The presentation, clinical features, complications, and treatment of congenital dacryocystocele

Purpose To determine the incidence and presenting features of congenital dacryocystocele in the United Kingdom. To report on those cases complicated by dacryocystitis, respiratory compromise, and the treatment undertaken. Methods A prospective observational study of cases of congenital dacryocystocele presenting in the United Kingdom between September 2014 and October 2015. Infants <3 months of age presenting with a cystic swelling in the medial canthal area were included. Cases were identified via the British Ophthalmology Surveillance Unit (BOSU) reporting system. Results A total of 49 cases were reported during the study period. This gives an incidence of 1 in 18 597 live births. There was a 71% response rate to the questionnaire. The average age at presentation was 16.94 days. Dacryocystoceles were unilateral in 91% of cases. Dacryocystitis was a complicating factor in 49% of patients and 17% had respiratory distress. Uncomplicated dacryocystocele responded well to conservative measures in 86%. Surgical intervention was required in 23% of patients. Those cases complicated by dacryocystitis (29%) and nasal obstruction (17%) were more likely to require surgical intervention compared to those with dacryocystocele alone (14%). Digital massage appears to reduce the likelihood of requiring surgical intervention. The mean time to resolution was 19 days. Conclusions Congenital dacryocystocele is a rare presentation in the United Kingdom. Dacryocystitis and respiratory compromise commonly complicate a dacryocystocele. The use of digital massage as an early intervention is advocated and conservative measures may be sufficient in cases of uncomplicated dacryocystocele

Pollution Removal Efficiency in a Restored Anabranching Wetland

Improving water quality is a serious concern of many state and local governments across the U.S. Nutrients, including nitrogen and phosphorus, can significantly impair water quality when found in high concentrations. Constructed and restored wetlands are known to capture pollutants and improve water quality. Anabranching is a new design for restored wetlands in which a primary stream is diverted into smaller braided streams and wetland cells. Its effectiveness at capturing pollutants has not yet been evaluated. This study investigates the effectiveness of an anabranched wetland at removing total nitrogen and total phosphorus from urban run-off during several winter storm events. The analysis compares the mass balances of total nitrogen and total phosphorus flowing into and out of the restoration area to determine the amount of nutrient reduction. Flow regimes were manipulated to divert water out of or into a stream or wetland cells. Stream and wetland configurations were compared to determine the effectiveness of the wetland cells in nutrient removal compared to streams alone. Results show that for a given discharge, wetland cells have a residence time up to six times longer than streams. Results indicate that streams may be effective at capturing total phosphorus during low discharge events and ineffective at capturing total phosphorus during high discharge events; the stream configuration does not appear to capture total nitrogen on a consistent basis. Wetland cells appear to be ineffective at retaining total nitrogen over winter storm events; wetland cells may be able to more effectively retain total phosphorus, but this pattern is inconsistent. Results show no clear relationships between discharge and nutrient removal efficiency for the stream or wetland configuration, which is noted in this limited study