Our study found a significant reduction in SSI rates after introduction of topical vancomycin. Thus, this simple intervention should be considered in all open craniotomy patients as both infection prophylaxis and a potential cost saving intervention.

BackgroundBlunt cardiac trauma is diagnosed in less than 10% of trauma patients and covers the range of severity from clinically insignificant myocardial contusions to lethal multi-chamber cardiac rupture. The most common mechanisms of injury include: motor vehicle collisions (MVC), pedestrians struck by motor vehicles and falls from significant heights. A severe complication from blunt cardiac trauma is cardiac chamber rupture with pericardial tear. It is an exceedingly rare diagnosis. A retrospective review identified only 0.002% of all trauma patients presented with this condition. Most patients with atrial rupture do not survive transport to the hospital and upon arrival diagnosis remains difficult.Case presentationWe present two cases of atrial and pericardial rupture. The first case is a 33-year-old female involved in a MVC, who presented unresponsive, hypotensive and tachycardic. A left sided hemothorax was diagnosed and a chest tube placed with 1200 mL of bloody output. The patient was taken to the OR emergently. Intraoperatively, a laceration in the right pericardium and a 3 cm defect in the anterior, right atrium were identified. Despite measures to control hemorrhage and resuscitate the patient, the patient did not survive.The second case is a 58-year-old male involved in a high-speed MVC. Similar to the first case, the patient presented unresponsive, hypotensive and tachycardic with a left sided hemothorax. A chest tube was placed with 900 mL of bloody output. Based on the output and ongoing resuscitation requirements, the patient was taken to the OR. Intraoperatively, a 15 cm anterior pericardial laceration was identified. Through the defect, there was brisk bleeding from a 1 cm laceration on the left atrial appendage. The injury was debrided and repaired using a running 3–0 polypropylene suture over a Satinsky clamp. The patient eventually recovered and was discharged home.ConclusionsWe present two cases of uncontained atrial and pericardial rupture from blunt cardiac trauma. Contained ruptures with an intact pericardium present as a cardiac tamponade while uncontained ruptures present with hemomediastinum or hemothorax. A high degree of suspicion is required to rapidly diagnose and perform the cardiorrhaphy to offer the best chance at survival.

TX 75083-3836, U.S.A., fax 01-972-952-9435. AbstractThe effect of initial water saturation on gas recovery by cocurrent spontaneous water imbibition and imbibition rate was investigated both theoretically and experimentally. Equations correlating initial water saturation, gas recovery, imbibition rate, rock/fluid properties, and imbibition time were derived and used to conduct the theoretical analysis. These equations foresee that gas recovery and imbibition rate could increase, remain unchanged, or decrease with increase in initial water saturation, depending on rock properties, the quantity of residual gas saturation, the range of initial water saturation, and the units used in the definitions of gas recovery and imbibition rate. The theoretical predictions were verified experimentally by conducting spontaneous water imbibition at five different initial water saturations, ranging from 0 to about 50%. Water phase relative permeabilities and capillary pressures were calculated using the experimental data of spontaneous imbibition. The effects of initial water saturation on residual gas saturation, water phase relative permeability, and capillary pressure were also studied experimentally. The results in different rocks were compared. It was found that the residual gas saturation by spontaneous imbibition in a fired Berea sandstone sample (clay was removed by firing) was lower than in a natural Berea sandstone sample (clay was not removed). This demonstrates significant wettability alteration caused by firing. In other words, there may be significant wettability differences among different gas-liquid-rock systems.

It has been a challenge to understand why recovery by spontaneous imbibition could both increase and decrease with initial water saturation. To this end, mathematical models were developed with porosity, permeability, viscosity, relative permeability, capillary pressure, and initial water saturation included. These equations foresee that recovery and imbibition rate can increase, remain unchanged, or decrease with an increase in initial water saturation, depending on rock properties, the quantity of residual gas saturation, the range of initial water saturation, and the units used in the definitions of gas recovery and imbibition rate. The theoretical predictions were verified experimentally by conducting spontaneous water imbibition at five different initial water saturations, ranging from 0 to approximately 50%. The effects of initial water saturation on residual saturation, relative permeability, capillary pressure, imbibition rate, and recovery in gas/water/rock systems by cocurrent spontaneous imbibition were investigated both theoretically and experimentally. Water-phase relative permeabilities and capillary pressures were calculated with the experimental data of spontaneous imbibition. Experimental results in different rocks were compared.where A and L are the cross-sectional area and the length of the core, respectively. w is the viscosity of water, S wi is the initial