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Diced rib cartilage is an acceptable option in severe nasal deformities. We present our preliminary experience in KAMC in nasal septoplasties using the autologous diced costal cartilage. This is a retrospective study of the 22 cases who needed the autologous diced costal cartilage in our centre in 4 years. All our patients needed autologous diced rib cartilages. Twelve were wrapped with temporalis fascia, eight needed rectus fascia and perichondrium was used in only 2 cases. The naso-frontal angle for the whole series decreased by a mean of 4.41° (p=0.008) for the group using the rectus fascia diced cartilage graft. From the aesthetic point of view, all cases were satisfied except 3 (13.6%); two in the group of diced cartilage temporalis fascia; group 1. From the functional breathing view, only 1 case was not satisfied. He was in group 1. Autologous rib cartilage was shown to be a good graft in nasal septoplasty especially if wrapped with rectus fascia.

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INTRODUCTION AND AIM: Emergency thoracotomy is performed either immediately at the scene of injury, in the emergency department or in the operating room. It aims to evacuate the pericardial tamponade, control the haemorrhage, to ease the open cardiac massage and to cross-clamp the descending thoracic aorta to redistribute blood flow and maybe to limit sub-diaphragmatic haemorrhage, bleeding and iatrogenic injury are the common risk factors. We aimed to review our experience in the field of emergency thoracotomies, identify the predictors of death, analyze the early results, detect the risk factors and asses the mortalities and their risk factors. PATIENTS AND METHODS: Our hospital records of 197 patients who underwent emergency thoracotomy were reviewed. We retrospectively analyzed a piece of the extensive experience of the Mansoura University Hospitals and Mansoura Emergency Hospital; Egypt and Saudi German Hospitals; Jeddah in the last 12 years in the management of trauma cases for whom emergency thoracotomy. The aim was to analyse the early results of such cases and to detect the risk factors of dismal prognosis. RESULTS: Our series included 197 cases of emergency thoractomies in Mansoura; Egypt and SGH; Jeddah; KSA in the last 12 years. The mean age of the victims was 28 years and ranged between 5 and 62 years. Of the 197 patients with emergency thoracotomy, the indications were both penetrating and blunt chest trauma, iatrogenic and postoperative hemodynamito a surgical cause. The commonest indication was stab heart followed by traumatic diaphragmatic ruptures. CONCLUSION: The results of emergency thoracotomy in our series were cooping with the results of other reports, mainly due to our aggressive measures to achieve rapid stabilization of the hemodynamic condition. We emphasize the importance of emergency medicine education programs on rapid diagnosis of traumatic injuries with early intervention, and adequate hemodynamic and respiratory support. Emergency thoracotomy has an important role in emergency big volume hospitals and can save a lot of lives. Outcome can be improved by increasing the learning curve and the integrated cooperation of the emergency and surgical teams.

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BACKGROUND: The most frequent cause of accidental household death in children under 6 years of age is inhalation of a foreign body. Delayed management is blamed for death. The absence of a recognizable penetration syndrome complicates and delays not only the diagnosis but also the treatment of foreign body inhalation. OBJECTIVE: This report aimed to highlight the problem of radiopaque foreign body inhalation and analyze part of our experience in the treatment of such cases. METHODS: A multicenter experience in the management of radiopaque inhaled foreign bodies in 3 centers in Egypt and Saudi Arabia was reviewed retrospectively, including old and new techniques to remove the foreign body. The study included data from 136 cases. RESULTS: The majority of patients were female (91.17%). The mean age was 12 years. More than one-third of the inhaled foreign bodies were found on the left side. A positive history of chocking was reported in more than 95%. Almost 87% presented in the first 24 h after inhalation. CONCLUSION: Early rigid bronchoscopic extraction of inhaled radiopaque foreign bodies can be achieved with acceptable results. Video-assisted bronchoscopic removal of an inhaled foreign body may be safer.

