A first attempt for using of combined sorption and anaerobic processes for handling source separated human urine.

Processing human urine with clinoptilolite results in a solid phase upon which majority of nutrients are concentrated, which may be used as fertilizer; in addition to a liquid residue to be disposed of which is saline, rich in organics and contains residual nutrients. Despite several work regarding nutrients recovery from human urine, the fate of organic matter in the liquid residue is yet to be revealed. This study aims to investigate the combination of sorption and anaerobic processing (ANA) to accomplish concurrent nutrient recovery, and organic matter removal from hydrolyzed human urine (HHU) for environmental protection. Fixed bed clinoptilolite columns were used for nutrient recovery from HHU and an anaerobic expanded granular sludge bed reactor (AnEGSB) was used for removal of organic matter from residue of the former process. Furthermore, the effluent of AnEGSB was subjected to post treatment using stage-wise sorption to enhance the effluent quality before disposal. Majority of nutrients were removed by the sorption process with 80% of ammonium and almost all of phosphorus. Sorption removed 35% of orgnic matter while ANA was responsible for the rest. Post treatment helped to polish the quality of the AnEGSB effluent to the permissible level of domestic wastewater discharge standards of EU.With the proposed combination, almost 100% of nitrogen and phosphorus were recovered for further use as fertilizer providing benefits for sustainability. Also, 97% of organic matter could be removed from HHU to provide environmental protection, which was accompanied by methane (CH4) production of 0.4 L CH4/day which is equivalent to 0.113 L CH4/g COD removed. Successful implementation of the proposed combination helps improve management of domestic wastewater.

The effect of different exercise types on sedentary young women's lipid profile.

BACKGROUND: Individualized exercise programs should be prepared according to duration and intensity. OBJECTIVE: The current study focused on the effect of different types of exercises regularly done for eight weeks on sedentary young women's body components and lipid profile. METHODS: The sample of the study was composed of 30 sedentary women recruited from Afyon Kocatepe University. The participants were randomly sorted into three groups and received combined exercises (aerobic + resistance exercises), aerobic exercises and cardio tennis exercises three days a week for eight weeks but no dietary program was given. Before and after the exercise programs, participants' body weights, heights, waist and hip circumferences were measured and their body components were analyzed through the bioelectrical impedance method. For the lipid profile analyses, 5 cc. of blood samples were drawn from forearm veins of the participants with the help of health specialists, and a biochemical doctor analyzed lipid profile markers such as total cholesterol, triglyceride, HDL, LDL, and VLDL. RESULTS: It was found that exercises regularly done for eight weeks affected young women's body components considerably while it did not influence their lipid profile. CONCLUSIONS: The effect on body components depended on time. No difference was found in terms of exercise type.

Krukenberg tumor presenting with amenorrhea as the sole initial symptom: Case report and review of the literature.

Krukenberg tumor (KT), mostly originates from gastric cancer, is the metastatic tumor of ovaries accounting for 1-2% of all ovarian cancer. Common presenting symptoms include abdominal pain, distension, and ascites. Rests of the patients have non-specific gastrointestinal symptoms including dyspepsia, weight loss, nausea and vomiting. Gynecologic symptoms such as virilization, menstrual bleeding or irregularity and amenorrhea are much less frequent in the literature cases. Here, we present an unusual case of KT presented with amenorrhea as the sole initial symptom.

The effect of small-molecular-weight heparin added to chemotherapy on survival in small-cell lung cancer - A retrospective analysis.

