The value of open lung biopsy in immunocompetent patients with community-acquired pneumonia requiring hospitalization.

OBJECTIVE: To determine the role of open lung biopsy in immunocompetent patients with community-acquired pneumonia who require hospitalization. DESIGN: A group of 1,118 patients with severe community-acquired pneumonia that required hospitalization were enrolled in the study. Of the patients, 26 underwent open lung biopsy. Another 18 of these patients were immunocompromised and were excluded from this segment of the study. SETTING: Tertiary care 800-bed hospital from November 1981 to May 1989. RESULTS: Progressive diffuse pulmonary infiltrates and negative conventional cultures were the indications for biopsy in most of these patients. Eighteen (69 percent) were immunocompromised. The eight immunocompetent patients underwent a retrospective review of their course in hospital. Three patients died. The diagnostic yield from open lung biopsy was 25 percent. A specific histologic diagnosis was made in one patient--lipoid pneumonia. The pulmonary histologic finding were nonspecific in the remaining patients, but in four, in combination with the clinical data, gave useful information and resulted in therapy change. Culture of a pulmonary tissue yielded cytomegalovirus in one other patient. Serologic testing had a low yield in this group with three patients having a positive result. CONCLUSIONS: Open lung biopsy is rarely necessary in immunocompetent patients with community-acquired pneumonia. In a small group of patients where it is necessary, however, both positive and negative results are important in directing therapy.

The response of the intestinal epithelium in B10.A mice to infection with Trichinella spiralis.

Previous studies on intestinal trichinosis have dealt mainly with areas other than the intestinal epithelium. Since the epithelium is now known to be the parasite's habitat, its response to infection is important. Infection with Trichinella spiralis in immunologically slow-responding B10.A mice was associated with crypt hyperplasia and villus atrophy. With similar infection levels in both primary and challenge infections, there was no difference in the maximal degree of atrophy or hyperplasia between the 2 groups. However, challenged mice underwent these mucosal changes in about half the time. Expulsion of worms always occurred during regeneration of the intestinal epithelium suggesting that the host's defense mechanism of altering the kinetics of the epithelium was not the prime factor causing expulsion. Pulse labelling of enterocytes with [3H] thymidine showed that there was no significant increase in the relative size of the proliferation zone. This indicates that the crypt cell output was not altered by this parasite. Atrophy of the villus was analysed with respect to its 3-dimensional shape. There was a decrease in both height and width of the villus but not thickness. Thus, there is a real decrease in the size of the enterocyte population per villus. Histochemical staining of the enterocyte brush border by an alkaline phosphatase method showed that (1) hyperplastic crypts have an enlarged maturation zone and (2) the villus epithelium is composed entirely of mature cells. The distribution of the nematode population was compared to these changes in the intestine. Trichinella spiralis showed a marked anteriad (distal to proximal) migration prior to expulsion. Thus, utilizing a novel approach to study intestinal trichinosis, the response of the mucosal epithelium has been characterized.

Cell injury caused by Trichinella spiralis in the mucosal epithelium of B10A mice.

Most of the mucosal epithelium in the anterior small intestine of B10A mice infected with Trichinella spiralis showed no cytopathology. However, isolated foci of damaged cells or dense masses of multinucleate cytoplasm were seen in the crypt-villus junction, or the base of the villi. Cells occupied by the nematode ranged from a nearly normal appearance, showing only compressed nuclei and organelles, to progressive inflation and vesiculation of endoplasmic reticulum, loss of terminal web and hence disoriented and reduced microvilli, and pycnosis of nuclei. Damaged cells and multinucleate cytoplasmic masses may be derived from the cells previously occupied by the nematode that were linked together by fusion of their lateral cell membranes. Damaged cells and multinucleate masses are apparently sloughed from the epithelium at the villus base without migrating up the villi. Eosinophils were seen in the lamina propria, in the mucosal epithelium (usually associated with damaged cells) and in the intestinal lumen (also with damaged cells). As no eosinophils were seen in contact with the nematode, their activities may be related more to the cells killed by the worm than to the worm itself.

The complementary role of hepatobiliary scintigraphy and abdominal sonography in a patient with a hepatic cyst and suspected acute cholecystitis.

A 51-year-old woman was admitted with suspected acute cholecystitis. A large hepatic cyst was found incidentally by abdominal sonography, which displaced an "abnormal" gallbladder. Hepatobiliary scintigraphy visualized the gallbladder and excluded acute cholecystitis, but required the anatomic information from sonography to verify the abnormal location of the gallbladder. Additionally, scintigraphy showed the cyst not to communicate with the biliary tract. Pathologic findings revealed mild chronic cholecystitis and a simple mesothelial hepatic cyst. This case illustrates the complementary role of hepatobiliary scintigraphy and abdominal sonography in patients with distorted hepatobiliary anatomy and suspected acute cholecystitis.

Packed- and fluidized-bed biofilm reactor performance for anaerobic wastewater treatment.

