Post cholecystectomy common bile duct dilatation: a study from upper hills of Himachal Pradesh, India

Background: Relationship between cholecystectomy followed by postoperative dilatation of the common bile duct is uncertain. Various studies have shown variable results regarding the dilatation of common bile duct after cholecystectomy.Methods: This study was a 1-year prospective study conducted at IGMC, Shimla with consent and ethical approval from the committee. Total 50 cases of symptomatic cholelithiasis belonging to either sex admitted in Surgical Wards of IGMC Shimla for elective surgery were selected for the present study. Cholecystectomy was done in all cases, after doing all the investigations.Results: The mean preoperative CBD diameter in the study group was 4.2mm, 48 hours postoperatively was 5.58mm and at 1-month interval following cholecystectomy was 6.02mm, so the mean postoperative diameter observed was (6.02+5.58=5.8mm).Conclusions: Significant dilatation does occur in CBD which is purely compensatory as there was no evidence of any pathological dilatation. This dilatation occur only in early post-operative period till the CBD adapts to contain bile equal to the Gall Bladder

3D representation and CNC machining of 2D digital images

First published by Elsevier, https://dx.doi.org/10.1016/j.promfg.2018.07.001 © 2018. This open-access article is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/In this paper a new paradigm for CNC carving of digital images in the form of lookalike three-dimensional (3D) surfaces on wooden or metallic plaques is discussed. This work is focused on development of a single page windows based console application for conversion of a two-dimensional (2D) digital image into a 3D freeform surface representation in the form of a point cloud data and STL format. Subsequently, the 3D surface data is then used for generating an efficient toolpath data for 3-axis CNC finish machining using a ball end mill tool. The results from the developed algorithm are validated using a machining simulation in the virtual environment of an Open-GL based 3D graphical simulator ToolSim [1]

Laparoscopic management of a giant prostatic utricle: A case report and review of literature

Prostatic utricle is a Mullerian duct remnant with an incidence of 1 %. Excision of utricle is challenging because of the close proximity of seminal vesicle, ejaculatory ducts, bladder, rectum, ureter, and nerve plexus. Here, we report the case of a 23-year-old male presented with complaints of painful terminal hematuria associated with clots along with retrograde ejaculation. The abdominal and local examination was within normal limits. MRI pelvis showed a large non-communicating cystic structure present in the pelvic cavity, compressing posterior wall of the urinary bladder, seminal vesicle, anterior wall of the rectum and also causing left hydroureteronephrosis. After evaluation, the patient was diagnosed with giant prostatic utricle cyst. Laparoscopic excision of prostatic utricle cyst was done successfully. Postoperative period was uneventful and the patient was discharged in satisfactory condition. Laparoscopic excision of prostatic utricle cyst is technically challenging but with acceptable complications and good surgical results

Surgical management of penile mondor’s disease: Case report and brief review of literature

Penile Mondor’s disease (PMD) is a rare condition characterized by thrombosis of superficial dorsal vein of the penis. PMD is usuallycaused due to vigorous sex or repeated trauma to the penis leading to painful swelling of the penis. Most of the patients improvegradually on conservative treatment. Very rarely cord like lesion persists and causes painful erection and intercourse, meriting surgicalmanagement. Here, we report the case of a traumatic Thrombophlebitis of Superficial Dorsal Vein of Penis managed surgically alongwith a brief explanation of the surgical technique. Color Doppler was helpful in delineating the whole extent of thrombus in thevein. Excision of the whole length of the thrombosed vein was done. Abstinence from sex was advised for six weeks and the patientimproved symptomatically

Adrenocortical carcinoma with contralateral renal metastases and tumor thrombus: A case report

Adrenocortical carcinoma (ACC) is a rare aggressive malignancy. ACC with renal vein or inferior vena cava (IVC) thrombus is very rare. ACC with contralateral renal metastasis with renal vein thrombus has never been reported. Here we report first such case in the literature where a 40-year-old male presented with right flank pain and weight loss. Definitive reoperative diagnosis failed to be established. Intraoperatively, there was right adrenal mass with left renal vein thrombus invading its wall and extending upto IVC. Right adrenalectomy with left radical nephrectomy with thrombectomy was done. On cut specimen, there was a small mass lesion in the left kidney (upper pole). The diagnosis of ACC with left renal metastasis and renal vein tumor thrombus was confirmed by pathological and immune-histochemical examination. We faced various perioperative challenges in our case. Care must be taken in  preoperative diagnostics, intraoperative planning, and postoperative management as ACC may present with contralateral renal metastasis and tumor thrombus.&nbsp

