Risk analysis and outcome of mediastinal wound and deep mediastinal wound infections with specific emphasis to omental transposition

<p>Abstract</p> <p>Background</p> <p>To report our experience, with Deep mediastinal wound infections (DMWI). Emphasis was given to the management of deep infections with omental flaps</p> <p>Methods</p> <p>From February 2000 to October 2007, out of 3896 cardiac surgery patients (prospective data collection) 120 pts (3.02%) developed sternal wound infections. There were 104 males & 16 females; (73.7%) CABG, (13.5%) Valves & (9.32%) CABG and Valve.</p> <p>Results</p> <p>Superficial sternal wound infection detected in 68 patients (1.75%) and fifty-two patients (1.34%) developed DMWI. The incremental risk factors for development of DMWI were: Diabetes (OR = 3.62, CI = 1.2-10.98), Pre Op Creatinine > 200 μmol/l (OR = 3.33, CI = 1.14-9.7) and Prolong ventilation (OR = 4.16, CI = 1.73-9.98). Overall mortality for the DMWI was 9.3% and the specific mortality of the omental flap group was 8.3%. 19% of the "DMWI group", developed complications: hematoma 6%, partial flap loss 3.0%, wound dehiscence 5.3%. Mean Hospital Stay: 59 ± 21.5 days.</p> <p>Conclusion</p> <p>Post cardiac surgery sternal wound complications remain challenging. The role of multidisciplinary approach is fundamental, as is the importance of an aggressive early wound exploration especially for deep sternal infections.</p

Effectiveness of Protease Inhibitor Monotherapy versus Combination Antiretroviral Maintenance Therapy: A Meta-Analysis

The unparalleled success of combination antiretroviral therapy (cART) is based on the combination of three drugs from two classes. There is insufficient evidence whether simplification to ritonavir boosted protease inhibitor (PI/r) monotherapy in virologically suppressed HIV-infected patients is effective and safe to reduce cART side effects and costs

Estimating compressive and flexural strength of travertines with respect to laminae-orientation by geomechanical properties

Travertine is an anisotropic rock considered as one of the most popular stone materials in the building industry. Due to its bedding and lamination planes, the determination of rock strength properties regarding anisotropic orientation is a critical issue. In this research, different techniques were applied to estimate the compressive and flexural strengths of four types of travertines, selected from Hamedan and Markazi Provinces located in the west and central parts of Iran. For this purpose, after sample preparation and assessment of mineral composition, fabric (texture and structure) and pore characteristics (pore shape and pore sizes), the selected samples were characterized using physical and mechanical tests. These properties were evaluated with respect to two major anisotropic orientations (perpendicular and parallel to the bedding/lamination axis). Statistical analyses, including simple and multiple linear regressions, were utilized to correlate physical and mechanical parameters with compressive and flexural strength, and to establish some new equations. Based on the test results, it can be concluded that the percentage/type of matrix and porosity have a more important effect on the physical and mechanical properties than the rock structure. Data analysis in simple regression shows that bulk specific gravity (saturated surface dry) and Brazilian tensile strength are the most and least influential factors on compressive strength at perpendicular and parallel directions, respectively. In addition, effective porosity and Brazilian tensile strength are the most and least influential factors on flexural strength at both directions, respectively. Based on best subset multiple regression method, one or two equations were extracted for calculating compressive and flexural strength in the perpendicular and parallel directions. Also, pore shape factor and pore radius were used as independent parameters in multiple regression to establish some new equations for predicting compressive and flexural strength considering cutting directions. These parameters have more influence on flexural strength than compressive strength, because the parameters show significant correlation with flexural strength. Consequently, the results of statistical analyses show that the proposed equations are not necessarily composed of parameters with the higher/stronger determination coefficient in simple regression. Therefore, prediction studies not only offer some rational approaches, they also give a better insight into the main factors determining rock strength