EPDL is a fairly common clinical picture seen in patients undergoing continuous compression bandaging. It may be produced by opportunistic, particularly fungal, infection. In almost half an infective aetiology cannot be demonstrated and a pyoderma gangrenosum-like process may be implicated.

Background:Gasretention in the peritoneal cavity plays an important role in inducing postoperative pain after laparoscopy, which is inevitably retained in the peritoneal cavity.Objectives:The aim of this study was to detect the relation between the volume of residual gas and severity of shoulder and abdominal pain.Patients and Methods:In this Prospective study 55 women who were referred for laparoscopic cholecystectomy, were evaluated for the effect of residual pneumoperitoneum on postlaparoscopic cholecystectomy pain intensity. The pneumoperitoneum was graded as absent, mild (1-5 mm), moderate (6-10 mm) and severe (> 11 mm). Patients were followed for postoperative abdominal and shoulder pain using visual analogue scale (VAS), postoperative analgesic requirements, presence of nausea and vomiting, time of unassisted ambulation, time of oral intake and time of return of bowel function in the recovery room and at 6, 12 and 24 hours after operation.Results:At the end of the study, 17 patients (30.9%) had no residual pneumoperitoneum after 24 hours; which 23 (41.81%) had mild residual pneumoperitoneum, eight (14.54%) had moderate pneumoperitoneum and seven (12.72%) had severe pneumoperitoneum. Patients with no or mild residual pneumoperitoneum had significantly lower abdominal and shoulder pain scores than whom with moderate to severe pneumoperitoneum (P = 0.00) and need less meperidine requirements (P = 0.00). Patients did not have any significant difference in time of oral intake, return of bowel function, nausea and vomiting percentages.Conclusions:We conclude that volume of residual pneumoperitoneum is a contributing factor in the etiology of postoperative pain after laparoscopic cholecystectomy.

patients were not being treated by haemodialysis or peritoneal dialysis. Blood was collected immediately after the start of haemodialysis in the case of patients on haemodialysis and before breakfast in the case of other patients. All the patients in the study had given written informed consent that had been approved by the Ethics Committee of Oita University. We measured serum levels of 5-S-CD by high-performance liquid chromatography with electrochemical detection as described by Wakamatsu et al. 4 Levels of both blood urea nitrogen and serum creatinine were measured by conventional methods. With the exception of the samples from the patient with acute renal failure and from patients with relatively good renal function, all serum samples contained elevated levels of 5-S-CD. Although the blood level of urea nitrogen and the serum level of 5-S-CD were somewhat correlated (correlation coefficient 0AE59), serum levels of creatinine and 5-S-CD were strongly correlated ( Fig. 1; correlation coefficient 0AE78; P ¼ 4AE5 · 10 )5 by Spearman's rank correlation). Serum levels of 5-S-CD and creatinine clearance were inversely correlated, although there was variation in values.5-S-cysteinyldopa is a 316-kDa precursor of phaeomelanin and is produced by melanocytes and some nonmelanogenic cells. 5 The renal clearance of 5-S-CD was reported to be about 80 mL min )1 in healthy subjects 4,6 and 69-30 mL min )1 in patients with metastatic melanoma. 7 These values correspond to 70% and 44% of the creatinine clearance rate, respectively. Although rates of renal clearance of 5-S-CD varied, our analysis showed clearly that a high level of serum 5-S-CD in cases of chronic renal failure does not always mean the aggravation of malignant melanoma. Thus care should be exercised in the interpretation of elevated levels of 5-S-CD. Y . A s a d a S . A r a k a w a S . F u j i w a r a

