Investigation of the potential of buffalo and couch grasses to grow on AFIs and for removal of nutrients from paper mill wastewater.

The potential growth of buffalo grass (Stenotaphrum secundatum) and couch grass (Cynodon dactylon) on artificial floating islands (AFIs) and their ability to remove total nitrogen (TN) and total phosphorus (TP) from a simulated paper mill wastewater was studied. This was done to assess the potential of AFIs for removal of nutrients from aerated stabilization basins (ASBs) that had occasional growth of blue-green algae (BGA) to bloom levels. Small scale AFIs were prepared using polyethylene foam and planted with the grasses in 30 L of tested water. Trials were conducted in a plastic covered greenhouse over a three-month period where temperatures ranged from 15 to 44 °C. The results showed that both buffalo and couch grasses can adapt to planting in AFIs showing increases of 125% and 148% in wet weight, respectively. Nutrient uptake by buffalo grass and couch grass were found to be similar. Percentage uptakes of TP and TN from the synthetic water by the buffalo grass were 82% and 47%, whereas by couch grass, uptakes were 83% and 45%, respectively.

Pulmonary carcinoid associated with melanoma: two cases and a review of the literature.

To our knowledge, this is the first report in the British literature documenting the co-occurrence of melanoma and pulmonary carcinoid. The only other report is from America and documents pulmonary carcinoid in association with a parathyroid hormone-producing melanoma. We report two patients with melanoma who presented with nodules on chest X-ray. Both underwent resection of assumed lung metastasis which unexpectedly revealed primary pulmonary carcinoid. Evidence of an association between these two tumours which show striking biological and pathological similarities is discussed. The incidence of pulmonary carcinoid is increasing and with the improved power of radiological assessment we may see additional accounts of such an association in the near future.

Prawns masquerading as endobronchial tumours.

This report details the events surrounding the case of an 89-year-old woman referred for surgery with a suspected endobronchial tumour. At rigid bronchoscopy she was found to have inspissated sputum within which the remains of organic foreign bodies (king prawns) were found obstructing the left main and left upper lobe bronchi. We outline her presentation, initial diagnosis and eventual outcome, and re-emphasise the importance of bronchoscopy as a vital tool in the assessment of any endoluminal lesion of the airway.

Delayed presentation of esophageal perforation simulating paraesophageal hernia.

Generally, benign lesions, which make up the majority of mediastinal tumors and cysts, are asymptomatic; however, they may produce clinical findings. We report on a patient with presumed silent esophageal perforation whose clinical and radiologic assessment was suggestive of massive paraesophageal hiatus hernia. However, surgery revealed a paraesophageal cyst and histology was reported as acute organizing pleurisy. A reasonable, tentative, preoperative diagnosis for each mediastinal lesion can be frequently made by considering its location in the mediastinum, the age of the patient, the presence or absence of local or constitutional symptoms and signs, and the association of a specific systemic disease state. However, the precise nature of a lesion in the mediastinum, as elsewhere, cannot be determined without histologic examination of the tissue. To our knowledge, this unusual clinical case is not been reported in the literature.

Extrapleural bronchial artery ligation for life-threatening hemoptysis in cystic fibrosis--a case report.

