On Left Ventricle Stroke Work Efficiency in Children with Moderate Aortic Valve Regurgitation or Moderate Aortic Valve Stenosis.

The optimal timing for management of pediatric patients with moderate aortic valve disease [moderate aortic stenosis (modAS) or moderate aortic regurgitation (modAR)] remains unknown and largely unexplored. Although usually asymptomatic, the risk of increased left ventricular (LV) wall stress, irreversible myocardial fibrosis and sudden death in untreated moderate conditions warrants clearer risk stratification for appropriate timely intervention. In this study, we explore the use of a patient-specific mathematical model to introduce a new evaluative parameter of LV performance in patients with moderate aortic valve disease. Synthetic patient data (N = 520) representing healthy patients, and patients with modAS or modAR were first generated. Then, data from twenty-five pediatric patients were included in this study (healthy = 9; moderate AS = 8; modAR = 8). The effect of modAS or modAR on LV performance was evaluated by LV stroke work (LVSW) efficiency, a new non-invasive parameter. The results demonstrate that healthy patients possess a very high LVSW efficiency (synthetic data: 91 ± 2%, in vivo data: 92 ± 3%). However, modAS patients have a significant reduction in LVSW efficiency (synthetic data: 78 ± 2%, in vivo data: 76 ± 5%, p < 0.05), whereas modAR patients had the lowest LVSW efficiency (synthetic data: 58 ± 3%, in vivo data: 66 ± 7%; p < 0.05). This highlights that patients with moderate aortic valve disease require careful myocardial assessment, regardless of onset of clinical symptoms as their LV performance is significantly reduced. The evaluation of LVSW efficiency offers a promising avenue for future stratification of mixed aortic valve disease for optimal timing of management and intervention.

The impact of intermediate thermal hydrolysis on the degradation kinetics of carbohydrates in sewage sludge.

The purpose of this paper is to report the results, from laboratory-scale investigations, on the impact of intermediate thermal hydrolysis process (ITHP) on already digested sludge in general, and sludge carbohydrate content degradation process efficiency in particular. The ITHP performance data were compared with the performance of established conventional thermal hydrolysis process (THP). The degradation of sludge carbohydrates as a result of thermal pre-treatment and anaerobic digestion followed the first order kinetics. The overall sludge organic matter degradation kinetics rate constants indicated that the use of THP as an intermediate digestion step can enhance the already digested sludge organic matter degradation; further reducing the sludge mass and increasing its conversion to biogas.

Potentially toxic element release by fenton oxidation of sewage sludge.

The presence, in sewage sludge, of excess levels of the potentially toxic elements (PTE) copper, zinc, chromium, cadmium, nickel, lead and mercury, could impact on our ability to recycle these residues in the future. Far stricter limits on the levels of PTEs are likely in proposed legislation. A method involving the dosing of Fenton's reagent, a mixture of ferrous iron and hydrogen peroxide, under acidic conditions was evaluated for its potential to reduce metal levels. The [Fe]:[H2O2] (w/w) ratio was found to give a good indication of the percentage copper and zinc elution obtainable. Sites with no iron dosing as part of wastewater treatment required extra iron to be added in order to initiate the Fenton's reaction. A significant reduction, in excess of 70%, of the copper and zinc was eluted from both raw primary and activated sludge solid fractions. Cadmium and nickel could be reduced to below detection limits but elution of mercury, lead and chromium was less than 40%. The iron catalyst concentration was found to be a crucial parameter. This process has the potential to reduce the heavy metal content of the sludge and allow the recycling of sludge to continue in a sustainable manner.

The odour of digested sewage sludge--determination and its abatement by air stripping.

This paper describes a project to investigate the odour of sewage sludge after anaerobic digestion. The impact of air stripping on the odour of liquid sludge and on the quality of the dewatered product was evaluated at a full-scale sludge treatment installation. A continuous and a batch air-stripping mode were tested. Odour samples were collected during air stripping from the liquid sludge and from the biosolids surface during long term storage. The biosolids were also analysed for hedonic tone and for their potential odour expressed as an odour unit per unit mass. The odour emission profiles for continuous and batch air stripping demonstrated a reduction in the overall (time weighted) emissions during a 24 hr-period compared with emissions from the quiescent liquid storage tank. The averaged specific odour emission rate (Esp) of the biosolids derived from the continuous process was only 13% of the Esp of the biosolids derived from unaerated liquid sludge during the first month of storage. The results of the total potential odour and the hedonic tone of the biosolids underpin the beneficial effects of the air stripping. Odour dispersion modelling showed a noticeable reduction in overall odour impact from the sludge centre when air stripping was applied. The reduction was primarily associated with the reduced odour from stockpiled biosolids. The continuous air-stripping mode appeared to provide the greatest benefits in terms of odour impact from site operations.

