Forecasting the flap: predictors for pediatric lower extremity trauma reconstruction

Background@#Predicting the need for post-traumatic reconstruction of lower extremity injuries remains a challenge. Due to the larger volume of cases in adults than in children, the majority of the medical literature has focused on adult lower extremity reconstruction. This study evaluates predictive risk factors associated with the need for free flap reconstruction in pediatric patients following lower extremity trauma. @*Methods@#An IRB-approved retrospective chart analysis over a 5-year period (January 1, 2012 to December 31, 2017) was performed, including all pediatric patients (<18 years old) diagnosed with one or more lower extremity wounds. Patient demographics, trauma information, and operative information were reviewed. The statistical analysis consisted of univariate and multivariate regression models to identify predictor variables associated with free flap reconstruction. @*Results@#In total, 1,821 patients were identified who fit our search criteria, of whom 41 patients (2.25%) required free flap reconstruction, 65 patients (3.57%) required local flap reconstruction, and 19 patients (1.04%) required skin graft reconstruction. We determined that older age (odds ratio [OR], 1.134; P =0.002), all-terrain vehicle accidents (OR, 6.698; P<0.001), and trauma team activation (OR, 2.443; P=0.034) were associated with the need for free flap reconstruction following lower extremity trauma in our pediatric population. @*Conclusions@#Our study demonstrates a higher likelihood of free flap reconstruction in older pediatric patients, those involved in all-terrain vehicle accidents, and cases involving activation of the trauma team. This information can be implemented to help develop an early risk calculator that defines the need for complex lower extremity reconstruction in the pediatric population.

use of a submerged membrane bioreactor for the treatment of a styrene containing synthetic wastewater

In this study, the potential of a membrane bioreactor for treating styrene contaminated synthetic wastewater, with COD that simulated a petrochemical wastewater, was evaluated and compared with previous studies. At hydraulic retention times of 18 and 24 hours, the removal efficiency of COD and styrene was consistently higher than 99%. More significantly no styrene was detected in the exhaust air, which meant that, at both hydraulic retention times, the mechanism of styrene removal in the membrane bioreactor was exclusively through biodegradation. The lower contribution of stripping to overall styrene removal obtained in the present work compared to that previously reported for traditional activated sludge processes was attributed to the higher Mixed Liquor Suspended Solids [MLSS] that can be achieved in a membrane bioreactor. Decrease of hydraulic retention time from 24 h to 18 h also resulted in significant increase in the rate of membrane fouling as quantified by transmembrane pressure gradiant. This was attributed to decrease in extracellular polymeric substance concentration which resulted in sludge deflocculation. As a consequence, the particle size distribution of the activated sludge shifted to lower mean particle sizes and the increase in the percentage of smaller particles resulted in increase in the rate of membrane fouling

[Evaluation of the risk factors for ectopic pregnancy in laparotomy patients during 1991-2001]

Ectopic pregnancy [EP] is one of the major causes of maternal death during pregnancy. This study was designed to determine the risk factors of EP in Mahdiyeh Hospital over 10 years. This case-control study included 200 women who underwent laparotomy with the diagnosis of EP in Mahdiyeh Hospital between the years 1991 and 2001. Also, 400 randomly selected pregnant women with normal vaginal delivery were included as controls. A direct relationship was found between EP and history of abortion, previous EP, PID, pelvic surgery, appendectomy, infertility, using clomiphene, current IUD and IVF. The chance of developing an EP [odds ratio with 95% confidence interval] was 26.7 [9.01-79.06] in women using clomiphene, 21.16 [2.71-164.8] in women with a previous history of EP, 3.29 [1.94-5.58] in those with prior appendectomy, and 9.63 [5.24-17.67] times greater in women who got pregnant while having an IUD. It is concluded that among outpatients, previous abdominal or pelvic surgery, current IUD, history of previous EP, and history of using clomiphene increase the risk of developing an EP. This study did not find any association between EP and previous usage of IUD, mini-pill or age

One-year efficacy of expanded polytetrafluoroethylene vascular graft in eighty-three hemodialysis patients

To evaluate the patency and efficacy of expanded Polytetrafluoroethylene [ePTFE] vascular graft in hemodialysis patients. In a prospective study from January 1999 to January 2001 at Sina hospital 41 patients underwent implantation of 6-mm vascular grafts and 42 underwent implantation of 8-mm grafts in order to make vascular assess for hemodialysis. They were followed up to 12 months, observing the complications. Mean patients' age was 52.2 years. Thirty-seven of them were females and 46 were males. Over a 12 months period of follow-up, 12 cases of graft infection [14.5%], 21 cases of thrombosis [25.3%], 7 cases with both complications [8.4%], and 1 case of pseudoaneurism [1.2%] were observed. One-year patency rate was 34.9%. Diabetes was the only factor associated with lower patency rate [27% versus 57%, p<0.05]. ePTFE vascular graft seems to be an appropriate substitute for arteriovenous fistula as a vascular assess in hemodialysis patients. Educating patients and good care can decrease the rate of infection, thrombosis, and other complications, resulting in a better patency and lower morbidity rate

Comparison of PCT after vaginal and oral bromocriptine use in women with hyperprolactinemia and infertility

Hyperprolactinemia is the most common cause of amenorrhea and infertility. Oral bromocriptine is the drug of choice for the treatment of hyperprolactinemia. Due to complications of its oral use, vaginal bromocriptine has been introduced as an effective and safe method. There is limited information regarding possible side effects of vaginal bromocriptine on motile sperm count in PCT results. Thus, in this clinical cross-sectional study, we sought to determine possible effects of vaginal bromocriptine on motile sperm count in PCT after resumption of ovulatory cycle in outpatients in reproductive age with hyperprolactinemia and complaints such as galactorrhea, menstrual irregularity and infertility. After exclusion of all confounding factors, the patients were divided in two groups. The study group [n=11] was treated with vaginal bromocriptine 2.5mg daily, and the control group [n=15] was treated with oral bromocriptine 2.5-5mg daily. Treatment duration needed for marked reduction in prolactine and also initiation of menses and ovulatory cycles were evaluated in both groups. After restoration of ovulation, PCT was done on 13-14th day of cycle in the presence of good cervical mucus, 8-12 hours after coitus. The numbers of motile sperm count atozoa/HPF in both groups were recorded and statistically compared with Mann Whitney U test. Treatment durations needed for initiation of ovulatory cycles in study group and the control group were 4-8 [mean5.5] weeks and 4-7 [mean 5.8] weeks, respectively with no statistical difference [p>0.05]. PCT results showed 11-20 [mean15.3] motile sperm/HPF with progressive forward movement in study group, who were treated with vaginal bromocriptine. By using oral bromocriptine, PCT showed 10-23 [mean 14.4] motile sperm/HPF with progressive forward movement in the control group. There were no statistical difference in PCT results between these two groups [p>0.05]. These results suggests the hypothesis, that vaginal bromocriptine has no adverse effects on motile sperm count in PCT, and vaginal bromocriptine can be used safely without possible adverse effect on sperm function in women with hyperprolactinemia and infertility. However, larger studies with more cases are necessary to confirm this hypothesis and to determine if vaginal bromocriptine has any effect on fertility in both groups