Missile Cardiovascular Injuries

Background: Missile Cardiovascular injuries have taken epidemic proportion in Kashmir valley since the eruption of militancy in 1990. Present study was undertaken to analyse the mode, pattern, presentation and management of missile cardiovascular injuries. Study Design: Prospective and retrospective. Material & Methods: Retrospective study of patients with missile cardiovascular injury from Jan 1996 to Oct 2008. 386 patients with missile cardiovascular injury were studied. All patients of cardiovascular injury due to causes other than missiles were excluded from the study. Results: All patients of missile cardiac injuries were treated by primary cardiorrhaphy. Right ventricle was the most common chamber affected. Left anterior thoracotomy was most common approach used. Most of the patients of missile vascular group were treated by reverse saphenous vein graft or end to end anostomosis. Most common complication was wound infection (20.83%) followed by graft occlusion (1.94%) in missile vascular group. Amputation rate was 4.66%. Amputation rate was higher in patients with delay of >6 hours and associated fractures. Conclusions: Missile cardiac injuries are becoming common due to use of more sophisticated weapons in domestic violence. 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. Missile vascular injury needs prompt resuscitation and revascularisation. Preoperative angiography is seldom necessary. Doppler study may sometimes be needed to aid the diagnosis

Evaluating conservative treatment for acute appendicitis with lump formation

Background: Interval appendectomy after acute appendicitis with lump formation (phlegmon) remains controversial. We conducted this study to determine the risk of recurrent appendicitis following initial non-operative treatment for appendicitis, and evaluate factors associated with recurrence. Secondarily, we evaluate the efficacy of interval appendectomy versus no appendectomy. Materials and Methods: Patients who received conservative treatment for appendicitis with lump formation were prospectively studied from June 2006 to June 2008. These patients were followed for recurrence of appendicitis. Results: Of 763 patients with acute appendicitis some 220 patients had lump formation (28.8%). Median age was 28 years. Conservative treatment was successful in 213 (96.8%) patients. The rate of recurrence was 13.1%, all occurring within six months after the index admission. Mean follow-up was 26±18 months. Conclusion: Conservative treatment of appendicitis with lump formation is efficient and the recurrence rate is low. Routine interval appendectomy after initial conservative treatment for lump formation is not a cost-effective intervention and not recommended

Reninoma presenting as cardiac syncope

Reninoma, a renin-secreting tumor of the juxta-glomerular cells of the kidney, is a rare but surgically treatable cause of secondary hypertension in children. We report a case of reninoma presenting as cardiac syncope with long QTc on electrocardiogram due to hypokalemia

Reninoma presenting as cardiac syncope

Reninoma, a renin-secreting tumor of the juxta-glomerular cells of the kidney, is a rare but surgically treatable cause of secondary hypertension in children. We report a case of reninoma presenting as cardiac syncope with long QTc on electrocardiogram due to hypokalemia