The incidence of haemorrhagic complications of intracranial pressure monitoring (ICPM) has previously been reported. However, in these studies, the techniques employed to access the inside of the cranium varied. While 3-mm essentially blind 'twistdrill' craniostomies have been used, their role has been limited for fear of haemorrhagic sequelae. This has also restricted their use in clinical applications other than ICPM. We conducted a prospective observational study looking at haemorrhagic complications of the twistdrill in order to determine its safety and whether it has a role in other clinical settings. Over the period January 1994-February 2001, 941 patients had 1032 twistdrill procedures. There were 550 (58.4%) male patients and 391 (41.6%) female. The age range was 3 months to 93 years (median age 35 years). Only four procedures (0.38%) caused clinically significant bleeds attributable to the twistdrill --all of which were managed conservatively without requiring surgical evacuation. We conclude that twistdrill craniostomies are safe and that their use could be extended to other neurosurgical procedures and potentially to ICPM in non-neurosurgical centres.

Case seriesPatient: Male, 44 • Male, 58Final Diagnosis: Soft tissue sarcomasSymptoms: Discomfort • swellingMedication: —Clinical Procedure: Image guided biopsy • metastatic work up • neoadjuvant radiotherapy • radical resectionSpecialty: SurgeryObjective:Rare diseaseBackground:Soft tissue sarcomas (STS) account for approximately 1% of adult malignancies, with 50 to 60% occurring in the extremities. Liposarcoma is the most common type of STS and represent about 20% of total adult sarcomas. There are rare syndromes associated with increased risk of developing STS. Further, chemical compounds such as chlorinated phenols and a few chemotherapeutic drugs have been linked to STS, along with ionizing radiation. Nevertheless, the etiology is uncertain for most of these lesions.Case Report:This report details 2 cases of metachronous bilateral STS of the lower extremities. The first of these presented as a local recurrence of a previously resected right thigh liposarcoma and a new liposarcoma in the left thigh. As mentioned above, among the different subtypes of STS, liposarcoma has the highest tendency for multifocality. The second patient had multifocal metachronous leiomyosarcoma with lung metastases occurring simultaneously with the second presentation. Leiomyosarcoma is another subtype reported to present with multi-focal disease.Conclusions:Despite the rarity of bilateral lesions, their occurrence should not be overlooked in the initial diagnosis and follow-up of the initially detected tumor. Early detection can affect patient survival because their presence predicts unfavorable outcomes.

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The incidence of cardiac rupture following blunt trauma is rare, occurring in 0.3%-0.5% of all blunt trauma patients. It can be fatal at the trauma scene, and is frequently missed in the emergency room setting. The severity of a cardiac trauma is based on the mechanism and degree of the force applied. The objective of this study was to report the case of a 32-year-old male patient who was involved in a motor vehicle collision and presented to the emergency room with signs of hypovolemic shock. The patient was found to have severe chest trauma associated with massive hemothorax requiring immediate intervention. The patient had an emergent thoracotomy revealing a right atrial injury. Repair of the atrial injury reversed the state of shock. The patient was discharged after 35 days of hospitalization in good condition.