Malignant mixed tumor ex eccrine spiradenoma: an unusual pattern of malignant dedifferentiation.

Eccrine spiradenoma (ES) is a benign tumor of the skin adnexal origin. It is often seen in the head and neck region of young adults and may be present for years. While there have been numerous case reports of malignant degeneration within ES, they have been mostly carcinomatous dedifferentiation and rarely carcinosarcomas. A malignant mixed tumor is a neoplasm with a malignant epithelial component and areas of chondroid and myxoid differentiation within the malignant epithelial proliferation. While the epithelial component is malignant, the mesenchymal component is felt to represent a benign, metaplastic response of the stroma. While the malignant mixed tumor has a benign counterpart, the benign mixed tumor, the former is usually not seen in continuity with the latter. We describe a case of ES with malignant degeneration and demonstrate the transformation from benign to malignant. The histology and immunohistochemistry of the neoplasm supports a malignant mixed tumor, an extremely unusual neoplasm to see in association with ES or any benign adnexal neoplasm.

A simple technique for repair of rectus sheath defects.

Several approaches for repair of diastasis recti during abdominoplasty and repair of rectus sheath defect during transverse rectus abdominis musculocutaneous flap harvest have been described. Although these have generally been effective, we feel our procedure to be advantageous. The method presented is quick, easy, and efficient. In addition, because a looped (double), monofilament suture is used, a stronger, more aesthetic repair is accomplished. This technique has been used in 39 patients over a 25-month period. No recurrences of diastasis recti and no hernias have been observed. Furthermore, all patients remain without complaint.

A comparative study of free and pedicle flaps for lower extremity wounds.

Sixty-four flaps were used to treat wounds in 58 patients over a 5-year period. In this series there was a high incidence of healing of both tibial fractures and chronic osteomyelitis when covered with muscle. Better contour is achieved with muscle covered with meshed skin grafts than with musculocutaneous flaps. The survival rate for free flaps was 93% and for pedicle flaps, 100%. Complication rates were higher for pedicle flaps (45%) than for free flaps (30%), although major complications for free flaps (14%) were higher than for pedicled flaps (9%).

Experimental evaluation of free-tissue transfer to promote healing of infected wounds in dogs.

An experimental model was designed to evaluate the course of healing and the changes in bacterial concentrations of infected forelimb wounds with devascularized bone in dogs. Infected leg wounds were allowed to heal by secondary intention or were covered with a full-thickness or split-thickness skin graft, an epigastric skin/fat flap, or a gracilis musculocutaneous flap. All skin grafts failed. Gracilis muscle flaps were superior to epigastric skin/fat flaps in decreasing soft-tissue bacterial concentrations. Quantitative bone cultures, however, were positive at reexploration 6 weeks later in 33% of all legs covered with a flap. X-ray films were successful in predicting the presence or absence of bone infection in 70% of all legs. Postmortem arteriograms of legs covered with muscle flaps showed neovascularity to bone. This study suggests muscle flap coverage of wounds debrided of contaminated, necrotic, or infected bone and soft tissue to be an excellent method of providing well-vascularized soft tissue promoting healing and resolution of infection.

Spindle cell sarcoma of scrotum.

Sarcomas of paratesticular origin are rare tumors. They usually manifest themselves as a scrotal mass that should be differentiated from testicular tumors. There are problems regarding their pathologic diagnosis and treatment. We report a case of spindle cell sarcoma of the gubernaculum testis in a young patient. Electron microscopy was used in the histogenetic typing of this tumor.

The use of a simplified standardized hyperalimentation formula.

The use of a standardized hyperalimentation solution that can be modified is discussed. A comparison of in-hospital addition of electrolytes with factor addition of electrolytes is presented, in which both solutions are acceptable to patients and in which the labor and cost to the pharmacy are decreased in the factory-mixed additives.