Application of aerobic microorganisms in bioremediation in situ of soil contaminated by petroleum products

Aerobic microorganisms able to biodegrade benzene, toluene, ethylbenzene, xylene (BTEX) have been isolated from an area contaminated by petroleum products. The activity of the isolated communities was tested under both laboratory and field conditions. Benzene, toluene, ethylbenzene and xylene were added to the cultures as the sole carbon source, at a concentration of 500 mg/L. In batch cultures under laboratory conditions, an 84% reduction of benzene, 86% of toluene and 82% of xylene were achieved. In cultures with ethylbenzene as the sole carbon source, the reduction was around 80%. Slightly lower values were observed under field conditions: 95% reduction of benzene and toluene, 81% of ethylbenzene and 80% of xylene. A high biodegradation activity of benzene (914 microM/L/24h), toluene (771 microM/L/24h), xylene (673 microM/L/24h) and ethylbenzene (644 microM/L/24h) was observed in the isolated communities.

Re-innervation pattern of the 'neovagina' created from the bladder flap in patients with Mayer-Rokitanski-Kistner-Hauser syndrome: an immunochemical study

BACKGROUND

Cystovaginoplasty (CVP) is a method of vaginal reconstruction in women with Mayer-Rokitansky-Kistner-Hauser Syndrome (MRKHS). The neo-vagina allows normal sexual intercourses, but after CVP, the sexual life of patients with MRKHS does not differ significantly from normal females. Therefore, we decided to elucidate the pattern of sensory re-innervation of the bladder flap used for the surgery.

METHODS

Biopsies were taken from vaginal vestibule and urinary bladder during the CVP and 1 year later in four patients with MRKHS. The following neurotransmitters were studied calcitonin gene-related peptide (CGRP), galanin (GAL), vasoactive intestinal polypeptide (VIP) and pituitary adenylate cyclase-activating peptide (PACAP).

RESULTS

CGRP and PACAP nerve fibres were sparse under the urothelium and in submucosal layer of the neovagina, they were more numerous around blood vessels and in the vicinity of smooth muscles. This was similar to the pattern observed in the urinary bladder. VIP- and GAL-positive nerve fibres were most numerous in the submucosa around blood vessels and in smooth muscle bundles of neovagina. They were distinctly less numerous beneath the epithelium. This innervation pattern mimicked that seen in normal vagina and in vaginal vestibule of patients with MRKHS.

CONCLUSIONS

Our findings demonstrate considerable nervous system plasticity in the bladder flap. Distribution of presumably sensory CGRP and PACAP immunoreactive nerve fibers was similar to the pattern observed within the intact bladder wall, and VIP or GAL immunoreactive nerve fibers (vasomotor functions) were distributed in a manner similar to that observed in the intact vaginal wall.

Seroprotection against serogroup C meningococcal disease in adolescents in the United Kingdom: observational study

OBJECTIVE

To determine the persistence of bactericidal antibody titres following immunisation with serogroup C meningococcal glycoconjugate vaccine at age 6-15 years in order to examine changes in persistence of antibodies with age.

DESIGN

Observational study.

SETTING

Secondary and tertiary educational institutions in the United Kingdom.

PARTICIPANTS

Healthy adolescents aged 11-20 years previously immunised between 6 and 15 years of age with one of the three serogroup C meningococcal vaccines.

INTERVENTION

Serum obtained by venepuncture.

MAIN OUTCOME MEASURES

Percentage of participants with (rabbit complement) serum bactericidal antibody titres of at least 1:8; geometric mean titres of serogroup C meningococcal serum bactericidal antibody.

RESULTS

Five years after immunisation, 84.1% (95% confidence interval 81.6% to 86.3%) of 987 participants had a bactericidal antibody titre of at least 1:8. Geometric mean titres of bactericidal antibody were significantly lower in 11-13 year olds (147, 95% confidence interval 115 to 188) than in 14-16 year olds (300, 237 to 380) and 17-20 year olds (360, 252 to 515) (P<0.0001 for both comparisons). Within these age bands, no significant difference in geometric mean titres of bactericidal antibody between recipients of the different serogroup C meningococcal vaccines was seen. More than 70% of participants had received a vaccine from one manufacturer; in this cohort, geometric mean titres were higher in those immunised at aged 10 years or above than in those immunised before the age of 10.

