A fractured tracheostomy tube is a rare complication; cases have been reported in the past, usually associated with prolonged usage in patients with chronic airway obstruction. We present here a fracture occurring in a new tube, and also describe a method for retrieving the tube from the tracheobronchial tree.
The incidence of breakage of Piezon-Master ultrasonic K files were evaluated. Three groups of unused files were subjected to three treatments, namely; free vibration in air without irrigation, free vibration in root canal while minimizing contact with the wall of canal in the presence of irrigation and light filing in root canal with free flow of irrigation. Cavitation produced by files in contact and free of contact with a glass surface was examined in order to observe the relationship between cavitation defects and breakage. In addition, the fractured and unfractured files were examined under a scanning electron microscope for the presence of cavitation pits. The results indicated that more files broke in air. In water, a higher incidence of breakage occurred when files were allowed to freely vibrate while no breakage occurred when the files were used in filing. All files generated cavitation which resulted in pitting of their surfaces. However, it was considered unlikely that the pits contributed to fracture. Fatigue cracks which could be the result of the manufacturing process were observed at some of the corners of the cross sections of the fractured files and could be the main contributory factor to fracture.
This is a cross-sectional study on the use of halovest appliance in the Orthopaedic and Traumatology Department, Kuala Lumpur Hospital from June 1993 to September 1996. Fifty-three patients with cervical spine injuries were treated by halovest stabilization. Majority of cases was caused by motor-vehicle accident; others were fall from height at construction sites, fall at home, hit by falling object and assault. The injuries were Jefferson fracture of C1, odontoid fractures, hangman fractures, open spinous process fracture and fracture body of C2, and fracture, and fracture-dislocation of the lower cervical spines. Majority of patients had hospital stay less than 30 days. The use of the halovest ranges from 4 to 16 weeks and the healing rate was 96%. Two patients of lower cervical spine injury had redislocation and one of them was operated. There was one case of non-union of type II odontoid fracture and treated by posterior fusion. Other complications encountered during halovest treatment were minor. They were pin-site infection, pin-loosening, clamp loosening and neck pain or neck stiffness. This method of treatment enables patient to ambulate early and reduces hospital stay. We found that halovest is easy to apply, safe and tolerable to most of the patients.
Acromio-clavicular joint (ACJ) dislocation usually occurs in young adults following trauma or sports injury. Fourteen patients underwent surgical treatment for symptomatic total ACJ dislocation (Rockwood and Matsen Type III-VI) in our unit between January 1996 and June 1997. Eight patients were operated within three weeks of injury and six in the chronic period (after three weeks). In the acute group, two patients had Botsworth procedure and six had Weaver-Dunn operations. All six in the chronic group had Rockwood procedure. Nine patients achieved excellent outcome with full range of shoulder movement, pain free and return to work within three months of surgery. Two patients had good outcome. Three other patients had satisfactory outcome with tolerable pain and light duty at three months. Two patients developed chronic shoulder pain and one had painful hypertrophic surgical scar. Two patients had screw breakage requiring revision surgery. In conclusion, surgical treatment for ACJ dislocation produces good results. We suggest that surgical treatment be the treatment of choice for young patients requiring early recovery and good shoulder function.
Between May 1992 through October 1998, twenty-two patients who had adolescent idiopathic scoliosis were treated using Universiti Kebangsaan Malaysia (UKM) spinal instrumentation and fusion. The minimum length of follow-up was 2 years with an average of 2.9 years. Nineteen patients were female and three patients were male. The mean age at the time of the operation was 16.2 years (range, 13 to 24 years). The average blood loss was 1,878 ml and the average operating time was 291 minutes. The mean pre-operative curve was 61.2 degrees, with a range of 40 degrees to 90 degrees. The average post-operative correction of the Cobb's angle was 53.5 per cent, with a range of 33 per cent to 81 per cent. Post-operative immobilization consisted of a maximum of six months in a body cast. There were no neurological injuries, no deep wound infections, and no evidence of pseudoarthroses. Only three complications occurred and these did not disturb the progress of the fusion. This technique safely achieves the objectives of scoliosis correction, and is cost-effective in the treatment of adolescent idiopathic scoliosis.
We studied 60 intertrochanteric fractures of the femur fixed with Dynamic Hip Screw (DHS). There were 10 cases (16.7%) with cutting-out of device through femoral head and neck. Stable fracture pattern, postero-inferior and central position of screw in the femoral neck and head produced high percentage of good result, whereas anterior or superior position of screw produced higher incidence of cut-out. We found osteoporosis and distance of screw tip to subchondral bone to have no influence on the final outcome.
Matched MeSH terms: Equipment Failure/statistics & numerical data
This is a preliminary report on the use of the modified Airway Management Device in 50 spontaneously breathing patients undergoing elective day care surgery. We were successful in establishing a clear airway in all 50 patients, 46 of these patients had a patient airway on the first attempt. All patients were successfully managed with the Airway Management Device throughout the surgery. Partial airway obstruction during maintenance of anaesthesia occurred in three cases requiring only minor manipulations. Our result showed that the Airway Management Device may be used as an alternative airway management in anaesthesia.
