French Drain Research Articles

Performance of surface, subsurface and trench‐type drainage systems in paddy fields for non‐rice farming

AbstractEffective drainage is a crucial factor in paddy fields, especially in regions with waterlogging or heavy clay soils. Identifying an effective drainage system is essential for the successful removal of excess soil water from paddy fields to prepare them for subsequent crops. This study aimed to evaluate three different drainage systems, shallow surface drainage (shallow ditch), conventional subsurface pipe drainage and trench‐type subsurface drainage (French drain), in paddy fields in terms of drainage water volume, water table depth, drainage intensity, soil moisture and cracks. Experiments were carried out in a physical model capable of simulation with a 7.5 m drain spacing. The findings indicated that trench‐type drainage was more effective in reducing soil moisture due to its higher drainage water volume compared to other systems. The time required for the topsoil to reach its lower plastic limit in the subsurface, trench‐type and shallow surface drainage systems was 14, 11 and 15 h after the depletion of excess water over the soil surface, respectively. Although shallow surface drainage represented faster depletion of excess water, trench‐type drainage eventually proved to be the most effective alternative for providing appropriate qualifications for secondary cultivation. Crack areas on the soil surface were twice as extensive in trench‐type and subsurface drainage systems as in shallow surface drainage systems, indicating their superior performance.

Soil Phosphorus in Farmed Potholes: Assessing Concentrations and Testing Export Mitigation with Steel Media

Highlights Phosphorus concentrations were higher near the bottom of farmed potholes compared to soils outside of the potholes. Benchtop flow-through experiments demonstrated that steel shavings effectively adsorbed dissolved reactive phosphorus. A blind inlet amended with steel shavings reduced phosphorus export from a surface-drained pothole. Abstract. The Prairie Pothole Region, which extends from north-central Iowa northward into Canada and westward to Montana, is typified by closed depressions that formed over 10,000 years ago during the most recent glacial retreat. Today, many of these potholes contain artificial drainage to lower the water table, allowing for agricultural production of the land. Even when drained, farmed potholes can become inundated with phosphorus (P) enriched surface waters after large rain events. The goal of this study was to characterize the spatial distribution of soil P in farmed potholes and evaluate a steel media-modified blind inlet as a tool to reduce P export from farmed potholes. Results from the soil sampling indicated that Bray-1 soil test P concentrations are nine times higher near the bottom of the pothole compared to locations outside of the farmed pothole. Steel shavings were evaluated for P sorption in a laboratory flow-through cell evaluation where they removed between 60 and 70% (discrete P), even when cumulative P loading was over 6000 mg kg-1. In a field investigation, a modified blind inlet containing a mixture of steel shavings and pea gravel replaced a Hickenbottom surface intake. The modified blind inlet retained an average of 83% of the influent dissolved reactive P and 62% of the influent total P based on five paired samples. The results from this study demonstrate that farmed potholes contain a significant amount of legacy soil P and that blind inlets containing steel shavings can replace surface intakes and reduce P export from farmed potholes. This research could inform future design and implementation of these P removal structures. Keywords: Drainage, Farmed wetland, French drain, Iron filings, Iron shavings, Iron tailings, Prairie pothole, Surface intake, Tile.

A randomized controlled trial: Comparison of 14 and 24 French thoracic drainage after minimally invasive lobectomy – MZ 14-24 study

