The treatment of post-processing liquid from the hydrothermal carbonization of sewage sludge

The liquid phase, being a major product of the hydrothermal carbonization of sewage sludge, is highly problematic due to numerous toxic compounds that make it impossible to dispose of without adequate purification. Therefore, this study is focused on the two groups of selected advanced methods of post-processing water derived from the hydrothermal carbonization process of sewage sludge. The first group included membrane processes, namely ultrafiltration, nanofiltration and double nanofiltration. The second included coagulation, ultrasonication and chlorination. Chemical and physical indicators were determined to confirm the validity of these treatment methods. The highest reduction values were found for double nanofiltration, which showed a spectacular decrease in the Chemical Oxygen Demand by 84.9 %, specific conductivity by 71.3 %, nitrate nitrogen by 92.4 %, phosphate phosphorus by 97.1 %, total organic carbon by 83.3 %, total carbon by 83.6 %, and inorganic carbon by 88.5 %, as compared to the liquid phase after hydrothermal carbonization. In the second group, for the largest number of parameters, the greatest reduction was achieved when 10 cm3/L of iron coagulant was added to the permeate from ultrafiltration. Additionally, COD decreased by 41 %, P-PO43- content by 78 %, phenol content by 34 %, TOC content by 97 %, TC content by 95 % and IC content by 40 %.

Identification of Potential Harmful Transformation Products of Selected Micropollutants in Outdoor and Indoor Swimming Pool Water

This paper presents the estimation of micropollutant decomposition effectiveness and the identification of transformation intermediates formed during selected processes used in the treatment of swimming pool water. Tests were carried out under both indoor and outdoor conditions to simulate the removal of contaminants in different types of pool water basins. Model swimming pool water spiked with caffeine, carbamazepine, bisphenol A and oxadiazon were subjected to chlorination, ozonation, UV radiation, and artificial and sun lightening, carried out as single or combined processes. It was noted that organic micropollutants decompose faster during exposure to natural sunlight than artificial lighting. Caffeine and carbamazepine belong to compounds that are resistant to single ozone or light decomposition. Bisphenol A was completely removed by the action of the chlorination agent NaOCl. The highest compound removal degrees were noted for the integrated action of natural sunlight, NaOCl and O₃. This process allows also for the decomposition of all caffeine and oxadiazon decomposition by-products that potentially are toxic to swimming pool users.

Impact of swimming pool water treatment system factors on the content of selected disinfection by-products

Recommendations regarding disinfection by-products (DBPs) in pool waters consider the content of trihalomethanes (THMs) and combined chlorine (CC) as indicators of DBPs based on which the health risk for swimmers and staff of pool facility can be determined. However, the content of DBPs in swimming pools depends on many factors. In this paper, the influence of selected factors (physicochemical parameters of water and technological parameters) on the content of THMs and CC in pool water was determined. During the 6-month period, 9 pools of various functions were analyzed. The water in pools was subjected to the same method of treatment. The content of THMs and CC was compared against the content of organic matter, free chlorine and nitrates, pH, temperature, redox potential and turbidity, technological, and operational parameters. The THM content did not exceed the limit value of 0.1 mg/L. The content of CC varied significantly, from 0.05 to 1.13 mg Cl2/L. It was found that a very large water volume per person, in comparison to a very small one, contributed to the low content of CC and THMs. The high load expressed as m3 of water per person or m2 of water per person and the specific function of hot tubs (HT1 and HT2) led to the average concentration of CC in these pools exceeding 0.3 mg Cl2/L. The THM concentrations in hot tubs (especially in HT1) were also among the largest (0.038-0.058 mg/L). In terms of the analyzed microbiological indicators, the quality of the tested pool water samples was not in doubt. It was found that the purpose of the pool, its volume, and number of swimmers should be the key parameters that determine the choice of methods of water treatment. The research on the pool water quality in the actual working conditions of swimming pool facilities is necessary due to the need to preserve the health safety of swimmers and staff.

The potential of the organic micropollutants emission from swimming accessories into pool water

The potential leaching of organic micropollutants from swimming accessories was studied in the laboratory experiment. Seventeen different swimming accessories have been placed in various water matrices under different conditions in order to reproduce the actual environmental conditions of swimming pool water. The presence of micropollutants in water samples, after the exposure of swimming accessories, was assessed using indirect indicators (Total Organic Carbon and Phenol Index) and directly using a gas chromatograph coupled with a mass spectrometer with electron ionization. A wide range of organic compounds emitted from swimming accessories have been identified. The most common in tested samples was isophorone. The frequency of its occurrence in 50 swimming pools located in Poland was equal to 89% in concentrations ranged from 0.75 to 1.01 µg L^-1 (below the concentration of 40 µg L^-1, which is estimated to increase the cancer risk). Content of combined chlorine (1.52-3.16 mgCl₂ L^-1) in chlorinated matrices indicated a high potential for disinfection by products (DBPs) formation from organic matter emitted into pool water from swimming accessories. Ten of seventeen tested samples showed the toxic effect, measured as the bioluminescence inhibition of bacteria Aliivibrio fischeri.

