Full scale implementation of the nutrient limited BAS process at Södra Cell Värö.

A combination of the suspended carrier biofilm process and the activated sludge process (biofilm-activated sludge--BAS) has been shown to be very successful for the treatment of different types of pulp and paper mill effluents. The robust biofilm pre-treatment in combination with activated sludge results in a stable, compact and highly efficient process. Recent findings have shown that nutrient limited operation of the biofilm process greatly improves the sludge characteristics in the following activated sludge stage, while minimising sludge production and effluent discharge of nutrients. The nutrient limited BAS process was implemented at full scale at the Södra Cell Värö kraft mill and taken into operation in July 2002. After start-up and optimisation over about 5 months, the process meets all effluent discharge limits. The removal of COD is close to 70% and the removal of EDTA greater than 90%. Typical effluent concentrations of suspended solids and nutrients during stable operations have been 20-30 mg/L TSS, 0.3-0.5 mg/L phosphorus and 3-5 mg/L nitrogen. The sludge production was 0.09 kgSS/kg COD removed and the sludge volume index was 50-100 mL/g.

Expression of birch pollen-specific IgE-binding activity in seeds and other plant parts of birch trees (Betula verrucosa Ehrh.).

Dot immunoblotting of crude extracts of various aerial parts of birch trees, using patient serum rich in birch pollen IgE, showed IgE-binding activity in leaves, buds, twigs, seeds, bark, and old male catkins. Seed extracts analysed by SDS-PAGE, electroblotting to nitrocellulose and immune detection using isotope-conjugated anti-IgE verified the presence in seeds of an IgE-binding protein of an approximate molecular weight of 12 kD, distinct from the major allergen (molecular weight 17 kD) of Betula verrucosa pollen. The allergen of birch seeds was readily leachable from the seeds. Many of the birch plant part extracts were active in RAST inhibition using birch pollen RAST discs, but showed low potency relative to the allergenicity of birch pollen allergens.

Computed tomography of the brain in cases with venous vasculitis compared with an age-matched reference group.

Patients with a particular, steroid-sensitive headache and often characteristic pathology at orbital phlebography, have been suggested to suffer from venous vasculitis. Fifty such patients were examined with computed tomography (CT) of the brain. The findings were compared with those of an age-matched reference group selected at random to represent normal subjects. The CT examinations were analyzed with respect to size of lateral ventricles and signs of atrophy. In both groups, there was a significant increase of atrophy with age. There was also a significantly higher degree of atrophy in the patient group as compared with the reference group. The findings indicate that the supposedly underlying venous vasculitis is related to early aging and atrophy of the brain.

School screening for adolescent idiopathic scoliosis.

Two school examination schemes for scoliosis were compared in a defined population of 13,757 children. During the first period, there was no screening program. During the second period, all children in grades 4-8 were examined yearly by forward-bending tests. Brace treatments were started in 0.39%. The two periods did not differ significantly with respect to frequency of children regularly observed for scoliosis by orthopedic surgeons, frequency of brace treatment, age at detection, or mean scoliotic curve at the start of treatment. A single forward-bending test in grade 4 appears to be sufficient for detection of scoliosis requiring treatment.

Stereotactic radiation therapy of intracranial lesions. Methodologic aspects.

A technique for stereotactic radiation therapy of cerebral tumours and arteriovenous malformations using a linear accelerator (6 MV photons) is proposed. Treatment relies on a fixation system that permits a precise use of the coordinates estimated at stereotactic angiography or stereotactic computed tomography. The field of treatment can be exactly outlined in the CT images during repeat examinations, thus facilitating the recognition of changes induced by radiation. The system also allows the extent of the arteriovenous malformation, as seen at angiography, to be accurately traced in the CT sections thus enabling evaluation of possible radiation damage to surrounding brain structures. The precision of the method as well as its hypothetical merits and disadvantages are discussed. The number of patients treated is still small and the follow-up time is too short in the majority of cases to allow definite conclusions. Examples of preliminary results are given.

Stereotactic radiation therapy of intracranial arteriovenous malformations.

Twenty-six patients with large intracranial arteriovenous malformations (AVM), not suited for open surgery or radiosurgery, have been treated by fractionated stereotactic radiation therapy using a linear accelerator. The preliminary results are based on follow-up angiography one and a half years after treatment, and in 5 cases also 5 years after treatment. In 2 cases a complete obliteration of the AVMs has occurred, and in the majority of the remaining cases a reduction of the size of the lesion has been obtained. Further development of the method is needed in order to improve the results. Today treatment with this technique is only recommended in cases which cannot be treated with other methods.

Smooth pursuit eye tracking, neuropsychological test performance, and computed tomography in schizophrenia.