CONCLUSIONS

Higher concentrations of bactericidal antibody are seen five years after immunisation with serogroup C meningococcal vaccine at age 10 years or above than in younger age groups, possibly owing to immunological maturation. This provides support for adolescent immunisation programmes to generate sustained protection against serogroup C meningococcal disease not only for the vaccine recipients but also, through the maintenance of herd immunity, for younger children.

Geomicrobiological aspects of the oxidation of reduced sulfur compounds by photosynthesizing bacteria

The activity of photosynthesizing sulfur bacteria in a continuous culture was studied. The bacteria were isolated from the natural environment with the use of the Winogradski column. Isolated bacteria were cultured in synthetic medium and in the effluent from the column containig HS-. Sulphides, the main product of reduction of sulfates in phosphogypsum, were used by green sulfur bacteria in the photosynthetic column. Almost 70% reduction of the concentration of sulfides was observed. After the experiment, diffractometric methods where employed to analyze the sediment from the column.

A large germline deletion in the Chek2 kinase gene is associated with an increased risk of prostate cancer

BACKGROUND

Germline mutations in the Chek2 kinase gene (CHEK2) have been associated with a range of cancer types. Recently, a large deletion of exons 9 and 10 of CHEK2 was identified in several unrelated patients with breast cancer of Czech or Slovak origin. The geographical and ethnic extent of this founder allele has not yet been determined.

PARTICIPANTS AND METHODS

We assayed for the presence of this deletion, and of three other CHEK2 founder mutations, in 1864 patients with prostate cancer and 5496 controls from Poland.

RESULTS

The deletion was detected in 24 of 5496 (0.4%) controls from the general population, and is the most common CHEK2 truncating founder allele in Polish patients. The deletion was identified in 15 of 1864 (0.8%) men with unselected prostate cancer (OR 1.9; 95% CI 0.97 to 3.5; p = 0.09) and in 4 of 249 men with familial prostate cancer (OR 3.7; 95% CI 1.3 to 10.8; p = 0.03). These ORs were similar to those associated with the other truncating mutations (IVS2+1G-->A, 1100delC).

CONCLUSION

A large deletion of exons 9 and 10 of CHEK2 confers an increased risk of prostate cancer in Polish men. The del5395 founder deletion might be present in other Slavic populations, including Ukraine, Belarus, Russia, Baltic and Balkan countries. It will be of interest to see to what extent this deletion is responsible for the burden of prostate cancer in other populations.

A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma

OBJECTIVES

This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (<or=5 cm), solitary, low-stage N0 M0 tumour suspicious for renal cell carcinoma (RCC) and a normal contralateral kidney.

METHODS

541 patients were randomised in a prospective, multicentre, phase 3 trial to undergo NSS (n=268) or RN (n=273) together with a limited lymph node dissection.

RESULTS

This publication reports only on the complications reported for both surgical methods. The rate of perioperative blood loss<0.5l was slightly higher after RN (96.0% vs. 87.2%) and the rate of severe haemorrhage was slightly higher after NSS (3.1% vs. 1.2%). Ten patients (4.4%), all of whom were treated with NSS, developed urinary fistulas. Pleural damage (11.5% for NSS vs. 9.3% for RN) and spleen damage (0.4% for NSS and 0.4% for RN) were observed with similar rates in both groups. Postoperative computed tomography scanning abnormalities were seen in 5.8% of NSS and 2.0% of RN patients. Reoperation for complications was necessary in 4.4% of NSS and 2.4% of RN patients.

CONCLUSIONS

NSS for small, easily resectable, incidentally discovered RCC in the presence of a normal contralateral kidney can be performed safely with slightly higher complication rates than after RN. The oncologic results are eagerly awaited to confirm that NSS is an acceptable approach for small asymptomatic RCC.

Characteristics of Patients Presenting with LUTS/BPH in Six European Countries

OBJECTIVES

Knowledge of the clinical profile of the population with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) is important for health care management, impacting on manpower requirements, pharmacologic demands and health service costs. Data collected by the TransEuropean Research Into the Use of Management Policies for LUTS suggestive of BPH in Primary Health care project were used to profile 4979 patients from six European countries newly presenting with LUTS/BPH to general practitioners or office-based urologists.

METHODS

At recruitment, the clinician completed a questionnaire detailing the treatment provided, examination results, and covariates including age, initial symptom severity and comorbidities. The patient completed an International Prostate Symptom Score/quality-of-life questionnaire.

