Influence of sediment quality and microbial community on the functioning capacity of a constructed wetland treating alkaline leachate after 5.5 years in operation

Constructed wetlands (CWs) have been demonstrated as a cost-effective alternative to chemical treatment systems for mine waters, with the microbial communities attributed to promoting carbonation and aiding pH neutralization. However, few data are available for the long-term use of CWs treating alkaline leachates nor the activity of microbes within them. To investigate the feasibility of CW to buffer alkaline pH, a pilot-scale wetland was implemented in 2015 to treat alkaline bauxite residue leachate. After 5.5 years, samples of supernatant water and sediment were taken at 0.5 m increments along the 11 m long wetland. Waters were analysed for pH, EC and metal(loid) content, while sediment was subjected to physico-chemical assessment and element fractionation. Microbial biomass and community were assessed by phospholipid fatty acid analysis (PLFA) and functionality by the Rapid Automated Bacterial Impedance Technique (RABIT). Evidence presented demonstrates that the CW operating for 66 months effectively treats bauxite residue leachate, with reduced influent pH from 11.5 to 7.8. Trace element analysis revealed effective reduction in Al (94.9 %), As (86.7 %) and V (57.6 %) with substrate analysis revealing a frontloading of elevated pH and trace element content in the first 5 m of the wetland. Sediment Al, As and V were present mostly (>94 % of total) in recalcitrant forms. Sediment Na was mostly soluble (48-62 %), but soils were not sodic (ESP < 15 %). Investigations into the microbial community revealed greatest biomass was in the first 5 m of the wetland, where pH, EC and metal contents were greatest. Microbial respiration using endemic Phragmites australis as a substrate demonstrates an ability to cycle recalcitrant carbon sources within a CW system. These novel microbial findings highlight the need for further investigation into the microbial communities in alkaline CWs.

Effect of biomass concentration on methane oxidation activity using mature compost and graphite granules as substrata

Reported methane oxidation activity (MOA) varies widely for common landfill cover materials. Variation is expected due to differences in surface area, the composition of the substratum and culturing conditions. MOA per methanotrophic cell has been calculated in the study of natural systems such as lake sediments to examine the inherent conditions for methanotrophic activity. In this study, biomass normalised MOA (i.e., MOA per methanotophic cell) was measured on stabilised compost, a commonly used cover in landfills, and on graphite granules, an inert substratum widely used in microbial electrosynthesis studies. After initially enriching methanotrophs on both substrata, biomass normalised MOA was quantified under excess oxygen and limiting methane conditions in 160ml serum vials on both substrata and blends of the substrata. Biomass concentration was measured using the bicinchoninic acid assay for microbial protein. The biomass normalised MOA was consistent across all compost-to-graphite granules blends, but varied with time, reflecting the growth phase of the microorganisms. The biomass normalised MOA ranged from 0.069±0.006μmol CH4/mg dry biomass/h during active growth, to 0.024±0.001μmol CH4/mg dry biomass/h for established biofilms regardless of the substrata employed, indicating the substrata were equally effective in terms of inherent composition. The correlation of MOA with biomass is consistent with studies on methanotrophic activity in natural systems, but biomass normalised MOA varies by over 5 orders of magnitude between studies. This is partially due to different methods being used to quantify biomass, such as pmoA gene quantification and the culture dependent Most Probable Number method, but also indicates that long term exposure of materials to a supply of methane in an aerobic environment, as can occur in natural systems, leads to the enrichment and adaptation of types suitable for those conditions.

Acquired Anterior Laryngeal Web in a Shotgun Injury

We report the first case of an anterior laryngeal web post gunshot wound in the modern literature. A 27 year-old man suffered a close range shotgun injury to his neck. He presented with stridor and a large open neck wound. Emergency tracheostomy was required. A postoperative fibreoptic laryngoscopy revealed anterior glottic web formation. This case report highlights the difficulties in managing acquired anterior laryngeal webs and reviews the only other case in the in the literature from 1915.

A case of quinsy following high-pressure water jet injury

High-pressure water injuries of the oropharynx are uncommon but can cause significant injury and airway compromise when they occur. A small number of cases of high-pressure water injury of the oropharynx have been presented in the literature, detailing a range of effects and outcomes. We describe the first reported case of high-pressure water injury of the oropharynx associated with peritonsillar abscess (quinsy) requiring surgical drainage.

