Multistage Treatment Research Articles

Explantation, Followed by Serial Debridement Without Antibiotic Spacers and Subsequent Revision With Cementless Components, Is Associated With High Remission Rates and Low Mortality in Periprosthetic Hip Joint Infections

BackgroundIn difficult-to-treat cases, it is necessary to add debridement steps in prosthesis-free interval of 2-stage exchange. We aimed to analyze the functional and clinical outcome of patients treated with a multistage exchange of total hip arthroplasty without the use of spacers, rather only cementless implants. MethodsBetween 2009 and 2018, 84 patients (mean age: 67.3 [39-90] years) suffering chronic late-onset periprosthetic joint infection (PJI) were treated using a multistage prosthesis exchange without spacers. The mean follow-up was 70 ± 45.3 [14-210] months. The treatment included prosthesis exchange and at least 1 additional revision step before a reimplantation, owing to ongoing acute infection in the prosthesis-free interval. High-efficiency antimicrobial therapy was administered in between, which was discontinued after cementless revision implantation. ResultsThe mean number of revisions between explantation and implantation was 2.6 (1-9). The most common microorganism was Staphylococcus epidermidis (53.6%) followed by Staphylococcus aureus (16.7%) and Cutibacterium acnes (11.9%). The bacterial load was more than one bacterium per patient in 38% of cases. All patients could be treated using a cementless implant. PJI remission was achieved in 92% of cases. Overall, 9 prostheses (11%) were replaced because of an ongoing PJI or fracture. The mean modified Harrison Hip Score was 63.4 (22-88) points. No patient died. ConclusionMultistage total hip arthroplasty exchange showed high remission rates and low mortality in difficult-to-treat cases. Spacer-free and multistage treatment had no negative effect on the success rate or functional outcome, consistent with the results of published 2-stage exchange studies. Implantation of an uncemented press-fit prosthesis was possible in all patients with no elevated periprosthetic fracture rate.

Advancing Production Flow Profiling With Subatomic Fingerprints and Big Data Analytics

This article, written by JPT Technology Editor Judy Feder, contains highlights of paper SPE 196172, “Unleashing the Power of Smart Particles for Completion Diagnostics: Advancing the Production-Flow-Profiling Technology With Subatomic Fingerprints and Big-Data Analytics,” by Talgat Shokanov, SPE, and Pavel Khudorozhkov, QuantumPro, and Adilkhan K. Shokanov, Abai University, prepared for the 2019 SPE Annual Technical Conference and Exhibition, Calgary, 30 September-2 October. The paper has not been peer reviewed. This paper describes a smart-tracer-portfolio testing and design solution for multistage hydraulic fracturing which will, write the authors, enable operators to reduce operating cost significantly and optimize production in shale wells. The technology combines recently developed smart tracers with advanced subatomic measurements in an automated process with stringent quality control that assures precise tracer addition onsite and provides accurate and actionable completion diagnostics results at a fraction of the cost of production-logging testing, distributed temperature testing, or distributed acoustic sensing. Introduction Multistage hydraulic fracturing operations costs - including high-pressure pumping, proppant, and fluid - ranged from $2.9 million to $5.6 million per well in a typical US shale well in 2018, representing close to 60% of the total drilling and completion cost for each well. Yet industry studies reported that up to 50% of the clusters and stages and up to 40% of the fracture net-works do not produce in the current geometric factory-mode-completion approach, leading to estimates that up to 40% of the drilled and completed shale wells in North America alone could be uneconomical. Additionally, interactions between fractures in adjacent horizontal wells, and the costly negative effects of these interactions, have become the focus of much discussion and debate within the technical community. The impetus for this attention has been the effect of these interactions on productivity and the mechanical integrity of the parent wells. These issues drive the need for oil and gas operators to have more-accurate, affordable, and timely data on the performance of individual fracturing stages, measured intrawell communication, and temporary and long-term frac/frac connections to enable improved decision-making and optimization of multistage hydraulic fracturing operations as well as overall field development. The complete paper describes smart tracer technology, including a patented portfolio and fracturing-/completion-optimization work flow; laboratory testing and performance analysis; and integration with completion diagnostics. Smart Tracer Technology To control the effectiveness of multistage hydraulic fracturing stimulation treatments, it is essential to use special tracing methods based on the addition of the labeled substance to the proppant, water, or gas, and monitor the release of tracers with flowback water and produced oil and gas from the current well or nearby observation wells. Currently, conventional water- and oil-soluble chemical substances with fluorescent properties and ionic, organic materials, or radioactive isotopes, are used as the tracers. Tracers with fluorescent properties and ionic and organic materials are high-cost, limited to chemical-measurement techniques at a molecular level, and often have reported false-positive results for long-term communication. Environmental regulations in many countries prohibit the use of radioactive tracers (i.e., radioactive isotopes) because they pollute the environment and could contaminate subsurface layers.

