Missile cardiac injuries: review of 16 years' experience.

BACKGROUND: Penetrating cardiac trauma represents an increasingly important form of trauma due to the frequent use of firearms and bombs in civilian violence. We report our experience over the past 16 years with missile-induced cardiac injuries. METHODS: A retrospective study reviewing 40 cases (30 males, 10 females) of missile cardiac injuries was conducted. The nature of injuries, management and outcomes were analyzed. RESULTS: The ages ranged from 14-68 years. The mean time in which patients reached the hospital was 4.1 hours. Forty percent of the patients had firearm injuries and the remaining 60% had pellet or splinter injuries to the heart. Survival was noted in 37.5% in the gunshot group and in 66.6% in the splinter/pellet group. The survival in patients with isolated cardiac injury was 60%, while it was only 40% in those with associated injuries. Single-chamber injury was noted in 87.5% of the patients and the survival in these was 62.8%. Fourteen complications were noted in the patients who were resuscitated. One patient was re-explored for excessive bleeding and a missed right ventricular perforation was repaired. CONCLUSION: In missile cardiac injuries, results are best if operated early, and outcome depends upon multiple factors including clinical status at arrival, time interval till management, nature of injury, and associated injuries.

Albendazole as an adjuvant to the standard surgical management of hydatid cyst liver.

BACKGROUND: The treatment options for hydatid cyst liver include non-operative and operative methods. Operative methods include conservative and radical procedures. Non-operative methods include chemotherapy and percutaneous treatment of liver hydatidosis. MATERIAL AND METHODS: The study was conducted at Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India, over a period of two years from March 2001 to February 2003 with further follow-up of 5-6 years. The study included 64 cases in the age group of 15 years to 64 years, comprising 36 males and 28 females. The aim of the study was to know the effect of preoperative and postoperative albendazole therapy on the viability of protoscolices and recurrence rate of hydatid disease of liver. Patients were divided into four group of 16 each. In group A, patients were directly subjected to surgery. In group B, patients were given albendazole for 8 weeks followed by surgery. In group C, patients were given albendazole for 8 weeks preoperatively followed by further postoperative course for 8 weeks. In group D, patients were first taken for surgery followed by postoperative course of albendazole for 8 weeks. RESULTS: Out of those patients who received preoperative albendazole only 9.37% had viable cysts at the time of surgery as compared to 96.87% of patients who did not receive any preoperative albendazole. In those patients who did not receive any albendazole therapy, recurrence rate was 18.75% whereas recurrence was 4.16% in patients who received albendazole therapy. CONCLUSION: We conclude that albendazole is safe and effective adjuvant therapy in the treatment of hydatid liver disease.

Ascariasis-induced empyema of gallbladder: report of a case.

A rare case of a 52-year-old woman with empyema of the gallbladder due to ascariasis causing an obstruction in the cystic duct is presented. She was admitted on September 20, 2000, and on September 23 an emergency cholecystectomy was performed. Ultrasonography is a highly sensitive and specific method for diagnosing gallbladder ascariasis, and a cholecystectomy is considered mandatory for the treatment of empyema of the gallbladder.