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treatment of choice in adults and has been described utilizing endoscopic shears and holmium laser technology. The ability of holmium laser to manage both ureterocoele and calculi simultaneously makes holmium laser management a procedure of choice at centers that possess the equipment [6,7]. The purpose of this paper is to highlight the fact that, although rare, possibility of ureterocoele should be kept in mind while performing investigations in a patient with recurrent urinary tract infections. Conflicts of Interest None identified References 1. Singh I. Adult bilateral non-obstructing orthotopic ureterocoeles with multiple calculi: endoscopic management with review of literature. Int Urol Nephrol; 2007; 39: 71-4. 2. Berrocal T, Lopez-Pereira P, Arjonilla A, Gutierrez J. Anomalies
279 of the distal ureter, bladder and urethra in children: Embryologic, radiologic and pathologic features. Radiographics 2002; 22: 1139-64. 3. Nakane A, Hayashi Y, Kojima Y, Mizuno K, Kurokawa S, Kohri K. Development of multiple calculi in duplex system ureterocoeles. Int J Urol 2006; 13: 1445-7. 4. Thiel DD, Petrou SP, Broderick GA. Orthotopic ureterocoele masquerading as a bladder tumor in a woman with pelvic pain. Int Braz J Urol 2005; 31: 549-51. 5. Do Nascimento HD, Hachul M, Macedo A Jr. Magnetic resonance in diagnosis of ureterocoele. Int Braz J Urol 2003; 29: 248-50. 6. Mizuno K, Kamisawa H, Hamamoto S, Okamura T, Kohri K. Bilateral single-system ureterocoeles with multiple calculi in an adult woman. Urology 2008; 72: 294-5. 7. Shah HN, Sodha H, Khandkar AA, Kharodawala S, Hegde SS, Bansal M. Endoscopic management of adult orthotopic ureterocoele and associated calculi with holmium laser : experience with 16 patients over four years and review of literature. J Endourol 2008; 22: 489-96.
Journal Scan Cox ED, Schreiber MA, McManus J, Wade CE, Holcomb JB. New haemostatic agents in the combat setting. Transfusion 2009; 49:248S-55S. Haemorrhage is a leading cause of potentially preventable death in both civilian and military trauma patients. Animal data have shown that haemostatic bandages reduce haemorrhage and improve survival. This article reports recent clinical observations regarding the efficacy and evolution of use of two new haemostatic bandages employed in the global war on terrorism. The authors performed a retrospective cohort review of soldiers treated with either the QuikClot or HemCon haemostatic bandages between April and October 2006. Haemostatic dressings were placed on wounds either in the field or at the combat support hospital (CSH). During the six month study period, 1691 trauma patients were admitted to the CSH. Fifty uses of haemostatic dressings in 44 patients (2.6% of admissions) were identified. Forty patients were treated with HemCon dressings, three patients with QuikClot and one with both QuikClot and HemCon. Eighteen percent of the dressings were used in the field, predominantly on extremity wounds (7/8).
MJAFI, Vol. 66, No. 3, 2010
In contrast, most dressings used in the CSH were for truncal wounds (26/36 patients). Haemostatic dressings were applied to extremity wounds in prehospital and hospital settings, either alone or in conjunction with tourniquets. In surviving patients (95%), the treating surgeon determined that the haemorrhage was either stopped or greatly decreased by use of haemostatic dressings. Two of the four patients treated with QuikClot had burns from exothermic reactions, while no adverse reactions were noted with HemCon. Thus the authors from United States Army Institute of Surgical Research, Fort Sam Houston, Texas concluded that the haemostatic agents stop or decrease bleeding. Whereas HemCon appears to be safe, QuikClot may produce superficial burns. These new haemostatic agents have a place in the surgical armamentarium to assist in controlling internal haemorrhage from truncal and pelvic haemorrhage, especially during damage-control surgery. Contributed by Col Man Mohan Harjai* * Senior Advisor (Surgery & Paediatric Surgery), Command Hospital (SC), Pune-40.
