Transient pressures of multiple entrapped air pockets in a tunnel with double-side inflows: a numerical investigation

Diffuse large B-cell lymphoma can present as either primary lymph nodal disease or with involvement of extra-nodal sites. In gastrointestinal involvement, the clinical presentation is often insidious, such as abdominal pain, nausea, vomiting, anemia, weight loss, fever, and occasionally small bowel obstruction or a palpable mass. Small-bowel perforation as the first manifestation of non-Hodgkin’s lymphoma is extremely rare. The case of a 73-year-old woman is reported who presented to the emergency department complaining of a generalized abdominal pain and vomiting. Contrast enhanced computer tomogram (CECT) of the abdomen showed multiple air pockets in left side of abdomen, right hemidiaphragm, edematous small bowel loops with fat stranding with multiple tiny air pockets. Laparotomy was performed that revealed a focally perforated segment of the jejunum. Histological evaluation reported diffuse large B-cell non-Hodgkin’s lymphoma. This case illustrates a rare complication of large B-cell non-Hodgkin’s lymphoma of the jejunum that was responsible for small-bowel perforation and peritonitis. This clinical pattern may appear as a leading presentation of small intestinal neoplastic disease in which surgical resection may have to be considered.

In deep stormwater tunnel systems (DSTSs), entrapped air pockets are prone to pressurization and deformation during rapid filling, resulting in pressure surges that threaten system security. This study investigates the effects of structural and inflow parameters on peak pressures. To simulate the pressure surges of entrapped air pockets, a rigid-column model was developed for a simplified DSTS configuration comprising two shafts and one tunnel. The global sensitivities of the air pocket, system structure, and inflow parameters were calculated using the Extended Fourier Amplitude Sensitivity Test (EFAST), which employed indicators of the maximum pressure and relative increment. The results indicate that parameters related to the shape and initial state of the air pocket exert a substantial and direct effect on pressure surges in rapid filling, whereas tunnel system parameters tend to exhibit minimal influence. Notably, compared to the total inflow discharge, the flow difference between two shafts imposes a more significant and direct impact. For the maximum pressure of air pocket, the initial pressure and the maximum water level height of shafts demonstrate more pronounced effects. The proposed sensitivity analysis could be integrated into methodologies for system safety assessment, while the rigid-column model may be extended to accommodate multiple shafts and air pockets.

Dosimetric Effects of Air Pockets Around High–Dose Rate Brachytherapy Vaginal Cylinders

The behaviour of elongated air pockets in downward sloping pipes is investigated. The observed flow regimes in co-current air–water flow in downward sloping pipes are described. The effects of pipe diameter and surface tension on the air pocket motion are quantified and two criteria for the observed flow regime transitions are derived. One criterion stems from energy considerations and marks the transition from the presence of one elongated air pocket to multiple air pockets. The second criterion predicts the required water velocity to start the motion of elongated air pockets in the downward direction. Both criteria were validated with experimental data for a range of downward sloping pipe angles, lengths and diameters.

Usefulness of free intraperitoneal air detected by CT scan in diagnosing bowel perforation in blunt trauma: Experience from a community-based hospital

Assessment of the distribution and volume of air chambers around the inner auditory canal on high-resolution computed tomography scans of the temporal bone.

Purpose: Loco-regional hyperthermia combined with mitomycin C is used for treatment of nonmuscle invasive bladder cancer (NMIBC). Air pockets may be present in the bladder during treatment. The aim of this study is to quantify the effect of air pockets on the thermal dose of the bladder.Methods: We analysed 16 patients treated for NMIBC. Loco-regional hyperthermia was performed with the in-house developed 70 MHz AMC-4 hyperthermia device. We simulated treatments with the clinically applied device settings using Plan2Heat (developed in-house) including the air pockets delineated on CT scans made following treatment, and with the same volume filled with urine. Temperature distributions simulated with and without air pockets were compared.Results: The average air and fluid volumes in the bladder were 6.0 ml (range 0.8 − 19.3 ml) and 183 ml (range 47–322 ml), respectively. The effect of these air pockets varied strongly between patients. Averaged over all patients, the median bladder wall temperature (T50) remained unchanged when an air pocket was present. Temperature changes exceeded ±0.2 °C in, on average, 23% of the bladder wall volume (range 1.3–59%), in 6.0% (range 0.6–20%) changes exceeded ±0.5 °C and in 3.2% (range 0.0–7.4%) changes exceeded ±1.0 °C. There was no correlation between the differences in temperature and the air pocket or bladder volume. There was a positive correlation between air pocket surface and temperature heterogeneity.Conclusion: Presence of air causes more heterogeneous bladder wall temperatures and lower T90, particularly for larger air pockets. The size of air pockets must therefore be minimized during bladder hyperthermia treatments.

