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Sokol Z, Werheim E, Oselkin M. Internal jugular vein fistula mimicking dural arteriovenous fistula after cardiac pacemaker placement. Radiol Case Rep 2024; 19:1679-1684. [PMID: 38384700 PMCID: PMC10877110 DOI: 10.1016/j.radcr.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 02/23/2024] Open
Abstract
Carotid jugular arteriovenous fistulas are a documented complication of cannulation of the internal jugular vein. They may present with neck pain, headache, and cardiovascular aberrations. However, carotid jugular fistula secondary thrombus formation after jugular cannulation with radiographic presentation similar to dural arteriovenous fistula has not yet been reported in the literature. Below, we report the case of a 68-year-old male with an incidentally found carotid-jugular fistula secondary to pacemaker placement who had intracranial reflux on imaging, which was ultimately treated successfully through an endovascular approach.
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Affiliation(s)
- Zachary Sokol
- Department of Neurosurgery, St Luke's University Health Network, 801 Ostrum St., Bethlehem, PA 18015, USA
- Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad St., Philadelphia, PA 19140, USA
| | - Erik Werheim
- Department of Neurosurgery, St Luke's University Health Network, 801 Ostrum St., Bethlehem, PA 18015, USA
- Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad St., Philadelphia, PA 19140, USA
| | - Martin Oselkin
- Department of Neurosurgery, St Luke's University Health Network, 801 Ostrum St., Bethlehem, PA 18015, USA
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Nag DS, Swain A, Sahu S, Swain BP, Sam M. Pitfalls in internal jugular vein cannulation. World J Clin Cases 2024; 12:1714-1717. [PMID: 38660082 PMCID: PMC11036472 DOI: 10.12998/wjcc.v12.i10.1714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/07/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
Central venous catheter insertion in the internal jugular vein (IJV) is frequently performed in acute care settings, facilitated by its easy availability and increased use of ultrasound in healthcare settings. Despite the increased safety profile and insertion convenience, it has complications. Herein, we aim to inform readers about the existing literature on the plethora of complications with potentially disastrous consequences for patients undergoing IJV cannulation.
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Affiliation(s)
- Deb Sanjay Nag
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Amlan Swain
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Seelora Sahu
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Bhanu Pratap Swain
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Merina Sam
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
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Urimoto G, Suzuki T, Matsuda M, Ito K, Orihashi Y, Suzuki T. Effect of Back-Cut Point Needle Bevel Angle on Deterioration After Multiple Punctures in Central Vein Simulation. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2024; 17:89-95. [PMID: 38404633 PMCID: PMC10894522 DOI: 10.2147/mder.s447188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/12/2024] [Indexed: 02/27/2024] Open
Abstract
Background Multiple needle punctures during central venous line insertion can lead to serious complications. Needle deterioration owing to repeated punctures may be a major cause. We hypothesized that there is an optimal bevel angle for a back-cut point needle that is resistant to deterioration. In this study, we examined the effect of bevel angle differences in a back-cut point needle on needle tip deterioration caused by multiple punctures. Methods The resin target was punctured perpendicularly using back-cut point needles with three bevel angles (15°, 17°, and 19°; n=8 for each angle) at a speed of 200 mm/min. The same needle was used for ten consecutive punctures at different locations on the target. The force applied to the needle was recorded as puncture force. The puncture force waveform is bimodal. The second peak values, which formed the maximum values of puncture force, were the focus of the main analysis. We considered a 5% elevation from the first to the 10th puncture force as needle deterioration, and the average slope value of the regression line between the puncture number and puncture force was used. When the upper limit of the 95% confidence interval (CI) of the slope value was less than 0.008889, the needle was considered to be resistant to deterioration. Results The slopes of the second peak values during 10 consecutive punctures for each bevel angle (15°, 17°, 19°) were 0.003011 ± 0.01085 [-0.006056, 0.012077], 0.006116±0.007431 [-0.000096, 0.012328], and 0.001515 ± 0.005783 [-0.003320, 0.006349], respectively (mean ± standard deviation [95% CI]). Only the 19° angle needle had a smaller upper limit of the 95% CI for a slope value of 0.008889. Conclusion The 19° bevel angle back-cut point needle was more resistant to deterioration than the 15° and 17° angle needles were.
