Ground-Based Mobile Measurements to Track Urban Methane Emissions from Natural Gas in 12 Cities across Eight Countries.

To mitigate methane emission from urban natural gas distribution systems, it is crucial to understand local leak rates and occurrence rates. To explore urban methane emissions in cities outside the U.S., where significant emissions were found previously, mobile measurements were performed in 12 cities across eight countries. The surveyed cities range from medium size, like Groningen, NL, to large size, like Toronto, CA, and London, UK. Furthermore, this survey spanned across European regions from Barcelona, ES, to Bucharest, RO. The joint analysis of all data allows us to focus on general emission behavior for cities with different infrastructure and environmental conditions. We find that all cities have a spectrum of small, medium, and large methane sources in their domain. The emission rates found follow a heavy-tailed distribution, and the top 10% of emitters account for 60-80% of total emissions, which implies that strategic repair planning could help reduce emissions quickly. Furthermore, we compare our findings with inventory estimates for urban natural gas-related methane emissions from this sector in Europe. While cities with larger reported emissions were found to generally also have larger observed emissions, we find clear discrepancies between observation-based and inventory-based emission estimates for our 12 cities.

Dorsal pancreas agenesis and ductal adenocarcinoma: surgical implications of an extremely rare association.

It is presented the case of a 44-year-old woman with ductal adenocarcinoma of the pancreatic head with associated dorsal pancreas agenesis. In this case, curative intent surgery implies removal of the whole pancreas with its consequences--parental insulin requirement and exocrine pancreatic insufficiency. A review of the literature on the previously reported cases was performed.

Surgical treatment of chronic pancreatitis--a 14 years experience.

BACKGROUND: Operative treatment of chronic pancreatitis is indicated for patients with intractable pain after failed medical and endoscopic treatment, or in the presence of complications of the disease. AIMS: This study evaluates a single-center experience with operative management of chronic pancreatitis over a period of time of 14 years, regarding indication, surgical technique, early and late results. PATIENTS AND METHODS: The records of 265 consecutive patients who underwent surgery for chronic pancreatitis between 1995 and 2008 were retrospectively reviewed and analyzed. Long-term outcomes were assessed by patient survey, with a median follow-up of 40 months. RESULTS: 265 patients underwent 275 operations for chronic pancreatitis with the main indication abdominal pain (46.8%), followed by suspected malignancy in 24.8% and recurrent episodes of acute pancreatitis in 18.6%. Resection procedures 54.5% (150), drainage procedures 1.09% (3), bypass and denervation procedures 44.36% (122) and exploratory laparotomy 3.27% (9) were performed with an overall morbidity of 22% and an in-hospital mortality rate of 2.64%. After a median follow-up of 40 months survival information was available for 137 patients (51.69%) with a 5-and actuarial survival rate of 74.7% and quality of life improvement in most patients, especially in the resected group. CONCLUSION: Our results suggest that in chronic pancreatitis the type of surgery has to be individualized in each patient (resection VS drainage) and organ preserving operations are safe and effective in providing long-term pain relief and in treating CP-related complications

[Spleen preserving subtotal pancreatectomy for chronic pancreatitis: case report]. / Pancreatectomie subtotala cu prezervarea splinei pentru pancreatita cronica: prezentare de caz.

Subtotal pancreatectomy is an exceptional solution for the pain in chronic pancreatitis affecting the whole pancreas, which evolves with non-dilated Wirsung duct or in cases in which drainage procedures fail to achieve improvement of symptoms. If it is possible to avoid splenectomy, this type of surgical procedure enters in the modern concept of treatment of chronic pancreatitis named "organ sparing", basically being a Beger procedure combined with a distal pancreatectomy with spleen preservation. The case reported here is of a young male (29 years old) with idiopathic chronic pancreatitis progressively affecting the whole pancreas which had the main symptom the resistant pain to medical and non-resectional surgical treatment (left thoracoscopic splanchnicectomy at 4 years after diagnosis); at 8 years after diagnosis the pain becomes almost permanent, a cystic tumor is evolving in the body of pancreas and CA 19-9 tumor marker reaches values over 100 U/mL. In this context it was decided to perform a spleen-preserving subtotal pancreatectomy 95% (near total pancreatectomy) as the last therapeutic resource. The postoperative course was complicated with a biliary leak treated conservative and the patient was discharged in the 54th postoperative day. After 12 months the results are good regarding pain control, serum glucose levels and quality of life.

The impact of a resident's seniority on operative time and length of hospital stay for laparoscopic appendectomy: outcomes used to measure the resident's laparoscopic skills.

