Bifurcated rib with vertebral defects - A rare anatomical variant: Case report with literature review.

INTRODUCTION: Bifurcated ribs are a neuroskeletal anomaly which are incidentally discovered on chest X-ray. It is a developmental disorder where sternal end of a rib is split into two, commonly found in males, on the right side and unilaterally not associated with a vertebral defect. PRESENTATION OF CASE: In this report we discuss a case of a 17-year-old girl with a left bifid rib alongside a segmental defect of the vertebra. DISCUSSION: Bifurcated ribs usually occur in isolation or with other rib abnormalities associated with vertebral defects. Most cases are asymptomatic or found at post-mortem. Gorlin Syndrome is a condition where both these anatomical defects form a part of its criteria. CONCLUSION: With barely any data on significance of bifid rib with vertebral defects and no conclusive exclusion of Gorlin Syndrome, close monitoring coupled with regular follow-ups in such patients is the likely plan of treatment. In addition, genetic testing for susceptible genes should be strongly considered.

Hydatid cyst of the cardiac interventricular septum.

Hydatid cysts of the cardiac interventricular septum are rare and present a diagnostic and therapeutic challenge. We report the case of a 48-year-old woman who was successfully treated with cyst excision and capitonnage.

Transfer delay and in-hospital mortality of trauma patients in Pakistan.

BACKGROUND: Mortality and morbidity in trauma remain a major problem in developing countries. Organized emergency response systems for transfer of trauma patients to hospitals are absent and the consequent delays could cause significant complications. AIMS: This study assessed the outcomes as a result of hospital transfer and delays in trauma patients. METHODS: The study was based on trauma patients presenting to the Aga Khan University Hospital (AKUH), Karachi, Pakistan from 1998 to 2005, meeting the trauma team activation criteria. Data were collected and entered in a Trauma Registry. The study focused on analyzing the outcomes of injury to delay in definitive treatment and survival. RESULTS: Out of 978 patients, only 303 (30.9%) patients reached the emergency room (ER) within an hour. The mean time from injury occurrence to arrival in the ER was 4.7h. There was no significant difference in mortality between all patients presenting early and those with more than 1h delay (OR=0.9, 95% CI: 0.6, 1.5). CONCLUSIONS: Transfer and delay in admission to a tertiary care center does not affect in-hospital mortality of trauma patients in a setting with no emergency response system. This may be due to self selection of patients who survive long enough to reach the hospital.