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Affiliation(s)
- Genya Urimoto
- Department of Anesthesiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Takeshi Suzuki
- Department of Anesthesiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Mitsumasa Matsuda
- Department of Anesthesiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Kenzi Ito
- Department of Anesthesiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Yasushi Orihashi
- Division of Clinical Research, Kitasato University Hospital, Kanagawa, Japan
| | - Toshiyasu Suzuki
- Department of Anesthesiology, Tokai University School of Medicine, Kanagawa, Japan
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Riopelle JM, Kozmenko VV, Wyche MQ, Yapuncich ML, Pitre EJ. Lower Double-Wall Puncture Rate During Ultrasound-Guided Internal Jugular Vein Cannulation Using Sharper, Narrower-Gauge, and/or Length-Optimized Needles: A 6-Year Quality Improvement Clinical Series in Adult Patients. Ochsner J 2023; 23:232-242. [PMID: 37711474 PMCID: PMC10498959 DOI: 10.31486/toj.22.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Background: During internal jugular vein (IJV) cannulation, needle tip injury to vulnerable subjacent cervical anatomic structures can be prevented if the cannulating needle tip is not permitted, even momentarily, to penetrate the deep portion of the IJV wall, an event known as double-wall puncture (DWP), also called posterior wall puncture. Methods: We conducted a 6-year ultrasound-guided IJV cannulation quality improvement project, seeking to minimize the occurrence of DWP in 228 adult patients using needles of different gauge and tip sharpness. Most needles were length-optimized to the distance between the skin puncture site and the IJV mid-lumen for a selected angle of needle insertion by (1) using a nylon screw-on needle stop or (2) using a cannulating needle that already had the desired shaft length. Results: Standard central venous cannulation kit needles were long enough to reach or traverse the deepest portion of the IJV wall in nearly all patients. Use of extra-sharp, smaller-diameter needles in place of standard needles was associated with a 26.3% relative reduction in DWP rate. Use of needles length-optimized to reach only the IJV mid-lumen was associated with a 78.4% relative reduction in DWP rate. A 0% DWP rate was attained using length-optimized 21-gauge extra-sharp needles and length-optimized 20-gauge needles of intermediate sharpness. Conclusion: The 9.2% DWP rate achieved during this project was approximately half the rate reported at the time of project inception. Use of length-optimized, sharper, narrower-gauge cannulating needles may help avoid DWP during ultrasound-guided IJV cannulation.
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Affiliation(s)
- James M. Riopelle
- Department of Anesthesiology, Louisiana State University Health Sciences Center–New Orleans, New Orleans, LA
| | - Valeriy V. Kozmenko
- Office of Medical Education, University of South Dakota Medical Center Sanford School of Medicine, Vermillion, SD
| | - Melville Q. Wyche
- Department of Anesthesiology, Louisiana State University Health Sciences Center–New Orleans, New Orleans, LA
- Department of Anesthesiology, New Orleans Veterans Administration Medical Center, New Orleans, LA
| | - Marion L. Yapuncich
- Department of Anesthesiology, Louisiana State University Health Sciences Center–New Orleans, New Orleans, LA
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Lip HTC, Huei TJ, Peng LE, Huan KZ, Sen CJ, Muhamad I, Mohamad Y, Alwi RI. Outcomes of traumatic extremity vascular injuries from a Malaysian level 1 trauma center. Injury 2022; 53:3005-3010. [PMID: 35410740 DOI: 10.1016/j.injury.2022.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/03/2022] [Accepted: 03/23/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND In Malaysia, management of traumatic vascular injuries is at the discretion of the treating surgeon (trauma or vascular surgery). This study was conducted to report on the epidemiology, mechanism of injury and outcomes of vascular injuries managed in a regional level 1 trauma center. METHODS This is a retrospective cohort study of all patients treated for traumatic extremity vascular injuries from January 2018 to December 2020. Demography, mechanism of injury, pre-operative physiologic vital signs, vessel injured, injury severity (NISS, RTS and TRISS score), type of revascularization surgery, fasciotomy, post-operative blood investigations, operative outcomes (amputation, length of stay and ICU admission) and long-term rehabilitation follow-up were recorded and analyzed. RESULTS Amongst the 35 recorded vascular injuries only 28 patients had adequate data that were included in the analysis. Majority of patients were males (23/28patients; 82%). Blunt injury to vessels was more likely in motorcycle crashes (16/28patients; 76%) than in automobile crashes (5/28patients; 24%). There were three lower limb amputees (3/3patients; 100%) that had early fasciotomy and were associated with three-fold higher post-operative median (interquartile range) CK levels of 16740 (8157 to 23116) u/l. Only two thirds (16/28 patients) had active rehabilitation follow-up and were back to work after a median duration of four months. CONCLUSION Male gender, blunt injury, road traffic crashes and motorcycles were the majority of vascular injuries. Lower limb vascular injuries had poorer outcome with three amputations performed after attempts at revascularization. Fasciotomy and high CK level may be related to higher risk of limb loss. Our study highlights the importance of rehabilitation and long-term follow-up in this cohort of patients.