Aims and Background: Small cell lung cancer (SCLC) is a chemotherapy-responsive tumor and associated with alterations in the coagulation system. Addition of low-molecular-weight heparin (LMWH) to combination chemotherapy (CT) had resulted in increase in survival. The present retrospective trial was designed to determine whether the duration of dalteparin usage has an effect on progression and survival. Materials and Methods: The medical records of 67 patients with SCLC who were given cisplatin-etoposide and concomitant LMWH (dalteparin) was evaluated retrospectively. Results: Median follow-up of patients was 11.3 months. Outcome: 10.6% complete response, 3.0% good partial response, 36.4% partial response, 10.6% stable disease, and 39.4% progressive disease. Side-effects were seen in 40.3% of the patients. Median dalteparin duration was 6,1 months. According the duration of dalteparin patients were grouped in three: who took dalteparin less than 4 months (Group A), 4-6 months (Group B) and more than 6 months (Group C). Mean overall survival (OS) in Group A was 6.5 months, in Group B 11.8 months, and Group C 14.6 months. Mean OS in Group B and C were statistically significantly (P < 0.001) longer than Group A, between Group B and C there was not any significant difference (P = 0.037). Mean progression free survival (PFS) was 9 months. Conclusions: The CT plus LMWH minimum 4 months long is well-tolerable, and may improve PFS and OS in patients with SCLC. For treatment of patients with SCLC CT plus LMWH may be considered as effective future-therapy, and further multi-centre randomised prospective clinical trials must be done to determine the new standard treatment approach for SCLC.

Confectionery industry: a case study on treatability-based effluent characterization and treatment system performance.

Source-based wastewater characterization and stream segregation provide effective management of industrial wastewaters. The characterization of wastewater sources from a confectionery factory was presented and performance of the wastewater treatment plant was evaluated in this study. All of the wastewater sources in the factory, except the vacuum water line, can be characterized by high concentrations of soluble pollutants and low pH. High organic content of the wastewater generated from the confectionery industry promoted the application of anaerobic technology as a pre-treatment before the conventional aerobic treatment. The average chemical oxygen demand (COD) removal and biogas production for expanded granular sludge bed reactor were 88% and 1,730 Nm(3)/day, respectively. The effluent from the investigated facility can be used for irrigation provided that conductivity values are within acceptable limits.

Safety and efficacy of transdermal fentanyl in patients with cancer pain: phase IV, Turkish oncology group trial.

We have performed a prospective evaluation of the efficacy, safety and convenience of the transdermal therapeutic system - fentanyl (TTS-F) in Turkish cancer patients when it was newly available in Turkey. Ninety-nine patients with historically confirmed malignancy and pain entered the study; the mean age was 55.1 (16-58) years. The study duration was 28 days. Transdermal therapeutic system - fentanyl was used in opioid-naïve or pre-treated patients. Most patients reported a decrease in pain severity. Use of rescue medication decreased from day 4 to day 28. The majority of patients rated patch convenience of use as excellent. A total of 22.2% of patients experienced adverse events that were either probably related or very likely to be related to the study drug. The majority of the adverse events mentioned were related to the digestive system. Eighteen serious adverse events were reported by 13 patients. Six events were doubtfully related, and 12 events were not related to the study drug. Four patients died during the trial. None of these deaths was attributed to the study drug. In conclusion, the trial showed that TTS-F is easily managed, effective and will help to enable the appropriate opioid administration to patients who are suffering from cancer pain in Turkey.

Solitary plasmacytoma: experiences from Central Anatolia.

BACKGROUND: Solitary plasmacytoma localised to bone or soft tissue without myeloma. AIM: Clinical features and survival was analysed in patients from Central Anatolia. METHODS: Twenty-three solitary plasmacytoma (18 male, 5 female) were evaluated retrospectively. Median age was 58 years (46-72). The major localisation was vertebral column. RESULTS: All patients but one (larynx) had surgical resection and 21 patients received radiotherapy postoperatively. Multiple myeloma developed in eight patients (35%) and local relapse was detected in one patient. Eight patients died, causes of death were multiple myeloma progression in six patients, local relapse of intracranial plasmacytoma in one patient and cranial trauma in one patient who was in complete remission. Three and 5 years progression free survival were 45.6% and 22.8% respectively and overall survivals were 54.4% and 27.2% respectively. CONCLUSION: Solitary plasmacytoma cases should be followed carefully regarding local relapse and progression to myeloma.

