Recovery of projectile through nose - an unusual presentation

Presentation of civilian gunshot injuries, especially to the face, have increased tremendously in the past decade in Karachi. Cranio-facial region when affected has a high mortality rate because projectile may lodge anywhere in the skull. Management of these gunshot wounds demands experience and expertise. A case of 21 year old male is reported, who sustained such an injury by a stray bullet, with the projectile entering from the lateral margin of the left nasal cavity and getting lodged within. Position of the projectile was assessed via series of X-rays. The projectile was removed under direct visualization from the nasal cavity in the Emergency Room. Endoscopic approach has been discussed for removal of deeper projectiles

Clinical Outcome in Patients with Early versus Delayed Decompression in Cervical Spine Trauma

STUDY DESIGN: Prospective observational study. PURPOSE: To assess the clinical outcome after early versus late decompression for traumatic cervical cord injury. OVERVIEW OF LITERATURE: Traumatic spinal cord injury is common globally with the most tragic outcomes in the cervical spine. Although recent studies have shown that early decompression results in more favourable outcome, its authority is yet to be established. METHODS: Study on 98 patients with a traumatic cervical cord injury was conducted over a period of 5 years. The patients who were operated on within 24 hours of the onset of the primary injury (n=34) were classified as the early group, and those who were operated on after 24 hours of the onset of the injury (n=64) were categorized as the late group. The outcome of both the groups was assessed using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) at the 6-month follow-up. RESULTS: The patients in the early group were operated on at a mean time of 18.4 hours (range, 13-24 hours) while patients were operated on at a mean time of 52.7 hours (range, 31-124 hours) in the late group. At the 6-month follow-up, 7 (23.3%) in the early group and 5 (8.7%) in the late group showed >2 grade improvement in the AIS. CONCLUSIONS: The results of patients undergoing decompression within 24 hours of the injury are better than those who are operated on later. An attempt should be made to decompress the traumatic cervical spine early in all possible cases.