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UNLABELLED: INTRODUCTION AND AIM OF THE WORK: Chylothorax is a clinical challenge. This study aims at determination of the predictors of prolonged drainage of chylothorax after cardiac surgery in a single tertiary centre in Jeddah, Saudi Arabia. PATIENTS AND METHODS: A retrospective analysis of 52 patients of chylothorax with a mean age of 30 months (range 1 month to 60 years) who developed chylothorax after heart surgery (January 2007-September 2010). Data were collected regarding patients demographics, procedures, chylous drainage and its management, complications and follow-up. RESULTS: There was one hospital mortality. All patients were managed by fat-free diet or Monogen. Lone fat-free diet with steroids were used a in eight patients (15.4%). Somatostatin analogue (Octreotide) was used adjunctively in 7 (13.5%) patients and in two patients (3.8%), steroids and octreotide were used adjunctively. The median duration of chest tube drainage was 10.5 days (range 4-34 days). The median amount of chest tube drainage/kg/day was 18 mL (range 6.6-72 mL). All patients responded to medical treatment except one case who required thoracic duct ligation and a patient who died. The use of octreotide and steroids therapy significantly reduced the amount chest tube drainage. At median follow-up of 12 months (range 1-40 months) after hospital discharge, no recurrence of chylothorax was observed. CONCLUSIONS: Chylothorax is much more common post-pediatric cardiac than post-adult cardiac surgery. Conservative therapy of chylothorax after cardiac surgery remains the standard approach. Steroids and or octreotide can be used with an acceptable success. The most significant predictor of prolonged chest tube drainage in chylothorax is triglyceride/cholesterol ratio more than 2.

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I am presenting my 15 years personal Egyptian experience in the management of inhaled veil pins.

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INTRODUCTION: Bilateral superior vena cava-to-pulmonary artery anastomoses are technically challenging. Bilateral superior vena cavae (SVCs) have been thought to be a risk factor for poor outcome in children needing single-ventricle palliation. METHODS: The files of forty children who underwent bilateral cavopulmonary anastomoses (CPAs) were reviewed. RESULTS: Forty patients (31 male, 9 female) had bilateral bidirectional Glenn shunts in King Faisal Specialist Hospital and Research Center, Jeddah, in 7 years. Interrupted inferior vena cava (IIVC) was present in 8 patients. All IIVC cases featured a hypoplastic right ventricle. Twenty-four patients had a hypoplastic right ventricular morphology, and 16 patients had a hypoplastic left ventricular morphology. CONCLUSIONS: In single-ventricle anatomy, cases of a bilateral SVC are more often associated with an IIVC than a single SVC. Patients who undergo bilateral CPAs with an IIVC have a difficult early postoperative course. We should look for IIVC and either exclude or prove IIVC in cases of bilateral SVCs. Postoperative anticoagulation therapy in children with bilateral CPAs is important but should be investigated further.

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This article has been removed, consistent with Elsevier policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The Publisher apologises for any inconvenience this may cause.

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A 32-year-old male was presented with massive haemoptysis. An urgent chest X-ray (Fig. 1a) and CT chest (Fig. 1b-e) was done revealing a right lower lobe consolidation collapse. An urgent rigid bronchoscopy was performed to localize the source of bleeding and try to control it. A right lower lobectomy was done using a double-lumen endotracheal tube. Preoperative and intraoperative impressions of non-specific inflammation were accused to be the aetiology. Histopathology revealed pulmonary venous congestion with bilharsial ova.

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BACKGROUND: The aim of this study is to review the problems encountered in treating pulmonary hydatid and bilharsiasis and to highlight the risks associated with chemotherapy and the delay of their surgical treatment. METHODS: The medical records of 60 patients with pulmonary hydatid and bilharsiasis were retrospectively investigated. The patients were divided into two groups based on whether the parasite was hydatid (group 1, n=56) or schistosomiasis (group 2, n=4). The group 1 was divided into group 1a (complicated cyst n=32) and group 1b (n=24 noncomplicated hydatids). RESULTS: In all cases of pulmonary bilharsiasis and intact pulmonary hydatid cysts, the lesions were either incidental findings or the patient had presented with haemoptysis, cough, dyspnea and chest pain. The differences between the groups with respect to the rates of preoperative complications and postoperative morbidity, frequency of decortication and hospital stay were statistically insignificant (p>0.05). CONCLUSIONS: Complicated cases have higher rates of preoperative and postoperative complications but the differences are insignificant. Complicated cases are easier to diagnose. This underlines the need for paying more attention to the possibility of pulmonary parasitosis especially in lower lobe lesions in endemic areas.

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