Background: Early diagnosis and management of traumatic diaphragmatic hernia (TDH) can be challenging for the emergency department or the trauma surgeon, as these injuries are often clinically masked by other associated severe injuries. Methods: We retrospectively reviewed data of 50 patients diagnosed with an acute traumatic hernia from September 2014 to September 2017. Results: 50 patients were included in this study. Blunt trauma was the main cause in 40 patients (80%) patients. TDH occurred more on the left side; in 72% of patients. The diagnosis was preoperative in 20 patients (40%). In our study, 74% of cases were repaired through abdominal approach and 26% patients through thoracic approach. Complications of TDH occurred in 30 patients (60%) and were mainly pneumonia in 16 patients (32%), only 8 patients (16%) died (6 patients of them had delayed referral and 3 patients of them had severe head injury). Conclusions: TDH may be masked by associated injuries in multiple trauma patients and may lead to life-threatening intestinal and gastric strangulation. So, early diagnosis and treatment of TDH are important. Emergency physicians and trauma surgeon should maintain a high index of suspicion of TDH while dealing with patients assessed for abdominal or respiratory symptoms regardless the history of trauma was recent or delayed.

CAD represents the commonest cause of myocardial hypoxia. Understanding the pathophysiology of arterial disease with subintimal atheroma and plaque formation has been a breakthrough in modern medicine. An outcome of CABG carries an overall mortality of about 3%; elective primary coronary bypass causes a mortality rate of approximately 1.7%. CABG Complications include renal failure, neurologic injury, heart failure, haemorrhage, respiratory failure, and renal dysfunction. Overall, CABG achieves excellent outcomes regarding anginal relief and resumption of normal activities. In general, completeness and stability of revascularization are superior with surgical revascularization versus percutaneous interventions [1]. this study aimed at assessment of the early postoperative outcome of the first 100 CABG cases grafted in the cardiothoracic surgery department, Qena university hospital. This study was conducted on 100 patients with coronary artery disease. Only 5 patients had single vessel disease and 95 patients had multi-vessel disease two or more, no one had left main disease. There was a great prevalence of DM (55%), hypertension (69%), Dyslipidaemia (55%) and smoking (58%). Operative details show that most of the patients had 3 or more vessels, and we use LIMA to LAD anastomosis in the majority of cases only two cases RIMA has been used, great saphenous vein graft used in anastomosis of remaining diseased vessel. Obviously, most cases underwent elective CABG. An intra-aortic balloon pump was used only in 2%. Septicaemia was a significant complication. The postoperative mortality is shortened in Table 5. After 6 months, 97% of the patients were alive. Institutional results are essential to enable surgeons and interventionists to decide if international data is keeping with local findings or not. However, one limitation of this study is that the data were collected from one centre. However, the likenesses between international data and our results confer confidence in our findings.

Introduction and importance: Empyema necessitans is a rare and severe complication of pleural effusion characterized by the extension of purulent material from the pleural cavity into the surrounding soft tissues, resulting in the formation of a subcutaneous abscess. Case presentation: A one-year-old boy presented with symptoms that were in line with empyema necessitans, and Escherichia coli was shown to be the causative organism. A successful outcome required early detection, rapid diagnosis, and proper management, which included targeted antibiotic medication and drainage of the pleural collection. When a young patient exhibits a growing chest wall swelling, empyema necessitans should be considered in the differential diagnosis. Clinical discussion: The best care for individuals with empyema necessitans requires a multidisciplinary approach comprising pediatricians, thoracic surgeons, infectious disease experts, and interventional radiologists. Escherichia coli infection requires a comprehensive approach involving antibiotic therapy and surgical intervention if necessary. Conclusion: Empyema necessitans in pediatric patients, caused by Escherichia coli , is an infrequent disease that requires more investigation to enhance our understanding of the associated risk factors, optimal treatment modalities, and potential long-term consequences. Highlights:

