A Case of Sphenoidal Meningoencephalocele Masquerading as an Isolated Sphenoid Mucocele

Isolated sphenoid sinus disease is often misdiagnosed because of its rarity and varing clinical presentation. A 51-year-old male visited the hospital with abnormal brain CT findings which showed homogenous opacification associated with sinus wall expansion on the right sphenoid sinus. Under the impression of isolated sphenoid mucocele, the fenestration of sphenoid sinus was conducted without surgical complication. But, cerebrospinal fluid rhinorrhea spontaneously developed 3 days after fenestration operation and then stopped by sealing the suspicious leakage site with free graft of inferior turbinate mucosa. Based on the pathological findings, paranasal sinus CT and MRI findings, this case is reported to be meningoencephalocele developed in sphenoid sinus.

Intracranial hypotension as a unique complication of the rupture of an anterior sacral meningocele into a recurrent pilonidal cyst

Background: Intracranial hypotension (IH) is an underdiagnosed, but important cause of new-onset, daily persistent headache, especially among the young- and middle-aged population. It results from a cerebrospinal fluid (CSF) leak with subsequent lowered CSF pressure. Case Description: A 37-year-old female presented to the emergency department with sudden onset severe headaches. Two years earlier, she had undergone surgery for resection of a pilonidal cyst (PC). The night before admission, she had watery discharge from the recurrent PC and severe diffuse positional headaches associated with photophobia and neck pain. The head computed tomography showed pneumocephalus in the posterior fossa and a spine magnetic resonance imaging revealed an anterior sacral meningocele (ASM) in close contact with the recurrent PC. A final diagnosis was made of headaches due to IH. The leakage site was the rupture of the ASM in the PC. The surgical repair of the ASM was achieved suturing two overlapping dural flaps. There was no more CSF leakage from the PC and the headaches disappeared. Conclusion: This is a unique case of IH due to the rupture of an ASM into a recurrent PC. The association of an ASM and PC, at the best of our knowledge, is unique. Moreover, the fistulation of the ASM to the PC is exceptional. ASM can be successfully closed with a posterior approach, using two overlapping dural flaps.

Imaging and leaks in peritoneal dialysis

Dialysate leaks are non-rare mechanical but dreaded complications in peritoneal dialysis (PD). They usually occur at the beginning of PD, with various clinical events depending on their location. Use of imaging tests such as computed tomography (CT) peritoneography, or magnetic resonance imaging (MRI) peritoneography, or scintigraphic peritoneography, can confirm the diagnosis and guide surgical intervention if needed. These simple, non-invasive, and accessible tests can be done in collaboration between the radiological et peritoneal teams. Depending on the leakage site, PD can be pursued with small volumes with a cycler. In other cases, it must be interrupted and the patient transferred to hemodialysis, in order to permit the peritoneal cavity to regain its integrity by cicatrization or with surgical intervention. Imaging can help to make sure peritoneal cavity has regained its integrity after this period of transition. Early leaks can be avoided by delaying PD start with by 14 days. Intraperitoneal pressure does not seem to contribute significantly. Prevention of PD leaks essentially depends on individual risk factors such as obesity or anterior abdominal surgeries. This article reviews the characteristics of dialysate leaks in PD and the imagery tests to limit transfer to hemodialysis.

Correlation of sectoral choroidal vascularity with angiographic leakage in central serous chorioretinopathy

