Re-exploration due to bleeding is not associated with severe postoperative complications.

OBJECTIVES: In cardiac surgery, postoperative bleeding remains a frequent complication with various possible adverse outcomes. Re-exploration due to bleeding is frequent in this type of patient. Sternal wound infection is an infrequent but serious and devastating complication. Whether re-exploration due to bleeding significantly affects the incidence of sternal wound infection is uncertain. There is no consensus on allowed severity of bleeding and timing of intervention. METHODS: A retrospective, observational cohort study of 15 350 consecutive patients who underwent cardiac surgical procedures from 1 April 2006 through 31 December 2013 in 3 different university hospitals in Denmark was performed. Re-exploration due to postoperative bleeding occurred in 873 patients. To adjust for possible confounders, propensity score matching and logistic regression analyses were performed based on the centre, EuroSCORE I/II factors, extracorporeal circulation time, drugs affecting bleeding and coagulation, postoperative bleeding and units of blood transfusions. Patients were matched into 2 groups of 779 patients each for further analysis. The short-term outcomes were sternum infection, 30-day mortality and acute renal failure needing dialysis. The long-term outcome was the number of deaths 6 months after surgery. RESULTS: The incidence of re-exploration was 5.7%. In the raw data, sternal infection was higher in the re-exploration group (2.4% vs 1.4; P = 0.020). After propensity score matching, no differences in sternal infection or other measured outcomes were found between the groups, either by crude or adjusted analyses. CONCLUSIONS: Our study indicates that re-exploration is not associated with a higher frequency of severe postoperative complications. Probably the time of intervention for bleeding is important.

Dual inferior venae cavae with mitral stenosis.

A 34-year old woman with rheumatic mitral stenosis was found to have complete dual inferior venae cavae with bilateral infrarenal and suprarenal segments, on balloon mitral valvuloplasty. The bilateral, renal, and gonadal veins drained separately on the ipsilateral side. The left inferior vena cava was larger than the right, and the right inferior vena cava had an aneurysmal dilatation near its origin. The left inferior vena cava drained into the superior vena cava-right atrial junction.

Ecology, economics, and equity of the pastoral systems in the Khangchendzonga National Park, Sikkim Himalaya, India.

The Khangchendzonga National Park is a part of the eastern Himalaya global biodiversity hotspot and is located in the Sikkim state of India. Increasing livestock populations coupled with the government policy to ban grazing and its selective implementation resulted in conflict. Hence we undertook this multidisciplinary study involving consultations with traditional resource users, field surveys, and remote sensing. We found that in the greater Himalayan part, over the past 6 decades sheep have been increasingly replaced by yaks (and their crossbreeds), who descend only up to the multilayered temperate and subalpine forests during winter. These forests have been extensively manipulated by the yak herders to increase the fodder availability. In terms of economics and equity in benefit sharing, we found that a few yak herders earn high incomes by maintaining large herds while the sheep and pack animal herders earn subsistence level incomes from small herds. We propose a reduction in yak (and their female crossbreed) numbers with adequate alternative livelihood support for the herders.