A polymer - zeolite composite for mixed metal removal from aqueous solution.

Heavy metals become inevitable pollutants that are toxic to life. Lots of treatment methods are available; adsorption is a cheap option. Metals are mostly found as mixtures in wastewaters. Taking this into account, a natural composite adsorbent aims to remove multiple heavy metals (Pb2+, Cu2+, Cd2+). Alginate was combined with clinoptilolite to form alginate - clinoptilolite (A-C) beads. First, factors influencing the removal efficiency of metals were investigated. Then, continuous column experiments were performed to evaluate the real application potential of the adsorbent. A-C beads preferably adsorbed Pb2+. Batch experiments showed metal uptake reached equilibrium after 24 hours and kinetics were compatible with the first-order. Also, pH values near neutral levels were observed to increase heavy metal removal. On the other hand, adsorption equilibrium was well described by the Langmuir model for Cu2+ and Cd2+ and by the Freundlich model for Pb2+. The highest heavy metal uptake was calculated as 2,145 mg /g A-C beads for Pb2+. Continuous column operations were suggested to apply low flow rates (<2 mL/min) and heavy metal concentration (<10 mg/L) for effectiveness. A-C beads can be a good candidate for mixed heavy metal removal composed of environmentally friendly and low-cost materials.

New Crosslinked Hyaluronan Gel, Intrauterine Device, or Both for the Prevention of Intrauterine Adhesions.

BACKGROUND AND OBJECTIVES: To compare the efficacy of 3 different techniques for prevention of adhesion reformation after hysteroscopic adhesiolysis in patients with moderate-to-severe intrauterine adhesions. Short-term assisted reproductive outcomes were also compared. STUDY DESIGN: Total of 72 cases were randomized to Lippes loop intrauterine device (IUD) only, IUD plus a new crosslinked hyaluronan (NCH) gel, or NCH gel only following hysteroscopic adhesiolysis. All cases received hormonal therapy and a second hysteroscopy was carried out. Endometrial thickness values were measured using transvaginal ultrasonography and American Fertility Society adhesion scores were noted during first and second hysteroscopy in all groups. Reproductive outcomes were also compared for those who received in vitro fertilization treatment. RESULTS: Transvaginal ultrasonography revealed significantly better endometrial thickness in the IUD+NCH (7.5 mm) and NCH-only groups (6.5 mm) than the IUD-only group (5 mm) (P < .001). All groups revealed enhanced but comparable American Fertility Society adhesion scores on second-look hysteroscopy. A total of 37 patients received in vitro fertilization treatment after surgical management of adhesions. Ongoing pregnancy rates after in vitro fertilization were 27%, 40%, and 36% in IUD, IUD+NCH, and NCH groups, respectively. However, the difference between the groups did not reach statistically significant difference. CONCLUSION: All interventions are of similar efficacy in the prevention of adhesion reformation after hysteroscopic adhesiolysis for moderate to severe intrauterine adhesions. However, better endometrial thickness values were observed in those who received NCH gel either alone or in combination with IUD. Assisted reproductive outcomes of both groups were comparable for ongoing pregnancy rates.

[Analgesia Nociception Index for perioperative analgesia monitoring in spinal surgery]. / Índice de analgesia/nocicepção para monitorização da analgesia perioperatória na cirurgia da coluna vertebral.

BACKGROUND AND OBJECTIVES: The Analgesia Nociception Index is an index used to measure the levels of pain, sympathetic system activity and heart rate variability during general anesthesia. In our study, Analgesia Nociception Index monitoring in two groups who had undergone spinal stabilization surgery and were administered propofol-remifentanil (Total Intravenous Anesthesia) and sevoflurane-remifentanyl anesthesia was compared regarding its significance for prediction of postoperative early pain. METHODS: BIS and Analgesia Nociception Index monitoring were conducted in the patients together with standard monitoring. During induction, fentanyl 2µg.kg-1, propofol 2.5mg.kg-1 and rocuronium 0.6mg.kg-1 were administered. During maintenance, 1.0 MAC sevoflurane+remifentanil 0.05-0.3µg.kg-1.min-1 and propofol 50-150µg.kg-1.min+remifentanil 0.05-0.3µg.kg-1.min-1 were administered in Group S and Group T, respectively. Hemodynamic parameters, BIS and Analgesia Nociception Index values were recorded during surgery and 30min postoperatively. Postoperative visual analog scale (VAS) values at 30minutes were recorded. RESULTS: While no difference was found between mean Analgesia Nociception Index at all times of measurement in both groups, Analgesia Nociception Index measurements after administration of perioperative analgesic drug were recorded to be significantly higher compared to baseline values in both groups. There was correlation between mean values of Analgesia Nociception Index and VAS after anesthesia. CONCLUSION: Analgesia Nociception Index is a valuable parameter for monitoring of perioperative and postoperative analgesia. In spine surgery, similar analgesia can be provided in both Total Intravenous Anesthesia with remifentanil and sevoflurane administration. Analgesia Nociception Index is efficient for prediction of the need for analgesia during the early postoperative period, and therefore is the provision of patient comfort.

Conservative management of hemorrhoids: a comparison of venotonic flavonoid micronized purified flavonoid fraction (MPFF) and sclerotherapy.

