Unusual ovarian hyperstimulation syndrome presentation:Pleural effusion without ascites.A case report

BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique manifestation of OHSS involving pleural effusion(PE)in a patient without identifiable risk factors.CASE SUMMARY A 39-year-old woman who underwent controlled ovarian hyperstimulation for an in vitro fertilization(IVF)cycle experienced dyspnea on the eleventh day of post oocyte retrieval.The diagnosis was severe OHSS with a unique manifestation of PE without ascites.Clinical management involved fluid balance and treatment with albumin,furosemide,thromboembolic prophylaxis,and thoracentesis.A continued drainage of the pleural cavity was performed.The patient had a favo-rable outcome,and a dichorionic diamniotic gestation passed without incident.CONCLUSION OHSS and its potential complications can include respiratory distress and PE,as well as thromboembolic disorders.

Subxyphoid Pericardial Drainage for Tuberculous Pericardial Effusion in Antananarivo

Introduction: Tuberculosis is the leading cause of pericardial effusion in sub-Saharan African countries. The aim of this study was to describe the diagnosis and the surgical management of tuberculous pericardial effusion in low-income country. Methods: This was a retrospective and descriptive study performed at Vascular Surgery Unit for 10 years-period (from January 2012 to December 2021), including all cases of drainage of pericardial effusion due to tuberculosis. Results: Sixty-seven cases were recorded, including 38 males (56.71%) and 29 women (43.28%). The average age was 35.47 years old. Patients lived in urban areas in 67.16% of cases. Thirteen patients (13.43%) had a previous history of pulmonary tuberculosis. The most common risk factors for tuberculosis infection were malnourishment (80.59%), indoor air pollution (77.61%) and close contact with tuberculosis patient (40.29%). The commonest symptom were dyspnea, (95.52%), chest pain (89.55%), fever (67.16%), tachycardia (95.52%) and cough (80.59%). Twenty-seven patients (39.02%) presented clinical signs of cardiac tamponade. Electrocardiogram showed sinus tachycardia (97.53%) with microvoltage (39.02%). Chest-X-ray showed cardiomegaly (100%) and pleural effusion (56.71%). Echocardiography showed moderate (43.28%) and large (56.71%) pericardial effusion. All patients underwent subxiphoid pericardial drainage. Mycobacterium tuberculosis detection via GeneXpert test of pericardial effusion were positive in 38.80% of patients. Pericardial biopsies confirmed the diagnosis of tuberculosis in 41.79%. The mortality rate was 8.95%. Conclusion: Subxiphoid pericardial drainage reduced thr risk of cardiac tamponade in patients with massive pericardial effusion. Histopathology of pericardial biopsies made a definitive diagnosis for tuberculosis.

Bacteriological Profile of Effusion Fluids Infections at Charles De Gaulle University Pediatric Hospital from 2017 to 2020

Introduction: Microbiology of effusion fluids in children in Burkina Faso is characterized by the scarcity of data. This work aimed to study the bacteriological and antibiotics susceptibility profile of bacteria involved in effusion fluid infections in paediatrics in order to improve the choice of probabilistic antibiotics therapy. Methods: A cross-sectional, descriptive study was used in children aged 0 to 15 years from 2017 to 2020 at the Charles De Gaulle Pediatric University Hospital Center (CHUP-CDG) in Ouagadougou. Classical bacteriology methods such as macroscopy, Gram staining, identification galleries and antibiotics susceptibility testing were used. Results: Of 231 samples, 64 bacteria were isolated. The most common bacterial strains of pleural fluid were Staphylococcus aureus (25%) and 40% for Enterobacteriaceae. Of the peritoneal fluid, 77% were Enterobacteriaceae with 57% Escherichia coli;and from joint fluid, 33% were S. aureus and 22% for P. aeruginosa. The overall susceptibility profile showed 29% extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL), 10% methicillin-resistant S. aureus (MRSA), and 8% carbapenemases. Conclusion: Bacteriological profile is characterized by ESBL-producing Enterobacteriaceae and MRSA. The most active antibiotics were macrolides, aminoglycosides, and cefoxitin (methicillin) for Gram-positive cocci, carbapenems, and aminoglycosides for Gram-negative bacilli. Then, the monitoring of antibiotics resistance must be permanent.

Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.

