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Model for Plateau border drainage of power-law fluid with mobile interface and its application to foam drainage.

A model for drainage of a power-law fluid through a Plateau border is proposed which accounts for the actual Plateau border geometry and interfacial mobility. The non-dimensionalized Navier-Stokes equations have been solved using finite element method to obtain the contours of velocity within the Plateau border cross section and average Plateau border velocity in terms of dimensionless inverse surface viscosity and power-law rheological parameters. The velocity coefficient, the correction for the average velocity through a Plateau border of actual geometry compared to that for a simplified circular geometry of the same area of cross section, was expressed as a function of dimensionless inverse surface viscosity and flow behavior index of the power-law fluid. The results of this improved model for Plateau border drainage were then incorporated in a previously developed foam drainage model [G. Narsimhan, J. Food Eng. 14 (1991) 139] to predict the evolution of liquid holdup profiles in a standing foam. Foam drainage was found to be slower for actual Plateau border cross section compared to circular geometry and faster for higher interfacial mobility and larger bubble size. Evolution of liquid holdup profiles in a standing foam formed by whipping and stabilized by 0.1% beta-lactoglobulin in the presence of xanthan gum when subjected to 16g and 45g centrifugal force fields was measured using magnetic resonance imaging for different xanthan gum concentrations. Drainage resulted in the formation of a separate liquid layer at the bottom at longer times. Measured bubble size, surface shear viscosity of beta-lactoglobulin solutions and literature values of power-law parameters of xanthan gum solution were employed in the current model to predict the evolution of liquid holdup profile which compared well with the experimental data. Newtonian model for foam drainage for zero shear viscosity underpredicted drainage rates and did not agree with the experimental data.

Journal Article↗

Subcutaneous drainage versus no drainage after minilaparotomy in gynecologic benign conditions: a randomized study.

OBJECTIVE: The purpose of this study was to determine the outcomes of subcutaneous drainage in patients who are affected by benign gynecologic diseases that are treated by a Kustner's minilaparotomy incision. STUDY DESIGN: We performed a randomized controlled study with 72 patients who underwent operation for benign gynecologic disease. Patients were assigned intraoperatively to two groups: group A (36 patients) had a closed drainage system and group B (36 patients) had no drainage. Historic data, clinical and surgical characteristics, and perioperative complications were recorded prospectively. Postoperative care data, surgical incision complications, and hospital stay were analyzed. Patients were to be seen 4 weeks after the operation to assess wound healing. RESULTS: No patients had intraoperative complications or blood transfusions. A significant difference was observed between the drainage versus no-drainage groups regarding postoperative complications and hospital stay (P =.001, both groups). No patients had surgical complications at 4 weeks after the last operation. CONCLUSION: Our data suggest that routine prophylactic subcutaneous drainage is indicated in patients who undergo Kustner's minilaparotomy incision for benign gynecologic operation. Drains significantly prevent wound complications and reduce hospital stay.

Adolescent↗

Comparison of silicone oil removal with passive drainage alone versus passive drainage combined with air-fluid exchange.

PURPOSE: To compare silicone oil removal with passive drainage alone versus passive drainage combined with air-fluid exchange in regard to floaters. METHODS: Twenty-five consecutive patients who were seen at the Retina Center in St. Louis, Missouri between May 1996 and May 1999 and underwent silicone oil removal were requested to complete a mailed questionnaire regarding the presence of floaters. The medical records of the 21 patients (22 eyes) who returned the questionnaire were also reviewed retrospectively for clinical evidence of floaters if they were identified in the postoperative fundus examination. RESULTS: Fifteen patients (16 eyes) (73%) reported floaters after silicone oil removal. Three (14%) of these eyes also had clinical evidence of floaters on postoperative fundus examination. Univariate analyses of primary eye disease other than proliferative diabetic retinopathy, duration of silicone oil retention in the eye, and final visual acuity were not associated with the patients' reported incidence of floaters. No patients with proliferative diabetic retinopathy reported floaters after silicone oil removal. Silicone oil removal procedure (i.e., removal with passive drainage alone or passive drainage combined with air-fluid exchange) did not influence the reported occurrence of floaters (P = 0.65). CONCLUSION: Silicone oil removal is often associated with floaters from residual oil droplets. There is no difference in the incidence of floaters seen after silicone oil removal with passive drainage alone versus passive drainage combined with air-fluid exchange.

