Controlling Condensate Gas Well by Lubricating and Bleed-Off Method, Case Study

During flow a condensate gas well, downstream pressure dropped many times. The reason was partially plug which was occurred in choke manifold adjustable path due to producing abnormal cutting, junk and debris. Produced debris led to other problems such as malfunctioning in the Christmas tree and subsurface safety valve. The goal of this article is to present the procedure of lubricating and bleed-off method to control a gas well during production when there are malfunctioning in x-mas tree valves and subsurface safety valve. In this paper, other operations such as the Christmas tree substitution with a new one, installing and retrieving blanking plug, and mending subsurface safety valve malfunction are explained stepwise.

A potential misdiagnosis in the COVID-19 pandemic era: a case report of superimposed thrombosis or tumor recurrence

Background The clinical manifestations of coronavirus disease 2019 (COVID-19) overlap with those of other disorders, especially cardiovascular disease. Case presentation We herein describe a 58-year-old woman who presented with syncopal episodes and dyspnea on exertion with a left atrial (LA) mass, scheduled for surgical removal and mitral valve replacement. Nearly 3 months later, the patient developed dyspnea, fever, and a sore throat, resulting in hospital admission with suspected COVID-19. During the diagnostic evaluation, a larger LA mass was detected. The mass seemed to be a COVID-19–induced organized thrombus with prosthetic mitral valve malfunction. Resection was, therefore, planned. An immunohistochemistry study revealed a liposarcoma. Conclusions The unusual early recurrence of liposarcomas and the misdiagnosis with COVID-19–induced thrombosis are the hallmark of the present case.

In vitro testing of explanted shunt valves in hydrocephalic patients with suspected valve malfunction

Diagnosis of symptomatic valve malfunction in hydrocephalic patients treated with VP-Shunt (VPS) might be difficult. Clinical symptoms such as headache or nausea are nonspecific, hence cerebrospinal fluid (CSF) over- or underdrainage can only be suspected but not proven. Knowledge concerning valve malfunction is still limited. We aim to provide data on the flow characteristics of explanted shunt valves in patients with suspected valve malfunction. An in vitro shunt laboratory setup was used to analyze the explanted valves under conditions similar to those in an implanted VPS. The differential pressure (DP) of the valve was adjusted stepwise to 20, 10, 6, and 4 cmH2O. The flow rate of the explanted and the regular flow rate of an identical reference valve were evaluated at the respective DPs. Twelve valves of different types (Codman CertasPlus valve n = 3, Miethke Shuntassistant valve n = 4, Codman Hakim programmable valve n = 3, DP component of Miethke proGAV 2.0 valve n = 2) from eight hydrocephalic patients (four male), in whom valve malfunction was assumed between 2016 and 2017, were replaced with a new valve. Four patients suffered from idiopathic normal pressure (iNPH), three patients from malresorptive and one patient from obstructive hydrocephalus. Post-hoc analysis revealed a significant difference (p < 0.001) of the flow rate between each explanted valve and their corresponding reference valve, at each DP. In all patients, significant alterations of flow rates were demonstrated, verifying a valve malfunction, which could not be objectified by the diagnostic tools used in the clinical routine. In cases with obscure clinical VPS insufficiency, valve deficiency should be considered.

A Potential Misdiagnosis in the COVID-19 Pandemic Era: A Case Report of Superimposed Thrombosis or Tumor Recurrence

Background: The clinical manifestation of coronavirus disease 2019 (COVID-19) overlap with other disorders especially cardiovascular diseases (CVD). The prevailing conditions in the COVID-19 pandemic can distract us from other differential diagnoses.Case presentation: We report a 58 years old female presented with syncope episodes and dyspnea on exertion (DOE) with the left atrial (LA) mass, candidate for surgical removal and mitral valve replacement. Nearly 3 months later, she developed dyspnea, fever, and a sore throat cause to admit her with suspected COVID-19. During diagnostic evaluation, a larger LA mass detected that seemed to be COVID-19 induced organized thrombus with prosthetic mitral valve malfunction. The mass resected and immunohistochemistry revealed liposarcoma.Conclusions: The unusual early recurrence of liposarcoma and misdiagnosis with COVID-19 induced thrombosis is the hallmark of the present case that we keep other causes in mind besides COVID-19.

Hypotension

In critically ill patients it is imperative to resolve and treat the cause of haemodynamic shock as quickly as possible in order to save lives and minimize end-organ damage. Intensive Care doctors trained to perform echocardiography can rapidly diagnose and effect management changes in hypotensive patients. A goal-directed approach is required seeking to urgently identify and differentiate distinct clinical syndromes that may occur in this setting. Such an approach utilizes the primary transthoracic echocardiographic subcostal, parasternal, and apical windows and identifies the key issues that can be addressed in the available views. Key to the success of goal-directed echocardiography is the integration of clinical and echocardiographic data in each individual patient. Keeping an open mind regarding the coexistence of more than one cause of hypotension and the need for more comprehensive echocardiography testing is important. Specific situations such as papillary muscle rupture, localized tamponade following cardiac surgery and prosthetic valve malfunction are more reliably diagnosed using the transoesophageal approach. Some diagnoses, such as aortic dissection, acute mitral or aortic regurgitation and acute cardiomyopathy require a multidisciplinary approach and immediate consultation with Cardiology and cardiothoracic services will be required. The simultaneous interpretation of echocardiographic images and the institution of active management are what distinguish critical care echocardiography.