[Treatment of gunshot wounds and prevention of complications during the healing process]. / Osetrení strelných poranení a prevence vzniku komplikací v prubehu hojení.

INTRODUCTION: The objective of the research is the assessment of the way and results of a case-series of treatment of gunshot wounds and to remain of the requirement of complete wound treatment in peace time. MATERIALS AND METHODS: During the period from 1997 to 2006, we treated 60 patients who had penetrating gunshot wounds. The case series included 12 female and 48 male patients ranging in ages from 18 to 71 years (average age 37 years). Weapons that caused injuries included pistol (33), rifle (5), assault rifle AK-47 (1), air gun (9), firecrackers (2), and unknown weapons (10). We assessed outcomes of different therapeutic approaches by monitoring early and late postoperative complications and by total recovery time. RESULTS: Two patients died within the first 24 hours; no other patients die after the first 24 hours of initiation of treatment. Thirty-nine patients were hospitalized with hospital stays ranging from 1 to 40 days (average length of stay 13.2 days). Total recovery time varied from 3 to 330 days averaging 65.7 days until full recovery and ability to work. Fifteen patients had bone injury, eight of which needed osteosyntesis. Four patients received external fixators, two were treated by titanium intramedullar nail, and two by transfixation with Kirchner wire eighteen patients (30%) had secondary sutures. Perioperative complications were osteomyelitis (two patients), pseudoarthrosis of upper extremity proximal phalange (one patient) and non-lethal pulmonary embolism (one patient). CONCLUSION: Standard treatment of penetrating gunshot wounds should consist of primary and prompt detailed debridement, sufficient fasciotomy, and complete drainage of the wound.

Effect of rotifers on the stability of aerobic granules.

The current study evaluated the effect of rotifers on the stability of aerobic granules. Two sequence batch reactors (SBRs) with airflow rates of 4 (R1) and 6 (R2) 1 min(-1), respectively, were used to develop aerobic granules. Granules were well developed with excellent settleability in terms of SVI30 (sludge volume index,) of about 50 ml g(-1) in both reactors at the beginning. With the outgrowth of rotifers, granules completely disintegrated in R1 around cycle 500 (a cycle was 3 hours). However, after the rotifers disappeared, i.e. cycle 550, granules re-appeared with a slow settling rate in R1 (SVI30: 200-300 ml g(-1)). The rotifers mechanically damaged the structure of granules, resulting in disintegration. However, granules developed under high shear force seem to have strong resistance to rotifers. During re-granulation, a long time lag between the improvements of morphology and settleability suggested that re-granulation resulted from entanglement more than bio-attachment or bio-growth. Additionally, it was confirmed that the ratio of carbohydrate to protein extracellular polymeric substances (EPS) could well indicate the strength of granules. Protein EPS well correlated with the difference between SVI5 and SVI30 in R1, therefore, decreasing protein EPS would increase the compactness of granules.

[Hemipelvectomy, constant surgical dilema]. / Hemipelvektomie, konstantní chirurgické dilema.

INTRODUCTION: In this report we present our experience in "post war" environment in our institution. Any king of pelvic surgery is challenging and impacts significantly on limb and visceral function. Any surgeon has to ask a question "is heroic surgery justifiable". We aim to asses functional, oncologic and surgical outcomes following pelvis tumor resections. MATERIALS AND METHODS: Between 1998-2005, 7 patients (mean age 48.2 years) underwent pelvic tumor resections. All of them were primary malignant tumors. We did not identify secondary tumors and benign tumors in our series. Bone tumors were 3 osteosarcomas and 4 chondrosarcomas. Tumors involved the ilium, acetabulum, pubic bones, sacrum or a combination of these. No patient had metastases at presentation. RESULTS: All 7 patients underwent hindquarter amputations. Surgical margins were marginal (4), wide (2), and radical (1). There was 1 intraoperative death, 2 local recurrences and 2 metastases. Death from disease occurred at a mean of 12.4 months with mean follow-up of 24 (1-72) months. Emotional acceptance was surprisingly high. Pelvic resections are complex. Functional outcome is significantly affected by surgery. Disease control is similar to limb tumors. Emotional acceptance of surgery in survivors was surprisingly high. CONCLUSION: Major pelvic resection for malignancy appears justified.

Aerobic granular sludge: a promising technology for decentralised wastewater treatment.

In order to evaluate the characteristics of aerobic granular sludge, a sequencing batch reactor, feeding with synthetic wastewater at the organic loading rate of 8 kg COD/m3 d, was employed on the laboratory scale. Granules occurred in the reactor within 1 week after the inoculation from conventional flocculent sludge. Aerobic granular sludge was characterised by the outstanding settling properties and considerable contaminates removal efficiencies. The SVI30 values were in the range of 20 to 40 ml g(-1). However, the sludge volume index of short settling time (e.g. SVI10--10 min) is suggested to describe the fast settling properties of aerobic granular sludge. The potential application in the decentralised system is evaluated from the point view of footprint and high bioactivity. The occurrence of sloughing, resulting from the outgrowth of filamentous organisms, would be responsible for the instability of aerobic granules. The starvation phase should therefore be carefully controlled for the maintenance and stability of aerobic granular sludge system.