Acetates↗

[The calibrating drainage of the common bile duct (C.B.D.). Value of "axial exit" drainage (author's transl)].

The authors believe that utilisation of calibrating drainage is justified in case of difficult restauration of the C.B.D. of normal caliber, either throughout its length or in one segment. They underline that "axial exit" has not the disadvantages of the "lateral exit" of T-tubes. They recall the various modalities of "axial exit" (transcystic, transpapillary, transhepatic, "en seton") and their own contribution to the improvement of the transpapillary drainage by the association of a systematic sphincterotomy. Abstract of their clinical series, technics, postoperative mortality and morbidity, calibrating drainage duration and results (in connection with etiology) are reported. Main advantages of the "axial exit" are the absence of any risk of stenosis on a non dilated C.B.D. (as for the "lateral exit") and the facility for long time calibration up to several years. No hemorrhage, no bile leakage have been observed. The one only risk of this sort of drainage is the premature fall of transcystic or transpapillary drains ; but this disadvantage does not exist for "en seton" drainage. Shortly : "axial exit" calibrating drainage is recommandable when a very long time calibration after restauration of non dilated C.B.D. is necessary.

Adult↗

Internal biliary drainage, unlike external drainage, does not suppress the regeneration of cholestatic rat liver after partial hepatectomy.

We previously showed that hepatic cells proliferate in obstructive jaundice alone without partial hepatectomy and found that external biliary drainage for obstructive jaundice markedly suppresses liver regeneration after partial hepatectomy. In this study, we produced a model system for internal biliary drainage in which bile was drained into the stomach of rat fed a liquid diet. The regeneration capacity of the liver was assessed on the basis of the induction of DNA polymerase-alpha activity, as well as the mitotic index of hepatic cells. A remarkable difference was observed in the regeneration capacities of cholestatic livers between two groups--one in which jaundice was released by the internal and one by external biliary drainage before hepatectomy. After 5 days of internal biliary drainage, the regeneration capacity remained at a level comparable to that of sham-operated control rats, in sharp contrast to the impaired regeneration after external biliary drainage. These results clearly indicate that internal biliary drainage is preferable for release of biliary obstruction before partial resection of cholestatic liver.

Animals↗

Long-term outcome of kidneys with initially poor drainage or no drainage following pyeloplasty.

Pyeloplasty for congenital ureteropelvic junction (UPJ) obstruction enjoys a 90-95% success rate. Although treatment of the failed pyeloplasty has been addressed in the literature, management of the poorly draining or nondraining renal unit in the immediate postoperative period has not received any attention. For this purpose the medical records of 33 consecutive children (37 renal units) treated by dismembered pyeloplasty between 1986 and 1992 were reviewed. All of our pyeloplasties were stented and urine was diverted via a nephrostomy tube. All patients underwent a nephrostogram following stent removal 1 week postoperatively. These studies showed poor drainage, or no, across the newly reconstructed anastomosis in 7 of 37 renal units (19%). The ages of these 4 boys and 3 girls at the time of pyeloplasty ranged between 7 weeks and 5 years (mean 22 months). In four patients, good drainage occurred without intervention by 2-4 weeks postoperation. In two patients, percutaneous balloon dilation of the anastomosis via the intraoperatively placed nephrostomy tube was required at 3 and 6 weeks, respectively. The remaining patient failed percutaneous dilation, necessitating a ureterocalycostomy at 9 weeks following pyeloplasty. The long-term follow-up for the entire group of 33 children averaged 30 months and consisted of radionuclide diuresis renography in 84% of cases or intravenous pyelography in the remainder. All patients had excellent long-term outcomes as assessed by comparison of the postoperative studies with the baseline studies obtained preoperatively. Our results show that kidneys with initially poor drainage, or even no drainage, across the newly reconstructed anastomosis following pyeloplasty can be salvaged with an excellent long-term outcome comparable with that of the group with initially good drainage. In addition, intervention was necessary in only 43% of renal units with initial compromise and was facilitated by the intraoperatively placed nephrostomy tube. We recommend that percutaneous dilation be done at between 4 and 6 weeks postpyeloplasty, as the waiting period was long enough to allow for spontaneous improvement without precluding a successful outcome if drainage failed to occur. Ureterocalycostomy was rarely necessary.

