Synthetic cores containing various percentages of different clay minerals were flooded with water which contained different types of salts in varied amounts, and the flow rate·was measured during the application of direct electrical current at varying current density. Kerosene also was used as the flowing fluid, and some chemical additives, such as sodiwn acid pyrophosphate, were tested in conjunction with the application of electrical current.The experimental results indicated that the increase in the flow rate of liquids was due not only to the electroosmotic effect but also to some changes in the pore structure. These changes in the pore configuration took place during the electrochemical treatment and generally resulted in higher final hydrodynamic permeability. As a result of the physicochemical changes in the clay properties, the tendency of the clay to swell and absorb water was markedly decreased. In these systems, the electrical or electrochemical treatment appeared to be an irreversible process. The extent to which these electrochemical changes were produced depended in general on the amount of current passed, the magnitude of potential gradient imposed, the amount and type of clay minerals present, and the type and concentration of electrolytic solution used.
Objectives/Hypothesis
Spontaneous cerebrospinal fluid (CSF) leaks of the skull base are associated with obesity, multiparity, and elevated intracranial pressure. Although spontaneous CSF leaks often present with rhinorrhea, they can be an underdiagnosed cause of chronic aspiration pneumonitis, a complication that has not been previously reported in detail.
Study Design
Retrospective case series.
Methods
The authors retrospectively reviewed all patients undergoing surgical repair of CSF fistulae at the University of Southern California between 2011 and 2018 to identify those presenting with pulmonary symptoms including dyspnea, aspiration, chronic cough, and shortness of breath caused by chronic noniatrogenic CSF pneumonitis.
Results
Symptomatic chronic pneumonitis was evident in six of 20 patients with spontaneous CSF rhinorrhea. Five women (mean body mass index = 36) had CSF leaks arising from the fovea ethmoidalis (n = 4) and lateral sphenoid region (n = 1). One man had a middle fossa floor dehiscence draining through the eustachian tube. All patients had bilateral ground‐glass opacities in their lungs on computed tomography imaging that were attributed to spontaneous CSF fistulae arising from noniatrogenic skull base defects, and one patient underwent a biopsy of a lung lesion at another hospital showing chronic bronchiolitis and adjacent peribronchiolar metaplasia. Five patients underwent endoscopic endonasal repair using an autologous fascial graft and pedicled nasoseptal flap, and one underwent craniotomy for repair. All patients underwent successful repair with no complications or evidence of recurrence. Upon repair of the spontaneous CSF leaks, both pneumonitis symptoms and ground‐glass opacities on imaging resolved in all six cases.
Conclusions
Skull base CSF fistulae should be considered as a reversible cause of chronic pneumonitis that is not alleviated or worsens with standard treatment.
Level of Evidence
4 Laryngoscope, 131:462–466, 2021
Ventricular septal defect (VSD) is a rare complication of right ventricular infarction (RVI) which is associated with significant mortality, if not treated appropriately. It typically occurs within the first 10–14 days after myocardial infarction. Surgical repair has been shown to reduce in-hospital mortality from 90% to 33–45%. Early surgical VSD repair has also been associated with high 30-day operative mortality of 34–37%. Furthermore, after an acute MI the friable myocardium enhances the risk of recurrent VSD with early surgical repair. We present a case of a middle-aged woman who developed VSD after an RVI. Her surgical repair was delayed by 2 weeks due to development of Staphylococcus aureus bacteremia. During this period, she was managed medically and later on underwent percutaneous repair with an amplatzer VSD occluder device. Keeping this patient encounter in mind, we would like to emphasize on the limited recommendations available for early against late surgical repair of VSD.
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