Search results for: postoperative recovery

Authors: Rachel Ashwell, Sally Millett

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Introduction: Adequate post-operative pain relief is a key priority in the delivery of caesarean sections. This improves patient experience, reduces morbidity and enables optimal mother-infant interaction. Recommendations outlined in the NICE guidelines for caesarean section (CS) include offering peri-operative intrathecal/epidural diamorphine and post-operative opioid analgesics; offering non-steroidal anti-inflammatory drugs (NSAIDs) unless contraindicated and taking hourly observations for 12 hours following intrathecal diamorphine. Method: This audit assessed the provision of post-CS analgesia in 29 women over a two-week period. Indicators used were the use of intrathecal/epidural opioids, use of post-operative opioids and NSAIDs, frequency of observations and patient satisfaction with pain management on post-operative days 1 and 2. Results: All women received intrathecal/epidural diamorphine, 97% were prescribed post-operative opioids and all were prescribed NSAIDs unless contraindicated. Hourly observations were not maintained for 12 hours following intrathecal diamorphine. 97% of women were satisfied with their pain management on post-operative day 1 whereas only 75% were satisfied on day 2. Discussion: This service meets the proposed standards for the provision of post-operative analgesia, achieving high levels of patient satisfaction 1 day after CS. However, patient satisfaction levels are significantly lower on post-operative day 2, which may be due to reduced frequency of observations. The lack of an official audit standard for patient satisfaction on postoperative day 2 may result in reduced incentive to prioritise pain management at this stage.

Keywords: Caesarean section, analgesia, postoperative care, patient satisfaction

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Authors: Maksim Barsakov

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Introduction. In modern plastic surgery, there are a large number of breast lift techniques.Due to the spreading information about the "side effects" of silicone implants, interest in implant-free mastopexy is increasing year after year. However, despite the variety of techniques, patients sometimes do not get full satisfaction from the results of mastopexy because of the unexpressed filling of the upper pole, extended anchoring postoperative scars and sometimes because of obtaining an aesthetically unattractive breast shape. The stability of the result after mastopexy depends on many factors, including postoperative rehabilitation. Stability of weight and hormonal background, stretchability of tissues. The high recurrence rate of ptosis and short-term aesthetic effect of mastopexy indicate the urgency of improving surgical techniques and increasing the stabilization of breast tissue. Purpose of the study. To develop and introduce into practice a technique of mastopexy based on the use of a modified Ribeiro flap, as well as elements of tissue movement and fixation designed to increase the stability of postoperative mastopexy. In addition, to give indications for the application of this surgical technique. Materials and Methods. it operated on 103 patients aged 18 to 53 years from 2019 to 2023 according to the reported method. These were patients with primary mastopexy, secondary mastopexy, and also patient with implant removal and one-stage mastopexy. The patients were followed up for 12 months to assess the stability of the result. Results and their discussion. Observing the patients, we noted greater stability of the breast shape and upper pole filling compared to the conventional classical methods. We did not have to resort to anchoring scars. In 90 percent of cases, a inverted T-shape scar was used. In 10 percent, the J-scar was used. The quantitative distribution of complications identified among the operated patients is as follows: worsened healing of the junction of vertical and horizontal sutures at the period of 1-1.5 months after surgery - 15 patients; at treatment with ointment method healing was observed in 7-30 days; permanent loss of NAC sensitivity - 0 patients; vascular disorders in the area of NAC/areola necrosis - 0 patients; marginal necrosis of the areola-2 patients. independent healing within 3-4 weeks without aesthetic defects. Aesthetically unacceptable mature scars-3 patients; partial liponecrosis of the autoflap unilaterally - 1 patient. recurrence of ptosis - 1 patient (after weight loss of 12 kg). In the late postoperative period, 2 patients became pregnant, gave birth, and no lactation problems were observed. Conclusion. Thus, in the world of plastic surgery methods of breast lift continue to improve, which is especially relevant in modern times, due to the increased attention to this operation. The author's proposed method of mastopexy with glandular autoflap allows obtaining in most cases a stable result, a fuller breast shape, avoiding the presence of extended anchoring scars, and also preserves the possibility of lactation. The author of this article has obtained a patent for invention for this method of mastopexy.

Keywords: mastopexy, mammoplasty, autoflap, personal technique

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Authors: Anis Al-Yakhiri

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Introduction: The World Health Organization (WHO) classifies malignant epithelial thyroid tumors into four major groups (papillary, follicular, medullar and undifferentiated) . Papillary thyroid carcinoma (PTC) is the most common type, for about eight out of ten thyroid cancers belong to this histological type. Radioactive iodine (RAI) is considered effective for patients with total or nearly total thyroidectomy, but the beneficial effects of RAI are still controversial. War conditions forced us to study alternative methods of using radioactive iodine in the treatment of patients with PTC. Material and methods: Between January 2014 and June 2021, in Al-Yakhiri hospital, 57 Total Thyroidectomy with Radical BilateralNeckDissection (RBND) were performed, 50 for malignant disease,7 for false positive cytology.RBND involves surgical clearance of Levels II-VI. Mean age was 40.7 years old and 92% of the patients were female. 7(14%) patients had hypothyroidism which required preoperative thyroid hormone treatment. The Thyroid Stimulating Hormone- Suppression Therapy (TSH-ST) immediately started after RBND for mostpatients on the first day. It consisted in reducing the level of TSH< 0.1 mIU/L. Results: The Apron flap was used on most operations (40)80% and with lateral extensions had 10(20%). RBND involves surgical clearance of Levels II-VI performed in all operated patients, besides that, 4(8%) of them had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV) withclearance of Levels IB. The PTC was the most common 80.9% (38 patients from 47)by histopathological report. and 4(8%) patients of 50 had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV). The postoperative mortality rate not observed (0%). The postoperative morbidity rate was 22.8% (n =13).Seroma(8.7%),Hypocalcimia(7%), Wound infection(5.3%), Bleeding(1.8%). To suppress TSH and growth of any residual thyroid theTSH-ST (levothyroxine150 – 600mcg)was performed in all patients 57(100%) on the first day afterRBND. We tracked the results of treatment for two years in 30 patients with PTC, only 3 of them received radioactive iodine abroad. Biennial Recurrence rate for PTC appeared in one woman (2%), who had RAI postoperatively in the form of neck lymph nodes metastasis. Conclusion: For patients with PTC, thyroidectomy plus prophylacticRBND is a safe and efficient procedure and it results in lower recurrence rate. Postoperative treatment with exogenous thyroid hormone in doses sufficient to suppress TSH (not less than 150mcg), decreases incidence of recurrence. Total Thyroidectomy with RBND followed by TSH-ST, in our opinion, applicable optimal treatment scheme care for this patient population.

