Simultaneous appearance of leukemoid reaction and phlegmasia cerulea dolens

A leukemoid reaction is an extreme form of reactive leukocytosis defined as granulocytic leukocytosis above 50 7 109/L produced by normal bone marrow, mostly in response to systemic infection or cancer. The mechanism as to how the haematopoetic system is altered to elevate production of myeloid cells is not known. A 69-year-old man presented with phlegmasia cerulea dolens caused by massive iliofemoral thrombosis. His workout at admission revealed absolute white blood cell count of 73.4 7 109/L, with neutrophil granulocyte of 68.5 7 109/L. The new increase in white blood cell count happened at day 5 after admission, when the haematoma of the anteromedial thigh was evacuated in general anaesthesia. There was a gradual decrease in counts until they reached the normal range. Deteriorated general condition with signs of systemic inflammatory response syndrome improved with supportive therapy, and the patient was discharged from hospital after 30 days. During hospitalization we did not identify any infectious focus, or any malignancy. We could not exclude other occult chronic conditions (malignancy) but the patient did not develop any other condition during 4.5 years of follow-up

ESTIMATION OF EXTERNAL COSTS OF ELECTRICITY GENERATION USING EXTERNE MODEL

The external costs of electricity generation can be characterised by the resulting social and environmental impacts. The most significant impacts are the air pollutions impact on health, built in environment, crops, forests, agricultural areas and on global warming. The primary impact considered is the air pollution’s effect on human health. The monetised value of the health impact, the external costs are calculated for two regional coal power plants, the effects are examined on the EU level with the ExternE methodology.External costs, human health, monetized environmental impacts, energy production, coal power plants, air pollution, Environmental Economics and Policy, Health Economics and Policy, Research Methods/ Statistical Methods,

Analysis of rolling bearing power loss models for twin screw oil injected compressor

The mechanical losses inside a screw compressor limit the performance of the compressor in terms of efficiency. These losses arise due to relative motion between elements inside the screw compressor. The estimation of mechanical losses predicted in the literature is around 10-15% of the total shaft power. One of the elements which contribute significantly to these losses is rolling element bearings. There are numerous mathematical models available which predict power losses in the rolling bearings. The objective of this paper is to study different models to predict power loss for rolling bearings and to predict the power losses for the bearings used for oil injected, twin screw compressor. A comparison between different power loss models for different operating conditions of compressor is also presented in this paper and results of analysis are compared with available experimental observations. The analysis helps to determine suitable power loss model for different operating conditions and more realistic predictions of the power losses. This allows designers for more accurate estimation of the performance of screw compressors

Dominant Role of the pi Framework in Cyclobutadiene

The extrinsic antiaromaticity of archetypal cyclobutadiene (CBD) is addressed with particular emphasis on the sigma-pi separability problem. The destabilization energy E(d)(CBD) of CBD is obtained by appropriate homodesmotic reactions involving the open chain zigzag, polyene(s). It is shown that E(d)(CBD) does not depend on the electron correlation and the zero-point vibrational energy contributions, since they are small and of the opposite sign. Consequently, they cancel in the first approximation. Further, it turns out that E(d)(CBD) can be estimated accurately enough with a very modest cc-pVDZ basis set at the Hartree-Fock (HF) level. The extrinsic antiaromatic destabilization E(ean)(CBD) of CBD is deduced after extracting the angular strain energy estimated to be 32 kcal/mol. The resulting E(ean)(CBD) value of 52 kcal/mol is in excellent agreement with the experimental thermodynamic data. If the E(ean)(CBD) is estimated relative to two isolated C=C double bonds, then it assumes 38 kcal/mol, which is roughly 10 kcal/mol per one pi electron. It is, therefore, safe to state that extrinsic antiaromaticity of CBD is larger than its angular strain. Although the sigma and pi electrons are coupled by a mutual Coulomb interaction V-ee(sigmapi), several attempts of their decoupling is made by using three partitioning schemes: stockholder, equipartition, and standard pi-electron theory recipe. The latter allocates the V-nn and V-ee(sigmapi) terms to the sigma- and pi-electron frameworks, respectively. The nuclear repulsion term V-nn is dissected into sigma and pi components in the former two partitioning schemes by using stockholder criterion. It appears that the extrinsic antiaromatic destabilization E(ean)(CBD) is determined by the pi-electron framework according to all three partitioning models

