Aortic dissection (AD) is an uncommon life-threatening emergency. Its development is usually subtle and easily missed. On the other hand, an aneurysm nearly always requires immediate surgical intervention. Both interventions are technically different and pose their own challenges. We experienced a distinct case of AD of the ascending aorta in a 65-year-old lady, who presented with a sudden onset of severe chest pain and shortness of breath. Thoracic aortic aneurysm was suspected as computed tomography revealed a saccular aneurysm of the proximal ascending aorta with no involvement of the valve and aortic branches. Surgery was decided after considering the risk of rupture and mortality. However, a diagnosis of localized aortic dissection was discovered and repaired accordingly. We discuss the pitfalls of diagnostic modalities and the techniques of surgical repair.

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Purpose: Amongst the ASEAN countries, Malaysia has the highest road fatality risk (>15 fatalities per 100 000 population) with 50% of these fatalities involving motorcyclist. This contributes greatly to ward admissions and poses a significant burden to the general surgery services. From mild rib fractures to severe intra-abdominal exsanguinations, the spectrum of cases managed by surgeons resulting from motorcycle accidents is extensive. The objective of this study is to report the clinical characteristics and identify predictors of death in motorcycle traumatic injuries from a Malaysian trauma surgery centre. Methods: This is a prospective cross-sectional study of all injured motorcyclists and pillion riders that were admitted to Hospital Sultanah Aminah and treated by the trauma surgery team from May 2011 to February 2015. Only injured motorcyclists and pillion riders were included in this study. Patient demography and predictors leading to mortality were identified. Significant predictors on univariate analysis were further analysed with multivariate analysis. Results: We included 1653 patients with a mean age of (35 +/- 16.17) years that were treated for traumatic injuries due to motorcycle accidents. The mortality rate was 8.6% (142) with equal amount of motorcycle riders (788) and pillion riders (865) that were injured. Amongst the injured were male predominant (1 537) and majority of ethnic groups were the Malays (897) and Chinese (350). Severity of injury was reflected with a mean Revised Trauma Score (RTS) of 7.31 +/- 1.29, New Injury Severity Score (NISS) of 19.84 +/- 13.84 and Trauma and Injury Severity Score (TRISS) of 0.91 +/- 0.15. Univariate and multivariate analysis revealed that age >= 35, lower GCS, head injuries, chest injuries, liver injuries, and small bowel injuries were significant predictors of motorcycle trauma related deaths with p < 0.05. Higher trauma severity represented by NISS, RTS and TRISS scores was also significant for death with p < 0.05. Conclusion: Age, lower GCS, presence of head, chest, liver, small bowel injuries and higher severity on NISS, RTS and TRISS scores are predictive of death in patients involved with motorcycle accidents. This information is important for prognostic mortality risk prevention and counselling. (C) 2019 Chinese Medical Association. Production and hosting by Elsevier B.V.

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. (C) 2019 Elsevier Ltd. All rights reserved.

A diagnosis of cystic lesion of epigastrium is challenging without strong evidence from history and physical examination. A 33-year-old lady has an epigastric mass without hepato-pancreaticobiliary symptoms, was unable to be diagnosed through radiological assessment and biochemical markers. She was diagnosed with hepatobiliary cystadenoma through intraoperative assessment. We present a case of biliary cystadenoma with diagnostic challenge.

Aortic dissection (AD) is an uncommon life-threatening emergency. Its development is usually subtle and easily missed. On the other hand, an aneurysm nearly always requires immediate surgical intervention. Both interventions are technically different and pose their own challenges. We experienced a distinct case of AD of the ascending aorta in a 65-year-old lady, who presented with a sudden onset of severe chest pain and shortness of breath. Thoracic aortic aneurysm was suspected as computed tomography revealed a saccular aneurysm of the proximal ascending aorta with no involvement of the valve and aortic branches. Surgery was decided after considering the risk of rupture and mortality. However, a diagnosis of localized aortic dissection was discovered and repaired accordingly. We discuss the pitfalls of diagnostic modalities and the techniques of surgical repair. �Copyright 2018 by Gazi University Medical Faculty.

