A physicochemical model for rationalizing SARS-CoV-2 concentration in sewage. Case study: The city of Thessaloniki in Greece.

Detection of SARS-CoV-2 in sewage has been employed by several researchers as an alternative early warning indicator of virus spreading in communities, covering both symptomatic and asymptomatic cases. A factor that can seriously mislead the quantitative measurement of viral copies in sewage is the adsorption of virus fragments onto the highly porous solids suspended in wastewater, making them inaccessible. This depends not only on the available amount of suspended solids, but also on the amount of other dissolved chemicals which may influence the capacity of adsorption. On this account, the present work develops a mathematical framework, at various degrees of spatial complexity, of a physicochemical model that rationalizes the quantitative measurements of total virus fragments in sewage as regards the adsorption of virus onto suspended solids and the effect of dissolved chemicals on it. The city of Thessaloniki in Greece is employed as a convenient case study to determine the values of model variables. The present data indicate the ratio of the specific absorption (UV254/DOC) over the dissolved oxygen (DO) as the parameter with the highest correlation with viral copies. This implies a strong effect on viral inaccessibility in sewage caused (i) by the presence of humic-like substances and (ii) by virus decay due to oxidation and metabolic activity of bacteria. The present results suggest days where many fold corrections in the measurement of viral copies should be applied. As a result, although the detected RNA load in June 2020 is similar to that in April 2020, virus shedding in the city is about 5 times lower in June than in April, in line with the very low SARS-CoV-2 incidence and hospital admissions for COVID-19 in Thessaloniki in June.

Influence of methotrexate on radiographic progression in rheumatoid arthritis: a sixty-month prospective study.

OBJECTIVE: To evaluate if methotrexate (MTX) can slow disease progression, as determined radiographically, in comparison to other disease modifying drugs in rheumatoid arthritis (RA) patients. MATERIALS AND METHODS: Pairs of hand and wrist radiographs from 30 patients treated with MTX and 30 treated with D-penicillamine (DP) were evaluated blindly and separately by two radiologists (A and B) using reference radiographs for scoring. A scale scoring similar to Larsen's standard radiographs with minor modifications was used. The radiographs studied were obtained at the beginning and 5 years after therapy in both groups. RESULTS: A significantly greater worsening was found in the DP-treated patients (p = 0.025), as compared to MTX patients. Methotrexate showed a slower rate of disease progression than DP. Furthermore, in the MTX group 15 patients remained radiographically stable, 9 worsened and 6 were healed. In contrast, in the DP group 22 patients remained radiographically stable, 8 worsened and none improved. CONCLUSIONS: The rate of radiographic progression in RA patients was lower in MTX-treated patients compared to those treated with DP. Six patients showed radiological improvement after MTX treatment. Therefore, it seems that MTX could be considered a disease modifying drug.

[Iatrogenic injuries to the distal ureter during gynecologic interventions]. / Les traumatismes iatrogènes de l'uretère pelvien dans les interventions gynécologiques.

Surgical injury to the ureter is an important problem that confronts the urologist, the gynecologist and the general surgeon. The authors report 20 cases of iatrogenic pelvic ureteral injuries (22 ureters) observed after gynecological surgery between January 1985 and January 1995. The ureter was injured during ligation of the lumbo-ovarian vascular pedicle because it was inadequately protected during the operation. Open surgery and double pigtail stent insertion using retrograde route were used for treatment. The iatrogenic ureteral injury was in 18 patients unilateral and in the remaining 2 patients both ureters were damaged. As regards treatment, the authors recommend immediate repair, whenever the lesion is noticed at operation. In the post-operative period, ureteral stent or double pigtail stent insertion using balloon dilatation or ureteroscope, may be a successful conservative treatment. If the damage is only diagnosed subsequently, they recommend a ureterovesical implantation, using the psoas hitch bladder procedure or the Boari-Cassati-Küss procedure if the lesion is in the lower ureter or a transuretero-ureterostomy if it is in the upper ureter.

[Endoscopic resection of a peri-stenotic fibrous callus of the urethra using Guillemin's method]. / La résection endoscopique du callus fibreux péristénotique de l'urètre selon la technique de Guillemin.

