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Longer duration of extracorporeal membrane oxygenator support, low pH and urine output in the first 24 hours, and renal failure are significant factors associated with mortality during extracorporeal membrane oxygenator support. Exposure to high amounts of blood transfusion during extracorporeal oxygenation, extended extracorporeal membrane oxygenator support, and sepsis increase risk of death after successful decannulation.

Background: Perforation of the bowel is the most serious complication of typhoid fever. The role of early limited surgery in managing these patients needs to be assessed. Methods: The records of 110 cases of typhoid enteric perforation treated at JLN Hospital, Ajmer between 1990 and 1995 were reviewed. Results: A total of 42.7% of the patients were in the 21-30-year age group, and 83.6% were male. All patients presented with the classic features of typhoid enteric perforation. A total of 83.6% were operated on within 36 h of perforation. Surgical management consisted of primary closure of the perforation (74.5%), closure with omental graft (14.5%), resection and anastomosis (3.6%), and only drainage (7.3%). A total of 79.1% of patients developed wound infection and 10% of patients developed faecal fistula. The overall mortality rate was 16.4%. Increasing the time interval between perforation and operation significantly increased the mortality ( P < 0.05). The mortality was least with early primary closure of the perforation. Patients with postoperative faecal fistula had higher mortality rates (P < 0.001). Conclusions:Early limited surgery with thorough peritoneal lavage provides optimal results, faecal fistula is a grave complication, and the use of the McBurney incision may provide better results in terms of subsequent wound healing.

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Paralysis of diaphragm on one or, exceptionally, both sides is a common cause of delayed recovery and excessive morbidity following pediatric cardiac surgery. The consequences of this complication after all forms of congenital heart surgery in newborns and young infants can be potentially serious. The impact of diaphragmatic palsy on the physiology after single ventricle palliations is particularly significant. It is necessary for all professionals taking care of children with heart disease to be familiar with the etiology, diagnosis, and management of this condition. Early recognition and prompt management of diaphragmatic palsy can potentially reduce the duration of mechanical ventilation and intensive care in those who develop this complication. This review summarizes the anatomy of the phrenic nerves, reasons behind the occurrence of diaphragmatic palsy, and suggests practical guidelines for management.

SynopsisThe rheological behavior of a comb-like associative polymer with pendant hydrophobes in the presence of nonylphenol polyethoxylate ͑NPe͒ nonionic surfactants is examined. In particular, the effects of surfactant concentration, polymer concentration, and surfactant's hydrophilic-lipophilic balance ͑HLB͒ are investigated with the latter being varied by using surfactants with different number of ethoxylate units ͑e = 6, 8, 12, and 15͒. Steady shear and dynamic measurements are performed and the zero/low shear viscosity ͑ 0 ͒, the number and average life time of the hydrophobic junctions, and the numbers of polymer hydrophobes and NP8 surfactant molecules per hydrophobic junction are determined. The trend of zero/low shear viscosity with increasing NP8 surfactant concentration exhibits four distinct regions, each of them related to molecular-level changes: ͑1͒ surfactant addition to the hydrophobic junctions ͑no change in 0 from that of pure hydrophobically modified alkali-soluble emulsion polymer solution͒; ͑2͒ formation of mixed micelles containing surfactants and several polymer hydrophobes ͑ 0 increases͒; ͑3͒ saturation of each polymer hydrophobe by individual surfactant micelles ͑ 0 decreases͒; and ͑4͒ formation of free surfactant micelles ͑ 0 is constant͒. The viscosity trend of the polymer/NP8 surfactant systems with increasing surfactant concentration does not change upon increasing polymer concentration from 0.5 to 1 wt %. Moreover, the number of surfactant molecules bound to polymer hydrophobes at the viscosity maximum is the same for both polymer concentrations. In terms of the effects of surfactant HLB on polymer/NPe surfactants systems, we find essentially similar trends of zero/low shear viscosity with increasing surfactant concentration for systems containing surfactants of higher HLB ͑NP12 and NP15͒. However, the viscosity maximum is lower, and viscosity in the fourth region gradually decreases for systems containing higher HLB surfactant. In contrast, systems containing a surfactant with lower HLB ͑NP6͒ exhibit a different behavior with a continuous increase in zero/low shear viscosity with increasing surfactant concentration.