Leaching potential of nano-scale titanium dioxide in fresh municipal solid waste.

With the rapid development in nanotechnology in recent years, the number of commercially available products containing engineered nanomaterials (ENMs) has increased significantly. It is expected that large fractions of these ENMs will end up in landfills for final disposal. Despite the wide use of ENMs, little data is available on their fate within landfills. This study examined the leaching behavior of nanoscale titanium dioxide (nano-TiO2), one of the mostly used ENMs, in fresh municipal solid wastes (MSWs). Batch reactors containing municipal waste samples were spiked with a range of nano-TiO2 concentrations at different pH and ionic strength conditions. The Ti concentrations in leachate decreased rapidly and reached steady state after about 12-24 h. Results suggest that, for the environmental conditions considered, approximately 3-19% of the added nano-TiO2 remained in leachate. Batch tests conducted with individual synthetically-prepared solid waste components also showed low leaching potential (5.2% for organic waste, 3.3% for glass, 1.7% for both textile and paper and 0.6% for metal), indicating that all components of MSW contributed to the retention of the nano-TiO2 mass within the solid matrix.

Correlation between c-erbB2 expression, lymphovascular invasion and other biological and clinical prognostic factors and preoperative tumor markers in patients with early-stage and locally advanced breast cancer.

PURPOSE: To evaluate the correlation between c-erbB2 expression, lymphovascular invasion and other biological and clinical prognostic variables and preoperative CA 15-3 and CEA levels in patients with early-stage and locally advanced breast cancer. METHODS: Preoperative serum concentrations of CA 15- 3 and CEA were measured in 123 patients undergoing surgical treatment for stage I-III breast cancer and the association between these markers and clinical and biological variables were evaluated. RESULTS: With cut-off values of 45 U/ml (CA 15-3) and 2.5 ng/ml (CEA), the sensitivity for CA 15-3 and CEA was 10% and 24% and their mean values were 23 U/ml and 2.32 ng/ml, respectively. A significant correlation between preoperative levels of CA 15-3 and CEA was noticed (p=0.023). Preoperative CA 15-3 levels were significantly higher in patients with tumors > 5 cm (p<0.0001), with positive axillary lymph nodes (p=0.04), with increasing nodal burden (p= 0.025) and in patients with stage III disease (p=0.003). Tumor size >5 cm (p=0.002), increasing axillary nodal burden (p=0.02) and stage III disease (p<0.0001) were also significantly correlated with CEA values above the cut-off level. There were no correlations between CA 15-3 and CEA levels and other variables including c-erbB2 expression, age, grade, hormone receptor status, and lymphovascular invasion. CONCLUSION: Preoperative CA 15-3 and CEA levels are significantly correlated with tumor size, axillary nodal status and stage in patients with non-metastatic breast carcinoma. No correlation between preoperative values of CA15-3/CEA and c-erbB2 status, lymphovascular invasion and other prognostic factors was detected.

Surgical experience of hydatid disease of the liver: omentoplasty or capitonnage versus tube drainage.

BACKGROUND/AIMS: The aim of this paper was to report our experience and comparison of surgical treatment methods for hepatic hydatid cyst disease. METHODOLOGY: Between January 1990 and December 1998, 66 patients with hepatic hydatid disease in two centers were operated on. Patients were assessed by clinical examination, laboratory methods and ultrasonography and computed tomography and magnetic resonance. We also compared omentoplasty or cappitonage with external drainage with or without cyctectomy. RESULTS: Common pathology was solitary cysts and most of them were placed in the right lobe. Omentoplasty was performed for 35 cysts and cappitonnage for 36 and external drainage for 31 cysts. No operative mortality was reported. Patients with omentoplasty developed fewer complications and had a significantly shorter hospitalization than those with external drainage. CONCLUSIONS: Although omentoplasty seems to be the best possible surgical alternative for the radical treatment of hepatic hydatid cysts, the management of hydatid cysts should be flexible, taking into consideration a number of factors and variables.

Management of sigmoid colon volvulus.

