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Background: Aortic Valve Replacement (AVR) is usually done through median sternotomy. The present study aimed to compare the right anterolateral thoracotomy and median sternotomy approaches for AVR., Materials and Methods: The present prospective study was conducted on 60 patients who had aortic valve disease and were subjected to AVR. Thirty patients underwent aortic valve replacement via right anterolateral thoracotomy (study group) and thirty patients via median sternotomy (control group). Statistical analysis was done using Mann Whitney U test and Fischer's Exact test. Statistical Package SPSS -17 was used for data analysis., Results: The mean length of the incision was 18.7±1.8 cm in the patients who had undergone AVR through median sternotomy, while 7.8±0.9 cm in the study group patients. Besides, the mean bypass time was 121.8±18.6 minutes for the patients who had undergone AVR through median sternotomy, while 122.1±20.8 minutes for the study group. In addition, the mean aortic cross clamp time was 67.7±13.4 minutes for the patients who had undergone AVR through median sternotomy, while 68.0±8.9 minutes for the study group. The mean operating time was 181.6±31.5 minutes for the patients who had undergone AVR through median sternotomy, while 190.8±29.8 minutes for the study group. Patient satisfaction with respect to cosmesis was higher in the study group. Only 50% of the patients who had undergone AVR through median sternotomy in comparison to 73.3% of those in the study group were satisfied with the cosmesis., Conclusions: The right anterolateral thoracotomy approach for aortic valve replacement proved to be easy to perform whilst maintaining the maximum security for the patients. Besides its better cosmetic result especially in female patients, this approach proved to have several advantages.

Spontaneous adrenal hemorrhage is an acute hemorrhage from the adrenal gland which occurs in the absence of trauma. The incidence of this condition during pregnancy is unknown. We describe a patient with massive unilateral adrenal hemorrhage which occurred during labor. The patient was successfully managed conservatively with complete resolution of the hematoma. A review of the literature of this rare condition is also presented.

Today's biosensors and drug delivery devices are increasingly incorporating lithographically patterned circuitry that is placed within microns of the biological molecules to be detected or released. Elevated temperatures due to Joule heating from the underlying circuitry cannot only reduce device performance, but also alter the biological activity of such molecules (i.e. binding, enzymatic, folding). As a consequence, biochip design and characterization will increasingly require local measurements of the temperature and temperature gradients on the biofunctionalized surface. We have developed a technique to address this challenge based on the use of DNA molecular beacons as a nanoscale temperature probe. The surface of fused-silica chips with lithographically patterned, current-carrying gold rings have been functionalized with a layer of molecular beacons. We utilize the temperature dependence of the molecular beacons to calibrate the temperature at the center of the rings as a function of applied current from 25 to 50 degrees C. The fluorescent images of the rings reveal the extent of heating to the surrounding chip due to the applied current while resolving temperature gradients over length scales of less than 500nm. Finite element analysis and analytic calculations of the distribution of heat in the vicinity of the current-carrying rings agree well with the experimental results. Thus, molecular beacons are shown to be a viable tool for temperature calibration of micron-sized circuitry and the visualization of submicron temperature gradients.

Background: Prophylactic drainage of wounds is aimed to reduce the wound complications and thereby morbidity. Obese patients are at more risk. The objective of the present study was to determine whether subcutaneous drainage can reduce such complications in elective abdominal surgery (cholecystectomy) in obese patients., Design: Randomized, prospective and comparative study., Methods: Two hundred and fifty obese patients with body mass index (BMI) >32 and subcutaneous fat thickness of >3 cm undergoing elective Cholecystectomy were allocated into two groups, viz. study (n=125) and control (n=125). Incision technique was standardized for all the patients. Patients with sepsis, spillage and comorbid conditions were excluded from the study., Results: Overall seroma formation occurred in 11 (8.80%) patients in the study group and 42 (33.60%) patients in the control group (p<0.05), the likelihood of seroma formation without drains was 6.5 times and 9.3 times more in patients with subcutaneous fat thickness of 3-3.9 cm and 4-5 cm, respectively. 71.43% of patients in the control group and 54.55% patients in the study group who developed seroma presented in the first week of surgery., Conclusion: Prophylactic use of subcutaneous drains in obese patients undergoing cholecystectomy was found to reduce the seroma formation significantly.

Lobsters (Homarus americanus) in the wild inhabit ocean waters where temperature can vary over a broad range (0-25 degrees C). To examine how environmental thermal variability might affect lobster physiology, we examine the effects of temperature and thermal change on the acid-base status of the lobster hemolymph. Total CO(2), pH, P(CO)2 and HCO(-)(3) were measured in hemolymph sampled from lobsters acclimated to temperature in the laboratory as well as from lobsters acclimated to seasonal temperatures in the wild. Our results demonstrate that the change in hemolymph pH as a function of temperature follows the rule of constant relative alkalinity in lobsters acclimated to temperature over a period of weeks. However, thermal change can alter lobster acid-base status over a time course of minutes. Acute increases in temperature trigger a respiratory compensated metabolic acidosis of the hemolymph. Both the strength and frequency of the lobster heartbeat in vitro are modulated by changes in pH within the physiological range measured in vivo. These observations suggest that changes in acid-base status triggered by thermal variations in the environment might modulate lobster cardiac performance in vivo.

The lobster Homarus americanus inhabits ocean waters that vary in temperature over a 25 degrees C range, depending on the season and water depth. To investigate whether the lobster heart functions effectively over a wide range of temperatures we examine the temperature dependence of cardiac performance of isolated lobster hearts in vitro. In addition, we examined whether modulation of the heart by serotonin depends on temperature. The strength of the heartbeat strongly depends on temperature, as isolated hearts are warmed from 2 to 22 degrees C the contraction amplitude decreases by greater than 60%. The rates of contraction and relaxation of the heart are most strongly temperature dependent in the range from 2 to 4 degrees C but become temperature independent at warmer temperatures. Heart rates increase as a function of temperature both in isolated hearts and in intact animals, however hearts in intact animals beat faster in the temperature range of 12-20 degrees C. Interestingly, acute Q10 values for heart rate are similar in vivo and in vitro over most of the temperature range, suggesting that temperature dependence of heart rate arises mainly from the temperature effects on the cardiac ganglion. In contrast to earlier reports suggesting that the strength and the frequency of the lobster heartbeat are positively correlated, we observe no consistent relationship between these parameters as they change as a function of temperature. Stroke volume decreases as a function of temperature. However, the opposing temperature-dependent increase in heart rate partially compensates to produce a relationship between cardiac output and temperature in which cardiac output is maximal at 10 degrees C and significantly decreases above 20 degrees C. Serotonin potentiates contraction amplitude and heart rate in a temperature-independent manner. Overall, our results show that although the parameters underlying cardiac performance show different patterns of temperature dependence, cardiac output remains relatively constant over most of the wide range of environmental temperatures the lobster inhabits in the wild.