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Affiliation(s)
- Henry Tan Chor Lip
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia.
| | - Tan Jih Huei
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
| | - Lee Ee Peng
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
| | - Khoo Zi Huan
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
| | - Chuah Jun Sen
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
| | - Izwan Muhamad
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
| | - Yuzaidi Mohamad
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
| | - Rizal Imran Alwi
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
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AlAttab N, Alshehri KM, Alturki AY, Wani T, Alwan A, Alomar K, AlGhofili H. External Carotid Artery-Jugular Vein Fistula Caused by Blunt Trauma: A Case Report & Literature Review. Vasc Endovascular Surg 2022; 56:802-807. [PMID: 35945671 DOI: 10.1177/15385744221120202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acquired carotid-jugular fistula usually occurs due to neck stab wounds, gunshots, or central vein catheterization. Blunt trauma is a rare cause. These cases usually present with pulsatile swelling, tinnitus, and continued thrills in the neck. Both surgical and endovascular options have been used to manage these fistulas. Coil embolization is also applied in high-flow fistulas. We present a case of a 38-year-old woman free of any pre-existing medical conditions, presenting with a fistula between the external carotid artery and external jugular vein distally and with a high flow. She was treated with fistula embolization using coils while limiting the high flow via a balloon in the jugular vein. Our case highlights the possibility of using coils in high-flow fistulas in anatomically challenging fistulas. Furthermore, relevant literature review is presented to recapitulate unique features and effective management of carotid-jugular fistulas.
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Affiliation(s)
- Nashwan AlAttab
- Vascular Surgery Department, King Salman Heart Center, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khaled Mohammed Alshehri
- Vascular Surgery Department, King Salman Heart Center, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Tariq Wani
- Vascular Surgery Department, King Salman Heart Center, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulwali Alwan
- Vascular Surgery Department, King Salman Heart Center, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Alomar
- Vascular Surgery Department, King Salman Heart Center, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hesham AlGhofili
- Vascular Surgery Department, King Salman Heart Center, 37849King Fahad Medical City, Riyadh, Saudi Arabia
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Islam MR, Ansari A, Rahman A, Saklayen SMG, Muhammad N, Shah SK, Chavda VK, Chaurasia B, Hossain M. The perplexing postsurgical complication of carotid-jugular fistula: A bitter experience. Surg Neurol Int 2022; 13:2. [PMID: 35127202 PMCID: PMC8813626 DOI: 10.25259/sni_967_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Vascular injuries occur in approximately 25% of all penetrating neck traumas, with carotid artery injuries being particularly lethal. Penetrating neck injuries are potentially fatal. Vascular injuries occur in approximately 25% of cases, which can lead to the formation of arteriovenous fistulas. Case Description: The authors present a case of delayed open surgery to repair a carotid-jugular fistula that resulted in an unprecedented complication, as well as a brief review of the condition’s diagnosis and treatment options. Conclusion: This case report suggests us that, penetrating neck injuries should be thoroughly evaluated for arteriovenous fistulae. To avoid complications, common carotid-jugular fistulas must be treated as soon as possible. Postoperative complications can be effectively managed with prompt action.