Keywords: thyroid cancer, Yemen war, absence of radioactive iodine, neck dissection, surgery results

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Authors: L. Kashyap, S. Jha, D. Shende, V. K. Mohan, P. Khanna, A. Aravindan, S. Kashyap, L. Singh, S. Aggarwal

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Obesity is associated with a chronic inflammatory state. During surgery, there is an interplay between anaesthetic and surgical stress vis-a-vis the already present complex immune state. Moreover, the postoperative period is dictated by inflammation, which is crucial for wound healing and regeneration. An excess of inflammatory response might hamper recovery besides increasing the risk for infection and complications. There is definite evidence of the immunosuppressive role of inhaled anaesthetic agents. This immune modulation may be brought into effect directly by influencing the innate and adaptive immunity cells. The effects of propofol on immune mechanisms in has been widely elucidated because of its popularity. It reduces superoxide generation, elastase release, and chemotaxis. However, there is no unequivocal proof of one’s superiority over the other. Hence, an anaesthetic regimen with lesser inflammatory potential and specific to the obese patient is needed. OBESITA trial protocol (2019) by Sousa and co-workers in progress aims to test the hypothesis that anaesthesia with sevoflurane results in a weaker proinflammatory response compared to propofol, as evidenced by lower IL-6 and other biomarkers and an increased macrophage differentiation into M2 phenotype in adipose tissue. IL-6 was used as the objective parameter to evaluate inflammation as it is regulated by both surgery and anesthesia. It is the most sensitive marker of the inflammatory response to tissue damage since it is released within minutes by blood leukocytes. We hypothesized that maintenance of anaesthesia with propofol would lead to less inflammation than that with desflurane. Aims: The effect of two anaesthetic techniques, total intravenous anaesthesia (TIVA) with propofol and desflurane, on surgical stress response was evaluated. The primary objective was to compare serum interleukin-6 (IL-6) levels before and after surgery. Methods: In this prospective single-blinded randomized controlled trial undertaken, 30 obese patients (BMI>30 kg/m2) undergoing laparoscopic bariatric surgery under general anaesthesia were recruited. Patients were randomized to receive desflurane or TIVA using a target-controlled infusion for maintenance of anaesthesia. As a marker of inflammation, pre-and post-surgery IL-6 levels were compared. Results: After surgery, IL-6 levels increased significantly in both groups. The rise in IL-6 was less with TIVA than with desflurane; however, it did not reach significance. IL-6 rise post-surgery correlated positively with the complexity of procedure and duration of surgery and anaesthesia, rather than anaesthetic technique. Both groups did not differ in terms of intra-operative hemodynamic and respiratory variables, time to awakening, postoperative pulmonary complications, and duration of hospital stay. The incidence of nausea was significantly higher with desflurane than with TIVA. Conclusion: Inflammatory response did not differ as a function of anaesthetic technique when propofol and desflurane were compared. Also, patient and surgical variables dictated post-operative inflammation more than the anaesthetic factors. Further, larger sample size is needed to confirm or refute these findings.

Keywords: bariatric, biomarkers, inflammation, laparoscopy

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Authors: L. Raczynski, P. Moskal, P. Kowalski, W. Wislicki, T. Bednarski, P. Bialas, E. Czerwinski, A. Gajos, L. Kaplon, A. Kochanowski, G. Korcyl, J. Kowal, T. Kozik, W. Krzemien, E. Kubicz, Sz. Niedzwiecki, M. Palka, Z. Rudy, O. Rundel, P. Salabura, N.G. Sharma, M. Silarski, A. Slomski, J. Smyrski, A. Strzelecki, A. Wieczorek, M. Zielinski, N. Zon

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The J-PET scanner, which allows for single bed imaging of the whole human body, is currently under development at the Jagiellonian University. The J-PET detector improves the TOF resolution due to the use of fast plastic scintillators. Since registration of the waveform of signals with duration times of few nanoseconds is not feasible, a novel front-end electronics allowing for sampling in a voltage domain at four thresholds was developed. To take fully advantage of these fast signals a novel scheme of recovery of the waveform of the signal, based on ideas from the Tikhonov regularization (TR) and Compressive Sensing methods, is presented. The prior distribution of sparse representation is evaluated based on the linear transformation of the training set of waveform of the signals by using the Principal Component Analysis (PCA) decomposition. Beside the advantage of including the additional information from training signals, a further benefit of the TR approach is that the problem of signal recovery has an optimal solution which can be determined explicitly. Moreover, from the Bayes theory the properties of regularized solution, especially its covariance matrix, may be easily derived. This step is crucial to introduce and prove the formula for calculations of the signal recovery error. It has been proven that an average recovery error is approximately inversely proportional to the number of samples at voltage levels. The method is tested using signals registered by means of the single detection module of the J-PET detector built out from the 30 cm long BC-420 plastic scintillator strip. It is demonstrated that the experimental and theoretical functions describing the recovery errors in the J-PET scenario are largely consistent. The specificity and limitations of the signal recovery method in this application are discussed. It is shown that the PCA basis offers high level of information compression and an accurate recovery with just eight samples, from four voltage levels, for each signal waveform. Moreover, it is demonstrated that using the recovered waveform of the signals, instead of samples at four voltage levels alone, improves the spatial resolution of the hit position reconstruction. The experiment shows that spatial resolution evaluated based on information from four voltage levels, without a recovery of the waveform of the signal, is equal to 1.05 cm. After the application of an information from four voltage levels to the recovery of the signal waveform, the spatial resolution is improved to 0.94 cm. Moreover, the obtained result is only slightly worse than the one evaluated using the original raw-signal. The spatial resolution calculated under these conditions is equal to 0.93 cm. It is very important information since, limiting the number of threshold levels in the electronic devices to four, leads to significant reduction of the overall cost of the scanner. The developed recovery scheme is general and may be incorporated in any other investigation where a prior knowledge about the signals of interest may be utilized.

