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Fulltext A rare case of traumatic bilateral sixth cranial nerve palsy

Hamidon, B.B., Md Shariful, H.S., Nasaruddin, M.Z.

International Medical Journal Malaysia, 2012;11(2):50-52.
MyJurnal

Traumatic bilateral sixth cranial nerve palsy is a rare condition which is typically associated with additional intracranial, skull, and cervical spine injuries. We describe a case of complete bilateral sixth nerve palsy in a 28-year-old female patient after an alleged motor vehicle accident. She had altered level of consciousness but no intracranial lesion or associated skull or cervical spine fracture was detected. In this case, we discussed the differential diagnoses, initial workup, and possible treatment options in cases of traumatic 6th nerve palsy.

Matched MeSH terms: Neck Injuries
Fulltext A delayed unusual presentation of a penetrating foreign body

Lee ST

Singapore Med J, 1992 Jun;33(3):304-5.
PMID: 1631596

Complications resulting from the penetrating percutaneous foreign bodies almost always arise in the early post injury period. Delayed presentations of previous asymptomatic foreign bodies are rare. In this case report, symptoms of tracheal irritation arose seven years following the initial penetrating shrapnel injury to the neck. Computed tomography scans enabled localisation of the foreign body at the tracheal wall and carotid sheath interface. The usefulness of this radiologic modality in the evaluation of the penetrating soft tissue injury is highlighted. A review of the phenomenon of the migrating and asymptomatic foreign body follows.

Matched MeSH terms: Neck Injuries
Suicide and ethnicity in Malaysia

Murty OP, Cheh LB, Bakit PA, Hui FJ, Ibrahim ZB, Jusoh NB

Am J Forensic Med Pathol, 2008 Mar;29(1):19-22.
PMID: 19749611 DOI: 10.1097/PAF.0b013e31815b4c57

This article highlights methods of ending life in different ethnic groups. This inference is drawn from analysis of data from suicidal cases from the University Malaya Medical Centre mortuary. This study also looked at sex, age, social, and employment factors. Kuala Lumpur has sizeable populations of Muslims, Chinese, Indians and Indonesian, etc. This study is based on 251 cases of suicide that were reported at the University Malaya Medical Centre from 2000 to 2004. Malaysia has a population of 22,662,365 people with 3 major ethnic groups: Malay (58%), Chinese (24%), and Indians (8%) with a minority of "others" (10%), which includes foreigners, Sabahan, and Sarawakian. This research found suicides of 164 male (65%) and 87 female (35%) victims. Their age ranged from 15 to 80 years. The age group from 21 to 30 had the highest total cases of suicide (83 of 251; 33.1%). Among ethnic groups highest rate of suicide was among Chinese with a total of 120 cases (120 of 251; 47.8%). As far as lone method of suicide is concerned, hangings accounted for the highest proportion of cases (108 of 251; 43%). Among ethnic groups, jumping from height was the commonest method used by Chinese (49 of 120; 41%), Malay (9 of 16; 56%), and others (15 of 28; 53.4%); whereas, hanging was the commonest method of committing suicide by Indians (49 of 87); Muslims showed the lowest cases of suicide (18 of 251; 7.2%). In poisoning group Indian was the highest ethnic group who used this method (20 of 37; 54.1%).

Matched MeSH terms: Neck Injuries/mortality
Medico-legal aspects of embolism with a case illustration

Sarvesvaran R

Malays J Pathol, 1991 Dec;13(2):89-100.
PMID: 1823096

An adult male sustained a number of stab injuries and other injuries including a fatal stab injury to the neck. There was evidence of air embolism which was considered to be a major factor causing death. The discussion is in four parts. Part I is confined to the post mortem examination. Part II relates to the medico-legal aspects of the case. Part III is a general discussion on embolism and its medico-legal significance whilst Part IV is on the medico-legal aspects of air embolism.

