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A mining settlement on the moon is our gateway for settling the solar system. We will not mine for gold, but for ice that can be turned into rocket fuel [...]

Background:Clostridium difficilehas become recognized as a cause of nosocomial infection which may progress to a fulminant disease. Methods:Literature review using electronic literature research back to 1966 utilizing Medline and Current Contents. All publications on antibiotic-associated diarrhea, antibiotic-associated colitis, and pseudomembranous colitis as well as C. difficileinfection were included. We addressed established and potential risk factors for C. difficiledisease such as an impaired immune system and cost benefits of different diagnostic tests. An algorithm is outlined for diagnosis and both medical and surgical management of mild, moderate and severe C. difficiledisease. Results:Diagnosis of C. difficileinfection should be suspected in patients with diarrhea, who have received antibiotics within 2 months or whose symptoms started after hospitalization. A stool specimen should be tested for the presence of leukocytes and C. difficiletoxins. If this is negative and symptoms persist, stool should be tested with ‘rapid’ enzyme immunoabsorbent and stool cytotoxin assays, which are the most cost-effective tests. Endoscopy and other imaging studies are reserved for severe and rapidly progressive courses. Oral metronidazole or vancomycin are the antibiotics of choice. Surgery is rarely required for selected patients refractory to medical treatment. The threshold for surgery in severe cases with risk factors including an impaired immune system should be low. Conclusion:C. difficileinfection has been recognized with increased frequency as a nosocomial infection. Early diagnosis with immunoassays of the stool and prompt medical therapy have a high cure rate. Metronidazole has supplanted oral vancomycin as the drug of first choice for treating C. difficileinfections.

Purpose The aim of this study was to report on a rare cause of small-intestinal obstruction caused by small-intestinal enteroliths. METHODS: We present three different cases of enterolith formation in the small intestine. One occurred after nontropical sprue, one patient had multiple jejunal diverticula, and another patient had enterolith formation in a blind loop after a small-bowel side-to-side anastomosis. RESULTS: After initial conservative therapeutic approach all patients underwent surgery. In two patients the enteroliths were removed by ileotomy or jejunostomy. In the third patient the bowel anastomosis had to be revised after removal of the enterolith. CONCLUSION: Small-intestinal enteroliths may cause small-bowel obstruction. The first therapeutic approach is nonsurgical; however, if obstruction proceeds, surgical removal with or without revision of underlying pathology is necessary. We discuss the causes and therapeutic management of enteroliths and give a review of related literature.

INTRODUCTION: Various substances and agents have been evaluated to prevent postoperative adhesion formation. Recently a sodium hyaluronate-based bioresorbable membrane was introduced with promising clinical results. Its application was regarded as safe and efficient. METHODS: We present the first reported case of a severe inflammatory reaction to a bioresorbable membrane and give a review of the related literature. CONCLUSION: Bioresorbable membranes are increasingly used by general surgeons and gynecologists to reduce postoperative adhesion formation. Bioresorbable membranes may produce extensive inflammatory reactions.

Western states are beginning to face the economic and social challenges involved in transferring water from agricultural use to municipalities and industries. Because massive water development projects are not likely to be undertaken in the future, wise water management entails providing the legal tools to permit water to be shifted to areas of greatest need at the least harm to traditional agricultural users. Coping with these transfers requires, in many instances, changes in existing prior appropriation water laws. For example, efforts to promote more efficient use of water on farmlands should be accompanied by provisions to allow the sale of salvaged water. This article discusses such scenarios for protecting the social and economic interests of rural areas in the context of growing urban water demands.

Controversy exists regarding the role of prophylactic oophorectomy during resection for primary colorectal cancer. PURPOSE: A prospective, randomized trial was initiated to evaluate the influence of oophorectomy on recurrence and survival in patients with Dukes Stages B and C colorectal cancer. METHOD: Between November 1986 and March 1997, 155 patients were randomized to oophorectomy or no oophorectomy at laparotomy for resection of colorectal cancer. RESULTS: No incidence of gross or microscopic metastatic disease to the ovary was found among 77 patients randomized to oophorectomy, in contrast to previous reports. Preliminary crude survival curves suggested a survival benefit for oophorectomy between two and three years from surgery, but Kaplan-Meier survival analysis indicated that this was not statistically significant and the benefit does not appear to persist at five years. Kaplan-Meier curves of recurrence-free survival, however, suggest a more substantial separation of the curves, with 80 percentvs. 65 percent five-year disease-free survival for oophorectomyvs. nonoophorectomy, but further patient accrual is necessary to provide sufficient statistical power. CONCLUSIONS: Occult colorectal carcinoma metastatic to the ovaries has not been documented in this series of putative Dukes Stages B and C tumors. The possibility of a recurrence-free survival advantage emphasizes the need to continue this preliminary work.

