Boosting nitrification by membrane-attached biofilm.

Nitrification is a key step for reliable biological nitrogen removal. In order to enhance nitrification in the activated sludge (AS) process, membrane-attached biofilm (MAB) was incorporated in a conventional activated sludge tank. Simultaneous organic carbon removal and nitrification of the MAB incorporated activated sludge (AS + MAB) process was investigated with continuous wastewater treatment. The effluent TOC concentration of AS and the AS + MAB processes were about 6.3 mg/L and 7.9 mg/L, respectively. The TOC removal efficiency of both AS and AS + MAB were above 95% during the wastewater treatment, indicating excellent organic carbon removal performance in both processes. Little nitrification occurred in the AS process. On the contrary, successful nitrification was obtained with the AS + MAB process with nitrification efficiency of about 90%. The volumetric and surface nitrification rates were about 0.14 g/Ld and 6.5 g/m2d, respectively. The results clearly demonstrated that nitrification in the conventional AS process was boosted by MAB. Furthermore, the microfaunal population in the AS + MAB process was different from that in the AS process. The high concentration of rotifers in the AS + MAB process was expected to decrease the generation of excess sludge in the process.

Clinicopathologic factors influencing the long-term prognosis following hepatic resection for large hepatocellular carcinoma more than 10 cm in diameter.

We resected 158 cases of hepatocellular carcinoma (HCC), including 20 (12.6%) cases of large HCC. These 20 cases were divided into group 1 (curative resection, n = 9) and group 2 (noncurative resection, n = 11). The clinicopathologic features and long-term survival of the cases were evaluated. In groups 1 and 2, portal vein invasion (Vp+) was noted in 44.4% and 63.3%, intrahepatic metastasis (IM+) in 77.8% and 100%, absence of a fibrous capsule (Fc-) in 55.6% and 63.6%, and stage III or IV in 77.8% and 100%, respectively. The DNA ploidy pattern was aneuploid in 44.4% of group 1 and 100% of group 2. In group 1, the 1-, 3-, and 5-year cumulative survival rates were 75%, 62.5%, and 62.5%, respectively (the longest survivor is alive after 11 years 1 month). Five cases survived more than 3 years in group 1, and all were Vp(-) and nonaneuploid. On the other hand, in group 2, the 1-year survival rate was only 33.3%; none survived more than 2 years. These results suggest that even patients with large HCC have a favorable long-term prognosis if their clinicopathologic factors are Vp(-) and nonaneuploid, and if curative resection can be performed.

Congenital laryngeal atresia: two autopsy cases, one describing the use of computed tomography.

Two autopsy cases of congenital laryngeal atresia (CLA) were studied. In the first case (a boy delivered at 37 weeks of gestation) the subglottic lumen was almost totally occupied by a dome shaped cricoid cartilage with a pharyngotracheal duct (PTD). No tracheoesophageal fistula (TEF) was found. In the second case (a girl born at 41 weeks of gestation) histology showed that the subglottic lumen was almost occluded by an epithelial lamina and a dome-shaped cricoid cartilage. Again no TEF was found. Both cases had PTD and showed normal development of the lungs. These deformities coincided with Smith & Bain's type II subglottic atresia. The anatomy of the lesion was confirmed by postmortem three-dimensional reconstruction CT, the use of which has not previously been reported.

Disinfection kinetics of Legionella pneumophila by ultraviolet irradiation.

Disinfection kinetics of Legionella pneumophila by ultraviolet irradiation was investigated. The change in viable cell concentration with exposure time could be divided into three steps: lag step in which little change in viable cell concentration was observed, fast disinfection step and slow disinfection step. The slow disinfection step was not observed at the initial cell concentrations below about 10(6) cfu/mL. The disinfection kinetics were well described with two parameters; lag time and disinfection rate constant of the fast disinfection step. The effects of UV intensity, temperature and initial cell concentration in the kinetic parameters were investigated. With increasing initial cell concentration, the lag time decreased and the disinfection rate constant increased. The effects of initial cell concentration on the kinetic parameters were considered to be attributed to the decrease in the effective UV irradiation intensity due to the partial shield of UV light by the disinfected cells. The empirical correlations were presented for predicting the lag time and disinfection rate constant. Furthermore, UV disinfection of L. pneuophila in a model hot-tub connected with external irradiation chamber was also discussed.

[Adenocarcinoma arising in diverticulum of female urethra--a case report and review of the literature].

We report a case of adenocarcinoma within a female urethral diverticulum. The patient was a 54-year-old woman, with a three-month history of dysuria. On physical examination a soft, round mass was palpable in the anterior vaginal wall. Excretory urography demonstrated elevation of the bladder floor. Panendoscopy demonstrated a diverticulum at the 7 o'clock position in proximal urethra. A papillary mass confined to the diverticulum was identified and biopsied. The histopathologic findings showed adenocarcinoma. The patient underwent total cystectomy, pelvic lymphadenectomy, and creation of an ileal conduit. She was well 1 year and 5 months later.

