Quantitative assessment of deep-seated CO2 leakage around CO2-rich springs with low soil CO2 efflux using end-member mixing analysis and carbon isotopes.

This study examined a mountainous area with two hydrochemically distinct CO2-rich springs to understand the origin, flow, and leakage of CO2, which may provide implications for precise monitoring of CO2 leakage in geological carbon storage (GCS) sites. The carbon isotopic compositions of dissolved inorganic carbon (DIC) in CO2-rich water (δ13CDIC) and those of soil CO2 (δ13CCO2) indicated a deep-seated CO2 supply to the near-surface environment in the study area. The hydrochemical difference (e.g. pH, total dissolved solids) for the two CO2-rich springs separated by 7 m, despite similar δ13CDIC and partial pressure of CO2, was considered as the result of different evolution of shallow groundwater affected by deep-seated CO2 preferentially rising along fracture zones. Electrical resistivity tomography also suggested flow through fracture zones beneath the CO2-rich springs, showing low resistivity compared to other surveyed zones. However, soil CO2 efflux was low compared to that in other natural CO2 emission sites, and in particular it was noticeably low near the CO2-rich springs, whereas δ13CCO2 was high close the CO2-rich springs. The dissolution of CO2 in the near-surface water body seemed to decrease the deep-seated CO2 leakage through the soil layer, while δ13CCO2 imprinted the source. End-member mixing analysis was performed to assess the contribution of deep-seated CO2 to the low soil CO2 efflux by assuming that atmospheric CO2 and soil CO2 (by respiration) as well as deep-seated CO2 contribute to the soil CO2 efflux. For each end-member, characteristic δ13CCO2 and CO2 concentrations were defined, and then their apportionment to soil CO2 efflux was estimated. The resultant proportion of deep-seated CO2 was up to 8.8%. Unlike the spatial distribution of high soil CO2 efflux, high proportions exceeding 3% were found around the CO2-rich springs along the east-west valley. The study results indicate that soil CO2 efflux measurement should be combined with carbon isotopic analysis in GCS sites for CO2 leakage detection because CO2 dissolution in the underground water body may blur leakage detection on the surface. The implication of this study is the need to quantitatively assess the contribution of deep-seated CO2 using the soil CO2 concentration, soil CO2 efflux, and δ13CCO2 at each measurement site.

A modified and rapid method for the single-well push-pull (SWPP) test using SF6, Kr, and uranine tracers.

In the present study, a single-well push-pull (SWPP) test was conducted with multi-component tracers, including inert gas (SF6 and Kr) and uranine (conservative), to understand the volatile/semi-volatile component transport characteristics in the groundwater system. In an SWPP test, it is essential to obtain an initial breakthrough curve (BTC) of the inert gas concentration at the beginning of the pulling stage to analyze the hydraulic properties of the groundwater system. As a result of the SWPP test using a proposed method in this study, physicochemical parameters of the groundwater and BTC of gas tracers and uranine were acquired simultaneously and successfully. In addition, on-site measurements of uranine, pCO2, and water quality data, such as electrical conductivity (EC), temperature, pH, and dissolved oxygen, were undertaken. Modification of an existing pCO2 measuring system allowed the gas samples to be collected, transported, and analyzed for inert gas components within a few hours. As a result, reliable and interpretable data with a recovery ratio of 26%, 85%, and 95% for SF6, Kr, and uranine, respectively, were obtained. The differences in the recovery ratio were utilized to identify the environmental system, whether it contains gas inside the isolated system (closed) or not (open), and to understand plume behavior characteristics in the experimental zone. By applying a two-dimensional advection-dispersion model to the acquired tracer test data and comparing the observed and computed tracer concentrations, helpful information was obtained on the hydraulic and transport characteristics of the targeted zone. This method can be extended to the design of dissolved CO2 transport monitoring of an aquifer above a CCS site.

Constraining the effectiveness of inherent tracers of captured CO2 for tracing CO2 leakage: Demonstration in a controlled release site.