Hemoptyses are common in cystic fibrosis (CF) patients. They range from massive life-threatening (> 240 mL/24 hours) to recurrent minor streaking. Limited pulmonary reserve, potential concurrent chest infection, and the progressive nature of CF pose a high risk to this subgroup. Conservative management and selective bronchial artery embolization (BAE) control most acute episodes, but the recurrence rate is high. The possible need for lung transplantation in future makes an extrapleural approach for bronchial artery ligation desirable. The aim of this study was to assess the role of extrapleural bronchial artery ligation in the treatment of recurrent hemoptysis in CF patients. This is a retrospective analysis of four patients between 1986 and 1999 treated by extrapleural thoracotomy and ligation of bronchial arteries. Indications, surgical experience, and outcome are presented. Three patients underwent unilateral, and one patient bilateral extrapleural thoracotomy (in two separate sessions) for bronchial artery ligation. There were three men and one woman, with a mean age of 26.6 years (range 19-32 years). Indications were failure to stabilize the bronchial arterial catheter for BAE (three cases), recurrence after BAE previously controlled bleeding (one case), and communication with the right costocervical trunk signifying risk to the spinal circulation (one case). The mean follow-up was 68 months (range 3-144 months). There was one death in this series, a patient who was asphyxiated with hemoptysis, requiring ventilation preoperatively. He underwent successful extrapleural thoracotomy for bronchial artery ligation, with no further bleeding but succumbed to severe chest infection and multiorgan failure a few days later. Two patients had recurrent bleeding 12 and 36 months after surgery. Selective bronchial angiography proved the contralateral bronchial arteries to be the culprit. Extrapleural bronchial artery ligation is an effective method of controlling hemoptysis in CF, when BAE has failed. This approach minimizes pleural adhesions and is, therefore, desirable in the future consideration for lung transplantation. In this experience, muscle-sparing thoracotomy and postoperative epidural analgesia significantly improved the postoperative recovery.

Two applications of transmucosal milled ceramic in implantology: preliminary clinical examples.

Two new implant systems, the Compound Implant and the TFM coping/abutment, are based on the association of titanium in the infrabony portion and a dense milled ceramic in the transgingival portion. The coating of zirconium ceramic on the transmucosal collar of the Compound Implant is particularly indicated for a single-stage surgical implant technique. The isolating properties and the high wettability of this material favor gingival healing and reduce the accumulation of plaque; the esthetic collar permits a supragingival or juxtagingival cervical margin favoring plaque control and minimizing the consequences of tissue remodeling. The hardness of the ceramic also allows it to undergo conventional prophylaxis with ultrasonic scalers without alteration of its surface quality. In addition to the above-mentioned advantages, the TFM coping/abutment, an implant-prosthesis connector in alumina ceramic, for use in a two-stage technique, provides electrogalvanic isolation of the implant, and personalized abutment preparation allows for simplified fabrication of an implant-supported prosthesis.

Allograft replacement of the trachea. Experimental synchronous revascularization of composite thyrotracheal transplant.

We describe a method for experimental tracheal transplantation that uses synchronous revascularization based on the blood supply of the related thyroid gland. This study compares the structural integrity and histologic features of nonvascularized tracheal transplants, revascularized thyrotracheal composite allografts, with and without immunosuppression. Eighteen adult beagle dogs underwent tracheal transplant operations with one of the preceding methods. Postmortem specimens were studied macroscopically and histologically, 3 to 28 days postoperatively. Proximal, mid, and distal segments of each graft (twelve-ring segments) were examined microscopically. Nonvascularized tracheal transplants necrosed completely as early as 3 days postoperatively. The vascularized composite thyrotracheal allografts survived for up to 28 days. Six dogs did not receive immunosuppressive agents; tracheal cartilage was preserved in this group, but soft tissue necrosis developed. Six dogs received cyclosporine; tracheal cartilages and all soft tissues remained histologically intact. This difference may be due to early tracheal cartilage ischemia in the nonvascularized group, rejection of the soft tissues in the nonimmunosuppressed group, and viability of all structures in the vascularized and immunosuppressed group. Revascularization of the transplanted trachea with the thyroid arteries maintains the vascularity and hence the viability of the trachea. A reliable substitute for long-segment tracheal resections is finally found. We predict that clinical application of this technique will solve a major problem in the surgery of the airways.

Health effects from exposure to organophosphate pesticides in workers and residents in Israel.

