STUMP, a surprise finding in a large fibroid uterus in a 20-year-old woman.

We report on a case of a 20-year-old nulliparous woman with menorrhagia associated with a smooth muscle tumor of uncertain malignant potential (STUMP) that was responsive to Goserelin. This case details the investigation and management of a young woman who desires ongoing fertility preservation. STUMP is a rare uterine tumor with a paucity of literature available regarding management and subsequent malignant potential, particularly in the case of a patient who desires fertility preservation.

Predictors and outcomes of acute pancreatitis in critically ill patients presenting to the emergency department of a tertiary referral centre in Australia.

OBJECTIVE: To provide a current review of the clinical characteristics, predictors and outcomes in critically ill patients presenting to the ED with acute pancreatitis and subsequently admitted to an intensive care unit (ICU) of a tertiary referral centre in Australia. METHODS: A retrospective single-centre study of adult patients admitted with pancreatitis. Severe acute pancreatitis defined by Bedside Index of Severity in Acute Pancreatitis (BISAP) score ≥2. RESULTS: Eighty-seven patients fulfilled criteria for inclusion during the study period, representing 0.9% of all ICU admissions. The median age of patients was 54. Survival was independent of patients' age, sex, aetiology and comorbidities. Mortality was 30.8% for both inpatient referrals to the ICU and for direct referrals via the ED. Higher mortality was identified among patients requiring mechanical ventilation (74.2 vs 24.6% in survivors; P < 0.0001), vasopressor support (85.7 vs 33.8% in survivors; P < 0.0001) or renal replacement therapy (60 vs 16.9% in survivors; P < 0.002). BISAP score surpasses Ranson's and Acute Physiological and Chronic Health Examination (APACHE) II scores in discriminating between survivors and non-survivors among unselected patients with acute pancreatitis admitted to ICU, whereas APACHE II discriminates better in the cohort admitted from ED. CONCLUSION: Severe acute pancreatitis is associated with high mortality. Aetiology and comorbidity did not predict adverse outcomes in this population. BISAP score is non-inferior to APACHE II score as a prognostic tool in critically ill patients with acute pancreatitis and could be used to triage admission. Evidence of persistent organ dysfunction and requirements for organ support reliably identify patients at high-risk of death.

Elevated concentrations of primordial radionuclides in sediments from the Reedy River and surrounding creeks in Simpsonville, South Carolina.

A gamma-ray survey and analysis of 16 riverbed samples from the Reedy River watershed near Simpsonville, SC were conducted and compared with national and international studies of primordial radionuclides. The study reported here follows on a recent discovery of anomalously high uranium concentrations in several private well waters in the area. An HPGe spectrometer was used for quantification of gamma emitting radionuclides in the sediments. All sediments contained radionuclides from the uranium and thorium series as well as (40)K. Uranium-238 concentrations in sediment samples ranged from 11.1 to 74.2Bqkg(-1). The measured radionuclide concentrations were compared with data from UNSCEAR and NURE reports. The river and stream sediment data were augmented by in situ NaI(Tl) gamma-ray spectrometer measurements. Comparisons between the ex situ and in situ measurements indicate equivalently distributed uranium in the surface soils and stream sediments, the source of which is likely attributed to the monazite belts that are known to exist in the area.

Evaluation of flow cell detector configurations combining simultaneous preconcentration and scintillation detection for monitoring of pertechnetate in aqueous media.

Flow cell detectors were developed for simultaneous concentration and scintillation detection of technetium-99 in water. Evaluated flow cell geometries consisted of a coil and a fountain flow cell design; the latter is based on radial solution flow through a resin bed interfaced with a photomultiplier tube through a polycarbonate window. The sorptive scintillating media investigated were (1) an extractive scintillator combining a porous polystyrene resin with the extractant Aliquat-336 and fluor 2-(1-naphthyl)-5-phenyloxazole, (2) a mixed bed of organic scintillator (BC-400) and Tc-selective resin (TEVA), and (3) a mixed bed of inorganic scintillator particles (CaF2-Eu) with either TEVA resin or strong base anion-exchange resin (Dowex 1 x 8-400(Cl)). Depending on flow cell geometry and medium, the detection efficiencies for 99Tc ranged from 7.26 (BC-400/TEVA in coil geometry) to 50.20% (CaF2(Eu)/Dowex 1 x 8-400(Cl) in fountain flow cell geometry). The configuration with the highest sensitivity, CaF2(Eu)/Dowex 1 x 8-400(Cl) in coil geometry, can detect 99Tc as low as 3.78 Bq L(-1) for a 100-s count interval and a 200-mL sample, which is below the current regulatory level of 33 Bq L(-1). The issue of sensor reusability was addressed in this research, and its potential application at near neutral pH was demonstrated. The optimal sensor design was evaluated with a 99Tc-spiked synthetic groundwater matrix.

