Influence of shear on nitrification rates in a membrane bioreactor.

Grundfos BioBooster (GBB) installed and operated a membrane bioreactor (MBR) test plant in 2012. During the period it became evident that the nitrification rate was lower than expected and a study was carried out to investigate the possible reasons for the observed low-nitrification rate. Tests were conducted at a pilot plant and the effect of shear from the BioBooster membrane system and the pressure reduction component on the nitrification rate was investigated. The possible effect of selection of microbial communities caused by the filtration unit was also investigated. The results revealed an unchanged nitrification rate when exposed to shear from the filtration unit and the pressure reduction component. When testing the effect of selection, the nitrification rate was also unchanged.

Floc-forming properties of polyphosphate accumulating organisms in activated sludge.

The physico-chemical characteristics of polyphosphate-accumulating organisms (PAO) involved in enhanced biological phosphorus removal (EBPR) was investigated in order to find a novel method for phosphorus recovery. If the physico-chemical characteristics of PAO are different from those of other main floc components, it may be possible to enrich PAO in bulk water or in the floc material for improved recovery of phosphorus. A combination of shear tests, chemical manipulation, and quantification of PAO by fluorescence in situ hybridization was applied. The microcolony strength of both Rhodocyclus-related PAO and Actinobacteria-related PAO was generally high as no treatment could break up more than 20% of all PAO in microcolonies. In contrast, it was possible to remove 20-40% of the organic matter and other bacterial cells by applying a high pH value or adding EDTA. With that a selective enrichment of PAO in the remaining floc material was possible. The feasibility of applying this selective PAO enrichment in flocs remains to be evaluated in full-scale plants for P-recovery.

Ticarcillin plus clavulanic acid versus moxalactam in the treatment of skin and soft tissue infections.

A formulation of 3.0 g of ticarcillin and 0.1 g of clavulanic acid was evaluated in the treatment of skin and soft tissue infections, and its efficacy was compared with that of moxalactam in a randomized open study. Thirty-three patients received 3.1 g of ticarcillin plus clavulanic acid every six hours via intravenous infusion, and 36 patients received 2.0 g of moxalactam every eight hours via intravenous infusion. Diagnostic categories included intramuscular abscesses, cellulitis, skin ulcers, gangrene, and perirectal abscesses. The average age of the patients and the duration of therapy were similar in both groups. Overall, 45 aerobic and 25 anaerobic bacteria were isolated from the ticarcillin plus clavulanic acid-treated patients; 58 aerobic and 24 anaerobic bacteria were isolated from the moxalactam-treated patients. Thirty of 33 patients in the ticarcillin plus clavulanic acid-treated group had a satisfactory response; a skin rash developed in one patient; therapy failed in one patient with Staphylococcus aureus infection; and one patient died as a result of a bleeding peptic ulcer. In the moxalactam-treated group, 32 of 36 patients had a satisfactory response; a skin rash developed in one patient; therapy failed in a patient with Pseudomonas aeruginosa infection; and two patients were unevaluable. Ticarcillin plus clavulanic acid as a single agent was found to be as effective as moxalactam in the treatment of skin and soft tissue infections.

The pros and cons of outpatient breast biopsy.

A review of the 130 breast biopsies performed on women during the past three years at the Martin Luther King, Jr, General Hospital showed that 90 were performed on outpatients and 40 on inpatients. Of the 90 outpatient procedures, 61 were under local anesthesia and 29 under general. Only three outpatient biopsy specimens were malignant and required subsequent patient admission to the hospital for mastectomy at an interval of 9 to 14 days. In all three, the axillary nodes were uninvolved. In two, no residual tumor was found in the mastectomy specimen.

Bacteriology of the human biliary tract and the duodenum.

Using the modern anaerobic transport media and meticulous culture techniques, 74 patients undergoing biliary tract surgery were studied. The biliary system was found to be sterile in 58 patients (78%). Fifteen patients had 35 isolates of aerobic and facultative bacteria. The most common ones were Klebsiella, Enterococcus, and Escherichia coli. The only anaerobe isolated was Clostridium perfringens. Eight of 17 patients (47%) with acute cholecystitis and five of 49 patients (10%) with chronic cholecystitis, harbored bacteria in the biliary system. This study suggests that anaerobes are rare in the human biliary system; therefore, if antibiotic therapy is considered, aerobic coverage should suffice.

Exteriorized repair in the management of colon injuries.

In an attempt to reduce septic complications following colonic injury in penetrating abdominal trauma, we tested the efficacy of the exteriorized repair, also known as primary repair and exteriorization of the injured colonic segment. From June 1973 to August 1979, 50 patients with colonic injuries suitable for exteriorized repair were entered into this study. Their ages ranged from 4 to 47 years; 42 were male, eight, female. Thirty-eight had gunshot wounds, 12 had stab wounds. The majority had various associated injuries, but only five were in shock. In 33 patients (66%) the colonic wounds successfully healed and the exteriorized loop was returned into the peritoneal cavity within 14 days. In 17 patients (34%), fecal leakage developed at the repair site and the exteriorized loops were converted into colostomies without sepsis. There was no mortality and a low complication rare (18%). This method of management for selected patients has a special merit in combining the safety of exteriorization with the economy of primary repair.