BACKGROUND/AIMS: Sigmoid colon is the most frequent site for a volvulus. The condition has been a formidable one, fraught with innumerable complications responsible for many deaths. In this report, we reviewed our experience with sigmoid colon volvulus. METHODOLOGY: We present our experience of 61 cases of sigmoid volvulus admitted to our department. Twenty-four patients were subjected to non-operative decompression and the others underwent emergency operation. RESULTS: Intestinal volvulus has quite a high morbidity and mortality. Mortality rate of elective resection following sigmoidoscopy was 7.6%. Mortality rate for emergency surgical detortion, primary resection and Hartman procedure were respectively 13%, 16.6% and 37.5%. Important factors such as the patient's features and frequent late diagnosis can influence the complicated outcome of the disease. Plain X-ray of the abdomen is helpful. CONCLUSIONS: Management with the conservative method of treatment in the form of detortion by sigmoidoscopy and rectal tube application is initially effective in most cases of volvulus of the sigmoid colon. On the other hand, elective or emergency sigmoid resection is the most effective treatment for the disease.

Traumatic rupture of the diaphragm.

Diaphragmatic rupture following trauma is often an associated and missed injury. The diagnosis is difficult, so is usually made intraoperatively. Twenty-one patients with traumatic rupture of the diaphragm (TRD) who presented between 1995 and 1998 were retrospectively analysed: 12 had penetrating injuries and nine had blunt injuries. Right-sided defects exceeded left (12 vs 9). Only seven patients had signs and symptoms directly referrable to rupture of the diaphragm. All patients were operated on through a midline laparotomy. Diaphragmatic hernia was seen in six patients (28.5%); 20 (95%) patients had concomitant injuries. The liver was the most commonly injured organ (10 patients). The aim of this study was to report our experiences with TRD and review the literature. We conclude that correct preoperative diagnosis of TRD needs a high index of suspicion. It can be diagnosed intraoperatively by explorative laparotomy. Most ruptures can be repaired by the abdominal approach.

Experimental study on the role of mast cells in peritoneal adhesion formation.

OBJECTIVE: To investigate the potential role of mast cell stabilisation in the prevention of post-operative adhesions. DESIGN: Laboratory animal experiment. SETTING: University hospital, Turkey. SUBJECTS: Ninety Wistar albino rats. INTERVENTION: Under anaesthesia, a lower midline laparotomy was performed, the caecum exposed and grasped until haemorrhage occurred. The rats were divided into three groups. Group 1, 2 and 3 were intra-peritoneally administered 1 ml of saline, disodium cromoglycate 5 mg/kg in 1 ml of saline and 10 mg/kg in 1 ml of saline, respectively thirty minutes prior to laparotomy and immediately subsequent to abdominal closure. They were later sacrificed, laparotomy repeated and the presence and extent of intraabdominal adhesions evaluated. RESULTS: Adhesion scores were best in the high disodium cromoglycate dose group of rats (p < 0.05) and the number of degranulated mast cells was significantly low in this group (p < 0.05). CONCLUSION: Disodium cromoglycate may be an effective agent for attenuating adhesion formation when administered in suitable doses.

The effects of thromboxane synthase inhibition on reperfusion injury and endothelin-1,2 levels in allograft kidney transplantation in rats.

Thromboxane A2 is a proaggregative vasoconstrictor that is synthesized and released in reperfusion injury. We aimed to investigate the effects of thromboxane synthase inhibitor, UK 38485, on endothelin-1,2 (ET) response of the renal endothelium and lipid peroxidation and protein oxidation in the early period of kidney transplantation. Four groups (n=8 in group IV and n=10 in the others) [corrected] of Sprague-Dawley rats were designed as Group I (sham nephrectomy), Group II (autotransplantation), Group III (allotransplantation) and Group IV (allotransplantation group in which the allografts were perfused with UK 38485. All subjects underwent right nephrectomy after transplantation. The grafts were flushed with 4 ml of ice-cold Ringer's lactate and in Group IV 10 microg of UK 38485 was added into the solution for each kidney. In allotransplantation groups, the kidneys were harvested from allogeneic white Wistar albino rats. The kidney grafts were allowed 120 min of reperfusion after 40 min of cold ischemic period. ET-1,2 plasma concentrations in the renal vein blood and diene conjugates (DC), hydroxyalkanals (HAA), hydroxyalkenals (HAE) and malondialdehyde (MDA) levels as the products of lipid peroxidation, protein carbonyls and protein sulfhydryls as the indicators of protein oxidation were analyzed in kidney tissue. Plasma ET-1,2 concentrations increased significantly in Group II and Group III (P<0.01) when compared to Group I but decreased in Group IV in comparison with Group III (P<0.05). DC, HAA, HAE and MDA levels increased in Groups II and III (P<0.001). Significant protein oxidation occurred only in Group III (P<0.01). Perfusion of the allografts with UK 38485 prevented lipid peroxidation and protein oxidation in Group IV. Histopathological changes were mild in the last group. We concluded that, in kidney transplantation, local administration of UK 38485 has cytopreservative effects on the allografts and this effect can be related to ET-1,2 concentrations.