Comparison of nutrient removal efficiency between pre- and post-denitrification wastewater treatments.

A shortage of organic substances (COD) may cause problems for biological nutrient removal, that is, lower influent COD concentration leads to lower nutrient removal rates. Biological phosphorus removal and denitrification are reactions in which COD is indispensable. As for biological simultaneous nitrogen and phosphorus removal systems, a competition problem of COD utilisation between polyphosphate accumulating organisms (PAOs) and non-polyphosphate-accumulating denitrifiers is not avoided. From the viewpoint of effective utilisation of limited influent COD, denitrifying phosphorus-removing organisms (DN-PAOs) can be effective. In this study, DN-PAOs activities in modified UCT (pre-denitrification process) and DEPHANOX (post-denitrification process) wastewater treatments were compared. In conclusion, the post-denitrification systems can use influent COD more effectively and have higher nutrient removal efficiencies than the conventional pre-denitrification systems.

Noise-induced regularity of spatial wave patterns in subalpine abies forests

In subalpine forests dominated by Abies species in Japan and northeastern United States, trees show traveling wave of regeneration with many striped zones of tree dieback, moving downwind at a constant rate. Previous theoretical studies have demonstrated that a very simple model can generate wave-like spatio-temporal patterns of tree regeneration in a lattice-structured habitat with each site occupied by a cohort of trees. A cohort taller than the average height of its windward neighbor experiences stand-level dieback in the next time step and the height becomes zero. Otherwise the cohort increases its height at a constant rate. Starting from a random initial pattern, this simple deterministic model can generate a saw-toothed pattern that moves downwind at a constant rate, but the distance between adjacent dieback zones has a large variance. In this paper, we study the effects of "noises" in tree dieback rules in two forms which help to generate more regular patterns: (1) additional random disturbances at a low rate, which change the size of "clusters" (defined as a group of cohorts between adjacent dieback zones) by splitting a large cluster into two or by merging a small one with a neighbor, and (2) the stochastic rule of tree dieback, represented by the probability of dieback in unit time being a sigmoidal function of the difference in the tree height between the site and the windward neighbors. These noises are effective both for one-dimensional and two-dimensional models, but spatial patterns are much more regular in the two-dimensional model than in the one-dimensional model. Copyright 1998 Academic Press

Detection of K-ras point mutations in the supernatants of peritoneal and pleural effusions for diagnosis complementary to cytologic examination.

To determine whether DNA analysis can be performed using the supernatants of body fluids after centrifugation at 2,000 rpm for 10 minutes, peritoneal or pleural effusions or bile were examined for K-ras mutations in 34 cases of pancreatic, colorectal, gastric, esophageal, or hepatocellular carcinoma and 15 noncancer cases. The polymerase chain reaction products for K-ras gene codons 2 to 97 of exons 1 and 2 were generated with 41 (93%) of 44 body cavity fluid and 5 (100%) of 5 bile samples. By the single strand conformation polymorphism method, point mutations were detected in the ascites supernatants of 8 (89%) of 9 cases of pancreatic carcinoma. In the remaining case, no point mutation was demonstrated because few malignant cells were present in the ascites fluid. Furthermore, K-ras point mutations were observed in the ascites supernatants of 2 cases of colorectal carcinoma and 1 case of gastric carcinoma. The DNA analysis of the supernatant of ascites fluid showed a K-ras point mutation in 3 cases of false-negative cytologic diagnosis (2 cases of pancreatic carcinoma and 1 case of colorectal carcinoma). Direct sequencing confirmed identical point mutations in the supernatants, whole cell pellets, malignant cells from the cytologic smears of ascites fluid, and cancer tissues. This novel method allows simultaneous testing for genetic abnormalities in supernatants of body fluid, after removing cells for cytologic diagnosis.

An integrated metabolic model for the aerobic and denitrifying biological phosphorus removal.

In this work, an integrated metabolic model for biological phosphorus removal is presented. Using a previously proposed mathematical model it was shown to be possible to describe the two known biological phosphorus removal processes, under aerobic and denitrifying conditions, with the same biochemical reactions, where only the difference in electron acceptor (oxygen and nitrate) is taken into account. Though, apart from the ATP/NADH ratio, the stoichiometry in those models is identical, different kinetic parameters were found. Therefore, a new kinetic structure is proposed that adequately describes phosphorus removal under denitrifying and aerobic conditions with the same kinetic equations and parameters. The ATP/NADH ratio (delta) is the only model parameter that is different for aerobic and denitrifying growth. With the new model, simulations of anaerobic/aerobic and anaerobic/denitrifying sequencing batch reactors (A(2) SBR and A/O SBR) were made for verification of the model. Not only short-term behavior, but also steady state, was simulated. The results showed very good agreement between model predictions and experimental results for a wide range of dynamic conditions and sludge retention times. Sensitivity analysis shows the influence of the model parameters and the feed substrate concentrations on both systems.