Keywords: plastic scintillators, positron emission tomography, statistical analysis, tikhonov regularization

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Authors: Douglas Shabe

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The world of the performing musician is one of high pressure that comes from the expected high standards they have to live up to and that they expect from themselves. The pressure that musicians put themselves under can manifest itself in physical problems such as focal dystonia. Knowledge of the contributing factors and potential rehabilitation strategies cannot only give players hope for recovery but also the information to prevent it from happening in the first place. This dissertation presents a multiple case study of two performing brass musicians who developed focal dystonia of the embouchure, also known as embouchure dystonia, combined with an autoethnography of the author’s experience of battling embouchure dystonia and our attempts at recovery. Extensive research into the current state of focal dystonia research was done to establish a base of knowledge. That knowledge was used to develop interview questions for the two participants and interpret the findings of the qualitative data collected. The research knowledge, as well as the qualitative data from the case studies, was also used to interpret the author’s experience. The author determined that behavioral, environmental, and psychological factors were of prime importance in the subjects’ development of focal dystonia and that modifications of those factors are essential for the best chance at recovery.

Keywords: focal dystonia, embouchure dystonia, music teaching and learning, music education

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Authors: Yaya Gao, Bing Zhong, Yafeng Liu, Fei Chen

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Aim: The purpose of this study was to explore the difference between acellular dermal matrix (ADM) combined with anterolateral thigh (ALT) flap and ALT flap alone. Methods: HSCC patients were treated and divided into group A (ALT) and group B (ALT+ADM) between January 2014 and December 2018. We compared and analyzed the intraoperative information and postoperative outcomes of the patients. Results: There were 21 and 17 patients in group A and group B, respectively. The operation time, blood loss, defect size and anastomotic vessel selection showed no significant difference between two groups. The postoperative complications, including wound bleeding (n=0 vs. 1, p=0.459), wound dehiscence (n=0 vs. 1, p=0.459), wound infection (n=5vs.3, p=0.709), pharyngeal fistula (n=5vs.4, p=1.000) and hypoproteinemia (n=11 vs. 12, p=0.326) were comparable between the groups. Dysphagia at 6 months (number of liquid diets=0vs. 0; number of partial tube feedings=1vs. 1; number of total tube feedings=1vs. 0, p=0.655) also showed no significant differences. However, significant differences was observed in dysphagia at 12 months (number of liquid diets=0vs. 0; number of partial tube feedings=3 vs. 1; number of total tube feedings=10vs. 1, p=0.006). Conclusion: For HSCC patients, the use of the ALT flap combined ADM, compared to ALT treatment, showed better swallowing function at 12 months. The ALT flap combined ADM may serve as a safe and feasible alternative for selected HSCC patients.

Keywords: hypopharyngeal squamous cell carcinoma, anterolateral thigh free flap, acellular dermal matrix, reconstruction, dysphagia

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Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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 Background and aims: Peripheral regional anesthesia has been integrated into most analgesia protocols for total knee arthroplasty which considered among the most painful surgeries with a huge potential for chronicization. The adductor canal block (ACB) has gained popularity. Similarly, the IPACK block has been described to provide analgesia of the posterior knee capsule. This study aimed to evaluate the analgesic efficacy of this block in patients undergoing primary PTG. Methods: 90 patients were randomized to receive either an IPACK, an anterior sciatic block, or a sham block (30 patients in each group + multimodal analgesia and a catheter in the KCA adductor canal). GROUP 1 KCA GROUP 2 KCA+BSA GROUP 3 KCA+IPACK The analgesic blocks were done under echo-guidance preoperatively respecting the safety rules, the dose administered was 20 cc of ropivacaine 0.25% was used. We were to assess posterior knee pain 6 hours after surgery. Other endpoints included quality of recovery after surgery, pain scores, opioid requirements (PCA morphine)(EPI info 7.2 analysis). Results: -groups were matched -A predominance of women (4F/1H). -average age: 68 +/-7 years -the average BMI =31.75 kg/m2 +/- 4. -70% of patients ASA2 ,20% ASA3. -The average duration of the intervention: 89 +/- 19 minutes. -Morphine consumption (PCA) significantly higher in group 1 (16mg) & group 2 (8mg) group 3 (4mg) - The groups were matched . -There was a correlation between the use of the ipack block and postoperative pain Conclusions :In a multimodal analgesic protocol, the addition of IPACK block decreased pain scores and morphine consumption ,

Keywords: regional anesthesia, analgesia, total knee arthroplasty, the adductor canal block (acb), the ipack block, pain

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Authors: Myles Frederick McLellan

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When errors in the criminal justice process lead to wrongful convictions and miscarriages of justice, it falls upon the State to make reparation for the egregious harms brought to innocent individuals. Of all the remedies available to seek compensation, private and public law litigation against the police and prosecution services is the most widely used. Unfortunately, all levels of court including the Supreme Court of Canada have explicitly endorsed the prospect of striking out or dismissing these claims at the outset on an expedited basis. The burden on agents of the State as defendants to succeed on motions for such relief is so low that very few actions will survive to give an innocent accused his or her day in court. This paper will be a quantitative and qualitative analysis on the occurrence and success of motions to strike and dismiss to forestall financial recovery for the damage caused when a criminal investigation and prosecution goes wrong. This paper will also include a comparative component on the private law systems at common law (e.g. USA, UK, Australia and New Zealand) with respect to the availability of a similar process to pre-emptively terminate litigation for the recovery of compensation to an innocent individual.

Keywords: compensation, innocence, miscarriages of justice, wrongful convictions

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Authors: Choppala Pratheek, Vineet Ahuja

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Background: Crohn's disease (CD) recurrence following surgery is a common challenge, and current detection methods rely on risk factors identified in Western populations. This study aimed to investigate the risk factors and rates of postoperative CD recurrence in a tuberculosis-endemic region like India. Retrospective data was collected from a structured database from a specialty IBD clinic by reviewing case files from January 2005 to December 2021. Inclusion criteria involved CD patients diagnosed based on the ECCO-ESGAR consensus guidelines, who had undergone at least one intestinal resection and had a minimum follow-up period of one year at the IBD clinic. Results: A total of 90 patients were followed up for a median period of 45 months (IQR, 20.75 - 72.00). Out of the 90 patients, 61 received ATT prior to surgery, with a mean delay in diagnosis of 2.5 years, although statistically non-significant (P=0.078). Clinical recurrence occurred in 50% of patients, with the cumulative rate increasing from 13.3% at one year to 40% at three years. Among 63 patients who underwent endoscopy, 65.7% showed evidence of endoscopic recurrence, with the cumulative rate increasing from 31.7% at one year to 55.5% at four years. Smoking was identified as a significant risk factor for early endoscopic recurrence (P=0.001) by Cox regression analysis, but no other risk factors were identified. Initiating post-operative medications prior to clinical recurrence delayed its onset (P=0.004). Subgroup analysis indicated that endoscopic monitoring aided in the early identification of recurrence (P=0.001). The findings contribute to enhancing post-operative CD management strategies in such regions where the disease burden is escalating.