[Prostatic carcinoma in a young adult: a case report].

We report a case of carcinoma of the prostate in a 30-year-old man. Serum acid phosphatase was normal. A transrectal biopsy of the prostate demonstrated an undifferentiated carcinoma. Total prostatocystectomy was performed and subsequent pathologic report stated that the mass was an undifferentiated carcinoma of the prostate gland. Metastases to the intrapelvic lymph node were present. Although immunohistochemical prostatic acid phosphatase (PAP) activity was not demonstrated, prostatic specific antigen (PSA) staining revealed a positive reaction within the tumor cells, confirming prostatic carcinoma. The patient's course has been uneventful without any recurrence by the intermittent adjuvant chemotherapy 8 months postoperatively. Review of the literature in Japan disclosed 16 cases (including our case) of carcinoma of the prostate in patients under 40 years of age.

[Periarteritis nodosa of the epididymis].

A thirty-one-year-old man with a scrotal swelling on the left side was found to have periarteritis nodosa of the epididymis (epididymal arteries). No systemic symptoms were present. Review of the literature revealed only two similar cases.

[A case of penile necrosis in a patient with diabetic nephropathy].

The patient was a 63-year-old male. He was diagnosed as having diabetes mellitus in 1987, and hemodialysis was begun in October 1991 for diabetic nephropathy. He complained of glans pain from the middle of May 1992. Although he was administered antibiotics, a small ulcer arose on the glans penis at the end of May. The lesion became progressively black and carbonized on the whole glans penis by the first of June and involved the prepuce by the end of June. Partial penectomy was performed in July. Histopathological examination showed marked stenosis with calcification in the terminal branches of the dorsal penile artery and thickened wall of the small arteries due to vascular lesions as a result of diabetes mellitus. The patient was in generalized deterioration of clinical condition postoperatively and died of gastrointestinal bleeding in September. Penile necrosis in patients with diabetes mellitus is very rare and only ten cases including our own case have been reported. We reviewed the literature with special reference to the relationship with chronic renal failure.

[Advanced prostate cancer with normal serum prostate-specific antigen values].

Although prostate-specific antigen (PSA) is a valuable marker of prostate cancer, some untreated patients with advanced prostate cancer have normal PSA values. Over a period of 5 years, we reviewed pretreatment serum PSA levels in 131 patients with advanced prostate cancer (stages C and D). Ten patients (7.6%) had normal PSA values. The histological type of prostate cancer associated with normal PSA values was variable and the prognosis was not so poor. Immunostaining for PSA was performed on the resected prostate tissue of the 10 patients. PSA staining was positive in 5 cases, negative in 3 cases, and equivocal in the remaining 2 cases. In conclusion, PSA is not always useful, especially for following patients with normal PSA values.

[True hermaphrodite with ipsilateral vas deferens and intrascrotal ovary].

A 15-year-old, legally male patient came to our department with chief complaint of gynecomastia. Serum testosterone was at a low level of 1.6 ng/ml, and prolactin a high level of 23 ng/ml. Blood type was a mixed type of both type A and type B, and a chromosomal analysis with peripheral blood lymphocytes demonstrated a mosaic of 46, XX/46, XY. During the follow-up, he complained a painful swelling in his right scrotum, and received an emergent surgery. A large amount of blood was noted in the right scrotum. Unicorn uterus, Fallopian tube and finbriae were observed, and a thumb-sized gonad with hemorrhage and fissure was also seen in the upper part of the scrotum. The right gonad was an ovary and no testicular tissue was confirmed in the right scrotum, whereas the right vas deferens was noted. The left testis was accompanied by an induration on its upper pole which was histologically found to be ovarian tissue. The patient was diagnosed as a true hermaphroditism with 46, XX/46, XY chimera that had an ovary with inguinal uterus hernia and an unusual vas deferens in the right scrotum and an ovotestis in the left. It was considered that an adequate amount of testosterone secreted from the left testis during the early embryonal period might have affected the descent of the right ovary into the scrotum and on the development of the right vas deferens.

[Up to date of multidisciplinary treatments centering around hepatectomy for advanced liver cancer in stage IV-A].

Patients with advanced Stage IV-A primary liver cancer, hepatocellular carcinoma (HCC) can be divided into subgroups: those with involvement of a major branch of the portal (Vp3) or hepatic (Vv2, Vv3) veins and those having multiple tumors in both lobes without Vp3 or Vv2, Vv3. The prognosis of Stage IV-A patients with Vv2 or Vv3 may be improved by extended hepatectomy with resection and reconstruction of hepatic veins or IVC. In those with Vp3, multidisciplinary treatments consisting of extended hepatectomy and adjuvant chemotherapy, i.e. intra-arterial injection or TACE, are thought to be feasible at the present, but the outcomes are still poor. On the other hand, there are some Stage IV-A patients with multi-centrical tumors who have multiple tumors in both lobes without major vascular invasion, and their prognoses are improved by partial resection of each tumor. However, when there are multiple tumors caused by intrahepatic metastases, multidisciplinary treatments consisting of reduction surgery, microwave ablation, ethanol injection, and intra-arterial chemotherapy might be useful at present.

