RESUMEN

Co-contaminant behavior of arsenic (As) and selenium (Se) in groundwater is examined in this study at a former lead and zinc smelting facility. We collected water quality data, including concentrations of trace metals, major ions, and metalloid speciation, over a 15-year period to document long-term trends and relationships between As, Se, geochemical parameters, and other redox-sensitive trace metals. Concentrations of dissolved As and Se were negatively correlated (Kendall's Tau B correlation coefficient, r = -0.72) and showed a distinctive L-shaped relationship. High-concentration arsenic wells (>5 mg L-1) were characterized by intermediate oxidation-reduction conditions (75 < Eh < 275 mV), near-neutral pH (6.1-7.9), low Ca/Na ratios, elevated Fe and Mn concentrations, and high proportions of As(III) relative to total dissolved As. High-concentration Se wells (>500 µg L-1) were characterized by more positive Eh (305-500 mV), low Fe concentrations, and high proportions of As(V). Batch micocosm experiments showed that aquifer solids contain mineral surfaces and/or microbial communities capable of removing selenate from groundwater. Electron microprobe and Se K-edge X-ray absorption near-edge spectroscopic analyses demonstrated that Se was predominantly associated with elemental Se in the reduced aquifer solids. Factor analysis revealed three discernible groupings of trace metals. Group I includes U, Se, and nitrate-N, all of which are mobile under oxygenated to moderately oxygenated conditions. Group II includes elements that are mobile under Fe(III)-reducing conditions: Fe, total dissolved As, As(III), and ammonium-N. Group III elements (Mo, Sb, and V) showed mobility across the entire range of redox conditions encountered in site groundwater; As(V) clustered with this group of elements. Geochemical modeling suggests that As and Se species were in a state of disequilibrium with respect to measured parameters indicative of redox conditions, although predicted patterns of redox-controlled mobility and attenuation were confirmed. This analysis is important to better understand groundwater contaminant behavior in response to redox conditions ranging from oxic/suboxic to Fe(III)-reducing, but excluding sulfate-reducing conditions.

RESUMEN

PURPOSE: We sought to determine the nature and timing of complications after common anorectal operations by using a prospective quality tracking tool. METHODS: A prospectively maintained quality database was queried to identify patients who underwent pilonidal sinus excision, hemorrhoidectomy, sphincterotomy, abscess drainage, or fistulotomy during an 11-year interval. All hospital complications were recorded by a single nurse practitioner and verified jointly by the surgical team. Any posthospital complications were registered at the first postoperative visit. RESULTS: A total of 969 patients underwent one of the five index anorectal procedures during the study period. Forty-nine complications occurred in 38 patients (3.9 percent). The majority of complications were minor (40/49; 82 percent) and were primarily urinary retention, minor bleeding, and wound infection. Twenty-five of the 40 minor complications (62 percent) were identified only after hospital discharge in the outpatient setting. Eight of the nine major complications occurred in patients already hospitalized for major concomitant illnesses and were unrelated to the anorectal surgery. The remaining patient had a postoperative deep vein thrombosis. CONCLUSIONS: Complications after anorectal procedures are infrequent, typically minor, and occur after hospital discharge. Major complications reflect concomitant illness, not surgical quality. Meaningful outcome measures are needed to assess the quality of anorectal surgery.

Asunto(s)

RESUMEN

PURPOSE: Anastomotic leaks are among the most dreaded complications after colorectal surgery. However, problems with definitions and the retrospective nature of previous analyses have been major limitations. We sought to use a prospective database to define the true incidence and presentation of anastomotic leakage after intestinal anastomosis. METHODS: A prospective database of two colorectal surgeons was reviewed over a 10-year period (1995-2004). The incidence of leak by surgical site, timing of diagnosis, method of detection, and treatment was noted. Complications were entered prospectively by a nurse practitioner directly involved in patient care. Standardized criteria for diagnosis were used. A logistic regression model was used to discriminate statistical variation. RESULTS: A total of 1223 patients underwent resection and anastomosis during the study period. Mean age was 59.1 years. Leaks occurred in 33 patients (2.7%). Diagnosis was made a mean of 12.7 days postoperatively, including four beyond 30 days (12.1%). There was no difference in leak rate by surgeon (3.6% vs. 2.2%; P = 0.08). The leak rate was similar by surgical site except for a markedly increased leak rate with ileorectal anastomosis (P = 0.001). Twelve leaks were diagnosed clinically versus 21 radiographically. Contrast enema correctly identified only 4 of 10 leaks, whereas CT correctly identified 17 of 19. A total of 14 of 33 (42%) patients had their leak diagnosed only after readmission. Fifteen patients required fecal diversion, whereas 18 could be managed nonoperatively. CONCLUSIONS: Anastomotic leaks are frequently diagnosed late in the postoperative period and often after initial hospital discharge, highlighting the importance of prospective data entry and adequate follow-up. CT scan is the preferred diagnostic modality when imaging is required. More than half of leaks can be managed without fecal diversion.

Asunto(s)