Smooth pursuit eye movements (SPEM) were measured in 18 patients who met Research Diagnostic Criteria for schizophrenia. Some degree of SPEM impairment was present in most patients. Deviant eye tracking was not related to ratings of severity of illness, but was related to recurrent episodes of hospitalization, antipsychotic medication, and lower ratings in anxiety and delusions. Worse SPEM tended to be associated with larger lateral ventricles as assessed on computed tomography. Three patients with reversed occipital asymmetry had more deviant eye tracking than the remaining patients. Eye movement impairment was related to worse performance in Finger Tapping and in the Trail-Making Test, and to fewer perceived alternations of a Necker cube, suggesting that frontoparietal disturbances are related to poor pursuit eye tracking in schizophrenia.

Pes anserinus transfer for the unstable knee. A 7-year follow-up of 43 cases of ruptured anterior cruciate ligament.

On average 7 years postoperatively, we evaluated 43 consecutive patients who had had pesoplasty for chronic injury of the anterior cruciate ligament. Fourteen patients had undergone further surgery during the follow-up period; ten of these had extra- or intra-articular stabilizing procedures, and eight meniscectomies were performed after the index operation. At follow-up of the 33 knees that had not had additional stabilizing surgery, only one-third of the knees had normal radiograms, and the majority had anterolateral rotational instability (pivot shift) which, however, did not exclude satisfactory knee function. We conclude that improvement after transfer of the pes anserinus tendons was due to the simultaneous meniscectomy; we do not believe that the pesoplasty changed the natural course of the chronic rupture of the anterior cruciate ligament.

Alcohol abuse and superego conflicts.

This paper reports the author's experiences with alcohol abusers in their initial or premorbid phase. The emphasis is on their superego conflicts and how these conflicts relate to their alcohol abuse. The adaptational function of their heavy drinking pattern is to neutralize an archaic persecutive superego through an oral-sadistic counterattack. The drinking is an attempt to reach inner structural change, which is successful during the first moments of intoxication, but often backfires when the ego strength is lessened under the influence of alcohol.

Cerebroventricular size and cerebrospinal fluid monoamine metabolites in schizophrenic patients and healthy volunteers.

Computed tomography (CT) measures and cerebrospinal fluid (CSF) levels of the monoamine metabolites homovanillic acid (HVA), 3-methoxy-4-hydroxyphenylglycol (MHPG), and 5-hydroxyindoleacetic acid (5-HIAA) were determined in 43 healthy volunteers and in 26 patients with an acute psychosis of the schizophrenic type. There were no differences in the mean CSF levels of monoamine metabolites between the two groups. However, the patients had significantly wider lateral and third ventricles as compared to the volunteers. In the volunteers there were no significant correlations between ventricular sizes and monoamine metabolite levels, whereas in the patients a significant negative correlation was obtained between the size of the lateral ventricles and the levels of HVA and 5-HIAA in the CSF. These results may indicate that the enlargements of the brain ventricles found in a subgroup of schizophrenic patients may be associated with deficiencies in central monoamine transmission mechanisms.

Adjustable computerized stereotaxic brain atlas for transmission and emission tomography.

A computerized brain atlas adjustable to the patient's anatomy would serve serveral purposes. It could be used in stereotaxic surgery. Even more important would be its use in medical imaging to identify various brain structures, such as the basal ganglia and their nuclei, as well as individual cortical gyri. This atlas could be used for additional mapping of nonvisible structures in images obtained with methods having a high spatial resolution, such as computed tomography and nuclear magnetic resonance. Anatomic information obtained in this way might then be transferred to images of low resolution, such as those obtained in positron emission tomography or single-photon emission computed tomography, in order to select anatomically correct regions of interest. The methods used in the construction of such an atlas are briefly described. An attempt to implement such an atlas based on digitized photographs of brain slices is described.

Effect of dexamethasone treatment on volume and contrast enhancement of intracranial neoplasms.

In a prospective study the effect of dexamethasone treatment on tumor volume and contrast enhancement was evaluated by computed tomography (CT) in 15 patients with intracranial lesions. Histological diagnoses were confirmed in 13 patients who had undergone surgical intervention. A CT study of the head, with and without contrast medium, was performed prior to the dexamethasone treatment and at various intervals during the treatment for 8-19 days. The volume, attenuation, and contrast enhancement of the tumor were measured and related to the time after the start of the treatment. In six meningiomas there was no change in the volume and enhancement of the tumors. Out of four gliomas, there was an increase in volume of two tumors, whereas the other two cases showed a decrease in the tumor volume. In one glioma a distinct decrease in enhancement was observed. In three cases of metastasis a decrease in enhancement and tumor volume was noted. An acoustic neurinoma and an unverified lesion, considered radiologically to be a glioma, also showed a decrease in tumor volume and contrast enhancement. In tumors that responded to the treatment, a decrease both in volume of the tumor and peritumoral brain edema as well as a decrease in contrast enhancement of the tumor were observed.