Successful multi-stage treatment of stoma limb perforation following Hartmann\u2019s operation report a case

BackgroundStoma-related complications are not rare, whereas the spontaneous perforation of the stoma limb is relatively rare. Herein, we report a case of stoma limb perforation which occurred after Hartmann’s operation.Case presentationA 50-year-old Japanese man presented to our Hospital with acute and severe abdominal pain. Abdominal computed tomography (CT) scan revealed that an abscess with free air was formed around the sigmoid colon. We performed Hartmann’s operation, whereas he experienced redness, purulent discharge, and swelling around the colostomy at 10 days postoperatively. The contrast-enhanced CT scan of the abdomen revealed an abscess formation with air around the colostomy. He was diagnosed with an abdominal wall abscess due to perforation of the stoma limb.After the drainage, his symptoms were ameliorated by oral analgesics, anti-inflammatory drugs, and prophylactic antibiotic. Four months after the first operation, we performed a closedown of the sigmoid colostomy and fistula resection. The patient’s postoperative course was uneventful, and he was discharged 14 days later.ConclusionsThis case depicts rare complications of Hartmann’s operation. Operation is usually performed in patients with stoma limb perforation. However, if they are stable and the abscess is located in their abdominal wall, they may be treated successfully using a multi-stage approach of local drainage toward the stoma wall followed by stoma closure.

TEM analysis of surface layer of Ti-6Al-4V ELI alloy after slide burnishing and low-temperature gas nitriding

Gas nitriding is one of the more effective ways of improving wear and corrosion resistance of titanium alloys, but this treatment performed at a high temperature degrades their high specific strengths. Therefore, we have subjected a Ti-6Al-4V alloy to a hybrid multi-stage treatment including turning with slide burnishing followed by gas nitriding at temperature reduced down to 540 °C. The mechanical treatment introduces a large number of defects in the form of dislocations and grain boundaries—opening additional paths for nitrogen diffusion. High resolution electron microscopy shows that after such mechanical treatment the surface is covered with an amorphous tribo-film. Below the surface, to a depth of some 100 nm, a layer of elongated dislocation cells is seen. The latter was backed by a 500 nm thick layer of strongly defected laths. Gas nitriding at 540 °C caused at first a crystallization of the tribo-layer (after 8 h), producing a mixture of nitrides and oxides. Next, below a tribo-layer, a dense layer of the δ-TiN phase is formed, with a thickness of 5 nm and 50 nm after 16 h and 24 h, respectively. Application of slide burnishing and low-temperature gas nitriding causes an increase in surface hardness by 5–10 % without compromising the strength of the core material.

A novel methodology for designing thermal processes in order to optimize stabilization of polyacrylonitrile (PAN) fibers

AbstractThe aim of this work is to describe a novel methodology for optimizing the stabilization of polyacrylonitrile (PAN) fibers, through designing of proper thermal treatment. The methodology is based on a set of design rules and the procedure for implementing them, utilizing the time‐temperature‐transition (TTT) and the maximum permittable stress (max.stress) plots. The proposed approach is implemented in order to optimize the stabilization of commercial PAN fibers, resulting in a series of multistage thermal treatments. The changes of both physical and chemical structures of PAN during the progress of the multistage treatments were investigated and showed that the fibers were progressively converted into completely stabilized material; this gradual transformation permitted improvement of fiber annealing and minimized the effect of the decomposition reactions. The proposed methodology can be universally applied for achieving the global optimum of the stabilization process for any PAN precursor.

