Potts puffy tumour (PPT) is a subperiosteal abscess arising from frontal bone osteomyelitis. We present a case of a 75-year-old lady with headache and a forehead swelling who was initially treated for sinusitis and giant cell arteritis in a primary care setting, but failed to improve. Following clinical deterioration and further investigation, CT appearances were consistent with a diagnosis of PPT and an extra-axial collection. Needle decompression, frontal trephine and endoscopic frontal sinusotomy were performed and intraoperative swabs cultured Streptococcus constellatus PPT is an unusual clinical entity that benefits from prompt antibiotic and surgical management, and therefore early recognition is paramount. We highlight that PPT should be a differential diagnosis in all patients presenting with forehead or frontal swelling. Use of radiological imaging (CT/MRI) is necessary to not only confirm a diagnosis of PPT but to identify further intracranial complications, which can be life-threatening.
A number of Oesophagogastric (OG) conditions such as Achalasia, Gastroparesis, Oesophageal dysmotility (OD) and Pyloric dysfunction (PD) can be treated with Botulinum Toxin A (BTxA). The aim of our study was to assess the use and costs of Botulinum Toxin A endotherapy within a tertiary Oesophagogastric unit. We performed a retrospective analysis of data collected over a 2-year period at a tertiary Oesophagogastric unit from November 2015 to November 2017. We found 68 eligible patients with Achalasia, Gastroparesis, Oesophageal dysmotility, Pyloric dysfunction. The median number of treatment sessions were Achalasia 2 (1-3), Gastroparesis: 2 (1-9), Oesophageal dysmotility: 1 (1-5) and Pyloric dysfunction: 1.5 (1-3). The mean number of units of BTxA used per procedure (Unit) were Achalasia 200, Gastroparesis 170, Oesophageal dysmotility 190 and Pyloric dysfunction 270. A total of 126 vials containing 63000 units (£19530) were opened. 25520 units were used, and 37480 2. Vbn vcfunits were wasted (£11618) over 2 years. On average, 67% of each vial of Dysport was wasted. The local annual wastage was £5810 per year, which roughly equates to a national wastage cost of £348,600 per year for these 4 OG conditions alone (assuming we serve population of around 1 million people and therefore multiplying by 60). An option for cost saving would be to consider using smaller volume vials to reduce wastage. We would recommend that guidelines are produced in order to standardise the optimal dose required and the vial sizes to stock for treatment of these conditions and avoid unnecessary expenditure.
This research discuss the performance and evaluation of Vbasin collector in heating systems of solar with different nanofluids and base fluids, where metal nanofluids [Ag (20nm) + DW + EG], and metal oxide nanofluid [TiO2 (40nm) + DW + EG]are the used operating fluids with flow rate of 25 lit/hr, 50 lit/hr and ratios of concentration (i.e. 1, 2, 3 and 5 % vol). The base fluids employed in these experiment is distilled water and ethylene glycol. The metal and oxide metal nanofluids are shown a significant improvement in the performance of V -basin tube solar collector with higher thermal conductivity as well as heat transfer comparing to the base fluid (distilled water and ethylene glycol). The metal nanofluids [Ag (20nm) + DW + EG]at 5 % vol and flow rate of 25, and 50 lit/hr showed an important impact in characteristics values of thermal solar for fR(τα),-fRULwere.-6.317 W/m 2 . 0 K, 0.522 and.-6.524 W/m 20 K, .0.542, whereas for the oxide nanofluid (TiO2 (40nm) + DW+EG) were -5.523 W/m 20 K, 0.473 and -5.1731 W/m 2 . 0 K, 0.502 severally. The characteristics values of thermal solar to Dw and EG for flow rate of 25 lit/hr and 50 lit/hr were -4.033 W/m 2 . 0 K, 0.382, -4.065 W/ m 2 . 0 K, and 0.421 severally. The size and type of nanofluid are necessary to enhancement heat transfer process, and improve performance of solar collector of V-basin type. The metal and oxide nanofluids used as a working fluid may improve the thermal performance of tube solar collector of Vbasin because of small nanoparticles for metal, oxide metal and high thermal conductivity of silver. The metal and oxide nanofluids achieved an improvement when it was compared to DW and EGmostly at a high. Inlet temperature. The impacts of metal .nanofluid and oxide metal nanofuids are taken into regard on solar nanofluids system of heating as well as different base fluids.
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