Catheterization↗

[What suction drainage is optimal for drainage of wound secretion? A clinico-experimental study exemplified by the knee joint].

In a randomized clinical study on 40 intraarticular knee joint drainages the effect of a high vacuum, middle vacuum, low vacuum and suction free drainages were examined. The maximum of the volume that was drained had been in the group of the suction free drainages. Drains with a long period of suction had a minimum of evaluated ultrasonographic effusion in the knee joint. The group with high vacuum was obviously not as long as open as in the other groups. Thrombi in the drainages could be found in every group. This refers to the observation that the finding of adherent thrombi is related to the material the drain is made of. Adherent thrombi decrease the possibility of secretion, not adherent thrombi do not decrease suction volume. Referring to these results it is obvious that not the high-vacuum drainage is the matter of choice for intraarticular drains. The suction-free drainages or drains with reduced vacuum have more advantages in respect to simple, secure and fast implantation and handling.

Equipment Design↗

A closed irrigation and drainage system for use with percutaneous abscess drainage: technical note.

A closed irrigation and drainage system has been used in 50 consecutive patients to assess its effectiveness in maintaining catheter patency and draining fluid collections. It consists of an irrigation fluid source, flushing syringe, drainage bag, and tubing to connect the components, and is assembled when the initial drainage procedure is performed. The system emphasizes the use of the siphon effect to maintain constant suction and a closed irrigation and drainage configuration that prevents spread of infection to others and minimizes contamination of the drained cavity. This method of irrigation and drainage also makes patient care considerably easier, and ensures catheter patency.

Abscess↗

Renal carbuncle: comparison between surgical open drainage and closed percutaneous drainage.

This article represents a retrospective study of 12 patients with renal carbuncle treated at the combined urological services of The Mason Clinic in Seattle, Washington, and Madigan Army Medical Center in Tacoma, Washington. All patients were initially treated with antibiotics. Two recovered without further treatment. Of the 10 patients who failed to respond, 2 underwent nephrectomy for nonfunctioning kidneys, 4 underwent closed percutaneous drainage, and 4 underwent surgical open drainage. All patients treated with open surgical drainage recovered and retained functioning kidneys. Of the 4 patients who underwent closed percutaneous drainage, 2 failed to respond and required subsequent emergency nephrectomy because of sepsis. The authors believe that renal exploration and open drainage should be the initial definitive mode of surgical treatment of renal carbuncle in those patients who fail antibiotic therapy alone.

Abscess↗

Comparison between 4-hour clamping drainage and nonclamping drainage after total knee arthroplasty.

A prospective randomized trial of postoperative drainage-clamping practice was performed in 89 knees undergoing total knee arthroplasty. In group 1 (43 knees), drainage was clamped for the first 4 postoperative hours. In group 2 (46 knees), drainage was not clamped. The average bloody drainage was significantly less in group 1 than group 2 (514.85 +/- 378.0 vs 843.4 +/- 366.4 mL). The decrease of hemoglobin and hematocrit after surgery was also significantly less in group 1. Group differences between postoperative range of motion and narcotics requirements, length of stay, immediate wound problems, and deep vein thrombosis were nonsignificant. These results suggested that clamping the drainage in the first 4 postoperative hours reduces postoperative blood loss without causing excess morbidity after total knee arthroplasty.