Abstract: A prospective evaluation of 149 patients with Dukes' B2 or C colorectal carcinoma, including periodic history, physical examination, chest radiograph, liver function tests, complete blood count, carcinoembryonic antigen (CEA) radioimmunoassay, barium enema, and endoscopic studies, has been underway since 1976. Thirty-four patients have had recurrence. This study suggests that the history and CEA are the most sensitive noninvasive methods with which to detect recurrent tumors but are unlikely to indicate recurrence at a therapeutically advantageous stage.

PURPOSE: To demonstrate a simple and effective repair of a poorly constructed ileal J-pouch with an extensive long efferent limb. METHOD: A retrospective case review was performed. RESULTS: The surgical procedure described preserves additional ileum and enlarges the ileal reservoir. The procedure succeeded in resolving the patient's complaints of partial obstruction, weight loss, and increased stool frequency. At five-month follow-up, the patient was doing well with three to six stools daily. Evaluation of the new ileal J-pouch showed no signs of inflammation, and the pouch size measured more than 20 cm compared with 12 cm preoperatively. CONCLUSIONS: Repair of a long efferent limb by this simple stapling technique is feasible, simple, and effective, with an excellent clinical result. It preserves valuable small intestine and enlarges the capacity of the reservoir, leading to better functional outcome.

Tucson, AZ is one of the nation's largest cities entirely dependent on groundwater for its water supplies. It faced a 1980 overdraft of over 60&percent; of the area's total groundwater withdrawals. The quality of its diminishing supply also is threatened by various sources of contamination. But important efforts are being made to solve these water problems by municipal conservation, by Arizona's adoption of a stringent new Groundwater Management Act, and by federal settlement of Indian water claims and construction of the Central Arizona Project. The competition among water uses—agricultural, municipal, and industrial—has not been eliminated, but a framework has been established for Tucson to end its overdrafts eventually. However, some major problems have not yet been resolved, including the socioeconomic impacts of water market solutions on Tucson area farmers and Indians, and groundwater contamination (primarily from copper mine tailings and trichloroethylene, TCE). Most importantly, fundamental issues of equity and carrying capacity are raised by the actions needed to provide water for Tucson's explosive growth in the midst of a desert.

Abstract: Adenocarcinoma of the colon developing at or about the sites of ureterosigmoid anastomoses for urinary diversion has been documented in the literature. A case report is presented that illustrates that a carcinoma can develop in a large bowel urinary conduit not exposed to the fecal stream. Colonic bladders are being used with increasing frequency, making observation for this delayed complication necessary. How this neoplastic transformatin might occur is discussed. Suggestions for the management of this problem and guidelines for follow-up are also presented.

Without Abstract:

Lymphangiomas of the colon are historically rare benign tumors. Only 331 cases have been reported in the world medical literature between 1931 and 2004. With widespread use of colonoscopy, however, they are being found more frequently. We report the case of a 74-year-old woman in whom a colonoscopy revealed a 3 x 4-cm submucosal lesion in the cecum that was eventually diagnosed as a lymphangioma. A CT of the abdomen showed a soft-tissue mass in the cecum and a low-density hepatic lesion. An endoscopic ultrasound of the colon showed a 3 x 4-cm hypoechoic lesion with internal septa arising from the submucosal layer of the cecum. This lesion resembled a vascular malformation; therefore a biopsy specimen was not taken. Pathologic findings of a specimen taken after a subsequent right hemicolectomy identified a submucosal lymphangioma. Published reports indicate that colonoscopy cures most lesions smaller than 2.5 cm in diameter. Resection should be reserved for larger lesions or those in patients exhibiting protein-losing enteropathy.

Chronic tubo-ovarian abscess is an uncommon finding in postmenopausal women. This abscess may rupture or fistulize to adjacent organs into the ischiorectal space.

Several letters to the editor are presented in response to articles in previous issues including "Heinrich J. Jarczyk at Haus Schlesian, Königswinter," by Raymond J. Steiner and Cornelia Seckel in the July-August 2010 issue, "Peeks & Piques," by Raymond J. Steiner in the July-August 2010 issue, and the article on visiting Trier in Germany and the Max Lazarus Exhibition.

The article presents letters to the editor in response to articles in previous issues including the editorial by Raymond J. Steiner about his solo show experience in the June 2006 issue and another one about the exhibition "Colors of the Hudson Valley" at the RiverWinds Gallery in the June 2006 issue.

Growing up on the east coast of Florida, I used to look of out my bedroom window and watch as rockets lifted off towards the Moon. I always assumed that one day I would become an engineer and work in the space pro-gramme. Although I fulfilled that dream, what I did not anticipate was that I would later fall in love with physics; leaving engineering to pursue a PhD in statistical mechanics.

Abstract: A modification of pelvic packing to control presacral bleeding is described. This method makes removal of the packing less uncomfortable and usually does not require anesthesia.