Effect of point-of-use, activated carbon filters on the bacteriological quality of rural groundwater supplies.

The water quality of 24 rural, domestic groundwater supplies treated with point-of-use, powdered activated carbon (PAC) filters was monitored to determine how such treatment might impact the bacteriological quality of private, residential drinking water supplies. Heterotrophic-plate-count (HPC) and total coliform analyses were performed on raw, PAC-treated, and overnight or stagnant (first-draw) PAC-treated water samples. Densities of HPC bacteria were elevated by 0.86 and 0.20 orders of magnitude for spring and well water systems, respectively, in PAC-treated effluents following overnight stagnation compared with levels in untreated treated effluents. Densities of HPC bacteria in PAC-treated effluents were significantly reduced (P < 0.01) below influent levels, however, after the point-of-use device was flushed for 2 min. While PAC significantly reduced the number of coliforms in product waters (P < 0.01), these indicator organisms were still detected in some effluents. Seasonal variations were evident in microbial counts from spring but not well water systems. It appears that aside from periods following stagnant-water use, such as overnight, PAC treatment does not compromise the bacteriological quality of drinking water obtained from underground sources.

Vaginal wall sling.

We describe a new technique for the treatment of urinary incontinence due to intrinsic sphincteric damage in which a sling constructed from vaginal wall is used to provide compression and support of the urethra. A rectangular island of in situ anterior vaginal wall underlying the urethra and bladder neck is developed, the 4 corners are anchored with polypropylene sutures and a ligature carrier is used to transfer the sutures to a suprapubic location. An anterior vaginal wall flap proximal to the island is advanced to cover the island. When the sutures are tied the resulting sling will support the urethra and increase urethral resistance by compression, restoring continence. The advantages are its simplicity, need for only a small incision, short operative time and hospital stay, and reliance on healthy, well vascularized, in situ tissue. Continence has been achieved in 29 of 32 cases. All patients voided spontaneously except for those with neuropathic urethral incompetence who required self-catheterization.

Effects of mechanical ventilation on the measurement of cardiac output by thermodilution.

Phasic variation in cardiac output (CO) of 10-50% during mechanical ventilation was documented in dogs, and in 1 patient by injection of thermal indicator at 1-sec intervals throughout the ventilation cycle. Measured flow variation increased with inflation pressure when other variables were unchanged, and was not influenced to a significant degree by the injection of iced vs room temperature injectate. Such variation can occur in adult patients requiring only minimally increased airway pressure for ventilation. The technique of injecting indicator at a particular moment of the ventilation cycle is not appropriate to monitor absolute or even relative changes in CO because of occasional changes in the phase relation between the ventilation cycle and the flow variation. The mean CO by thermodilution technique is approximately best by the mean of values taken at regularly spaced intervals through the ventilation cycle.

Is cholera a problem for US travelers?

Only ten cases of cholera in US travelers have been reported since the current cholera pandemic began in 1961. No important risk factors were apparent from assessing the age, place of acquisition, duration of mode of travel before infection, or history of cholera vaccination of the travelers who acquired cholera. All of the patients received medical treatment and all recovered; there were no secondary cases. Nine of the ten were infected by Vibrio cholerae 01 El Tor, the strain responsible for the current pandemic. Using the number of US citizens returning to the United States by commercial air carrier from Asia, Africa, and Oceania to estimate the population at risk, we found that the chance of acquiring a reported case of cholera is less than one case per 500,000 returning travelers.

High-frequency jet ventilation during the treatment of acute fulminant pulmonary edema.

High-frequency jet ventilation (HFJV) was used during the treatment of fulminant pulmonary edema in a 45-year-old man so that toxic levels of oxygen could be avoided when conventional methods of ventilation in combination with high levels of PEEP (20 cm H2O) were unsuccessful in raising PaO2. On each of four occasions, HFJV resulted in improved arterial oxygenation when compared with conventional modes.

CEA levels in patients with carcinoma of the esophagus.

Serum CEA levels were determined serially by the Hansen Z gel technique on 41 patients with carcinoma of the esophagus and compared to 276 controls. Seventy percent of patients with carcinomas of the esophagus had elevated CEA levels. CEA levels greater than 10.0 ng/ml after therapy correlated with significantly shortened survival. CEA appears promising as an indicator of tumor presence in patients with carcinoma of the esophagus.

Biologic markers in breast carcinoma. IV. Serum fucose-protein ratio. Comparisons with carcinoembryonic antigen and human chorionic gonadotrophin.

Serum fucose-protein ratio was evaluated as a potential biologic marker for patients with metastatic breast cancer. By analysis of the same blood samples, comparisons were made with carcinoembryonic antigen (CEA) and human chorionic gonadotrophin (hCG). For 150 patients with metastatic breast cancer, 85% had a value for serum-fucose protein ratio above the normal range in comparison to 75% for CEA and 40% for hCG. Serum fucose-protein ratio was exclusively increased in 12% of the patients, CEA in 4% and hCG in 2%. Both serum-fucose protein ratio and CEA were elevated in 39% of the patients, and together, either in combination of alone, were increased in 93% of the patients. Raised values for serum fucose-protein ratio as well as for CEA decreased with change in disease status from pretreatment to response for patients with measurable disease parameters and increased correspondingly with overt disease progression. Preliminary data indicate both serum fuxose-protein ratio and CEA frequently become elevated when patients progress from a disease free interval after surgery to recurrence.

Input/output considerations for large data bases.

Input/output devices, format designs, and programming for rejecting defective input, updating and correcting input, and for producing a variety of outputs from the input are discussed, especially from the viewpoint of a large data base and that of the information needs of the users.