Casing Design for High Pressure/High Temperature Wells

A satisfactorily and economically viable Surface and Intermediate Casing are designed for a high pressure, high temperature (HPHT) well (Nini-55) in the Niger Delta Basin. Based on the estimated parameters (Pore Pressure, Fracture Gradient, and Pressure Gradient) the Burst, Collapse and Tension loads were calculated employing their various design and safety factors. Based on the design calculations, the relevant physical properties (weight, grade, connector, and diameter) were selected from tables or Casing Catalogues. These properties were matched onto each design and the best combination strings were used. The numerical values of these design loads were plotted on a graph and interpreted. Also, treated in this work are the possible remedies for high pressure, high temperature wells. Keywords: surface casing, intermediate casing, burst pressure, collapse pressure, axial tensio

Empyema Thoracis in Zaria; a Preliminary Report

Aims and ObjectiveTo study the nature and pattern of presentation of empyema thoracis (and the association between duration or time of presentation and educational level and level of income respectively), the aetiology, and different treatment outcomes.                                                                Materials and MethodsA prospective study of all patients who presented with Empyema Thoracis between January 2008 to May 2010 was carried out at ABUTH Zaria. Thediagnosis of empyema thoracis was entertained from either the presence of pus in the pleural space or the culture of actively multiplying bacteria in a serous Data was analysed with SPSS 15.ResultsA total of 26 patients were managed, 19(73.1%) men, 7(26.9%) women. There were 4(15.4%) acute and 22(84.6%) chronic empyema. One male had bilateral chronic empyema giving 13 right-sided, and 14 left-sided empyema. Tuberculosis was responsible for 26.9% of the cases, 38.4% were postpneumonic, while postoperative, and AIDS were each responsible for 11.5% and trauma 7.7%. Five patients had decortication, 2 had rib resection and open drainage, and the remainder were managed on tube thoracostomy. Two patients were discharged against medical advice, 6 were lost during follow-up. Fourteen (53.8%) were educated (1 acute and 13 chronic). Twelve (46.2 %) were uneducated (3 acute and 9 chronic). Fourteen patients (2 acute and 12 chronic) earned average or above average income while 12 (46.2%) earned below average income (2 acute and 10 chronic). There was no association between duration of presenting complaints and level of education or level of income (Fisher's exact test was, 0.306 and 1.000, respectively) at a P value of 0.05.                          ConclusionEmpyema thoracis is persistent and prevalent in our environment despite improvements in diagnosis, treatment and prevention. Most patients present late and this is not related to income or level of education. The commonest organism isolated from empyema fluid in developing countries is Staphylococcus aureus but most empyema fluid are sterile due to prolong antibiotic use. The factors responsible for delayed presentation, the pattern of presentation and the pathology and outcome of treatment is part of an ongoing study.Key Words: Empyema Thoracis, Presentation, Aetiology, Treatmen

A Comparative Study of the Performance of Water Hyacinth (Eichhornia Crassipes) and Water Lettuce (Pistias Stratiotes) in the Remediation of Produced Water

The study presents the characteristics of produced water obtained from a detention pit in the Niger Delta region of Nigeria. Phytoremediation, an emerging remediation technology for contaminated soils, groundwater, surfacewater and wastewater that is both low-tech, low-cost, and environmental friendly have been employed in this study. Two aquatic macrophytes: water hyacinth (Eichhornia crassipes) and water lettuce (Pistias stratiostes) have been used to remediate this produced water harmless in the environment. The two aquatic macrophytes were comparatively studied to determine their effectiveness in remediation without the use of fertilizers to sustain their growth. Also, physico-chemical parameters were compared with standard discharge limits stipulated by the Department of Petroleum Resources (DPR). Parameters such as pH, EC, salinity, TDS, TSS, DO, BOD, COD, turbidity, sulphate, phosphate, ammonia, oil and grease, Cu, Pb, Cr, Zn, Fe, and total coliform of the produced water have been studied using standard protocol of APHA and ASTM. The physico-chemical analysis revealed that most of the parameters were above the permissible limits and that water hyacinth made a better clean up than water lettuce. One-way ANOVA analysis of variance was used to test for significant difference. Recommendations were also made for better cleanup goals and plants survivals. Keywords: produced water, phytoremidiation, aquatic macrophytes, water lettuce, water hyacinth, contaminants

Indications and Complications of Tube Thoracostomy with Improvised Underwater Seal Bottles