treatment of choice in adults and has been described utilizing endoscopic shears and holmium laser technology. The ability of holmium laser to manage both ureterocoele and calculi simultaneously makes holmium laser management a procedure of choice at centers that possess the equipment [6,7]. The purpose of this paper is to highlight the fact that, although rare, possibility of ureterocoele should be kept in mind while performing investigations in a patient with recurrent urinary tract infections. Conflicts of Interest None identified References 1. Singh I. Adult bilateral non-obstructing orthotopic ureterocoeles with multiple calculi: endoscopic management with review of literature. Int Urol Nephrol; 2007; 39: 71-4. 2. Berrocal T, Lopez-Pereira P, Arjonilla A, Gutierrez J. Anomalies
279 of the distal ureter, bladder and urethra in children: Embryologic, radiologic and pathologic features. Radiographics 2002; 22: 1139-64. 3. Nakane A, Hayashi Y, Kojima Y, Mizuno K, Kurokawa S, Kohri K. Development of multiple calculi in duplex system ureterocoeles. Int J Urol 2006; 13: 1445-7. 4. Thiel DD, Petrou SP, Broderick GA. Orthotopic ureterocoele masquerading as a bladder tumor in a woman with pelvic pain. Int Braz J Urol 2005; 31: 549-51. 5. Do Nascimento HD, Hachul M, Macedo A Jr. Magnetic resonance in diagnosis of ureterocoele. Int Braz J Urol 2003; 29: 248-50. 6. Mizuno K, Kamisawa H, Hamamoto S, Okamura T, Kohri K. Bilateral single-system ureterocoeles with multiple calculi in an adult woman. Urology 2008; 72: 294-5. 7. Shah HN, Sodha H, Khandkar AA, Kharodawala S, Hegde SS, Bansal M. Endoscopic management of adult orthotopic ureterocoele and associated calculi with holmium laser : experience with 16 patients over four years and review of literature. J Endourol 2008; 22: 489-96.
Journal Scan Cox ED, Schreiber MA, McManus J, Wade CE, Holcomb JB. New haemostatic agents in the combat setting. Transfusion 2009; 49:248S-55S. Haemorrhage is a leading cause of potentially preventable death in both civilian and military trauma patients. Animal data have shown that haemostatic bandages reduce haemorrhage and improve survival. This article reports recent clinical observations regarding the efficacy and evolution of use of two new haemostatic bandages employed in the global war on terrorism. The authors performed a retrospective cohort review of soldiers treated with either the QuikClot or HemCon haemostatic bandages between April and October 2006. Haemostatic dressings were placed on wounds either in the field or at the combat support hospital (CSH). During the six month study period, 1691 trauma patients were admitted to the CSH. Fifty uses of haemostatic dressings in 44 patients (2.6% of admissions) were identified. Forty patients were treated with HemCon dressings, three patients with QuikClot and one with both QuikClot and HemCon. Eighteen percent of the dressings were used in the field, predominantly on extremity wounds (7/8).
MJAFI, Vol. 66, No. 3, 2010
In contrast, most dressings used in the CSH were for truncal wounds (26/36 patients). Haemostatic dressings were applied to extremity wounds in prehospital and hospital settings, either alone or in conjunction with tourniquets. In surviving patients (95%), the treating surgeon determined that the haemorrhage was either stopped or greatly decreased by use of haemostatic dressings. Two of the four patients treated with QuikClot had burns from exothermic reactions, while no adverse reactions were noted with HemCon. Thus the authors from United States Army Institute of Surgical Research, Fort Sam Houston, Texas concluded that the haemostatic agents stop or decrease bleeding. Whereas HemCon appears to be safe, QuikClot may produce superficial burns. These new haemostatic agents have a place in the surgical armamentarium to assist in controlling internal haemorrhage from truncal and pelvic haemorrhage, especially during damage-control surgery. Contributed by Col Man Mohan Harjai* * Senior Advisor (Surgery & Paediatric Surgery), Command Hospital (SC), Pune-40.