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Background and Aims: Self-expanding metallic stents are increasingly used in the management of malignant and benign colorectal obstructions. We aimed to identify relevant predictive factors for stent failure and stent-related complications., Material and Methods: We conducted a retrospective single-center analysis of 204 consecutive patients who underwent emergency colorectal stenting procedures because of symptomatic bowel obstructions from 1996 to 2011 at the Sisters of Charity Hospital Linz, Austria., Results: A total of 204 patients (median age 74 years) with 36 (17.7%) benign and 168 (82.3%) malignant obstructions were included in the study. Technical success was achieved in 92.5% and clinical success in 86.8% of the cases. Major complications occurred in 2.9% and minor ones in 19.6%. Overall mortality during a median follow-up period of 4.3 years was 73% (149 patients). Relevant predictors of increased risk of complications were extracolonic obstruction (p = 0.001), complete obstruction (p = 0.066), and inflammatory bowel disease (p = 0.05). Stent localization at the splenic flexure, a stenosis of >8 cm in length, and the need for endoscopic guidance were associated with higher rates of technical and/or clinical stenting failure., Conclusion: Colorectal stenting is less invasive than other means of emergency treatment for large bowel obstruction; it is generally safe and effective in different types of colorectal obstruction. However, relevant rates of failure and complications were recorded and predictors could be determined., (© The Finnish Surgical Society 2014.)

Using constructed wetlands (CWs) with vertical flow and intermittent loading, high organic matter and ammonium removal can be achieved. In the case of additional requirements for phosphorus removal, which in Austria often occurs if the treated wastewater is discharged into small sensitive receiving waters, additional measures have to be taken. The objective of this work was to investigate the applicability of conventional phosphorus pre-precipitation with sodium aluminate for a CW system. The experiment was carried out at a full-scale CW in Oberwindhag in Lower Austria, a two-stage vertical flow CW with intermittent loading designed for a size of 60 person equivalents (PE). The goal was to reach the required value of 1.6 mg/L PO4-P for the effluent of the system. Prior to the experiments the plant was in operation for 3 years without measures for phosphorus removal. After pre-precipitation with sodium aluminate was activated, three different dosages were investigated. Satisfying results in the preliminary treatment chambers were not obtained until a high dosage (ß = 3.5, i.e. 3.5 times the dose required from stoichiometry) was applied. After an adaptation time of several months the required effluent concentration of 1.6 mg PO4-P/L could be reached and maintained. However, the additional phosphorus pre-precipitation increases the yearly operating costs of a vertical flow CW system significantly, e.g. for 60 and 25 PE, by 15 and 38%, respectively, thus indicating the need for optimizing the dosing of the chemical.

Representing the major part of the human colon microflora, members of the Bacteroides fragilis group are frequently involved in mixed aerobic and anaerobic infections. Recent studies show an increased resistance of the B. fragilis group against several antimicrobial agents. The aim of the present study was to determine the susceptibility of 87 B. fragilis group strains isolated in 2003/2004 in Western Austria against eight antimicrobial agents by Etest. Furthermore, the resistance patterns were compared with those of 45 B. fragilis group strains isolated in 1992 and referred to the world wide trend towards increased resistance. In 1992 as well as in 2003/2004, all strains were susceptible against metronidazole and imipenem. However, comparing the MIC-values of the B. fragilis group strains collected 1992 with data from 2003/2004, a significant increase in resistance was found for clindamycin (p<0.01). Regarding cefoxitin, a similar trend could be observed. However, this difference was not yet significant (p=0.144). Our findings underline the emerging resistance of the B. fragilis group against antimicrobial agents and underscore the importance of susceptibility testing of anaerobes even in routine laboratories.