Purpose: To correlate sectoral choroidal vascularity with angiographic leakage in eyes with central serous chorioretinopathy (CSCR). Methods: This was a retrospective, cross-sectional study including patients with active CSCR. Multimodal imaging including fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were performed to identify leakage site and obtain choroidal measurements, respectively. An automated algorithm was used to perform shadow compensation, choroidal boundary localization and binarization, three (3-D) dimensional mapping, and early treatment of diabetic retinopathy study (ETDRS) grid based choroidal quantification that is, choroidal thickness (CT) and choroidal vascularity index (CVI). Nested analysis of variance (ANOVA) was performed to compare CT and CVI in different sectors. Results: Thirty-two eyes with active CSCR were analyzed. CT values varied significantly among the sectors (range, 450.27–482.63 µm; p = 0.005) and rings (range, 459.71–480.45 µm; p < 0.001), however, CVI failed to show significant variation among various segments (sectors, rings, and quadrants; range, 0.53–0.54; all p values > 0.05). Among 25 leaking spots in 25 different sectors, 12 (48%) had an increased CT compared to the overall CT whereas only 24% had increased CVI compared to overall CVI. Mean CT and CVI of the sectors with leakage (427.1 ± 81.1 µm; 0.51 ± 0.05) and remaining sectors without leakage (411.3 ± 73.9 µm; 0.53 ± 0.04) were not statistically different ( p = 0.48; p = 0.12, respectively). Conclusion: Though CT varied in different segments and increased CT corresponded to leakage points on FFA in 48% of eyes, CVI changes were more diffusely spread and local changes in CVI were not predictive of leakage location in eyes with active CSCR.

Analysis of Leakage Cause of L415M Spiral Submerged Arc Welding Pipe

The causes of longitudinal crack in gas pipeline during pressure were analyzed by means of mechanical property test, microstructure analysis, sem analysis and energy spectrum analysis. The results show that the leakage of L415M spiral submerged arc welded pipe is caused by the contact between the base material of steel pipe and low-melting copper alloy in the process of high temperature, resulting in the brittleness of liquid metal. Specifically, when the leakage site of the steel pipe is heated at an abnormal high temperature, copper penetration along the grain boundary causes embrittlement, strength reduction and crack along the grain boundary, finally leading to the crack and leak of the steel pipe.

An Enhanced Crack-Plugging and Pressure-Bearing Oil-Based Drilling Fluid System

Compared with water-based drilling fluids (WBDF), oil-based drilling fluids (OBDF) are more prone to borehole leakage loss. Once borehole leakage occurs, it’s difficult to handle the leakage site and it will inevitably cause great economic losses. To cope with the major difficulties in OBDF leakage-proof and crack plugging, this paper conducted experiments on an enhanced crack-plugging and pressure-bearing OBDF system starting from the borehole leakage prevention measures. Then, by selecting and optimizing the materials of leakage-proof agent and crack-plugging agent for OBDF, this study prepared a new-type OBDF drilling leakage-proof agent and a new-type OBDF still crack-plugging agent and discussed their action mechanisms. Laboratory experiment and mechanism analysis results showed that, a well-proportioned combination of different type OBDF leakage-proof and crack-plugging materials such as rigid bridging particles, elastic filling particles, and fiber materials had a synergistic plugging effect and quickly formed a dense crack-plugging and pressure-bearing layer with a stable network structure (the "strong-force chain network" model), which had significantly improved the crack-plugging and pressure-bearing performance of the OBDF, and further optimized the enhanced crack-plugging and pressure-bearing OBDF system; before and after the heated rolling aging, the rheological properties and filtration loss performance of the system were good, and the filtration loss of the sand filter cake of the Permeability Plugging Apparatus (PPA) was only 11.4mL, therefore, the proposed agents exhibited good performance in drilling leakage-proof, crack-plugging, and pressure-bearing, and they were helpful to improve the pressure bearing ability of the earth stratums.

A Case of Petrous Apex Meningocele: Unusual Presentation of Cerebrospinal Fluid Leak Following Adenoidectomy

Cerebrospinal fluid (CSF) leak is possible and can be a cause of recurrent bacterial meningitis. Petrous apex meningocele (PAM) is mostly asymptomatic and is often found during incidental imaging tests. We experienced a case of CSF rhinorrhea with recurrent meningitis in bilateral PAM after adenoidectomy. This report highlights the diagnostic process of CSF leak, identification of leakage site, and surgical approach to petrous apex lesions.