Investigations of the origins of estrogenic A-ring aromatic steroids in UK sewage treatment works effluents.

The present preliminary study describes an investigation of a putative aromatisation pathway in sewage from cholesterol through the corresponding A-ring aromatic steroid, norcholest-1,3,5(10)-trienol (NCT) to estrone. The synthesis and analytical characterisation of NCT and of the trimethyl silyl ether by gas chromatography-mass spectrometry, is described. The analytical properties of synthetic NCT were used to direct a search for the compound over several months in 1998 in the effluents of two sewage treatment works (STW; Deephams and Harpenden, north London). The study was prompted by the earlier findings that increased vitellogenin concentrations in the plasma of caged male rainbow trout held in the STW effluents (so-called fish 'feminisation') could be attributed to the presence of A-ring steroids such as estrone. Until now it has been assumed that these steroids originate from the STW influents and it is not clear to what extent, if at all, aromatisation of steroids might occur during STW operation. NCT was only detected in the solid particles associated with the effluents on one occasion in 8 months. This suggests that the hypothesised pathway is not a major one. Confirmation of previous reports of estrone and 17 beta-estradiol was also obtained using a published analytical method and by a simple modification of the method these reports were extended to include a regular occurrence of the weaker estrogen, 16 alpha-estriol in the case of Harpenden STW effluents in 1998.

Diverticulitis of the right colon.

The authors' experience with right-sided diverticulitis is reviewed. The symptoms among 18 patients were continuous right lower quadrant abdominal pain and periumbilical pain radiating to the right lower quadrant. Only three patients had nausea and vomiting. Twelve patients (67 per cent) had an abnormally high white blood cell count; three had granulocytosis. Barium enema examination was not a helpful diagnostic aid; and in only two patients was the preoperative diagnosis correct. The operative procedures undertaken were right colectomy with ileotransverse colostomy (15 patients), partial right colectomy with ileoascending colostomy (two patients), and diverticulectomy and appendectomy (one patient). There were no deaths; the average hospital stay was 14.2 days (range 5 to 30 days). The authors conclude that there is no characteristic clinical pattern pointing to this diagnosis; diagnostic maneuvers are usually unrewarding; right hemicolectomy is a safe and expeditious procedure; and open cecotomy is not favored, as recommended in the medical literature, to establish the diagnosis.