Thoracic impalement injury by the barrel of a locally fabricated gun in 2 patients: case report.

Thoracic impalement injuries are uncommon among civilians. When it occurs, it´s usually a severe and dramatic form of chest injury that requires immediate operative intervention. The common mechanisms usually encountered involves either a patient falling from a height onto a pole, being driven into a pole following ejection during a road traffic accident or being impaled when a spear/an arrow is thrown at the patient or from long fragments following a blast. Impalement by a retrograde ejected barrel of a gun during recoil is a very uncommon mechanism. We report 2 recently managed patients. The first patient presented with an overt impaling mass and an initially missed tension pneumothorax. The second patient had a covert impalement chest injury. Both patients had surgical interventions with satisfactory outcomes. Our report aims to highlight this unusual mechanism of thoracic impalement injury and the principles of management. We also want to emphasize the importance of adhering to the advanced trauma life support (ATLS) management algorithm, as immediately life-threatening conditions may be missed when exploratory thoracotomy is the only focus.

Off pump coronary artery bypass surgery in a Nigerian teaching hospital.

Coronary artery bypass grafting has not been previously reported in the Nigeria medical literature. We report the case performed in our institution of a 56 year old Nigerian female who underwent off pump coronary artery bypass surgery (OPCAB) for an ostial lesion of the left anterior descending coronary artery. The left internal mammary artery was successfully anastomosed to the left anterior descending coronary artery. The patient was discharged home after 2 weeks, following correction of problems with glycemic control.