A retrospective study aimed to analyze our experience in 46 patients with blunt traumatic diaphragmatic rupture (BTDR) admitted to our tertiary hospital from 1995 to 2007. Charts, chest roentgenograms (CXR), and computed tomography (CT) scans were carefully reviewed. The mean age was 36.5+/-10.1 years, 36 (78.3%) were males. The etiology was a traffic accident in 36 (78.3%) patients. BTDR was left-sided in 34 (73.9%) and right-sided in 12 (26.1%) patients. CXR was diagnostic in 26 (56.5%) and CT in 12 (26.1%) patients. Associated injuries included lung 12 (26.1%), liver 10 (21.7%), spleen 24 (52.2%) and bowel 2 (4.2%) patients. BTDR was approached through thoracotomy 26 (56.5%), laparotomy 16 (34.8%), and combined approach 4 (8.7%) patients. The repair was primarily with interrupted non-absorbable sutures in 42 (91.3%) and by prosthetic mesh in four patients. Complications developed in 20 patients. Mortality was observed in 2 (4.3%) patients. We concluded that BTDR is a common lesion in young adult males on the left side caused by a traffic accident. A high index of suspicion combined with repeated and selective radiologic evaluation is necessary for early diagnosis. Associated injuries represent the main prognostic factor affecting morbidity and mortality. Thoracotomy and primary repair is adequate surgical treatment.

surgery for chondrosarcoma can be performed with acceptable morbidity and mortality. Proper selection of patients and radical en-block excision of the tumor are the keys for successful treatment and better outcomes.

Background: Increasing numbers of octogenarians and improvements in surgical techniques and postoperative care have resulted in increasing cardiac operations in this age. The aim is to analyze our experience of cardiac surgery on octogenarians and beyond concerning postoperative morbidities and mortality. Methods: 67 octogenarians and nonagenarians underwent open heart surgery in our hospital between 2001 to 2009 were retrospectively reviewed. Data included baseline preoperative status, intraoperative and perioperative course, and immediate outcomes. Results: The mean age was 86.22 ± 6.1 years. 86.6% patients were males. Symptoms were dyspnea; Class II in 13.4%, Class III in 55.2%, Class IV in 31.4% patients; angina in 82.1%, and CHF in 25.4% patients. The mean EF was 37.8% ± 10. Risk factors include smoking in 52.2%, DM in 37.3%, hypertension in 28.4%, obesity in 25.4%, previous MI in 22.4%, COPD in 17.9%, renal insufficiency in 11.9%, pulmonary hypertension in 7.5%, PVD in 6%, and cerebrovascular disease in 3% patients. The procedures were isolated CABG in 73%, AVR in 9%, MVR in 6%, CABG/valve in 9%, and MVR and AVR in 3% patients. Complications were 18%. It included renal impairment in 18%, arrhythmias in 14.9%, bleeding in 6%, prolonged ventilation in 13.4%, CHF in 4.5%, gastrointestinal bleeding in 4.5%, wound infection in 7.5%, and cerebrovascular accident in 3%. Hospital mortality was 9% patients. Conclusions: Cardiac surgery can be performed safely with acceptable hospital morbidity and mortality in octogenarians and beyond. Early referral and proper selection of patients are mandatory to improve immediate postoperative survival.