Aged↗

A prospective randomized study comparing retroperitoneal drainage with no drainage and no peritonization following radical hysterectomy and pelvic lymphadenectomy for invasive cervical cancer.

OBJECTIVE: To evaluate the postoperative morbidity and lymphocyst formation in invasive cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy (RHPL) with no drainage and no peritonization compared with retroperitoneal drainage and peritonization. METHODS: Between July 1999 and May 2000, 100 patients with stage IA-IIA cervical cancer undergoing RHPL in Chiang Mai University Hospital were prospectively randomized to receive either no peritonization and no drainage (Group A = 48 cases) or retroperitoneal drainage and peritonization (Group B = 52 cases). Perioperative data and morbidity were recorded. Transabdominal and transvaginal sonography were performed at 4, 8 and 12 weeks postoperatively to detect lymphocyst formation. RESULTS: Both groups were similar regarding age, size and gross appearance of tumor, tumor histology and stage. There was no difference between groups in respect of operative time, need for blood transfusion, intraoperative complications, hospital stay, number of nodes removed, nodal metastases, and need for adjuvant radiation and chemotherapy. Asymptomatic lymphocysts were sonographically detected at 4, 8 and 12 weeks postoperatively in 3 (6.8%), 2 (4.6%), and 3 (7.7%) of 44, 43, and 39 patients, respectively in Group A, whereas none was found in Group B (P = 0.2). No significant difference was found in term of postoperative morbidity in the two groups. CONCLUSION: Routine retroperitoneal drainage and peritonization after RHPL for invasive cervical cancer can be safely omitted.

Adult↗

Treatment of abdominal abscesses: comparative evaluation of operative drainage versus percutaneous catheter drainage guided by computed tomography or ultrasound.

Computed tomography and, to a lesser extent, ultrasonography provide detailed anatomic localization of intra-abdominal abscesses that permit precise percutaneous placement of catheters large enough to effect drainage. Using routes similar to surgical approaches, the authors have used this technique as definitive therapy for intra-abdominal abscesses. To assess its efficacy, the results in the 27 patients treated percutaneously over the last five years have been compared with the results in the 43 patients treated by operative intervention over the past ten years. In the percutaneous group, complications (4%), inadequate drainage (11%), and duration of drainage (17 days) were less than in the operative group (16%, 21% and 29 days respectively). These results indicate that percutaneous drainage is at least as efficacious as operative drainage and avoids the risks of a major operative procedure.

Abdomen↗

High-volume postobstructive choleresis after transhepatic external biliary drainage resolves with conversion to internal drainage.

We report high-volume postobstructive choleresis in two patients who underwent transhepatic external drainage for malignant biliary obstruction. Excessive loss of bicarbonate-rich biliary fluid (up to 6.5 L/day) caused orthostatic hypotension, prerenal insufficiency, hyponatremia, and a decrease in serum bicarbonate. Therapy with isotonic fluids containing sodium, chloride, lactate, bicarbonate, and potassium was based on measurement of biliary fluid volume and electrolyte concentrations. Biliary fluid loss was terminated by conversion to internal biliary drainage. The reason for this rare complication of external drainage of biliary obstruction is unknown, but such patients must be closely monitored for volume loss. When high-volume choleresis occurs, biliary fluid and electrolyte losses should be precisely measured and replaced, and external biliary drainage converted to internal drainage.

Adenocarcinoma↗

Prospective, randomised, controlled trial comparing suture needle drainage and argon laser drainage of subretinal fluid.

