Penetrating tracheal injuries – A Kashmir experience

Background: The increased incidence of tracheal injuries encountered during war like situation in the valley of Kashmir has prompted us to conduct this study.Method: The study was conducted retrospectively on 29 patients managed in the past in our hospital and 7 patients were managed after the study was undertaken. After recording the observations made in managing the patients of penetrating tracheal trauma, the results were analyzed and entered in the individual patients’ protocol.Results: There was a predominance of males with a male to female sex ratio of 5: 1. The majority (69% had fire arms trauma. Hissing wounds, respiratory distress and haemoptysis were the commonest presenting complaints. There were 4 deaths. Complications were observed in 16 (50%) of the 36 patients who survived and included hoarseness in 6 and tracheal stenosis in 5 cases.Conclusion: It was concluded that earliest possible diagnosis followed by securing ofairway and prompt repair is the mainstay of management of penetrating tracheal injuries

Penetrating Tracheal Injuries – A Kashmir Experience

Background: The increased incidence of tracheal injuries encountered during war like situation in the valley of Kashmir has prompted us to conduct this study. Method: The study was conducted retrospectively on 29 patients managed in the past in our hospital and 7 patients were managed after the study was undertaken. After recording the observations made in managing the patients of penetrating tracheal trauma, the results were analyzed and entered in the individual patients’ protocol. Results: There was a predominance of males with a male to female sex ratio of 5: 1. The majority (69% had fire arms trauma. Hissing wounds, respiratory distress and haemoptysis were the commonest presenting complaints. There were 4 deaths. Complications were observed in 16 (50%) of the 36 patients who survived and included hoarseness in 6 and tracheal stenosis in 5 cases. Conclusion: It was concluded that earliest possible diagnosis followed by securing of airway and prompt repair is the mainstay of management of penetrating tracheal injuries

Polymorphism of DNA repair gene XRCC1 in lung cancer among Kashmiri population

DNA repair plays a critical role in protecting the genome of the cell from insults of cancer-causing agents, such as those found in tobacco smoke. Reduced DNA repair capacity, therefore, can increase the susceptibility to smoking-related cancers. Recently, three coding polymorphisms in X-ray cross-complementing group 1 (XRCC1) DNA repair gene have been identified, and it is possible that these polymorphisms may affect DNA repair capacity and thus modulate cancer susceptibility. In humans, 70 genes are involved in the five major DNA repair pathways: direct repair, BER, NER, mismatch repair, and double-strand break repair. XRCC1 acts as a facilitator or coordinator in BER, through its interaction with poly(ADP-ribose) polymerase, DNA polymerase, and DNA ligase III. We explored the association between polymorphisms of the DNA repair gene XRCC1 codon 194 and lung cancer risk in males. The role of DNA repair gene XRCC1 in susceptibility to lung cancer has not been widely studied in Kashmir. In our case control study, the study population consisted of 70 lung cancer patients and 72 healthy controls. Cases and controls were matched by age and gender. We observed a significantly high risk of lung cancer among patients who were carriers of the variant genotype Trp/Trp (homozygous mutant) with OR = 3.33, 95% CI = 1.4 - 7.9, P = 0.0056, as compared with homozygous wild type genotype Arg/Arg and was statistically significant. We observed a high risk of about three-fold in case of the homozygous variants of codon194 Trp/Trp genotype. Cases with a codon194 Trp allele were also at high risk of developing lung cancer (OR= 2.28, 95% CI = 1.36 – 3.82, P = 0.0015) and was also statistically significant. In our study, we found that cases who smoke i.e. smokers, have higher frequency of Trp/Trp homozygous variant (36.66% vs. 14.89%) as compared with controls. We also observed a high risk of about two-fold in case of homozygous variants Trp/Trp in smokers (OR= 2.87, 95% CI = 1.06 – 7.74, P = 0.03) and observation was statistically significant. . It is thus concluded that there is an elevated risk for lung cancer in individuals with the codon194 XRCC1 polymorphism. Our study suggests that cases especially smokers with homozygous variant genotype Trp/Trp tend to be more fragile and susceptible to lung cancer as compared to non-smokers. Hence the analysis of the polymorphism of XRCC1 codon Arg194Trp may help in identifying individuals at risk of developing lung cancer

Posterolateral thoracotomy complicating paraplegia

Paraplegia complicating thoracotomy has been reported in literature in mid forties. However in sufficient data are available about the incidence of such a catastrophic complication. In the present study five cases of paraplegia following thoracotomy are presented. Pneumonectomy, lobectomy for bronchogenic carcinoma decortication for tubercular empyemas and thoracotomy for ductus ligation constituted one, one, two and one patient respectively. Two patients died in post operative period, two died in follow up and one patient is still on follow for the last twelve years.Department of Cardiovascular and Thoracic Surgery SKIMS, Soura, Srinaga