Proximal aortic arch cannulation for proximal ascending aortic aneurysms.

INTRODUCTION: Different arterial inflow sites have been reported to date for particularly challenging cardiac operations. The ascending aorta, femoral artery, and subclavian artery are the most commonly used sites. Although its use has been reported, the aortic arch has not gained popularity in the performance of cannulation. According to a search performed in the PubMed database, aortic arch cannulation for ascending aorta replacement has not been examined in a separate study before. In the present study, we report the treatment outcomes of patients with ascending aortic aneurysms in whom the aortic arch was cannulated for arterial inflow. MATERIAL AND METHODS: Twenty-seven patients with aneurysmal dilatation of the ascending aorta underwent ascending aorta replacement from April 2010 to March 2013. The mean age of the patients was 64 years. All operations were carried out by cannulating the aortic arch distally from the origin of the innominate artery. RESULTS: There was no mortality or cannulation-related morbidity. In 23 patients, only the supracoronary ascending aorta was replaced, whereas in 4 patients, the button modification of the Bentall procedure was performed to replace the root and the ascending aorta. CONCLUSIONS: The technique of aortic arch cannulation distal to the origin of the innominate artery is worthy of consideration in the treatment of aneurysms limited to the ascending aorta due to its safety, simplicity, and low morbidity.

Challenges in development and implementation of health-risk-based soil quality guidelines: Turkey's experience.

Management of contaminated sites is a critical environmental issue around the world due to the human health risk involved for many sites and scarcity of funding. Moreover, clean-up costs of all contaminated sites to their background levels with existing engineering technologies may be financially infeasible and demand extended periods of operation time. Given these constraints, to achieve optimal utilization of available funds and prioritization of contaminated sites that need immediate attention, health-risk-based soil quality guidelines should be preferred over the traditional soil quality standards. For these reasons, traditional soil quality standards are being replaced by health-risk-based ones in many countries and in Turkey as well. The need for health-risk-based guidelines is clear, but developing these guidelines and implementation of them in contaminated site management is not a straightforward process. The goal of this study is to highlight the problems that are encountered at various stages of the development process of risk-based soil quality guidelines for Turkey and how they are dealt with. Utilization of different definitions and methodologies at different countries, existence of inconsistent risk assessment tools, difficulties in accessing relevant documents and reports, and lack of specific data required for Turkey are among these problems. We believe that Turkey's experience may help other countries that are planning to develop health-risk-based guidelines achieve their goals in a more efficient manner.

Implementation of the European Union's Bathing Water Directive in Turkey.

The European Union (EU) Bathing Water Directive (2006/7/EC) sets out standards for designated bathing waters which should be complied with by all Member States. Turkey, being a candidate country to the EU, requires heavy-cost investments in achieving approximation with the EU Environmental Acquis. This paper provides a description of the technical measures and investment and operational cost assessment related to the implementation of the Bathing Water Directive in Turkey. Bathing waters are defined as "all running or still freshwaters or parts thereof and seawater, in which bathing is explicitly authorized by the competent authorities, or bathing is not prohibited and is traditionally practiced by a large number of bathers". Since there is no complete registration of bathing waters in Turkey, this study has targeted all coastal agglomerations and designated these as in proximity to "highly-touristic" and "other" agglomerations including the agglomerations in the proximity of six lakes that are popularly used as bathing waters. For each of these agglomerations an assessment of the existing infrastructure has been made. In defining the infrastructural need, two scenarios have been developed. According to Scenario 1, only highly-touristic and touristic places are to receive investment. The suggested further treatment was "disinfection+sea outfall" and "sea-outfall", for highly-touristic and touristic agglomerations, respectively. In Scenario 2, other coastal agglomerations and all freshwater lakes were also included and disinfection has been proposed for these settlements. It appears that the total investment is at around 12.6 million Euros for Scenario 1 and increases to 21.8 million Euros for Scenario 2; whereas the annual operational and maintenance costs are about 0.5 and 0.8 million Euros for Scenarios 1 and 2, respectively.