Pulmonary Edema and Pleural Effusion Detection Using Efficient Net-V1-B4 Architecture and AdamW Optimizer from Chest X-Rays Images

This paper presents a novelmulticlass systemdesigned to detect pleural effusion and pulmonary edema on chest Xray images,addressing the critical need for early detection in healthcare.A new comprehensive dataset was formed by combining 28,309 samples from the ChestX-ray14,PadChest,and CheXpert databases,with 10,287,6022,and 12,000 samples representing Pleural Effusion,Pulmonary Edema,and Normal cases,respectively.Consequently,the preprocessing step involves applying the Contrast Limited Adaptive Histogram Equalization(CLAHE)method to boost the local contrast of the X-ray samples,then resizing the images to 380×380 dimensions,followed by using the data augmentation technique.The classification task employs a deep learning model based on the EfficientNet-V1-B4 architecture and is trained using the AdamW optimizer.The proposed multiclass system achieved an accuracy(ACC)of 98.3%,recall of 98.3%,precision of 98.7%,and F1-score of 98.7%.Moreover,the robustness of the model was revealed by the Receiver Operating Characteristic(ROC)analysis,which demonstrated an Area Under the Curve(AUC)of 1.00 for edema and normal cases and 0.99 for effusion.The experimental results demonstrate the superiority of the proposedmulti-class system,which has the potential to assist clinicians in timely and accurate diagnosis,leading to improved patient outcomes.Notably,ablation-CAM visualization at the last convolutional layer portrayed further enhanced diagnostic capabilities with heat maps on X-ray images,which will aid clinicians in interpreting and localizing abnormalities more effectively.

Pleural effusion,ascites,colon ulcers and hematochezia:What we can learn from the diagnostic process of a patient with plasma cell myeloma:A case report

BACKGROUND Plasma cell myeloma(PCM)is characterized by hypercalcemia,renal impairment,anemia,and bone destruction.While pleural effusion,ascites,abdominal pain,and bloody stool are common manifestations of lung disease or gastrointestinal disorders,they are rarely observed in patients with PCM.CASE SUMMARY A 66-year-old woman presented with complaints of recurrent chest tightness,wheezing,and abdominal bloating accompanied by bloody stools.Computed tomography revealed pleural effusion and ascites.Pleural effusion tests showed inflammation,but the T-cell spot test and carcinoembryonic antigen were negative.Endoscopy showed colonic mucosal edema with ulcer formation and local intestinal lumen stenosis.Echocardiography revealed enlarged atria and reduced left ventricular systolic function.The diagnosis remained unclear.Further testing revealed elevated blood light chain lambda and urine immunoglobulin levels.Blood immunofixation electrophoresis was positive for immunoglobulin G lambda type.Smear cytology of the bone marrow showed a high proportion of plasma cells,accounting for about 4.5%.Histopathological examination of the bone marrow suggested PCM.Flow cytometry showed abnormal plasma cells with strong expression of CD38,CD138,cLambda,CD28,CD200,and CD117.Fluorescence in situ hybridization gene testing of the bone marrow suggested 1q21 gene amplification,but cytogenetic testing showed no clonal abnormalities.Colonic mucosa and bone marrow biopsy tissues were negative for Highman Congo red staining.The patient was finally diagnosed with PCM.CONCLUSION A diagnosis of PCM should be considered in older patients with pleural effusion,ascites,and multi-organ injury.

Subdural effusion associated with COVID-19 encephalopathy: A case report

BACKGROUND The precise mechanism by which severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)impacts the central nervous system remains unclear,with manifestations spanning from mild symptoms(e.g.,olfactory and gustatory deficits,hallucinations,and headache)to severe complications(e.g.,stroke,seizures,encephalitis,and neurally demyelinating lesions).The occurrence of single-pass subdural effusion,as described below,is extremely rare.CASE SUMMARY A 56-year-old male patient presented with left-sided limb weakness and slurred speech as predominant clinical symptoms.Through comprehensive imaging and diagnostic assessments,he was diagnosed with cerebral infarction complicated by hemorrhagic transformation affecting the right frontal,temporal,and parietal regions.In addition,an intracranial infection with SARS-CoV-2 was identified during the rehabilitation process;consequently,an idiopathic subdural effusion developed.Remarkably,the subdural effusion underwent absorption within 6 d,with no recurrence observed during the 3-month follow-up.CONCLUSION Subdural effusion is a potentially rare intracranial complication associated with SARS-CoV-2 infection.

Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment.A review

Otitis media with effusion(OME)is a frequent paediatric disorder.The condition is often asymptomatic,and so can easily be missed.However,OME can lead to hearing loss that impairs the child's language and behavioural development.The diagnosis is essentially clinical,and is based on otoscopy and(in some cases)tympanometry.Nasal endoscopy is only indicated in cases of unilateral OME or when obstructive adenoid hypertrophy is suspected.Otitis media with effusion is defined as the observation of middle-ear effusion at consultations three months apart.Hearing must be evaluated(using an age-appropriate audiometry technique)before and after treatment,so as not to miss another underlying cause of deafness(e.g.perception deafness).Craniofacial dysmorphism,respiratory allergy and gastro-oesophageal reflux all favour the development of OME.Although a certain number of medications(antibiotics,corticoids,antihistamines,mucokinetic agents,and nasal decongestants)can be used to treat OME,they are not reliably effective and rarely provide long-term relief.The benchmark treatment for OME is placement of tympanostomy tubes(TTs)and(in some cases)adjunct adenoidectomy.The TTs rapidly normalize hearing and effectively prevent the development of cholesteatoma in the middle ear.In contrast,TTs do not prevent progression towards tympanic atrophy or a retraction pocket.Adenoidectomy enhances the effectiveness of TTs.In children with adenoid hypertrophy,adenoidectomy is indicated before the age of 4 but can be performed later when OME is identified by nasal endoscopy.Children must be followed up until OME has disappeared completely,so that any complications are not missed.

Pericardiocentesis with cisplatin for malignant pericardial effusion and tamponade

AIM:To evaluate the role and outcome of pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer. METHODS:We retrospectively studied 7 patients who underwent pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer.After pericardiocentesis,we performed catheterization of the pericardial space under ultrasonogram guidance.Malignant etiology of the pericardial fluid was confirmed by cytological examination.Subsequently,cisplatin(10 mg in 20 mL normal saline) was instilled into the pericardial space. RESULTS:The mean total volume of the aspirated effusion fluid was 782±264 mL(range,400-1200 mL) . The drainage catheter was successfully removed in all patients,and the mean duration of pericardial drainagewas 7.7±2.7 d(range,5-13 d) .No fluid reaccumulation was observed.Mean survival time was 120±71 d(range,68-268 d) . CONCLUSION:Pericardiocentesis along with catheter drainage appears to be a safe and effective for pericardial malignant effusion and tamponade,and cisplatin instillation prevents recurrence.

Evaluation of serum and pleural levels of endostatin and vascular epithelial growth factor in lung cancer patients with pleural effusion

Objective:To evaluate the diagnostic value of endostatin(ES),vascular endothelial growth factor (VEGF) and careinoembryonie antigen(CEA) in both serum and pleural effusion of lung cancer patients.Methods:Levels of ES,VEGF and CEA in 52 malignant pleural effusion due to lung cancer and 50 patients with non-malignant disease were measured by using sandwich enzymelinked immunosorbent assay and microparticle enzyme immunoassay.Results:The ES.VEGF and CEA levels in pleural effusion and serum,and their ratio(F/S) were higher in lung cancer group than that in benign group,and the differences were statistically significant(P【0.05).The diagnostic efficiency of ES+VEGF for lung cancer was superior to either single detection.The diagnostic efficiency of ES+VEGK+CEA was superior to either ES+VEGF or ES+CEA.Conclusions: The results suggest that ES,VEGF and CEA might be useful in the differentiation between benign and malignant pleural effusion due to lung cancer.In comparison with either single determination of concentration in serum or pleural fluid,the couiljined detection of two or three markers is of important clinical significance in the diagnosis of lung cancer.

