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

Prevalence of exfoliative glaucoma among Kashmiri population: a hospital based study

The Prevalence of exfiolative glaucoma has shown extensive variation all over world ranging from 0 to 50%. To know the prevalence of exfoliative glaucoma in Kashmir. A hospital based cross-sectional study was conducted from January 2006 to January 2007 on 300 patients with documented raised intra ocular pressure [IOP], glaucomatous changes in the fundus and open angle of anterior chamber. The study included 236 males and 64 females. Out of 300 patients, 115 had exfiolative glaucoma and among those left eye was involved in 47 patients, right eye in 31 and 37 had bilateral involvement. The patients above 60 years of age were found to have this condition more frequently as compared to those below 60 years of age. Occupation of patients had a strong association with this condition, as the disorder was seen more commonly in patients engaged in outdoor activites. The patients with exfiolative glaucoma were found to be having less Visual acuity; a higher IOP at presentation and a more severe and early optic nerve head involvement as compared to those with open angle glaucoma. The study reveals that prevalence of exfoliative glaucoma as seen in our OPD based cross sectional study was found to be 38.3%. This prevalence was high as compared to prevalence studies conducted in southern parts of the country and low as compared to the studies conducted in the Scandinavian countries. The difference in the prevalence of the condition was probably inpart related to the differences in the climatic conditions, ethnic origin and in part related to genetic factors of the studied population

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