Treatment of the Low Extremity Severe Mechanical Injury with Uncompensated Ischemia (Case Report)

Relevance. Discussion of the criteria for decision making “amputation vs. preservation”, when viability of the extremity is uncertain, has been continuing. The case description. The lower extremity of a serviceman was injured by a caterpillar tractor. The severity of the damage was determined by the following conditions: open segmental fracture of the femoral diaphysis, 5 cm traction-compression damage of the popliteal artery, acute thrombosis of the popliteal and tibial arteries, sciatic nerve damage, circular detachment of the thigh skin, acute hemorrhage, II degree shock, and uncompensated lower extremity ischemia throughout 24 hours. The MESS score of the injured extremity was 8 indicating that an amputation would have been considered. Nevertheless, we choose the organ preservation solution with the revascularization of the injured limb segment. A multi-stage treatment was carried out including stabilization of bone fragments, primary reconstruction of the popliteal artery to restore the arterial blood flow in the injured extremity, reperfusion injury and myoglobinuria elimination, intensive kidney protection therapy, infection management, skin defects replacement, orthopedic surgery. As a result of the treatment, the injured limb was saved. The femur fracture healed allowing the patient to walk without assistance. Conclusion. The use of the programmed surgical treatment for severe mechanical injury of the lower extremity, an individual multi disciplinary approach, assessing the severity of systemic disorders, and timely use of extracorporeal detoxification made it possible to avoid amputation, perform organ preservation surgery, and create favorable conditions for restoring the supporting function of the lower extremity.

Stage treatment of patient with gunshot shin wound possessing bone and soft tissue defects in conditions of osteomyelitis

The paper presents a case of severe gunshot wound of the shin in a 16-year-old adolescent as a result of gunshot from a small distance. Comminuted fracture of the tibia, damage of the anterior tibial artery, defect of the soft tissue in the injured area were detected. When admitted to the hospital, the patient underwent surgical treatment of the wound and fixation of fragments in carboxylic rod apparatus of external transosseous fixation. Osteomyelitis was developed. Ten days later, reosteosynthesis was performed. The first stage of bilocal osteosynthesis of the right shin was implemented, necrotized soft tissues and bone fragments and detritus were removed, initial purulent process was arrested. There was started distraction of the distal fragment of the tibia obtained as a result of its corticotomy in the lower third into the bone defect measuring 5 cm, which occurred when implementing surgical treatment of the wound. Twenty-eight days after, open alignment of tibial fragments in the upper third and reinstallation of Ilizarov apparatus was performed. The site of fragment junction was closed with unfree skin flap on the pedicle measuring 4 6 cm, the transplant bed was closed with full-layer skin graft using Parins technique. The further consolidation of fragments was reached simultaneously with maturation of the bone regenerate. The total period of fixation in Ilizarov apparatus lasted for 8 months. The bone and soft tissue structural integrity was restored, full function of the lower limb and adjacent joints was reached. Ilizarov apparatus is indispensable in multistage treatment of gunshot fractures and provides dynamic correction in changeable conditions; it permits to preserve the limb and its functionality.

Effect of Pre-Aging, Over-Aging and Re-Aging on Exfoliation Corrosion and Electrochemical Corrosion Behavior of Al-Zn-Mg-Cu Alloys

By means of TEM, hardness, conductivity, tensile strength test, fracture toughness test, polarization curve and EIS, the Al-Zn-Mg-Cu alloys treated by a new multi-stage aging system, i.e. pre-aging, over-aging and re-aging (120°C/24h + 160°C/8h + 120°C/24h), were characterized. It is found that compared with the Al-Zn-Mg-Cu alloys treated by T76 (120°C/24h + 160°C/8h), the new multi-stage aging treatment can improve the tensile strength, fracture toughness, hardness and conductivity of the alloys at the same time. This is mainly due to the pre-aging, over-aging and re-aging process of super high strength aluminum alloys. Compared with the two-stage over aging process, the formation of multi-stage multi-phase precipitation structure can improve the strength, toughness and corrosion resistance of the alloys at the same time. The polarization curve is consistent with the conclusion. Therefore, we conducted this study to test how the comprehensive properties of the alloy can be improved.

