Berm design to reduce risks of catastrophic slope failures at solid waste disposal sites.

Existing waste disposal sites are being strained by exceeding their volumetric capacities because of exponentially increasing rates of municipal solid waste generation worldwide, especially in densely populated metropolises. Over the past 40 years, six well-documented and analyzed disposal sites experienced catastrophic failure. This research presents a novel analysis and design method for implementation of a series of in-situ earth berms to slow down the movement of waste material flow following a catastrophic failure. This is the first study of its kind that employs a dynamic landslide analysis model, DAN-W, and the Voellmy rheological model to approximate solid waste avalanche flow. A variety of single and multiple berm configuration scenarios were developed and tested to find an optimum configuration of the various earth berm geometries and number of berms to achieve desired energy dissipation and reduction in total waste material runout length. The case study application of the novel mitigation measure shows that by constructing a series of six relatively inexpensive 3 m high earth berms at an optimum distance of 250 m from the slope toe, the total runout length of 1000 m and associated fatalities of the Leuwigajah dumpsite catastrophic failure in Bandung, Indonesia, could have been reduced by half.

Virtual ileostomy following rectal cancer surgery: a good tool to avoid unusefull stomas?

BACKGROUND/AIMS: Anastomotic leak is a life threatening complication following surgery for rectal cancer below peritoneal reflection. Colostomy or ileostomy following colorectal or coloanal anastomosis protect the patients from general peritonitis or sepsis secondary to anastomotic leak. METHODOLOGY: In this paper the experience of the last 100 cases of rectal cancer below the peritoneal reflection treated from 2004 to 2010 was reviewed. RESULTS: In 79 cases, primary anastomosis was performed. In 44/79 cases virtual ileostomy was prepared and in 35/79 cases, based on risk factors and intraoperative decision of the surgeon, an open ileostomy was performed. In 8/44 cases virtual ileostomy was opened, thus avoiding in 35/79 cases a second operation. CONCLUSIONS: The goal for a good clinical outcome of patients with virtual ileostomy is a strict postoperative follow-up focused on fever onset and quality of drainage discharge. In our experience virtual ileostomy is a good tool to avoid open ostomy at time of primary colorectal or coloanal anastomosis in a good number of cases.

Expression of Medicago truncatula genes responsive to nitric oxide in pathogenic and symbiotic conditions.

Nitric oxide (NO) is involved in diverse physiological processes in plants, including growth, development, response to pathogens, and interactions with beneficial microorganisms. In this work, a dedicated microarray representing the widest database available of NO-related transcripts in plants has been produced with 999 genes identified by a cDNA amplified fragment length polymorphism analysis as modulated in Medicago truncatula roots treated with two NO donors. The microarray then was used to monitor the expression of NO-responsive genes in M. truncatula during the incompatible interaction with the foliar pathogen Colletotrichum trifolii race 1 and during the symbiotic interaction with Sinorhizobium meliloti 1,021. A wide modulation of NO-related genes has been detected during the hypersensitive reaction or during nodule formation and is discussed with special emphasis on the physiological relevance of these genes in the context of the two biotic interactions. This work clearly shows that NO-responsive genes behave differently depending on the plant organ and on the type of interaction, strengthening the need to consider regulatory networks, including different signaling molecules.

Glutathione synthesis is regulated by nitric oxide in Medicago truncatula roots.

Glutathione (GSH) is one of the main antioxidants in plants. Legumes have the specificity to produce a GSH homolog, homoglutathione (hGSH). We have investigated the regulation of GSH and hGSH synthesis by nitric oxide (NO) in Medicago truncatula roots. Analysis of the expression level of gamma-glutamylcysteine synthetase (gamma-ECS), glutathione synthetase (GSHS) and homoglutathione synthetase (hGSHS) after treatment with sodium nitroprusside (SNP) and nitrosoglutathione (GSNO), two NO-donors, showed that gamma-ecs and gshs genes are up regulated by NO treatment whereas hgshs expression is not. Differential accumulation of GSH was correlated to gene expression in SNP-treated roots. Our results provide the first evidence that GSH synthesis pathway is regulated by NO in plants and that there is a differential regulation between gshs and hgshs in M. truncatula.