To highlight the unusual postoperative clinical presentation of a retained sponge. Recognition of postoperatively retained foreign bodies is essential but often delayed, either because of medicolegal implications or because of a confusing clinical presentation and non-specific imaging features. In contrast to radio-opaque materials which are detected at follow-up imaging, radiolucent objects like sponges create problems in identification. A 30-year-old lady presented with intermittent non-bilious vomiting, epigastric pain and fever. Contrast-enhanced computed tomography of the abdomen showed a heterogeneous mass in the duodenum with multiple air pockets. Surgical exploration revealed a full-size surgical sponge with one end embedded in the gallbladder fossa and the other perforating the antrum of the stomach, thus causing an obstruction. The sponge was retrieved, and distal gastrectomy with Billroth II anastomosis was performed. The postoperative course was uneventful. A high degree of suspicion and awareness of non-specific symptomatology associated with retained sponges after surgery is essential for early diagnosis and correct treatment.

Background and AimsAim – Discuss a case report of pneumocephalus which is a rare complication after combined spinal epidural anaesthesia (CSE). Background – A 21 years old female P2L2 presented...

BackgroundPyruvate dehydrogenase complex (PDHC) deficiency is a rare mitochondrial disorder caused by a genetic mutation affecting the activity of the PDHC enzyme, which plays a major role in the tricarboxylic cycle. Few cases of surgery or anesthesia have been reported. Moreover, there is no recommended anesthetic method.CaseA 24-month-old child with a PDHC deficiency presented to the emergency room with respiratory failure, mental decline, systemic cyanosis, and lactic acidosis. During hospitalization period, the patient presented with pneumothorax, pneumoperitoneum, and multiple air pockets in the heart. Two surgeries were performed under general anesthesia using an inhalational anesthetic agent. The patient was discharged with home ventilation.ConclusionsAnesthesiologists should be wary of multiple factors when administering anesthesia to patients with PDHC deficiency, including airway abnormalities, acid-base imbalance, intraoperative fluid management, selection of appropriate anesthetics, and monitoring of lactic acid levels.

Traumatic abdominal wall hernia after impact from handlebar: A case report

Hemoptysis Due to LV Pseudoaneurysm

A 60-year-old female presented with pneumonitis of right lower zone. CT scan revealed mass like lesion with multiple air pockets. FNAC and ultrasound confirmed the diagnosis as isolated active pulmonary hydatid cyst, which is not common finding in adult population.

Thyroid abscesses are the most rare conditions of the thyroid gland but it could be potentially life threatening. Most patients are immunocompromised or has an underlying chronic thyroid disorder. We report a case of a 58year-old lady with underlying uncontrolled diabetes mellitus and a long standing uninvestigated goiter who presented with lethargy, a new anterior neck swelling with dysphagia and change of voice. Ultrasound and computed tomography were performed and showed collection with multiple air pockets in the right thyroid lobule extending to the anterior mediastinum. She was started on intravenous antibiotics and underwent serial bedside aspiration. Her symptoms improved and complete resolution was achieved after serial aspirations and antibiotics.

Pyometra, characterized by the accumulation of purulent material in the uterine cavity, can result in spontaneous uterine perforation, which is a rare but life-threatening complication. This report presents a unique case of uterine perforation as a result of pyometra in a postmenopausal woman. A 52-year-old postmenopausal woman presented to the emergency department with severe abdominal pain, fever, nausea, and vomiting. Clinical suspicion was initially directed toward acute appendicitis. However, imaging revealed pneumoperitoneum with multiple air pockets, suggesting intestinal perforation. Exploratory laparotomy uncovered no bowel perforation but revealed a 2x2 cm uterine fundal perforation with pus drainage. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology confirmed acute necrotizing inflammation extending into the myometrium, with no malignancy detected. Therefore, early diagnosis and surgical intervention, including hysterectomy, are critical for reducing the high morbidity and mortality associated with this condition. Hence, this case underscores the importance of considering uterine perforation as a differential diagnosis in elderly postmenopausal women presenting with acute abdomen for which prompt surgical management is essential to ensure a favorable outcome.