Структура и жаропрочность интерметаллидного ренийсодержащего сплава после термической обработки

The developed intermetallic Ni3Al compound-based alloys, known under the VKNA (ВКНА) and VIN (ВИН) brands, attract attention due to high operating temperatures --- up to 1200 °C, and relatively low density --- ~ 8 g / cm3. The first-generation intermetallic alloys such as VKNA-1V (ВКНА-1В) and VKNA-4U (ВКНА-4У) are known not to require multi-stage heat treatment. An increase in the strength characteristics caused by high requirements for the hot gas path materials also occurs due to an increase of high-melt alloying elements. Therefore, investigations in the field of temperature effects on the structure and properties of new generation intermetallic alloys become very relevant. In our research we studied the influence of heat treatment on the structural phase state of the VIN4 (ВИН4) intermetallic alloy containing rhenium. Findings show that annealing at close to solvus temperatures allows increasing the time to failure during 1100 °C stress-rupture strength tests. At the same time, during the heat treatment of the alloy with a high cooling rate, elements are redistributed with uneven allocation of phases of different morphology enriched in molybdenum and chromium, which negatively affects the results of stress- rupture strength. The research is an intermediate step in establishing patterns of influence of heat treatment parameters on intermetallic alloys depending on the degree of alloying.

Molecular surveillance of human rotaviruses in drinking water and investigation of the efficiency of their removal in Isfahan water treatment plant.

Enteric viruses, especially human rotaviruses present in aquatic environments, are microbial criteria in quality assessment of water resources. The present research aimed to investigate molecular monitoring of human rotavirus and efficacy evaluation of Isfahan water treatment plant (WTP) in the elimination of viruses. In total, 60 water samples were collected from different units of WTP. Zeta plus electropositive Virosorb cartridge filter and elution buffer was used for concentrating water samples. Enzyme-linked immunosorbent assay (ELISA) was used for detecting rotavirus antigen. Quantitative real-time reverse transcription PCR (qRT-PCR) with SYBR Green I fluorescent dye was performed for molecular detection of rotavirus. Multiplex nested reverse transcription-polymerase chain reaction (RT-PCR) was used for rotavirus G genotyping. Total coliform count varies from 102-103 CFU/mL in the raw water resources. Rotavirus antigen was detected in 17 samples (28.33%) by ELISA, and 13 samples (21.67%) were found positive by RT-PCR. These included 41.18% (7 cases) of raw water influent, 29.41% (5 cases) after sedimentation, 23.52% (4 cases) after ozonation, and 5.88% (1 case) after filtration in ELISA method. The highest number of rotaviruses was detected by qRT-PCR in autumn (46.15% (6 cases)). The commonest circulating G type in the sampling points was the mixed types, which was identified in 6 samples (46.15%), followed by non-typeable (23.07%), G3 (15.38%), G1 (7.69%), and G8 (7.69%), respectively. Despite the presence of rotavirus in raw water, after clarification and ozonation, filtration and treated water did not show the presence of rotavirus. The results of this study showed that multi-stage treatment has a positive effect on virus removal in WTP.

Multistage treatment of a patient with spontaneous rupture of the esophagus in a multidisciplinary hospital setting

The article presents a clinical case of 2-stage treatment of an elderly patient with spontaneous rupture of the esophagus. Exclusion the esophagus in the first stage of treatment with the use of minimally invasive technologies (endoscopy, laparoscopy, drainage of the pleural cavity) allowed to minimize surgical trauma and create conditions for the recovery of the patient, relief of mediastinitis, sepsis and restore the natural passage of food through the digestive tube during the second stage of treatment. The presented clinical case demonstrates the feasibility of the multistage approach using minimally invasive technology in the treatment of eldery patients with spontaneous rupture of the esophagus and severe sepsis.

Nanocellulose fabrication from Oryza sativa L. rice straw using combined treatment by hydrogen peroxide and dilute sulfuric acid solution

ABSTRACTA novel and facile multi-stage treatment of rice straw by hydrogen peroxide solution was used for the preparation of nanocellulose from rice straw in Vietnam. Firstly, the rice straw was treated by hydrogen peroxide and dilute sulfuric acid using sodium molybdate as a catalyst in optimal conditions followed by the alkaline extraction and peroxide bleaching for obtaining cellulose pulp with a brightness of 82% ISO. Secondly, the obtained bleached cellulosic pulp was treated with a dilute solution at 100–150°C followed by refining. After refining, nanocellulose was achieved in solution with a concentration of around 0.05–0.2%. The SEM images showed that the nanocellulose material had a particle diameter ranging up to 100 nm. Nanocellulose size fraction was determined by computer software NIS-Elements Br. The characteristics of nanocellulose were studied by FTIR and XRD.