The sentinel lymph node in papillary cancer of the thyroid including histological subtype.

BACKGROUND: The aim of this work was to reveal through sentinel node study the intraoperative presence of preoperatively undetected pathological lymph nodes. MATERIALS AND METHODS: At the Surgical Science Department of La Sapienza University of Rome The Authors studied from January 2003 to June 2004 18 patients with papillary carcinoma of the thyroid, who presented no clinical evidence of lymph node metastasis; they performed a total thyroidectomy in all cases, removing and histologically examining all lymph nodes of the upper anterior mediastinum. Where negative they were then subjected to immunohistochemical analysis with Pan Cytokeratin. RESULTS: The method was positive in 10 patients: 2 pure papillary carcinomas, 1 papillary carcinoma with poorly differentiated areas, 1 tall cell papillary carcinoma, 5 sclerosing carcinoma and 1 follicular variant papillary carcinoma; and negative in 8:5 pure papillary carcinomas, 2 sclerosing carcinoma and 1 case of follicular variant papillary carcinoma. Lymph node micrometastasis was found in 2 cases through study with Pan Cytokeratin on final histological examination. CONCLUSIONS: Analysis of the Authors' preliminary data shows that sentinel lymph node detection has 83.3% sensitivity and 100% specificity for Upper Anterior Mediastinum lymph nodes. The Authors can propose two main applications: select for dissection only patients with a positive sentinel node and reduce the number of cases to be subjected to postoperative treatment with iodine ablation, in patients with "low risk" thyroid tumours and negative sentinel nodes.

Bilateral synchronous parathyroid carcinoma in a patient on long-term hemodialysis: presentation of a rare clinical case and review literature.

Synchronous bilateral carcinoma of the parathyroid in subjects undergoing prolonged hemodialysis is an extremely rare pathology. After observing a clinical case, we reviewed the literature on parathyroid carcinoma. We describe the clinical case of a 61-year-old man with synchronous bilateral carcinoma of the parathyroid. He had a long history of terminal renal insufficiency and had been undergoing hemodialysis for about 18 years before being referred to us with a diagnosis of secondary hyperparathyroidism. The patient underwent total parathyroidectomy and total thyroidectomy. The interoperative parathormone assay displayed a 68% decrease in parathyroid hormone (PTH) compared with baseline value, and the histologic examination of the two inferior parathyroid glands revealed the presence of invasive parathyroid carcinoma. After reviewing the case, we hypothesized that in the presence of chronic parathyroid stimulation, the hyperplasia of the gland may subsequently be transformed into carcinoma. In patients undergoing hemodialysis, the predominance of females in cases of carcinoma of the parathyroid might be accounted for by a hormonal mechanism or by statistical artifacts attributable to the small number of case histories available. Further analysis was made of the apparently favorable prognosis of this type of patient compared with sporadic parathyroid carcinomas; the mean follow-up period reported in the literature was 42.2 months, with a relapse rate of 15.8%.

Prognostic significance of the age factor in the thyroid cancer: statistical analysis.

BACKGROUND AND OBJECTIVES: To determine whether thyroid carcinoma in elderly patients presents any peculiar characteristics, whether the greater biological aggressiveness of the neoplasm modifies the surgical treatment selected, and whether age greater than 70 years represents an independent prognostic factor. METHODS: Retrospective analysis of case histories from the Department of Surgery of "La Sapienza" University of Rome; 403 patients subjected to total thyroidectomy between 1993 and 1999, with a minimum follow-up period of 3 years subdivided into three groups: group I (patients aged between 20 and 50 years), group II (patients aged between 51 and 70 years) and group III (patients aged >70 years). The surgical and postoperative treatment is uniform in all study groups. RESULTS: Age greater than 70 years entails a significant increase in mortality; the mortality rate in the three groups was found to be 3%, 9% and 54%, respectively. Prognosis is significantly worse in the elderly patients group (group III) than in group I (P < or = 0.001) and in group II (P < or = 0.001); group II mortality was significantly higher than that of group I (P = 0.005); in group III, the neoplasm displays features of greater biological aggressiveness (greater incidence of undifferentiated forms, presence of lymph nodes at diagnosis and vascular invasion, locally advanced forms, greater incidence of stage IV). CONCLUSIONS: Statistical analysis shows that the greater biological aggressiveness of the neoplasm in elderly patients worsens the prognosis, although an age exceeding 70 years itself represents an unfavourable prognostic factor; total thyroidectomy does not present any counter-indications in elderly patients.