[Preoperative estimation of liver injury and operative risk].

We report on preoperative estimation of operative risk, principally rating liver injury in chronic liver disease, c.g., chronic hepatitis and cirrhosis, for liver resection and general surgery. Regarding general surgery, elective and standard operation are possible in Child A and operations with measures to lessen intraoperative blood loss and lymphadenectomy in Child B, but in Child C, surgery is limited to emergency palliative operations, and conservative treatment methods must chosen. In liver resection and major surgery it is important to estimate extent of liver resection and operative risk, primarily by R15 and KICG, and make an overall judgment based on fibronectin, hyaluronic acid, sinusoidal endothelial cell function measured by thrombomodulin, sigma IRI in the 75g OGTT, Fischer's ratio and other indices of lipid metabolism. Generally, surgery limits are: KICG, 40%. Conventional indices of hepatic reserve should be reviewed. Indices recently attracting interest in liver resection cases are quantitative 99mTC-galactosyl human serum albumin scintigraphy using liver cell surface asialoglycoprotein receptor, and functional hepatic resection rate using 99mTC-GSA SPECT images, which is important in estimating liver regeneration after percutaneous trashepatic portal embolization.

[Multidisciplinary therapy after hepatectomy for hepatocellular carcinoma from the view point of tumor recurrence].

This study was performed to elucidate the risk factors of early recurrence after hepatectomy for the 112 patients with hepatocellular carcinoma, excluding absolute non-curative resections and operative deaths, and effects of early prophylactic management were evaluated. In Cox's multivariate analysis, 3 pathological factors of portal vein invasion, intrahepatic metastasis and capsule formation or capsule infiltration as well as the nuclear DNA ploidy pattern were significantly correlated to postoperative recurrence. The patients with 2 or more pathological factors or with DNA aneuploid tumors developed recurrence at early postoperative period. However, even in the DNA aneuploid tumors, the patients with high DNA index and low S-phase fraction showed relatively better prognosis. Argyrophilic proteins of nucleolar organizer regions (AgNOR) were also correlated well to nuclear DNA analysis, showing one of the good indicators for estimating biological malignant nature. Therefore, intra-arterial regional chemolipiodolization therapy should be performed for these high risk patients at early period after hepatectomy. With these managements we have been getting much lower incidence of early recurrence.

Effect of alcohol ingestion on carcinogenesis by synthetic estrogen and progestin in the rat liver.

We examined the effect of alcohol ingestion on hepatocarcinogenesis induced by oral administration of synthetic female hormones, 0.075 mg of ethynylestradiol (EE) and 6.0 mg of norethindrone acetate (NA), every day for 12 months in female Wistar rats. Administration of 10% ethanol in drinking water for 5 days a week every week resulted in the development of hepatocellular carcinoma (HCC) in 38.4% of the hormone-treated rats at 12 months, which is approximately 5 times the incidence of HCC observed following EE and NA treatment alone. The number of hyperplastic nodules was significantly higher than the number observed in the case of EE and NA treatment alone after 4 months of the experimental period. The additional alcohol treatment also increased the value of unoccupied nuclear estrogen receptors (ERn) at months 6 and 8 of the experimental period, and increased the value of total ERn in the rat liver after 6 months of the experimental period. This indicates that additional alcohol treatment may increase occupied ERn (estrogen-ER complex) in the rat liver. A 32P-postlabeling analysis of liver DNA revealed that the maximum number of extra spots consisting of modified nucleotides induced by EE and NA appeared earlier when the additional alcohol treatment was imposed. Consequently, alcohol affects the hepatocarcinogenesis by EE and NA, promoting not only the change in kinetics of ER, but also DNA adduct formation induced by EE and NA in the rat liver.

Gas holdup, power consumption, and oxygen absorption coefficient in a stirred-tank fermentor under foam control.

For a laboratory stirred-tank fermentor (STF) with foaming system of 0.5M sulfite solution containing an anionic soft detergent, the performing of a foam-breaking apparatus with a rotating disk (FARD)fitted to the STF was evaluated. The gas holdup in a mechanical foam-control system (MFS), i.e., the stirred-tank fermentor with the rotating disk foambreaker, was confirmed to be larger than that in a nonfoaming system (NS), i.e., the STF with an antifoam agent added. The agitation power in the mechanical foam control system was found to be smaller compared with the agitation power in the nonfoaming system, due to the increased gas holdup. Comparison of the oxygen absorption coefficient between the mechanical foam control system and the nonfoaming system in terms of the specific power input also demonstrated the superiority of the mechanical foam control system, not only in oxygen transfer performance but also in power input economy.