Anaerobic degradation performance of a laboratory-scale packed-bed reactor (PBR) was compared with two fluidized-bed biofilm reactors (FBRs) on molasses and whey feeds. The reactors were operated under constant pH (7) and temperature (35 degrees C) conditions and were well mixed with high recirculation rates. The measured variables were chemical oxygen demand (COD), individual organic acids, gas composition, and gas rates. As carrier, sand of 0.3-0.5 mm diameter was used in the FBR, and porous clay spheres of 6 mm diameter were used in the PBR. Startup of the PBR was achieved with 1-5 day residence times. Start-up of the FBR was only successful if liquid residence times were held low at 2-3 h. COD degradations of 86% with molasses (90% was biodegradable) were reached in both the FBR and PBR at 6 h residence time and loadings of 10 g COD/L day. At higher loadings the FBR gave the best performance; even at 40-45 g COD/L day, with 6 h residence times, 70% COD was degraded. The PBR could not be operated above 20 g COD/L day without clogging. A comparison of the reaction rates show that the PBR and FBR per formed similarly at low concentrations in the reactors up to 1 g COD/L, while above 3 g COD/L the rates were 17.4 g COD/L day for the PBR and 38.4 g COD/L day for the FBR. This difference is probably due to diffusion limitations and a less active biomass content of the PBR compared with the fluidized bed.The results of dynamic step change experiments, in which residence times and feed concentrations were changed hanged at constant loading, demonstrated the rapid response of the reactors. Thus, the response times for an increase in gas rate or an increase in organic acids due to an increase in feed concentration were less than 1 day and could be explained by substrate limitation. Other slower responses were observed in which the reactor culture adapted over periods of 5-10 days; these were apparently growth related. An increase in loading of over 100% always resulted in large increases inorganic acids, especially acetic and propionic, as well as large increases in the CO(2) gas content. In general, the CO(2) content of the gas was very low, due to the large amount of dissolved CO(2) that exited with the liquid phase at low residence times. The performance of the FBR with whey was comparable to its performance with molasses, and switching of molasses to whey feed resulted in immediate good performance without adaptation.

Continuous culture in combined backmix-plug-flow-tubular-loop fermentor configurations.

Several combinations of backmix, tubular-loop, and plug-flow fermentors with and without culture recycle were studied by computer simulations. The steady-state concentrations of cell mass in a continuous culture were calculated as a function of dilution rate using Monod growth kinetics. It was found theoretically and verified for one case experimentally that the maximum dilution rate, over which microbial cells were washed out from the fermentor, could be elevated well beyond the maximum specific growth rate if a particular fermentor combination was used. A combination of two backmix fermentors has been analyzed previously by Sinclair and Brown. Application of this type of fermentor combination as a seed tank for performing continuous culture of microbes in a plug-flow reactor was shown with special reference to fermentation production using the kinetics proposed by Luedeking and Piret, van Dedem and Moo-Young, and Brown and Vass.

Kinetics of biofilm nitrification.

The reaction rates (r(NH(4) (+) ) and r(NO(2) (-) )) in the two-step nitrification reaction were measured in a fluidized-sand-bed biofilm reactor under a range of steady-state conditions with respect to bulk NH(4) (+), NO(2) (-), and O(2) concentrations. It was shown from theory and experiment that under low NH(4) (+) concentration conditions, if the O(2)/NH(4) (+) concentration ratio in the bulk liquid is less than the stoichiometric coefficient (3.4 mg/mg), then oxygen will be rate limiting. In all experiments r(NO(2) (-) ) decreased more than r(NH(4) (+) ) under low oxygen conditions. This resulted in high NO(2) (-) effluent concentrations under low residence time conditions. The influence of the oxygen penetration effects on the relative values of r(NH(4) (+) ) and r(NO(2) (-) ) was experimentally shown to be caused either by the Nitrobacter location in the inner biofilm regions or by a K(m) effect for oxygen. Theoretical support of these findings was provided by a differential diffusion-reaction model which was used to simulate the experimental results.

Modeling dynamic experiments on the anaerobic degradation of molasses wastewater.

The kinetics of anaerobic degradation of a molasses wastewater were measured under constant pH conditions in a laboratory scale packed bed reactor. In continuous and batch experiments the formation and degradation rates of the organic acids (butyric, propionic and acetic) have been followed. The influence of hydrogen gas on the acid degradation rates has been measured and, contrary to the literature and the thermo-dynamic calculations, no inhibition was detected, biofilm diffusional effects may be the reason. Two dynamic simulation models were tested, a heterogeneous model, which considered the biofilm diffusion-reaction phenomena and a quasihomogeneous model with the same kinetics. Except for hydrogen, the diffusion effects were found to be negligible. Otherwise both models gave essentially the same results and the time profiles of acids, hydrogen, carbon dioxide and methane agreed relatively well with dynamic startup experiments. Batch experiments showed the acid concentrations to be highly sensitive to the initial molasses concentration. This aspect was not included in the model but is being investigated further.

Operation of a three-phase biofilm fluidized sand bed reactor for aerobic wastewater treatment.

