Substituted ferrocenes and iodine as synergistic thermoelectrochemical heat harvesting redox couples in ionic liquids.

Combining ferrocene and iodine results in enhanced thermoelectrochemical (or thermogalvanic) waste heat harvesting abilities, for both the Seebeck coefficient and the overall power output. All systems displayed a mixture of ferrocene, ferrocenium, iodine and triiodide. The observed enhancement correlates with lower electron-density on the ferrocene; the synergistic improvement observed for mixtures of substituted ferrocenes and iodine is attributed to the formation of charge-transfer complexes. Combining dibutanoylferrocene and iodine resulted in the highest Seebeck coefficient of 1.67 mV K(-1).

Facile, room-temperature pre-treatment of rice husks with tetrabutylphosphonium hydroxide: Enhanced enzymatic and acid hydrolysis yields.

Aqueous solutions of tetrabutylphosphonium hydroxide have been evaluated as pretreatment media for rice husks, prior to sulphuric acid hydrolysis or cellulase enzymatic hydrolysis. Varying the water:tetrabutylphosphonium hydroxide ratio varied the rate of delignification, as well as silica, lignin and cellulose solubility. Pre-treatment with 60wt% hydroxide dissolved the rice husk and the regenerated material was thus heavily disrupted. Sulphuric acid hydrolysis of 60wt%-treated samples yielded the highest amount of glucose per gram of rice husk. Solutions with good lignin and silica solubility but only moderate to negligible cellulose solubility (10-40wt% hydroxide) were equally effective as pre-treatment media for both acid and enzymatic hydrolysis. However, pre-treatment with 60wt% hydroxide solutions was incompatible with downstream enzymatic hydrolysis. This was due to significant incorporation of phosphonium species in the regenerated biomass, which significantly inhibited the activity of the cellulase enzymes.

Attendances at a field hospital emergency department during operations in Iraq November 2003 to March 2004 (Operation Telic III).

OBJECTIVE: This study investigated the types of presentations; time lines and disposal of patients from the international, local and military community in Southern Iraq. METHODS: All presentations to the Emergency Department (ED) were clinically and demographically coded and entered onto an electronic database. RESULTS: During the period studied the emergency department dealt with 1455 new presentations of which 75% were UK Armed Forces personnel. CONCLUSIONS: This represented a busy period in the field hospitals time in Iraq and offered valuable training to emergency medicine trainees in an unusual environment.

Appropriate use of helicopters to transport trauma patients from incident scene to hospital in the United Kingdom: an algorithm.

A simple algorithm has been produced to assist front line ground ambulance personnel, air ambulance crews, and immediate care doctors attending trauma patients in selecting the most appropriate mode of transport from the incident scene to hospital.

Adult supraglottitis: an important cause of airway obstruction.

Supraglottitis in the adult can progress rapidly to complete airway obstruction. Successful management requires a high index of clinical suspicion at initial presentation and anticipation of a fulminant course. All cases should be assessed in a resuscitation area by senior medical staff.

Computed tomography-assisted management of splenic trauma.

BACKGROUND: In patients who have suffered an injury to the spleen, preservation of the organ is of the utmost importance. To assist in management, contrast-enhanced computed tomography (CT) has been used. We reviewed our experience with a protocol for nonoperative management of splenic trauma based on CT grading of the injury. METHODS: During the initial period of the study, 50 CT examinations for blunt abdominal trauma in adults were reviewed by staff radiologists for evidence of splenic injury. The radiologists, blinded to clinical management decisions, graded the CT studies as "A" if there was a subcapsular hematoma or capsular disruption, "B" if there was a parenchymal injury not extending into the hilum, or "C" if there was deep laceration of fracture of the hilum. Following confirmation of the accuracy and reproducibility of the grading scale, the splenic trauma management protocol was instituted, in which nonhilar injuries were managed nonoperatively. RESULTS: In the initial assessment, patients managed nonoperatively had shorter hospital stays and received fewer blood transfusions than those undergoing operation. Among 30 patients subsequently enrolled in the protocol, those treated nonoperatively remained in the hospital for fewer days than those treated surgically. Again, fewer units of blood and platelets were used in the nonoperative group. Institution of the protocol decreased the incidence of celiotomy. CONCLUSIONS: The severity of splenic trauma evident on CT staging guides safe nonoperative management. Patients not suffering injury to the splenic hilum (A and B scores) can be managed without operation, resulting in shorter hospital stays and fewer blood products used.

Adjuvant therapy: the effects on microvascular lower extremity reconstruction.

