Risk Evaluation of Pollutants Emission from Coal and Coal Waste Combustion Plants and Environmental Impact of Fly Ash Landfilling.

Emission factors (EFs) of gaseous pollutants, particulate matter, certain harmful trace elements, and polycyclic aromatic hydrocarbons (PAHs) from three thermal power plants (TPPs) and semi-industrial fluidized bed boiler (FBB) were compared. EFs of particulate matter, trace elements (except Cd and Pb), benzo[a]pyrene, and benzo[b]fluoranthene exceed the upper limits specified in the EMEP inventory guidebook for all combustion facilities. The comparison of trace elements and PAHs content in fly ashes (FAs) from lignite and coal waste combustion in TPPs and FBB, respectively, as well as the potential environmental impact of FAs disposal, was performed by employing a set of ecological indicators such as crustal enrichment factor, risk assessment code, risk indices for trace elements, and benzo[a]pyrene equivalent concentration for PAHs. Sequential analysis shows that the trace elements portion is the lowest for water-soluble and exchangeable fractions. The highest enrichment levels in FAs are noticed for As and Hg. Based on toxic trace elements content, FAs from TPPs represent a very high ecological risk, whereas fly ash from FBB poses a moderate ecological risk but has the highest benzo[a]pyrene equivalent concentration, indicating its increased carcinogenic potential. Lead isotope ratios for Serbian coals and FAs can contribute to a lead pollution global database.

Clinical trials needed to evaluate compression therapy in breast cancer related lymphedema (BCRL). Proposals from an expert group.

AIM: A mainstay of lymphedema management involves the use of compression therapy. Compression therapy application is variable at different levels of disease severity. Evidence is scant to direct clinicians in best practice regarding compression therapy use. Further, compression clinical trials are fragmented and poorly extrapolable to the greater population. An ideal construct for conducting clinical trials in regards to compression therapy will promote parallel global initiatives based on a standard research agenda. The purpose of this article is to review current evidence in practice regarding compression therapy for BCRL management and based on this evidence, offer an expert consensus recommendation for a research agenda and prescriptive trials. Recommendations herein focus solely on compression interventions. METHODS: This document represents the proceedings of a session organized by the International Compression Club (ICC) in June 2009 in Ponzano (Veneto, Italy). The purpose of the meeting was to enable a group of experts to discuss the existing evidence for compression treatment in breast cancer related lymphedema (BCRL) concentrating on areas where randomized controlled trials (RCTs) are lacking. RESULTS: The current body of research suggests efficacy of compression interventions in the treatment and management of lymphedema. However, studies to date have failed to adequately address various forms of compression therapy and their optimal application in BCRL. We offer recommendations for standardized compression research trials for prophylaxis of arm lymphedema and for the management of chronic BCRL. Suggestions are also made regarding; inclusion and exclusion criteria, measurement methodology and additional variables of interest for researchers to capture. CONCLUSION: This document should inform future research trials in compression therapy and serve as a guide to clinical researchers, industry researchers and lymphologists regarding the strengths, weaknesses and shortcomings of the current literature. By providing this construct for research trials, the authors aim to support evidence-based therapy interventions, promote a cohesive, standardized and informative body of literature to enhance clinical outcomes, improve the quality of future research trials, inform industry innovation and guide policy related to BCRL.

Does the addition of ketorolac and dexamethasone to lidocaine intravenous regional anesthesia improve postoperative analgesia and tourniquet tolerance for ambulatory hand surgery?

BACKGROUND: The inability to provide effective postoperative analgesia is one of the major disadvantages of intravenous regional anesthesia (IVRA). We designed a prospective, randomized, double blind study to evaluate the analgesic effectiveness of adding both ketorolac and dexamethasone to lidocaine for IVRA. METHODS: The study involved 45 patients undergoing ambulatory hand surgery. They were randomly allocated into three groups: Group L, Group LK and Group LDK. Group L received 3 mg x kg-1 lidocaine; Group LK received 3 mg x kg-1 lidocaine + 30 mg ketorolac; and Group LDK received 3 mg x kg-1 lidocaine for IVRA + 8 mg dexamethasone + 30 mg ketorolac for IVRA using a 40 mL solution. Sensory and motor block onset and recovery times were recorded. Tourniquet pain and pain at the operative site were assessed by a visual analog scale. In the first 24 h after surgery, opioid requirements and total analgesic consumption, including side effects, were noted. RESULTS: Sensory and motor block onset and recovery times were similar in all groups. Patients in Groups LK and LDK required less alfentanyl for control of intraoperative and early postoperative pain. Further, patients in Groups LK and LDK reported significantly lower pain scores compared to those in Group L (P<0.001). Patients in Groups LK and LDK required fewer postoperative ketorolac tablets (2.2+/-1.6 and 1.3+/-0.6 tablets, respectively) in the first 24 h after surgery and had significantly longer periods during which they required no analgesics (524 min and 566 min, respectively) compared to those in Group L (3.8+/-1.3 tablets; 122 min, P<0.001). CONCLUSION: IVRA with lidocaine and with the inclusion of ketorolac and dexamethasone provides effective perioperative analgesia for patients undergoing ambulatory hand surgery, when compared to the use of lidocaine alone or lidocaine with ketorolac IVRA.

