A Case of Non-Operative Management for Sulfuric Acid Burns

It is thought that severe chemical burns usually require a treatment of extended deep skin and subcutaneous tissue debridement and subsequent skin grafting. However, in this report we discuss the successful treatment of a severe dorsal chemical burn caused by sulfuric acid without skin grafting. A 45-year-old man was showered with highly concentrated (80%) sulfuric acid from a pipe burst at a factory. He sustained severe chemical burn injuries to the limbs and back. On arrival at the hospital, total body surface area burned, the burn index, and the prognostic burn index were 61.5%, 57.7, and 102.7, respectively. Considering the patient\u27s functional prognosis, surgical treatment of the limbs involving skin grafting was performed early in the treatment process. Additionally, daily bedside debridement of necrotic tissue of the back resulted in complete epithelialization without skin grafting. It is difficult to accurately assess the depth of dorsal burns due to the thickness of dorsal skin. In cases of chemical burns, skin color changes associated with chemical reaction make the assessment of burn depth even more difficult. The dorsal burn was estimated to be thirddegree on arrival in the present case. However, complete epithelialization without skin grafting suggests that it was a second degree burn. The patient was discharged 218 days after injury. The patient\u27s functional prognosis was satisfactory with soft skin texture and no contractures

異なる経過をたどった腎障害を合併したグリホサート中毒の2症例

グリホサート含有除草剤は比較的安全性の高い除草剤として知られているが，大量に内服した場合には死亡例も報告されている．特に腎機能障害を合併した症例は重症とされ血液透析も検討されるが，現在のところその導入基準及び有効性は明らかとなっていない．今回，腎機能障害を呈した重症中毒症例を２例経験したが，大きく異なる経過をとったため，血中グリホサート濃度の推移を踏まえ，透析の有用性について考察した．症例１は40歳代男性．自殺目的でグリホサートイソプロピルアミン塩を250 ml 飲用した後，嘔吐・下痢の症状を認め当院へ搬送された．来院時，意識は清明でバイタルサインは安定していたが，入院後，呼吸不全，腸閉塞，無尿を来したため，人工呼吸管理，イレウス管挿入を施行した．輸液負荷にて再度尿の流出が得られたため血液透析は施行しなかった．その後，腎機能障害は改善し，呼吸状態も安定．第16病日に抜管し第26病日に軽快退院した．症例２は70歳代男性．自殺目的でグリホサートカリウム塩を約250 ml 飲用し，当院へ救急搬送された．意識は清明でバイタルサインは安定していたが，来院時より無尿の状態であった．輸液負荷・利尿剤の持続投与に反応がないため，透析を施行した．透析後より自尿が得られ，第６病日に退院した．これは，同様に腎機能障害を合併した症例１と比較し，入院期間は約1/4と短期間である．血液透析を施行する前後で，グリホサートの血中濃度が低下しており，グリホサートを血液中から除去することで，症状の軽減，及び早期退院に結びついた可能性がある．グリホサート含有除草剤の中毒を２症例経験した．血液透析施行例で非施行例と比べ入院期間が短かったことから，血液透析が有効である可能性が示唆された．有用性の証明には，今後さらなる症例の蓄積が必要であるが，腎機能障害を合併したグリホサート含有除草剤中毒の症例に対し，血液透析を検討する価値があると思われた．Although glyphosate-surfactant herbicides (GlySH) are considered to be relatively safe, the ingestion of large quantities can cause death. Dialysis is often performed when GlySH poisoning is complicated with severe acute kidney injury (AKI). However, the introduction criteria and validity have yet to be determined.Here, we describe two patients with severe AKI that followed different courses after treatment with extracellular fluids and hemodialysis.Case 1: A man in his 40s tried to commit suicide by drinking GlySH containing glyphosate isopropylamine salt, which induced vomiting and diarrhea. His vital signs and consciousness were normal on arrival at hospital. Thereafter, he fell into respiratory failure, and developed intestinal obstruction and anuria. We intubated him and inserted an ileus tube. We intravenously administered extracellular fluid, which improved urine excretion and renal function. He was extubated on hospital day 16 and discharged on hospital day 26.Case 2: A man in his 70s tried to commit suicide by drinking GlySH containing glyphosate potassium salt. His vital signs and consciousness were normal on arrival at hospital, but anuria had already developed. The administration of diuretics and extracellular fluid did not improve his symptoms. Consequently, he was started on hemodialysis. Thereafter, urinary flow normalized and he was discharged on hospital day 6, which was 20 days earlier than Case 1. Although hemodialysis was effective for treating GlySH poisoning in this patient, further evidence is required to confirm this outcome