Major findings from our work on exposures and effects from organophosphate-containing pesticides in selected occupational and community patients and groups in Israel are reviewed as a basis for recommending control measures. The worker groups were pilots, ground-crews, and field workers; exposed nonworkers were adults and children living in kibbutzim with drift exposures, and household residents in houses treated by pest exterminators. In all groups, evidence of exposure-illness associations was found even though persons with acute poisoning were not seen. Complaints (headache, dizziness, fatigue, nausea, breathing problems, abdominal cramps, and tingling in extremities) were associated with within-normal depressions in cholinesterase activity. Whole blood and plasma cholinesterase activity were slightly more sensitive indicators of mixed exposure than red blood cell cholinesterase activity. High alkyl phosphate levels and symptoms were seen in individuals with within-normal limit depressions in cholinesterase activity. Complaints of weakness and tingling in hands and feet, together with low-grade changes in nerve conduction, suggest the possible influence of agents with a neurotoxic esterase-type activity independent of cholinesterase activity. Transient in-season neuropsychological changes in tests of mood status and performance were associated with exposure. Recommendations for exposure reduction include: accelerating the already declining use of pesticides in general, and organophosphates in particular; promoting the shift from more to less toxic organophosphates and other pesticides; and introducing rigid performance specifications for closed systems in loading and mixing at end-user sites. Dermal protection remains a problem. Cholinesterase activity levels and symptom interviews are useful for monitoring workers at risk, but alkyl phosphate levels are the definitive measure of exposure, surveys, investigations and surveillance.

Illness and excretion of organophosphate metabolites four months after household pest extermination.

Diethyl phosphate (DEP), an organophosphate metabolite, was found in the urine of symptomatic residents who resided in a household that had been sprayed with diazinon 4.5 mo earlier. Pre- and post-decontamination data with regard to symptoms, DEP, cholinesterase, and surface and air levels underscore the utility of alkyl phosphate metabolites for monitoring exposure. The data also emphasize the efficacy of clean-up measures when baseline data are not available to determine if "within-normal" cholinesterase levels are, in fact, depressed.

Comparison of cefonicid and cefazolin for treatment of soft-tissue infections.

Cefonicid was compared with cefazolin for the treatment of serious infections of soft tissue. According to a randomized, prospective protocol designed to assign twice as many patients to cefonicid, 38 patients were treated with cefonicid and 19 patients, with cefazolin. Dosages used were 1.0 g once daily intramuscularly or intravenously for cefonicid and 0.5-1.0 g three times a day intramuscularly or intravenously for cefazolin. Clinical diagnoses included cellulitis (39 patients), abscesses (14), infected ulcers (3), and bursitis (1). Bacteriologic diagnoses included Staphylococcus aureus alone (8 patients), group A Streptococcus alone (13), combined S. aureus plus streptococci (8), viridans group streptococci alone (1), and mixed anaerobes (1). Gram-negative rods were isolated from 11 patients, all in mixed cultures with gram-positive species. For two patients, gram-negative organisms were thought to be etiologic. All 57 patients responded satisfactorily to treatment. Treatment with either drug was neither interrupted nor discontinued because of toxicity. Both cefonicid and cefazolin appear to be effective for the treatment of infections of skin and soft tissues. Cefonicid has the advantage of once-daily dosing.

Exopolysaccharide production by viridans streptococci in experimental endocarditis.

Light and electron microscopy with histochemical staining were used to estimate exopolysaccharide production by strains of viridans streptococci recovered from patients with endocarditis. Six strains were selected for study because they represented a wide range of in vitro polysaccharide production. By light microscopy, there was good agreement between three polysaccharide stains (ruthenium red, periodic acid-Schiff and calcifluor white) in the amount of glycocalyx produced, which ranged from minimal (0 to 1+) to maximal amounts (4+). Two strains selected for minimal (strain 1) and maximal (strain 6) in vitro exopolysaccharide production were studied after we used them to experimentally infect cardiac vegetations. Glycocalyx could be demonstrated surrounding organisms in cardiac vegetations, and the relative amounts produced were similar to those seen in vitro. Vegetations formed by glycocalyx-producing strains were also larger than those formed by glycocalyx-deficient strains. Viridans group streptococci which produce exopolysaccharide in vitro also do so within cardiac vegetations. The relationship of exopolysaccharide production to maintenance of endocardial infection is discussed.