BackgroundThe optimal placement of a chest drain after video-assisted minimally invasive lobectomy should facilitate the aspiration of air and drainage of fluid. Typically, a conventional 24Ch polyvinyl chloride chest drain is used for this purpose. However, there is currently no scientific literature available on the impact of drain diameter on postoperative outcomes following anatomical lung resection. MethodsThis is a prospective, randomized, phase-1 trial that will include 40 patients, which will be randomly assigned into two groups. Group 1 will receive a 24 French chest drain according to current standards, while group 2 will receive a 14 French drain. Primary endpoint of the trial is the incidence of postoperative drainage-related complications, such as obstruction, dislocation, pleural effusion, and reintervention. Secondary endpoints are postoperative pain, chest drainage duration, incidence of complications, and hospital length of stay. The study aims to determine the number of subjects needed to achieve a sufficient test power of 0.8 for a non-inferiority study. DiscussionThoracic surgery is becoming more and more minimally invasive. One of the remaining unresolved problems is postoperative pain, with the intercostal drain being one of the main contributing factors. Previous data from other studies suggest that the use of small-bore drains can reduce pain and speed up recovery without an increase in drain-related complications. However, no studies have been conducted on patients undergoing anatomic lung resections to date. The initial step in transitioning from larger to smaller drains is to establish the safety of this approach, which is the primary objective of this trial.Trial registration: The study has been registered in the German Clinical Trials Register.Registration number: DRKS00029982.URL: https://drks.de/search/de/trial/DRKS00029982.

Mitigating Pumping in Pavement Shoulder Using Wicking Geotextile: An Experimental Study

Pumping is one of the major factors contributing toward concrete pavement failures, one which reduces the pavement life, affects road safety, and increases maintenance costs. Existing methods such as nonwoven geotextiles used as drainage systems can drain gravitational (free) water under saturated conditions but not the capillary water under an unsaturated conditions. The objective of this study is to explore and identify the feasibility of using a new wicking geotextile for pumping mitigation in pavement shoulder via laboratory tests and field test section monitoring. Laboratory results showed that soil installed with wicking geotextile was noticeably drier than that with a French drain as a drainage system because the wicking geotextile can drain capillary water. Nearly 3 years of field monitoring verified the effectiveness of using wicking geotextile to reduce water content, especially where the pavement was prone to pumping damage. In addition, exposing the edge of the wicking geotextile to the air further noticeably increased its drainage ability.

V11-08 SINGLE-PORT ROBOTIC ANTEGRADE BILATERAL INGUINAL LYMPH NODE DISSECTION

You have accessJournal of UrologyCME1 May 2022V11-08 SINGLE-PORT ROBOTIC ANTEGRADE BILATERAL INGUINAL LYMPH NODE DISSECTION Nathan Cheng, Christopher Wright, Nizar Bou Diab, Mubashir Billah, and Mutahar Ahmed Nathan ChengNathan Cheng More articles by this author , Christopher WrightChristopher Wright More articles by this author , Nizar Bou DiabNizar Bou Diab More articles by this author , Mubashir BillahMubashir Billah More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002632.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: High risk penile cancer following penectomy is often treated with inguinal lymph node dissection. Classically, inguinal lymph node dissections were performed by opening both inguinal regions, with risk of wound complications including skin break down, flap necrosis, and lymphatic complications such as lymphedema or lymphoceles. With the popularization of the single-port robotic system, novel surgeries have taken advantage of its ability to work in tight spaces. Here, bilateral inguinal lymph node dissection is performed through a single suprapubic incision using the single-port robot. The goals are to minimize wound complications associated with open inguinal lymph node dissections while maintaining safety and oncologic outcomes. METHODS: An 82-year-old male with T3 penile squamous cell carcinoma 4 months after recovery from a total penectomy with perineal urethrostomy was offered a single-port robotic antegrade bilateral inguinal lymph node dissection. The SP port was placed midline over the suprapubic region into the Space of Retzius similar to that of an extraperitoneal SP radical prostatectomy. Bilateral external iliac vessels were isolated and the spermatic cord was followed along its lateral edge distally until the inguinal ligament was seen. The external oblique aponeurosis was split anterior to the inguinal ligament, revealing the superficial compartment, where lymph nodes packets were retrieved. The deep compartment was then accessed by dissecting through fascia lata posteriorly and skeletonizing the femoral vessels. After completion of the deep inguinal lymph node dissection, bilateral 15 French drains were placed into both surgical sites. The abdominal wall fascial incision was closed with interrupted figure-of-8 absorbable sutures. RESULTS: Operative time was 3 hours and 16 minutes, with estimated blood loss 20 mL. The patient was discharged to home on post-op day 1 with both drains, which were then removed in 2 weeks. There was a total nodal yield of 15, all of which were negative for metastatic disease. There were no 30-day complications for this patient. CONCLUSIONS: An antegrade approach through a single suprapubic incision using the single-port robot gives excellent access to bilateral inguinal spaces that would be otherwise difficult with a multi-port robot. Larger case series should be performed, but its potential advantages include lower risk of wound complications, decreased risk of lymphatic complications, and access to pelvic lymph node dissection when appropriate. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e923 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Cheng More articles by this author Christopher Wright More articles by this author Nizar Bou Diab More articles by this author Mubashir Billah More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement PDF DownloadLoading ...