Treatment of giant follicular cyst of the upper jaw

Background. The article describes a clinical case of a successful surgical treatment of a large size follicular cyst pushing the anterior-inferior wall of the left maxillary sinus and the lower nasal concha, with the maxillary alveolar process osteoplasty.
 Clinical case description. According to the results of cone beam computed tomography, the size of the follicular cyst before the treatment was 45.423.339.7 mm. After the endodontic treatment, cystectomy, cystostomy, plastic surgery of the alveolar process of the upper jaw, the bone defect is reduced by two times, disconnected from the oral cavity.
 Conclusion. By the example of the presented clinical case, it has been shown that large jaw cysts require a multi-stage treatment with the participation of narrow specialists of related profiles.

First training and practical course on field surgery and trauma surgery «SMART» in Russia.

In recent years, significant progress has been made in the treatment of severe injuries and traumas. In critical situations, for the heaviest category of wounded, the outcome is largely determined in the next few minutes after admission to the hospital. The only possible tactic that gives a chance to save the lives of such victims is the tactics of multi-stage surgical treatment (damage control). The low effectiveness of traditional methods of training surgeons in the basics and techniques of this tactic makes it necessary to develop new forms of training. One of the most progressive and sought-after is training on biological material (large animals or cadaver material), but the methodology for conducting such studies has not been worked out before. For the first time in Russia in November 2018, a unique training and practical course «SMART» (Modern Methods and Algorithms for the Treatment of Wounds and Traumas) was conducted, combining training in both living tissues and cadavers. Participants were given the opportunity to see and independently work out the basic combinations of typical surgical techniques and maneuvers aimed at eliminating the life-threatening consequences of injuries and traumas.

Lung perfusion scintigraphy in the assessment of pulmonary circulation after completion of surgical treatment of a hypoplastic left heart syndrome (HLHS).

Hypoplastic left heart syndrome (HLHS) is an inborn complex heart malformation. A multi-stage treatment is initiated in a neonatal period with a Norwood surgery. The next step is Glenn surgery - a bidirectional superior cavo-pulmonary anastomosis. At the last stage anastomosis of inferior vena cava (IVC) with the right pulmonary artery (RPA) is formed as a result of a Fontan surgery. The aim of this study was to assess lung perfusion in patients with HLHS after completion of a surgical therapy, using a scintigraphic method. In 92 patients with HLHS a planar lung scintigraphy in anterior and posterior projections after administration of 99mTc-macroaggregates in activity 18-111MBq was carried out twice (in several day intervals). At first, a radiopharmaceutical was administered to the right extremity in order to assess the lung distribution of blood flowing through the anastomosis of superior vena cava (SVC) with RPA. In the next study, after administration of the tracer to the right lower extremity, the distribution of blood flowing through the anastomosis of IVC with RPA was assessed. The relative percentage of each lung in the total lung perfusion was calculated on a Xeleris workstation using the "Lung perfusion analysis" program. Lung perfusion was considered close to symmetrical when the proportion was in the range of 40-60%. In spite of the fact that mean relative values of distribution of blood flowing through the anastomosis of SVC with RPA to the left lung (LL) and right lung (RL) in the entire study group did not differ significantly: LLmean = 47%; RLmean = 53%, p = 0.14, relative values of perfusion of both lungs were differentiated - in 26% of patients LL was better perfused, in 38% RL was better perfused and in 36% a perfusion of both lungs was similar. The analysis of blood distribution by anastomosis of IVC with RPA showed that the mean relative perfusion of RL was significantly higher than that of LL (70% vs. 30%, p < 0.0000001). No signs of pulmonary emboli were detected. In 13% of studied patients, uptake of the radiopharmaceutical in kidneys was shown indicating the presence of shunt "from right to left". After completion of surgical treatment of patients with HLHS, differentiated blood supply of the lungs was observed through SVC with RPA anastomosis and a tendency to higher blood supply of RL than LL by anastomosis of IVC with RPA. No signs of pulmonary embolism were detected. The study revealed a "right to left" shunt in some patients.