Diagnosis and management of pericardial effusion

Pericardial effusion is a common finding in everyday clinical practice.The first challenge to the clinician is to try to establish an etiologic diagnosis.Sometimes,the pericardial effusion can be easily related to a known underlying disease,such as acute myocardial infarction, cardiac surgery,end-stage renal disease or widespread metastatic neoplasm.When no obvious cause is apparent,some clinical findings can be useful to establish a diagnosis of probability.The presence of acute inflammatory signs(chest pain,fever,pericardial friction rub) is predictive for acute idiopathic pericarditis irrespective of the size of the effusion or the presence or absence of tamponade.Severe effusion with absence of inflammatory signs and absence of tamponade is predictive for chronic idiopathic pericardial effusion,and tamponade without inflammatory signs for neoplastic pericardial effusion.Epidemiologic considerations are very important,as in developed countries acute idiopathic pericarditis and idiopathic pericardial effusion are the most common etiologies,but in some underdeveloped geographic areas tuberculous pericarditis is the leading cause of pericardial effusion.The second point is the evaluation of the hemodynamic compromise caused by pericardial fluid.Cardiac tamponade is not an"all or none"phenomenon,but a syndrome with a continuum of severity ranging from an asymptomatic elevationof intrapericardial pressure detectable only through hemodynamic methods to a clinical tamponade recognized by the presence of dyspnea,tachycardia,jugular venous distension,pulsus paradoxus and in the more severe cases arterial hypotension and shock.In the middle,echocardiographic tamponade is recognized by the presence of cardiac chamber collapses and characteristic alterations in respiratory variations of mitral and tricuspid flow.Medical treatment of pericardial effusion is mainly dictated by the presence of inflammatory signs and by the underlying disease if present.Pericardial drainage is mandatory when clinical tamponade is present.In the absence of clinical tamponade,examination of the pericardial fluid is indicated when there is a clinical suspicion of purulent pericarditis and in patients with underlying neoplasia.Patients with chronic massive idiopathic pericardial effusion should also be submitted to pericardial drainage because of the risk of developing unexpected tamponade.The selection of the pericardial drainage procedure depends on the etiology of the effusion.Simple pericardiocentesis is usually sufficient in patients with acute idiopathic or viral pericarditis.Purulent pericarditis should be drained surgically,usually through subxiphoid pericardiotomy. Neoplastic pericardial effusion constitutes a more difficult challenge because reaccumulation of pericardial fluid is a concern.The therapeutic possibilities include extended indwelling pericardial catheter,percutaneous pericardiostomy and intrapericardial instillation of antineoplastic and sclerosing agents.Massive chronic idiopathic pericardial effusions do not respond to medical treatment and tend to recur after pericardiocentesis, so wide anterior pericardiectomy is finally necessary in many cases.

Clinical Value of Vascular Endothelial Growth Factor Combined with Interferon-γ in Diagnosing Malignant Pleural Effusion and Tuberculous Pleural Effusion

In order to investigate the clinical value of vascular endothelial growth factor （VEGF） combined with interferon-γ （IFN-γ） in diagnosing malignant pleural effusion and tuberculous pleural effusion, 42 cases of malignant pleural effusion and 45 cases of tuberculous pleural effusion in Tongji Hospital, from March 2004 to May 2005, were included, The carcinoembryonic antigen （CEA）, VEGF and IFN-γ levels of pleural effusion were detected by using ELISA, and adenosine deaminase （ADA） activity was determined by using enzyme kinetic analytical method. The sensitivity, specificity, accuracy and area under the curve （AUCR^ROC） of CEA and VEGF, VEGF/IFN-γ ratio, ADA and IFN-γ were measured by receiver operating characteristic curve （ROC）, The results showed that CEA, VEGF levels and VEGF/IFN-γ ratio were significantly higher and the ADA and IFN-γ levels were significantly lower in malignant group than those in tuberculous group （P〈0,01）, The sensitivity, specificity, accuracy and AUCR^ROC of VEGF/IFN-γ ratio （88,7%, 99,8%, 94,4%, 0.96 respectively） were higher than those of CEA （67.8%, 96.1%, 82,4%, 0.78 respectively） and VEGF （81,5%, 84,3%, 82.9%, 0.79 respectively）. The sensitivity, specificity, accuracy and AUCR^ROC of IFN-γ （85.7%, 96,4%, 90.9%, 0.94 respectively） were higher than those of ADA （80,2%, 87,6%, 83.8%, 0,81 respectively）. It was concluded that VEGF/IFN-γ ratio and IFN-γ could be used as valuable parameters for the differential diagnosis of malignant pleural effusion and tuberculous pleural effusion.