BACKGROUND: Laparoscopic appendectomy (LA) frequently is performed by residents during calls. This study aimed at evaluating residents' surgical skills using parameters of operating time, length of hospital stay (LOS), and conversion rate in correlation with the operating team's level of seniority. In addition, this study compared the operating time for LA with that for open appendectomy performed by the same teams, and identified deterministic factors that have an impact on such parameters. METHODS: All records of patients undergoing appendectomy performed by residents alone during a 32-month period were reviewed retrospectively. Eight residents were assigned to two levels of seniority: juniors 3 years (S). Operating time and LOS were compared between the three surgical teams, namely, J/J, J/S, and S/J as operating and assistant surgeons, respectively. Operating time, conversion rates, and LOS were compared for the same team combinations. RESULTS: Residents alone performed 341 (151 laparoscopic and 190 open) appendectomies during on-call hours. Four of the residents had been 3 years or less in residency (J), and four had been in residency more than 3 years (S). The overall mean operating time was 1.33 +/- 0.48 h for LA and 1.2 +/- 0.5 h for open appendectomy (p = 0.016). The operating time correlated with the level of training for both LA (J/J, 1.6 +/- 0.38 h; J/S, 1.41 +/- 0.37 h; S/J, 1. 25 +/- 0.4 h; p = 0.03, ANOVA) and open appendectomy (J/J, 1.53 +/- 0.89 h; J/S, 1.4 +/- 0.63 h; S/J, 0.86 +/- 0.45 h; p = 0.023, ANOVA). The mean LOS was 2.9 +/- 3.1 days for open appendectomy and 2.1 +/- 2.8 days for LA (p = 0.065), and was not different after operation by any of the teams (J/J, J/S, S/J) for either the open or the laparoscopic procedure. CONCLUSIONS: There is a distinct difference in the surgical skills of residents according to level of seniority, as primarily reflected by operating time. Laparoscopic appendectomy requires longer time to perform in a teaching setting, but the most deterministic factor that dictates operating time is the composition of the surgical team rather than the laparoscopic approach.

Comparative study of the suitability of three lichen species to trace-element air monitoring.

To investigate the suitability of three lichen species (Cetraria islandica, Evernia prunastri, and Ramalina farinacea) as transplants to trace-element air biomonitoring, they were exposed on substratum-free supports, from July 1996 until July 1997, in three European countries with different climates (Germany, Italy, Romania), at six sites with different types of air pollutants (two in each country). After 2, 4, 6, and 12 months of exposure, some portions of thallus were collected, prepared, and measured by instrumental neutron activation analysis (INAA) at the Institute of Physics and Nuclear Engineering in Bucharest and by energy dispersive X-ray fluorescence analysis (EDXRFA) at the University of Hohenheim in Stuttgart. Fifteen environmentally relevant elements: As, Br, Ca, Co, Cr, Cu, Fe, K, Mn, Ni, Pb, S, Sb, V, and Zn were determined. The analytical results were compared statistically. To study the distribution of the trace-elements between the lichens and the lichen throughfall water inside a virtual column, the throughfall water was collected under the lichen transplants during 6 and 12 months. The dried residues were analysed by INAA at Bucharest. The accumulating capacity for all investigated species is evident. For a comparative evaluation, the initial element contents, the "accumulation factors" relative to the bulk deposition, the interspecies "calibration factors", and the "retention efficiencies", defined as ratios of the lichen enrichment to the sum of this enrichment and the content in the lichen throughfall water, were considered. These criteria attest the best suitability for Evernia prunastri, followed by Ramalina farinacea and Cetraria islandica.

Metabolic effects of continuous veno-venous haemofiltration in critically ill patients.

OBJECTIVE: To evaluate the short-term metabolic and haemodynamic effects of continuous veno-venous haemofiltration (CVVH) in critically ill patients with acute renal failure (ARF). DESIGN: Prospective study of nine consecutive critically ill patients with established acute oliguric renal failure. SETTING: A general ICU in an 800-bed university hospital. PATIENTS: Critically ill patients, mean age 56 +/- 6 years. Four had multi-organ failure, one had acute haemolytic uraemic syndrome, one had idiopathic lactic acidosis, two had haemorrhagic pancreatitis and one had urinary sepsis. INTERVENTIONS: All patients were mechanically ventilated with arterial and pulmonary artery catheters in situ. MEASUREMENTS AND MAIN RESULTS: Oxygen consumption (VO2), CO2 production (VCO2) resting energy expenditure (REE), continuous blood pressure, heart rate, central venous pressure (CVP), pulmonary artery pressure (PAP), and cardiac output (CO), as well as tidal and minute volumes, end-tidal CO2 and arterial blood gases, were continuously measured for one hour prior to and one hour following the institution of CVVH. Body temperature, arterial blood pressure, heart rate, CVP and pulmonary artery catheter data remained stable throughout the study period. Prior to CVVH, VO2 was 326 +/- 33 ml/min, VCO2 was 245 +/- 27 ml/min and REE was 2241 +/- 231 kcal/24 hours. Following institution of CVVH, VO2 was 324 +/- 33 ml/min, VCO2 was 244 +/- 27 ml/min and REE was 2227 +/- 230 kcal/24 hours. CONCLUSIONS: CVVH does not affect metabolic rate and haemodynamic stability in critically ill patients. The lack of any effect on the metabolic rate and haemodynamic parameters in such patients may have significant clinical importance and it further attests to the suitability of CVVH for the treatment of critically ill patients.