Prevention of postherniorrhaphy urinary retention with prazosin.

Urinary retention that necessitates catheterization after herniorrhaphy is a well known, but usually ignored, situation. Increased sympathetic activity resulting from surgery may be the contributing factor. Blockade of alpha receptors in the bladder neck and urethral sphincter may prevent postoperative urinary retention. In this prospective placebo-controlled study, the efficacy of prazosin in preventing postoperative urinary retention after herniorrhaphy was investigated in 156 patients. Patients were randomized into two groups. Patients in Group I (control) were given placebo orally 12 hours before surgery, just before surgery, and 12 and 24 hours after surgery. In Group II, 1 mg of prazosin was given in the same manner of placebo. Nine of 84 patients (10.8%) in the prazosin group and 18 of 72 patients (25%) in the placebo group developed urinary retention. Catheterization was required in only 3 patients (3.5%) in the prazosin group compared to 10 patients (13.8%) in placebo-treated group (P < 0.05). In conclusion, prophylactic use of prazosin after herniorrhaphy significantly reduced the incidence of urinary retention and catheterization.

The effects of prostaglandin E2 indomethacin & Ginkgo biloba extract on resistance to experimental sepsis.

We investigated the effect of 16,16-dimethyl prostaglandin E2 indomethacin and Ginkgo biloba extract on the survival in two experimental sepsis models in rats due to administration of 1 x 10(7) cfu and 1 x 10(9) cfu Escherichia coli. Animals in each model were then randomly divided (10/group) into four groups, administered saline, indomethacin, G. biloba extract and prostaglandin E2 respectively. When compared, there was no significant difference in the survival period between the two sepsis models (P > 0.05). The best survival rate was observed in the PGE2-administered animals in the first major model (P < 0.05). Indomethacin appeared not to decrease the mortality rates. There was no significant difference in PGE2 levels between two sepsis models (P > 0.05). Our results suggest that elevated prostaglandin E2 levels following major trauma are not responsible for the postinjury increased susceptibility to infectious complications. Our observations should also discourage aggressive use of cyclo-oxygenase inhibitors for protection against infectious complications after major trauma.

Factors affecting surgical mortality and morbidity in patients with obstructive jaundice.

The importance of clinical and laboratory parameters which have an effect on postoperative mortality and morbidity was evaluated in 124 patients operated on because of obstructive jaundice. The causes of obstructive jaundice were a malign disease in 38 patients (30.6%) and a benign disease in 86 patients (69.4%). Biliary enteric anastomosis in 66 patients (53%), external drainage in 46 patients (37%), and cholecystectomy in 12 patients (10%) were the surgical techniques of choice for correction of obstructive jaundice. There were significantly high mortality rates in patients with weight loss, more than 10 kg during preoperative the month (p < 0.05); jaundice longer than 21 days, (p < 0.001); and malignancy caused jaundice (p < 0.002). Haematocrite less than 30% (p < 0.05), albumin level below 3 g/dl (p < 0.01), blood urea nitrogen level above 30 mg/dl (p < 0.001), and bilirubine above 10 mg/dl (p < 0.01) were determined as risk factors in mortality. Direct relationships between the number of risk factors, complications, and mortality ratios were determined. One or more complications were determined in patients with more than six risk factors. High mortality rate was also determined in patients who had five and more risk factors. The following factors were evaluated: respiratory, circulatory, renal functions, and infection, and metabolic concomitant diseases, and comorbid scores for each patient were calculated. High rate complications in patients with eight and more comorbid scores and high mortality rates in patients with six and more were also determined. Finally, all these parameters were important in demonstrating postoperative mortality in obstructive jaundice patients. We suggest that surgery after treatment of correctable risk factors decreases postoperative morbidity and mortality.