Modeling and sensitivity analysis of grid-connected hybrid green microgrid system

The demonstrated research work analyses the technoeconomic modelling and sensitivity analysis of the available resources for the rural community in India. The various resources used in this study are solar, wind, hydro, battery and utility grid-connected system. The usefulness of the on-grid system in the rural sector is that excess amount of electricity produced through renewable energy sources (RES) could be sold back to the utility grid. A total of 12 possible configurations of various resources with and without a grid-connected system was analyzed for minimum Levelized Cost of Energy (LCOE) and Total Net Present Cost (TNPC). Further, sensitivity analysis is accomplished for different sensitive variables to understand the nature of the system for wider application in rural communities. The solar-wind-hydro-based utility grid-connected network is observed to be the best optimal configuration with a minimum value of LCOE of 0.056 $/kWh. The simulation results reveal that the effective utilization of RES has been a cost-efficient and reliable system to the power supply in remote communities

Proctitis following stereotactic body radiation therapy for prostate cancer

Background Proctitis after radiation therapy for prostate cancer remains an ongoing clinical challenge and critical quality of life issue. SBRT could minimize rectal toxicity by reducing the volume of rectum receiving high radiation doses and offers the potential radiobiologic benefits of hypofractionation. This study sought to evaluate the incidence and severity of proctitis following SBRT for prostate cancer. Methods Between February 2008 and July 2011, 269 men with clinically localized prostate cancer were treated definitively with SBRT monotherapy at Georgetown University Hospital. All patients were treated to 35-36.25Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray). Rectal bleeding was recorded and scored using the CTCAE v.4. Telangiectasias were graded using the Vienna Rectoscopy Score (VRS). Proctitis was assessed via the Bowel domain of the Expanded Prostate Index Composite (EPIC)-26 at baseline and at 1, 3, 6, 9, 12, 18 and 24 months post-SBRT. Results The median age was 69 years with a median prostate volume of 39 cc. The median follow-up was 3.9 years with a minimum follow-up of two years. The 2-year actuarial incidence of late rectal bleeding ≥ grade 2 was 1.5%. Endoscopy revealed VRS Grade 2 rectal telangiectasias in 11% of patients. All proctitis symptoms increased at one month post-SBRT but returned to near-baseline with longer follow-up. The most bothersome symptoms were bowel urgency and frequency. At one month post-SBRT, 11.2% and 8.5% of patients reported a moderate to big problem with bowel urgency and frequency, respectively. The EPIC bowel summary scores declined transiently at 1 month and experienced a second, more protracted decline between 6 months and 18 months before returning to near-baseline at two years post-SBRT. Prior to treatment, 4.1% of men felt their bowel function was a moderate to big problem which increased to 11.5% one month post-SBRT but returned to near-baseline at two years post-SBRT. Conclusions In this single institution cohort, the rate and severity of proctitis observed following SBRT is low. QOL decreased on follow-up; however, our results compare favorably to those reported for patients treated with alternative radiation modalities. Future prospective randomized studies are needed to confirm these observations

Modélisation multiphysique pour le diagnostic et le suivi de l’efficacité en ligne : application à la production d’H2 vert