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Affiliation(s)
- Md. Rokibul Islam
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh,
| | - Ayub Ansari
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh,
| | - Asifur Rahman
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh,
| | - S. M. G. Saklayen
- Department of Vascular Surgery, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh,
| | - Nur Muhammad
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh,
| | - Satish Kumar Shah
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh,
| | - Vishal K. Chavda
- Department of Anaesthesia, Dreamzz IVF Centre and Women’s Care Hospital, Ahmedabad, Gujarat, India,
| | - Bipin Chaurasia
- Department of Neurosurgery, Bhawani Hospital and Research Centre, Birgunj, Nepal
| | - Mohammad Hossain
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh,
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Application Value and Relevance Analysis of the Risk Evaluation System for Arteriovenous Fistula Puncture in Thrombosis after Puncture. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6919979. [PMID: 34900199 PMCID: PMC8660209 DOI: 10.1155/2021/6919979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022]
Abstract
Objective To analyze the application value and relevance of risk evaluation system for arteriovenous fistula (AVF) puncture in thrombosis after puncture. Methods The clinical data of 180 patients treated with hemodialysis in the hemodialysis center of our hospital from November 2017 to November 2019 were retrospectively analyzed. After puncture, all patients received the digital subtraction angiography (DSA) examination, and based on whether they had AVF thrombosis, they were divided into the nonthrombosis group (n = 102) and thrombosis group (n = 78), and then, according to the parity of their admission numbers, the patients in the thrombosis group were subdivided into the study group (n = 39) and the reference group (n = 39), so as to analyze the risk factors of thrombosis after AVF puncture and the application value of the risk evaluation system for AVF puncture in preventing and treating thrombosis. Results Compared with the reference group after intervention, the study group had significantly higher mean internal fistula blood flow volume (P < 0.001) and significantly lower total incidence rate of vascular complications in fistulas (P < 0.05); according to the multifactor binary logistic regression analysis, it was found that diabetes, systolic blood pressure reduction, hemoglobin, low-density lipoprotein cholesterol (LDL-C), ultrafiltration rate, and elevation of blood phosphorus and platelet levels were the risk factors of thrombosis after AVF puncture in hemodialysis patients. Conclusion When risk factors of thrombosis are found in patients treated with hemodialysis, timely detection and intervention shall be applied in the early stage. Adopting the AVF puncture risk evaluation system has an extremely high application value in the clinic and is of important meaning in prolonging the service life of fistulas.
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Tan Chor Lip H, Huei TJ, Mohamad Y, Alwi RI, Tuan Mat TNA. Critical adjustments and trauma surgery trends in adaptation to COVID-19 pandemic in Malaysia. Chin J Traumatol 2020; 23:207-210. [PMID: 32653358 PMCID: PMC7255157 DOI: 10.1016/j.cjtee.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/10/2020] [Accepted: 05/16/2020] [Indexed: 02/04/2023] Open
Abstract
Malaysia has one of the highest total numbers of COVID-19 infections amongst the Southeast Asian nations, which led to the enforcements of the Malaysian "Movement Control Order" to prohibit disease transmission. The overwhelming increasing amount of infections has led to a major strain on major healthcare services. This leads to shortages in hospital beds, ventilators and critical personnel protective equipment. This article focuses on the critical adaptations from a general surgery department in Malaysia which is part of a Malaysian tertiary hospital that treats COVID-19 cases. The core highlights of these strategies enforced during this pandemic are: (1) surgery ward and clinic decongestions; (2) deferment of elective surgeries; (3) restructuring of medical personnel work force; (4) utilization of online applications for tele-communication; (5) operating room (OR) adjustments and patient screening; and (6) continuing medical education and updating practices in context to COVID-19. These adaptations were important for the continuation of emergency surgery services, preventing transmission of COVID-19 amongst healthcare workers and optimization of medical personnel work force in times of a global pandemic. In addition, an early analysis on the impact of COVID-19 pandemic and lockdown measures in Malaysia towards the reduction in total number of elective/emergent/trauma surgeries performed is described in this article.
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Affiliation(s)
- Henry Tan Chor Lip
- Department of General Surgery, Hospital Sultanah Aminah, Malaysia Ministry of Health, Johor Bahru, Malaysia,Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Malaysia Ministry of Health, Johor Bahru, Malaysia,Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia,Corresponding author. Department of General Surgery, Hospital Sultanah Aminah, Malaysia Ministry of Health, Johor Bahru, Malaysia.
| | - Tan Jih Huei
- Department of General Surgery, Hospital Sultanah Aminah, Malaysia Ministry of Health, Johor Bahru, Malaysia,Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Malaysia Ministry of Health, Johor Bahru, Malaysia,Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Yuzaidi Mohamad
- Department of General Surgery, Hospital Sultanah Aminah, Malaysia Ministry of Health, Johor Bahru, Malaysia,Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Malaysia Ministry of Health, Johor Bahru, Malaysia
| | - Rizal Imran Alwi
- Department of General Surgery, Hospital Sultanah Aminah, Malaysia Ministry of Health, Johor Bahru, Malaysia,Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Malaysia Ministry of Health, Johor Bahru, Malaysia
| | - Tuan Nur' Azmah Tuan Mat
- Department of General Surgery, Hospital Sultanah Aminah, Malaysia Ministry of Health, Johor Bahru, Malaysia
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