Postoperative retention of urine in general surgical patients.

OBJECTIVE: To find out the incidence of retention of urine after various general surgical operations, and to assess the effects of applying a bag filled with warm water (40-45 degrees C), and encouraging early mobilisation onreducing the necessity for catheterisation. DESIGN: Open study. SETTING: Cumhuriyet University Hospital, Sivas, Turkey. SUBJECTS: 577 consecutive patients who had no history of urinary problems and had not already been catheterised, and who underwent general surgical operations between April 1989 and December 1991. MAIN OUTCOME MEASURE: Ability to pass urine spontaneously. RESULTS: 64 of 272 men (24%) and 47 of 305 women (15%) developed retention of urine (p = 0.02), and 15 and 11, respectively, required catheterisation. Patients were most likely to develop retention after repair of incisional hernia (13/32, 38%), midline laparotomy (19/82, 23%), and subcostal incisions (30/142, 21%), but there were no significant differences among these. Significantly more patients whose operations had lasted 60 minutes or more, and who had opiate analgesia, required catheterisation (5/232 compared with 21/345, p = 0.04, and 11/120 compared with 15 out of 457, p = 0.01, respectively). 85 of the 111 patients who went into retention (77%) were able to pass urine spontaneously after application of a bag containing warm water to the suprapubic region, and walking about. The mean period of catheterisation was 12 hours (range 4-76), and all patients but one passed urine spontaneously when the catheter was removed. Only two of the 26 patients who were catheterised developed microbiologically confirmed urinary tract infections. CONCLUSION: Retention of urine is a common complication after general surgical operations, but the necessity for catheterisation can be kept to a minimum by simple and inexpensive measures.

The alteration on serum thyroid hormones and iodine levels when the 10% povidone iodine solution was topically performed on ano-rectal mucosa.

In this experiment, the 10% povidone-iodine (PI) solution was topically administered on ano-rectal mucosa by enema and its effects on thyroid hormones and iodine levels in serum were examined in rabbits. The solution was given in a volume of 20 ml daily for three days. Blood samples were drawn at 1st, 4th and 7th days after the first enema. The serum iodine levels reached maximum values at the first day was still elevated at the 4th and 7th days, but T3, T4 and TSH values remained within the normal limits. Iodine did not produce alterations in the levels of thyroid hormones and TSH, although it is known that a considerable amount of it is absorbed from the intestinal lumen.

Ovarian haemangioma.

Although ovaries have a very rich vasculature, haemangiomas of the ovary are extremely rare. There are only another 39 cases of ovarian haemangioma recorded in the literature. We describe an 11-year-old girl with an ovarian haemangioma who presented clinically with an acute abdomen. The patient has been well without complications for a year.

Splenic abscesses due to Salmonella (report of two cases).

Two cases with splenic abscesses due to salmonella infection have been presented and the relevant literature has been reviewed. Diagnostic and therapeutic modalities have been discussed.

Treatment of experimental peritonitis with intraperitoneal povidone-iodine solution.

Intraperitoneal lavage with povidone-iodine solution has been reported by some to be beneficial in the treatment of peritonitis and by others to cause local and toxic side effects. In this study, 200 white mice, divided into four groups of 50, were subjected to bacterial peritonitis. The first group had no treatment; peritoneal lavage was carried out using povidone-iodine solution in the second group and a 0.9% sodium chloride solution in the third. In the fourth group, antibiotics (clindamycin and gentamicin) were instilled intraperitoneally without peritoneal lavage. The povidone-iodine solution had no beneficial effect, the death rate after 1 week (76%) being similar to that in the control group (78%) and much higher than that in mice treated with sodium chloride lavage (38%) and antibiotics without lavage (16%). A second series of experiments was, therefore, carried out to investigate the toxic effect of povidone-iodine solution intraperitoneally on mice without peritonitis; the solution was found to be toxic.