated veins in the wall of the rectum. These veins are bigger than usual and appears greenish-blue in colour. Dilated vascular systems always carry more blood flow than otherwise.

Patients with haemorrhoids that present with rectal bleeding always have these dilated veins in the lower rectal walls. These dilated blood vessels may rupture especially during bowel motion due to sudden increase in pressure within the blood vessels. Bleeding tend to be self-limiting due to minute rupture and the vessels will get clotted by itself quite easily.

Why these dilated blood vessels occur in the first place in patients that suffer common haemorrhoids is not well understood. It may be related to the stagnation of blood flow due to persistent intraabdominal pressure preventing normal blood flow out off the rectal wall area. These may explain the frequent occurence of common haemorrhoids in patients that always constipate and in pregnant ladies.

One unique medical condition that give rise to the dilated veins above is the varicose veins of the recto-anal region due to the new blood vessels connections between the systemic blood vessels of the anal region with the portal blood vessels of the lower rectum. This condition usually occur in patients with chronic liver disease and cirrhosis. Varicose veins in the recto-anal region is less common than the varicose veins(varices) in the oesophago-gastric region which presents with vomiting of blood.

The Pandemic Endoscopist

During this Coronavirus Pandemic, we the Gastrointestinal Endoscopist were advised to strictly select our patients indicated for endoscopy. For mild symptoms we will treat the patients symptoms first with a clinically presumed diagnosis without confirming by endoscopy. Only patients who do not respond to the initial medications or patients with severe symptoms suggesting the possibility of serious diagnosis like Ulcer or Cancer, only then immediate endoscopy is indicated.

Some patients will have to be done without knowing their Coronavirus status. For these patients, we will gear up with our protective shield and garments as shown in the above pictures.

All the endoscoped patients will be tested for coronavirus status at some stage of their hospitalisation. So far I have been lucky. None of my endoscoped patients turn out to be positive for coronavirus infection.

Common Skin Tumour

Many patients have been living with their skin tumours without any problem.

Benign skin rumours are common and they are usually small and pose no problem whatsoever to patients livelihood.

There are varieties of skin tumours. The above skin tumour has a shape of a Polyp. A polyp is a tumour which is made up of a stalk the attaches to the skin and the body that makes up the bulk of the tumour. The polypoidal skin tumour is frequently called Skin Tag.

Benign skin tumour grows very slowly if at all. If it does not cause any problem to patients, it does not need any particular treatment. If it causes a problem, even the unsightliness, the treatment is Surgical Removal. For a small skin tumour, it can be removed by various ablative methods like Thermocautery(heat)or Cryotherapy((ice).

A big skin tumour like in this picture requires a formal surgical operation. The above polyp has been causing pain and bleeding to patient with his pant on while walking. The polyp is located in his thigh.

The removed polyp is sent for histological examination which revealed a final diagnosis of Squamous Papilloma.

Post Thyroidectomy Complication

Surgery is one of the modern advances in Medicine. There are so many diseases which could not be cured before but with the advent of Surgery now become a routine success.

However, the Achilles heal of Surgery is the Surgical Complications. Although most surgical operations done by a well trained surgeon will go smoothly without any complication. Complications loom in every single operation nonetheless.

I have done so many Thyroidectomy ie. operation to remove thyroid glands during my surgical career. There are usually three possible complications that may occur after thyroid operations;

- hoarseness due to nerve injury

- cramps due to damage to the parathyroid glands

- bleeding

The above picture shows a patient after undergoing a thyroid operation suffering from a complication of minor bleeding post surgery. The central neck swelling is due to bleeding under the skin.This is confirmed by an ultrasound examination. Since the bleeding is small and the blood was quite solid clot, there is no specific treatment needed here. With time, the blood clot will be resorbed by the surrounding tissues.The Surgical scar is seen to be fully healed.