The results observed in a series of 40 patients treated for urethral stricture by endoscopic resection of the callus after internal endoscopic urethrotomy (Guillemin's technique) are presented. The mean age of the patients was 57 years, with a follow-up of five years. The authors obtained 80% (32 patients) of very good results for urethral strictures less than 1 cm long. The success rate of the technique was 10% (4 patients) when the callus was between 1 and 2 cm long. The recurrence rate was high for strictures longer than 2 cm (4 patients) (10%). Complications consisted of 2 cases of acute epididymitis, 2 cases of urethral perforation, 2 cases of urethral haemorrhage, 2 cases of perineal haematoma and 3 cases of meatal stenosis. The indications of this original technique therefore depend more on the length of the urethral stricture than on its topography or its aetiology.

[Internal urinary diversion in pelvic cancers and quality of life. Value of double "J" endoprosthesis]. / Dérivation urinaire interne en cancérologie pelvienne et qualité de vie. L'intérêt des endoprothèses double "J".

The ureteral double pigtail stents are versatile and valued for proper urinary drainage in the setting of trauma, fistula formation, after extra-corporeal shock wave lithotripsy (ESWL) and surgical manipulations of the upper urinary tract. Also they are used for prolonged urinary drainage in patients with chronic tumor-induced ureteral obstruction, and present an exceptional patient tolerance. The authors' experience is based upon 54 patients treated for ureteral obstruction of malignant origin between January 1989 and October 1995. Complications of this method as well as the quality of life of these patients are analysed and the results compared with those of the literature. The patient tolerance was excellent. Mean survival time after ureter catheterisation was 18 months. Complete urine diversion was achieved and hydronephrosis disappeared soon after stent placement in 42 patients (80%). In addition hydronephrosis persisted in 12 cases (20%), despite orthotopic positioning of the catheter and numerous stent changes for larger caliber stents. The palliative use of the double pigtail stent when no other treatment is possible for malignant ureteral obstruction, precludes the need for ureterostomy and offers the patient a comfortable quality of life. Bladder disease is a contraindication to the use of these catheters, although their insertion is rarely impossible. In case of acute obstruction, it is better to prepare the pathway with a standard ureteral catheter, which is easier to manage. It is always possible to insert the pigtail stent after some time has elapsed.

The diagnostic value of xero-mammography in clinically occult breast carcinoma.

Seventy-four clinically occult breast carcinomas were detected in 7535 patients who were examined clinically and by xeromammography. The criteria by which a diagnosis of clinically occult breast carcinoma was established are described in detail. The most frequent finding of a clinically occult breast carcinoma in the xeromammogram was an irregular mass density 1 cm in diameter or less with microcalcifications. Axillary lymph node metastases were present in 29.7% of the total group of patients, which is much fewer than what might have been expected if the carcinomas had been discovered by palpation during the clinical examination or by the patient herself. This means a better prognosis and a lower death rate from breast carcinoma. Screening xeromammography is encouraged for all women after the age of 40, especially for those who belong to the high-risk group, even though they are quite asymptomatic, as there is hope of detecting cancers before they become palpable.

[Radiologic findings on crohn's disease of the adult (author's transl)]. / Radiologische Befunde beim Morbus Crohn im Erwachsenenalter.

Roentgen signs of 42 patients with Crohn's disease are reported. Characteristic features are stenosis [30], fistulas (30), cobble-stone formation (14), asymetry of lesions (12), and thickening of the mucosal wall (10). Main locations are the ileum, predominantly its terminal part (32). The frequency of colon involvement has increased compared with earlier publications. 1 fistula between colon and urinary bladder is described as a rare type of tract formation. In comparison with a study of Hanke et al. (1978) in children there is no significant change in frequency distribution reported.

Indications and use of abdominal angiography in trauma.

A series of 148 angiographic examinations in patients with blunt abdominal trauma have been reviewed. The major indications for arteriography were: (1) manifestations of shock in conjunction with clinical signs of abdominal injury; (2) the necessity for differentiation of multiple abdominal injuries; and (3) clinical signs of delayed rupture. Few false positive or false negative results were noted. The typical angiographic findings are discussed.

[The value of galactography in the secreting breast]. / Die Bedeutung der Galaktgraphie bei der sezernierenden Mamma.

At the Institutes for Diagnostic Radiology of the Universities of Athens (Greece) and Freiburg/Br. (West Germany) the mammographic examination had to be supplemented in 4 res. 2 per cent by injection of contrast medium into the milk ducts (galactography). This procedure is indicated in cases with secreting of the mammary glands. Technic and results are presented. Recognition of small, non-palpable tumors which might not be detected by mammography alone is emphasized.

Pedunculated cirrhotic hamartoma of the liver.

A case of pedunculated cirrhotic hamartoma suspended from the lower surface of the liver is reported. The diagnosis was suggested by angiography. The tumor was surgically excised.