Bilhemia or bile mixing with blood is a rare clinical problem. The clinical presentation is usually transient self-resolving hyperbilirubinemia, progressive and rapidly rising conjugated hyperbilirubinemia, or recurre...Bilhemia or bile mixing with blood is a rare clinical problem. The clinical presentation is usually transient self-resolving hyperbilirubinemia, progressive and rapidly rising conjugated hyperbilirubinemia, or recurrent cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) plays an important role in diagnosis and management. Biliary decompression with endoscopic sphincterotomy is useful in treating these patients. If not recognized and treated in time, the condition can be fatal in a significant proportion of patients. This usually occurs after blunt or penetrating hepatic trauma due to a fistulous connection between the biliary radicle and portal or hepatic venous radical. Cases have been described due to iatrogenic trauma such as liver biopsy and percutaneous biliary drainage. However, the occurrence after trans-jugular intra-hepatic porto-systemic shunt (TIPS) is very rare. We report a case of bilhemia presenting as rapidly rising bilirubin after TIPS. The patient was managed successfully with ERCP and removal of a blood clot from the common bile duct.展开更多
In this work, historical background of power generation by small hydro-power plants across the world and specially across the Iran with emphasis on small hydro-power plant utilization as recovery turbine in water tran...In this work, historical background of power generation by small hydro-power plants across the world and specially across the Iran with emphasis on small hydro-power plant utilization as recovery turbine in water transmission pipeline have been attended firstly, and then, three water transmission pipelines from Chah-nemie to Zahedan city, Shirindare dam to Bojnord city and Mokhtaran desert to Birjand city in Iran have been studied as case study samples. According to the sample pipeline characteristics and pipeline topography, reachable energy have been estimated; in the next step, pay attending to reachable energy, initial investment cost, total benefit of operating period, benefit to cost ratio and other economical parameters for small hydro-power plants in case study pipelines have been presented and generated power cost of the same amount via other resources compared to the hydro-power cost. At the end, in agreement with environmental advantages of small hydro-power plants, the methods of generated power utilization, proper solution for optimization of reachable energy in water transmission pipeline and substitution of pressure reducing valve by small hydro-power plant in the pipelines as a major solution for energy recovering in water pipelines have been proposed.展开更多
文摘Bilhemia or bile mixing with blood is a rare clinical problem. The clinical presentation is usually transient self-resolving hyperbilirubinemia, progressive and rapidly rising conjugated hyperbilirubinemia, or recurrent cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) plays an important role in diagnosis and management. Biliary decompression with endoscopic sphincterotomy is useful in treating these patients. If not recognized and treated in time, the condition can be fatal in a significant proportion of patients. This usually occurs after blunt or penetrating hepatic trauma due to a fistulous connection between the biliary radicle and portal or hepatic venous radical. Cases have been described due to iatrogenic trauma such as liver biopsy and percutaneous biliary drainage. However, the occurrence after trans-jugular intra-hepatic porto-systemic shunt (TIPS) is very rare. We report a case of bilhemia presenting as rapidly rising bilirubin after TIPS. The patient was managed successfully with ERCP and removal of a blood clot from the common bile duct.
文摘In this work, historical background of power generation by small hydro-power plants across the world and specially across the Iran with emphasis on small hydro-power plant utilization as recovery turbine in water transmission pipeline have been attended firstly, and then, three water transmission pipelines from Chah-nemie to Zahedan city, Shirindare dam to Bojnord city and Mokhtaran desert to Birjand city in Iran have been studied as case study samples. According to the sample pipeline characteristics and pipeline topography, reachable energy have been estimated; in the next step, pay attending to reachable energy, initial investment cost, total benefit of operating period, benefit to cost ratio and other economical parameters for small hydro-power plants in case study pipelines have been presented and generated power cost of the same amount via other resources compared to the hydro-power cost. At the end, in agreement with environmental advantages of small hydro-power plants, the methods of generated power utilization, proper solution for optimization of reachable energy in water transmission pipeline and substitution of pressure reducing valve by small hydro-power plant in the pipelines as a major solution for energy recovering in water pipelines have been proposed.