Cisplatin plus oral etoposide (EoP) combination is more effective than paclitaxel in patients with advanced breast cancer pretreated with anthracyclines: a randomised phase III trial of Turkish Oncology Group.

Our objective was to determine whether oral etoposide and cisplatin combination (EoP) is superior to paclitaxel in the treatment of advanced breast cancer (ABC) patients pretreated with anthracyclines. From December 1997 to August 2003, 201 patients were randomised, 100 to EoP and 101 to paclitaxel arms. Four patients in each arm were ineligible. The doses of etoposide and cisplatin were 50 mg p.o. twice a day for 7 days and 70 mg m(-2) intravenously (i.v.) on day 1, respectively, and it was 175 mg m(-2) on day 1 for paclitaxel. Both treatments were repeated every 3 weeks. A median of four cycles of study treatment was given in both arms. The response rate obtained in the EoP arm was significantly higher (36.3 vs 22.2%; P=0.038). Median response duration was longer for the EoP arm (7 vs 4 months) (P=0.132). Also, time to progression was significantly in favour of the EoP arm (5.5 vs 3.9 months; P=0.003). Median overall survival was again significantly longer in the EoP arm (14 vs 9.5 months; P=0.039). Toxicity profile of both groups was similar. Two patients in each arm were lost due to febrile neutropenia. The observed activity and acceptable toxicity of EoP endorses the employment of this combination in the treatment of ABC following anthracyclines.

Meropenem +/- granulocyte colony stimulating factor in the treatment of febrile neutropenic patients with cancer: prospective randomized study.

The purpose of this study was to evaluate the impact of granulocyte-colony stimulating factor (G-CSF) on the therapy for febrile neutropenia (FN). Our patient population differed significantly from those of previous studies as no patients received antimicrobial or CSF prophylaxis before randomization and all were solid tumor patients. When the diagnosis of FN was established, patients were started on intravenous meropenem 1 g every 8 hours and randomly assigned to receive G-CSF (5 microg/kg body weight per day subcutaneously) or not. Twenty-eight patients with 30 FN episodes received G-CSF and 25 patients with 30 FN episodes did not receive G-CSF according to randomization. The time to resolution of fever, recovery of neutrophil count over 1000/mm3, duration of hospitalization, need for erythrocyte and platelet transfusion and mortality rate were similar in both study groups. Side effects of therapy were mild. These results provide preliminary evidence that G-CSF administration, in addition to effective antibiotic therapy as treatment of febrile neutropenic patients with solid tumor, does not help improve infection-related morbidity and mortality.

Post-operative sequential chemo-radiotherapy in high-grade cerebral gliomas with fotemustine.

High-grade gliomas are the most common primary brain tumors in adults. Twenty-seven patients with histopathologically proven anaplastic astrocytoma and glioblastoma multiforme were enrolled in this study from November 1998 to August 2002. Radiotherapy was administered after surgery and fotemustine (100 mg/m2) was sequentially administered every 3 weeks for 6 cycles. Overall, 111 cycles were administered to the 27 patients (median, 5 cycles; range, 1 to 6 cycles). Myelosuppression was mild to moderate. The median overall survival and progression free survival were 11+/-3.1 months (95%CI, 4.9-17.1) and 8+/-0.5 months (95%CI 7.1-8.9), respectively. One-year and two-year survivals were calculated at 48% and 7%, respectively. Significant prognostic factors (P<0.05) via univariate analysis were divided into two groups: completion of 6 cycles of chemotherapy versus incompletion of 6 cycles of chemotherapy. This trial demonstrates that postoperative radiotherapy and sequential fotemustine therapy is feasible, well tolerated, and may prolong survival in patients with newly diagnosed high-grade gliomas.

A randomized clinical trial of combination chemotherapy with and without low-molecular-weight heparin in small cell lung cancer.