A comparative analysis of anterior versus posterior squamous cell carcinoma of the tongue: a 10-year review

Introduction: The study sought to compare and contrast squamous cell carcinoma (SCC) of the anterior mobile tongue with SCC of the tongue base, with emphasis on clinical presentation, management and outcome.

Methods: This was a retrospective, comparative analysis of patients treated for SCC of the tongue over a 10-year period. Cox's regression model was used to assess the effect of tumour site on survival.

Results: The study included 142 patients, of whom 86 were treated for SCC of the anterior tongue and 56 for tongue base lesions. Patients with carcinoma of the anterior tongue tended to present with a visible lump or ulceration of the tongue, whereas the majority of patients with tongue base SCC presented with pain. Sixty per cent of anterior tongue lesions were early stage (I or II) at initial presentation as compared with 21 per cent of tongue base lesions.

Conclusion: Patients with anterior tongue lesions had a better prognosis, but this was not statistically significant when adjusted for stage.

Tonsillectomy--cold dissection vs. hot dissection: a prospective study

Throughout the years, investigators and surgeons have developed new techniques for tonsillectomy aiming to lessen the postoperative morbidity and complications of tonsillectomy. It is generally accepted that the ideal method should decrease operative time, blood loss, postoperative haemorrhage and morbidity. To compare the technique and post-operative morbidity of two different tonsillectomy methods: cold dissection and bipolar electrodissection. A prospective study including a total of 545 children (Age: 3-16 yrs) undergoing tonsillectomy at The Children's University Hospital in Dublin, Ireland, from January 2003 to December 2003. The incidence of primary, secondary haemorrhage and postoperative pain was compared between both techniques. The overall rate of haemorrhage was 3.6% (20 patients) this included primary haemorrhage in 0.3% (2 patients) and secondary haemorrhage in 3.3% (18 patents). Primary haemorrhage occurred only in the electrodissection technique. As regards to secondary haemorrhage it was higher in the electrodissection technique 2.3% (12 patients) compared to 1% (6 patients) of the cold dissection technique. Patients rated pain to be more severe in the electrodissection technique compared to the cold dissection technique. Cold dissection tonsillectomy technique is still considered to be a safe and effective method with less posoperative morbidity complications as evidenced from our study.

Parotid masses in patients with previous ear surgery

This paper describes three cases of patients presenting with lumps in their parotid gland, the origin of which was difficult to define. In each case the past medical history revealed that the patients had undergone previous ipsilateral middle ear surgery. We highlight the fact that where there has been previous incisions in the skin about the ear, there is a risk of epidermal inclusion cysts in the parotid gland. These cysts can occur many years after the initial surgery and therefore may not be identified as an obvious origin to lumps in the parotid gland. Rarely as this series highlights there may also be extension of a cholesteatoma (a collection of keratin which arises from the eardrum and extends into the middle ear space) from the mastoid bone to the parotid gland. We recommend formal ear examination where there is a history of previous ear surgery and an ipsilateral parotid gland lump is present.

Endolaryngeal cysts presenting with acute respiratory distress

This is a retrospective review of benign cysts of the adult endolarynx that presented as airway emergencies in four teaching hospitals of Dublin, Ireland, over 2 years. During that period nine patients with endolaryngeal cysts necessitating emergency airway intervention were managed. All cases were treated by endoscopic microlaryngeal marsupialization after securing the airway either at the same time or as a staged procedure. Four of these patients required tracheostomies, one performed under local anaesthesia and the others after initial endotracheal intubation. Definitive treatment was carried out in six cases at initial endoscopic diagnosis. Three of the tracheostomized patients had a staged management, two because of their medical status and one for further investigations. On the basis of our findings we suggest that all benign cysts around the endolarynx should simply be called 'endolaryngeal cysts' instead of the current practice of trying to classify them into various histological and morphological types with no prognostic or management differences. Benign cysts of the endolarynx presenting with airway obstruction would appear to be more frequent than is generally maintained in the literature.

