Right thoracotomy approach for open heart surgery

Background: Median sternotomy approach provides excellent exposure of all the chambers of heart for performing open heart surgery, but this approach is the most invasive used for any surgical procedure. Besides an ugly scar, median sternotomy not only increases the morbidity but at times mortality also. To have an acceptable postoperative scar and to avoid the morbidity and mortality associated with median sternotomy, the present study was conducted to find an alternative to median sternotomy in patients with atrial septal defect, mitral and tricuspid valve disease.Methods: Patients were positioned with right side elevated 30-45 degree, and heart was approached by right anterior thoracotomy, through 4th intercostals space. Pericardium was opened anterior to phrenic nerve, and upper end pericardial stay sutures given to get aorta more anterior. Aortic and bicaval cannulation was done and intracardiac procedures were performed as are done after standard median sternotomy.Results: Difficult aortic cannulation and fracture to costochondral junction was the problem observed in some patients. Repair of atrial septal defect was the most common operation performed. Sternotomy, rib resection and peripheral cannulation was not needed in any of these patients. Post-operative period was uneventful in majority.Conclusions: In all patients above 4 years of age, with normal aortic valve, without active lung disease / previous right thoracotomy, having isolated atrial septal defects, mitral and tricuspid valve disease the heart should be approached through right anterior thoracotomy.

Thermal diffusivity measurement of copper nanofluid using pulsed laser thermal lens technique.

The pulsed laser thermal lens technique was used to study the thermal diffusivity of fluids containing copper nanoparticles (Cu-NPs) prepared by γ-irradiation method. The samples were prepared for the different concentrations of Cu precursor at 20 KGy dose. A Q-switched Nd-YAG pulsed laser of wavelength 532 nm was used as an excitation source and He-Ne laser was used as a probe beam in the present thermal lens experiment. It was found that the thermal diffusivity of the solution depends on the density of Cu-NPs

Frequency and clinical patterns of stroke in Iran - Systematic and critical review

<p>Abstract</p> <p>Background</p> <p>Cerebrovascular disease is the second commonest cause of death, and over a third of stroke deaths occur in developing countries. To fulfil the current gap on data, this systematic review is focused on the frequency of stroke, risk factors, stroke types and mortality in Iran.</p> <p>Methods</p> <p>Thirteen relevant articles were identified by keyword searching of PubMed, Iranmedex, Iranian University index Libraries and the official national data on burden of diseases.</p> <p>Results</p> <p>The publication dates ranged from 1990 to 2008. The annual stroke incidence of various ages ranged from 23 to 103 per 100,000 population. This is comparable to the figures from Arab Countries, higher than sub-Saharan Africa, but lower than developed countries, India, the Caribbean, Latin America, and China. Similarly to other countries, ischaemic stroke was the commonest subtype. Likewise, the most common related risk factor is hypertension in adults, but cardiac causes in young stroke. The 28-day case fatality rate is reported at 19-31%.</p> <p>Conclusions</p> <p>Data on the epidemiology of stroke, its pattern and risk factors from Iran is scarce, but the available data highlights relatively low incidence of stroke. This may reflect a similarity towards the neighbouring nations, and a contrast with the West.</p

Dielectrical Properties of CeO2 Nanoparticles at Different Temperatures

A template-free precipitation method was used as a simple and low cost method for preparation of CeO2 nanoparticles. The structure and morphology of the prepared nanoparticle samples were studied in detail using X-ray diffraction, Raman spectroscopy and Scanning Electron Microscopy (SEM) measurements. The whole powder pattern modelling (WPPM) method was applied on XRD data to accurately measure the crystalline domain size and their size distribution. The average crystalline domain diameter was found to be 5.2 nm, with a very narrow size distribution. UV-visible absorbance spectrum was used to calculate the optical energy band gap of the prepared CeO2 nanoparticles. The FT-IR spectrum of prepared CeO2 nanoparticles showed absorption bands at 400 cm(-1) to 450 cm(-1) regime, which correspond to CeO2 stretching vibration. The dielectric constant (er) and dielectric loss (tan delta) values of sintered CeO2 compact consolidated from prepared nanoparticles were measured at different temperatures in the range from 298 K (room temperature) to 623 K, and at different frequencies from 1 kHz to 1 MHz

Profile of acute kidney injury after open heart surgeries in a tertiary care hospital

Our objective is to determine the incidence, etiology, risk factors and outcome of acute kidney injury (AKI) after open heart surgery. A prospective study was conducted on 62 patients who underwent open heart surgery and were followed-up for the development of AKI and to determine its incidence, etiology and outcome. Post-operative AKI was considered when the post-operative serum creatinine was >1.5 mg/dL or there was doubling of serum creatinine above the baseline (pre-operative) with a prior normal renal function. The incidence of AKI in the post-operative period in our study was 17.7%. The common etiological factors for AKI in our study were sepsis, hypotension, prolonged need for ventilator and inotropic support and drugs given in the post-operative period. The important risk factors for the development of AKI in the post-operative period were hypertension, diabetes mellitus, gout, prolonged total bypass time and prolonged aortic cross-clamp time. The overall mortality in our study subjects was 11.3% (seven of 62 died) and the mortality in the patients who developed post-operative AKI was 71.4%