Introduction:Diaphragmatic injury is usually missed in case of trauma patient, clinical picture is usually masked by other abdominal or thoracic injuries. CXR (chest X ray), abdominal ultrasound have a high rate of missing. High index of suspicion is required to diagnose diaphragmatic injury. Discussion:Comparison between 20 cases of traumatic diaphragmatic injury. Surgery is the only treatment. Different approaches are used, taking advantage of the wide spread practice of minimal invasive surgeryVATS (Video assisted thoracoscopic surgey) and laparoscopy. Overlooked injuries are usually on the right side and after blunt trauma in these cases open surgery is favoured.Prolene stitch repair (primary repair) was the main modality of repair, mesh repair was used in larger tears with poor quality tissues .Quality of life improves remarkably after repair with most patients discharged from hospital within few days. Conclusion:VATS and Laparoscopy show efficiency in both diagnosis and treatment of diaphragmatic injuries. Conversion to open surgery may be needed in case of severe visceral injuries.Combined approach needs good communication between thoracic and general surgeonsOutcome is usually favourable with competent long term repair. Uunfavourable outcome is associated with multiple visceral organ injury and critical pre operative status.
Between roughly 2010 and 2016, there was a proliferation of writing and analysis about every musical phenomenon in Egypt that was not mainstream pop, and phrases like the "independent" music scene, the "alternative" music scene, and the "underground" music scene became increasingly common. In 2020, the music scene has become too complex to be given a single name, and the image conjured up by an independent music scene fails to capture a much broader and more complex reality. Until 2014, any musician or group making music with aims and processes that differed from the commercial mainstream was considered to be making alternative or independent music; now, some of these acts have been absorbed into the mainstream and have become active participants in the market, whereas other acts have emerged to replace them in the alternative and underground currents. Numerous factors have shaped the musical experiences and experiments of the last twenty years that are considered alternative or independent. The first comprises the motive and vision that govern the moment of creation itself, regardless of genre or style: the ever-present impulse to escape repetition and tradition, whether by creating new materials or trying new production methods, or reviving old ones which, in a new context, create new results. For example, a classically trained string ensemble that usually plays with a symphony orchestra collaborates with a hip-hop group, or a classical Arabic ensemble covers a 1990s metal track. There are countless examples of this, but for those wishing to create new and alternative styles, beyond what was taught in music institutions and released by the mainstream music industry, there were at the time few opportunities to reach an audience. The time and space in which this vision becomes a tangible creation constitute the second consideration. Musicians of all styles depend on places where they can meet to share music news and stories, discover new sources, learn to play instruments and to sing, hold rehearsals, jam, and exchange newly acquired techniques. Since most musicians cannot afford long-term studio rentals, finding this kind of space usually means hiring a studio by the hour or using a private home or a single room in a family house. Sometimes it can mean a room that is available nights and weekends at a bandmember's place of employment, be that a business, a lawyer's office, or even a doctor's surgery. Musicians, especially those who work in a group, need time-to warm up mentally and musically both as individuals and as a group, to deal with distractions and disruptions, to set up sound equipment and to tune instruments-before the moment of creation occurs. In an expensive studio that has been hired out for two or three hours, there is pressure on musicians to make the most of the time they have, and many fall back on failsafe styles and techniques, or those that spring most easily to mind, those commonly used in the wider scene. 1 And so the real moments of inspiration and creativity often happen outside the stud...
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