Surgical ventricular restoration in our study has clearly demonstrated a positive effect on LV geometry.

Injuries following wild animal encounters continue to be a major public health problem. Majority of such injuries are minor, however, many injuries remain undocumented. Many victim die, primarily in third-world countries, before receiving adequate medical care. Penetrating injuries to the chest following the attack by the wild animals, though rare, present a challenging problem. Though a great number of papers have been published regarding the injuries following encounter with animals, least are the lethal injuries occuring in the thoracic region and the survival out of these grave injury is very minimum. We herein present the least possible surviving case with lethal penetrating injury of the chest and left lung following the goring by the rhinoceros.

Aims Arteriovenous fistula is considered as reliable form of vascular access for hemodialysis in Chronic Kidney Disease (CKD) patients. We aim to evaluate prospectively, the outcome and primary failure rate of Arteriovenous fistula in 30 Chronic kidney Disease patients with Glomerular Filtration Rate (GFR) <30ml/min. Materials and methods This prospective study was conducted at the department of cardiothoracic and vascular surgery (CTVS), College of Medical Sciences, Bharatpur from May 2011 to May 2012. Thirty patients ranging from age 25 to 76 years with stage IV and V CKD, i.e. GFR below 30ml/min, were included in this study. Detailed physical examination including arterial pulses i.e. axillary, brachial, radial and ulnar and blood pressure in both upper limbs was recorded. Allens test was performed on every patient and left upper limb was used for AV fistula formation. Brachiocephalic fistula was made in 19 (63.33%), while radiocephalic fistula was made in 11 (36.67%) patients. Patients were evaluated post operatively, on outdoor basis, weekly for 6weeks. All patients were evaluated for the presence or absence of complications i.e. infection, hematoma, thrombosis, aneurysms and steal syndrome. Results The complication was primary failure in two patients. One male patient got secondary infection and one female patient got post operative hematoma leading to 6.66% primary failure of fistula. No other complications were noted. Conclusion Arteriovenous fistula is the gold standard for vascular access for hemodialysis in patients with deteriorating renal function and end-stage renal disease. It is designed to improve the effectiveness of dialysis with fewer risks and complications than other vascular accesses. This study gives the higher success rate of 93.33% and concludes that age should not be a limiting factor when determining candidacy for arteriovenous fistula creation and is the safe procedure. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 1-6 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8693

Innovative communication tool in cardiac surgery Reddy DJ, Balasubramanian P, Ponraj P, Muralidharan KV, AshokK, Raju PSN Vijaya Heart Foundation, Chennai Background: Mankind continuously strain for the betterment of life and communication is an important tool for new invention and quality of life. Way back form the age of X ray lobbies and Tagarnos, to modern compact disks and computers, surgeons and students have to cluster around one screen to view and interact with imaging materials like coronary angiogram and echocardiograms.Methods: We developed a back-to-back monitor that allow two or more users seated across from each other to simultaneously view, share and work with the same digital content. Further, incorporation of simple software features or as plug-ins in proprietary content enables partial masking of content, selective information display, and provides interactive tools and features on anyone side, respectively. This monitor can also be switched off on one side, for single use.Results: Seated on either side of a notebook or desktop computer monitor, simultaneously viewing, sharing and digitally interacting with the same contents, like coronary angiogram, echocardiograms and complex surgeries is made easy with this device. Presentations and patient education can be effectively carried out.Conclusions: Medical training as well the professional need for explaining complex anatomical/physiological, clinical conditions to patients and their families, prior to surgery can be effectively addressed with this monitor, maintaining face-to-face contact.

Objective: To observe difference in the management of blunt trauma to the chest on the basis of conventional xray and computerised tomography of the chest. Methods: This prospective study was conducted between December 2011 to October 2012 in COMS in Bharatpur,a tertiary referral centre in central Nepal . Clinically stable thoracic injury patients were first evaluated with chest x-ray and the management on this basis was recorded. The findings of the CT chest were assessed and the type of management on the basis of CT was also recorded. Outcome was assessed in terms of mortality, morbidity, hospital and ICU stay with respect to the management on the basis of chest x-ray and CT scan. Results: Of the 129 patients, 74.4% were male and 25.6% were female with the patients ranging in age from 7 to 87 years (mean = 40.41 years). The most common mechanism of trauma to the chest was as a result of a motor vehicle accident (69.8%), followed by fall injury (20.2%). X-ray chest diagnosed rib fracture in 62%, haemothorax in 37%, pneumothorax in 27%, lung contusion in 10% and haemopneumothorax in 21% patients. Similarly CT chest diagnosed rib fracture in 86%, haemothorax in 54%, pneumothorax in 36%, lung contusion in 30% and haemopneumothorax in 30% patients. Mean hospital stay was 9.5 days in the group of patients having management on the basis of x-ray chest relative to mean stay of 10.2 days in the CT- chest group. In the management on the basis of xray group, there was a mean ICU stay of 2.8days compared to mean stays of 3.2 days in CT chest group. Conclusion: Though CT scan of the chest is more informative and differs the management of the blunt chest trauma, one should not forget to advise the cost effective, easily available and initial guiding agent, xray chest for early management of the chest injury patient. DOI: http://dx.doi.org/10.3126/jcmsn.v10i1.12764 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(1); 22-31