Keywords: crohns, post operative, tuberculosis-endemic, risk factors

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Authors: Ishwor Paudel, Pratima Gautam, Sandeep Bhattarai

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Bile spillage occurs frequently during laparoscopic cholecystectomy yet its impact on postoperative outcomes remains unknown. It might not be as innocuous as some surgeons tend to believe and in fact, might be associated with post-operative surgical site infections (SSI). It often leads to patient dissatisfaction, emergency department visits, with subsequent readmission and additional procedures. While some authors found no increase in SSI following bile spillage (BS) compared to non-bile spillage cases, others found bile spillage to be associated with SSI. Therefore we sought to examine whether bile spillage is indeed associated with an increased risk of postoperative wound infections after laparoscopic cholecystectomy. I hypothesize that patients who experience BS during operation, have an increased risk of SSI compared to those who do not. This is a prospective observational study conducted in the Department of Surgery, Patan Hospital over a period of one year. Patients undergoing Laparoscopic cholecystectomy were included and bile spillage, if happened was noted. All cases were followed up for 30 days and SSI was diagnosed as per CDC-defined criteria. Fisher’s test was applied to compare SSI in bile spillage versus non-bile spillage cases. A total of 112 patients were included in the final analysis. Bile spillage occurred in 20 cases and was absent in the rest i.e.92 cases. Among bile spillage cases, SSI was found in 4 cases (20%), whereas in nonbile spillage cases, SSI was found in 8 cases (8.7%). However, it was statistically not significant (p-value>0.05). Eleven (92%) cases were superficial SSI and one was an organ-space infection. No mortality or 30-day readmission. Spillage of Gallbladder content does not lead to an increase in SSIs. However as the rate of SSI is still higher, Surgeons should be careful to avoid iatrogenic gallbladder perforation and in case of bile spillage thorough peritoneal irrigation with normal saline should be done.

Keywords: organ space infection, Laparoscopic cholecystectomy, biliary spillage, surgical site infection

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Authors: Wissam Aljundi, Loay Daas, Yaser Abu Dail, Barbara Käsmann-Kellner, Berthold Seitz, Alaa Din Abdin

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Purpose: To investigate the effectiveness of nonsteroidal anti-inflammatory eye drops (NSAIDs) combined with oral acetazolamide for postoperative macular edema (PME) after uncomplicated phacoemulsification (PE) and to identify predictors of non-response. Methods: We analyzed data of uncomplicated PE and identified eyes with PME. First-line therapy included topical NSAIDs combined with oral acetazolamide. In case of non-response, triamcinolone was administered subtenonally. Outcome measures included best-corrected visual acuity (BCVA) and central macular thickness (CMT). Results: 94 eyes out of 9750 uncomplicated PE developed PME, of which 60 eyes were included. Follow-ups occurred 6.4±1.8, 12.5±3.7, and 18.6±6.0 weeks after diagnosis. BCVA and CMT improved significantly in all follow-ups. 40 eyes showed response to first-line therapy at first follow-up (G1). The remaining 20 eyes showed no response and required subtenon triamcinolone (G2), of which 11 eyes showed complete regression at the second follow-up and 4 eyes at the third follow-up. 5 eyes showed no response and required intravitreal injection. Multivariate linear regression model showed that diabetes mellitus (DM) and increased cumulative dissipated energy (CDE) are predictors of non-response. Conclusion: Topical NSAIDs with acetazolamide resulted in complete regression of PME in 67% of all cases. DM and increased CDE might be considered as predictors of nonresponse to this treatment.

Keywords: postoperative macular edema, intravitreal injection, cumulative energy, irvine gass syndrome, pseudophakie

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Authors: Lubna M. Al-Otaibi

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Mucocele is a common benign neoplasm of the oral cavity and the most common after fibroma. The lesion develops as a result of retention or extravasation of mucous material from minor salivary glands. Extravasation type of mucocele results from trauma and mostly occurs in the lower lip of young patients. The various treatment options available for the treatment of mucocele are associated with a relatively high incidence of recurrence making surgical intervention necessary for a permanent cure. The conventional surgical procedure, however, arouses apprehension in the patient and is associated with bleeding and postoperative pain. Recently, treatment of mucocele with lasers has become a viable treatment option. Various types of lasers are being used and are preferable over the conventional surgical procedure as they provide good hemostasis, reduced postoperative swelling and pain, reduced bacterial population, lesser need for suturing, faster healing and low recurrence rates. Er,Cr:YSGG is a solid-state laser with great affinity to water molecule. Its hydrokinetic cutting action allows it to work effectively on hydrated tissues without any thermal damage. However, up to date, only a few studies have reported its use in the removal of lip mucocele, especially in children. In this case, a 6 year old female patient with history of trauma to the lower lip presented with a soft, sessile, whitish-bluish 4 mm papule. The lesion was present for approximately four months and was fluctuant in size. The child developed a habit of biting the lesion causing injury, bleeding and discomfort. Surgical excision under local anaesthesia was performed using 2780 nm Er,Cr:YSGG Laser (WaterLase iPlus, Irvine, CA) with a Gold handpiece and MZ6 tip (3.5w, 50 Hz, 20% H2O, 20% Air, S mode). The tip was first applied in contact mode with focused beam using the Circumferential Incision Technique (CIT) to excise the tissue followed by the removal of the underlying causative minor salivary gland. Bleeding was stopped using Laser Dry Bandage setting (0.5w, 50 Hz, 1% H2O, 20% Air, S mode) and no suturing was needed. Safety goggles were worn and high-speed suction was used for smoke evacuation. Mucocele excision using 2780 nm Er,Cr:YSGG laser was rapid, easy to perform with excellent precision and allowed for histopathological examination of the excised tissue. The patient was comfortable and there were minimum bleeding and no sutures, postoperative pain, scarring or recurrence. Laser assisted mucocele excision appears to have efficient and reliable benefits in young patients and should be considered as an alternative to conventional surgical and non-surgical techniques.