Abstract 13023: Contemporary Echocardiography-Guided Pericardiocentesis Outcomes in a High-Volume Tertiary Teaching Hospital

Introduction: First performed in the 1970s, echo-guided pericardiocentesis has become the preferred approach for draining pericardial effusions. After identifying the largest pocket, a cardiology attending and fellow use a micropuncture needle kit, confirm placement with agitated saline, and leave a side and end hole 8 French drain stocked with sterile saline. This is drained every 8 hours by nursing and never left to gravity or else it tends to clot. The drain is removed when output is <25 cc in 24 hours, or by 7 days. Methods: We prospectively maintained an IRB approved database of pericardiocenteses performed by three experienced cardiology attendings directly supervising a multitude of fellows between 2009-2021 at Thomas Jefferson University Hospital. Results: Of 391 pericardiocenteses, 61% were for tamponade. 66% were done from an apical approach, 18% subcostal, 11% left parasternal, and 2% right parasternal. Drains were left in for an average of 3.1 days (range 1-10 days). An average of 578 mL were drained with the initial procedure (range 5-2670 mL), and 62% of effusions were bloody. A total of 42% were deemed idiopathic, without an identifiable cause, 27% were associated with malignancy (56% of these had positive cytology with remaining unlikely from any other cause), 9% after open heart surgery (valve replacement, heart transplant, dissection repair), 8% post-procedural (electrophysiology, cardiac catheterization, line placement), 5% were in chronic dialysis patients, and the remainder were due to a combination of hemorrhage not related to a procedure, rheumatic, post-radiation, or medication-induced. The rate of serious complications was 3% and included 4 pneumothoraces, 3 hemothoraces, 3 cases of pericardial decompression syndrome, 1 RV microperforation, and one PEA arrest resulting from cardiac perforation. There were no mortalities. The rate of non-serious complications was 4% and included pleural placement of drain in 8, severe pain remitting with drain removal in 5, prolonged bleeding from puncture site in 2, and SVT during placement in 1. Conclusion: Overall, echocardiography-guided pericardiocentesis by experienced providers supervising fellows-in-training is a safe and effective means of draining pericardial effusions.

Severe re-expansion pulmonary edema despite incomplete re-expansion of the lung: a case report

BackgroundRe-expansion pulmonary edema is a rare but potentially fatal (mortality up to 20%) complication of the rapid removal of air, fluid, or other space-occupying lesion from the pleural cavity. This case report highlights the fact that this complication is much more likely to occur when treating large, chronic pneumothoraces, and can occur even if the lung fails to fully re-expand.Case presentationA 49-year-old white British man presented to the emergency department with sudden onset of shortness of breath 5 days prior to admission. A left-sided pneumothorax was suspected on clinical examination, and chest X-ray confirmed a large, left-sided pneumothorax. A 12 French gauge chest drain was inserted and connected to an underwater seal. Shortly after insertion of the drain, the patient’s condition deteriorated rapidly with tachypnea and severe hypoxemia. A diagnosis of re-expansion pulmonary edema was made, and the patient was treated with high-flow oxygen and continuous positive airways pressure.ConclusionsThis case report serves as a reminder of the morbidity and potential mortality associated with a commonly performed medical procedure, and reveals a lack of clear and precise guidance on the management of large, chronic (> 72 hours) pneumothoraces in the current British Thoracic Society pleural disease guidelines.