Geological storage of carbon dioxide (CO2) is an integral component of cost-effective greenhouse gas emissions reduction scenarios. However, a robust monitoring regime is necessary for public and regulatory assurance that any leakage from a storage site can be detected. Here, we present the results from a controlled CO2 release experiment undertaken at the K-COSEM test site (South Korea) with the aim of demonstrating the effectiveness of the inherent tracer fingerprints (noble gases, δ13C) in monitoring CO2 leakage. Following injection of 396 kg CO2(g) into a shallow aquifer, gas release was monitored for 2 months in gas/water phases in and above the injection zone. The injection event resulted in negative concentration changes of the dissolved gases, attributed to the stripping action of the depleted CO2. Measured fingerprints from inherent noble gases successfully identified solubility-trapping of the injected CO2 within the shallow aquifer. The δ13C within the shallow aquifer could not resolve the level of gas trapping, due to the interaction with heterogeneous carbonate sources in the shallow aquifer. The time-series monitoring of δ13CDIC and dissolved gases detected the stripping action of injected CO2(g), which can provide an early warning of CO2 arrival. This study highlights that inherent noble gases can effectively trace the upwardly migrating and fate of CO2 within a shallow aquifer.

Contemplation of Legal Status of the Committee for the Appropriateness of Hospitalization Related to Involuntary Admission / 신경정신의학

The revised Mental Health Act, in which the legal status and role of “the committee for the appropriateness of hospitalization” as an administrative committee, which has been launched since June 2017, is discussed. The German and British laws were reviewed in comparison with the Korean laws, focusing on the similarities and differences among the laws and which parts require revision. This study reported that patient care should be considered not only from a constitutional point of view, but also from a health care point of view. Self-determination and medical paternalism are both important but generally incompatible values. In recent days, objective and fair diagnosis from medical experts have been challenging. The current Mental Health Act was inevitably revised to actively accept the decisions of the Constitutional Court and apparently guarantee the basic rights of people in the future. The pros and cons of “the committee for the appropriateness of hospitalization” and which parts need to be revised to perform its role properly as a guardian of the admission procedure are assessed. This should reflect the current reality of the mental health medical community. In addition, a face-to-face examination should be made in principle. Nevertheless, the basic rights of the mentally ill are not guaranteed based on current law because of the shortage of budget and human resources. The final option maybe the introduction of a judicial system on involuntary admission. Legitimacy and professionalism are engagements that should be adhered to when treating psychiatric patients.

Ghost cell odontogenic carcinoma on right mandible and its respective surgical reconstruction: a case report

Calcifying cystic odontogenic tumor (CCOT) is defined as an odontogenic cyst-like benign neoplasm that characteristically contains several ghost cells, ameloblastoma-like epithelium, and occasional calcification. Ghost cell odontogenic carcinoma (GCOC), a malignant form of CCOT, is an exceptionally rare malignant tumor. In this report, we present a case of a 53-year-old man whose chief complaint was a solitary mass on the right mandible area. The mass was completely removed through an extraoral surgical approach and reconstructive surgery was performed in two phases.

Deep Burn Following DC Cardioversion: A Case Report

PURPOSE: DC cardioversion is the treatment choice for atrial fibrillation and flutter. Because of the high voltage power across the thorax, most patients suffer some degree of superficial erythema or burn at the pad site. 2nd or 3rd degree burn and muscle necrosis is very rare after shock. We experienced one case of 3rd degree burn with ulceration after DC cardioversion. METHODS: A 44-year-old male was admitted to local hospital with the presenting palpitation and atrial fibrillation on ECG. During radiofrequency catheter ablation (RFCA) for the treatment of atrial fibrillatoin, DC cardioversion was performed. The patient did not complain of any pain or discomfort at the pad site during or immediately after the procedure. Approximately 14 days after the shock, he had blisters at the pad site. But he received simple dressing treatment at the local hospital for 6 months. When he visited our burn clinic, there was 3x5 cm sized 3rd degree burn with eschar and necrotic fat tissue at the pad site of right back. Surgical removal of a necrotic tissue was performed on the patient by STSG (Split thickness skin graft) with Matriderm(R). RESULTS: Muscle fascia was exposed after debridement of the necrotic skin and fat tissue. The skin graft was well taken within 2 weeks after operation. CONCLUSION: In case of using monophasic 360 J, approximately 3,000 V energy is discharged. The energy is sufficient to cause burn injury to skin. Damage may result both thermal burn and electrical burn. The burn degree in the electric circuit is proportional to amperage and time, is inversely proportional to pad site area. We therefore suggest that in order to reduce deep burn, DC cardioversion is started with lower energy shocks, proper pad placement and correct pad application is important. And we give a notice that deep pad burn possibly occur after the cardioversion procedure.