Factors related to pleural effusion following hepatectomy for primary liver cancer

BACKGROUND: Pleural effusion frequently complicates hepatectomy and multiple factors contribute to its development following hepatectomy for primary liver cancer. The purpose of this study was to evaluate these factors. METHODS: From March 2003 to May 2005, 228 consecutive patients with primary liver cancer underwent hepatectomy in our department were evaluated retrospectively to identify factors related to postoperative pleural effusion. RESULTS: Among the 228 patients, postoperative pleural effusions arose in 58 (25.4%). Univariate analysis showed significant differences in postoperative ascites, subphrenic collection, Pringle manoeuvre length, drainage amount on postoperative day 1, albumin level on postoperative day 7, alanine aminotransferase (ALT) level on postoperative days I and 3, prealbumin level on postoperative days 3 and 7, and tumor size (P<0.05). Ordinal regression analysis revealed that subphrenic collection, drainage on postoperative day I and ALT plus prealbumin on postoperative days I and 3 were statistically significantly related to postoperative pleural effusion (P<0.05). CONCLUSION: Subphrenic collection and operative injury to the liver appeared to be significantly related to pleural effusion after hepatectomy for primary liver cancer.

Association of asymptomatic otitis media with effusion in patients with adenoid hypertrophy

Objective: Clinical symptoms of otitis media with effusion are rarely brought forward to the guardians of young children who the disease is most prevalent in. This often leads to poor scholastic performances and difficult social interactions. The objective of this study was to identify asymptomatic cases of otitis media with effusion present in individuals with adenoid hypertrophy. Material and Methods: In a cross sectional study advocated in Justice K.S.Hegde Hospital, Karnataka India we evaluated one hundred patients above the age of three from August 2016 to December 2017. Candidates who presented with an adenoid nasopharyngeal ratio of more than 0.5 were selected for the study. Individuals who complained of otological symptoms were not considered for the study. Patients cleared of other pathological otological conditions were underwent audiological evaluation with pure tone audiometry and tympanometry for evaluating the middle ear status and hearing loss. Results: The study showed a total of 36% of patients evaluated presented with asymptomatic otitis media with effusion. In candidates who presented with a bilateral B tympanogram, 40% had significant conductive hearing loss of more than 25dB. Conclusion: An objective test such as impedance audiometry in all patients with adenoid hypertrophy would aid in the diagnosis of fluid in the middle ear, so that timely intervention can be done and possible complications be averted.

Malignant peritoneal effusion acting as a tumor environment in ovarian cancer progression: Impact and significance

Until recently, ovarian cancer research has mainly focused on the tumor cells themselves ignoring for the most part the surrounding tumor environment which includes malignant peritoneal effusions. However, one of the major conceptual advances in oncology over the last few years has been the appreciation that cancer progression cannot be explained by aberrations in cancer cells themselves and is strongly influenced by the surrounding tumor environment. The mechanisms of ovarian cancer progression differ from that of other solid tumors because ovarian cancer cells primarily disseminate within the peritoneal cavity.Malignant peritoneal effusion accumulates in the peritoneal cavity during ovarian cancer progression. These exudative fluids act as a unique tumor environment providing a framework that orchestrates cellular and molecular changes contributing to aggressiveness and disease progression. The composition of ascites, which includes cellular and acellular components, constantly adapts during the course of the disease in response to various cellular cues originating from both tumor and stromal cells. The tumor environment that represents peritoneal effusions closely constitute an ecosystem, with specific cell types and signaling molecules increasing and decreasing during the course of the disease progression creating a single complex network. Although recent advances aiming to understand the ovarian tumor environment have focused one at a time on components, the net impact of the whole environment cannot be understood simply from its parts or outside is environmental context.

Delayed internal pancreatic fistula with pancreatic pleural effusion postsplenectomy

The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amylase.This pancreatic pleural effusion is also called a pancreatic pleural fistula.It is characterized by profuse pleural fluid and has a tendency to recur.Here we report a case of delayed internal pancreatic fistula with pancreatic pleural effusion emerging after splenectomy.From the treatment of this case,we conclude that the symptoms and signs of a subphrenic effusion are often obscure;abdominal computed tomography may be required to look for occult,intra-abdominal infection;and active conservative treatment should be carried out in the early period of this complication to reduce the need for endoscopy or surgery.