Enhanced Drainage Protocol in Large Amoebic Liver Abscess.

Background Amebic liver abscess (ALA) contributes significantly to morbidity and mortality in patients of the developing world. Even though medical management is the primary modality of treatment, 15% of the cases are refractory and require intervention for drainage. Pigtail catheterization is inefficient and results in a long duration of hospital stay. So, we conducted a prospective observational study to determine the efficacy and safety of drainage of large ALA using a wide bore 24 French (Fr) drain compared with a conventionally used 10 Fr pigtail catheter. Materials and Methods A single center prospective observational study was conducted over a period of 5 years and data of 122 patients was collected. After starting empirical medical therapy, patients underwent drainage of ALA with either a 10 French pigtail or a 24 Fr drain. The primary outcome variables were resolution of clinical symptoms such as fever and pain in abdomen, length of hospital stay, and resolution of abscess on imaging at day 3. Secondary outcome was complications related to the procedures. Results Data of 122 patients was collected. Males constituted a vast majority (96%) of the study population and the fifth decade was the most common age group involved. Alcoholics had a higher chance of developing a large ALA. Sixty-eight patients underwent drainage of the ALA using a 24 Fr drain which resulted in faster resolution of symptoms (2.4 vs. 5.1 days, p -value 0.033), a shorter duration of catheter in situ (6.4 vs. 13.2, p -value 0.011), and a faster drainage of ALA (residual volume at day 3; 177 vs. 212 mL, p -value 0.021). Twenty-eight patients had a biliary communication of which 26 required therapeutic endoscopic retrograde cholangiopancreatography. Conclusion In patients with a large ALA, placement of a wide bore 24 Fr catheter hastens recovery of the patients when compared with drainage with a standard 10 Fr pigtail catheter. Placement of a biliary stent serves as a useful adjunct for their management and it may obliviate the need for a major biliary diversion surgery.

Notes About Crushing Sand from Bituminous Schist

Abstract People have used sand and stone for foundations for thousands of years. Significant refinement of the production and use of aggregate occurred during the Roman Empire, which used aggregate to build its vast network of roads and aqueducts. The invention of concrete, which was essential to architecture utilizing arches, created an immediate, permanent demand for construction aggregates. Construction aggregate, or simply “aggregate”, is a broad category of coarse to medium grained particulate material used in construction, including sand, gravel, crushed stone, slag, recycled concrete and geosynthetic aggregates. Aggregates are the most mined materials in the world. Aggregates are a component of composite materials such as concrete and asphalt concrete; the aggregate serves as reinforcement to add strength to the overall composite material. Due to the relatively high hydraulic conductivity value as compared to most soils, aggregates are widely used in drainage applications such as foundation and French drains, septic drain fields, retaining wall drains, and roadside edge drains. Aggregates are also used as base material under foundations, roads, and railroads. In other words, aggregates are used as a stable foundation or road/rail base with predictable, uniform properties (e.g. to help prevent differential settling under the road or building), or as a low-cost extender that binds with more expensive cement or asphalt to form concrete. Preferred bituminous aggregate sizes for road construction are given in EN 13043 as d/D (where the range shows the smallest and largest square mesh grating that the particles can pass). The same classification sizing is used for larger armour stone sizes in EN 13383, EN 12620 for concrete aggregate, EN 13242 for base layers of road construction and EN 13450 for railway ballast. Aggregates themselves can be recycled as aggregates. Unlike deposits of sand and gravel or stone suitable for crushing into aggregate, which can be anywhere and may require overburden removal and/or blasting, “deposits” of recyclable aggregate tend to be concentrated near urban areas, and production from them cannot be raised or lowered to meet demand for aggregates. Supply of recycled aggregate depends on physical decay of structures and their demolition. The recycling plant can be fixed or mobile; the smaller capacity mobile plant works best for asphalt-aggregate recycling. The material being recycled is usually highly variable in quality and properties.