Keywords: Erbium, excision, laser, lip, mucocele

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Authors: Eva L. Suarez, Daniel E. Meeroff, Yan Yong

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Current flooding risk modeling focuses on resilience, defined as the probability of recovery from a severe flooding event. However, the long-term damage to property and well-being by nuisance flooding and its long-term effects on communities are not typically included in risk assessments. An approach was developed to address the probability of recovering from a severe flooding event combined with the probability of community performance during a nuisance event. A consolidated model, namely the conflation flooding recovery (&FR) model, evaluates risk-coping mitigation strategies for communities based on the recovery time from catastrophic events, such as hurricanes or extreme surges, and from everyday nuisance flooding events. The &FR model assesses the variation contribution of each independent input and generates a weighted output that favors the distribution with minimum variation. This approach is especially useful if the input distributions have dissimilar variances. The &FR is defined as a single distribution resulting from the product of the individual probability density functions. The resulting conflated distribution resides between the parent distributions, and it infers the recovery time required by a community to return to basic functions, such as power, utilities, transportation, and civil order, after a flooding event. The &FR model is more accurate than averaging individual observations before calculating the mean and variance or averaging the probabilities evaluated at the input values, which assigns the same weighted variation to each input distribution. The main disadvantage of these traditional methods is that the resulting measure of central tendency is exactly equal to the average of the input distribution’s means without the additional information provided by each individual distribution variance. When dealing with exponential distributions, such as resilience from severe flooding events and from nuisance flooding events, conflation results are equivalent to the weighted least squares method or best linear unbiased estimation. The combination of severe flooding risk with nuisance flooding improves flood risk management for highly populated coastal communities, such as in South Florida, USA, and provides a method to estimate community flood recovery time more accurately from two different sources, severe flooding events and nuisance flooding events.

Keywords: community resilience, conflation, flood risk, nuisance flooding

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Authors: Asmaa M. El-Bandrawy, Afaf M. Botla, Ghada E. El-Refaye, Hassan O. Ghareeb

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Background: Urinary incontinence is a common problem among adults. Its incidence increases with age and it is more frequent in women. Pelvic floor muscle training (PFMT) is the first-line therapy in the treatment of pelvic floor dysfunction (PFD) either alone or combined with biofeedback-assisted PFMT. The aim of the work: The purpose of this study is to evaluate the efficacy of biofeedback-assisted PFMT in postoperative stress urinary incontinence. Settings and Design: A single blind controlled trial design was. Methods and Material: This study was carried out in 30 volunteer patients diagnosed as severe degree of stress urinary incontinence and they were admitted to surgical treatment. They were divided randomly into two equal groups: (Group A) consisted of 15 patients who had been treated with post-operative biofeedback-assisted PFMT and home exercise program (Group B) consisted of 15 patients who had been treated with home exercise program only. Assessment of all patients in both groups (A) and (B) was carried out before and after the treatment program by measuring intra-vaginal pressure in addition to the visual analog scale. Results: At the end of the treatment program, there was a highly statistically significant difference between group (A) and group (B) in the intra-vaginal pressure and the visual analog scale favoring the group (A). Conclusion: biofeedback-assisted PFMT is an effective method for the symptomatic relief of post-operative female stress urinary incontinence.

Keywords: stress urinary incontinence, pelvic floor muscles, pelvic floor exercises, biofeedback

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Authors: N. Nalini, Lokesh B. Bhajantri

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In Distributed Sensor Networks, the sensor nodes are prone to failure due to energy depletion and some other reasons. In this regard, fault tolerance of network is essential in distributed sensor environment. Energy efficiency, network or topology control and fault-tolerance are the most important issues in the development of next-generation Distributed Sensor Networks (DSNs). This paper proposes a node fault detection and recovery using Genetic Algorithm (GA) in DSN when some of the sensor nodes are faulty. The main objective of this work is to provide fault tolerance mechanism which is energy efficient and responsive to network using GA, which is used to detect the faulty nodes in the network based on the energy depletion of node and link failure between nodes. The proposed fault detection model is used to detect faults at node level and network level faults (link failure and packet error). Finally, the performance parameters for the proposed scheme are evaluated.

Keywords: distributed sensor networks, genetic algorithm, fault detection and recovery, information technology

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Authors: Lin Meng, Xi Lu, Haibo Wang, Yong Song, Lili Cao, Wenfang Song, Yong Hu

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China has abundant heavy oil resources, and thermal recovery is the main recovery method for heavy oil reservoirs. However, high energy consumption, high carbon emission and high production costs make heavy oil thermal recovery unsustainable. It is urgent to explore a replacement for developing technology. A low Carbon and cost technology of heavy oil recovery, chemical viscosity-reduction in layer (CVRL), is developed by the petroleum exploration and development research institute of Sinopec via investigated mechanisms, synthesized products, and improved oil production technologies, as follows: (1) Proposed a cascade viscous mechanism of heavy oil. Asphaltene and resin grow from free molecules to associative structures further to bulk aggregations by π - π stacking and hydrogen bonding, which causes the high viscosity of heavy oil. (2) Aimed at breaking the π - π stacking and hydrogen bond of heavy oil, the copolymer of N-(3,4-dihydroxyphenethyl) acryl amide and 2-Acrylamido-2-methylpropane sulfonic acid was synthesized as a viscosity reducer. It achieves a viscosity reduction rate of>80% without shearing for heavy oil (viscosity < 50000 mPa‧s), of which fluidity is evidently improved in the layer. (3) Synthesized hydroxymethyl acrylamide-maleic acid-decanol ternary copolymer self-assembly plugging agent. The particle size is 0.1 μm-2 mm adjustable, and the volume is 10-500 times controllable, which can achieve the efficient transportation of viscosity reducer to enriched oil areas. CVRL has applied 400 wells until now, increasing oil production by 470000 tons, saving 81000 tons of standard coal, reducing CO2 emissions by 174000 tons, and reducing production costs by 60%. It promotes the transformation of heavy oil towards low energy consumption, low carbon emissions, and low-cost development.

Keywords: heavy oil, chemical viscosity-reduction, low carbon, viscosity reducer, plugging agent

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Authors: D. Aubin, D. Won, H. Schleibinger, P. Lajoie, D. Gauvin, J.-M. Leclerc

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This paper describes the results obtained in a two-year randomized intervention field study investigating the impact of ventilation rates on indoor air quality (IAQ) and the respiratory health of asthmatic children in Québec City, Canada. The focus of this article is on the comparative effectiveness of heat recovery ventilators (HRVs) and energy recovery ventilators (ERVs) at increasing ventilation rates, improving IAQ, and maintaining an acceptable indoor relative humidity (RH). In 14% of the homes, the RH was found to be too low in winter. Providing more cold and dry outside air to under-ventilated homes in winter further reduces indoor RH. Thus, low-RH homes in the intervention group were chosen to receive ERVs (instead of HRVs) to increase the ventilation rate. The installation of HRVs or ERVs led to a near doubling of the ventilation rates in the intervention group homes which led to a significant reduction in the concentration of several key of pollutants. The ERVs were also effective in maintaining an acceptable indoor RH since they avoided excessive dehumidification of the home by recovering moisture from the exhaust airstream through the enthalpy core, otherwise associated with increased cold supply air rates.