Microflora of the human small intestine.

The human small intestine is normally sterile in nearly one half of North American subjects. In this study the duodenum, jejunum, and ileum were sterile in 82, 69, and 55 per cent of the cases, respectively. Gram-positive cocci were the most frequent finding. E. coli, Enterobacter, and Klebsiella were present in the small bowel in nearly 7, 15, and 35 per cent of duodenal, jejunal, and ileal samples, respecatively. They were present in significant numbers (greater than 1 X 10(5)/ml) in the mid-jejunum in two patients and in the mid-ileum in seven patients (23 per cent). Even with modern anaerobic techniques, anaerobes are scarce in the small bowel; 4 to 6 per cent of persons may have aerotolerant anaerobes like clostridia, but strict anaerobes like bacteroides are rare. Our study provides baseline data for use in interpreting the intestinal bacterial overgrowth associated with certain postoperative disorders.

Bacteriology of the appendix and the ileum in health and in appendicitis.

The bacteriology of the ileum and the appendix in appendicitis patients with or without perforation and compared with patients who had "incidental appendectomy" was studied. Of 42 appendicitis patients, 24 (57%) of them had anaerobic bacteria in the appendix compared with two of eight (25%) with normal appendix. Anaerobes were found in the ileal aspirates of 20 of 42 (47.6%) appendicitis patients and two of eight (25%) in normal persons. This suggests that anaerobic bacteria increasingly colonize the appendix and the ileum in cases of appendicitis.

Human intestinal tissue antibiotic concentrations. Clindamycin, gentamicin, and mezlocillin.

An antibiotic, to be effective for prophylaxis in abdominal trauma, should quickly achieve high concentrations in the intestinal wall and at enough inhibitory levels to kill most aerobic and anaerobic bacteria that are potential contaminants at the site of surgical incision. Therefore, we studied the intestinal tissue levels of clindamycin, gentamicin, and mezlocillin to see whether the tissue levels achieved by these antibiotics in the intestinal tissue were adequate. A single dose of mezlocillin, 4 grams; clindamycin, 600 mg and gentamicin, 80 mg; quickly reached the desired concentrations, i.e., 52.3, 9.69 and 6.1 micrograms/gram of intestinal tissue respectively. These levels were high enough to inhibit the growth of most isolates of E. coli and B. fragilis, common pathogens involved in intra-abdominal abscess.

Comparison of cefamandole and carbenicillin in preventing sepsis following penetrating abdominal trauma.

One hundred and five patients with penetrating abdominal injuries were treated with single-antibiotic regimens. Forty-seven patients were treated with intravenous (IV) cefamandole and for comparison 58 patients were treated with IV carbenicillin previously shown to be effective against postoperative infections associated with abdominal trauma. The overall incidence of deep infection on a single antibiotic therapy was 8.6 per cent, including two patients on cefamandole alone (4.3%) and seven (12.1%) on carbenicillin alone. One in each antibiotic group died of sepsis with a total mortality of 1.9 per cent. The authors concluded that cefamandole when used alone was found to be safe and more effective than carbenicillin alone in preventing sepsis in patients with abdominal trauma.

Evaluation of antibiotic therapy and surgical techniques in cases of homicidal wounds of the colon.

Infectious morbidity associated with colonic trauma was evaluated with respect to the specific site of the colonic injury, the surgical method used, and the antibiotic treatment prescribed. Septic complications were more frequent among patients who had left-sided colon injuries (P = less than 0.01) and among those who received antibiotics known to be ineffective against anaerobic bacteria (P = less than 0.01). A statistical analysis of the different surgical methods used, i.e., primary repair of the colon, primary repair with loop exteriorization, or colostomy, was indeterminable.

The antireflux feeding gastrostomy: an improved method.

For patients who are not able to maintain nutrition by normal oral feeding, the choices of nutritional support can be parenteral, enteral, or gastric. Very little has been written in recent surgical literature about permanent feeding gastrostomies. Dissatisfaction with the conventional Stamm and Witzel gastrostomies prompted the authors to devise an improved method that creates a stapler-constructed, proximally based, antral gastric tube with an antireflux valve made by imbricating the gastric wall around the base of the gastric tube. Forty such procedures done between 1982 and 1984 were reviewed.When properly constructed, this antireflux feeding gastrostomy has the distinct advantage of being physiologic, economical, and easy to maintain for long-term use. If the patient recovers to the point of no longer needing the feeding gastrostomy, the tube stoma can be closed easily under local anesthesia.