Can a patient be successfully prepared for pheochromocytoma surgery in three days? A case report.

The case of a patient who insisted on urgent surgical removal of a pheochromocytoma is presented. Rapid preparation started with continuous infusion of urapidil 3 days before surgery. On the evening before the operation, an additional infusion of magnesium sulphate was started. The target of preoperative optimization was to maintain blood pressure <140/90 mm Hg and heart rate <100 beats min(-l). Anesthesia was induced with fentanyl, propofol and rocuronium and maintained with sevoflurane in 100% oxygen and continuous infusion of fentanyl. Hypertensive events were treated by continuous infusions of urapidil and magnesium sulphate. Just before tumor resection, additional boluses of urapidil and MgSO4 were administered; both fentanyl infusion and end tidal concentration of sevoflurane were increased. Blood pressure was well maintained through the anesthesia; no transient periods of hypotension after tumor removal were observed. The patient's peroperative course was uneventful. He was discharged home without antihypertensive medication on the 5th postoperative day. This case demonstrates that with urapidil and magnesium sulphate administration rapid preparation for pheochromocytoma resection can be successfully achieved within 3 days.

Coagulation status and the presence of postoperative deep vein thrombosis in patients undergoing laparoscopic cholecystectomy.

BACKGROUND: Venous thromboembolism is a relevant social and health care problem because of its high incidence among patients who undergo surgery (20-30% after general surgical operations and 50-75% after orthopedic procedures), its pulmonary embolism-related mortality rate, and its long-term sequelae (postthrombotic syndrome and ulceration), which may be disabling. This study aimed to determine the coagulation status and the presence of postoperative deep vein thrombosis (DVT) in patients undergoing laparoscopic (LC) and open cholecystectomy (OC). METHODS: Prospectively, 114 patients were randomized into two groups. group 1 (58 patients undergoing LC) and group 2 (56 patients who are undergoing OC). The coagulation parameters (prothrombin time [PT], partial thromboplastin time [PTT], D-dimer, prothrombin F1 + 2, antithrombin III, and factor VII) were monitored preoperatively and during the operation, then 24 and 72 h after the operation. The patients in both groups underwent color duplex scan examination preoperatively, then 3 and 7 days after surgery to establish the presence of DVT. None of the patients in either group received thrombosis prophylaxis. RESULTS: In the LC group, postoperative DVT developed in four patients (6.9%; in the calf veins of 3 patients and in the popliteal vein of 1 patient). In the OC group, nine patients (16.07%) had postoperative DVT (in the calf veins of 7 patients and in the popliteal and femoral veins of 2 patients). The plasma levels of monitored parameters in the patients of both groups were altered, but the difference between the groups was not statistically significant. For the patients in both groups who experienced DVT, only the decrease of factor VII had statistical significance (p < 0.05). CONCLUSIONS: The incidence of postoperative DVT among the patients who underwent OC was higher than among the patients who underwent LC (p < 0.05). The decrease in factor VII among the patients who underwent surgery could be a potentially useful parameter indicating the patients at high risk for developing DVT.

Cortisol and immune measures in boars exposed to three-day administration of exogenous adrenocorticotropic hormone.

The aim of the study was to evaluate the effect of adrenal stimulation by adrenocorticotropic hormone (ACTH) on blood cortisol concentration and on circulating total and differential leukocyte counts during and in the 16 days after ACTH administration. Swedish Landrace boars aged approximately 6-7 months were used. ACTH-treated animals (n = 7) were given ACTH intravenously at 10 microg/kg body mass for 3 days. A control group of animals (n = 7) received 1 ml of sterile 0.9% saline intramuscularly. ACTH induced a highly significant increase (p>0.0001) in serum cortisol in treated boars. On the day after the last ACTH dose, the cortisol concentration was significantly higher, but the level of significance was lower than during ACTH administration (p>0.05). During ACTH treatment, a significant increase was recorded in total leukocyte count and neutrophil percentage (p>0.05 to p>0.0001), along with the increase in blood cortisol concentration, whereas percentage lymphocyte count showed a significant decrease. Lymphopenia disappeared upon cessation of treatment, but neutropenia developed in the week after treatment. On all three days of ACTH challenge, the neutrophil-to-lymphocyte ratio was significantly increased. An increase in eosinophil percentage was recorded on treatment days 1 and 2, whereas ACTH treatment had no effect on basophil percentage. In conclusion, three-day administration of ACTH to young boars during restraint caused effects similar to acute stress situations, as suggested by disappearance of the effects on immune function after the last drug dosage.

