Diagnosis and management of colovesical fistulas

Diagnosis and management may present difficult problems in patients with colovesical fistulas. Symptoms in the urinary tract are most common, and cystoscopy, and cystography are the most valuable diagnostic procedures. It may not always be possible to demonstrate the fistula by diagnostic tests, and a high index of suspicion should be maintained in patients with inflammatory or neoplastic disease of the rectosigmoid area or bladder with recurrent cystitis. Definitive treatment should include resection of the fistula and diseased segment of the intestine. Both one stage and multistage procedures have their place in the treatment of this condition. There are specific criteria for success for a one stage procedure.     

Upper extremity replantation: current concepts and patient selection

Dramatic advances in replantation and microsurgery have somewhat altered the criteria we use in selecting patients to be candidates for upper extremity replantation surgery. We suggest that contraindications for such replantation are: presence of associated life-threatening injuries; serious anesthetic risk; preexisting medical or psychiatric problems; previous injury or disease of the amputated part; warm ischemic time greater than 6-8 hours for extremities or greater than 10-12 hours for digits; and single-digit amputations (except thumb, for grasp). Replantation is feasible when: amputated part is properly preserved; injury type is sharp amputation, mild to moderate crush, or selected avulsion, and amputation is proximal to the DIP joint. Careful preservation of the amputated part, not in dry ice, is mandatory. On an individual basis, the decision to attempt replantation rests on the prediction that the patient may have better function with such surgery than with a prosthesis.     

Design approach to low-cost process control

The design of a control package for industrial use on small-scale processes is discussed. A modular system is described, made up of intelligent satellite and peripheral controllers plus various cards to provide communication with the industrial plant itself. The design is intended for operators who have little or no experience of computing. It is based on a language called paracode, an interpretive language structured to provide a number of control sequences which can run independently of each other or in parallel. Two applications of the design—a clean-in-place system and a beer-fermentation controller—are used as illustrations.     

Bilateral femoral neck fractures as a complication of myelography

This paper discusses two cases of bilateral subcapital fracture of the proximal femur as a complication of myelography with Conray 60. The literature is reviewed.     

Normal lung function in subjects heterozygous for surfactant protein-B deficiency

OBJECTIVE AND IMPORTANCE: We present a case report of a patient with a left frontal brain abscess. Cultures obtained from the abscess at the time of surgery were identified as dental flora known to establish a synergistic relationship in polymicrobial infections. This type of synergistic relationship makes the clearance of an infection more difficult for an intact immune system. A serum immunoglobulin (Ig) Type A deficiency was identified postoperatively. This immunodeficiency may have contributed to the development of the abscess. CLINICAL PRESENTATION: The patient presented with headaches and photophobia. Computed tomography of the head performed with intravenously administered contrast demonstrated a left frontal brain abscess. INTERVENTION: The patient was operated on through a left frontal approach, carefully avoiding the frontal sinus. The abscess was aspirated, and the patient was treated with intravenous antibiotics for several weeks. Postoperatively, the patient did well. There were no signs of enhancement on follow-up computed tomographic scans at 7 and 12 months postoperatively. CONCLUSION: Through a comprehensive immunological workup, an IgA deficiency was identified postoperatively. Although the deficiency of a single type of Ig may be asymptomatic, complications from recurrent or chronic bacterial infections may occur. The deficiency of IgA, combined with a synergistic polymicrobial infection, contributed to the development of an intracranial abscess. A patient presenting with a brain abscess without any predisposing medical history should be evaluated for an underlying immune deficiency.     

Load independent efficient,transformerless inverter for photovoltaic applications

The overall efficiency of photovoltaic power systems (PVPS) depends on the efficiency of the PV panels, the storage batteries, and the efficiency of the inverter circuitry. The last is greatly influenced by the connected load, as the efficiencies are severly reduced when operating at low loads. This is especially effective when the PVPS is most likely to operate with a fraction of the full load. The suggested inverter has excellent efficiency characteristics over a wide power range, and because it contains only electronic components further cost reduction can be expected. Experimentally this inverter is designed for a 120 W output using thyristor switching devices; the efficiency obtained is 88% at full load and 85.2% at 10% of full load, with a maximum output voltage of 60 V stepped sinewave with frequency of 50 Hz. However, higher power outputs could also be achieved with this type of inverter.     

Influence of moisture content on the specific methanogenic activity of dry mesophilic municipal solid waste digestate

The objective of this study was to evaluate the influence of moisture content on the specific methanogenic activity (SMA) of a fresh dry mesophilic digestate from a municipal solid waste digester plant. For this purpose, SMA tests were performed under mesophilic conditions in 500 mL glass bottles of volume used as batch reactors, during a period of 20–25 days. Cellulose, propionate and acetate were used as substrates (5 g_COD kg^?1 digestate) at four different moisture contents, ranging from 65 to 82%. The moisture content strongly influenced the specific methanogenic activity. The highest SMA values were observed at a moisture content of 82% (11.1, 7.8 and 6.0 mg_COD g_VS^?1 d^?1 for cellulose, propionate and acetate spikes, respectively). SMA and moisture content were found to be linearly linked. Dry digestion at low water content is thus detrimental to the biological activity, probably due to physical limitations. Copyright © 2011 Society of Chemical Industry