Contacts Burns Caused by Electric Pad

PURPOSE: The use of the Ondol, which is a traditional Korean floor heating system, has made the electric heating pad popular in Korea. Although the surface temperature of electric pads is around 45 degrees, rarely they can cause severe contact burns. Because an electric pad is usually used while sleeping, the skin could be exposed to heat and pressure for a prolonged period. The purpose of this study was to investigate the epidemiology and clinical features of these types of burns and to advise caution in the use of electric heating pads. METHODS: We performed a retrospective analysis of 58 cases identified from March 2007 to March 2012 at the Hangang Sacred Heart Hospital plastic surgery department. Collected data included sex, age, seasonal variation, distribution and extent of the burn, underlying disease, related factors, and treatment. RESULTS: Patients (23 females and 10 males) were predominantly in their twenties, with an average age of 40.7 years (range, 14~83). The majority of the burns occurred during winter (51.5%). According to the patients' histories, sleeping in a drunken state was the most common associated factor, with taking hypnotics and lying under spinal anesthesia being the second and third factors, respectively. Eight patients had diabetes mellitus and four patients had hypoesthesia after spinal cord injury and cerebral stroke. The lower extremity was the most commonly involved site (42.4%), followed by the buttocks (33%). The extent burn areas accounted for less than 2% of the total body surface area. But deep second degree and third degree burns were sustained that required surgical intervention. CONCLUSION: Unconsciousness and hypoesthesia were the primary factors that provoked contact burns related to the use of electrical pads. Although the percentage of body surface area burns is often small, the burns caused by electric pads can cause deep thermal injuries, necessitating the use of skin grafts and local flaps. These injuries could be prevented by taking precautions when using electric pads and by educating the public.

Coverage of Electrically Burned Upper Extremity Amputation Stumps by a Pedicled Latissimus Dorsi Flap

PURPOSE: In cases of high voltage electrical burns, a wound occurs as current enters or leaves the body and is accompanied by deep tissue injury. If upper extremity amputation is inevitable, consideration should be given to the residual limb functions, secondary reconstruction, and wearing of an upper prosthesis. Our hospital has achieved satisfactory outcomes through the use of a pedicled latissimus dorsi (LD) flap in patients undergoing transhumeral amputation and shoulder disarticulation due to upper extremity damage from high voltage electrical burns. METHODS: The study was targeted to five patients who suffered high voltage electrical burns, underwent above-elbow amputation, and were reconstructed in the acute and secondary phases using a pedicled LD flap from January 2005 to December 2011. All patients underwent equilateral pedicled LD flap surgery, with primary closure at the donating site. RESULTS: The average age of patients was 49.6 years (38~64); they were all male. One patient underwent sublayer skin grafting after a pedicled muscular LD flap, and four patients had a pedicled myocutaneous LD flap: one patient among the four had a forearm flap after the pedicled myocutaneous LD flap. All flaps were well adhered, and post-surgical flap reduction and local flaps were performed for adequate sizing and aesthetic improvement. CONCLUSION: In cases of upper arm amputation due to wide upper extremity damage caused by electrical burns, the use of the pedicled LD flap and adequate amputation length made subsequent wearing of a prosthesis possible. The pedicled LD flap procedure allowed reconstruction of a relatively large area of soft tissue and the surgery to the donating site was unproblematic.

