Case Report Spontaneous Rectus Sheath Hematoma in the Elderly: An Unusual Case and Update on Proper Management

Spontaneous rectus sheath hematoma (SRSH) is an uncommon medical emergency in the elderly. We present a case of SRSH with an atypical clinical presentation and discuss literature regarding diagnosis and proper management. A 75-year-old female patient was transferred to the emergency department due to acute dyspnoea and confusion. Her medical history revealed a viral infection of the upper respiratory tract, and no coughing or use of anticoagulants. The clinical examination showed tenderness of the left lower abdomen, although palpation was misleading due to patient's obesity. Laboratory investigations showed light anaemia. Ultrasonography and computed tomography revealed a large rectus sheath hematoma of the left abdominal wall. Despite further deterioration of the patient, conservative management including bed rest, fluid replacement, blood products transfusion, and proper analgesia was successful. No surgical intervention was needed. Prompt diagnosis and management of SRSH plays significant role in the prognosis, especially in elder patients. Independently of size and severity, conservative management remains the first therapeutic choice. Only by failure of supportive management, progressive and large hematoma or uncontrollable hemodynamic patients, interventional management including surgery or less invasive newer techniques is indicated

Spontaneous Rectus Sheath Hematoma in the Elderly: An Unusual Case and Update on Proper Management

Spontaneous rectus sheath hematoma (SRSH) is an uncommon medical emergency in the elderly. We present a case of SRSH with an atypical clinical presentation and discuss literature regarding diagnosis and proper management. A 75-year-old female patient was transferred to the emergency department due to acute dyspnoea and confusion. Her medical history revealed a viral infection of the upper respiratory tract, and no coughing or use of anticoagulants. The clinical examination showed tenderness of the left lower abdomen, although palpation was misleading due to patient’s obesity. Laboratory investigations showed light anaemia. Ultrasonography and computed tomography revealed a large rectus sheath hematoma of the left abdominal wall. Despite further deterioration of the patient, conservative management including bed rest, fluid replacement, blood products transfusion, and proper analgesia was successful. No surgical intervention was needed. Prompt diagnosis and management of SRSH plays significant role in the prognosis, especially in elder patients. Independently of size and severity, conservative management remains the first therapeutic choice. Only by failure of supportive management, progressive and large hematoma or uncontrollable hemodynamic patients, interventional management including surgery or less invasive newer techniques is indicated

Extraosseous Ewing Sarcoma: Diagnosis, Prognosis and Optimal Management

Extraosseous Ewing sarcomas (EESs) are rare tumours originating from soft tissues. Their clinical picture depends mainly on the primary site of the sarcoma. Patient characteristics and outcomes seem to be different in EES compared to patients with skeletal Ewing sarcoma, with implications for patient care and prognosis. However, multimodality therapeutic strategies are recommended for all types of the Ewing tumour family. The available diagnostic tools include ultrasonographic evaluation and computed tomography (CT) or magnetic resonance imaging as well as histopathologic and immunohistochemical tissue examination. Several histologic and genetic biomarkers have been established, although their utilization needs to be further tested by larger prospective studies. Regarding localized disease, the recommended treatment remains surgery. However, chemotherapy can be added to achieve improved survival, with neoadjuvant regimens showing more promising results than adjuvant regimens. Radiotherapy is an option to obtain local control, although its complications have reduced its utilization. In metastatic or recurrent disease, systematic chemotherapy improves survival

Techno-economic assessment of landfill gas (LFG) to electric energy: selection of the optimal technology through field-study and model simulation

Summarization: Landfill Gas (LFG) is a renewable energy resource. LFG quality and production rate are determined factors for the selection of the optimal technology for electric energy production. Environmental legislation, flue gas emissions, carbon footprint and maturity of technology should also be considered. The most common process for electric energy production from LFG is by Internal Combustion Engines (ICEs), which require approximately 40% minimum methane concentration. Microturbines have been also employed for electric energy production from LFG, requiring minimum methane concentration of approximately 35%. On the other hand, a relatively novel process, Gradual Oxidation (GO), can produce electric energy from LFG at methane concentrations as low as 1.5%. The present study examines the applicability of the above technologies for electric energy production from LFG, from various cells, at the landfill of Heraklion, Crete, Greece, from an economic point of view. The LandGEM (EPA) simulation model has been modified to account for the long them reduction of methane concentration in LFG, and has been adjusted, based on field measurements. The Net Present Values (NPVs) (for 15-years and 25-years from installation) for three distinct scenarios, with total electric energy production capacity of 800 kW, per scenario (using just ICEs, combination of ICE and GO or just microturbines), were calculated. The results indicated that the most profitable scenario (among the ones studied) was the one with the use of two microturbines with capacity 400 kW, each, yielding 15-years and 25-yeasr NPVs of 2.68 and 3.69 M€, respectively, for initial capital investment of 2.24 M€.Presented on: Chemospher