RESULTS

The majority of patients (77%) sought medical advice because of the bothersomeness of their symptoms, and presented at ages between 58 and 71 years. Small but statistically significant differences among countries were found in initial symptom severity, initial quality of life and age at diagnosis, but these are not thought to be clinically significant. There were marked national differences in patient management, with, for example, 10% of patients in France reporting no examinations, compared with 0.5% in Poland, while free-flow measurements varied from less than 1% in France to 35% in Poland.

CONCLUSIONS

Patient heterogeneity does not explain the differences in patient management among countries, which undoubtedly is the result of differences in health care traditions, infrastructure and socioeconomic factors, as well as patient preference.

[Palliative treatment of esophageal carcinoma]

The choice of the most beneficial method of the treatment of patients with esophageal cancer still remains a matter of debate. According majority of epidemiological reports only 10% of esophageal cancer patients has a chance for 5-year survival. Unfortunately, the curative surgical treatment is possible in relatively small number of patients, nevertheless esophagectomy is regarded as a principle method of treatment. Usually it referrers to the group of 50% of patients with locally advanced cancer. Thus, the management of the majority of esophageal cancer patients is palliative. Its main objective is to improve esophageal passage compromised by tumor narrowing esophageal lumen. Maintenance of esophageal passage facilitates food intake and usually postpones the stage of terminal cachexia and thus results in quality of life improvement. As it has been evident from up-to-date research currently used methods of palliative treatment do not significantly improve survival. In this paper we demonstrate a review of currently available methods of palliative treatment of patients with esophageal cancer and brief discussion on our own experience from last four years.

Impact of corticosteroids on the immune response to a MF59-adjuvanted influenza vaccine in elderly COPD-patients

The influence of steroids on the antibody response to a MF59-adjuvanted influenza vaccine in elderly COPD patients has not been studied previously. In the influenza season 2001/02 (October-February) elderly COPD patients were recruited at 14 doctor's offices and our 250-bed hospital. Patients were stratified into three groups according to current treatment regimen: (a) > 10 mg of prednisolone/day (SS); (b) inhaled steroids (IS); (c) no steroid treatment (control group, CG). All patients were vaccinated with the MF59-adjuvanted influenza vaccine. Antibodies against the influenza strains A/H1N1, A/H3N2, and B were measured at baseline, 4 and 24 weeks after vaccination by hemagglutination inhibition (HI) assay. One-hundred and sixty-two patients completed the study (CG n = 42; IS n = 87; SS n = 33). Mean age was 71.3 years (range 60-89). Twenty-one percent of all patients reported local reactions; no serious adverse events were observed. Four weeks after vaccination, mean geometric HI titres (GMT) for A/H1N1, A/H3N and B increased significantly in all groups (p < or = 0.05). After 24 weeks, GMTs to A/H1N1 and A/H3N2 returned to baseline, while GMTs to type B remained significantly higher than baseline in all groups. Significant differences between the groups as regards GMTs, seroconversion (56-89%) or seroprotection rates (64-93%) were not observed. Systemic steroids did not influence the antibody response towards the MF59-adjuvanted influenza vaccine. We found that the strains included in the vaccine showed varying long-term immunogenicity.

[The applicability of the ProSeal laryngeal mask airway for laparotomies]

OBJECTIVE

The ProSeal laryngeal mask airway (PLMA) has some design features, which in contrast to the classic LMA allow separation of the respiration from the gastrointestinal canal, a higher leak pressure and a better position assessment. It can be debated if these instrumental improvements justify the application of the PLMA for elective abdominal surgery in cases without aspiration risk. Insertion of airway instruments and gastric tube with regard to insertion time and difficulties and frequency of side effects were to be compared for the tracheal tube and the PLMA. The pharyngolaryngeal morbidity for both methods was also of interest. It was approached with direct and indirect postoperative interview techniques.

METHODS

65 patients were investigated both at the university hospital and at the hospital Neu-Bethlehem in Goettingen. The surgical intervention was a surgical or gynecological laparotomy. Anaesthesia was performed with a standardized application of propofol, alfentanil and rocuronium. Glycopyrroniumbromide was applied to minimize salivation. A total of 34 patients received the PLMA, 31 were intubated. All of them were provided with a gastric tube.