Metabolism of micro-organisms responsible for enhanced biological phosphorus removal from wastewater. Use of dynamic enrichment cultures.

The removal of phosphorus from wastewater is already widely applied. In many cases use is made of micro organisms capable of accumulating phosphorus as polyphosphate inside the cell. The main characteristic providing the competitive advantage to these polyphosphate accumulating bacteria is the capability to use polyphosphate, in the absence of external electron acceptors, as energy source for the uptake and storage of acetic acid in the form of polyhydroxybutyrate (PHB). The reduction equivalents for the formation of PHB are derived from the conversion of glycogen to PHB. Despite the widespread use and study of enhanced biological phosphorus removal no pure culture, having the above mentioned characteristics, has been isolated yet. All ecophysiological studies on these type of cultures have therefore been performed by enrichment cultures. This paper reviews the research on these type of organisms, and shows that it is possible to understand a complex microbial process on a metabolic level, both stoichiometrically and kinetically, without the availability of a pure culture.

A metabolic model for biological phosphorus removal by denitrifying organisms.

A metabolic model for biological phosphorus removal under denitrifying conditions has been established. The model is based on previous work with aerobic phosphorus removal. The form of the kinetic equations used is the same as for the aerobic model. The main difference is the value of P/NADH(2) ratio in the electron transport phosphorylation with nitrate (delta(N)). This value was determined independently from batch tests with an enriched culture of denitrifying phosphorus-removing bacteria. The measured delta(N) was approximately 1.0 mol ATP/mol NADH(2). This indicates that the energy production efficiency with nitrate compared to oxygen is approximately 40% lower. These batch tests were also used to identify a proper set of kinetic parameters. The obtained model was subsequently applied for the simulation of cyclic behavior in an anaerobic-anoxic sequencing batch reactor at different biomass retention times. The simulation results showed that the metabolic model can be used successfully for the denitrifying dephosphatation process. The obtained kinetic parameters for denitrifying enrichment cultures, however, deviated from those obtained for the aerobic enrichment cultures. (c) 1996 John Wiley & Sons, Inc.

Sympathetic and parasympathetic ganglia express non-NMDA type glutamate receptors: distinct receptor subunit composition in the principle and SIF cells.

The presence of non-NMDA glutamate receptors in the rat sympathetic and parasympathetic ganglia was examined by immunocytochemistry using specific antibodies against AMPA-type excitatory amino acid receptor subunits (GluR1-4). Three kinds of antibodies specific to the GluR1, GluR2 and 3, and GluR4 subunits were used. The superior cervical ganglion and pterygopalatine ganglion were examined as representatives of sympathetic and parasympathetic ganglia. In the superior cervical ganglion, GluR1- and GluR2/3-like immunoreactivity was observed in most principal neurons and SIF cells. In contrast, GluR4-like immunoreactivity was not observed in the principal cells; however, SIF cells exhibited intense immunoreactivity of GluR4. In the pterygopalatine ganglion, the profile of the immunoreactivity was similar to that seen in the superior cervical ganglia. The subunit compositions between the principal cells and SIF cells were different, whereas the compositions in cell species involved in the autonomic ganglia, sympathetic and parasympathetic ganglia were identical. This suggests that glutamate is another important preganglionic transmitter together with acetylcholine, and the responses elicited in the principal cells and SIF cells might be different because of the difference in subunit composition.

Lateralization of brainstem lesions by brainstem auditory evoked potentials.

In eight patients with unilateral pontine and midbrain lesions, brainstem auditory evoked potentials (BAEPs) were studied with ipsilateral (Cz-Ai) and contralateral (Cz-Ac) recordings after monaural stimulation. In all cases, the most prominent abnormality was noted in BAEP generated by stimulating the ear ipsilateral to the lesions. The Cz-Ai and Cz-Ac patterns showed similar abnormalities in five of the patients and dissociated abnormalities in two patients. We conclude that: (1) Lateralization of BAEP is possible in unilateral pontine and midbrain lesions. (2) Monaural stimulation with Cz-Ai and Cz-Ac recordings is essential for lateralization. (3) The BAEP in monaural stimulation is predominantly generated from the auditory structures ipsilateral to the stimulated ear.

Tarsal tunnel syndrome: electrophysiological study.

Tarsal tunnel syndrome (TTS) is a rare compression neuropathy of the posterior tibial nerve. Typical symptoms are burning pain and paresthesia in the toes and along the sole of the foot. The presence of Tinel's sign and objective sensory loss in the territory of any of the terminal branches of the posterior tibial nerve are diagnostically helpful. The terminal latency and sensory nerve conduction velocity in medial and lateral plantar nerves were studied in 20 normal controls and 21 cases of TTS in 17 patients. Prolonged terminal latency was observed in 11 cases, with TTS, while sensory nerve conduction abnormality (either absent nerve potential or slow sensory nerve conduction velocity) was found in 19. The sensory nerve conduction velocity in the lateral and medial plantar nerves is a superior objective diagnostic index of TTS.