Axillary recurrence after modified radical mastectomy.

Optimal management for axillary recurrence is poorly understood. The aim of this study was to evaluate the risk factors for overall survival in the patients with axillary recurrence. Data of 1098 patients were collected from breast cancer registers from Clinic for Oncology Nis between 1990-1995. All patients underwent modified radical mastectomy. Axillary recurence was diganosed in 43 (3.92%) patients. Most patients were presented with a localized, palpable axillary mass 30 (69.77%). Cox multivariate analysis of prognostic factors for breast cancer-specific survival showed that node status HR 4.69 (1.50 to 14.72), tumor size HR 3.18 (0.90 to 11.26) and axillary radiotherapy HR 1.99 (0.69 to 5.75) had statistically significant effect on breast cancer mortality. Log-rank (54.21 p < 0.001) analysis showed significant difference for overall survival among women with a axillary recurrence based on different cancer stages. Tumor size and node status were the most important prognostic factors in women with axillary recurrence.

Primary omental liposarcoma presenting as an incarcerated inguinal hernia.

Herein, we present a case of primary liposarcoma of the omentum found in an incarcerated inguinal hernia in a 52-year-old male patient. The patient was admitted to our hospital in June 2000 with sudden onset of left-sided abdominal and groin pain of 12 hours' duration with a large, irreducible inguinal hernia. This was not associated with nausea or vomiting. An emergency operation was performed, and in the hernia sac the tumor, arising from the greater omentum, was found. After we opened the transversal fascia and peritoneum, the tumor was resected with a block of the greater omentum, and hernioplasty was performed using Shouldice's method. The histopathological diagnosis of resected tumor showed myxoid type liposarcoma. In the English medical literature, omental liposarcoma has never before been reported as the content of a hernia sac.

[Correlation of diagnostic procedure with surgical findings in carotid stenosis]. / Korelacija dijagnostickih procedura sa operativnim nalazom kod karotidnih stenoza.

Authors are discussing dilemma about necessary diagnostic procedure in making decision for surgical treatment of the carotid disease. Attitudes are changing and the old opinion of the necessity for angiogram of extra cranial blood vessels is substituted by the opinion that CDS (Color Duplex Scan) is satisfactory in the majority of cases to indicate of the surgical treatment. Comparing the invasive and noninvasive diagnostic's with operative findings, authors empirically confirm the given hypotheses, looking back to the cases where angiogram is necessary. The following issues were discussed: Estimate of the locaton of maximal shrinking, degree of shrinking, length of shrinking and characteristics of plaque as the most important parameters for indication and operative tactics. Diagnostics with CDS is shown as reliable with high degree of matching with operative findings.

[D-dimer in the early detection of deep vein thrombosis in the lower extremity]. / D-dimer u ranom otkrivanju tromboze dubokih vena donjih ekstremiteta.

Deep vein thrombosis is important social and health care problem for its high incidence, pulmonary embolism-related mortality, and long-term sequelae which may be disabling (post-thrombotic syndrome and ulceration). The aim of our work was to determine the diagnostic potential and importance of D dimer in the early detection of deep vein thrombosis of lower extremities. Prospectively we have analyzed a group of 47 patients who were admitted to vascular department of Surgical Clinic in Nis during the period from 1.8.2001. to 31.3.2003. with echosonographically verified deep vein thrombosis of no more than 48 hours of duration. D dimer was measured before anticoagulant treatment started using commercial Nycomed test. The activation of coagulation process was detected with increase in D dimer values in 44 out of 47 examined patients (93.61%). D dimer is highly sensitive diagnostic tool that should be routinely used in the patients with suspected deep vein thrombosis of leg.

[Reconstruction of large defects of the abdominal wall using dermal and synthetic grafts]. / Rekonstrukcije velikih defekata trbusnog zida primenom koznog i sintetskog grafta.

Large defects of abdominal wall (greater than 8 cm in diameter) related to different cause, are still difficult problem of modern surgery. The best results in order to obtain safe and permanent anatomical and functional abdominal wall integrity are reached by autogenous dermal and synthetic grafts. Controversies concerning quality of these procedures are still presents. Our work is based on two equal experimental groups of 20 Vister rats each, with large artificial abdominal wall defects: one treated with autogenous dermal graft, another with synthetic Mersilene mesh graft. The animals from both groups were sacrificed in previous planned time intervals (3rd, 7th, 14th and 48th days). Afterwards detailed microscopic and gross examination of abdominal wall reparation and quality of reconstructed abdominal wall defects had been performed. According to our results both methods are easy to be performed and safety surgical procedures. Overestimated usage of synthetic grafts should be diminished because of advantages of autologous dermal graft--availability, substitution of firmly fibrosis tissue and endurance against infection.

