The economic pre-treatment of coal mine drainage water with caustic and ozone.

Coal mine drainage waters are low in pH with varying amounts of iron and manganese and are generally brackish. The Austar Coal Mine in NSW, Australia, sought alternatives to their current lime dosing as the pre-treatment before the downstream reverse osmosis plant. Undesirable operating aspects of the current system include manganese and gypsum scaling/fouling, the need for anti-scalants and reduced water recovery. Thirteen processes for acid mine drainage were initially considered. The preferred process of caustic and ozone for Mn(II) oxidation was pilot tested at up to 0.74 kL/hr at the mine site. Under proper conditions and no aeration, about 81 per cent of the Fe could be removed (initially at 156 mg/L) as green rust. Supplemental aeration followed first-order kinetics and allowed 99.9 per cent Fe(II) oxidation and removal but only with a hydraulic residence time of about 47 minutes. The addition of supplemental Cu catalyst improved Fe removal. Ozone applied after caustic was effective in stoichiometrically oxidising recalcitrant Mn(II) and any remaining Fe(II). Control of the ozonation was achieved using the oxidation reduction potential during oxidation of the Mn(II) species. The use of caustic, followed by ozone, proved economically comparable to the current lime pre-treatment.

A prospective multicenter study of the efficacy and tolerability of cryopreserved allogenic human keratinocytes to treat venous leg ulcers.

Allogeneic human keratinocyte cultures have been used to treat burn wounds, donor sites, and chronic skin ulcers with some success. Cryopreservation of these cultures allows for the production of large standardized batches that are readily available for use. The aim of the study presented in this report was to study effects of cryopreserved cultured allogenic human keratinocytes (CryoCeal) on chronic lower extremity wounds. Parameters were measured to study efficacy, tolerability, pain associated with chronic wounds, and quality of life of patients. Twenty-seven patients with hard-to-heal venous leg ulcers received a maximum of 9 applications of CryoCeal in a prospective, uncontrolled multicenter study lasting 48 weeks. Eleven out of 27 patients (41%; 95% CI: 22%-61%) had complete wound closure within 24 weeks (1 week). The time required for complete wound closure in these 11 patients ranged from 4.1 to 24.9 weeks. Only 1 patient had recurrence of the ulcer at 48 weeks. Local (wound) pain scores decreased from a mean of 2.5 at baseline to 0.9 at week 24. Fifty percent of the patients attained a pain score of 0 after 12 weeks and remained stable at this score until the end of the study. Overall, the patient quality of life was better at week 24, compared to baseline values. The treatment was well tolerated, and wound infection was the most frequently occurring adverse event.

Extended retinal tamponade in the treatment of retinal detachment with proliferative vitreoretinopathy.

We have used intraocular sulphur hexafluoride or liquid silicone as an adjunct to vitreous surgery in the treatment of a non-randomised sequential series of 19 eyes with retinal detachment complicated by proliferative vitreoretinopathy. We have studied the surgical results and complications of these two tamponades and drawn preliminary conclusions on their use in retinal reattachment surgery. After a seven-month minimum follow-up 13 (68%) of the eyes have reattached retinas. Six (60%) of 10 eyes treated only with silicone have reattached retinas, and four (67%) of six eyes treated only with sulphur hexafluoride gas tamponade have reattached retinas. An additional three eyes treated initially with silicone oil subsequently developed retinal detachments; all were successfully reattached with sulphur hexafluoride tamponade after silicone oil removal. Intraoperative pneumatic retinal reattachment to assess relief of retinal traction combined with the production of widespread chorioretinal adhesions to wall off persistent anterior traction and detachment, as well as extended postoperative gas tamponade of the retina, appears to enhance the surgical results in retinal detachment complicated by proliferative vitreoretinopathy. Silicone oil tamponade of the retina appears to be useful in cases where retinal traction cannot be entirely relieved and in patients who are unable to tolerate the head positioning required for effective gas tamponade of the retina. A controlled clinical study recently begun will be required to define further the precise role of these methods of retinal tamponade.

Bridging the gap between research and clinical practice: a collaborative approach.

In nursing, a gap sometimes exists between research and practice. This paper discusses how a group of 11 nurses successfully bridged this gap. The group was composed of nurses from a large teaching hospital, a regional outpatient cancer center, and a university. The result of the group's work over a two-year period was an externally funded research proposal. This paper discusses the strategies that led to the group's success and provides specific recommendations for nurses who want to form similar groups.

Sweet's syndrome and acute myelogenous leukemia in a patient who presented with a sudden massive swelling of the tongue.

We report a case of Sweet's syndrome in a patient in whom an acute myeloblastic leukemia was subsequently diagnosed. Approximately 10-20% of the reported cases of Sweet's syndrome occur in patients with a malignancy, the neoplastic condition most commonly reported being acute myelogenous leukemia. This case is of interest because of its unusual clinical presentation: the cutaneous lesions were accompanied by a massive swelling of the tongue. We suggest that this sudden macroglossia was caused by an infiltration of mature neutrophils, as seen in cutaneous lesions of Sweet's syndrome. There have been several reports recently of extracutaneous manifestations of Sweet's syndrome, and neutrophilic infiltrates have been found both in several internal organs and at mucosal locations.