Computed tomography of the brain in patients with acute psychosis and in healthy volunteers.

Evidence has been obtained by computed tomography (CT) that some chronic schizophrenic patients have enlarged cerebral ventricles and other brain abnormalities when compared to other patient groups and to healthy controls (Johnstone et al. (1976), Weinberger et al. (1979)). In order to investigate whether structural brain abnormalities can be demonstrated also in younger patients with acute psychosis we have undertaken a CT study in 46 patients and 46 healthy volunteers. Twenty-eight of the patients fulfilled the Research Diagnostic Criteria for schizophrenia. Nineteen had not been hospitalized for psychiatric reasons before. The lateral and third ventricles were significantly wider in the patients than in the volunteers. In the volunteers there was a significant positive correlation between age and size of the lateral ventricles, whereas in the patients, particularly those fulfilling the criteria for schizophrenia, no such correlation was obtained. These results indicate that schizophrenia may be associated with patho-physiological processes which interfere with the normal age-related enlargement of the ventricles. Signs of cortical atrophy, CSF circulation disturbances and reversed asymmetry of the occipital lobes were more frequent in the patient group then among the controls. These results are in accordance with previously published findings and indicate that structural brain abnormalities can be found in relatively young patients with acute psychosis.

Effect of dexamethasone treatment on peritumoral brain edema: evaluation by computed tomography.

In a prospective study, the effect of dexamethasone treatment on brain edema was evaluated by computed tomography (CT) in 14 patients with intracranial neoplasm. A CT study was made immediately prior to the beginning of the treatment and at various intervals for 8 to 19 days thereafter. The volume and attenuation of the edema were measured and related to the time after the start of treatment. In five cases of meningioma, only minor changes were shown; the edema volume either decreased or increased slightly or did not change at all. In four gliomas, a substantial decrease was noted in the edema volume in two cases and a smaller decrease was observed in two cases. In three metastases, a linear decrease in edema volume was noted during the entire follow-up, reducing it to one-fourth of the initial volume after 2 weeks of treatment. In one case of acoustic neuroma and in one undiagnosed lesion, a marked decrease in edema volume was also noted. The attenuation of the remaining edema was constant during the entire treatment time.

Attenuation profiles of the petrous bone with acoustic neuroma.

Attenuation profiles across the petrous bone covering the whole internal auditory meatus (IAM) were constructed from the printouts obtained by computed tomography (CT) with narrow collimation performed on 12 patients with 13 acoustic neuromas. In healthy patients the attenuation profiles of right and left petrous bone were very similar in shape. The attenuation values of the individual pixels in the pixel columns of the printout located at the site of the porus and the IAM reflected the demineralization of the petrous bone and the widening of the porus and the IAM caused by the acoustic neuroma. A widening deep in the meatus was demonstrated in a patient with an intracanalicular tumor, and therefore it seems possible to make this diagnosis by CT scanning combined with the construction of attenuation profiles across the petrous bone. In the presence of unilateral acoustic neuroma there was a significant and characteristic difference in shape between the attenuation profiles of the two sides with generally lower attenuation values on the tumor side together with signs of widening of the porus and the IAM. In cases of bilateral acoustic neuroma comparison of the attenuation profiles can be made with mean attenuation curves obtained from scanning normal petrous bones. The prevailing physical limitations for demonstrating a narrow bony canal like the IAM with CT was experimentally analyzed using bone-simulating plastic material.

A critical evaluation of two methods of head fixation.

Two head-fixation systems, one using Thermoplast and the other Lightcast were tested as to reproducibility by comparing stereotactic coordinates before and after CT scan and after removal and reapplication of the helmets. Helmets constructed of Lightcast were more consistently stable than those constructed of Thermoplast probably due in part to the dental fixation used with the former. With Lightcast the change in position of coordinates was consistently less than 3 mm, i.e. 2 pixels, which is within the tolerance of the system as a whole.

Attenuation values of the cerebrospinal fluid (CSF).

The attenuation value of CSF, obtained by lumbar puncture, was determined with computed tomography in 25 patients. Measurement of the protein content in the same samples showed no correlation with the attenuation value. It is concluded that in the normal range of protein concentrations, the effect on the attenuation is insignificant and that the attenuation value of the CSF might be used to check large deviations in the CT numbers due to artifacts.