Background: Tube thoracostomy is a lifesaving and frequently performed procedure in hospitals where the expertise and necessary tools are available. Where the ideal drainage receptacle is unavailable, the underwater seal device can be improvised with bottled water plastic can especially in emergency situations. Aims and Objectives: To determine the frequencies of the various indications and complications of tube thoracostomy with improvised underwater seal. Materials and Methods: A cross‑sectional study with a structured proforma was used for assessment over a 3‑year period (May 2010‑April 2013). The proforma was filled at the time of the procedure by the performing surgeon and patients were followed up with serial chest X‑rays until certified cured. A 1.5 L bottled water container was used as the underwater seal receptacle. The data was analysed with SPSS 15 software program. Results: A total of 167 patients were managed. There were 106 (63.5%) males and 61 (36.5%) females. The mean age was 34.85 ± 16.72 with a range of 1‑80 years. The most frequent indication was for malignant/paramalignant effusion, 46 (27.5%). Others were trauma, 44 (26.3%), Parapneumonic effusion, 20 (12%), postthoracotomy 14 (8.4%), empyema thoracis 12 (7.2%), heart disease and tuberculous effusion 11 (6.6%) each, pneumothorax 8 (4.8%) and misdiagnosis 1 (0.6%). A hundred and one (60.5%) of the procedures were performed by registrars, 41 (24.6%) by consultants, house officers 15 (9%) and senior registrars 10 (6%). The overall complication rate was 16.8% with the more frequent complications been empyema (5.6%) and pneumothorax (3.6%). The average duration of tube placement was 13.02 ± 12.362 days and range of 1‑110 days. Conclusion: Tube thoracostomy can be a relatively safe procedure with acceptable complication rates even with improvised underwater seal drainage bottles.Keywords: Complications, indications, improvisation, tube thoracostom

Reconstruction of the chest wall after excision of a giant malignant peripheral nerve sheath tumor

Primary chest wall tumors are uncommon and constitute 0.2-2% of all tumors. Metastatic tumors and tumors of local extension are more common. Malignant peripheral nerve sheath tumor (MPNST) of the chest wall is even rarer and its incidence on the chest wall not stated in the literature. The incidence in the general population is 0.0001% while therisk is approximately 4600 times higher in patients with type I  neurofibromatosis and 3-13% of them will finally develop into MPNST, usually after latent periods of 10-20 years. Clinically, these tumors are aggressive, locally invasive, and highly metastatic. Excision of giant chest wall tumor leaves a defect that is reconstructed using musculocutaneous flaps with or without a mesh. We report the case of a 24-year-old man who presented at the surgical outpatient clinic with 7 months history of persistent left sided chest pain minimally relieved by analgesics, 5 months of cough and worsening dyspnoea, and 3 months history of anterior chest swelling on the left side of the manubrium. Following evaluation and investigations, the tumor was excised and the residual defect closed with methylmetacrylate sandwiched between two prolene meshes and overlaid with both pectoralis major muscles. The histology of the excised mass revealed MPNST He made an uneventful postoperative recovery, but died barely 3 months later from widespread pulmonary metastases.A review of the literature revealed that such tumors hardly ever reach such large-size as in our case

Audit of Cardiothoracic Diseases seen at the National Cardiothoracic Centre Enugu Nigeria

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Zaria Universal Oxygenator Holder Phase I

Introduction: The conduct of cardiopulmonary bypass surgery requires the use of equipment and devices like the oxygenator. The oxygenator comes in different makes and each manufacturer customizes the carrier or ‘holder’ of this device specific to their design. Aim: This paper presents an innovation designed to overcome the need to purchase a different holder for every oxygenator thereby cutting the cost. Materials and Methods: A sheet of iron measuring 1.9 cm (width) × 0.1 cm (thickness) was used to design the holder circular main frame. Another sheet measuring 2 cm (width) × 0.6 cm (thickness) × 24 cm (length) was used to construct a V‑shaped handle with the arms of the V attached to the main frame 7 cm apart. At the narrow base of the handle is a latch requiring two 13‑gauge screws to attach the holder to the heart‑lung machine. Within the circumference of the main frame are four T‑shaped side arms which grip the oxygenator; located at 2, 5, 7 and 11 O’clock positions. The stem of the T consist of a 0.6 cm (thickness) × 13 cm (length) rod drilled through the main frame. The cross of the T consists of variable lengths of the same sheet as the mainframe attached to the stem by a screw mechanism. At the base of the T, is attached a circular handle (4 cm in diameter) made of 0.4 cm iron rod.Result: An oxygenator holder which weighs 1.75 kg with a total length of 54 cm (the diameter of the mainframe is 30 cm). Its advantages include (i) affordability, (ii) materials are locally accessible, (iii) versatility (iv) reproducibility. The disadvantages include, (i) it requires some time to fit, (ii) caution is required in fitting the oxygenator to avoid breakage, (iii) a spanner is required to lock the latch.Conclusion: The concept of a universal holder is pertinent, especially in resource poor environments to avoid purchasing a new holder whenever the usual oxygenator common to the centre is unavailable. This device is amenable to further modifications to meet the unforeseen challenges.Keywords: Holder, innovation, oxygenator, universa