A Study Aimed at Characterizing the Interfacial Structure in a Tin-Silver Solder on Nickel-Coated Copper Plate during Aging

This paper highlights the interfacial structure of tin-silver (Sn-3·5Ag) solder on nickel-coated copper pads during aging performance studies at a temperature of 150°C for up to 96 h. Experimental results revealed the as-solidified solder bump made from using the lead-free solder (Sn-3·5Ag) exhibited or showed a thin layer of the tin-nickel-copper intermetallic compound (IMC) at the solder/substrate interface. This includes a sub-layer having a planar structure immediately adjacent to the Ni-coating and a blocky structure on the inside of the solder. Aging performance studies revealed the thickness of both the IMC layer and the sub-layer, having a planar structure, to increase with an increase in aging time. The observed increase was essentially non-linear. Fine microscopic cracks were observed to occur at the interfaces of the planar sub-layer and the block sub-layer

KARAPANDZIC FLAP FOR RECONSTRUCTION OF LOWER LIP IN A 18-MONTH OLD BOY WITH CONGENITAL AGAMMAGLOBULINEMIA AND ECTHYMA GANGRENOSUM. CASE REPORT

The reconstruction of lower lip in children is extremely rare and challenging procedure. The etiology in literature reveals trauma and infection. An 18-month boy was admitted with sepsis and pneumonia. Laboratory tests revealed congenital agammaglobulinemia. Necrosis of lower lip developed and was diagnosed as ecthyma gangrenosum. Blood culture was positive for Pseudomonas aeruginosa. Multiple abscess formations were found in abdominal wall and gluteal region and were treated by incisions. After spontaneous demarcation of necrotic tissue in lower lip the Karapandzic flap technique was used for reconstruction. Karapandzic flap can be used as optimal method for reconstruction of lower lip in children with satisfactory functional and aesthetic results.Key words: Karapandzic flap, ecthyma gangrenosum, reconstructio

Clozapine-Induced Pericarditis

Objective: To report a case of a patient treated with clozapine who developed pericarditis with pericardial effusion that resolved when the drug was discontinued. Method: Case report of a 21-year-old man with psychotic disorder that had been stable on clozapine therapy for five months (after failure of atypical antipsyhotic agents) presented to the emergency department complaining of chest pain and progressive shortness of breath that had lasted for a few days. Echocardiography showed a pericardial effusion suggestive of a cardiac tamponade, and the fluid was removed by pericardiocentesis. All other possible causes of the pericardial effusion were ruled out and clozapine was suspected as the most likely explanation. Clozapine was discontinued and the patient’s symptoms improved markedly. Discussion: According to the Naranjo probability scale, clozapine is a probable cause of pericarditis. Although clozapine is a known cause of myocarditis and cardiomyopathy, there are only several reports in the literature describing clozapine-induced pericarditis and pericardial effusion. In our patient, the pericardial effusion cleared within several days following clozapine discontinuation. Conclusion: There have been only a few cases of clozapine-induced pericarditis reported in the literature, however this adverse effect of clozapine can occur, as this case report clearly  demonstrates. Cardiac adverse effects of clozapine are potentially life threatening, hence early recognition is essential to prevent serious outcomes.Key words: Clozapine; Pericarditis; Pericardial effusion; Adverse reactio

Long-term palliation of right-sided congestive heart failure after stenting a recurrent cor triatriatum dexter in a 10½-year-old pug.

A 10½-year-old, male neutered, pug presented with increasing ascites over two months. Echocardiography revealed cor triatriatum dexter with no concurrent cardiovascular anomalies, subsequently confirmed by computed tomography angiography. Balloon dilation of the perforated intra-atrial membrane under fluoroscopic guidance resulted in the transient resolution of all clinical abnormalities, but six months later stenosis and ascites recurred. After repeated balloon dilation, a stent was placed across the membrane. The dog remains asymptomatic fourteen months after the second procedure. One noteworthy feature of this case is the onset of congestive heart failure due to a congenital defect only at more than 10 years of age