Traumatic pancreatic pseudocysts.

At the Martin Luther King, Jr, General Hospital in Los Angeles, during the period from June 1972 to April 1981, seven patients underwent surgery for traumatic pancreatic pseudocysts. The overall average age was 28 and the average hospital stay was 31 days. Ultrasound was the most useful test for diagnosis and follow-up. Preoperatively, serum amylases were not consistently elevated. Overall recurrences and complications totaled 57 percent. There were no deaths. The authors consider a large cystogastrostomy the treatment of choice for mature cysts that are satisfactorily adherent to the stomach. The second preference is a Roux-en-Y cystojejunostomy. External drainage was employed for acute cysts that required drainage. A distal pancreatectomy was performed for patients with small pancreatic tail pseudocysts. Patients who underwent acute drainage were usually drained externally and had a poorer outcome than patients who were operated on later with internal drainage. When compared with another group of 15 alcoholic patients who were operated on for pancreatic pseudocysts, patients with traumatic pseudocysts had a poorer outcome.

Obstructing gastric carcinoma complicating pregnancy.

Although gastric cancer has not been reported in association with pregnancy, the authors encountered it in a paraplegic young pregnant woman presenting with gastric outlet obstruction.Fiberoptic gastroscopy and biopsy provided the surprising tissue diagnosis. Ultrasound was helpful in assessing the size and position of the fetus. Intravenous fluid therapy and total parenteral nutrition enabled the authors to correct the negative nitrogen balance and metabolic derangement, and to improve the operative risk to both the mother and the fetus.Cesarean section delivered a viable baby. A high gastrectomy relieved the patient of her obstruction and tumor burden. Although the long-term prognosis of gastric cancer remains grim, having saved the mother and the baby through such an ordeal is a rewarding experience.

Injuries to the profunda femoris artery and its branches.

Six cases of uncommon profunda femoris artery injury are analyzed. One half of the cases were not treated surgically at the time of injury and resulted in chronic arteriovenous fistulas. Even after operative correction, residual symptoms persisted in two of these three cases. The generous use of arteriography is recommended in cases of proximal thigh penetrating injuries to avoid this problem. Either repair or ligation of the injured vessel yielded the same good results. The postoperative hospital stay was short in all instances, ranging from four to eight days, and there were no deaths.

Small bowel obstruction: review of nine years of experience.

Strong evidence in the literature suggests that improvements in the management and outcome of small bowel obstruction result from early diagnosis, better fluid and electrolyte replacement, use of antibiotics, and early surgical intervention. This paper reviews the outcomes of 49 male and 31 female patients who were operated on for small bowel obstruction. The average age was 38 years (range, 3 to 87 years); the average hospital stay was 13 days. There was one death. The causes of obstruction included postoperative adhesions (78 percent), strangulated external hernia (11 percent), gangrenous bowel (4 percent), intussusception (2.5 percent), appendiceal mass (3.5 percent), and Meckel's diverticulum (1 percent). The outcome was worse with late presentation, perforation or gangrene of the bowel, and delayed surgery.

A "wandering bullet" in the thoracic esophagus.

This paper describes a patient with a perforation of the thoracic esophagus that was not recognized for 30 hours. Curiously, this patient did well without surgical intervention. Therapeutic considerations for thoracic and cervical esophageal perforations are discusses.

[Studies on the chemical constituents of Fritillaria in Hubei. X. Isolation and identification of alkaloids from Fritillaria ebeiensis var.purpurea G.D.Yu et P.Li].

The bulb of Fritillaria ebeiensis var. purpurea G.D. Yu et P. Li (Liliaceae) are commercially available as the substitute for the principal Chinese traditional medicine "Beimu". This plant is easily cultivated, has high alkaloid content and conspicuous antitussive and expectorant effects. Seven C-nor-D-homo steroidal alkaloids (I-VII) were isolated from the bulb cultivated in Suizhou district, Hubei. I-IV have been identified as the known alkaloids peimine, peiminine, ebeinine and ebeinone on the basis of spectral data and by TLC and mixed mp comparison with authentic samples. The alkaloid VI, C27H43NO2, mp 186-188 degrees C, named ziebeimine, is a new alkaloid isolated from the title plant. The structure of VI has been established as 5 alpha, 14 alpha-cevanine-13, 17-dehydro-3 alpha, 6 beta-diol on the basis of its IR, 1H-NMR, 13C-NMR and mass spectra. The structure of alkaloids V and VII is still under investigation.

[Recent migration from the Maghreb to Spain]. / Migraciones recientes de los paises magrebies a Espana.

"During the last few years, Spain has become a host country for Maghreb emigrants that cross the Straits of Gibraltar hoping to find a better life. This article evaluates the importance of this migratory trend, its evolution, location and characteristics. At the same time, this paper sets forth new data about the recent Official Registration process of alien residents." (SUMMARY IN ENG AND FRE)