RESULTS

The insertion of the PLMA took 70 seconds (21 - 234) on average, the intubation 57 seconds (35 - 145). Endotracheal intubation was accomplished in a shorter time period, but there was no significant difference in comparison with the PLMA-group (p = 0.1924). Insertion of the PLMA was significantly more difficult than oral intubation (p = 0.0006). The base of the tongue and the dorsal pharyngeal wall, but not the vocal cords or the epiglottis were visible in those cases, where the PLMA could not be positioned at all. Here the tip of the cuff was bended. The time period for positioning of the gastric tube was 38 seconds (15 - 75) in the PLMA- and 57 seconds (22 - 219) in the tracheal tube group. With these results the gastric tube positioning was accomplished in a significantly shorter time period in the PLMA-group (p = 0.0267), but not at a significantly higher level of difficulty for endotracheal intubation (p = 0,6247). In one case there was regurgitation through the drainage tube without aspiration before gastric tube placement. At the direct interview 16 patients in the PLMA-group and 23 of the tube group mentioned postoperative throat symptoms. The most frequent symptom was hoarseness (11 PLMA- and 18 intubated patients). There was no significant difference between PLMA- and tracheal tube application with regard to the total number of patients with pharyngolaryngeal morbidity and the frequency of single symptoms. The same is true for the degree of the symptoms. There was a tendency for a longer prevalence of throat symptoms after intubation, but no significant difference.

CONCLUSION

In this investigation the PLMA could be successfully applied for elective laparotomies in cases without the risk of aspiration. Proper patient selection and a deep level of anaesthesia are important. The advantage for patients receiving the PLMA is a smooth recovery without cough, but not so much a reduced amount of pharyngolaryngeal morbidity. From this observation it might be concluded that the invasiveness of the surgical intervention might also influence the tolerance for the airway instrument. The disadvantage in this study was the more difficult insertion of the PLMA compared with the oral intubation. Further studies with a larger number of patients must show if these first results of the "Proseal"-LMA for lararotomies are to be confirmed.

Distribution of collagen type VII in connective tissues of postmenopausal stress-incontinent women

OBJECTIVE

This study aimed to disclose the distribution changes of collagen VII-immunoreactive (CVII-IR) structures in the arcus tendineus fasciae pelvis (ATFP) of postmenopausal women with stress urinary incontinence (SUI).

PATIENTS AND METHODS

Fifty-five postmenopausal patients with a history of incontinence were examined for SUI. In patients with SUI, colposuspension was performed either after intravaginal estrogen therapy (ESTR) or without it (NON-ESTR). Age-matched patients without incontinence served as controls. During the surgery, connective tissue specimens from the ATFP and the rectus muscle external fascia (RMEF) were collected and prepared for immunohistochemistry.

RESULTS

SUI was diagnosed in 23 patients, 20 of them entered either the ESTR or the NON-ESTR group. No differences were found in the distribution of CVII-IR structures in RMEF specimens obtained from all groups. The organization of CVII-IR fibrils in the ATFP of stress-incontinent women was severely affected by degenerative processes. Within the ESTR group, the degree of CVII-IR fiber disintegration was lower.

CONCLUSIONS

Connective tissue from the urogenital suspensory apparatus of women with SUI demonstrates a degenerative distribution pattern of collagen type VII fibers.

Botulinum toxin a has antinociceptive effects in treating interstitial cystitis

OBJECTIVES

To present clinical evidence with botulinum toxin A (BTX-A) suggesting an antinociceptive role in patients with interstitial cystitis (IC). Intriguing evidence in a somatic pain model has suggested that BTX-A injection may have an antinociceptive effect on both acute and chronic (inflammatory) pain.

METHODS

Thirteen female patients (6 in the United States and 7 in Poland) with IC according to the criteria of the National Institute of Diabetes, Digestive and Kidney Disease were included. Under short general anesthesia or sedation, 100 to 200 U of Dysport (Polish patients) or Botox (U.S. patients) was injected through a cystoscope into 20 to 30 sites submucosally in the trigone and floor of the bladder. Patients were evaluated with the O'Leary-Sant validated IC questionnaire or with voiding charts and a visual analog pain scale 1 month postoperatively and at subsequent 3-month intervals. The Polish patients also underwent pretreatment and post-treatment urodynamic evaluations.

RESULTS

Overall, 9 (69%) of 13 patients noted subjective improvement after BTX-A treatment. The Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index mean scores improved by 71% and 69%, respectively (P <0.05). Daytime frequency, nocturia, and pain by visual analog scale decreased by 44%, 45%, and 79%, respectively (P <0.01). The first desire to void and maximal cystometric capacity increased by 58% and 57%, respectively (P <0.01).

CONCLUSIONS

Our results suggest that BTX-A has an antinociceptive effect on bladder afferent pathways in patients with IC, producing both symptomatic and functional (ie, urodynamic) improvements.