ダッシュボード損傷による外傷性気管断裂の1例

鈍的外傷に起因した頸部気管損傷は比較的稀な外傷であり,一般的に緊急で気道を確保しないと致命的である.今回,我々はダッシュボード損傷による頸部気管断裂をきたした重症外傷の1救命例を経験したので報告する.症例は21歳の女性.車の助手席に乗車中,交通事故にて受傷した.心肺停止状態で前医に搬送され蘇生処置に反応したために当院紹介となった.来院時JCS 300,バイタルサインは安定しており,診察上は前頚部に擦過傷を認めたのみであった.その際の画像検査で頸部気管断裂と診断されたが,気道開通は得られており換気可能であったために早急に気管再建術を施行しなかった.その後,待機的に気管切開術と気管断端処理を行い救命できた.本症例を経験し,力学的作用の面から受傷機転を考察するとともに,頸部気管断裂に対する治療戦略について文献的検討を加えて考察したので報告する.Blunt cervical tracheal injury is a rare trauma. However, it is critical and frequently requires emergency airway management with surgical intervention, such as, emergency neck exploration and tracheostomy or reconstruction of the tracheal airway. This is an interesting and rare case of blunt cervical tracheal injury which was successfully managed with only oral tracheal intubation in the initial resuscitation. A 21-year-old female passenger suffered dashboard injury in the neck due to a head-on collision. At the scene of the accident, she was in cardiac arrest on arrival of the rescue team. She was then transported to a near-by emergency hospital with cardio-pulmonary resuscitation. At the hospital she was successfully resuscitated with an uneventful endotracheal intubation. Her vital signs were stabilized but she did not regain consciousness. Therefore she was referred to this hospital for further evaluation of life-threatening injuries and treatment of hypoxic brain damage due to prolonged cardio-pulmonary arrest time. On her arrival to this hospital, her airway was maintained without suspicion of tracheal injury. Although, there was minor abrasion over the anterior neck, there was no noticeable subcutaneous emphysema or suggested tracheal injury. Since she had suffered a high-impact automobile accident, a pan-scan of whole body was performed to rule out fatal life-threatening injuries in the torso. And it turned out that she had a cervical tracheal injury with dislodgment of the tip of an endotrahceal tube through the tracheal rupture into the soft tissue of anterior neck. The airway was maintained by a side hole of the endotracheal tube which enabled air exchange from the tube to distal trachea. This misplacement of the tip was confirmed by a bronchoscopy and the tip position was successfully corrected into distal trachea to the tracheal injury site. After the bronchoscopic procedure, ventilation was successfully maintained without any respiratory problems. Seven days after admission, neurological evaluation revealed that her persistent unconsciousness might have been due to post-resuscitation encephalopathy. Therefore it was feasible to do a permanent tracheostomy rather than reconstruction of the trachea. Finally, the mechanism of the cervical tracheal injury and strategy of staged treatments in this case was discussed with review of past articles

