Determination of metals by total reflection X-ray fluorescence and evaluation of toxicity of a river impacted by coal mining in the south of Brazil.

Metal (Fe, Mn, Zn, Ni, Cd, and Pb) concentrations in the region of Criciuma (Brazil), a region impacted by coal mining, were determined in water and sediments using total reflection X-ray fluorescence (TXRF) spectroscopy. Samples were collected from the Mãe Luzia River (south Brazil) at five different stations, from the source down to the river mouth (Ararangua estuary). Water and sediment toxicity were also evaluated using bioassays with Daphnia magna as the bioindicator. The metal present in the highest concentrations both in water (1.3-11 mg L(-1)) and in sediments (34-142 mg L(-1)) was iron. Results suggest an influence of coal mining on the aquatic receptors, showing a clear relationship between metal content (mostly Fe) and ecotoxicity.

Anastomotic stenoses occurring after circular stapling in esophageal cancer surgery.

BACKGROUND: Circular staplers have reduced the incidence of anastomotic leaks in esophagovisceral anastomosis. However, the prevalence of stenosis is greater with staplers than with manual suturing. The aim of this study was to analyze potential risk factors for the onset of anastomotic stenoses and to evaluate their treatment and final outcome. METHODS: Between 1990 and 1995, 187 patients underwent esophagectomy and esophagogastrostomy with anastomosis performed inside the chest using a circular stapler. RESULTS: Twenty-three patients (12.3%) developed an anastomotic stenosis. The incidence of strictures was inversely related to the diameter of the stapler. Concomitant cardiovascular diseases; morphofunctional disorders of the tubulized stomach, such as those related to duodenogastric reflux; and neoadjuvant chemotherapy were also recognized as significant risk factors. Endoscopic dilatations proved safe and were effective in the treatment of most anastomotic stenoses. CONCLUSIONS: To reduce the risk of anastomotic stenosis after stapled intrathoracic esophagogastrostomy, adequate vascularization of the viscera being anastomized should be maintained, and it is mandatory to use the largest circular stapler suitable. Furthermore, it is essential to reduce the negative inflammation-inducing effects of duodenogastroesophageal reflux to a minimum. Endoscopic dilatations are safe and effective in curing the great majority of anastomotic stenoses.

[Echo-sclerotherapy in the management of varices of the lower extremities]. / La sclerosi ecoguidata nel trattamento delle varici degli arti inferiori.

Sclerotherapy has been used with satisfactory results, for several years in the treatment of varicose veins. Nevertheless sometimes sclerosis can be incomplete because of the morphology of lower limbs or because the varicose disease is not clinically evident. In addition, sclerotherapy can give rise to severe complications due to intrarterial or extraluminal injections. In order to exceed this limits, some authors suggested to use a new technique, the echosclerotherapy, which was presented for the first time in Strasburg 1989 by Knight and Vin. Echosclerotherapy is a good help for traditional sclerotherapy, especially when it is applied in the sclerosis of the short saphenous veins, of perforating veins or in unfavourable anatomical situations. From May to November 1993 at the Second Surgical Department of Padua University, 31 patients, 29 women and 3 men, have been treated by echosclerotherapy. 25 patients had great saphenous varicose veins; 3 patients had varices due to perforating veins of the popliteal fossa and 3 patients varices due to Hunter perforating veins. In 48.4% of cases we obtained a complete sclerosis of the vessel; in 38.7% a stump remained near the sapheno-femoral junction of about two centimeters; in one case the treatment was not completed and in one case remained a stump of ten centimeters. Only in two cases Echosclerotherapy was not able to obtain sclerosis. None of the patients had major complications and nobody had deep vein thrombosis. If we consider our results altogether we can say that in 87% of cases we had good results.(ABSTRACT TRUNCATED AT 250 WORDS)

[Duplex study of primary venous insufficiency of the legs. First results and methodologic comparison]. / Studio duplex dell'insufficienza venosa primitiva agli arti inferiori. Primi risultati e confronto metodologico.

Primary venous insufficiency is a pathologic condition characterized by reflux in the deep venous system not secondary to phlebothrombosis. The authors compare the diagnostic capabilities of duplex and Doppler US in the evaluation of this condition. At present, Doppler US has a more widespread use than the duplex method. Both lower limbs were examined in 46 patients known to be affected with mono/bilateral primary venous insufficiency thanks to previous retrograde phlebography. Ten patients with different phlebopathies and 10 healthy volunteers were also studied as a control group, duplex US had 92% sensitivity and 90% specificity, while Doppler had 86% and 75%, respectively. Duplex US appeared to be more accurate than Doppler in locating and quantifying the reflux. Finally, the authors draw attention to the segmentary reflux phenomenon they observed in asymptomatic patients and suggest the possibility of recognizing the preclinic stage of this condition by duplex US, which is a non-invasive and relatively inexpensive method. The latter could become, thanks to its intrinsic characteristics, the method of choice for monitoring.

[The Duplex system in the follow-up of sclerosing therapy of the greater saphenous vein. First results and considerations]. / Il sistema Duplex nel follow-up della terapia sclerosante della vena grande safena. Primi risultati e considerazioni.

The authors evaluated the long-term results of sclerosing therapy as an alternative to surgery by means of high-resolution US and Doppler dynamic fluximetry (duplex system). Seventy patients (53 females and 17 males) were examined, all of whom fulfilled the clinical criteria of recovery and efficacy of sclerosing therapy. Average follow up was 20 months (range: 6-26). The results, compared with duplex findings before sclerosing therapy, demonstrated: a) persistence of reflux and absence of US signs of sclerosis (9/70 patients); b) evident sclerosis with persistent residual lumen and reflux of variable entity at the thigh (33/70) cases; c) incomplete sclerosis sparing the crosse, with physiological flow and disappearance of reflux (8/70 patients); d) nearly complete sclerosis with vasal lumen obliteration (20/70 cases). No changes were observed in the deep venous system after sclerosing therapy. The authors stress the advantages of the duplex system they employed as an instrumental support to clinics for a complete monitoring of sclerosing therapy.

[Use of a latissimus dorsi myocutaneous flap in locally advanced breast cancer]. / L'uso del lembo miocutaneo di gran dorsale nel carcinoma mammario localmente avanzato.

Locally advanced breast cancer has a poor prognosis. Skin infiltration, ulceration and invasion of the chest wall, in the absence of distant metastases, worsen dramatically the quality of life. The Authors report 4 cases of one time wide resection and reconstruction using a pedicled myocutaneous flap of latissimus dorsi. This technique allowed good and rapid palliation of local symptoms.