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INTRODUCTION AND IMPORTANCE: Pneumopericardium is collection of gas in pericardial space. Retrospective reviews have described pneumopericardium as a complication of laparoscopic surgery, however, without any symptoms. By this report, we present a case who developed acute cardiopulmonary symptoms after retroperitoneal laparoscopic radical nephrectomy because of pneumopericardium. CASE PRESENTATION: A 40-year-old Vietnamese woman was admitted due to left flank pain. She was diagnosed with left dysfunctional hydronephrosis and right urolithiasis. Six hours post-operation of an elective retroperitoneal laparoscopic radical nephrectomy, she suddenly developed severe substernal chest pain and dyspnea. Evaluations for acute myocardial infarction and pulmonary embolism were immediately ordered with no abnormality. However, computed tomography scan of the chest showed pneumopericardium, pneumomediastinum, subcutaneous emphysema, gas collection in sub-peritoneal space and next to the aortic arch. She was then closely monitored and effectively managed by conservative treatments. CLINICAL DISCUSSION: Pneumopericardium is a rare complication of laparoscopy and mainly detected by radiographical measures incidentally. Several case studies reported symptomatic pneumopericardium, as in our presenting case. Some factors might contribute to the mechanism of our case that include retroperitoneal approach, thoroughly dissection the renal helium area and long-lasting operation. Post-operative collection of carbon dioxide is well self-limited; therefore, conservative treatments are efficient for stable cases. CONCLUSION: Pneumopericardium following laparoscopy is uncommon, and mostly subclinical. However, it can manifest as acute cardiopulmonary symptoms and signs that require carefully evaluation. The presence of gas in pericardial space is a negative prognosis factor itself; consequently, clinicians should be aware of when managing pneumopericardium subsequent to laparoscopic procedures.
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This study aims to investigate the adsorption behavior of a strong polyelectrolyte poly(styrenesulfonate) (PSS) onto alumina particles. Adsorption of PSS onto positively charged alumina surface increased with increasing ionic strength, indicating that non-electrostatic and electrostatic interaction controlled the adsorption. The removal of an emerging antibiotic ciprofloxacin (CFX) from water environment using PSS-modified alumina (PMA) was also studied. The removal of CFX using PMA was much higher than that using alumina particles without PSS modification in all pH ranges of 2-11. The removal of CFX reached 98% under the optimum conditions of pH 6, contact time of 120 min, adsorbent dosage of five milligrams per milliliter and ionic strength 104-M NaCl. The adsorption isotherms of CFX at different salt concentrations fit well with a two-step adsorption model, while the adsorption kinetic fit well with a pseudo-second-order model with a good correlation coefficient (R2 > 0.9969). The CFX-removal from a hospital wastewater using PMA was more than 75%. Our study demonstrates that adsorption of PSS onto alumina to modify the particle surface is important to form a novel adsorbent PMA for CFX-removal from water environments.