Objectives: Acute intermediate–high-risk pulmonary embolism (PE) is associated with right-ventricular (RV) dysfunction, biomarker elevation, and risk of early clinical deterioration. Ultrasound-assisted catheter-directed thrombolysis (USAT) using the Eko Sonic Endovascular System (EKOS) system is increasingly used in selected patients; however, real-world data on physiological response and clinically relevant in-hospital outcomes remain limited. Methods: We conducted a retrospective single-centre analysis of 128 consecutive patients with acute intermediate–high-risk PE treated with EKOS-guided USAT within a structured Pulmonary Embolism Response Team (PERT) pathway between August 2017 and December 2023. Changes in RV/LV ratio, B-type natriuretic peptide (BNP), and cardiac troponin before and after intervention were assessed. A composite end-point of death, extracorporeal membrane oxygenation (ECMO), renal replacement therapy, or invasive mechanical ventilation captured clinically meaningful deterioration. Multivariable logistic regression identified determinants of the composite end-point. Results: RV/LV ratio and biomarkers improved significantly after intervention. Median RV/LV ratio decreased from 1.6 to 1.0, and BNP declined from 2365 to 877 pg/mL (both P < .001). Clinically meaningful in-hospital deterioration requiring escalation of organ support occurred in a subset of patients and was predominantly associated with baseline disease severity. Short-term survival remained favourable (60-day probability 96.9%). Conclusions: In this real-world, PERT-guided cohort, EKOS was associated with rapid physiological improvement and favourable short-term survival in patients with intermediate–high-risk PE. These findings should be interpreted as descriptive single-centre experience.

Background: Perioperative right ventricular (RV) dysfunction is a frequent complication of cardiac surgery linked to poor outcomes and may result from the loss of pericardial support. We investigated whether pericardial closure preserves early postoperative RV function. Methods: We compared patients with pericardial closure versus open pericardium. Co-primary endpoints were early postoperative RV longitudinal function by tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV). Adjusted comparisons used analysis-of-covariance (postoperative value adjusted for baseline) with prespecified covariates (baseline outcome, LV global longitudinal strain, left-ventricular ejection fraction, LVEDVI, sex, procedure; cardiopulmonary bypass and cross-clamp times when available). Holm correction-controlled multiplicity across the co-primary endpoints. Sensitivity linear mixed-effects models (time × group) were performed. Results: Pericardial closure was associated with better early RV longitudinal function after multivariable adjustment. TAPSE: adjusted mean difference (AMD, Closed–Open) 1.531 mm (95% CI 0.130–2.931; p = 0.033). TASV: AMD 1.694 cm/s (95% CI 0.437–2.951; p = 0.009; Holm-adjusted p = 0.018). Sensitivity analyses yielded consistent estimates. Conclusions: Pericardial closure was independently associated with improved early RV longitudinal function. These adjusted findings address baseline LV imbalances and support considering closure to preserve RV performance; confirmation in prospective trials is warranted.

Background: Prosthesis-patient mismatch (PPM) is linked to a poor prognosis following surgical aortic valve replacement (SAVR). The exploration of sex differences in PPM outcomes is currently limited. This study seeks to assess the sex-specific effects of PPM following SAVR was rapid deployment AV (RDAVR) prosthesis the Edwards Intuity.Methods: From 2018 to 2023, a total of 256 patients (60 females and 196 males) who received isolated or combined RDAVR at our institution were included. The definition of PPM was established through the use of the indexed effective orifice area (EOAi) in accordance with the Valve Academic Research Consortium-3 (VARC-3) criteria. A Multivariate logistic regression was performed to identify predictors of any degree PPM.Results: Female had higher left ventricular ejection fraction preoperatively (p = 0.018). The incidence of any PPM-degree for patients with BMI <30 kg/cm² was significantly higher in female than in male [33 (55%) vs. 26(13.3%), p < 0.001]. The same was noted for the incidence of PPM in patients with BMI ≥30 kg/cm² [7 (11.7%) vs. 4 (2.0%), p = 0.004]. And the incidence of severe PPM (EOAi ≤0.65 cm²/m²) for patients with BMI <30 kg/cm² was 16.7% in females vs. 0 in males (p < 0.001). The in-hospital mortality did not differ between males and females. In the multivariate logistic regression, we could not identify independent predictors of PPM.Conclusions: In Patients receiving RDAVR, the incidence of PPM was significantly higher in female than in male. However, we did not find a correlation with early clinical outcomes. The incidence of severe PPM after RDAVR was low in both females and males. Due to differences in geometry and function of the LV in women, further studies are necessary to indicate whether the definition of PPM in men may adhere to elevated EOAi thresholds compared to women.