The importance of rapid ambulance response to emergency medical crises is undeniable. An early
access to advanced care is crucial to saving a life. Modern computerised call centre and the hospitalbased ambulance services are believed to enhance the quality of service delivery. However, whether
it will further reduce the ambulance response time is still debatable. A cross-sectional study was
conducted in June 2012 until July 2012 at three selected tertiary hospitals in Malaysia. The
ambulance response time was expressed in a median and interquartile range (IQR) and MannWhitney U test was used to determine the associations between types of ambulance and
computerised call centre system versus voice only. Wilcoxon Rank Sign Test was used to assess
the significance of means difference. A hospital-based ambulance had the median time of 0.19
minutes while community-based ambulance had the median time of 0.20 minutes (The Z score -
0.916, p-value - 0.360). The hospital with computer call centre had the median time of 0.19 minutes
while hospital without computer call centre had the median of 0.20 minutes (The Z score - 0.816, P
value - 0.414).The response time of hospital-based ambulance equipped with computerised call
centre system was comparable in three selected tertiary hospitals in Malaysia.
We describe a patient who had fever and bilateral cortical blindness and was later found to have leaking intracerebral mycotic aneurysm secondary to Staphylococcus aureus endocarditis. He had a vegetation at the .tricuspid valve with evidence of systemic embolisation, however, chest radiograph did not reveal any evidence of pulmonary emboli.
Keywords: Endocarditis, cortical blindness, mycotic aneurysm, Staphylococcus
INTRODUCTION: The understanding of the skin's vascular anatomy has improved in the last decade. It has lead to technique modification such as the staged procedure in performing sural flaps and improvement in the flap survival rate. The aim of this study was to evaluate the acute vascular complications (flap necrosis or congestion) of 29 patients who underwent distal base sural flap for coverage of wound around the ankle.
METHODS: Twenty-four males and five females with a mean age of 37.1 years old underwent sural flap surgery to cover wounds at around the ankle. There were 12 cases of open fracture, five infected fractures, four spoke injuries, four degloving injuries and four diabetic foot ulcers. Twentythree cases were done as a single stage procedure while six as a two-stage procedure. The flaps were tunnelled under the skin in three cases.
RESULTS: Twenty one flaps healed uneventfully, seven acute vascular complications occur in a single stage group: five developed partial necrosis, one had congestion with epidermolysis, and one had complete flap necrosis. Complications were treated by dressing or skin grafting and only one required a repeat flap surgery.
CONCLUSIONS: Acute vascular complications may be minimised when sural flap is done in stages for elderly, diabetic, smokers and/or patients with large wound around the ankle. Even if the flap appears necrotic, the underlying structure may still be covered as the fasciosubcutaneous layer of the flap may still survive.
The most common form of malignant renal neoplasms is renal cell carcinoma (RCC), which is classified into several different subtypes based on the histomorphological features. However, overlaps in these characteristics may present difficulties in the accurate diagnosis of these subtypes, which have different clinical outcomes. Genomic and molecular studies have revealed unique genetic aberrations in each subtype. Knowledge of these genetic changes in hereditary and sporadic renal neoplasms has given an insight into the various proteins and signalling pathways involved in tumour formation and progression. In this review, the genetic aberrations characteristic to each renal neoplasm subtype are evaluated along with the associated protein products and affected pathways. The potential applications of these genetic aberrations and proteins as diagnostic tools, prognostic markers, or therapeutic targets are also assessed.