Analysis of factors influencing oil recovery by polymer injection

Orientador: Rosângela Barros Zanoni Lopes MorenoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecânica e Instituto de GeociênciasResumo: A grande dependência da sociedade por produtos feitos a partir do petróleo e seus derivados, bem como seu preço elevado, motivam o estudo e o desenvolvimento de métodos de recuperação avançada. Estes métodos viabilizam explotar o maior volume possível de petróleo de forma contínua e por mais tempo. Os métodos de recuperação avançada de petróleo podem ser classificados como miscíveis, térmicos e químicos. A injeção de polímero é um método químico, onde polímero é adicionado à água de injeção com o objetivo de aumentar sua viscosidade e, consequentemente, reduzir a razão de mobilidade e aumentar a eficiência de varrido. Entretanto, este processo não é aplicável a qualquer caso, sendo necessário o uso de métodos de seleção e descarte, além de uma atenção especial para que suas propriedades não sejam degradadas durante a aplicação do método. Este trabalho apresenta uma análise da recuperação de petróleo por injeção de água alternada com banco de polímero (WAP) em comparação com a injeção contínua de água (WF) através da utilização de um simulador comercial. Além disso, foram analisadas variações em relação ao volume de solução polimérica injetada, ao instante de início da injeção de polímero, às curvas de permeabilidade relativa, à viscosidade da solução polimérica, bem como, às saturações de óleo residual e inicial de água, a fim de verificar os efeitos na recuperação de óleo. O estudo de modelos de reservatório em escala laboratorial é realizado como uma primeira e simplificada análise de seu potencial de recuperação de petróleo. A escala laboratorial permite uma análise mais detalhada do comportamento dos fluidos dentro do modelo, além de admitir a realização de testes para posterior aplicação no modelo real. Assim, foi realizado o estudo em escala laboratorial, para um modelo homogêneo, três modelos com heterogeneidades horizontais e dois modelos com heterogeneidades verticais. Posteriormente, o modelo homogêneo foi utilizado para uma análise de aumento de escala, a fim de verificar se os modelos estão bem representados. E em seguida foi realizada uma análise econômica. Entre os resultados observados, pode-se mencionar que: quanto maiores os bancos de solução polimérica injetados, maiores foram os volumes de óleo produzido, porém com menores volumes de óleo produzido por massa de polímero; a antecipação na injeção da solução polimérica gera uma antecipação na produção; o uso de soluções com polímero mais viscosas reduz o valor da razão de mobilidade e aumenta a produção de óleo, entretanto demanda pressões de injeção mais elevadas; quanto menor é o valor da permeabilidade relativa à água na saturação de óleo residual, maior é o ganho de produção de óleo, uma vez que o valor da razão de mobilidade é menor; quanto menores forem as saturações de óleo residual e de água inicial, maior é a recuperação, uma vez que a quantidade de óleo móvel é maior. Os melhores resultados em relação à recuperação de óleo foram obtidos pelos modelos heterogêneos verticais em comparação com o modelo homogêneo e heterogêneos horizontais. E o modelo em escala de campo demonstrou estar muito bem representado, sem divergência de valores em relação ao modelo em escala laboratorialAbstract: The significant dependence of society for products made from petroleum and its derivatives, as well as its high price, motivate the study and the development of advanced recovery methods. This methods enable the exploitation of the largest possible volume of oil continuously and longer. The enhanced oil recovery methods can be classified as miscible, thermal and chemical methods. The polymer injection is a chemical process, where polymer is added to the injection water aiming increase its viscosity, consequently reducing the water-oil mobility ratio and increasing the sweep efficiency. However, this process does not apply to any case, requiring the use of screening criteria, and particular attention to that their properties are not degraded during the application of the recovery. This paper presents an analysis of oil recovery by water injection alternated with a polymer slug (WAP) compared to the continuous water flooding (WF) with the use of a commercial simulator. Moreover, variations in the slug size of the injected polymer solution, injection starting time of the polymer slug, relative permeability curves, polymer viscosity, residual oil and initial water saturation were carried out to determine the effects on oil recovery. The study of reservoir models in laboratory scale is made on a first and simplified analysis of their oil recovery potential. The laboratory scale allows a more detailed discussion of fluid behavior inside the model, and admits to testing for further application in the real model. Thus, the study was conducted in laboratory scale, for one homogeneous model, three models with horizontal heterogeneities and two models with vertical heterogeneities. Subsequently, the homogeneous model was used for analysis of size increase in order to ascertain whether templates are well represented. And then an economic analysis was performed. Among the results, it can be mentioned that: larger slugs of polymer solution lead to larger volumes of produced oil, however with decreasing amounts of produced oil per mass of polymer; the anticipation on the injection of the polymer solution leads to an anticipation in oil production; the use of higher viscous polymer solutions lead to lower value of the mobility ratio and higher oil production, however requires higher injection pressures; lower values of relative permeability to water at residual oil saturation lead to large difference on relative gain of oil production once the final mobility ratio is lower; lower residual oil and initial water saturation leads to a high oil recovery, mainly as consequence of the greater amount of mobile oil. The best results for oil recovery were obtained by vertical heterogeneous models compared to the homogeneous model and horizontal heterogeneous. And the model in field scale proved to be well represented, without deviation values relative to the model in laboratory scaleMestradoReservatórios e GestãoMestra em Ciências e Engenharia de Petróle