AIMS: This study was designed to compare suture needle drainage (SND) with argon laser drainage (ALD) of subretinal fluid. METHODS: A prospective, randomised, controlled, clinical trial was carried out on 93 patients undergoing external drainage of subretinal fluid during scleral buckling surgery for rhegmatogenous retinal detachment. The incidence of successful drainage, incidence of subretinal haemorrhage, incidence of retinal incarceration, and incidence of retinal perforation were determined. RESULTS: The success rate was 97.9% in the ALD group and 84.8% in the SND group (difference-13.1%, 95% CI-26.4% to 2.0%). The incidence of clinically significant subretinal haemorrhage was 4.3% in the ALD group compared with 28.3% in the SND group (difference 24.0%, 95% CI 7.6% to 40.4%). The incidence of incarceration was comparable in each group. There were no cases of retinal perforation. CONCLUSIONS: The use of ALD was associated with a higher rate of successful SRF drainage, and a lower incidence of clinically significant subretinal haemorrhage than SND. ALD is preferred when an endolaser is available.

Adolescent↗

Biliary-jejunal drainage for failed biliary-duodenal drainage.

Percutaneous biliary drainage, as palliation for malignant biliary obstruction, is subject to complications, particularly blockage of the drainage tube. Blockage may occur because of duodenal tumour involvement. In nine patients with blockage of the biliary-duodenal drainage tube, conversion to biliary-jejunal drainage allowed continued internal drainage of bile.

Aged↗

Intercostal tube drainage of pleura: urosac as chest drainage bag.

Chest drainage bags are an alternative to underwater seal drainage. Urosac functions on the same principles and therefore can be used as a cheap and easily available substitute. 40 patients requiring intercostal tube drainage (ICD) were included in the study. 29 pneumothoraces and 11 pleural effusions of various etiologies were treated with intercostal drain attached to urosac bag. The period of ICD ranged from 4 days to 106 days. 2 patients were treated at home for prolonged periods without any complications. Urosac used as a chest drainage bag is safe and effective and can be used as an alternative to underwater seal drainage with several advantages.

Chest Tubes↗

Closed suction drainage versus no drainage following pelvic lymphadenectomy for gynecological malignancies.

The present study was undertaken in the Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore between October 1998 and July 1999. One hundred and forty three consecutive patients with various gynecological malignancies undergoing pelvic +/- aorto-caval lymphadenectomy as part of definitive surgical procedures, were analyzed. Sixty nine patients had closed suction retroperitoneal pelvic drainage (Group A) and 74 patients had no suction drainage and no pelvic reperitonealization (Group B). The mean postoperative hospitalization was 10 days in both groups. Six patients in Group A and four patients in Group B developed paralytic ileus which responded to conservative line of management. Five patients in Group A and two patients in Group B developed lymphocysts (P > 0.05). The present study demonstrates that closed suction retroperitoneal pelvic drainage following pelvic + aorto-caval lymphadenectomy confers no advantage over no drainage & no pelvic reperitonealization. The partial closure of pelvic peritoneum with no drainage was associated with increased lymphocyst formation (7/25 cases, 28%) during the period immediately before this modified study was undertaken.

Adolescent↗

Management of chronic subdural haematoma: burr hole drainage, replacement with Hartmann's solution, and closed-system drainage.

Although the treatment of chronic subdural haematoma by burr hole drainage has been performed in the past with or without using a closed drainage system, the problem of intracranial air entrapment still persists and can cause a deterioration in the level of consciousness or seizures in the postoperative period. Cerebral infarction may also develop a few days after surgery because of the intracranial hypotension that occurs during the drainage procedure. In an attempt to minimise these complications and to prevent cerebral infarction and its attendant morbidity, we have developed a technique of treating chronic subdural haematoma-namely, performing burr hole drainage, irrigation and replacement of the haematoma with Hartmann's solution, and closed-system drainage of the subdural space with a silicone catheter. The blood pressure is closely monitored and maintained by the infusion of fluids throughout the procedure. An illustrative case using this technique is presented in this paper.

Journal Article↗