Case Report Primary Amyloidosis Manifesting as Cholestatic Jaundice after Laparoscopic Cholecystectomy

A 71-year-old female patient with cholelithiasis who had undergone laparoscopic cholecystectomy was admitted with obstructive jaundice (total bilirubin ∼6 mg/dL) three months later. An ERCP was performed, in which a gallstone was found, followed by a sphincterotomy and cleansing of the bile duct. Due to deterioration of jaundice (>25 mg/dL), a new, unsuccessful ERCP and stent placement was carried out. Because of ongoing cardiac failure, she underwent an echocardiogram which revealed restrictive cardiomyopathy possibly due to amyloidosis. A liver biopsy was performed, which was positive for amyloid deposits in the liver, and the diagnosis was confirmed by the detection of monoclonal IgG protein in urine. The patient's jaundice gradually deteriorated and she died one week later from hepatic insufficiency

Investigation of the parameters affecting the thermosiphonic phenomenon in solar water heaters

Cyprus is currently the leading country in the world with respect to the application of solar water heaters for domestic applications, with more than 93% of the houses equipped with such a system. The great majority of these solar water heaters are of the thermosiphonic type. Thermosiphonic is a natural phenomenon where the flow of the solar heated water from the collector to the storage tank occurs from a small flow created due to the difference in density between hot and cold water. The main advantage of such systems is that they do not require a pump for circulating the water and circulation exists as long as there is sunshine. This reduces the maintenance requirements and the system is foolproof. In spite of the fact that extensive analyses of the performance of solar water heaters has been carried out by numerous researchers, almost all of them concerned forced circulation systems which use a circulating pump. Currently, the knowledge on the parameters affecting the ‘thermosiphonic phenomenon’ is rather poor while on an international level (ISO and CEN committees) there isn’t any standard to test thermosiphon solar collectors. The deeper understanding of the ‘thermosiphonic phenomenon’ and the identification of the key parameters affecting it, is the main aim of a research project currently in process in Cyprus. In this work the first preliminary results of the experimental procedure are presented. More specifically, a special test rig was set up and equipped with all sensors necessary to measure all parameters that are most likely to affect the ‘thermosiphonic phenomenon’. All tests were conducted according to ISO 9459- 2:1995(E). The system was able to operate in various weather and operating conditions and could accommodate the change of inclination of the collector. Initially, the solar collector was tested according to EN12975-2:2006 in order to determine the thermal performance at a flow and operation conditions specified by the standard. Subsequently, the efficiency of the collector operating thermosiphonically was calculated based on quasi-dynamic approach. Finally, a series of correlations were attempted using the data acquired when the collector is operating themosiphonically which are the following: (i) the temperature difference of the water at the outlet and the inlet of the collector (ΔΤ) with the solar global radiation, (ii) the water mass flow with the solar global radiation, (iii) the water mass flow with the temperature difference of the water at the outlet and the inlet of the collector (ΔΤ). The results of the data analysis showed that these parameters are very well correlated between them since the coefficient of determination (R2) is over 0.91 in all cases

Experimental investigation of the thermosiphonic phenomenon in domestic solar water heaters

The deeper understanding of the ‘thermosiphonic phenomenon’ and the identification of the key parameters affecting it, is the main aim of a research project currently in process in Cyprus. In this work a review of the existing standards and scientific knowledge concerning domestic solar water heaters is presented. The first preliminary results of the experimental investigation of the ‘thermosiphonic phenomenon’ in domestic solar water heaters are also presented. For this purpose a special test rig was set up and equipped with all sensors necessary to measure all parameters that are most likely to affect the ‘thermosiphonic phenomenon’. All tests were conducted according to ISO 9459- 2:1995(E). At first, the solar collector was tested according to EN12975-2:2006 in order to determine the thermal performance characteristics at a flow and operation conditions specified by the standard. Consequently, the efficiency of the collector operating thermosiphonically was calculated based on quasi-dynamic approach. Finally, a series of correlations were attempted using the data acquired when the collector is operating themosiphonically which are the following: (i) the temperature difference of the water at the outlet and the inlet of the collector (ΔΤ) with the solar global radiation, (ii) the water mass flow with the solar global radiation, (iii) the water mass flow with the temperature difference of the water at the outlet and the inlet of the collector (ΔΤ). The results of the data analysis showed that these parameters are very well correlated between them since the coefficient of determination (R2) is over 0.91 in all cases

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Experimental investigation of the night heat losses of hot water storage tanks in thermosyphon solar water heaters

The effects of night heat losses on the performance of thermosyphon solar water heaters have been experimentally examined. Three typical thermosyphon solar water heating systems with different storage tank sizes were tested by utilising the method suggested by ISO 9459-2:95. The results were analysed to quantify the night heat losses and to investigate the effect that these may have on the system daily performance. Analysis of the results showed that a linear behavior of the heat losses with the night mean ambient temperature exists. The correlation coefficients of the linearity, for the three systems under consideration, range from 0.93 to 0.97, with the losses reaching almost 8000 kJ at a mean ambient air temperature of 10 C. This value represents a significant percentage of the daily collected energy, making the night losses one of the most important sources of energy loss in thermosyphonic systems

Generation of a “typical meteorological year” for Nicosia, Cyprus

The present study is concerned with the generation of a Typical Meterological Year for Nicosia, Cyprus. The above tool will be useful for the prediction and comparison of the performance and cost effectiveness of passive and active solar systems in the island. The Typical Meteorological Year was generated from available hourly meteorological data recorded during the period 1986–1992, using the Filkenstein-Schafer statistical method

Primary Amyloidosis Manifesting as Cholestatic Jaundice after Laparoscopic Cholecystectomy

A 71-year-old female patient with cholelithiasis who had undergone laparoscopic cholecystectomy was admitted with obstructive jaundice (total bilirubin ~6 mg/dL) three months later. An ERCP was performed, in which a gallstone was found, followed by a sphincterotomy and cleansing of the bile duct. Due to deterioration of jaundice (>25 mg/dL), a new, unsuccessful ERCP and stent placement was carried out. Because of ongoing cardiac failure, she underwent an echocardiogram which revealed restrictive cardiomyopathy possibly due to amyloidosis. A liver biopsy was performed, which was positive for amyloid deposits in the liver, and the diagnosis was confirmed by the detection of monoclonal λ IgG protein in urine. The patient’s jaundice gradually deteriorated and she died one week later from hepatic insufficiency