Dimethylthiourea, an unexpected hazard for textile workers.

Our patient was a 24-year-old female textile cutter who had a conjunctivitis and an erythematous itching dermatitis of the eyelids, nasal mucous membranes, and the corners of the mouth. The patch tests with the standard series and a pharmaceutical test battery were negative. Further epicutaneous testing revealed a strong positive reaction to the textile cutting patterns she handled, which were duplicated by diazo processing. Specifically, the contact dermatitis reaction was caused by dimethylthiourea, an additive in diazo-sensitized paper.

The management of subretinal gas following attempted pneumatic retinal reattachment.

Pneumatic retinopexy is a recently described procedure for treating retinal detachments with cryotherapy and intraocular gas injection, rather than scleral buckling. Prospective studies are underway to assess its safety and efficacy. One potential complication of this technique is persistent detachment due to subretinal gas. We report seven cases of subretinal gas following attempted pneumatic retinal reattachment. In all cases, multiple fish-egg gas bubbles were present following injection; some of these bubbles gained access to the subretinal space during the early postoperative period. The subretinal gas gave the detached retina a pearly, dome-shaped, refractive sheen. Three cases were managed by positioning the patients' heads to allow the subretinal gas to pass through the retinal break back into the vitreous cavity. One case underwent successful scleral buckling that closed the retinal break despite the presence of a small subretinal gas bubble. Three cases required vitrectomy, air-fluid exchange, and cryotherapy or endolaser treatment. In five of the seven eyes the retina was eventually reattached successfully.

Double-blind comparison of itraconazole with griseofulvin in the treatment of tinea corporis and tinea cruris.

Seventy-eight patients with tinea corporis or tinea cruris participated in a double-blind study with either 100 mg itraconazole or 500 mg ultramicronized griseofulvin for 15 consecutive days. Clinical outcome was significantly in favor of itraconazole at completion of treatment (72% response rate vs. 51%) and at the follow-up visit (91% response vs. 64%). The most important difference between both treatments was the mycologic outcome, for which itraconazole showed a cure rate of 87% compared to 57% for griseofulvin 2 weeks after completion of therapy. It is suggested that 100 mg of itraconazole orally once daily is significantly more effective than 500 mg of griseofulvin once daily for 15 days in the treatment of glabrous skin infections. Both drugs were well tolerated.

Melanoma screening: results of the first one-day campaign in Belgium ('melanoma Monday').

BACKGROUND: Although the incidence of melanoma is increasing and many informative campaigns have been organized. The general population is still little informed about this tumour. AIMS: To organize a media campaign, with more relevant information and the opportunity for free skin inspections. METHODS: A 'Task Force' organized a media campaign in April 1999 and convinced 65% of the Belgian dermatologists to give up 4 h of their time to do free skin examinations for skin cancer on Monday 26 April 1999; it was called 'Melanoma Monday'. RESULTS: A total 2767 patients were screened. We found 25 melanomas and suspected 59 basal cell carcinomas. In the following 4 weeks another 141 melanomas were found. These 166 melanomas found in one month represent 15-20% of the total number of melanomas per year in Belgium. SUMMARY: A media campaign with relevant information combined with screening opportunities can lead to the early detection of melanomas in a large number of patients and can continue to alert people at risk in the following weeks.

Information needs of women during early treatment for breast cancer.

This study assessed the information needs of 70 women with breast cancer being treated by surgery, chemotherapy or radiation therapy. Information needs were measured by the breast cancer version of the Toronto Informational Needs Questionnaire (TINQ-BC). All women had high information needs, irrespective of type of treatment received. They mainly wanted information about their disease, treatments and investigative tests. An examination of individual items on the TINQ-BC revealed that all women wanted information about recurrence, specifically they wanted to know if the cancer would come back and how to tell if it had recurred. The results provide nurses with some direction as to what information to give women receiving early treatment for breast cancer.

Informational needs of women with a recent diagnosis of breast cancer: development and initial testing of a tool.

This study developed and tested the Toronto Informational Needs Questionnaire-Breast Cancer (TINQ-BC), a questionnaire designed to identify the information which women with a recent diagnosis of breast cancer need to deal with their illness. The 73-item questionnaire had content validity based on findings in the literature and opinions of expert oncology nurses. It was administered to 114 women with a recent diagnosis of breast cancer during chemotherapy (n = 39), radiation therapy (n = 40) or surgery (n = 35). Item analysis determined that 51 items in five subscales should be retained in the questionnaire. The subscales, labelled Disease, Investigative Tests, Treatments, Physical, and Psychosocial had good internal consistency reliabilities with Cronbach's alphas of 0.81 to 0.93. Informational needs of women were high with mean scores over 200 in a possible range of 51-255. Informational needs were greatest in either the Disease or Treatments subscales. Marital status, level of education, and level of income were not related to level of informational need. Younger women had a greater need for information than older women (r = -0.35, P = 0.003). The results suggest that information is important to help women with breast cancer manage their illness. Nurses should give women an opportunity to ask questions and be prepared to give accurate information.