Patient-adjusted intermittent electrostimulation for treating stress and urge urinary incontinence

OBJECTIVE

To assess the safety and efficacy of pelvic floor muscle electrostimulation (ES) in women with stress urinary incontinence (SUI) or mixed UI (MUI, urge and interstitial cystitis), using a new portable electrostimulator (Miniaturo, Biocontrol Medical Inc., Yehud, Israel) which delivers different forms of stimulation for treating these two conditions.

PATIENTS AND METHODS

For SUI the stimulator is activated on demand only by a sudden increase in intra-abdominal pressure; for frequency and urgency a milder, continuous ES is used. The intensity of ES can be adjusted according to the patient's sensation. Women were enrolled into the study after satisfying inclusion criteria and pad testing; 23 participated in two study groups, i.e. 16 with SUI and seven with MUI (severe frequency, urgency and urge, and mild SUI). The pelvic floor muscles were stimulated through an electrode inserted paraurethrally, positioned similarly in all patients. In patients with SUI and MUI a pressure sensor was also inserted into the rectum, to record intra-abdominal pressure. Stimulation was applied for 1-4 h in patients with SUI and for 6 h in those with MUI. The evaluation was based on urinary symptoms (frequency, urgency, leaking episodes), quality-of-life questionnaires and pad tests at baseline and during stimulation.

RESULTS

All patients in both groups improved significantly; of the 16 patients with SUI, nine were completely dry during ES, and the remaining seven had a reduced mean pad weight, from 23 to 6 g (74%). There was no significant reduction in pad weight after sham ES (17 g before vs 24.2 g after). In four patients with SUI who continued ES for 4 h the mean cumulative stimulation time (calculated from the stimulator memory) was 3 min (1.3% of 4 h). In the MUI group there were no leakage episodes during ES and significant reductions in voiding variables (Student's t-test) in all. The mean (Sd) voiding frequency, urinary urgency and leaking episodes decreased from 8.1 (4.2) to 1.9 (1.5), 6.4 (2.3) to 0.7 (1.3) and 2.1 (0.7) to 0.7 (0.5) (all P < 0.001), respectively.

CONCLUSIONS

The concept of this ES system for treating UI is promising; this study supports the efficacy of this form of ES but no conclusions about clinical efficacy are possible at this stage, and thus a trial to evaluate the safety and efficacy of this implantable device is ongoing.

[History of vaginal reconstruction]

The paper presents the outline of the history of vaginal reconstruction since antiquity, mainly in vaginal agenesis. The review presents first concepts of vaginoplasty originating from Hippocrates and Celsus, a few attempts of vaginal reconstruction in 18th-19th centuries nad moderate advances in the USA in 19th century. A breakthrough in this field was related to introduction of split thickness skin graft for covering neovaginal channel by Abbe at the turn of 19th and 20th century. Subsequent evolution of surgical techniques was based on Abbe's concept and was directed to finding an ideal material accelerating the epitheliazation of vaginal channel. At the turn of 20 and 21st century medical technology development e.g. laparoscopy played its role in this field of surgery too. Tissue engineering and molecular biology will definitely play increasing role in vaginal reconstruction. Conservative and minimally invasive methods of vaginal creation were also briefly discussed. The considerable input of Polish scientist into the development of both experimental and clinical problems of vaginoplasty is presented.

P27 Kip1 and Ki-67 expression analysis in transitional cell carcinoma of the bladder

P27(Kip1) protein is a cell cycle inhibitor which blocks the transition of cells from G1 to S phase, while Ki-67 is the most specific marker of proliferative activity. Both proteins are independent predictors of clinical outcome in various neoplasms. The aim of the study was to assess the prognostic value of p27(Kip1) and Ki-67 expression in urothelial bladder tumours. P27(Kip1) and Ki-67 expressions were evaluated immunohistochemically in archival samples of 45 superficial and 26 invasive transitional cell carcinomas obtained by a transurethral resection. In the patients with superficial tumours, disease-free survival (DFS) was positively influenced by good histological differentiation as well as by concurrent high p27(Kip1) and low Ki-67 expression. Multivariate analysis has confirmed that tumour grade and p27(Kip1)/Ki-67 status were independent predictors of DFS ( p=0.028 and p=0.029, respectively). P27(Kip1) or Ki-67 expressions did not influence overall survival. We conclude that a variable combined of p27(Kip1) and Ki-67 expressions is a better predictor of DFS in superficial bladder tumours than either protein alone.