[Experimental and clinical possibilities of transplantation of the injured and totally devascularized spleen]. / Eksperimentalne i klinicke mogucnosti transplantacije konkvasirane ili totalno devaskularizovane slezine.

The most severe spleen lesions with conquasation and devascularisation of entire organ, when it is practically impossible to do any preservating surgical procedure, are the true indications for the transplantation of this extremely important immunological organ. We have performed the evaluation of the surgical procedure of heterotopic auto transplantation in the 30 dogs with severe spleen lesions. Simulation of totally devascularized spleen with the lesions of V degree was performed by disrupting all segmental blood vessels with deep and long longitudinal transhilar incision. During the 3 months follow-up period, animals were subjected to numerous explorations in order to macroscopically and histologically valuate the implant. In most cases (80-85%) implants had complete vitality with the preservation of normal tissue architecture, while 15-20% of implants had partial or total fibrosis. There were no mortality and no complications after this preservation procedure. The presence of fibrosis in some implants suggests that the implant preparation should be better performed and that transplantation of larger tissue volume is needed. Enriched with this experimental experience we have performed heterotopic auto transplantation in 2 patients with spleen lesion of V degree (car accident and injury at work) with very satisfactory results.

Synthesis and antiproliferative activity of epoxy and bromo compounds derived from estrone.

Based on biological properties of epoxyquinols from natural sources, bromo and epoxyquinols derived from estrone were synthesized and screened against Fem-X, HeLa and K(562) cell lines. Evidence was found that the bromine atom and the epoxy moiety significantly increase the antiproliferative activity within the series.

Mirror design for two-dimensional magneto-optic lenses and compressors.

A novel mirror arrangement that enables large interaction lengths between atomic beams and laser fields by use of a small amount of laser power is presented. Its application to focusing and compression of neutral atomic beams is discussed.

[Treatment of postmenopausal osteoporosis with 1-alpha(OH)D3]. / Lecenje postmenopauzne osteoporoze sintetskim analogom vitamina de-tri.

To evaluate the efficacy and safety of 1-alpha(OH) vitamin D3 in the treatment of postmenopausal osteoporosis, we conducted a six month prospective, double blind study in 20 postmenopausal women. Women were randomly divided into two groups. One group (n=12) received 1-alpha(OH) vitamin D3 (0.25 mcg twice a day), the other (n=8) received placebo. At the same time both groups received one calcium tablet (500 mg daily). In the group treated with 1-alpha(OH) vitamin D3, there was a significant increase in serum calcium (p<0.01), urinary excretion of calcium (p<0.05), and serum 1.25(OH)2 vitamin D3 concentracion (p<0.01), while parathyroid hormone levels showed tendency to fall without statistical significance. In the group treated with placebo and calcium, after treatment there was only a significant increase in serum calcium (p<0.01). In the placebo group occurrance of one new vertebral fracture was recorded. There were no side effects during treatment in both groups. It was concluded that the administration of 1-alpha(OH) vitamin D3 is a safe and potentially efficient drug in the treatment of postmenopausal osteoporosis.

Oxidation of steroidal 5-en-3 beta-ols with Jones reagent in ether.

The two-phase oxidation of steroidal 5-en-3 beta-ol (via 5-en-3-ones) into corresponding 4-en-3,6-diones in diethyl ether with Jones reagent was investigated. It was found that the system Jones reagent/diethyl ether enables short reaction times and easy isolation of the obtained products. The exclusive abstraction of 4 alpha-hydrogen during oxidation, together with molecular mechanics (MM2), and semiempirical (PM3) calculations, suggest that boat conformation of ring A precedes the formation of corresponding radicals (or cations).

Oral health in SFR Yugoslavia in 1986.

A pilot oral health epidemiological survey using WHO assessment forms was conducted in Yugoslavia in the year 1986. The study population consisted of 2600 persons aged 6, 12, 15, 18, 35-44, and over 65 yr. The survey included 22 towns (11 developed and 11 underdeveloped) in the six Republics and two Provinces of Yugoslavia. The results showed the prevalence of dental caries in the Yugoslav population to be very high (98.7% in 12-yr-olds). The mean decayed, missing, and filled teeth (DMF) scores were as follows: 6.1 at age 12 yr, 9.6 at age 15, 10.9 at age 18, 18.0 at age 35-44, and 28.0 in persons aged over 65 yr. Assessment of the periodontal status showed calculus to be the predominant disorder in the age groups 18 and 35-44 yr, while loss of sextants prevailed in persons aged over 65 yr.