BACKGROUND: Small cell lung cancer (SCLC) is a chemotherapy-responsive tumor type but most patients ultimately experience disease progression. SCLC is associated with alterations in the coagulation system. The present randomized clinical trial (RCT) was designed to determine whether addition of low-molecular-weight heparin (LMWH) to combination chemotherapy (CT) would improve SCLC outcome compared with CT alone. METHODS: Combination CT consisted of cyclophosphamide, epirubicine and vincristine (CEV) given at 3-weekly intervals for six cycles. Eighty-four patients were randomized to receive either CT alone (n = 42) or CT plus LMWH (n = 42). LMWH consisted of dalteparin given at a dose of 5000 U once daily during the 18 weeks of CT. Results Overall tumor response rates were 42.5% with CT alone and 69.2% with CT plus LMWH (P = 0.07). Median progression-free survival was 6.0 months with CT alone and 10.0 months with CT plus LMWH (P = 0.01). Median overall survival was 8.0 months with CT alone and 13.0 months with CT plus LMWH (P = 0.01). Similar improvement in survival with LMWH treatment occurred in patients with both limited and extensive disease stages. The risk of death in the CT + LMWH group relative to that in the CT group was 0.56 (95% confidence interval 0.30, 0.86) (P = 0.012 by log rank test). Toxicity from the experimental treatment was minimal and there were no treatment-related deaths. CONCLUSIONS: These results support the concept that anticoagulants, and particularly LMWH, may improve clinical outcomes in SCLC. Further clinical trials of this relatively non-toxic treatment approach are indicated.

Effect of high salinity on anaerobic treatment of low strength effluents.

In anaerobic treatment, it is obligatory to know the effect of potentially inhibitory compounds due to the fact that methane formation may retard severely and may proceed slower than organic acid production. One of the most important inhibitory substances in anaerobic treatment is high salinity. In many cases, the main collectors of a municipal sewer system should have been built in the coastal zone and below the ground water level due to the available topography of wastewater catchments area, which is carrying the risk of seawater infiltration. Besides, one of the most convenient methods for leachate control is to treat landfill leachates with domestic wastewaters in the central municipal wastewater treatment plants such as in Istanbul. Thus, the nitrogen load of the treatment plants increase significantly. In this study, the effects of high salinity and ammonium nitrogen levels on mesophilic anaerobic tretament processes were investigated. In the first part of the study, high salinity effect on anaerobic treatment was investigated by feeding synthetic wastewater containing high salinity between 0.15%-1.5% ratios. In the second part of the study, the simultaneous effect of high salinity and ammonia (1.5% salinity+1,000 mg NH3/l) was examined by a lab-scale Upflow Anaerobic Sludge Bed Reactor (UASBR). Results indicated no significant inhibition in both cases and effective COD removals (89%) and total biogas productions having methane content of 84% could be achieved.

A new process for the combined treatment of municipal wastewaters and landfill leachates in coastal areas.

One of the most convenient methods for leachate control is to treat landfill leachates with domestic wastewaters. In this framework, a two-stage treatment system including anaerobic pre-treatment combined with a chemical post-treatment system such as ammonia stripping and/or Magnesium Ammonium Phosphate (MAP) precipitation can be comparable with a conventional secondary biological treatment. In this study, 2.5% and 2% of leachate by volume was mixed with domestic wastewater as the feed for the mesophilic Upflow Anaerobic Sludge Bed Reactor (UASBR). pH, feed strength and hydraulic retention time (HRT) were monitored for the evaluation of the performance of the anaerobic process. The HRT's varied from 0.76 to 0.52 d and 58% and 85% COD removal efficiencies were obtained at Organic Loading Rates (OLR) of 0.63 and 2 kg COD/m3.d respectively. The average biomass (VS) concentration in the reactor increased from 40 g/l to 50 g/l during the study. Effluents from the UASBR were further treated chemically either with lime for ammonia stripping or with MAP precipitation. MAP precipitation was applied both at the stoichiometric ratio (Mg:NH4:PO4 = 1:1:1) and above the stoichiometric ratio (Mg:NH4:PO4 = 1:1:1.3). Maximum NH4 removal of 66% was achieved at the pH of 9.3 at the stoichiometric ratio, whereas 86% NH4 removal was obtained at the pH of 9.3 above the stoichiometric ratio. Alternatively, ammonia stripping was applied either to the effluents directly taken from the anaerobic reactor or to the effluents to which MAP precipitation was applied stoichiometrically. Ammonia stripping was conducted for 24 h and 89% NH4 removal was observed at the end of 24 h. Consequently, this study indicates that anaerobic pre-treatment combined with chemical post-treatment (MAP) produced high quality of effluent comparable to the conventional biological treatment especially in terms of N and P levels.