Spontaneous Flexor Tendon Rupture of the Burned Hand

PURPOSE: Spontaneous tendon rupture of finger is defined the rupture of tendon without any intrinsic or extrinsic pathological processes in finger. Spontaneous flexor tendon ruptures are rare. Burn affects not only skin but also muscle and tendon according to the depth. Particularly, burn in hand badly affects movement of finger. Thus, We report the case of spontaneous flexor tendon rupture of finger that happened after burn. METHODS: We studied a 42 year old male presented with third degree electrical burn at the palm of the right hand. And then, Terudermis(R) was applied on 23rd day after burn and split thickness skin graft was applied on 37th day after burn. After operation, there were no special symptoms for some period. But, on 74th day after burn, while providing physical therapy to finger, he could not flex his thumb of the hand with popping sound and edema. So we performed US and MRI scan, finally diagnosed complete tear on FPL tendon of the right hand which was in flexor tendon injury zone IV. We harvested donor from Palmaris longus and tendon graft was applied. RESULTS: After operation, graft was well taken without other problem. And after applying splint, 4th day after tendon graft, active finger extension was done with passive flexion achieved using a rubber band attached to the finger tip. 4 weeks after the operation, splint was removed and the patient gently started active exercise. CONCLUSION: Spontaneous rupture of flexor tendon is rare and moreover, there was no case report of rupture after burns so far. We are now reporting that we early diagnosed the spontaneous flexor tendon rupture of the burned hand and functionally corrected by tendon graft.

Pelviscopic Management Of The Chemical Panperitonitis Due To Ruptured Ovarian Endometrioma: Two Cases / 대한산부인과학회지

Rupture of ovarian endometrioma is rarely occurred. It causes chemical panperitonitis resulting in low fertility and requiring differential diagnosis of acute abdomen. So it needs fast and accurate diagnosis. We have experienced two cases of chemical panperitonitis due to ruptured ovarian endometrioma managed by pelviscopy with a brief review of the literature.

Anesthesia for Heart Transplantation in a Jehovah,s Witness: A case report / 대한마취과학회지

Jehovah,s Witnesses who require operation represent a challenge to the physician because of the patient,s refusal to accept blood transfusion. An orthotopic heart transplantation was succesfully performed in a 40-year old Jehovah,s Witness without use of any blood product. During the operation, cell saver was used for shed blood and aprotinin was administered intravenously. The use of blood conserving methods, meticulous operative technique and brisk postoperative diuresis has added to the efficacy of heart transplantation in this patient. Total postoperative drainage was 860 ml and the lowest hemoglobin level was 11.8 g%. The patient recovered uneventfully and discharged on the 60th postoperative day.

Anesthetic Experience of Dynamic Cardiomyoplasty: A case report / 대한마취과학회지

Dynamic cardiomyoplasty is a recently introduced surgical method to improve myocardial performance. It consists of a placement of a skeletal muscle flap around the heart and stimulation of the flap in synchrony with ventricular contraction. We experienced a case of cardiomyoplasty in a 25 year old male patient with congestive heart failure. Anesthesia was induced and maintained with fentanyl, midazolam and isoflurane. The operation was performed for 8hrs without cardiopulmonary bypass and the patient was transferred to the intensive care unit. He was mechanically ventilated electively overnight and extubation was done 18hrs postoperatively. The patient was discharged home on the 40days after operation and improved in exercise tolerance. We report the anesthetic management and hemodynamic changes in a patient who underwent dynamic cardiomyoplasty.

A Comparison of Inhalation Anesthesia with Enflurane and Intravenous Anesthesia with Ketamine Hydrochloride in Lung Surgery of Patients with Decreased Pulmonary Function / 대한마취과학회지

BACKGROUND: Serious pulmonary complications after lung surgery increase morbidity and mortality in perioperative period. Ketamine hydrochloride produces strong analgesic effect in spite of the psychomimetic effects. Intravenous anesthesia with ketamine was performed in lung surgery of patients with decreased pulmonary function and compared with inhalation anesthesia with enflurane. METHODS: Sixty patients, scheduled for elective lung surgery, were randomly assigned to two groups. Patients received either enflurane (Group 1, n=30) or ketamine (Group 2, n=30) as main anesthetic drug. Blood pressure and heart rate were compared in preinduction, postinduction, postintubation, postincision, intraoperative period (30 minutes, 60 minutes) and recovery room between groups, and in each group. Arterial blood gas analysis was compared in preoperative period, intraoperative period and recovery room between groups. Postoperative psychological complications evaluated in group 2. RESULTS: Blood pressure and heart rate were significantly different in postinduction, postintubation and recovery room between groups. PaO2 in group 2 was higher than in group 1 during intraoperative period and recovery room. Postoperative psychological complications occured in 4 patients (13%) in group 2. CONCLUSIONS: Ketamine affords advantage over enflurane anesthesia in terms of PaO2 during intraoperative period and recovery room in lung surgery of patients with decreased pulmonary function.