Epithelioid haemangioendothelioma of the parotid salivary gland: a case report.

Haemangioendothelioma is a vascular tumour characterised by the proliferation of endothelial cells with an epithelioid appearance. The behaviour of this neoplasm is intermediate between haemangioma and angiosarcoma. It may be localised in a wide range of sites, with a preference for soft and bone tissue. It is only rarely localised in the head and neck and even more rarely in the salivary glands. We describe a case of haemangioendothelioma in a 28-year-old man that originated in the retroneural region of the parotid gland, compressing the gland tissue and posteriorly infiltrating the muscular plane. A total parotidectomy surgical operation including the removal of lymph nodes in the region was performed followed by radiotherapy. An immunohistochemical investigation, carried out using the oxidase-antiperoxidase method, indicated that the neoplastic elements of the marker of the endothelial cells CD34 were positive for vimentine and for muscle-specific actin, showing a moderate proliferative action of the cellular elements with MIB-1 positivity estimated at around 6%. The peculiarity of the case we describe resides in the rarity of the haemangioendothelioma localisation in the parotid gland.

Synchronous bilateral renal tumour: a case report.

We report a case of synchronous bilateral renal carcinoma treated by partial nephrectomy on the right and total nephrectomy on the left. Follow-up at 42 months after surgery showed no recurrence of the disease. The increasing use of diagnostic imaging techniques such as ultrasound tomography, computerised tomography and nuclear magnetic resonance now allows even small-sized renal formations to be identified. Synchronous bilateral renal tumour has a favourable prognosis, especially when compared with single or asynchronous renal tumours. The recommended intervention is total monolateral nephrectomy combined with partial nephrectomy. The treatment of neoplasms at a more advanced stage, of such a nature as to necessitate bilateral nephrectomy or chemotherapy, results in a significant increase in mortality. Recently, biological therapy has been proposed as a more promising short-term option using interferon-alpha (IFN-alpha) and gamma.

Parotid gland tumours. Our experience and a review of the literature.

In this study the authors examine the experience of their department in treating parotid tumours, evaluating in particular the various surgical techniques as a function of the prognosis and the incidence of relapses. Between 1 January 1970 and 31 December 2002, 336 patients with parotid tumour were observed in the Department of Surgical Sciences of "La Sapienza" University in Rome. Two hundred and thirty-nine patients with benign tumours and 65 with malignant tumours were analysed. As far as histological forms were concerned, the benign forms presented a prevalence of pleomorphic adenomas (55.2%) and of Warthin's tumours (36.4%). In the case of malignant tumours, the highest incidence was found for mucoepidermoid carcinomas (29.3%). In the case of benign neoplasms, the surgical strategy opted for was preneural parotidectomy performed in 148 cases (61.9%). Relapsing pleomorphic adenomas were observed in 11.65% of patients controlled, and relapsing Warthin's tumours in 8.7%. In malignant tumours, total parotidectomy was performed in principle, with possible enlargement modulated as a function of tumour stage; owing to causes related to the neoplasm, 18 patients (38.3%) died. In the treatment of benign parotid tumours, preneural parotidectomy is the preferred surgical strategy as it significantly reduces the relapse rate and, when performed by skilled surgeons, is characterized by a complication rate comparable to that of conservative surgery. In the treatment of malignant tumours, total parotidectomy is the basic procedure; extension of the action and the use of ancillary techniques are dependent on tumour stage.