ABSTRACT
BACKGROUND: Diagnosis of sternal dehiscence after sternotomy for cardiac surgery is still made clinically. The aim of this study was to identify radiographic signs of sternal dehiscence by routine chest X-ray (CXR) in patients with and without clinically diagnosed sternal dehiscence. METHODS: 75 patients (group I: 65 +/- 9.3 years, f/m = 12/63) with clinically diagnosed sternal dehiscence, necessitating surgical revision and 75 patients with uneventful sternal healing (matched to group I by age, sex, preoperative risk factors and surgical procedures; group II: 66 +/- 9.0 years, f/m = 12/63) were included in this study. Serial CXRs immediately after surgery until re-intervention or discharge were analyzed by a radiologist, blind to the date of redo surgery. RESULTS: In 39 patients of group I (52%) vs. 8 (10.7%) in group II, abnormalities in the sternal wire and/or a midsternal stripe could be found (p < 0.0001): rotated wires (p = 0.003), shifted wires (p = 0.043), and ruptured wires (p = 0.312). Seven patients presented with combined wire abnormalities in group I vs. 0 in group II. Midsternal stripe sign could be detected in 26 patients of group I vs. 3 in group II (p < 0.0001). Sternal dehiscence was suspected based on the above mentioned abnormalities as early as three days postoperatively (Q1 = 2; Q3 = 8 days) in 39 patients, whereas clinical diagnosis of sternal dehiscence was delayed up to ten days postoperatively (Q1 = 7; Q3 = 13 days). CONCLUSIONS: Radiographic signs of sternal dehiscence could be detected before the clinical diagnosis was apparent and predicted sternal dehiscence in more than half of the patients.
Subject(s)
Radiography, Thoracic , Sternum , Surgical Wound Dehiscence/diagnostic imaging , Thoracotomy/adverse effects , Aged , Cardiac Surgical Procedures/adverse effects , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Male , Retrospective Studies , Wound HealingABSTRACT
PURPOSE: For treatment of univentricular heart, the Fontan operation has been established as the definitive palliation. The current controversy is mainly based on the high incidence of arrhythmias after an intra-atrial lateral tunnel Fontan operation. METHODS: From January 1995 until April 2002, 46 children underwent a Fontan-type operation with or without a small fenestration. In 33 patients (group I) an intracardiac tunnel and in 13 patients (group II) an extracardiac conduit procedure was performed. PRINCIPAL FINDINGS: There was no perioperative mortality. All patients showed postoperative a significant increase of arterial oxygen saturation, from 76 to 86% after surgery with fenestration, or to 90.5% without fenestration respectively. In patients with fenestration procedure, the saturation rose to 90% after closure of fenestrations 9 to 12 months after operation. CONCLUSIONS: Modified Fontan operations can be performed in normothermia on the beating heart with acceptable mortality. The extracardiac conduit Fontan procedure has the benefits of less surgical injury and a higher intraoperative flexibility.
Subject(s)
Fontan Procedure/methods , Heart Defects, Congenital/surgery , Adolescent , Adult , Cardiopulmonary Bypass , Child , Child, Preschool , Female , Follow-Up Studies , Fontan Procedure/adverse effects , Humans , Infant , Intraoperative Period , Male , Oxygen/bloodABSTRACT
"Using data from the 1985-1990 [U.S.] County-to-County Migration Flow Files..., which facilitate a disaggregated analysis of the effects of migration patterns on the extent of black concentration in the South, this paper analyzes and assesses how migration to and from the South has affected the distribution of blacks and whites in both metropolitan and nonmetropolitan areas."
Subject(s)
Black or African American , Demography , Population Dynamics , Suburban Population , Urban Population , White People , Americas , Culture , Developed Countries , Emigration and Immigration , Ethnicity , Geography , North America , Population , Population Characteristics , Residence Characteristics , United StatesABSTRACT
"The purpose of the present paper [is] to investigate further the role of migration in developing countries by analyzing the components of population growth in 26 large metropolitan areas in Africa, Asia, and Latin America." The process of urban population growth is first described. Then, using data from censuses and official U.N. sources, the author examines the relative importance of migration and natural increase in urban growth and in the growth of the largest urban areas. The focus is primarily on the period 1960-1970. Consideration is also given to "estimates of the natural increase of migrants after their arrival in the city in order to assess the full effect of net migration on metropolitan growth, analyses of the relationships between the components of growth and several structural variables and, finally, a discussion of the results." The importance of migration as a factor affecting urban growth is noted.