2164 Percutaneous Transhepatic Single-Operator Cholangioscopy With Electrohydraulic Lithotripsy in the Management of Intrahepatic Stones in a Post-Orthotopic Liver Transplant Patient With Ischemic Cholangiopathy

INTRODUCTION: Advancements in endoscopic retrograde cholangiopancreatography (ERCP) have revolutionized the management of biliary stones. However, endoscopic management of intrahepatic stones continues to be challenging. We discuss a patient with intrahepatic stones who was treated with percutaneous transhepatic cholangioscopy with electrohydraulic lithotripsy (EHL). CASE DESCRIPTION/METHODS: A 68-year-old man with alcoholic cirrhosis underwent orthotopic liver transplant from a deceased after cardiac death donor. His post-transplant course was complicated by ischemic cholangiopathy, biloma development and recurrent episodes of cholangitis. He underwent placement of an external biliary drain for management of his biloma. An MRCP demonstrated persistent biloma as well as mural irregularities within the intrahepatic ducts concerning for intrahepatic stones. Due to recurrent cholangitis, a combined IR (interventional radiology)-biliary endoscopic procedure was undertaken. IR performed a percutaneous cholangiogram (PTC) which demonstrated multiple filling defects in the left hepatic ducts consistent with stones. A 5 French Fogarty balloon was advanced and inflated with multiple sweeps in an attempt to extract the filling defects into the common bile duct. Antegrade cholangioscopy was then performed with single-operator cholangioscope (SpyGlass 2™) passed through a 14 French PTC sheath. Using the cholangioscope we were able to visualize impacted stones within the left intrahepatic system and treat them utilizing EHL with a catheter setting of 40-50 Watts for stone fragmentation and suction. The single-operator cholangioscope was then directed at the common bile duct and two large retained stones were treated with EHL. Subsequently, a traditional ERCP was performed which noted filling defects within the common bile duct. Balloon sphincteroplasty was performed and using an 8.5-11.5 mm balloon catheter, CBD exploration and balloon sweeps were performed with extraction of 2 large stones and sludge. Occlusion cholangiogram at the completion of the procedure revealed no further stones and patent anastomosis. To allow adequate biliary drainage, a retrievable 10 mm × 60 mm SEMS covered metal biliary stent and a new 14 French external biliary drain was placed. The biliary stent was removed 3 months later with ERCP demonstrating no recurrent stones. DISCUSSION: Complex intrahepatic lithiasis may be successfully managed with a multi-disciplinary collaborative approach between Interventional Radiology and biliary endoscopists.

Simulation of the hydraulic performance of highway filter drains through laboratory models and stormwater management tools

Road drainage is one of the most relevant assets in transport infrastructure due to its inherent influence on traffic management and road safety. Highway filter drains (HFDs), also known as "French Drains", are the main drainage system currently in use in the UK, throughout 7000km of its strategic road network. Despite being a widespread technique across the whole country, little research has been completed on their design considerations and their subsequent impact on their hydraulic performance, representing a gap in the field. Laboratory experiments have been proven to be a reliable indicator for the simulation of the hydraulic performance of stormwater best management practices (BMPs). In addition to this, stormwater management tools (SMT) have been preferentially chosen as a design tool for BMPs by practitioners from all over the world. In this context, this research aims to investigate the hydraulic performance of HFDs by comparing the results from laboratory simulation and two widely used SMT such as the US EPA's stormwater management model (SWMM) and MicroDrainage®. Statistical analyses were applied to a series of rainfall scenarios simulated, showing a high level of accuracy between the results obtained in laboratory and using SMT as indicated by the high and low values of the Nash-Sutcliffe and R 2 coefficients and root-mean-square error (RMSE) reached, which validated the usefulness of SMT to determine the hydraulic performance of HFDs.