Struvite precipitation from anaerobically treated municipal and landfill wastewaters.

A two-stage treatment system including upflow anaerobic sludge blanket reactor pre-treatment combined with a chemical post treatment system such as magnesium ammonium phosphate (MAP) precipitation was proposed as a comparable alternative to conventional biological treatment. In this study, anaerobically pre-treated domestic wastewater, domestic wastewater mixed with 2% and 3% of leachate by volume and raw leachate were further treated chemically with MAP precipitation. MAP precipitation was both applied at the stoichiometric ratio (Mg:NH4=PO4; 1:1:1) and above the stoichiometric ratio (1.1:1:1 and 1.1:1:1.1) on domestic wastewater + 3% leachate mixture. Maximum NH4-N removal of 68% was achieved at the pH of 9.2 at the stoichiometric ratio, whereas at the same pH value 70 to 72% NH4-N removal was obtained above the stoichiometric ratio. Additional ammonia recovery studies were conducted on Fenton's oxidation applied effluents before MAP precipitation and no significant additional ammonium removal was achieved. However, by the application of Fenton's oxidation high additional COD removals were obtained. Consequently, chemical treatment by MAP precipitation and/or Fenton's oxidation after anaerobic treatment yielded very effective removals for COD and NH4-N in domestic wastewaters + leachate mixtures.

Advanced treatment of high strength opium alkaloid industry effluents.

The purpose of this study was to investigate an effective treatment system which can be applicable to treat opium alkaloid industry (OAI) effluents characterised with high COD, TKN, dark color and non-biodegradable organic pollutants. In the first phase of the study, lab-scale anaerobic (UASBR) + aerobic (SBR) treatability studies were carried out on opium processing industry effluents. Effluent CODs from the two staged biological treatment system were relatively high (-700 mg l(-1)) and additional post treatment was required. Physico-chemical treatability studies previously carried out on the effluent of opium alkaloid wastewater treatment plant, were not effective in removing residual COD and color. In the second phase of the study, the refractory organics causing higher inert COD values in the SBR effluent were additionally treated by using Fenton's Oxidation. The batch tests were performed to determine the optimum operating conditions including pH, H2O2 dosage, molar ratio of Fe2+/H2O2 and reaction time. It was found that removal efficiencies of COD and color for 30 minutes reaction time were about 90% and 95%, respectively. The ratio of H2O2/FeSO4 was determined as 200 mg l(-1)/600 mg l(-1) for the optimum oxidation and coagulation process at pH 4. Experimental results of the present study have clearly indicated that the Fenton's oxidation technology is capable to treat almost all parts of the organics which consist of both soluble initial and microbial inert fractions of COD for opium alkaloid industry effluents. Effluents from the Fenton's Oxidation process can satisfy effluent standards for COD and color in general.

Ammonia recovery from high strength agro industry effluents.

