Coronary sinus perforation is a relatively uncommon but much feared complication that may occur during the placement of left ventricular pacing lead. Coronary sinus perforation, especially in the presence of an obstructive flap, usually indicates the need to abandon the implantation attempt, as there are difficulties in crossing the obstructive flap as well as uncertainty of whether the lead is in the true lumen or into the pericardial space. We describe our experience in successfully placing the left ventricular lead safely despite the problems arising from these circumstances.
We present a case of a foreign body which migrated to the maxillary ostia by mucociliary action from its initial location on the floor of the maxillary sinus where it was traumatically introduced. This report illustrates that a powerful mechanism of mucociliary action can cause relatively heavy objects within the maxillary sinus to migrate naturally to the sinus ostia against gravitational force.
Penetrating neck trauma present difficult management issues by virtue of their rarity. Undiagnosed laryngotracheal injuries have serious implications, especially in the context of multiple trauma, where other injuries overshadow that of the laryngotracheal complex. This is a case of a schizophrenic patient with multiple self-inflicted cuts on his throat and abdomen. Injuries include open, comminuted laryngeal complex lacerations with vocal cord avulsion, as well as evisceration of small bowel. Adequate assessment using both direct laryngoscopy and rigid endoscopy, coupled with open exploration, allowed optimal exposure and fixation of the larynx in the anatomical configuration. The post-operative outcome of the airway and voice remained satisfactory at follow-up. A high index of suspicion coupled with adequate surgical approach allowed establishment of a functional larynx.
The effect of supplementing 200 mg/kg body weight palm vitamin E (PVE) and 200 mg/kg body weight alpha-tocopherol (alpha-Toc) on the healing of wounds in streptozotocin-induced diabetic rats was evaluated. The antioxidant potencies of these two preparations of vitamin E were also evaluated by determining the antioxidant enzyme activities, namely, glutathione peroxidase (GPx) and superoxide dismutase (SOD), and malondialdehyde (MDA) levels in the healing of dermal wounds. Healing was evaluated by measuring wound contractions and protein contents in the healing wounds. Cellular redistribution and collagen deposition were assessed morphologically using cross-sections of paraffin-embedded day-10 wounds stained according to the Van Gieson method. GPx and SOD activities as well as MDA levels were determined in homogenates of day-10 dermal wounds. Results showed that PVE had a greater potency to enhance wound repair and induce the increase in free radical-scavenging enzyme activities than alpha-Toc. Both PVE and alpha-Toc, however, were potent antioxidants and significantly reduced the lipid peroxidation levels in the wounds as measured by the reduction in MDA levels.
Emergency lung resection for chest trauma is a rare event with a reported incidence of 0.08-1.3% but is associated with a high morbidity and mortality especially if a pneumonectomy is required, if due to blunt chest trauma or when concomitant injuries are present. We report three cases of young adult males with penetrating chest injuries that required emergency thoracotomy (ET) and anatomical lung resection to achieve definitive control of life threatening pulmonary haemorrhage. All patients survived to hospital discharge and remained well on follow-up. Indications for an ET and what constitutes the optimal operative management of such patients is discussed.
A 66-year-old man sustained an injury to his right foot while gardening. Despite receiving tetanus toxoid one hour later and adequate wound toilet, he developed severe tetanus complicated with autonomic dysfunction six days later. He died 20 days after admission. This case shows that tetanus toxoid alone may not be sufficient to prevent tetanus in wounded patients. Careful consideration must be given to the immune status of the patient and to the nature of the wound sustained. Incompletely immunised patients or patients with unknown immune status who sustain a tetanus prone wound should be protected with both tetanus toxoid and tetanus immunoglobulin.
Flying feather is a traditional street weapon, which is believed to be originated from Philippine. It is a famous weapon in Tawau, Sabah, shot within short distance and being used with the aim to debilitate the victims. Some may even apply poison at the tip of the weapon. We report two cases of severe chest injuries in resulting from flying feathers. Case 1, a 25-year old man sustained left sided hemothorax with anterior right ventricle injury. He underwent thoracotomy and was discharged well. Case 2, a 40-year old man, presented to emergency department with no signs of life, sustained penetrating injury to the left second intercostal muscle, the pericardium and the anterior wall of the right ventricle adjacent to the interventricular septum. These cases highlight the severity spectrum of cardiac injury resulting from flying feathers.
Marjolin's ulcers are malignancies that arise from previously traumatised, chronically inflamed or scarred skin. We present a case with childhood burns, who had repeated irritation of his forearm skin with palm oil thorns that eventually led to malignant change.