PURPOSE: To compare the results of the conservative management of hemorrhoids between venotonic flavonoid micronized purified flavonoid fraction (MPFF) and sclerotherapy, in terms of the subjective and objective outcome of patients after a follow-up period of 2 years. METHODS: One hundred and twenty-six patients who suffered from 1st-and 2nd-degree hemorrhoids were divided into 2 groups. The first (n = 64) and second (n = 62) groups underwent venotonic flavonoid MPFF (VF) and sclerotherapy (SCL). The Average Symptoms Score (ASS), Average Anascopy Score (AAS) and the subjective scale were used to assess the success of the treatments. RESULTS: A total of 113 patients agreed to participate in the follow-up study. ASS and AAS decreased in both of the groups in the first three visits (P < 0.05). At the end of the second visit, ASS and AAS significantly declined in the VF group. In addition, ASS and AAS decreased to the nadir level in the groups at the end of the 26th week. During the remaining time of the follow-up period, ASS showed a significant rise pattern in the VF group in comparison to the SCL group. The resolved and improved rate was significantly higher in the SCL group at the end of the study (P < 0.05). CONCLUSIONS: Sclerotherapy was a more efficient treatment modality than VF in the long-term follow-up. SCL also had an acceptable success rate in the short-term follow-up.

Serum tumor marker CA19-9 in the follow-up of patients with cystic echinococcosis.

BACKGROUND: The aim of this study was to compare results of the determination of carcinoembryonic antigen, carbohydrate antigens, alpha-fetoprotein, and human chorionic gonadotropin before and after surgical and pharmacologic treatment in patients with cystic echinococcosis (CE). METHODS: Serum samples were obtained from 40 CE patients (all with cysts in the liver) and from 10 sex- and age-matched healthy donors (control group). Serum samples were drawn (1) before (presurgical group) and after (postsurgical group, including a 3-month cycle of albendazole) surgical and pharmacologic treatment. Serum tumor markers were measured, and indirect hemagglutination assay was performed. RESULTS: In 90% of confirmed cases of CE, indirect hemagglutination assay was positive. Mean (SD) serum CA19-9 concentrations for all patients in the presurgical and postsurgical groups were 45.1 +/- 30 kU/L and 17.02 +/- 11 kU/L, respectively. CA19-9 concentrations were significantly greater in CE patients in the presurgical compared with the control group. Also, increased CA19-9 concentrations decreased significantly in the postsurgical compared with the presurgical group. CONCLUSIONS: A significant decrease in serum CA19-9 concentrations after surgical and pharmacologic therapy was demonstrated in the clinical follow-up of patients with CE (patients were tested 3 months after surgery). If our findings are confirmed and more-sensitive methods are developed for measuring serum CA19-9 concentrations, new and interesting perspectives will be gained for the monitoring and treatment of patients with CE.

Comparison of bariatric and non-bariatric elective operations in morbidly obese patients on the basis of wound infection.

BACKGROUND: Wound infection rates after various types of bariatric operations have been well described. The question of whether bariatric surgery increases wound infection rate compared with similar elective surgical procedures in obese patients has not been clearly answered. The purpose of this study was to investigate wound status of morbidly obese patients after elective general surgery. METHODS: A prospective evaluation was conducted of 141 morbidly obese patients undergoing bariatric (n=60) and non-bariatric elective general surgery operation of similar invasiveness (n=81) with the ASEPSIS wound surveillance method. RESULTS: Median age of patients undergoing non-bariatric elective surgery (51, 32-68) was significantly higher than patients exposed to bariatric surgery (39, 24-57). Patients undergoing bariatric surgery had higher BMIs (44.0, 35-52.5) compared to the others (38.4, 35-43). All patients enrolled in the study were followed for a 21-day period. At the 7th postoperative day, 9 patients in the bariatric surgery group developed infection (15%), whereas 13 patients (16%) in the non-bariatric surgery group suffered wound infection. Wound infection was still present in 2 patients (3.4%) in the bariatric surgery group and 3 patients (3.7%) in the non-bariatric surgery group at the 21st day. Risk factors for wound infection included history of coronary artery diseases, diabetes, chronic respiratory illness and malignant disease. CONCLUSION: Bariatric surgery does not cause an additional risk of postoperative wound infection in morbidly obese patients, compared to elective general surgical operations of the same invasiveness.

V-Y advancement flap closures for complicated pilonidal sinus disease.

BACKGROUND AND AIMS: Hair entry into the midline is the generally accepted theory in pilonidal sinus formation. This theory is also involved in the pathogenesis of the recurrence after different types of operations for pilonidal sinus disease. The relationship of the suture lines and the midline was evaluated in this study. PATIENT AND METHODS: Thirty-four patients with stage 4 or recurrent pilonidal sinus disease who underwent V--Y advancement flap closure were randomized into two groups: vertical suture line unrelated to midline (VLUM, n=18) and vertical suture line related to midline (VLRM, n=16). RESULTS: None of the patients with or without a suction drain developed flap necrosis, local haematomas or seromas. The median length of the postoperative hospital stay was 3 days for theVLRM group and the VLUM group (p>0.05). The median follow-up period was 32 months. During the follow-up period, two recurrences were determined 22 and 15 months after operation in the VLRM group. Recurrences were situated in the scar tissue over the midline. INTERPRETATION AND CONCLUSION: Routine application of suction drains is not recommended after V--Y advancement flap closure. Avoidance of the relationship of the postoperative suture line and the midline, if possible, offers a safe method of definitive reconstruction.

Jejunal perforation in mentally retarded patient due to an ingested chicken bone.

We report a mentally retarded case with jejunal perforation by ingested chicken bone. Foreign body ingestion constructs a health threat for mentally retarded people. Under guidance of the literature, travel of the bones in the gastrointestinal tract, diagnosis and treatment strategies are evaluated.