A biofilm fluidized sand bed column reactor (14 L) has been operated in the three-phase mode on a soluble glucose-yeast hydrolysate substrate in which the biofilm-sand phase (1-2.5 L) was suspended by direct aeration of the bed. Within two weeks a tight biofilm was formed whose activity resulted in a 90% reduction, with loads of 10.7 kg TC/m(3)day. The residence time was 1 h. The biofilm remained intact during operation with high residence times (up to 23 h) over three weeks. Oxygen transfer coefficients varied with aeration rate and sand quantity between 0.02 and 0.04 s(-1) during non growth conditions; they decreased with increasing amounts of clean sand and were higher and relatively independent of the sand fraction with biofilm-covered sand. Aeration rates used in the 14 L reactor were 23-40 L/min (2.4-4.1 cm/s) and were sufficient to suspend 78-92% f the biofilm-covered sand. Clean sand was 50-75% suspended. Oxygen uptake rates varied between 15.4 and 23.1 mol/m(3) h.

Biological denitrification of drinking water using autotrophic organisms with H(2) in a fluidized-bed biofilm reactor.

Biological denitrification of drinking water was studied in a fluidized sand bed reactor using a mixed culture. Hydrogen gas was used as the reaction partner. The reaction kinetics were calculated with a double Monod saturation function. The K(s) value for hydrogen was below 0.1% of saturation. No appreciable biofilm diffusion effects were detected. Reactor performance was a function of the culture's past history. Batch experiments always exhibited an accumulation of NO(2) (-), but continuous experiments with a sufficiently long residence time always resulted in complete nitrogen removal. Rates of up to 23 mg N/L h, 25 mg N/g DW h, and 7.9 mg H(2)/L h were achieved. Residence times of 4.5 h would be required for complete denitrification of water containing 25 mg NO(3) (-)-N/L or approximately 1 h for every 5 mg/L.

Influence of oxygen on the growth of Saccharomyces cerevisiae in continuous culture.

Baker's yeast, Saccharomyces cerevisiae, was investigated for the combined influence of dissolved oxygen and glucose concentration in continuous culture. A reactor was operated at a range of dilution rates (0.1, 0.2, 0.25, 0.27, and 3.0 h(-1)), above and below the critical value that separates the oxidative and fermentation regions. For each dilution rate (D), steady states were established at each of five to ten different dissolved oxygen concentrations (DO) in the range of 0.01-5 mg/L. The use of on-line mass spectrometry facilitated the measurement of gaseous and dissolved O(2), CO(2), and ethanol. Intracellular carbohydrate, protein, RNA, DNA, lipid, and cytochrome concentrations were measured. Cell size measurements were reduced to specific surface areas. Cytochrome content showed up to 100% variation during a 20-day period of adaptation at D = 0.2 h(-1) to low DO. Eventually, the culture behaved the same at DO = 0.05 mg/L as it did initially at 3 mg/L. At D = 0.2, 0.25, and 0.27 h(-1), the transition between oxidation and fermentation was characterized by a critical DO which decreased with decreasing D. The X-D curves were shifted such that the critical D value was reduced with decreasing DO. Specific oxygen update rates varied with DO according to the saturation kinetics. Specific cell surface areas increased with decreasing DO. Cytochrome content generally decreased with decreasing DO, and Q(O(2) ) could be linearly related to the total cytochrome content, which exhibited a maximum at D = 0.27 h(-1).

Modeling of experiments on biofilm penetration effects in a fluidized bed nitrification reactor.

A four-component, diffusion-reaction model with double Michaelis-Menten kinetics was used to describe the experimental data obtained from a laboratory biofilm, fluidized-bed nitrification reactor. Theory and experiment demonstrated that the stoichiometric ratio (3.5 mg O(2)/mg NH(4)(+)-N) can be employed as a criterion to determine whether the limiting substrate is oxygen or ammonia. For the present work, in the range of concentrations where limitation occurred, 4 mg/L NH(4)(+)-N and 14 mg/L O(2), the ratio of oxygen to ammonia in the bulk liquid determined which substrate was penetration-limiting-O(2) if <3.5 and NH(4)(+) if > 3.5. Half-order kinetics with respect to the limiting substrate described the apparent overall rates. Simulations provided biofilm concentration profiles which demonstrated the role of the oxygen-ammonia ratio. Experiments indicated that, generally, high NO(2)(-) concentrations can be expected. These depend on the residence time, biofilm area, and oxygen concentration. This dependency was investigated with the model, as was the parametric sensitivity with respect to the saturation constants. Particularly important for the NO(2)(-) levels were the ratios of the saturation constants for oxygen.

Transient-state behavior of a biofilter removing mixtures of vapors of MEK and MIBK from air.

In the work reported here, selected aspects of the dynamic behavior of biofilters for waste air treatment have been investigated. Emphasis was placed on transient state elimination of mixtures of methyl ethyl ketone (MEK) and methyl isobutyl ketone (MIBK) vapors and on explanation of the observed phenomena. The initial startup, the response of the biofilter to step changes in the pollutant loadings, responses to pollutant pulses, restarting after starvation, and the influence of step changes in gaseous phase oxygen partial pressure are presented and discussed.