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Fulltext Inadvertent diaphragmatic rent following thoracic surgery for empyema thoracis successfully repaired with mesh

Henry Tan Chor Lip, Tan Jih Huei, Simon Jerome Vendargon

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):322-324.
MyJurnal

Iatrogenic diaphragmatic entry following thoracic surgery is rare with only two cases reported till date. This case reports on a 46-year-old male with persistent pleural sepsis due to right empyema thoracis despite best medical ef- forts. Following a right thoracotomy and decortication, the right diaphragm was inadvertently incised due to dense adhesions between the diaphragm and thickened cortex. To our knowledge, this is the third case reported of iatro- genic diaphragmatic entry following thoracic surgery for empyema thoracis. The pearls from this case report is that any evidence of empyema thoracis involving the lower lobe on imaging should warn the surgeons to be aware of inadvertent entry into the peritoneal cavity, as the diaphragm can be adherent to the cortex trapping the lower lobe.
Fulltext A rare case of neurenteric cyst of spinal cord with thoracic vertebra fusion successfully managed with spinal cyst excision and posterior instrumentation surgery

Tan Jih Huei, Henry Tan Chor Lip, Chan Chee Kong, Ariz Chong B. Abdullah@Chong Chee Yong, Noor Azman Bin A. Rahman

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):348-350.
MyJurnal

The incidence of neurenteric cyst (NC) is rare amongst spine tumors. It is most often asymptomatic but may present
with sensory and motor symptoms. When associated with thoracic vertebra fusion it is not reported before, this complicates the placement of pedicle screw during posterior instrumentation. Herein, we report a case of thoracic spinal
neurenteric cyst in a 40-year-old man that presents with chronic back pain, left lower limb weakness and numbness.
Elective excision of NC over T6-T7 with laminectomy and multilevel posterior instrumentation was successfully
performed with significant improvement of the symptoms. Neurenteric cyst is a rare spinal cord lesion which may
cause permanent neurological sequalae. Complete surgical excision with spine fixation in this case provides good
long-term outcome.
Fulltext A Rare Case of Ileocecal Tuberculosis with Pulmonary Embolism and Deep Vein Thrombosis

Huei TJ, Henry TCL, Ho CA, Mohamad Y

J Clin Diagn Res, 2017 Jul;11(7):PD03-PD04.
PMID: 28892968 DOI: 10.7860/JCDR/2017/27923.10192

Venous thromboembolism in tuberculosis is not a well recognised entity. It is a less frequently reported complication of severe pulmonary tuberculosis. It is exceedingly rare when it complicates extrapulmonary tuberculosis. Here, we present a case of 22-year-old young female with abdominal tuberculosis complicated with reverse ileocecal intussusception, deep vein thrombosis and pulmonary embolism. An emergency vena cava filter was inserted prior to a limited right hemicolectomy. In this article, we discuss the rare association of venous thromboembolism with ileocecal tuberculosis.
Development and validation of a new simplified anatomic trauma mortality score

Tan JH, Mohamad Y, Imran Alwi R, Henry Tan CL, Chairil Ariffin A, Jarmin R

Injury, 2019 May;50(5):1125-1132.
PMID: 30686543 DOI: 10.1016/j.injury.2019.01.027

BACKGROUND: Most trauma mortality prediction scores are complex in nature. GAP (Glasgow Coma Scale, Age, Systolic blood pressure) and mGAP (mechanism, Glasgow Coma Scale, Age, Systolic blood pressure) scores are relatively simple scoring tools. However, these scores were not validated in low and middle income countries including Malaysia and its accuracies are influenced by the fluctuating physiologic parameters. This study aims to develop a relevant simplified anatomic trauma scoring system for the local trauma patients in Malaysia.
METHOD: A total of 3825 trauma patients from 2011 to 2016 were extracted from the Hospital Sultanah Aminah Trauma Surgery Registry. Patients were split into a development sample (n = 2683) and a validation sample (n = 1142). Univariate analysis is applied to identify significant anatomic predictors. These predictors were further analyzed using multivariable logistic regression to develop the new score and compared to existing score systems. The quality of prediction was determined regarding discrimination using sensitivity, specificity and receiver operating characteristic [ROC] curve.
RESULTS: Existing simplified score systems (GAP & mGAP) revealed areas under the ROC curve of 0.825 and 0.806. The newly developed HeCLLiP (Head, cervical spine, lung, liver, pelvic fracture) score combines only five anatomic components: injury involving head, cervical spine, lung, liver and pelvic bone. The probabilities of mortality can be estimated by charting the total score points onto a graph chart or using the cut-off value of (>2) with a sensitivity of 79.2 and specificity of 70.6% on the validation dataset. The HeCLLiP score achieved comparable values of 0.802 for the area under the ROC curve in validation samples.
CONCLUSION: HeCLLiP Score is a simplified anatomic score suited to the local Malaysian population with a good predictive ability for trauma mortality.
Fulltext Unexpected complication of arteriovenous fistula of the left common carotid to internal jugular vein following central venous catheterization

Henry TCL, Huei TJ, Yuzaidi M, Safri LS, Krishna K, Rizal IA, et al.

Chin J Traumatol, 2020 Feb;23(1):29-31.
PMID: 31744657 DOI: 10.1016/j.cjtee.2019.10.001

Incidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of <1%. This is due to the advancements and wide availability of ultrasound to guide its insertion. Formation of arteriovenous fistula after arterial puncture is an unexpected complication. Till date, only five cases (including this case) of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture. The present case is a 26-year-old man sustained traumatic brain injuries, chest injuries and multiple bony fractures. During resuscitative phase, attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery. Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula. The catheter was removed successfully and common carotid artery was repaired. Postoperatively, the patient recovered and clinic visits revealed no neurological deficits. From our literature review, the safest method for removal is via endovascular and open surgical removal. The pull/push technique (direct removal with compression) is not recommended due to the high risk for stroke, bleeding and hematoma formation.