DOZ047.118: Surgical treatment of children with button battery injury

Abstract Introduction The foreign body of the esophagus—button battery causes severe changes of the esophagus. Ingestion of large-sized button batteries (≥20 mm) in children younger than 4 years is associated with increased morbidity and mortality. The most serious complication is the perforation of the esophagus or tracheoesophageal fistula (TEF), which may require a long-term multistage surgical treatment. Other issues that can be caused by button battery injury are esophageal stenosis and laryngeal paralysis. There are 40 children with esophageal injuries who were treated in Filatov Children Hospital between 2011 and 2019. Among them, several children did not need surgical treatment at all (40%), but five patients (12.5%) needed colon transposition. Button battery injury also causes reversible or irreversible damage of the recurrent laryngeal nerve, which required complex reconstructive operations on the larynx and trachea. Patients and Methods We retrospectively analyzed 40 patients with different types of injury after button battery removal. The average age of the patients was 1 year and 8 months. A total of 16 patients (40%) have had no esophageal or laryngeal pathology after button battery removal. Six patients (15%) developed esophageal stenosis. Two patients (5%) had esophageal perforations. Sixteen patients (40%) developed TEF. Bivocal chord paralysis was identified in 10 patients (25%). Results Esophageal dilations were performed in five patients (12.5%). Eight patients (20%) underwent laparoscopic fundoplication and gastrostomy. Spontaneous TEF closure formed in four patients (10%). Ten patients (25%) underwent different types of reconstructive surgeries in different periods after battery removal. Among eight patients (20%) who underwent early reconstructive surgeries three (7.5%) developed different complications, which require esophageal replacements. Tracheostomy was performed in 11 children (27.5%), five (12.5%) of whom required reconstructive surgery on the larynx. There was no mortality in our observation. Conclusion In this study, we conclude that TEF after button battery removal can close spontaneously and should not be operated in the acute period. Fundoplication and gastrostomy and tracheostomy can be procedures of choice in these patients. Also recurrent nerve injuries can be unstable. They can cause severe injuries of esophagus, trachea, and larynx, which can require esophageal replacement and vocal chord lateralization procedures with long-term and multiple-stage treatment.

New Interactive Cementing System Improves Zonal Isolation in Horizontal Wells

This article, written by JPT Technology Editor Judy Feder, contains highlights of paper SPE 191561, “Effective Zonal Isolation in Horizontal Wells: Mitigating Negative Impact of Mud Channels,” by Petr Kolchanov, SPE, Dominic Perroni, SPE, Anatoly Medvedev, SPE, Yan Gao, Randy Tercero, SPE, Larry Todd, SPE, and Bernhard Lungwitz, SPE, Schlumberger, and Kenneth Cowan and William Turner, SPE, Occidental Petroleum, prepared for the 2018 SPE Annual Technical Conference and Exhibition, Dallas, 24–26 September. The paper has not been peer reviewed. Hydraulic isolation of wells drilled with nonaqueous fluids (NAFs) relies heavily on eliminating mud from the annuli before placing cement. Failure to expel all NAFs results in residual fluid channels that may compromise well integrity and can serve as nonproductive communication pathways during subsequent stimulation treatments. This paper presents an interactive cementing system (ICS) that is designed to mitigate these risks by reducing conductivity of the residual mud channels. Introduction Currently, most horizontal wells drilled in the US are completed with multistage stimulation treatments. Isolation between stages is required both inside and outside the production casing string for effective stimulation. Although plugs can be used between stages for effective isolation inside the casing, cement must create external isolation. Lateral cement jobs are pumped according to plan; however, it is difficult to optimize fully all design inputs needed for an optimal cement job. With few operators logging horizontal well sections to understand actual lateral cement quality, mud channels are frequently identified as the root cause of stimulation inefficiency. Because completion effectiveness and well productivity depend upon good zonal isolation, profitability of the well is thought to be compromised. Mud removal remains an integral part of the cementing process. A cement formulation was developed to improve zonal isolation in the case of poor mud removal. The ICS reacts with the hydrocarbons present in NAFs, reducing channel permeability and mobility to significantly improve the likelihood of hydraulic isolation. Specialized testing protocols were developed to demonstrate the capabilities of this new system. Additionally, American Petroleum Institute (API) testing methods and analytical techniques were used to optimize the slurry. Historically, zonal isolation was dependent on complete mud removal, which was a function of many parameters. Even after well preparation is completed, mud removal is dependent on adequate centralization. Although most drilling engineers agree that well-centralized casing results in a better cement job, the tradeoff comes with the challenges of getting casing to bottom on long-lateral and extended-reach wells. Rotating and reciprocating casing can improve mud removal and cement quality, but significant cost and safety concerns limit their use. Spacer type and volume also influence mud removal. After decisions have been made on these cement-design parameters, cement placement should be optimized using computer simulation models to maintain adequate rheological parameters and achieve mud removal. The likelihood of a mud channel is much greater if these design parameters are not optimized.