BackgroundTo survey genitourinary (GU) organ injury following general trauma, we performed an epidemiologic study of urogenital injuries in trauma patients referred to our hospital (a teaching hospital affiliated with the Zahedan University of Medical Sciences).ObjectivesWe aimed to assess the epidemiology of urogenital system injuries in southeastern Iran.Patients and MethodsFrom April 2009 to November 2011, all patients with GU injuries referred to our hospital were studied. The data including age, sex, type of injury, mechanism of trauma, and prognosis of patients was collected and analyzed.ResultsFrom a total of 3450 patients, 66 (1.91%) had injuries of the urogenital system; 49(74.24%) were male and 17(25.75%) female. The patients’ mean age was 23 ± 12 years (range 2 to 75 years). Of these 66 patients, 61 (94.24%) had blunt trauma, and 5 (7.57%) had penetrating trauma. Motor vehicle accidents were the most common cause of trauma (63.63%). The most common injured organs were kidneys in 41 (62.12%) and the bladder in 9 (13.6%); 47 patients (71.21%) had associated intra-abdominal injuries, and 42 (63.63%) had other accompanying injuries; 23(34.84%) patients required surgical intervention. Three patients (4.54%) died due to the severity of injuries (Injury Severity Score > 12).ConclusionsIn our assessment, blunt trauma including road traffic accidents were the main cause of urogenital injuries. Most patients with urogenital trauma had multiple injuries, and required a multidisciplinary approach for management.

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Drilling fractured formations by overbalanced method causes lost circulation of drilling fluid in fractures. The lost circulation in drilling fractured zones has been traditionally accepted due to inability to control its occurrence. Most of drilled wells in fractured oil zones after completion are conducted on acid job in order to obtain well flowing. If the radius of skin due to lost circulation of drilling fluid through fractured oil zones be determined, the volume of acid needed to conduct any acid job can be calculated. The main goal of this work is to obtain a mathematical model for determination of skin radius in naturally fractured oil reservoir wells. In this study, one vertical fracture is assumed to symmetrically intersect a wellbore. During a lost circulation drilling fluid enters the fracture and displaces formation fluid. The mechanism of lost circulation through the modeled porous medium is formulated using mass transfer phenomena. Obtained equations give concentration of the lost fluid with respect to time and position. Filtration of the drilling fluid at walls of the fracture is considered to be exponential which is ceased after mud cake is formed. A simulator is developed using derived equations in this work. The concentration of the drilling fluid could now be plotted against the position in the fracture and also against the position in lateral direction for each point in the fracture at a given time. These curves tend to be S-shaped. The position in the fracture at which the curve of concentration reaches zero could be considered to represent skin radius caused by drilling operation. Similarly the position in lateral direction at which the concentration reaches zero represents lateral penetration of the drilling fluid in the matrix from its corresponding position in the fracture. Introduction Drilling of a potentially productive formation can be expected to cause some skin damage. The seriousness of that damage depends upon the nature of the formation, the composition and properties of the drilling fluid, and the drilling conditions. Usually the drilling fluid pressure is greater than the formation pore pressure. As a result there may be invasion by whole drilling fluid and solids from the drilling fluid as well as invasion by drilling fluid filtrate. Most of the factors known to affect particle and filtrate invasion are not readily subject to control. For example, high differential pressure often must be tolerated. Scrapping action of bit and drill string cannot be eliminated. There are limits to adjustments that can be made in drilling fluid circulating rates. On the other hand, the filtration characteristics of the drilling fluid can be controlled to prevent invasion. Further protection against formation damage can be exercised by selecting a type of drilling fluid to limit or avoid undesirable interaction of filtrate with the formation.[1] During invasion, drilling fluid displaces formation fluid and causes a mixing zone with a resultant S-shaped concentration profile to develop. Dispersion phenomena may be attributed to several physical phenomena including molecular diffusion, velocity profile effect, series of mixing cells, stagnant pockets and variation in flow paths. All these phenomena except molecular diffusion are dependent on convection of fluids through a porous medium.[2] There are different methods so far provided in order to simulate dispersion in a fractured formation. These modeling approaches are divided into two main classes: continuum models and discrete fracture models.[3] Dispersion in fractured media is typically simulated using one or more of the following conceptual models:equivalent porous medium (EPM),dual porosity,discrete fracture network (DFN), orhybrid DFN/EPM approaches.[4]

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