On the simultaneous growth of multiple hydraulic fractures emanating from an inclined well

The primary focus of this paper is to investigate the interaction between simultaneously propagating multiple fractures, initiated from an inclined well. In particular, the aim is to better understand the influence of the well inclination angle on the stress shadow between the fractures and on the overall resulting geometry of individual cracks. To simplify the analysis, the paper assumes the limit of large perforation friction, which leads to a uniform flux distribution between the fractures. The mathematical model for multiple hydraulic fractures is constructed by coupling together the respective models for individual fractures, each representing a single planar fracture model. In this approach, the fracture induced stress or stress shadow from a previous time step is used as an input for a given single hydraulic fracture to propagate independently. Further, to reduce computational burden, the effects associated with tangential stresses and displacements are neglected, whereby the stress interaction between the fractures is solely described by the normal opening and the normal stress component. Numerical results are presented for the storage viscosity dominated regime, whereby the effects of toughness and leak-off are negligible. An interesting behaviour is observed, demonstrating that the well inclination angle plays a significant role on the overall fracture symmetry. For zero inclination, all the fractures are nearly symmetrical and identical. However, once well inclination is introduced, this breaks the symmetry, making a profound effect on the final result.

Analysing prognostic factors among patients with perforative peritonitis

Background: The mortality of perforation peritonitis is highly dependent on early approach to the hospital, quick diagnosis and prompt surgical treatment as it correlates with the duration and degree of peritoneal contamination, the patient's age, the general health of the patient and the nature of the underlying aetiology. The present study was done to assess the role of various prognostic factors which have a bearing on the final outcome of the patients.Methods: This prospective observational cross-sectional study was conducted in the at a tertiary level hospital in Maharashtra, in which 47 patients who presented a surgical emergency of perforation peritonitis and underwent an exploratory laparotomy were included. We compared different variables between patients who survived and those who died. Results: High mortality was also found in patients who presented after 24 hours of developing symptoms. Ileal perforation was significantly more common among dead patients (50%) as compared to patients who survived (20%), p-value<0.05. There were significantly higher proportion of patients who had shock on day 1 who died (67%) as compared to those who survived (12%), p-value<0.05. Also, the group of patients who died, had significantly higher MPI (p-value<0.01), higher proportion of patients with multiple perforations (p-value<0.05), larger perforations (p-value<0.01) and contamination more than 1000 ml (p-value<0.05). Conclusions: High mortality was observed in patients who presented late, had ileal perforations, multiple and large perforation and developed shock on day one.

A comparative study of the outcome of tympanoplasty in dry and wet ear

<p class="abstract"><strong>Background:</strong> Many factors which influence the success rate of tympanic membrane closure, including age of the patient, size of the perforation, duration of the ear discharge, the presence or absence of infective discharge at the time of surgery. Aim was to find the effect of this discharge from the ear on the success of tympanoplasty. </p><p class="abstract"><strong>Methods:</strong> This is prospective study which was conducted on 100 cases with 50 patients each in dry and wet ear group. The study was conducted on patients of age 6 years to 60 years and of either sex presenting with chronic otitis media. </p><p class="abstract"><strong>Results:</strong> Ear discharge for less than 10 years, 78% in dry ear group and 81% in wet ear group. Around 64% had hearing impairment for&lt;5 years in dry ear group and 60% in wet ear group. The size of perforation in dry ear group, medium size perforation was found predominant 46%, large in 42% and small in 12% patients. In wet ear group 46% patients had medium, 16% patients small and 38% patient’s large perforation. Hearing improvement seen in 35 (70%) cases and worsening in 3 (6%) cases in dry ear group and 38 (76%) hearing improvement, 3 (6%) worsening in wet ear group.</p><p class="abstract"><strong>Conclusions:</strong> Graft failure was 4(8%) in dry ear and 5(10%) in wet ear. Hearing worsened in 6% cases in dry and wet ear group both. No other complications were seen in patients during follow up.</p><p class="abstract"> </p>

Type 1 tympanoplasty in patients with large perforations: Comparison of temporalis fascia, partial-thickness cartilage, and full-thickness cartilage

Objective This study aimed to compare the results of different graft materials in type I tympanoplasty for patients with a large perforation of the tympanic membrane. Methods We performed a retrospective study on 180 patients with type I tympanoplasty. The patients were divided into three groups according to the repair materials used. Age, sex, pre- and postoperative hearing levels, mean air–bone gap, rate of graft success, hearing gain, and the postoperative graft failure rate were evaluated. We continued to follow-up the patients to 1 year after surgery. Results The air conduction threshold was significantly higher before the operation than after the operation in the temporalis fascia, partial-thickness cartilage, and full-thickness cartilage groups. Although the hearing gain in the temporalis fascia group and the partial-thickness cartilage group was higher than that in the full-thickness cartilage group, there was no significant difference in the graft success rate among the groups. Conclusions Temporalis fascia, partial-thickness cartilage, and full-thickness cartilage can be used as appropriate transplantation materials for tympanoplasty type I in patients with a large perforation. Temporalis fascia and partial-thickness cartilage may be best for improvement of hearing.

An Approach to the study of vessels climber species

The angiosperms are characterized by vessels in wood, and therefore, vessel elements were selected to study them in climber species. Xylem is the specialized tissue that transports water and nutrients from the plant–soil interface to stem and leaves and provides mechanical support and storage. Water is the primary solvent for plant nutrition and metabolism and is essential for photosynthesis, turgor and for transport of minerals, hormones and other molecules. Studies on vessels showed that the characters of vessels can throw some light on the phylogeny of species. The short vessel members with many perforation plates with a single large perforation are most specialized and those that were long with elongate obliquely placed perforation plates with many perforations separated by bars that together give a scalariform appearance are primitive. The degree of specialization of vessel elements can be measured in terms of vessel length, breadth and the number of bars on the end plate of vessels. Vessels show highly evolved and primitive vessel elements. Mostly elongated vessel elements are present in middle region of the stem. During this study the broadest vessels were found in the middle part of the stem of dicots (Clitoria, Daemia and Aristolochia) and root of the monocots (Gloriosa) and the narrowest vessel elements were found in different parts of the species investigated. The present work is supported with line drawings of prepared stained sections, provides a framework of the vessels. This study will be very useful to a wideseries of community, who work with plants.

Large posterior perforation of duodenal ulcer: A rare surgical emergency

A 20-year-old man was admitted with a complaint of a constant dull aching pain in the epigastrium and back for five days, with subsequent worsening and generalization of the pain. Clinically the abdomen was tender all over with board-like rigidity. Chest radiography revealed pneumoperitoneum, and a decision was made to explore the patient. During laparotomy, we found a peritoneal collection with no perforation in the anterior surface of the stomach, duodenum, or the entire gastrointestinal tract. After opening the lesser sac, we found a large perforation of the posterior wall of the duodenum. After direct repair with stitching through duodenotomy and duodenoplasty also done, the patient recovered and was discharged after 14 days. Posterior perforation of a duodenum ulcer is a very rare condition.