Keywords: asthma, field study, indoor air quality, ventilation

Procedia PDF Downloads 274

Authors: Ayat N. El-Shazly, Dina Magdy Abdo, Hamdy Maamoun Abdel-Ghafar, Xiangju Song, Heqing Jiang

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Product water recovery and draw solution (DS) reuse is the most energy-intensive stage in forwarding osmosis (FO) technology. Sucrose solution is the most suitable DS for FO application in food and beverages. However, sucrose DS recovery by conventional pressure-driven or thermal-driven concentration techniques consumes high energy. Herein, we developed a spontaneous and sustainable solar-driven evaporation process based on a photothermal membrane for the concentration and recovery of sucrose solution. The photothermal membrane is composed of multi-walled carbon nanotubes (f-MWCNTs)photothermal layer on a hydrophilic polyvinylidene fluoride (PVDF) substrate. The f-MWCNTs photothermal layer with a rough surface and interconnected network structures not only improves the light-harvesting and light-to-heat conversion performance but also facilitates the transport of water molecules. The hydrophilic PVDF substrate can promote the rapid transport of water for adequate water supply to the photothermal layer. As a result, the optimized f-MWCNTs/PVDF photothermal membrane exhibits an excellent light absorption of 95%, and a high surface temperature of 74 °C at 1 kW m−2 . Besides, it realizes an evaporation rate of 1.17 kg m−2 h−1 for 5% (w/v) of sucrose solution, which is about 5 times higher than that of the natural evaporation. The designed photothermal evaporation process is capable of concentrating sucrose solution efficiently from 5% to 75% (w/v), which has great potential in FO process and juice concentration.

Keywords: solar, pothothermal, membrane, MWCNT

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Authors: M. Asgari, N. Heydari, N. Shojai Kaveh, S. N. Ashrafizadeh

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Chemical flooding methods are having importance in enhanced oil recovery to recover the trapped oil after conventional recovery, as conventional oil resources become scarce. The surfactant/alkaline process consists of injecting alkali and synthetic surfactant. The addition of surfactant to injected water reduces oil/water IFT and/or alters wettability. The alkali generates soap in situ by reaction between the alkali and naphthenic acids in the crude oil. Oil recovery in fractured reservoirs mostly depends on spontaneous imbibition (SI) of brine into matrix blocks. Thus far, few efforts have been made toward understanding the relative influence of capillary and gravity forces on the fluid flow. This paper studies the controlling mechanisms of spontaneous imbibition process in chalk formations by consideration of type and concentration of surfactants, CMC, pH and alkaline reagent concentration. Wetting properties of carbonate rock have been investigated by means of contact-angle measurements. Interfacial-tension measurements were conducted using spinning drop method. Ten imbibition experiments were conducted in atmospheric pressure and various temperatures from 30°C to 50°C. All experiments were conducted above the CMC of each surfactant. The experimental results were evaluated in terms of ultimate oil recovery and reveal that wettability alteration achieved by nonionic surfactant, which led to imbibition of brine sample containing the nonionic surfactant, while IFT value was not in range of ultra low. The displacement of oil was initially dominated by capillary forces. However, for cationic surfactant, gravity forces was the dominant force for oil production by surfactant solution to overcome the negative capillary pressure.

Keywords: alkaline, capillary, gravity, imbibition, surfactant, wettability

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Authors: Juliana C. Alencar, Monica Ferreira do Amaral Porto

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Watercourses in Brazilian urban areas are constantly being degraded due to the unplanned use of the urban space; however, due to the different contexts of land use and occupation in the river watersheds, different intervention strategies are required to requalify them. When it comes to requalifying watercourses, we can list three main techniques to fulfill this purpose: restoration, revitalization and recovery; each one being indicated for specific contexts of land use and occupation in the basin. In this study, it was demonstrated that the application of these three techniques to three small basins in São Paulo city, listing the aspects involved in each of the contexts and techniques of requalification. For a protected watercourse within a forest park, renaturalization was proposed, where the watercourse is preserved in a state closer to the natural one. For a watercourse in an urban context that still preserves open spaces for its maintenance as a landscape element, an intervention was proposed following the principles of revitalization, integrating the watercourse with the landscape and the population. In the case of a watercourse in a harder context, only recovery was proposed, since the watercourse is found under the road system, which makes it difficult to integrate it into the landscape.

Keywords: sustainable drainage, river restoration, river revitalization, river recovery

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Authors: Guncel Ozturk

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Background: Rhinoplasty is the most commonly performed cosmetic operations in plastic surgery. Maneuvers used in rhinoplasty lead to a firm and stiff nasal tip in the early postoperative months. This unnatural stability of the nose may easily cause distortion in the reshaped nose after severe trauma. Moreover, a firm nasal tip may cause difficulties in performing activities such as touching, hugging, or kissing. Decreasing the stability and increasing the mobility of the nasal tip would help rhinoplasty patients to avoid these small but relatively important problems. Methods: We use delivery approach with closed rhinoplasty and changed positions of intranasal incisions to reach a dynamic and mobile nose. A total of 203 patients who had undergone primary closed rhinoplasty in private practice were inspected retrospectively. Posterior strut flap that was connected with connective tissues in the caudal of septum and the medial crurals were formed. Cartilage of the posterior strut graft was left 2 mm thick in the distal part of septum, it was cut vertically, and the connective tissue in the distal part was preserved. Results: The median patient age was 24 (range 17-42) years. The median follow-up period was15.2 (range12-26) months. Patient satisfaction was assessed with the 'Rhinoplasty Outcome Evaluation' (ROE) questionnaire. Twelve months after surgeries, 87.5% of patients reported excellent outcomes, according to ROE. Conclusion: The soft tissue connections between that segment and surrounding structures should be preserved to save the support of the tip while having a mobile tip at the same time with this method. These modifications would access to a mobile, non-stiff, and dynamic nasal tip in the early postoperative months. Further and prospective studies should be performed for supporting this method.