Background. Cricoid pressure (CP) is a step during rapid sequence induction. Previous studies showed a poor clinical application of CP despite a reasonable theoretical knowledge of CP. This study aims to evaluate the proficiency and knowledge retention on CP among the emergency staff in the Emergency Department, Universiti Kebangsaan Malaysia Medical Centre. Materials and Methods. This is questionnaire-based observational comparative study. Once the questionnaire is filled, the application of CP is tested on an airway model and competency level is documented. An education hand out is passed to all participants after the procedure. The improvement and knowledge retention were assess after 2 month. Results. A total of 81 completed surveys were returned comprises of of 34 medical officers, 23 staff nurses and 24 assistant medical officers. 75.3% subjects have work experience more than a year but only 59.3% of them were trained in CP application. A total of 69.1% participants passed the pre educational handout test and 100% passed the post educational handout test. However, for pre educational handout phase, 81.5% participants passed the theory part while only 42% passed the practical component. In post educational handout phase, the number of respondents who passed both components was 97.5% and 63% respectively. There are positive correlation between designation and working experience with overall passes in this study. Conclusion. The theoretical knowledge of CP is satisfactory but clinical application is poor especially in the pre educational handout phase. The educational handout is proved to improve the knowledge transfer and retention with regards to CP. � 2014. Societ� Editrice Universo (SEU).

Acute pancreatitis is a common surgical emergency with a variety of aetiologies. Hypertriglyceridaemia is considered as one of the causes, especially in elevated triglyceride levels in the absence of other culprits. However, it rarely occurs in combination with oral contraceptives. We present a case of a 35-year-old woman with acute pancreatitis caused by oral contraceptive-induced hypertriglyceridaemia. This case report highlights the importance of considering rare side effects of oral contraceptives, which are commonly used by women at childbearing age. Proper clinical history and evaluation with measurements of fasting serum lipid profile in high-risk patients will help explain the aetiology of pancreatitis to avoid further morbidity in the future.

The incidence of pancreatic ascites is unusual. It is uncommon sequelae of chronic pancreatitis. Smith first discovered it in 1953 in the literature. The etiology includes chronic pancreatitis, pancreatic pseudocyst, pancreatic trauma and idiopathic in origin. Despite a rise in the incidence, it is scarcely reported. This is a case of a 20-year-old man presented with repeated acute pancreatitis episode complicated with gross ascites. Pancreatic duct stones were identified intra-operatively. Frey's surgery was the procedure of choice. We discuss the presentation, choice of treatment and outcome.

Radiofrequency ablation (RFA) has evolved to become the treatment of choice for non-resectable recurrent colorectal liver metastasis. It is however, not without complications. Portal vein thrombosis following RFA is rare but can be fatal to the outcome of the patient. Here, we present a case of a 66-year-old man who developed portal vein thrombosis following RFA. CT scan revealed a left portal vein thrombosis. This case report highlights the challenges and multimodal treatment of portal vein thrombosis following Radiofrequency ablation (RFA) in a cirrhotic patient.

The endoclip design that will be done is by designing cartridge components that have several clips. In essence, endoclip is a mechanical device in the world of health, especially for endoscopic activities, which are also used for the process of hemostasis and also non-hemostatic applications. This study describes the relationship between end-time end-endoscopic problems during gastrointestinal standards. Currently, market-available endoclips only focus on single-firing, where the process is carried out one by one. The use of Endoclip at this time is very difficult because of the repetition of the clip loading process to the applicator. Therefore, the purpose of this research is to design cartridges which consist of several clips for endoclip and allow for mechanical movements. The method of selecting the appropriate and important part of the tip which is the most important way to solve the problem and the design and process of the simulation is done using CATIA V5 software. The aim of this study was achieved by increasing the critical part of the catheter by replacing it with a cartridge design that contained several clips that allowed the clipping process to be multi-firing, not one-shot and also by simulating the mechanism.