Background/Objective: The National Kidney Foundation Kidney disease outcomes quality initiative guidelines suggest that the creation of more native arteriovenous fistulas (AVFs) would improve the quality of life of end stage renal failure patients. However, the ability to comply with this suggestion is affected by the failure rate of AVFs mainly due to thrombosis. Heparin is a well-accepted treatment to prevent thrombosis in general but has not been suggested in arteriovenous fistula. This study was conducted to investigate the effect of intraoperative systemic heparin on the thrombosis rate and associated morbidities over a duration of six weeks.

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous neoplasm with a high frequency of recurrence after inadequate primary treatment. It is most commonly seen in individuals in their third to fifth decades but has been reported in all age groups. Literatures regarding Dermatofibrosarcoma protuberans accounts for less than 0.1% of all malignant neoplasms and approximately 1% of all soft tissue sarcomas. The incidence has been estimated to be 0.8 to 5 cases per 1 million people per year. A wide-margin surgical excision with microscopically disease-free margins is the standard treatment. We report two cases of dermatofibrosarcoma protuberans at different sites of the body and present a detailed discussion of the diagnosis, treatment and outcomes with reference to available literatures.

A 13-year-old Indian boy presented with right iliac fossa pain, vomiting, diarrhea and fever for the past 4 days. On further history taking, he also complained of weight loss about 7 kg in 1 month. Otherwise, there was no constitutional symptom. Patient has a strong family history of malignancy. Patient's mother was diagnosed breast cancer and patient's grandmother was diagnosed lingual cancer. Initial diagnosis was acute appendicitis. We proceeded with emergency open appendicectomy and intraoperative finding was inflamed retrocecal appendicitis, Tip of appendix was thickened and adhered deeply to the posterior peritoneum, otherwise caecal base was healthy and no Meckel's diverticulum found. Histopathology examination (HPE) result showed carcinoid tumor with tumor size 0.5cm and base was free. Immunohistochemistry staining for Synaptophysin: Positive, Chromogranin: Positive and CD56: Positive. Urine 5-HIAA result was normal. CT Thorax, Abdomen and Pelvis showed no evidence of distant metastasis. We plan to follow up this patient every 6 monthly clinically. Case 2: A 24-year-old Malay gentleman presented with right iliac fossa pain, diarrhea and fever for one day duration. Abdominal examination demonstrated tenderness over the right iliac fossa. Abdominal X-ray shows only fecal loaded over the ascending colon. Blood parameters were normal limits. Our initial diagnosis was acute appendicitis. We proceeded with emergency open appendicectomy. Intraoperative finding was perforated tip of appendix with 10cc pus but base was healthy. Patient was discharge home well at post operative day three. Patient was reviewed back in clinic in 1 month and the HPE result showed carcinoid tumor with tumor size 0.5cm, base and body is free. Immunohistochemistry staining for Synaptophysin: Positive, Chromogranin: Positive and CD56: Positive. Urine 5-HIAA and result was normal. CT Thorax, Abdomen and Pelvis showed no evidence of distant metastasis. We plan to follow up this patient every 6 monthly clinically.

Extraosseous Ewing's sarcoma is a rare entity that involves the lower extremities, paravertebral regions of the spine, retroperitoneum, pelvis, and the chest wall. Involvement of mesentery as this case has been only reported five times in English literature. An eleven-year-old girl was planned for gynaecological surgery for suspected ovarian dysgerminoma. Intraoperatively she was referred to the surgical team since tumor arising from mesentery of the terminal ileum. Complete resection of the tumor with a right hemicolectomy was done. Histopathological assessment of the tumor revealed features of small blue round cell tumor which after an expert immunohistochemical staining reported as extraosseous Ewing sarcoma. She underwent a course of adjuvant chemotherapy and currently well during follow up. Due to the rarity of this tumor, a proper consensus on management has not been outlined. However, complete resection and adjuvant chemotherapy remain a standard therapy which showed an excellent post-operative outcome.

Splenic artery aneurysms (SAAs) account for more than half of all visceral artery aneurysms. SAAs are the third most common intraabdominal aneurysm. Although SAAs is rare but are potentially life threatening [1]. It can cause complications, such as spontaneous intraperitoneal rupture, into the neighbouring hollow organs, and fistulisation into the pancreatic duct.