Central giant cell granuloma: Diagnostic difficulty and multi-stage treatment

Central giant cell granuloma: Diagnostic difficulty and multi-stage treatment - JOOO- Print ISSN No: - 2395-6186 Online ISSN No:- 2395-6194 Article DOI No:- 10.18231/j.jooo.2019.007, Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology-J Oral Med Oral Surg Oral Pathol Oral Radiol

Development of an integrated treatment strategy for a leather tannery landfill leachate

This study aimed at developing an efficient multistage treatment strategy for a complex industrial landfill leachate: a leather tannery landfill leachate. Based on the leachate physicochemical characteristics, the following treatment train was delineated and tested: (i) initial biological process for removal of biodegradable organics, ammonium and alkalinity, (ii) coagulation/flocculation process for total removal of chromium and partial removal of recalcitrant organics and suspended solids, (iii) advanced oxidation process (AOP) or electrochemical AOP (EAOP) for degradation of recalcitrant organics and biodegradability enhancement, and (iv) final biological polishing step. Two initial biological treatment configurations were applied: one comprising nitrification and the other nitrification-denitrification. Coagulation/flocculation was optimized in terms of pH, coagulant dosage (iron(III) chloride) and flocculant nature and dosage. The following AOPs/EAOPs were tested: Fenton, photo-Fenton with UVA or UVC radiation (PF-UVA or PF-UVC), anodic oxidation (AO), electro-Fenton (EF) and photoelectro-Fenton with UVA radiation (PEF-UVA). The biological nitrification-denitrification was beneficial not only because it avoided the need for alkalinity addition during nitrification and decreased the amount of substrate added during denitrification, as expected. Over and above that, it reduced the acid consumption in the coagulation/flocculation, avoided the application of an additional stage comprising nitrites oxidation to nitrates prior to the AOP/EAOP, and improved the efficiency of Fenton’s reaction based processes. Following nitrification-denitrification, the coagulation/flocculation was maximized at pH 3.0 and 400 mg Fe L−1 with no flocculant addition. The PEF-UVA process was the best AOP/EAOP. The final leachate fulfilled the discharge limits into waterbodies.

Congenital obstructive bowel anomalies presenting after neonatal age.

Delayed presentation might affect the ultimate management of children with congenital bowel obstructive bowel anomalies (CBA). We evaluated the profile, challenges of treatment and outcome of CBA presenting after neonatal age. We did a retrospective analysis of data of children with CBA presenting after neonatal age from January 2013 to November 2017. We used the Statistical Package for Social Sciences (SPSS) for data entry and analysis. There were 57 cases in total comprising of Hirschsprung's disease (HD; 37 cases), anorectal malformation (ARM; 15 cases), and duodeno-jejunal web (5 cases), with median age of 9 months (IQR 4 months - 2 years) on presentation. Overall, 52 (91.2%) patients had one or more complications on presentation. Definitive procedure did not differ from established operations, but only 9 (15.8%) had primary procedures and 48 (84.2%) cases required multi-stage treatment. After an average follow up period of 19.5 months (range: 1-45 months), 18 (31.6%) cases developed procedure-related complications and 3 (5.3%) had residual bowel dysfunction, but there was no mortality. The morbidity was limited to cases with HD and ARM. In our setting, HD is the commonest bowel anomaly that presents after the neonatal age. The delayed presentation may predispose to complications and preclude single-stage treatment in some cases. Training of healthcare providers to improve recognition and early referral of these anomalies may lead to early diagnosis and minimize morbidity.