A 20-year-old male was impaled through the chest, abdomen, and right upper thigh by three 1.5 cm (0.59 in) diameter rods, each 2 m (6.56 ft) in length. The first rod entered below his right nipple, the second through the right hypochondrium, and the third through the right upper thigh. He was transported to the hospital with the rods in situ. This paper provides insight as to how these unusual injuries were managed in a limited-resource environment. Even in a developing country, the challenges posed by multiple impalement injuries can be managed successfully by rapid prehospital transfer, along with an adequate and coordinated hospital team effort.

The tension applied to the girth is usually based on an individual's experience rather than by scientific measurement or procedure. The equine thorax is a dynamic structure, and therefore the actual readings of girth tensions at rest and during exercise (actual tension) are likely to vary from the tension to which the girth was intended to be tightened at rest while standing (intended tension). This study was undertaken to determine the variability of girth tensions at rest and during exercise. A total of 19 Hanoverian horses were lunged on a 20 m circle in walk, trot and canter on both reins. In a randomized design, each horse was exposed to intended tensions 6, 10, 14 and 18 kg (saddle and girth at appropriate intended tensions). Girth tension was measured and recorded continuously using an in-line load cell. Intended girth tensions were not significantly different with mean actual girth tensions while standing. Actual girth tensions increased significantly (P < 0.001) between walk, trot and canter at all tensions except rest to trot at tension 6 kg, where the significance level was P < 0.01. Actual girth tension was significantly higher (P < 0.001) on the left rein at tension 14 kg in walk and trot, and at tensions 6, 10 and 14 kg during canter, and there was an overall trend for higher actual girth tensions on the left rein for the other tensions. As the thorax is a dynamic structure, girth tension variation could be due to multiple factors such as respiration, breath holding, muscular contraction, back flexion and extension, speed, gait and vertical acceleration of the saddle. Girth tension is a relatively new area of research, and as there are many opportunities for further research, a better understanding of the impact the girth has on the horse could help to improve performance and welfare.

Congenital arteriovenous fistulas between the thoracic arteries and the systemic veins are rare, and in clinical terms may mimic patency of the arterial duct. We present a neonate with a large arteriovenous fistula between the left sixth intercostal artery and the left brachiocephalic vein, to the best of our knowledge a unique site of drainage. To our knowledge, ours is also the earliest presentation and treatment of a thoracic arteriovenous fistula.

We present the first case of a thoracic ranula which originated from the left submandibular area extending into the subcutaneous tissue planes of the anterior chest wall. The patient had a history of surgery for a previous benign left salivary gland cyst, and presented with an enlarging mass in the anterior chest wall. This was a recurrence of a ranula, with an extension into the anterior thoracic wall. The thoracic ranula was excised, together with ipsilateral sublingual and submandibular glands, via a transcervical approach. No recurrence was detected over a 3-year post-operative follow up.