Adjuvant therapy and microsurgery have allowed advances in surgical extirpation of lower extremity neoplasms. This retrospective study was designed to evaluate the microvascular transfer for lower extremity reconstruction in patients receiving pre- or post-operative irradiation and chemotherapy alone and in combination. Over a 5-year period, 24 free tissue transfers were performed in 22 patients undergoing surgical resection with adjuvant therapy for lower extremity neoplasms. There were 13 male and 9 female patients with an average age of 51 years. The latissimus dorsi muscle was most commonly transferred (N = 15). Eighteen tumors received pre- and three received postoperative radiotherapy. Two tumors received a combination of radiotherapy and brachytherapy. Pre- and/or postoperative chemotherapy was used in 14 patients. Twelve of these patients had both chemo- and radiation therapy. A total of six complications occurred, with no flap loss. Complications were evenly distributed among adjuvant regimens. All patients who underwent attempted limb salvage were able to ambulate postoperatively, except for 1 patients who had local recurrence. In conclusion, adjuvant therapy did not increase the complication rate for free tissue transfer in the lower extremity. Adjuvant therapy did not require alterations in the free tissue transfer and, similarly, free tissue transfer did not alter adjuvant therapy. We believe that free tissue transfer in complicated wounds allows for better wound healing with adjuvant therapy rather than local or primary wound closure alone.

Intraoperative transoesophageal echocardiography for implantation of a pulsatile left ventricular assist device.

We describe the insertion of a permanent implantable left ventricular assist device and intraoperative transoesophageal echocardiography in this instance. We also review the literature on the use of intraoperative transoesophageal echocardiography.

Combined coronary artery bypass surgery and abdominal aortic aneurysm repair.

The proper management of patients with asymptomatic abdominal aortic aneurysms and significant coexistent coronary artery disease is still debatable. The most common approach has been to perform the coronary artery bypass surgery some weeks before the abdominal aortic aneurysm repair in the hope of reducing the cardiac morbidity and mortality. We report our initial experience of three consecutive elective cases where the coronary artery bypass surgery and the abdominal aortic aneurysm repair were performed at one operation by the same operating surgeon.

Adult respiratory distress syndrome following closure of a chronic ventricular septal defect: possible relationship to the use of intracardiac gelatin-resorcin-formaldehyde glue.

Gelatin-resorcin-formaldehyde glue is now widely used in cardiac surgery, particularly in Europe. A case is reported where its use may have contributed to the pulmonary dysfunction seen postoperatively after elective closure of a postinfarct ventricular septal defect. It is believed that this is a result of a relatively high exposure of the pulmonary circulation to the glue, in particular to formalin. Although not proven, the authors advise caution when using the glue within the cardiac chambers.

The use of Foley balloon catheters in cardiac surgery.

Situations may arise during elective and emergency surgery when vascular control is required but conventional vascular clamps cannot be used. We have found the Foley catheter useful for the control of inadvertent perforation of the heart especially in "redo" operations. We describe the use of the Foley catheter for the control of the difficult aorta and illustrate its potential versatility in a variety of uncommon situations. As Foley catheters are present in every operating theatre we hope that our experience will be of benefit to other surgeons who encounter similar problems.

Subcapsular hematoma as a predictor of delayed splenic rupture.

Over the past 46 months at a level I trauma center, 966 computed tomography (CT) scans were performed for blunt abdominal trauma. Eighty-three (8.6%) demonstrated splenic injury, and 31 (3.2%) of these showed a subcapsular hematoma with or without associated parenchymal damage. Of the 31 patients, 23 were managed conservatively, based initially upon surgeons' preference (14 patients) and after March 1990 to conform to the authors' splenic trauma protocol (nine patients). The eight patients operated upon were hemodynamically stable and all underwent splenectomy. Subcapsular hematoma, as diagnosed by preoperative CT scan, was confirmed in each of the eight celiotomies. Parenchymal involvement, which had also been identified in these eight patients by CT, was evident at operation in all, and hilar involvement occurred in three. None of the 23 observed patients developed delayed splenic rupture. All were discharged home with outpatient follow-up in surgical clinic to at least 1 month without further complication. The authors came to the following conclusions: 1) Subcapsular hematoma is neither a predictor for delayed splenic rupture, nor by itself an indication for operative management of the injured spleen in the hemodynamically stable patient; 2) Degree of parenchymal injury based on CT morphology, specifically hilar involvement, signifies the need for laparotomy with splenectomy; 3) Splenorrhaphy has a reduced role in splenic trauma because most injuries now operated upon are severe.

Carcinogens and cancers in freshwater fishes.

Epizootics of neoplasms in freshwater fish species are considered in relation to circumstantial and experimental evidence that suggest that some epizootics of neoplasia of hepatocellular, cholangiocellular, epidermal, and oral epithelial origin may be causally related to contaminant exposure. Although there is concern for the safety of consuming fish affected with neoplasms, this concern may be misdirected as direct transmission of cancer by ingesting cancerous tissue would seem unlikely. Of greater concern is the matter of toxic and cancer-causing chemicals present in edible fish that exhibit neoplasia as a symptom of past exposure via residence in a polluted waterway. There is ample evidence to suggest that contaminant chemicals ingested via contaminated Great Lakes fish may already be affecting both human and ecosystem health, but these effects are subtle and may require new approaches to the study of the affected systems.