Keywords: closed rhinoplasty, dynamic, mobile, tip

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Authors: Ehsan Ahmed Yahia

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Introduction: The nursing role in nutrition screening and assessing hospitalized patients is important. Malnutrition is a common and costly problem, particularly among hospitalized patients, and can have an adverse effect on the healing process. The study's goal is to assess the prevalence of malnutrition among adult hospitalized orthopedic patients and to detect the barriers to the nutrition screening process. Aim of the study: This study aimed to (a) assess the prevalence of malnutrition in hospitalized orthopedic patients and (b) evaluate the relationship between malnutrition and selected clinical outcomes. Material and Methods: This prospective field study was conducted for three months between 03/2022 and 06/2022 in the selected orthopedic departments in a teaching hospital affiliated withCairo University, Egypt. with a total number of one hundred twenty (120) patients. Patients' assessment included checking for malnutrition using the Nutritional Risk Screening Questionnaire. Patients at risk for malnourishment were defined as NRS score ≥ 3. Clinical outcomes under consideration included 1) length of hospitalization, 2) mobilization after surgery and conservative treatment, and 3) rate of adverse events. Results: This study found that malnutrition is a significant problem among patients hospitalized in an orthopedic ward. The prevalence of malnutrition was the highest in patients with lumbar spine and pelvis fractures, followed by the proximal femur and proximal humerus fractures. Patients at risk for malnutrition had significantly prolonged hospitalization, delayed postoperative mobilization, and increased incidence of adverse events.27.8% of the study sample were at risk for malnutrition. The highest prevalence of malnourishment was found in Septic Surgery with 32%, followed by Traumatology with 19.6% and Arthroplasty with 15.3%. A higher prevalence of malnutrition was detected among patients with typical fractures, such as lumbar spine and pelvis (46.7%), proximal femur (34.4%), and proximal humeral (23.7%) fractures. Additionally, patients at risk for malnutrition showed prolonged hospitalization (14.7 ± 11.1 vs. 21.2 ± 11.7 days), delayed postoperative mobilization (2.3 ± 2.9 vs. 4.1 ± 4.9 days), and delayed to mobilize after conservative treatment (1.1 ± 2.7 vs. 1.8 ± 1.9 days). A significant statistical correlation of NRS with individual parameters (Spearman's rank correlation, p < 0.05) was observed. The rate of adverse incidents in patients at risk for malnutrition was significantly higher than that of patients with a regular nutritional status (37.2% vs. 21.1%, p < 0.001). Conclusions: Our results indicate that the prevalence of malnutrition in surgical patients is significant. The nutritional status of patients with typical fractures is especially at risk. Prolonged hospitalization, delayed postoperative mobilization, and delayed mobilization after conservative treatment is significantly associated with malnutrition. In addition, the incidence of adverse events in patients at risk for malnutrition is significantly higher.

Keywords: malnutrition, nutritional risk screening, surgery, nursing, orthopedic nurse

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Authors: Javed Younas

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Fiscal challenges pervade the electricity sector in many developing countries. Low bill payment and high theft mean utility customers have little incentive to conserve. It also means electricity distribution companies have less to invest in infrastructure maintenance, modernization, and technical upgrades. The low-quality electricity services can result impair the economic benefits from connections to the electrical grid. We study the impacts of two interventions implemented in Karachi, Pakistan, with the goal of reducing distribution losses and increasing revenue recovery: infrastructure improvements that made illegal connections physically more difficult and institutional innovations designed to increase communities’ trust in and cooperation with the utility. Using differences in implementation timing across space, we estimate the interventions’ impacts before the COVID-19 pandemic and their role in mitigating the pandemic’s effects on electricity services. Results indicate that the infrastructure improvements reduced losses, as well as the electricity delivered to the distribution system, a proxy for a generation. The institutional innovations significantly impacted revenue recovery, but not losses in their initial months; however, the efforts mitigated the pandemic’s negative effect on the utility finances.

Keywords: electricity, infrastructure, losses, revenue recovery

Procedia PDF Downloads 197

Authors: Shilkin A.G., Goncharov D.V., Rotanov D.A., Voitecha M.A., Kulyagina Y.I., Mochalova U.E.

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Context: Phacoemulsification is a surgical technique used to remove cataracts, but it has a higher number of complications when dense cataracts are present. The risk factors include thin posterior capsule, dense nucleus fragments, and prolonged exposure to high-power ultrasound. To minimize these complications, various methods are used. Research aim: The aim of this study is to develop and implement optimal methods of ultrasound phacoemulsification for dense cataracts in order to minimize postoperative complications. Methodology: The study involved 36 eyes of dogs with dense cataracts over a period of 5 years. The surgeries were performed using a LEICA 844 surgical microscope and an Oertli Faros phacoemulsifier. The surgical techniques included the optimal technique for breaking the nucleus, bimanual surgery, and the use of Akahoshi prechoppers. Findings: The complications observed during the surgery included rupture of the posterior capsule and the need for anterior vitrectomy. Complications in the postoperative period included corneal edema and uveitis. Theoretical importance: This study contributes to the field by providing insights into the special features of phacoemulsification for dense cataracts. It highlights the importance of using specific techniques and settings to minimize complications. Data collection and analysis procedures: The data for the study were collected from surgeries performed on dogs with dense cataracts. The complications were documented and analyzed. Question addressed: The study addressed the question of how to minimize complications during phacoemulsification surgery for dense cataracts. Conclusion: By following the optimal techniques, settings, and using prechoppers, the surgery for dense cataracts can be made safer and faster, minimizing the risks and complications.

Keywords: dense cataracts, phacoemulsification, phacoemulsification of cataracts in elderly dogs, осложнения факоэмульсификации

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Authors: Christoph Speer

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Decentralized ventilation systems should combine a small and economical design with high aerodynamic and thermal efficiency. The Counter Flow Heat Recovery Fan (CHRF) provides the ability to meet these requirements by using only one cross flow fan with a large number of blades to generate both airflows and which simultaneously acts as a regenerative counter flow heat exchanger. The successful development of the first laboratory prototype has shown the potential of this ventilation system. Occurring condensate on the surfaces of the fan blades during the cold and dry season can be recovered through the characteristic mode of operation. Hence the CHRF provides the possibility to avoid the need for frost protection and condensate drain. Through the implementation of system-specific solutions for flow balancing and summer bypass the required functionality is assured. The scalability of the CHRF concept allows the use in renovation as well as in new buildings from single-room devices through to systems for office buildings. High aerodynamic and thermal efficiency and the lower number of required mechatronic components should enable a reduction in investment as well as operating costs. The rotor is the key component of the system, the requirements and possible implementation variants are presented.