One-stage coclear implantation via a facial recess approach in children with otitis media with effusion

Objective:To investigate surgical indications, operative techniques, complications and auditory and speech rehabilitation for cochlear implant (CI) in children with otitis media with effusion (OME). Material and methods:This is a retrospective review of records of 24children with bilateral profound sensorineural hearing loss and OME who were implanted during January 2011 to November 2014 in the Department of Otorhinolaryngology and Head and Neck Surgery at the PLA Hospital, using one-stage implantation via the facial recess approach and round window insertion. The incus was removed in 8 cases during the implantation procedure. Local infiltration of dexamethasone and adrenaline in the middle ear was also performed. Postoperative complications were examined. Preoperative and postoperative questionnaires including Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and the Meaningful Auditory Integration Scale (MAIS) were collected. Results: All electrodes were implanted successfully without any immediate or delayed complications. Inflammatory changes of middle ear mucosa with effusion were noted in all implanted ears. The scores of post-implant CAP and SIR increased significantly in all 24 cases (t ? ?25.95 and ?14.09, respectively for CAP and SIR, p<0.05). Conclusions:One-stage CI via the facial recess approach with round window insertion is safe and effective in cochlear implant candidates with OME, as seen in the 24 children in our study who achieved improved auditory performance and speech intelligibility after CI. Copyright ? 2015, PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Experiment on Adiabatic Film Cooling Effectiveness in Front Zone of Effusion Cooling Configuration

Experimental investigation is performed to investigate the cooling characteristics in the front zone of effusion configuration. Effects of blowing ratio,multi-hole arrangement mode,hole-to-hole pitch and jet orientation angle on the adiabatic film cooling effectiveness are concentrated on. The results show that the film layer displays an obvious"developing"feature in the front zone of effusion cooling scheme,for either the staggered or inline multi-hole arrangement. The varying gradient of the laterally-averaged adiabatic cooling effectiveness along the streamwise direction is greater for the staggered arrangement than that for the inline arrangement. The holes array arranged in staggered mode with small hole-tohole pitches is in favor of obtaining developed film coverage layer rapidly.

Prevention and management of pleural effusion following hepatectomy in primary liver cancer

Postoperative pleural effusion occurs frequently after hepatectomy. The risk factors, prevention and management of postoperative pleural effusion in patients with primary liver cancer (PLC) who have undergone hepatectomy and the value of the argon beam coagulator (ABC) for the prevention of pleural effusion are studied. METHODS:A total of 523 patients with PLC at our institution who had had right hepatectomy from July 2000 to June 2004 were studied retrospectively. Comparative analysis was made to identify the factors contributing to postoperative pleural effusion and the efficacy of various managements. RESULTS:Of the 523 patients whose livers were dissociated using argon beam cutting and/or coagulation, 20(3.8%) developed pleural effusions;whereas in the other 467 patients underwent hepatectomy with suture ligation of the diaphragmatic secondary wound surface during the same period, 49(10.5%) had pleural effusion (P<0.01). The factors contributing to postoperative pleural effusion included subphrenic collection, postoperative hepatic insufficiency with ascites, duration of hepatic occlusion and underlying cirrhosis. CONCLUSIONS: Dissociation of the liver by argon beam cutting and/or coagulation can save suture ligation of the diaphragmatic secondary wound surface and may also prevent postoperative pleural effusion. Pleural drainage using an indwelling central-venous-catheter (CVC) in the pleural cavity is safe and efficacious.

Correct diagnosis and successful treatment for pericardial effusion due to toothpick injury: A case report and literature review

We reported a 55-year-old man who suffered from chest pain and dyspnea on exertion for two weeks associated with night sweating, general malaise, poor appetite, and body weight loss. Physical examination revealed friction rub with distant heart sound, bilateral clear breathing sound, no abdomen tenderness, and normal bowel sound. Subsequent chest X-ray revealed cardiomegaly and cardiac echo showed massive pericardial and pleural effusion with normal left ventricular function. Constrictive pericarditis was diagnosed based on clinical information. Tuberculosis (TB), malignancy, autoimmune disease, infection, hypothyroidism, and idiopathic could be the causes but excluded by further study. High-resolution lung CT scan after reconstruction revealed a moderate amount pericardial effusion with possible superimposed infection. Thickness of pericardium and left lobe liver abscess were found. A straight tubular structure about 6 cm in length transverses the lateral segment of liver to pericardial space and unknown foreign body was suspected. Laparotomy was performed, 6.5 cm toothpick was found through the liver into pericardium. Post-operative course was uneventful and he discharged one week later. The patient could not remember swallowing the toothpick before. He had no chest pain and dyspnea on exertion during a 6-mo follow-up period.