The aim of the study was to investigate ammonia recovery from high strength agro industry effluents involving significant amounts of ammonia, by applying magnesium ammonium phosphate (MAP) precipitation technology. Two types of industrial effluents have been tested in the study. The first plant was an opium alkaloid processing industry and the second one was a baker's yeast industry. High chemical oxygen demand (COD), total Kjeldahl nitrogen (TKN) and unacceptable dark brown color characterized effluents from both industries. Effluents from the biologically treated opium alkaloid and baker's yeast industries were both applied at the stoichiometric ratio (Mg:NH4:PO4 = 1:1:1) and above the stoichiometric ratio (Mg:NH4:PO4 = 1.1:1:1.1) to MAP precipitation. NH4 removals of 61-80% were achieved at the pH of 9.2 at the stoichiometric ratio, whereas 83% NH4 removal was obtained at the pH of 9.2 above the stoichiometric ratio. Experimental studies performed on both anaerobically and/or aerobically treated baker's yeast and opium alkaloid industry effluents have clearly indicated that MAP precipitation was an appropriate treatment option for NH4 removal or struvite recovery from high ammonia content agro industry effluents. Additional ammonia recovery studies were conducted on ozonated and Fenton's oxidation applied effluents and these have also indicated that the amounts of struvite and the quality of MAP precipitate was increased significantly. In this framework, MAP sludge recovered from combined biological and Fenton's oxidation treatment effluents were considered as a more valuable slow release fertilizer for agricultural use.

Rapidly relapsing squamous cell carcinoma of the renal pelvis associated with paraneoplastic syndromes of leukocytosis, thrombocytosis and hypercalcemia.

A case history is reported here in which leukocytosis, thrombocytosis and hypercalcemia associated with rapidly relapsing squamous cell carcinoma (SCC) of the renal pelvis were observed. In a 58-year-old man, SCC of the renal pelvis was documented during nephrolithotomy, and right nephrectomy was performed. Local relapse of the tumor occurred rapidly in 2 months' time and hypercalcemia, leukocytosis and thrombocytosis worsened in accordance with tumor volume. Cranial computerized tomography (CT), thorax CT and bone scintigraphy were negative for metastasis. The serum parathyroid hormone level was 28 pg/ml (normal 9- 55 pg/ml). To disclose leukocytosis and thrombocytosis, peripheral smear and bone marrow aspiration were performed and no pathologic finding regarding any hematologic disorder was found; the samples were also BCR-ABL negative and Philadelphia chromosome negative. Production of several factors by tumor cells may be responsible for this paraneoplastic syndrome. The association of SCC of the renal pelvis with this triple paraneoplastic syndrome is an extremely rare occurrence.

Facial nerve paralysis and paraplegia as presenting symptoms of acute myeloid leukemia.

Granulocytic sarcoma is an extramedullary tumor associated with acute or chronic leukemias or myeloproliferative disorders. Rarely, the tumor may be seen before the diagnosis of leukemia. Symptomatic facial nerve paralysis and spinal cord invasion by granulocytic sarcomas are also relatively uncommon. We present here a 17-year-old-female patient who had facial nerve paralysis and paraplegia due to granulocytic sarcoma as the presenting symptoms of acute myeloid leukemia.

Effects of DMSO on platelet functions and P-selectin expression during storage.

Recent studies suggested that the expression of P-Selectin on stored platelets is related to in vitro activation and loss of viability. We examined the effects of dimethylsulfoxide (DMSO) on in vitro function and P-Selectin expression of platelet concentrates. Fresh random-donor platelet units (n = 60) were divided into four equal groups. A DMSO-free group was chosen as a control. DMSO (0.5%, 1.0%, and 3.0%) was added to the other three groups. The samples were stored on a horizontal shaker at room temperature. Biochemical, morphological and platelet function tests and P-Selectin expression were monitored during storage. In all groups, P-Selectin expression, lactate and LDH levels, mean platelet volumes and PO2 increased but the aggregation response to agonist, the recovery response to hypotonic shock, platelet count, glucose level, pCO2, and HCO3 decreased during storage. In DMSO-containing groups, the P-Selectin expression which is a predictor of in vitro activation, was found significantly less often than in the DMSO-free group.