Persistent infection of the chin with an unusual skin pathogen (Streptococcus milleri): a sign of intraoral carcinoma

Streptococcus milleri is a commensal of the oropharynx and gastrointestinal tract which is not generally associated with skin disease. We now report a patient who presented with a pustular mass of the chin with lower lip anaesthesia. He was initially thought to have sycosis barbae, but response to treatment was poor and lesional swabs repeatedly cultured S. milleri. After some delay, squamous cell carcinoma of the mouth, involving the mandible and overlying skin, was detected. We consider that the S. milleri either invaded through the tumour from the mouth or root canal or colonized the skin from saliva dribbled over the numb lower lip. Isolation of an unusual organism and numbness of the chin are features that should suggest the need for early radiography.

Potential indicators of radiosensitivity in squamous cell carcinoma of the head and neck

Recently, attention has focused on the potential of oncogenes, tumour suppressor genes, and assessment of cell proliferation as biological response indicators in human cancer. In this study, immunocytochemical analysis was used to evaluate the usefulness of Ki67, epidermal growth factor receptor (EGFr), and the protein products of c-Myc and Bcl-2 as indicators of radiosensitivity in primary cultures of head and neck tumours. Primary cultures established from tumours taken at surgery were divided into two groups; the control group remained untreated, and the treatment group received a single dose of 2 Gy. The cultures were incubated for 14 days, after which time they were fixed and examined immunocytochemically. The response to treatment of the cultures was measured as the percentage of growth inhibition (%GI) in the treated cultures relative to the untreated controls. Expression of Ki67 measured after a single dose of 2 Gy significantly differentiated the radioresistant and radiosensitive groups (P = 0.045); high percentages of Ki67+ cells correlated with radioresistance. A significant difference was found between the expression of EGFr in the resistant and sensitive groups, as measured in control cultures and after a dose of 2 Gy (P = 0.002 and P = 0.03, respectively); high levels of expression of EGFr correlated with radioresistance. The level of expression c-Myc+ cells, as measured in control cultures, significantly distinguished the radiosensitive group from the radioresistant group (P = 0.05). These results indicate a potential role for these proteins as indicators of radioresistance.

Maternal mortality in the Irish Republic, 1989-1991

The aim was to study the numbers and causes of Maternal Mortality in the Irish Republic in the years 1989-1991, inclusive and publish sufficient detail to allow for international comparative studies. Maternal Deaths were identified via Death Certificates, Coroners' Reports and Hospital Annual Reports. Details of these deaths were then obtained from relevant clinicians and analysed by the authors with further consultation with involved parties, if necessary. There were nineteen deaths notified in the three year period. According to ICD9 these were classified as five direct, seven indirect, and seven fortuitous deaths. Amongst the five Direct deaths, two were associated with amniotic fluid embolism, and one with each of eclampsia, septicaemia and pulmonary embolism, a direct maternal mortality rate of 3.2 per 100,000 births.

The G syndrome/Opitz oculo-genital-laryngeal syndrome/Opitz BBB/G syndrome/Opitz-Frias syndrome

We report on a family exhibiting a range of congenital anomalies consistent with the G syndrome of Opitz. Three members of the family had laryngo-tracheo-oesophageal clefts, one of which succumbed. There was a strong family history of perinatal mortality on the maternal side of the family. We note also the paucity of reported cases of this syndrome in the otolaryngological literature and stress the necessity of early diagnosis in the management.

Chondrosarcoma of the larynx: a histo-radiologic analysis

Chondrosarcoma of the larynx is a rare malignant cartilaginous neoplasm. To date, the serial sectioned laryngeal specimens of this disease have not been correlated with the pre-operative computed tomographic findings. A retrospective analysis of 833 serially sectioned laryngeal specimens found chondrosarcoma in six cases (0.72%), of which four cases had a pre-surgical computed tomography (CT). Radiologic axial sections were compared with microscopic sections in the same plane. Whole organ sections showed the tumor to have an expansile growth pattern, showing little impulse to infiltrate adjacent cartilage. CT scanning successfully predicted the diagnosis of a cartilage neoplasm prior to surgery, and accurately reflected the site and extent of laryngeal involvement. We conclude that CT is a reliable method of evaluating chondrosarcoma of the larynx, thereby predicting the feasibility of partial laryngeal resection.