A thermoluminescent dosimetry (TLD) postal dose inter-comparison was carried out amongst radiotherapy centres in Malaysia. The aim of this TLD inter-comparison was to compare the uniformity involved in the measurement of absorbed dose among the participating centres. A set of 5 TLD chips placed within acrylic trays were mailed to all participating centres for irradiation to an absorbed dose to water of 2 Gy. Measurements were made for 6 MV and 60Co photon beams. Results show an agreement of +/- 5% for all but three radiotherapy centres. The ratios of the TLD readings to that of the reference centre are comparable with other national/regional dose inter-comparisons. The importance of a proper ongoing quality assurance program is essential in maintaining the consistency and uniformity of doses delivered.
Failure analysis was performed to investigate the failure of the femur fixation plate which was previously fixed on the femur of a girl. Radiography, metallography, fractography and mechanical testing were conducted in this study. The results show that the failure was due to the formation of notches on the femur plate. These notches act as stress raisers from where the cracks start to propagate. Finally fracture occurred on the femur plate and subsequently, the plate failed.
Biofouling control is important for effective process of membrane bioreactor (MBR). In this study, phenomena of biofouling for immersed type extended aeration MBR with two different anti-fouling aeration intensities were studied through a laboratory set up. The objectives of this study were (a) to observe biofouling phenomena of MBR that operates under different anti-fouling bubbling intensity, and simultaneously monitors performance of the MBR in organic carbon and nutrients removal; (b) to compare effectiveness of detergent and detergent-enzyme cleaning solutions in recovering biofouled membranes that operated in the extended aeration MBR. For MBR, which operated under continuous anti-fouling aeration, deposition and accumulation of suspended biomass on membrane surface were prohibited. However, flux loss was inescapable that biofilm layer was the main problem. Membrane cleaning was successfully carried out with detergent-enzyme mixture solutions and its effectiveness was compared with result from cleaning with just detergent solution.
Catheter knotting is a rare complication of bladder catheterisation. Retention of catheter parts resulting in calculus formation is even rarer. We report a case of a vesical calculus formed over a broken and retained supra-pubic catheter which to the best of our knowledge has yet to be reported, along with three other cases of bladder catheter knotting.
Illuminance level in the softcopy image viewing room is a very important factor to optimize productivity in radiological diagnosis. In today's radiological environment, the illuminance measurements are normally done during the quality control procedure and performed annually. Although the room is equipped with dimmer switches, radiologists are not able to decide the level of illuminance according to the standards. The aim of this study is to develop a simple real-time illuminance detector system to assist the radiologists in deciding an adequate illuminance level during radiological image viewing. The system indicates illuminance in a very simple visual form by using light emitting diodes. By employing the device in the viewing room, illuminance level can be monitored and adjusted effectively.
Glove perforation during surgery has always been a matter of concern as it increases the infection rate and the risk of transmission of blood borne diseases. To determine the common causes, the site and the awareness of glove perforations in orthopaedic surgery, a prospective study was conducted to assess the rate of glove perforation during 130 consecutive orthopaedic operations. All gloves worn by the surgical team were assessed after the surgery using the water-loading test. A total of 1452 gloves were tested, and the rate of perforation was 3.58%. Most of these perforations (61.5%) were unnoticed. The main surgeons had the most perforations (76.9%), followed by first assistants (13.5%) and second assistants (9.6%). Most perforations occurred at the non-dominant hand. The commonest site of perforation was the index finger followed by the thumb. Shearing force with instruments accounted for 45% of the noticed perforations. Majority of these occurred during nailing procedures (33%) and internal fixation without the use of wires (19%). Our rate of glove perforation is similar to other series. Most of them went unnoticed and were mainly due to shearing injuries rather than perforation by sharps. Therefore, there is an increased risk of contamination and break in asepsis during surgery.
Matched MeSH terms: Equipment Failure/statistics & numerical data
This study was focused on investigating the optimum fluidising velocity during the combustion of rice husk in a bench-scale fluidised bed combustor (ID 210mm) to obtain low carbon ash in the amorphous form. When all other parameters are held constant, the optimum fluidizing velocity aids in almost complete combustion, thereby releasing the entrapped carbon for further conversion. This results in ash with consistently low carbon content (less than 2wt%). The range of fluidising velocities investigated was from as low as 1.5U(mf) to as high as 8U(mf). It was found that the optimum fluidising velocity was approximately 3.3U(mf) as the mixing of rice husk with the bed was good with a high degree of penetration into the sand bed. The resulting ash retained its amorphous form with low residual carbon content (at 2.88wt%) and minimal sand contamination as shown by the X-ray diffraction analysis.
We demonstrate an enhanced multiwavelength L-band Brillouin-erbium fiber laser (BEFL), in which the Brillouin pump is pre-amplified before entering the single-mode fiber. The Brillouin pump pre-amplification provided by the Erbium-doped fiber has created higher intensity of Brillouin Stokes line generated in the single-mode fiber that leads to the homogenous gain saturation. Thus the built-up of self-lasing cavity modes is suppressed in a wider wavelength range. In contrary to the conventional linear-cavity BEFL, the number of output channels is enhanced within the same tuning range.