Investigation of Air Bulging Beneath Geomembranes Used as a Liner for the Datun Reservoir

Extensive and thick permeable strata are found beneath many reservoir sites. The leakage problem in these reservoirs can be effectively solved by constructing a full geomembrane liner design. However, applying this particular solution for the reservoir induces novel engineering problems. The air bulging produced beneath the geomembrane results in geomembrane rupture and causes a renewed leakage in reservoirs. The groundwater level may be relatively low during construction because of seasonal variation and dewatering. Geomembranes isolate pore air from the atmosphere, and a significant amount of air is trapped in the pores of the unsaturated soil above the groundwater level. The rise in the groundwater level or the compression of soil decreases pore-air volume and increases pore pressure, thereby causing air bulging to occur and prompting the ultimate destruction of the geomembrane. The presence of air bulging beneath the geomembrane is studied in the design process of the Datun Reservoir in Dezhou City, Shandong Province, China. Investigation results reveal that a rise in the groundwater level significantly influences the air bulging beneath the geomembrane. The French drain is set to prevent air bulging beneath the geomembrane from occurring. The 75-m French drain spacing is not reasonable because the air pressure beneath the geomembrane will result in air bulging. A comparison among French drains with spacings of 25 m and 50 m indicates that the original design comprising French drains spaced 50 m apart is reasonable and economical.

Archeological Test Excavations in Areas to be Affected by a Proposed French Drain West of the Granary, Mission San Jose State Site (41BX3), Bexar County, Texas

Limited archeological test excavations were conducted along the west wall of the granary at Mission San Jose State Historic Site (41BX3) in Bexar County, Texas, during July and August, 1979. The investigations were designed to provide information regarding the presence or absence of significant archeological materials in areas to be affected by the construction of a proposed French drain intended to relieve moisture-related structural problems along the west wall of the granary. six 0.5 by 1 meter test pits were excavated; 1,303 artifacts and 1,809 bone and shell fragments were recovered. Seven features were documented; these included a wall and a flagstone floor remnant, 4 pits and a lime filled trench. The wall and floor may represent the remains of a Spanish Colonial blacksmith shop while the pits probably originated during the late 19th Century. The artifacts are primarily trash resulting from nearly 240 years of activity at the mission complex although some items may be relatable to the smithy. Two alternatives for the proposed construction are suggested: 1) abandon plans for a French drain and develop an alternate non-disruptive method for relying moisture problems; or, 2) continue plans for constructing a French drain but precede the modifications with an intensive program of archeological excavations in a broad area along the west wall of the granary.

EUS-guided transmural gallbladder drainage: a new era has begun.

The first line management of acute cholecystitis remains surgery for patients who are good operative candidates. In high-risk operative candidates, a conservative approach of intravenous fluids and antibiotics is recommended. In those who fail conservative management, nonsurgical decompression of the gallbladder is urgently needed to prevent sepsis, perforation and death. Percutaneous gallbladder drainage (PTGBD) has been described since the 1970s [Elyaderani and Gabriele, 1979]. This can be performed with gallbladder puncture under transabdominal ultrasound or computed tomography (CT) guidance followed by placement of an indwelling 6-10 French pigtail catheter drain [Akhan et al. 2002]. This technique has been well studied with prospective data and randomized trials showing success rates upwards of 95% [Ito et al. 2004; Hatzidakis et al. 2002; Sugiyama et al. 1998]. However, PTGBD has significant complications including bleeding, bile leak, bile peritonitis, pneumothorax, bowel perforation, secondary infections and catheter dislodgement [Akhan et al. 2002]. In addition, it cannot be performed in patients with ascites or those on anticoagulants. The need for leaving an exterior drainage tube can be burdensome and uncomfortable, requiring multiple sessions [Kedia et al. 2015] and tube dislodgement occurs in 0.3–12% of patients [Ito et al. 2004, Hatzidakis et al. 2002, Kiviniemi et al. 1998]. Interestingly percutaneous drainage of the gallbladder has been increasingly used in an attempt to ‘cool off’ the gallbladder and facilitates a future resection.