Renewable Energy Sources (RES) have emerged as a sustainable alternative to carbon-based energy sources as the world is struggling in limiting the greenhouse effect in the coming years. The use of RES, such as solar and wind, alone is non-reliable due to their intermittent nature. The surplus electricity generated during off-peak hours must be stored to tackle the problem of the unavailability of energy. Green Hydrogen (GH_2) generation using electrolyser running on RES has seen an increase in recent years for the storage of this surplus energy due to its advantages over conventional methods (such as batteries and ultra-capacitors) for long term storage and transport. Proton Exchange Membrane (PEM) based electrolysers are better suited for the coupling with RES as compared to the alkaline electrolysers due to their faster start-up times and fast dynamic load changing capability. The intermittent nature of RES affects the performance and operation dynamics of the PEM electrolyser and must be analysed and studied in order to make these systems more reliable and safer to use. Mathematical modelling is one of the possible solutions for studying their behavior and developing supervision algorithms.Under the framework of the E2C project of the European Interreg 2-Seas program, a generic dynamic multi-physics model of a PEM electrolyser has been proposed in this work based on Bond Graph (BG) approach. Various components of the PEM electrolyser have been modelled in the form of BG capsules. These capsules can be connected based on the piping and instrumentation diagram of the PEM electrolyser system to have a global model of the system. The developed model is capable of representing different configurations of PEM electrolysers ranging from laboratory scale to industrial scale. The model is also capable of facilitating efficiency tracking in real-time. The developed model in the BG form has been converted into MATLAB® Simulink block diagram from the implementation point of view.The model was then validated using a single cell PEM electrolyser powered by a Hybrid Multi-source Platform (HMP) running on solar and wind energy at the University of Lille. The proposed model was also extended for the modelling and performance study of Anion Exchange Membrane (AEM) electrolysis cell, in collaboration with the University of Exeter of England, which shares a similar configuration and architecture.The developed model for the PEM electrolysis system is also suitable for the development of control, diagnosis, and prognosis algorithms. Therefore, a model-based robust fault diagnosis for PEM water electrolyser has been proposed in this work. The proposed diagnosis algorithms and model have been then utilized for developing the graphical user interface for online supervision.L’hydrogène vert est le vecteur d’énergie du futur le plus prometteur car il est d’une part capté par des sources renouvelables et inépuisables qui sont les énergies éolienne et/ou solaire et d’autre part permet de meilleurs transport et stockage de l’énergie sur le long terme en bouteilles haute pression par un électrolyseur pour produire ensuite de l’électricité par des piles à combustible sans émission d’aucun polluant. La nature intermittente des SER dégrade la performance et le fonctionnement dynamique des électrolyseurs PEM et leur couplage doit être étudié afin d’assurer la disponibilité opérationnelle et la pérennité du fonctionnement des équipements par une détection précoce des défauts et l’estimation de leurs durées de vie mais aussi le suivi en ligne des performances technico économiques. L’objectif de la thèse réalisé dans le cadre du projet Européen Interreg-2 Mers E2C est de développer un modèle dynamique multi-physique d’un électrolyseur PEM, basé sur une approche Bond-Graph pour une utilisation générique pour d’autres types d’électrolyseur non seulement pour l’analyse mais aussi pour la conception de systèmes de supervision en ligne pour la détection et localisation de défauts. La modélisation des divers composants de l’électrolyseur a été réalisée sous forme de capsules Bond-Graph. Ces capsules peuvent être connectées en tenant compte de la structure du diagramme d’instrumentation pour obtenir un modèle dynamique global. Ce modèle est capable de représenter différentes configurations, du pilote de laboratoire jusqu’à l’échelle industrielle, et également de suivre l’efficacité en temps réel. Le modèle a été converti en MATLAB® Simulink pour implémentation, puis validé expérimentalement sur une cellule alimentée par une Plateforme Multi-Source Hybride comprenant des sources d’énergie solaire et éolienne. Le modèle a été adapté pour représenter et étudier la performance d’un électrolyseur à Membrane Echangeuse d’Anions, dont la configuration et l’architecture sont similaires, en collaboration avec l’Université d’Exeter. Le modèle permet également de développer des algorithmes de commande, diagnostic et pronostic ; ainsi, un diagnostic robuste des défauts est présenté dans ce travail. Une Interface Utilisateur Graphique pour la supervision en ligne incorpore le modèle et les algorithmes de diagnostic

Modélisation multiphysique pour le diagnostic et le suivi de l’efficacité en ligne : application à la production d’H2 vert

