Reducing sediment and phosphorus in tributary waters with alum and polyacrylamide.

The Salton Sea is the largest inland water body in California, covering an area of 980 km(2). Inflow to the Salton Sea (1.6 km(3) yr(-1)) is predominately nutrient-rich agricultural wastewater, which has led to eutrophication. Because internal phosphorus release from the bottom sediments is comparatively low and external phosphorus loading to the Salton Sea is high, reduction of tributary phosphorus is expected to reduce algal blooms, increase dissolved oxygen, and reduce odors. Removing both dissolved phosphorus and phosphorus-laden sediment from agricultural drainage water (ADW) should decrease eutrophication. Both alum and polyacrylamide (PAM) are commonly used in wastewater treatment to remove phosphorus and sediment and were tested for use in tributary waters. Laboratory jar tests determined PAM effectiveness (2 mg L(-1)) for turbidity reduction as cationic > anionic = nonionic. Although cationic PAM was the most effective at reducing turbidity at higher speeds, there was no observed difference between the neutral and anionic PAMs at velocity gradients of 18 to 45 s(-1). Alum (4 mg L(-1) Al) reduced turbidity in low energy systems (velocity gradients < 10 s(-1)) by 95% and was necessary to reduce soluble phosphorus, which comprises 47 to 100% of the total P concentration in the tributaries. When PAM was added with alum, the anionic PAM became ineffective in aiding flocculation. The nonionic PAM (2 mg L(-1)) + alum (4 mg L(-1) Al) is recommended to reduce suspended solids in higher energy systems and reduce soluble P by 93%.

Hospital costs of surgical complications.

Fifteen patients who had a general or gynecologic abdominal operation were operated on a second time for a complication of the first operation. There were three deaths. Extra costs attributable to the complications amounted to +211,503, of which one third was uncollectible. One half of the extra hospital days for surviving patients were spent in the intensive care unit.

Complications in surgical patients. A comparison of methods for identifying occurrence.

Because reporting of complications by physicians is not reliable, monitoring of the hospital course of surgical patients by nurses can improve effectiveness of identifying complications. Monitoring the course of only those patients who remain in the hospital more than four postoperative days will disclose 90 per cent of complications expected in all patients undergoing operation. Twenty hours per week of a nurse's time is sufficient to monitor 1,300 such patients annually. Identification of patients with large hospital bills will include most patients with complicated hospital courses but does not discriminate them from the large number of uncomplicated courses which also generate large hospital charges.

Primary appendectomy.

A review of 403 patients undergoing appendectomy in a community hospital led to the following conclusions. Appendectomy with the finding of a normal appendix and no other condition requiring operation was accompanied by a higher complication rate and longer hospitalization than appendectomy for nonperforated diseased appendix. A high frequency of removal of normal appendices did not result in a lower incidence of appendiceal perforation. An increased diagnostic accuracy in the surgical treatment of "acute appendicitis" was not associated with increased incidence of appendiceal perforation. These findings support the thesis that a more discriminate diagnosis of acute appendicitis will lower the incidence of unnecessary appendectomy without increasing the morbidity from unrecognized appendiceal disease.

Rupture of the cervical esophagus from blunt trauma.

A patient had a left anterolateral linear tear of the lower cervical esophagus with concomitant second rib fracture after a steering wheel injury. Diagnosis of the lesion was delayed because of initial absence of physical signs. Subsequent operative drainage and repair were unsuccessful.