Evaluation of the Use of Recycled Concrete Aggregate in French Drain Systems

Abstract Recycled concrete aggregate (RCA) is often used as a replacement for virgin aggregate in road foundations (base course), embankments, hot-mix asphalt, and Portland cement concrete. However, the use of RCA in exfiltration drainage systems, such as French drains, is still uncommon. The primary concerns with using RCA as drainage media are excessive fines and calcite precipitation that can cause a reduction in permeability performance. This study investigates the potential benefits of RCA as drainage material. This paper presents and discusses: (1) the results of a nationwide survey on current practices and policies, (2) physical and chemical properties, (3) effective fine-removing methods, (4) re-cementation potential, (4) permeability (under varied fine content), and (5) long-term drainage performance of RCA as drainage material. Test results indicate that RCA No. 4 gradation does not restrict the flow of water, but the RCA fines being generated during aggregate handling process (e.g., stockpiling, placing and transporting) may cause clogging buildup over time.

Blood in a chest drain

A 21-year-old male with Ehlers-Danlos type IV (EDS IV) presented to the emergency department with sudden onset right-sided pleuritic chest pain. On examination, some of the typical features of EDS IV including large eyes and small chin were noted, although other features such as sunken cheeks, thin nose and lips, and lobeless ears were not noted [1]. His respiratory rate was 20 breaths·min−1, saturations were 93% on air increasing to 98% on 28% oxygen via a venturi mask. Pulse was 115 beats·min−1 in sinus rhythm and his blood pressure was 112 over 64 mmHg. There was decreased air entry in the right hemithorax, with decreased vocal resonance. The trachea was central and there was no surgical emphysema. ### Task 1 1. What is the best description of the chest radiograph (fig. 1)? Figure 1 Chest radiograph on admission. 1. A right-sided tension hydro-pneumothorax 2. A right-sided hydro-pneumothorax 3. A right-sided cavitatory pneumonia 4. A right-sided pneumo-peritoneum 2. What would the next therapeutic step be? 1. Simple observation and high flow oxygen 2. Aspiration of pneumothorax 3. Insertion of a small 12-French bore Seldinger chest drain 4. Insertion of a large-bore chest drain ### Answer 1 The chest radiograph shows a right-sided hydro-pneumothorax and the next therapeutic step would be insertion of a small 12-French bore Seldinger chest drain. Local anaesthetic was instilled into the second intercostal space and it was possible to aspirate air via the green needle. A 12 French intercostal drain was inserted using the Seldinger technique with no immediate complications and connected to an underwater seal bottle which …

Complications in Caroli Disease

Purpose: Caroli disease is a rare inherited disorder characterized by nonobstructive, multifocal areas of saccular dilatation of intrahepatic biliary ducts. It is thought to be a genetically acquired disease, and is linked often to autosomal recessive polycystic kidney disease. It is diagnosed through imaging, and magnetic resonance cholangiopancreatography (MRCP) is emerging as the diagnostic modality of choice. A 62-year-old female with previously diagnosed Caroli disease and polycystic kidney disease presented as a hospital transfer for further evaluation of a complex liver cyst. Prior to admission, she had a complicated course with intermittent severe abdominal pain that was occurring over the past 3 weeks. Initially, when she sought treatment, she was provided an oral narcotic and sent home. The subsequent week, she developed fevers and returned to the outside hospital, was admitted, treated with unknown antibiotics for presumed colitis, and discharged after improvement. A week thereafter, she developed dyspnea on exertion, ascites, and edema of her lower extremities, causing her return to the hospital. During her second outside hospital admission, she was noted to be jaundiced and spiking intermittent fevers. Magnetic resonance imaging (MRI) was performed, which demonstrated a complex liver cyst abutting the upper pole of the right kidney, which appeared infected. Upon arrival to our facility, blood cultures were obtained, intravenous fluids were initiated, and piperacillin-tazobactam was continued. MRI showed a 6.7-cm hepatic cyst in segment VI of the liver with a fluid level, thickened walls, and edema in surrounding hepatic parenchyma. US-guided drainage of 60 mL of purulent material and fluoroscopic-guided 10 french drain was placed via the transhepatic approach. Cyst fluid revealed aerobic culture, showing no growth and anaerobic culture showing Bacteroides fragilis. The patient's abdominal pain improved, she remained afebrile, and blood cultures were negative. She was subsequently discharged with 6 weeks of levofloxacin and metronidazole, with follow-up appointments for her hepatic drain to be evaluated and with infectious disease. Morbidity and mortality from Caroli disease usually comes from complications including cholangitis, hepatolithiasis, biliary abscesses, sepsis, cirrhosis, portal hypertension, cholangiocarcinoma, and renal failure. Prognosis is determined largely by the frequency and severity of cholangitis, which can cause sepsis or death. This case illustrates the potential for complications in Caroli disease and the importance of definitive identification of any source of abdominal pain in these patients. Delay in diagnosis and treatment can lead to significant morbidity and mortality.