L’hydrogène vert est le vecteur d’énergie du futur le plus prometteur car il est d’une part capté par des sources renouvelables et inépuisables qui sont les énergies éolienne et/ou solaire et d’autre part permet de meilleurs transport et stockage de l’énergie sur le long terme en bouteilles haute pression par un électrolyseur pour produire ensuite de l’électricité par des piles à combustible sans émission d’aucun polluant. La nature intermittente des SER dégrade la performance et le fonctionnement dynamique des électrolyseurs PEM et leur couplage doit être étudié afin d’assurer la disponibilité opérationnelle et la pérennité du fonctionnement des équipements par une détection précoce des défauts et l’estimation de leurs durées de vie mais aussi le suivi en ligne des performances technico économiques. L’objectif de la thèse réalisé dans le cadre du projet Européen Interreg-2 Mers E2C est de développer un modèle dynamique multi-physique d’un électrolyseur PEM, basé sur une approche Bond-Graph pour une utilisation générique pour d’autres types d’électrolyseur non seulement pour l’analyse mais aussi pour la conception de systèmes de supervision en ligne pour la détection et localisation de défauts. La modélisation des divers composants de l’électrolyseur a été réalisée sous forme de capsules Bond-Graph. Ces capsules peuvent être connectées en tenant compte de la structure du diagramme d’instrumentation pour obtenir un modèle dynamique global. Ce modèle est capable de représenter différentes configurations, du pilote de laboratoire jusqu’à l’échelle industrielle, et également de suivre l’efficacité en temps réel. Le modèle a été converti en MATLAB® Simulink pour implémentation, puis validé expérimentalement sur une cellule alimentée par une Plateforme Multi-Source Hybride comprenant des sources d’énergie solaire et éolienne. Le modèle a été adapté pour représenter et étudier la performance d’un électrolyseur à Membrane Echangeuse d’Anions, dont la configuration et l’architecture sont similaires, en collaboration avec l’Université d’Exeter. Le modèle permet également de développer des algorithmes de commande, diagnostic et pronostic ; ainsi, un diagnostic robuste des défauts est présenté dans ce travail. Une Interface Utilisateur Graphique pour la supervision en ligne incorpore le modèle et les algorithmes de diagnostic.Renewable Energy Sources (RES) have emerged as a sustainable alternative to carbon-based energy sources as the world is struggling in limiting the greenhouse effect in the coming years. The use of RES, such as solar and wind, alone is non-reliable due to their intermittent nature. The surplus electricity generated during off-peak hours must be stored to tackle the problem of the unavailability of energy. Green Hydrogen (GH_2) generation using electrolyser running on RES has seen an increase in recent years for the storage of this surplus energy due to its advantages over conventional methods (such as batteries and ultra-capacitors) for long term storage and transport. Proton Exchange Membrane (PEM) based electrolysers are better suited for the coupling with RES as compared to the alkaline electrolysers due to their faster start-up times and fast dynamic load changing capability. The intermittent nature of RES affects the performance and operation dynamics of the PEM electrolyser and must be analysed and studied in order to make these systems more reliable and safer to use. Mathematical modelling is one of the possible solutions for studying their behavior and developing supervision algorithms.Under the framework of the E2C project of the European Interreg 2-Seas program, a generic dynamic multi-physics model of a PEM electrolyser has been proposed in this work based on Bond Graph (BG) approach. Various components of the PEM electrolyser have been modelled in the form of BG capsules. These capsules can be connected based on the piping and instrumentation diagram of the PEM electrolyser system to have a global model of the system. The developed model is capable of representing different configurations of PEM electrolysers ranging from laboratory scale to industrial scale. The model is also capable of facilitating efficiency tracking in real-time. The developed model in the BG form has been converted into MATLAB® Simulink block diagram from the implementation point of view.The model was then validated using a single cell PEM electrolyser powered by a Hybrid Multi-source Platform (HMP) running on solar and wind energy at the University of Lille. The proposed model was also extended for the modelling and performance study of Anion Exchange Membrane (AEM) electrolysis cell, in collaboration with the University of Exeter of England, which shares a similar configuration and architecture.The developed model for the PEM electrolysis system is also suitable for the development of control, diagnosis, and prognosis algorithms. Therefore, a model-based robust fault diagnosis for PEM water electrolyser has been proposed in this work. The proposed diagnosis algorithms and model have been then utilized for developing the graphical user interface for online supervision

Modélisation multiphysique pour le diagnostic et le suivi de l’efficacité en ligne : application à la production d’H2 vert

