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68. Rigid Fixation for the Prevention and Treatment of Sternal Complications

Author

Nazerali, Rahim S, Hinchcliff, Katharine, and Wong, Michael S

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Patient Safety, Prevention, Adolescent, Adult, Aged, Bone Plates, Female, Fracture Fixation, Internal, Fractures, Bone, Fractures, Ununited, Funnel Chest, Humans, Male, Mediastinitis, Middle Aged, Orthopedic Procedures, Postoperative Complications, Reoperation, Retrospective Studies, Sternotomy, Sternum, Surgical Wound Dehiscence, Surgical Wound Infection, Treatment Outcome, Young Adult, reconstruction, mediastinitis, sternal plating, sternum, rigid fixation, Surgery, Clinical sciences, Dentistry
Abstract

BackgroundMost surgical specialties working with bone have transitioned from wire fixation to more stable plate and screw fixation. Rigid plate fixation results in more rapid bony healing with decreased rates of nonunion, malunion, and infection. Despite sternotomies being the most frequently performed osteotomy, cerclage wire fixation remains the standard technique of closure. This study reviews our 5-year experience with rigid fixation at the University of California Davis Medical Center.Materials and methodsA retrospective review of patients who underwent rigid sternal fixation between January 2006 and December 2012 at UC Davis Medical Center was performed. Demographic factors, indications for surgery, and risk factors for postoperative complications including mediastinitis and nonunion were reviewed. The type of fixation system was recorded. Outcomes assessed included dehiscence, deep and superficial infections, sternal instability, and need for reoperation.ResultsFifty-seven rigid sternal fixations were performed (M/F, 37:20; average age, 54 years; range, 16-79 years). Indications for operation included prophylaxis against mediastinitis (61.4%), sternal nonunion (24.6%), sternal fractures (7.0%), and pectus deformities (7.0%). Of the rigid fixation systems used, 87.3% used SternaLock, 12.7% used Talon, 1.8% Lactosorb, and 1.8% Flexigrip. Thirty-five patients were plated for prophylaxis against mediastinitis. In the prophylactic group, the average number of risk factors per patient was 3.92, indicating very high-risk patients. Fourteen patients were plated for sternal nonunion. The average number of risk factors in the nonunion group was 1.57. Other less common indications for rigid sternal stabilization included sternal fracture (4 patients) and pectus deformity (4 patients). Eight patients had a pectoralis flaps performed at the time of their sternal fixation, 7 for soft tissue coverage of plates and 1 for coverage of a contaminated wound bed. All patients went on to heal their sternums without evidence of mediastinitis.ConclusionsRigid sternal fixation is a natural extension of principles learned from bone stabilization in other parts of the body. It can be used for rigid bony fixation of osteotomies performed after median sternotomy as well as in sternal reconstructions for traumatic fractures, nonunions, and pectus deformities. Rigid sternal fixation can be used safely and effectively in the prophylaxis against the development of mediastinitis in addition to the treatment of sternal nonunion or malunion in high-risk patients.

Published
2014

75. L'archivio JSTOR

Author

Rajan, Rahim S.

Subjects
L. Information technology and library technology
Abstract

This is a presentation of the JSTOR archive, a collection of journals (of academic interest) digitized thanks to an initiative by Andrew W. Mellon Foundation; launched in 1994, the initiative today includes 353 titles by 217 publishers, for a total heritage of 13 millions of digitized pages.

Published
2003

82. AB0498 PREDICTIVE BIOMARKERS OF TOFACITINIB THERAPY IN RHEUMATOID ARTHRITIS: REAL WORLD DATA FROM MALAYSIAN RHEUMATOLOGY BIOLOGIC REGISTRY (MARBLE)

Author

Janahiraman, S., primary, Too, C. L., additional, Ch’ng, S. S., additional, Eow, L. H., additional, Mageswaren, E., additional, Lim, A. L., additional, Chong, H., additional, Ong, P. S., additional, Mohamed Ismail, A., additional, Ab Rahim, S. M., additional, Ng, C. R., additional, Suahilai, D. M., additional, Ramlan, A. H., additional, Leong, C. O., additional, and Shahril, N. S., additional

Published
2023
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89. New adipate esters from Cunninghamella echinulata: isolation, identification, biosynthesis and in silico prediction of potential opioid/anti-opioid and antidiabetic activities.

Author

Ibrahim, Abdel-Rahim S. and Ragab, Amany E.

Subjects
ALDOSE reductase, ESTERS, OPIOID receptors, BIOSYNTHESIS, DRUG target
Abstract

Metabolites of the fungus Cunninghamella echinulata NRRL 1382 were investigated under the effect of fusidic acid (1) feeding. In addition to ergosterol (2) which is a fungal sterol, two novel adipate esters (3, 4) were isolated, and their structures were fully investigated using various spectroscopic analyses, including 1 D, 2 D NMR and HRESIMS. In silico biological target prediction and molecular docking investigation revealed a potential agonist/antagonist activity for compound 3 by binding to µ opioid receptor and antidiabetic effect by aldose reductase inhibitory activity for compound 4. [ABSTRACT FROM AUTHOR]

Published
2023
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