ISOTOPIC DATA: IMPLICATIONS FOR THE SOURCE(S) OF OSIREION GROUNDWATER, ABYDOS, EGYPT

Among the many wars which depicted and documented at the ancient Egyptian history, little of themThe Osireion, formerly concealed within a West Bank Nile terrace, is thought to have been animportant building to the Ancient Egyptians. Its huge building blocks define a rectangular centralstone island surrounded by a water-filled channel nearly 13m below the surrounding land surface.The channel was cleared of debris to 4.3m in 1925, but not to its original depth. Westerman (2008)successfully probed to 10.4m using a metal rod. Seismic data suggest its walls may extend 15mbelow the water table. Westerman listed six questions that elude archeologists and Egyptologists.Why, when and how was the Osireion built? Is in the interior of the island hollow? Why was it built inwater? What is the source of the water? Eleven water samples were collected including the Nile,Osireion, two nearby idle dewatering wells, an active eastern French drain and six active watersupply wells. a18O and aD were measured by EAEA and PO4, Cl, Na+K and TDS by SohagUniversity. Factors such as evaporation, mixing, relative humidity, surface elevation and rechargeclimate can influence isotopic contents. The Nile sample appears most affected by evaporation,consistent with Lake Nasser’s great size and arid climate. Water samples fall below the GMWL andpaleowater line in a region expected of modern precipitation in arid, low latitude climates. Sinaigroundwater by contrast are isotopically lighter, suggestive of recharge at higher elevation duringcooler climates. a18O, aD, PO4, Cl, Na+K and TDS concentrations suggest Osireion waters are noteasily explained by simple evaporation of any supposed end member. a18O and aD concentrationsare strikingly different from two nearby down groundwater gradient, dewatering wells most likely froma mixed source not typical of the ten other samples. Upfllowing from a semi-confined artesianaquifer, possibly also diffuse regional leakage through the Esna Shale are suggested.

Highway filter drain waste arisings: a challenge for urban source control management?

Essential maintenance activities on highway BMP drainage controls involve refurbishment of filter (French) drains which can generate substantial amounts of "controlled waste". An innovative procedure for their re-instatement is described which offers a more sustainable option for filter drain/trench management. The quality classification of these waste arisings is problematical and it is difficult to reliably identify the risks posed by such materials and the most effective forms of management and disposal options.

Contaminated Alluvial Ground Water in the Butte Summit Valley

Ground water in alluvial sediments of upper Silver Bow Creek is chronically contaminated with heavy metals, including Cd, Cu, Fe, Mn, and Zn. Most of this contamination stems from slag, mill tailings, and waste rock from the Butte mining district that had been deposited along the ancestral Silver Bow Creek floodplain. Much of this mine waste is now buried by fill, topsoil, buildings, or parking lots. Although the pH values of most wells in the region are in the 5.5 to 7.0 range, a cluster of monitoring wells near the site of a former mill and smelter contain water that is strongly acidic (pH < 4.5), with extremely high dissolved metal concentrations (Cu up to 750 mg/L; Zn up to 490 mg/L). Ground water discharging from the area is currently collected by a subsurface French drain and conveyed to a treatment facility where lime is added to precipitate metals from solution.