Profile of Chest Trauma in Zaria, Nigeria: A Preliminary Report

Aims and ObjectivesTrauma continues to be a major cause of morbidity and mortality world over. This study is aimed at the patterns of presentation and the outcome of management. Materials and MethodsA prospective study of trauma patients admitted to Ahmadu Bello University Teaching Hospital through the Accident and Emergency units was commenced in January 2008.This preliminary report is for the period of 27months.The clinical history, physical examination and outcome of management recorded in a predesigned proforma, were analysed with SPSS 15 and the patients were followed up in the surgical outpatient department.ResultsA total of 4784 patients (3143 men and 1641 women) were admitted during this period for trauma. There were a total of 628(13.13%) deaths. Of the 42 consecutive patients identified with chest trauma35 (83.3%) were males and 7(16.7%) were females. The age range was from 5-75years and the mean age was 35.4years, while the most affected ages were in the range of 20 to 49years. Blunt injury constituted 71.4% and penetrating injury constituted 28.6%. Road traffic accident was responsible for 61.9%, stab injury 21.4%, falls 7.1%, gunshot injury 4.8%, impalement 2.4% and animal attack also 2.4%. The average time taken between accident and admission was 31hours,40minutes and 12seconds while the average duration of hospital stay was 16.10 days. The injury pattern included rib fracture(s) (23.8%), hemopneumothorax (14.3%), hemothorax (7.1%),pneumothorax (4.8%), combinations of chest injuries (7.1%), chest laceration 7.1%, bruises 11.9%, lung contusion 4.8%, subcutaneous empyema 2.4%, flail chest 4.8% and no specific injury (11.9%). Associated injuries included head injury (63.6%), orthopaedic injury (27.3%) and combinations (abdominal, head, orthopaedic (9.1%). The fatality of road traffic accident was 36.8%. No patient was attended to by paramedics at the scene of accident while 21.9% of the patients had prehospital resuscitation in peripheral clinics before admission. The transfusion requirement was 14.3%. One patient (2.4%) required a median sternotomy and cardiopulmonary bypass, 54.8% required tube thoracostomy while 42.9% had general resuscitation /non-operative intervention. Only one (2.4%) required ICU care. The complication rate was 4.8%. The mortality rate was 2.4%. Only 7(16.7%) patients were seen beyond the first outpatient clinic appointment.ConclusionMost patients arriving at the hospital survived, requiring general resuscitation or simple tube thoracostomy with few complications. Mortalities from trauma and the cause of death at the site of accident are often not accounted for due to nonpresentation to the hospital and lack of autopsy for those that present.Key words: Trauma, Chest, Presentations, Management,  Recommendation

Tricuspid Atresia with Normal Axis on ECG Palliated With A Central Shunt; A Case Report

Background: Tricuspid Atresia is the 3rd commonest cyanotic congenital Heart disease .It is characterized by lack of communication between the right atrium and right ventricle. The treatment often requires a palliative systemic to pulmonary shunt before definite surgery. The use of a central shunt via a median sternotomy is suggested here as an alternative to other traditional shunts via a thoracotomy. Method:The management of a 3 month old boy who presented with dyspnoea, fever, cough and cyanosis is presented here as obtained from Clinical records. Result: Following resuscitation, a central shunt (Ascending Aorta to main Pulmonary Artery) was constructed and the patient did well despite a turbulent post -operative period. Conclusion: The management of tricuspid atresia likes other cyanotic heart disease is daunting but palliative treatment is possible in our environment and definitive treatment where possible affords a fairly satisfactory prognosis. Keywords: Tricuspid Atresia, Normal Axis, Central Shunt, Prognosis and Treatment.Nigerian Journal of Medicine Vol. 17 (4) 2008: pp. 462-46