Background: Penetrating cardiac injuries are rare and considered the most lethal of all trauma patients. Managing cardiac injuries is a great challenge for the trauma surgeons and the outcome of the treatment of such critical condition depends on the mechanism of injury, haemodynamic status of the patients at the time of presentation, heart chamber involved and other associated injuries. Materials and Methods: This is a prospective observational study of consecutive six patients with penetrating cardiac injuries from January 2015 to December 2019 treated in Regional Institute of Medical Sciences, Imphal, India. eFAST and CT scan of the chest were the main imaging methods used for diagnosis. All patients underwent tube thoracostomy for associated haemothorax in the emergency ward. Results: All the patients had penetrating cardiac injuries due to stabbing. Five (63.3%) patients presented with features of cardiac tamponade or with severe hypotension (systolic BP less than 80 mmHg) and one (16.7%) patient who was haemodynamically stable at the time of presentation had developed features of cardiac tamponade after 24 hours. Four patients had undergone emergency left anterolateral thoracotomy, one patient had undergone median sternotomy, and one patient underwent left anterolateral thoracotomy on the second day after admission. Conclusion: A high index of suspicion for cardiac trauma is extremely important in patients presented with penetrating thoracic injuries or upper abdominal injuries. Computed tomography of the chest can show the haemopericardium giving detailed information of associated pulmonary injury and hemothorax. Prompt diagnosis and early surgical intervention play a vital role to save these critically injured patients.

Background: Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide with the potential to cause a dreaded pulmonary embolism (PE). Disease and patient-specific considerations are preferably incorporated into therapeutic options for effective management. Materials and methods: Sixty-eight cases of acute deep vein thrombosis were treated within a period of 3 years from January 2016. All the cases were subjected to routine investigations with the Doppler study of the affected limb. Low molecular weight heparin (dalteparin) was administered in all the cases for a period of 15 days and the Doppler study was repeated at the end of the drug therapy. After the course of low molecular weight heparin, the patients were given acenocoumarol 2mg daily. Estimation of partial thromboplastin time and prothrombin time were performed before starting and during the treatment of the low molecular weight heparin and acenocoumarol regularly. A venogram was done only when the repeated Doppler study revealed unsatisfactory response to low molecular weight heparin therapy. Eight cases underwent thrombectomy and the postoperative period was uneventful. Results: Age group of 21-30 years was most affected (80.8%) with right lower limb being the commonest affected site of injection and associated lesions. Conclusion: DVT in the young population remains a challenge to the evaluating clinician. A variety of disease states can alter the anticoagulant factors. Urgent diagnosis and appropriate intervention carry paramount importance.

BACKGROUND Pleural effusions, parapneumonic effusions and empyema thoracis are known complications of bacterial pneumonia Underlying disorders as well as treatment approaches dramatically reduce the rate of morbidity and mortality in children. METHODS Forty-six children below 12 years of age admitted with pleural effusions or empyema thoracis between October 2016 and May 2019 were prospectively analysed. Thoracocentesis and pleural fluid specimens were checked within 30 minutes of collection, for anaerobic organisms. Daily thoracocentesis, intercostal tube drainage (ICD), open thoracotomy and decortication were performed among appropriate patients. RESULTS Patient required thoracocentesis in 14 (30.4%) cases with thin pleural fluid and tube drainage in 32 (69.6%) patients with frank pus. Four of fourteen children (28.5%) on serial thoracocentesis underwent ICD for failure of resolution. 4 of 32 (12.5%) cases on ICD required decortication. Median length of stay was 12.4 days for patients treated with serial thoracocentesis, 18.6 days for patients treated with ICD and 29.2 days for operated patients. CONCLUSIONS Conservative management (with either thoracentesis or tube thoracostomy) of pleural effusions or empyema thoracis with antibiotics covering S. aureus and S. pneumoniae along with ICD is safe and effective without the need for prolonged hospital stay. Surgical intervention is needed only when conservative approach fails.

BACKGROUND Blunt chest injury is the most common thoracic injury. Although majority of the blunt chest injuries are benign, it can also result in many intrathoracic complications which requires prompt diagnosis and appropriate treatment. Injuries to the thoracic cavity or its contents require urgent intervention as a life-saving measure. METHODS This is a prospective observational study of 324 patients with blunt chest injuries from January 2015 to December 2018 in Regional Institute of Medical Sciences, Imphal. All patients with blunt chest injuries admitted in the Surgery ward and Orthopaedic ward with or without associated injuries were included in this study. Patients with penetrating chest injuries and patients with rib fracture who were not admitted in the ward were excluded from this study. Chest drain output of more than 1000 ml (at the initial drain), persistent air leak, and diaphragmatic rupture were considered as an indication for thoracotomy. Patients with minimal haemothorax or pneumothorax were managed conservatively with closed monitoring of vitals and follow up CT scan of the chest during the hospital stay. RESULTS A total of 324 patients (M=271, F=53) with blunt chest injuries were prospectively analysed. Mean age was 29 years (range 18-82 years). Majority of the patients were in the age group of 21 to 40 years comprising 177 (54.6%) patients (Table I). Road traffic accident (RTA) was the most common cause of blunt chest injuries comprising 88.9%. Rib fracture with or without associated haemothorax or pneumothorax was the most common injury (87.1%). This was followed by haemothorax (60.2%) and haemopneumothorax (5.9%). 11 (3.4%) patients presented with flail chest with varying amount of bilateral haemothorax. Traumatic asphyxia was the least common injury in patients with blunt chest injuries. CONCLUSIONS Blunt chest injuries carry a high morbidity and mortality risk if not managed with appropriate and urgent treatment. Tube thoracostomy is the main procedure performed in any chest injury. High index of suspicion is required for any intrathoracic organ involvement in management of chest injuries due to blunt trauma. Early decisions to perform surgical intervention can improve outcomes for patients with severe thoracic injury unnecessary.

BACKGROUND Peritonitis developing as a result of hollow viscus perforation is a common condition in a developing country like India. Even if the patient reaches the hospital in time and is operated, the postoperative period is still unpredictable. Secondary peritonitis is the consequence of contamination of the peritoneal cavity due to contents of a hollow viscus within the peritoneal cavity. As peritonitis following hollow viscus perforation is a life threatening condition commonly encountered in our hospital, a uniform scoring system is good to judge the efficacy of the health care as well for prognostic purposes. It helps in selecting patients at high risk who may require intensive management. Thus there has been a search for accurate risk scoring system that can be used to compare patient's outcome. POSSUM scoring system with its 12 physiological score and 6 operative score was used to predict the expected morbidity and mortality. METHODS: The present study was a cross sectional study where cases diagnosed as perforative peritonitis undergoing laparotomy in the Department of Surgery, RIMS, Imphal, Manipur, India were studied. RESULTS Out of the 100 patients in the study, 5 died and 28 had some form of morbidity. There were no patients with predicted morbidity score of less than 25. The minimum score is 6 and maximum is 48. CONCLUSIONS POSSUM scoring is a good tool to predict morbidity and mortality in patients undergoing laparotomy following hollow viscus perforation provided risk stratification is done.