Renewable Energy Sources (RES) have emerged as a sustainable alternative to carbon-based energy sources as the world is struggling in limiting the greenhouse effect in the coming years. The use of RES, such as solar and wind, alone is non-reliable due to their intermittent nature. The surplus electricity generated during off-peak hours must be stored to tackle the problem of the unavailability of energy. Green Hydrogen (GH_2) generation using electrolyser running on RES has seen an increase in recent years for the storage of this surplus energy due to its advantages over conventional methods (such as batteries and ultra-capacitors) for long term storage and transport. Proton Exchange Membrane (PEM) based electrolysers are better suited for the coupling with RES as compared to the alkaline electrolysers due to their faster start-up times and fast dynamic load changing capability. The intermittent nature of RES affects the performance and operation dynamics of the PEM electrolyser and must be analysed and studied in order to make these systems more reliable and safer to use. Mathematical modelling is one of the possible solutions for studying their behavior and developing supervision algorithms.Under the framework of the E2C project of the European Interreg 2-Seas program, a generic dynamic multi-physics model of a PEM electrolyser has been proposed in this work based on Bond Graph (BG) approach. Various components of the PEM electrolyser have been modelled in the form of BG capsules. These capsules can be connected based on the piping and instrumentation diagram of the PEM electrolyser system to have a global model of the system. The developed model is capable of representing different configurations of PEM electrolysers ranging from laboratory scale to industrial scale. The model is also capable of facilitating efficiency tracking in real-time. The developed model in the BG form has been converted into MATLAB® Simulink block diagram from the implementation point of view.The model was then validated using a single cell PEM electrolyser powered by a Hybrid Multi-source Platform (HMP) running on solar and wind energy at the University of Lille. The proposed model was also extended for the modelling and performance study of Anion Exchange Membrane (AEM) electrolysis cell, in collaboration with the University of Exeter of England, which shares a similar configuration and architecture.The developed model for the PEM electrolysis system is also suitable for the development of control, diagnosis, and prognosis algorithms. Therefore, a model-based robust fault diagnosis for PEM water electrolyser has been proposed in this work. The proposed diagnosis algorithms and model have been then utilized for developing the graphical user interface for online supervision.L’hydrogène vert est le vecteur d’énergie du futur le plus prometteur car il est d’une part capté par des sources renouvelables et inépuisables qui sont les énergies éolienne et/ou solaire et d’autre part permet de meilleurs transport et stockage de l’énergie sur le long terme en bouteilles haute pression par un électrolyseur pour produire ensuite de l’électricité par des piles à combustible sans émission d’aucun polluant. La nature intermittente des SER dégrade la performance et le fonctionnement dynamique des électrolyseurs PEM et leur couplage doit être étudié afin d’assurer la disponibilité opérationnelle et la pérennité du fonctionnement des équipements par une détection précoce des défauts et l’estimation de leurs durées de vie mais aussi le suivi en ligne des performances technico économiques. L’objectif de la thèse réalisé dans le cadre du projet Européen Interreg-2 Mers E2C est de développer un modèle dynamique multi-physique d’un électrolyseur PEM, basé sur une approche Bond-Graph pour une utilisation générique pour d’autres types d’électrolyseur non seulement pour l’analyse mais aussi pour la conception de systèmes de supervision en ligne pour la détection et localisation de défauts. La modélisation des divers composants de l’électrolyseur a été réalisée sous forme de capsules Bond-Graph. Ces capsules peuvent être connectées en tenant compte de la structure du diagramme d’instrumentation pour obtenir un modèle dynamique global. Ce modèle est capable de représenter différentes configurations, du pilote de laboratoire jusqu’à l’échelle industrielle, et également de suivre l’efficacité en temps réel. Le modèle a été converti en MATLAB® Simulink pour implémentation, puis validé expérimentalement sur une cellule alimentée par une Plateforme Multi-Source Hybride comprenant des sources d’énergie solaire et éolienne. Le modèle a été adapté pour représenter et étudier la performance d’un électrolyseur à Membrane Echangeuse d’Anions, dont la configuration et l’architecture sont similaires, en collaboration avec l’Université d’Exeter. Le modèle permet également de développer des algorithmes de commande, diagnostic et pronostic ; ainsi, un diagnostic robuste des défauts est présenté dans ce travail. Une Interface Utilisateur Graphique pour la supervision en ligne incorpore le modèle et les algorithmes de diagnostic