Juvenile angiofibroma: a review of the literature and a case series report

Juvenile angiofibroma is a rare, histologically benign tumor which occurs almost exclusively in adolescent boys. The morbidity and mortality associated with this tumor are related to its prominent vascularity and its propensity for aggressive local growth. From 1974 through 1988, 21 male patients with a diagnosis of juvenile angiofibroma were managed at the Toronto General Hospital or the Hospital for Sick Children, Toronto. Preoperative computed tomography was performed on 20 patients, selective angiography on 21 patients, and preoperative embolization on 15 patients. Primary surgery was performed on 67% of these patients, with radiation therapy used for advanced stage II and stage III disease or in response to patient preference. Pterygopalatine fossa involvement was demonstrated in 90% of the patients; as a result, the lateral rhinotomy approach was most commonly used in the surgical cases. A successful outcome was achieved in 86% of patients treated with surgery alone. Two patients underwent radiotherapy for salvage following postoperative recurrence. There were no treatment-related deaths and no major surgical complications. The value of computed tomography is discussed, the authors' treatment protocol is outlined, and the case series results are presented.

Case report: solitary haemangioblastoma of the fourth ventricle in an adolescent male

We report a solitary haemangioblastoma arising from a pedicle in the wall of the fourth ventricle of the brain, which we believe to be the first report of haemangioblastoma occurring in this location. Computed tomography (CT), angiography and magnetic resonance imaging (MRI) made possible accurate pre-operative tumour identification and localization which facilitated a minimally invasive surgical resection.

Globus pharyngeus: long-term follow-up and prognostic factors

A prospective trial of 80 patients with globus pharyngeus is reported. An in-depth analysis of the typical history at presentation is given. The average follow-up period was 27 months (range, 21 to 42 months). The asymptomatic rate at this interval was 25%, with a further 35% reporting a significant improvement in symptoms. Three independent factors were found to influence prognosis (p less than .05). These were sex, length of history at consultation, and the presence or absence of associated throat symptoms. Male patients having a history of the globus symptom for less than 3 months and not complaining of any associated throat symptoms had the best chance of becoming asymptomatic or symptomatically improved. The presence or absence of heartburn or its treatment had no bearing on outcome.

The Kilkenny Health Project: a community research and demonstration cardiovascular health programme

Ireland has one of the highest death rates in the world from coronary heart disease (CHD) and has not shared in the rapid decline in mortality which has occurred in other countries. The Kilkenny Health Project was established as a community-based research and demonstration programme for cardiovascular disease prevention in County Kilkenny and as a pilot project for future national initiatives. The first phase of the health promotion programme in Kilkenny is being carried out between 1985 and 1990. Changes in behaviour and in factors associated with CHD will be estimated by the difference in changes over time between Kilkenny and the reference area, as measured by independent random sample surveys of men and women aged 35 to 64 years. CHD and stroke events, fatal and non-fatal, will be registered in both areas from 1987-1992. The Project has studied attitudes to CHD and its prevention. Health behaviours have been studied in adults and in post-primary school pupils. Risk factors for CHD have been measured in adults in accordance with the methods of the international MONICA Project. It has been demonstrated that health and education professionals can incorporate preventive activities and health education into everyday practice.

Diagnosis, complications, and treatment of malignant otitis externa

Malignant otitis externa (MOE) is a severe penetrating infection which has spread outside the confines of the external auditory canal to involve temporal bone, mastoid air cells and periaural soft tissues. It is a rare but important condition, having a mortality rate of between 23%-75%. Clinical diagnosis in the early stage is difficult because the symptoms are similar to acute otitis externa. Diabetes Mellitus is an important predisposing factor present in up to 94% of patients. Two cases of MOE are presented underlining the clinical findings, spectrum of activity and treatment of the disease, and stressing the importance of early diagnosis.

The diagnosis of knee injuries in casualty--a prospective study

A prospective study of all knee injuries seen at a Casualty Department was organized. A clinical diagnosis was made in each case, based on standardized criteria, and the subsequent progress followed. Meniscal tears tended to be over-diagnosed clinically. Many injuries thus classified settled in three to four weeks without further sequelae. Conversely, complete ligament tears were under-diagnosed and in particular these tended to be missed in the presence of a haemarthrosis. Examination under anaesthesia is recommended if there is any doubt concerning ligamentous stability and all unexplained haemarthrosis should have early examination under anaesthesia and arthroscopy. Among those injuries initially regarded as less serious e.g. traumatic synovitis, no serious pathology subsequently emerged.