Characterization, classification and stabilization of industrial wastes for hazard property HP3: Flammable self-heating; assessment and evaluation of 50 industrial wastes.

A pilot assessment procedure is introduced and used for the self-heating behavior of 50 industrial wastes based on UN N. 4 test and their subsequent classification as hazardous or non-hazardous, according to the Waste Framework Directive (WFD). When a waste contains self-heating substances it is classified as 'Hazardous Waste' by hazard property HP3: Flammable according to Regulation (EU) No 1357/2014. Self-heating is considered as a precursor stage to spontaneous ignition and fire under certain circumstances, with environmental effects and both human and property losses. The influence of the following parameters on the self-heating nature of the industrials wastes was assessed: temperature, granulometry and moisture. It was demonstrated that although some wastes are classified as absolute non-hazardous (ANH), they may still exhibit self-heating and thus must be classified as hazardous by HP3. It seems that there is a gap between the definition of hazardous waste according to WFD and the entry type of List of Wastes (LoW), regarding the ANH entries. This was found to be the case with two of the wastes examined. Finally, for a waste exhibiting self-heating, experiments were performed with addition of inert material, in order to secure safe management of the waste.

Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy.

BACKGROUND: Block of parietal nociceptive afferent nerves using continuous wound infiltration with local anaesthetics may be beneficial in multimodal postoperative pain management. The effectiveness of continuous wound infusion of ropivacaine for postoperative pain relief after open nephrectomy was analysed in a prospective, randomized, double-blinded, placebo-controlled trial. METHODS: One hundred and sixty-eight patients were randomized to either 0.5% ropivacaine (ON-Q group) or 0.9% NaCl (control group), using an elastomeric pump which delivered 4 ml h(-1) over 48 h through two multiholed Soaker catheters placed between the transverse and the internal oblique muscles and the s.c. space. All patients received a standard postoperative pain management protocol, including patient-controlled analgesic morphine and ketorolac. Outcomes measured over 48 h after operation were visual analogue scale (VAS) and incident (i) VAS pain scores, morphine consumption, and side-effects; time to bowel function recovery; and mean length of hospitalization. RESULTS: Side-effects were similar between the two groups. VAS and i-VAS pain scores, morphine consumption [11.5 (0.27) vs 21.8 (0.37) mg; P<0.001], time to bowel recovery [21.8 (0.4) vs 33.6 (0.9) h; P<0.001], and mean length of hospitalization [2.1 (0.03) vs 3.2 (0.1) days; P<0.001] were significantly reduced in the ON-Q group. Cost analysis revealed an overall savings of approximately 273 euros per patient in the ON-Q group. CONCLUSIONS: Continuous surgical wound infusion with ropivacaine improved pain relief and accelerated recovery and discharge reducing overall costs of care.

Tracheotomy-related posterior tracheal wall rupture, trans-tracheal repair.

Laceration of the membranous part of the tracheo-bronchial tree is a rare complication that can occur after single lumen intubation, double-lumen intubation, percutaneous and surgical tracheotomy. The case of a 76-year-old male is presented in whom a posterior tracheal wall laceration, related to tracheotomy, was diagnosed and immediately treated at the end of a head and neck operation. A 6 cm long laceration started 1.5 cm below the tracheotomy level and ended 2 cm above the carina. The tear was closed from distal to proximal area via the tracheotomy opening with PDS 4/0 interrupted sutures using a thoracoscopic needle-holder. This original surgical technique is described in detail. In tracheotomy related tears, the fact that an opening in the trachea already exists and that the lesion rarely extends beyond the carina, should guide the surgeon to make every effort to repair the laceration through this already existing access.

Fluorouracil-alone versus high-dose folinic acid and fluorouracil in advanced colorectal cancer: a randomized trial of the Italian Oncology Group for Clinical Research (GOIRC).

One hundred eighty-one patients with measurable recurrent or metastatic colorectal cancer, who had not received prior chemotherapy, were randomized in a prospective controlled trial to receive 5-fluorouracil (5FU), 13.5 mg/kg, for five days (arm A) or high-dose folinic acid [Cyanamid-Lederle, Italy] (FA), 200 mg/m2, for five days and 5FU, 400 mg/m2 for five days (arm B). The treatments were repeated every four weeks. One hundred fifty-five patients were evaluable for response. The two arms were balanced for all potential prognostic factors studied. The response rate (CR+PR) was 18% in the 5FU arm and 16% in the 5FU plus FA arm. Median duration of response was 56 weeks for 5FU alone and 42 weeks for the combination (p = 0.48). Median time to failure (TTF) was 20 weeks for arm A and 21 for arm B (p = 0.62). Median survival was 62 weeks on the 5FU arm and 53 weeks on the FA plus 5FU arm (p = 0.14). Dose intensity (DI) delivered was the same in both arms. Diarrhea and mucositis were the most frequent adverse reactions in arm B; 20% of the patients in arm A and 38% of those in arm B experienced diarrhea (p = 0.008). Mucositis occurred in 34% of patients in arm A and 42% in arm B (p = 0.04). In general nausea and vomiting were moderate. Hematological toxicity was more severe in patients treated with 5FU alone: 31% in arm A and 14% in arm B developed leukopenia (p = 0.015). In the combination arm one patient died due to gastrointestinal and hematological toxicity after the seventh cycle. This study indicates that, in advanced colorectal cancer, the combination of high-dose FA and 5FU is not superior to 5FU alone when utilized at standard high-dose intensity.

[Randomized study on the use of propofol for anesthesia in intracranial tumors. Comparison with balanced anesthesia]. / Studio randomizzato sull'uso del propofol nell'anestesia dei tumori intracranici. Confronto con anestesia bilanciata.

There is currently no anesthesiological technique which enables volume, cerebral blood flow and spinal fluid pressure to be kept constant. The aim of the present study was to compare two techniques of anesthesia in patients with cerebral tumours: one of a balanced type (AB) and the other of a continuous ev type (AEC) using propofol in order to assess which guaranteed the greatest cerebral protection. The results of the study have shown that the use of propofol may represent a useful alternative in intracranial tumour surgery since changes in systolic pressure and heart rate observed during AEC anesthesia were statistically lower in comparison to AB anesthesia. No statistically significant differences were observed in relation to changes in diastolic pressure, PVC, ApCO2 and the incidence of bleeding or cerebral edema. The quality of awakening was better in patients in the AEC group in terms of renewed breathing and spontaneous motility, verbal response and space-time orientation.

Phase II study of interferon alpha-2a and dacarbazine in advanced melanoma.

Based on the report of some activity of combination therapy with dacarbazine (DTIC) and interferon alpha-2a (rIFN alpha-2a) in disseminated melanoma, we conducted a phase II study to determine the feasibility and efficacy in a large series of patients. DTIC was administered in 79 patients at the dose of 800 mg/m2 every 3 weeks and rIFN alpha-2a was given daily at the dose of 9 X 10(6) IU for the first 10 weeks and three times a week thereafter. Among the 75 evaluable patients, 25% achieved an objective response, with 8% complete and 17% partial remissions. The regression occurred within a mean time of 1.9 +/- 1.03 months from starting therapy and the mean duration of response was 8.2 +/- 4.2 months. The major side effects were vomiting, anorexia, fever, fatigue, and myalgia. There was one death related to sepsis after myelosuppression. In the other patients bone marrow and liver toxicities were not remarkable. Our data reveal that a combination regimen of rIFN alpha-2a with a cytotoxic agent has some therapeutic activity in the management of advanced malignant melanoma.