Matched MeSH terms: Neck Injuries*
Suicide patterns in children and adolescents: a review from a pediatric institution in England

Zainum K, Cohen MC

Forensic Sci Med Pathol, 2017 Jun;13(2):115-122.
PMID: 28349246 DOI: 10.1007/s12024-017-9860-y

Suicide is a catastrophic event to both families and communities yet it is potentially preventable. This study aims to determine incidence and patterns of suicide in children and young adolescents in our region, raise awareness of this entity as a potentially preventable cause of death in this age group, and identify its possible associated risk factors. We retrospectively reviewed suicide cases presenting as sudden unexpected death in children and adolescents that underwent coronial post-mortems at our institution. This is the largest pathological review of completed suicide in children and young adolescents within a single institution in the United Kingdom. We identified 23 suicide cases during a 12 year period from 2003 to 2015, in which 18 cases (78%) were male and 5 cases (22%) were female. The age range was from 8 to 16 years (mean age 12.82 +/- 2.52 SD). With the exception of one case, all of the victims were Caucasian. The majority, 19 cases (81%), were found dead inside their place of residence, 15 of whom were discovered in their own bedrooms. Twenty-one cases (91%) died from neck compression due to hanging; 6 cases (26%) had used the cord of a dressing gown and 5 (22%) opted to use a belt as the ligature. Two cases (9%) that died from multiple-drug toxicity were female. In 7 cases (30.5%) there was evidence of self-harm and in 3 cases (13%) there was a history of previous suicide attempts. Petechial hemorrhages were found at autopsy in more than half of hanging victims and only three cases (14%) displayed dual distribution of post-mortem hypostasis (back and legs). Seven victims (30.5%) left some form of suicide message to family members and friends, 2 of which wrote the message on their arm. Parental separation, conflict with parents, and depression, were common amongst decedents prior to committing suicide. Substance abuse was uncommon in suicide within our cases. Valuable information is available from thorough review of suicide data in children and young adolescents from a single institution. Pathologists and clinicians can play crucial roles in identifying potential risk factors that may contribute to prevent future deaths.

Matched MeSH terms: Neck Injuries/mortality
Superior long term functional and scar outcome of Meek micrografting compared to conventional split thickness skin grafting in the management of burns

Lee SZ, Halim AS

Burns, 2019 09;45(6):1386-1400.
PMID: 31054957 DOI: 10.1016/j.burns.2019.04.011

INTRODUCTION: Autologous skin grafting is the mainstay of treatment in burn patients. Extensive full thickness burns remains a challenge to the burns surgeon due to the lack of autologous skin donor sites. The conventional split thickness skin grafting (SSG) and the Meek micrografting (Meek) technique are part of the armamentarium of the burns surgeon to curtail the challenge of paucity of donor sites. With advances in burn care, mortality rates of burn patients have reduced. As a result, with more patients surviving acute burn, there is a paradigm shift of research towards assessment of functional outcomes and quality of life of the burn survivors. As there is lack of research regarding the functional outcome of the Meek technique, this study was designed to examine the long term functional outcome of the Meek technique and SSG in burns.
METHOD: A cross-sectional study was conducted in Hospital Universiti Sains Malaysia to assess patients with burns between 10 to 40% total body surface area (TBSA) and with at least one year after injury. The Burn Specific Health Score-brief (BSHS-B) was utilized to compare the functional outcome whilst the Vancouver Scar Scale (VSS) was used for comparison on the scar outcome of the two skin grafting techniques.
RESULTS: Forty three patients (Meek,15; SSG,28) were included. The mean current age (years old) of Meek and SSG was 24.7 (range, 7-75) and 25.9 (range, 7-65) respectively. The mean TBSA (%) of the Meek group was 26.7 (range, 13-40) while that of the SSG group was 16.1 (range, 10-32). A simplified domain structure was used for the BSHS-B questionnaire. The work and sexuality subscale were analyzed separately due to missing data. There mean scores of affect and relations was higher in Meek compared to SSG (Meek, 3.86; SSG, 3.75; p > 0.05). Function domain was also better in Meek compared to SSG (Meek, 3.88; SSG, 3.73; p > 0.05). The Meek group displayed superior scar outcome compared to SSG as evidenced by the statistically significant difference in score for the pigmentation, pliability, height and total VSS score.
CONCLUSION: The Meek group showed more favorable BSHS-B scores compared to the SSG group. The scar outcome of the Meek technique is significantly superior to SSG. Therefore, the Meek technique is superior in the management of burns because the long term scar and functional outcome of this technique is better compared to conventional SSG.

Matched MeSH terms: Neck Injuries/surgery