Keywords: CHRF, counter flow heat recovery fan, decentralized ventilation system, renovation

Procedia PDF Downloads 355

Authors: Mrudula Kudtarkar, Rajesh Mane

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Introduction: Cleft lip repair is one of the common surgeries performed in India and the usual method used for post-operative analgesia is perioperative opioids and NSAIDs. There has been an increase in use of regional techniques and Opioids are the common adjuvants but their efficacy and safety have not been studied extensively in children. Aim: A prospective, randomized, double-blind study was done to compare the efficacy, duration and safety of intraoral infraorbital nerve block on post-operative pain relief using bupivacaine alone or in combination with fentanyl or pethidine in paediatric cleft lip repair. Methodology: 45 children between the age group 5 – 60 months undergoing cleft lip surgery randomly allocated into 3 groups of 15 each received bilateral intraoral infraorbital nerve block with 0.75ml of solution. Group B received 0.25% bupivacaine; group P received 0.25% bupivacaine with 0.25mg/kg pethidine, group F received 0.25% bupivacaine with 0.25microgm/kg fentanyl. Sedation after recovery, post-operative pain intensity and duration of post-operative analgesia were assessed using Modified Hannallah Pain Score. Results: The mean duration of analgesia was 17.8 hrs in Group B, 23.53 hrs in Group F and 35.13 hrs in Group P. There was statistically significant difference between the means of the three groups- ANOVA (p < 0.05). Conclusion: Thus we conclude that addition of fentanyl or pethidine to bupivacaine for Bilateral Intraoral Infraorbital Nerve Block prolong the duration of analgesia with no complications and can be used safely in paediatric patients.

Keywords: cleft lip, infraorbital block, NSAIDS, Opiods

Procedia PDF Downloads 237

Authors: H. Vahdani

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By the adsorption of polar compounds and/or the deposition of organic material, the wettability of originally water-wet reservoir rock can be altered. The degree of alteration is determined by the interaction of the oil constituents, the mineral surface, and the brine chemistry. Recently improving oil recovery by tuning wettability alteration is believed as a new recovery method. Various researchers have demonstrated that low salt water injection has a significant impact on oil recovery. It has been shown, for instance, that additional oil can be produced from reservoir rock by managing the injection water. Large wettability sensitivity has been observed, indicating that the oil/water capillary pressure profiles play a major role during low saline water injection simulation. Although the exact physics on how this alteration occurs is still a research topic; however, it has been reported that some of its effect can be captured by a relative permeability shift from an oil-wet system to a water-wet system. Modeling of low salt water injection mainly is based on the theory of wettability alteration and is hence strongly dependent on the wettability of the reservoir. In this article, combination of different wettabilities has been simulated and it is observed that the highest recoveries were from the cases were the reservoir initially was water-wet, and the lowest recoveries was from the cases were the reservoir initially was considered oil-wet. However for the cases where the reservoir initially was oil-wet, the effect of low-salinity waterflooding was the largest.

Keywords: low salt water injection, wettability alteration, modelling, relative permeability

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Authors: Mateusz Kudasik, Katarzyna Kozieł

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The work included detailed studies of CO₂/CH₄ exchange on a shale core from the Lewino-1G2 well (Poland) from a depth of 3408 m. The sample permeability coefficients were determined under conditions of confining pressure from 5 MPa to 35 MPa. These studies showed that at a confining pressure of 35 MPa – corresponding to a depth of about 1000 m, the shale core was impermeable in the direction perpendicular to the bedding, and in the direction parallel to the bedding, the sample had very low permeability (k∞=0.001 mD). The sorption tests performed showed low sorption capacities, which amounted to a maximum of 1.28 cm³/g in relation to CO₂ and 0.87 cm³/g to CH₄ at a pressure of 1.4 MPa. The most important study used to assess the possibilities of CO₂ storage and gas recovery from shale rocks were the CO₂/CH₄ exchange experiments, which were carried out under confining pressure conditions of 5 MPa and 30 MPa. These experiments were carried out on a unique apparatus, which makes it possible to apply a confining pressure corresponding to in situ conditions. The obtained results made it possible to carry out a comprehensive balance of gas exchange during the injection of CO₂ into the shale sample, with simultaneous recovery of CH₄. Based on the conducted sorption and gas exchange studies on the core sample under confining pressure conditions, it was found that in situ conditions, at the depths of shale gas occurrence in Poland of 3000-4000 m, where the confining pressure can be about 100 MPa: (i) poorly developed pore structure, (ii) very low permeability, and (iii) low sorption properties, make shale rocks poorly predisposed to the application of CO₂ storage technology with simultaneous recovery of CH₄. Without the stimulation of CO₂/CH₄ exchange rates through fracturing processes, the effectiveness of CO₂-ESGR technology on shale rock is very low. The research presented in this work is extremely important from the point of view of precise assessment of the potential of CO₂-ESGR technology.

Keywords: shale gas, shale rocks, CO₂/CH₄ exchange, permeability, sorption, CO₂, CH₄

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Authors: Avinashkumar Karre

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Sulfur recovery unit, most commonly called as Claus process, is very significant gas desulfurization process unit in refinery and gas industries. Explorations of new natural gas fields, refining of high-sulfur crude oils, and recent crude expansion projects are needing capacity expansion of Claus unit for many companies around the world. In refineries, the sulphur recovery units take acid gas from amine regeneration units and sour water strippers, converting hydrogen sulfide to elemental sulfur using the Claus process. The Claus process is hydraulically limited by mass flow rate. Reducing the pressure drop across control valves, flow meters, lines, knock-out drums, and packing improves the capacity. Oxygen enrichment helps improve the capacity by removing nitrogen, this is more commonly done on all capacity expansion projects. Typical upgrades required due to oxygen enrichment are new burners, new refractory in thermal reactor, resizing of 1st condenser, instrumentation changes, and steam/condensate heat integration. Some other capacity expansion options typically considered are tail gas compressor, replacing air blower with higher head, hydrocarbon minimization in the feed, water removal, and ammonia removal. Increased capacity related upgrades in sulfur recovery unit also need changes in the tail gas treatment unit, typical changes include improvement to quench tower duty, packing area upgrades in quench and absorber towers and increased amine circulation flow rates.

Keywords: Claus process, oxygen enrichment, sulfur recovery unit, tail gas treatment unit

Procedia PDF Downloads 125