Anomalously high levels of uranium and other naturally occurring radionuclides in private wells in the piedmont region of South Carolina.

Anomalously high levels of uranium and 210Pb have been detected in untreated domestic groundwater wells near Simpsonville/Fountain Inn, South Carolina. Nine wells were sampled from the affected area and analyzed for total uranium, 234, 235, 238U, 226, 228Ra, 222Rn, and 210Pb as well other water quality parameters. These data augment other uranium concentration measurements and limited 226, 228Ra and 222Rn concentration measurements collected on private and public wells by the South Carolina Department of Health and Environmental Control. The observed radionuclide data were compared to maximum levels published in several national surveys from the past 30 years. The total uranium concentration in the groundwater ranged from 44.3 to 5,570 microg L(-1), with one well having the second highest published concentration in the U.S. The U/U activity ratio ranged from 1.1 to 2.5. 226Ra concentrations ranged from less than the minimum detectable concentration (< MDC) to 1,154 mBq L(-1) while the 228Ra concentration ranged from < MDC to 532.8 mBq L(-1) and the 222Rn levels ranged from 62 to 1,510 Bq L(-1). The 210Pb concentrations ranged from < MDC to 844 mBq L(-1).

Evolution of nitrogen species air pollutants along trajectories crossing the Los Angeles area.

Ambient aerosol sampling was conducted in Diamond Bar, Mira Loma, and Riverside, CA, to observe at close range the effects of ammonia emissions on air quality. These sites are located upwind,within, and downwind, respectively, of the Chino dairy area, the largest single source of ammonia emissions in the Los Angeles area. Inertial impactors and bulk filter samplers provided 4-7-h measurements of aerosol chemical composition and size distribution. Daily average fine particle mass concentrations were in the range 22.4-143.0 microg m(-3). On some days the fine particulate matter concentrations were more than two times greater than the proposed 24-h Federal standard of 65 microg m(-3). Ammonium nitrate was the largest component of fine particle mass at all three sites; 24-h average fine particulate ammonium plus nitrate concentrations ranged from 11.7 to 75.4 microg m(-3). A single air mass was studied as it passed the Diamond Bar air monitoring site in the morning and stagnated near Mira Loma in the evening of the same day. Between these two sites NO was oxidized to NO2, and the ammonia concentration increased by a factor of 5. A second air parcel trajectory, which stagnated near Mira Loma during the early morning and passed near the Riverside site approximately 24 h later, showed a decrease in ammonia concentration over time that is consistent with dilution as the air mass moved downwind from the source of ammonia in the dairy area. Particulate NH4NO3 concentration in that air parcel remained approximately constant over time, consistent with a continued excess of NH3 relative to HNO3 downwind of the dairy area.

Evaluation of an air quality model for the size and composition of source-oriented particle classes.

Air quality model predictions of the size and composition of atmospheric particle classes are evaluated by comparison with aerosol time-of-flight mass spectrometry (ATOFMS) measurements of single-particle size and composition at Long Beach and Riverside, CA, during September 1996. The air quality model tracks the physical diameter, chemical composition, and atmospheric concentration of thousands of representative particles from different emissions classes as they are transported from sources to receptors while undergoing atmospheric chemical reactions. In the model, each representative particle interacts with a common gas phase but otherwise evolves separately from all other particles. The model calculations yield an aerosol population, in which particles of a given size may exhibit different chemical compositions. ATOFMS data are adjusted according to the known particle detection efficiencies of the ATOFMS instruments, and model predictions are modified to simulate the chemical sensitivities and compositional detection limits of the ATOFMS instruments. This permits a direct, semiquantitative comparison between the air quality model predictions and the single-particle ATOFMS measurements to be made. The air quality model accurately predicts the fraction of atmospheric particles containing sodium, ammonium, nitrate, carbon, and mineral dust, across all particle sizes measured by ATOFMS at the Long Beach site, and in the coarse particle size range (Da > or = 1.8 microm) atthe Riverside site. Given thatthis model evaluation is very likely the most stringent test of any aerosol air quality model to date, the model predictions show impressive agreement with the single-particle ATOFMS measurements.