An alternative exhaust manifold system, the Perforated Manifold, Muffler, and Catalyst (PMMC), is proposed to improve sound suppression while reducing engine pumping losses and exhaust emissions. One-dimensional predictions from acoustic theory are used to configure the initial design. Preliminary evaluation of the concept is based on bench tests, including an extended impedance tube set-up for...

A 75-year-old woman presented with a 5-day history of abdominal pain, constipation and vomiting. Her symptoms followed acute gastroenteritis, which was managed conservatively at another centre. She was also experiencing obscure pain in her right knee. On examination, her body mass index was 16, and she was dehydrated. Abdominal examination revealed central distention with visible bowel coils. T...

Acquired diverticula of the small intestine are rare and, in most patients, asymptomatic. They may come to the doctor’s attention incidentally, during radiographic examination or under a laparotomy performed for other reasons, or they may cause vague and unspecific chronic symptoms, or acute symptoms due to the occurrence of complications, such as intestinal occlusion, haemorrhage or perforatio...

A 26-year-old man (human immunodeficiency virus-positive and not taking highly active antiretroviral treatment [HAART]) presented to the emergency room with 2 months of malaise, 20 kg weight loss, high spiking fevers, generalized lymph nodes, night sweats, dry cough, and chest pain when swallowing. On physical examination, he had multiple cervical lymphadenopathies. Suspecting a systemic opport...

BACKGROUND Acute appendicitis is a rare complication of colonoscopy that has been reported only 12 times in the English-language literature and is usually associated with obstruction of the appendiceal lumen with fecal matter during colonoscopy. None of the previous reports have described findings of perforation of the appendix within 24 hours of colonoscopy. METHODS We present the case repor...

Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. A scarcity of high-quality studies about the condition limits the knowledge base for clinical decision making, but a few published randomised trials are available. Although Helicobacter pylori and use of non-steroidal anti-inflammatory drugs are common causes, demographic differences...

A 65-year-old lady presented with a 5-day history of watery diarrhoea and right-sided abdominal pain. Overnight she developed localised peritonitis in the left iliac fossa. An abdominal computed tomography scan revealed free fluid in the abdominal cavity, free air in the retroperitoneum and a small bowel perforation. An emergency laparotomy was carried out which revealed multiple jejunal divert...

Diverticula rarely occur within the lumen of the duodenum and are diagnosed in 2-5% of patients. They usually arise near the papilla of Vater and extend distally [1]. Duodenal diverticula are classified into two types: extraluminal or intraluminal. Although the patient with a diverticulum may be asymptomatic, a duodenal diverticulum usually presents with typical or atypical symptoms of peptic u...