Missile diaphragmatic injuries: Kashmir experience

Importance of repairing a diaphragmatic tear due to a missile injury cannot be overemphasized.Even a small diaphragmatic rent should be repaired because of morbidity and mortality caused by subsequent herniation and strangulation. Fifty-three cases with diaphragmatic injuries caused by penetrating missiles were studied from January 1997 to January 2007. All the patients were primarily explored either for thoracic or abdominal penetrating trauma; the diaphragmatic injury was an associated incidental intraoperative finding. Thoracotomy was performed in 18 patients, Laprotomy in 33 patients and in two patients combined thorocoabdominal approach was utilised for managing associated visceral injuries. Overall mortality was 37.7%. Mortality was dependent on associated injuries of thoracic and abdominal viscera. Most patients died due to associated injuries and septicaemia. None of the patients had any sequelae of diaphragmatic repair. Immediate repair of diaphragmatic injury is of paramount importance to prevent subsequent complications of herniation and strangulation

Atrial myxoma: trends in management

Myxomas are the most common type of cardiac tumours in all age groups accounting for one-third to one-half of cases at postmortem and for about three quarter of tumours treated surgically. Most atrial myxomas, whether left or right, arise from the atrial sptum. About 10% have other sites of origin, particularly posterior wall, anterior wall and the appendages [in order of frequency]. Myxomas are frequently located in left atrium and produce symptoms when they fragment and cause systemic emboli or when they interfere with cardiac valvular function and cause pulmonary congestion. Careful surgical management of these lesions should be curative with minimal early and late morbidity and mortality. Recurrence of atrial myxomas can occur most likely in about 3% of patients. However, extensive resection of the myxoma attached to atrial septum or atrial wall can reduce the likehood of recurrence to a greater extent. Long term clinical and echocardiographic follow-up is mandatory