Preparation, Characterization and Adsorption Potential of Grainy Halloysite-CNT Composites for Anthracene Removal from Aqueous Solution

Grainy Hal-CNT composites were prepared from powder halloysite nanoclay (Hal) and carbon nanotubes (CNTs). The effect of the amount and type of CNTs, as well as calcination temperature on morphology and properties of Hal-CNT composites and their adsorption capacity of anthracene (ANT), were studied. The surface topography of granules was heterogenous, with cracks and channels created during granulation of powder clay and CNTs. In FTIR, spectra were exhibited only in the bands arising from halloysite, due to its dominance in the granules. The increase in the heating temperature to 550 °C resulted in mesoporosity/macroporosity of the granules, the lowest specific surface area (SSA) and poorest adsorption potential. Overall, SSA of all Hal-CNT composites were higher than raw Hal, and by itself, heated halloysite. The larger amount of CNTs enhanced adsorption kinetics due to the more external adsorption sites. The equilibrium was established with the contact time of approximately 30 min for the sample Hal-SWCNT 85:15, while the samples with loading 96:4, it was 60–90 min. Adsorption isotherms for ANT showed L1 type, which is representative for the sorbents with limited adsorption capacity. The Langmuir model described the adsorption process, suggesting a monolayer covering. The sample Hal-SWCNT 85:15 exhibited the highest adsorption capacity of ANT, due to its highest SSA and microporous character.

Application of Ultrafiltration in a Swimming Pool Water Treatment System

Swimming pool water was treated using an ultrafiltration process using ceramic and polymer membranes for comparison. It was determined that the efficiency of the process depended on the type of membrane used. The polymer membrane decreased the absorbance and concentration of combined chlorine in the pool water to a greater extent than the ceramic membrane. In the case of a ceramic membrane, the concentration of combined chlorine in the permeate exceeded the limit values. During the ultrafiltration process, the permeate flux decreased, causing the blockage of membrane pores. The extent of this phenomenon was similar for both tested membranes. In the case of the ceramic membrane, flushing it with water could significantly restore its initial performance. For both tested membranes, a high regeneration efficiency was observed during chemical treatment with an alkaline solution. SEM photos of the polymer membrane showed low resistance of this polymer to the chlorine present in the swimming pool water.

Estimation of physicochemical properties of 2-ethylhexyl-4-methoxycinnamate (EHMC) degradation products and their toxicological evaluation

The organic UV filters, commonly used in personal protection products, are of concern because of their potential risk to aquatic ecosystems and living organisms. One of UV filters is ethylhexyl-4-methoxycinnamate (EHMC) acid. Studies have shown that, in the presence of oxidizing and chlorinating factors, EHMC forms a series of products with different properties than the substrate. In this study, the toxicities of EHMC and its transformation/degradation products formed under the influence of NaOCl/UV and H₂O₂/UV systems in the water medium were tested using Microtox® bioassay and by observation of mortality of juvenile crustaceans Daphnia magna and Artemia Salina. We have observed that oxidation and chlorination products of EHMC show significantly higher toxicity than EHMC alone. The toxicity of chemicals is related to their physicochemical characteristic such as lipophilicity and substituent groups. With the increase in lipophilicity of products, expressed as log K_OW, the toxicity (EC₅₀) increases. On the basis of physicochemical properties such as vapour pressure (VP), solubility (S), octanol-water partition coefficient (K_OW), bioconcentration factor (BCF) and half-lives, the overall persistence (P_OV) and long-range transport potential (LRTP) of all the products and EHMC were calculated. It was shown that the most persistent and traveling on the long distances in environment are methoxyphenol chloroderivatives, then methoxybenzene chloroderivatives, EHMC chloroderivatives, methoxybenzaldehyde chloroderivatives and methoxycinnamate acid chloroderivatives. These compounds are also characterised by high toxicity.

Degradation pathways of pentachlorophenol and benzo(a)pyrene during heterogeneous photocatalysis

Organic micropollutants, in particular those of anthropogenic origin, may have a toxic influence on water organisms. Photochemical oxidation processes are one of the most effective methods of decomposition of a wide range of those compounds. During the oxidation process a large number of different by-products are generated, which can still be biologically active. The development of analytical techniques, including the reduction of the detection limit to several fg/L, allows the identification of even trace concentrations of compounds. The paper presents the determination of pentachlorophenol and benzo(a)pyrene degradation pathways during the process of heterogeneous photocatalysis carried out in the presence of titanium dioxide. The gas chromatography-mass spectrometry (GC-MS) analysis of post-processing samples indicated the formation of different by-products of the parent micropollutants. Moreover, the toxicity assessment demonstrates for both tested micropollutants an increase in the toxicity within the whole time of the UV irradiation process run.

Interrelationship between Cardiac Structure and Function and Incidence of Arrhythmia in Peritoneal Dialysis Patients

Cardiovascular complications in patients with end-stage renal disease requiring dialytic therapy are frequent and account for approximately 40% of all deaths in these patients. The aim of this study was to analyze the occurrence of cardiac arrhythmia in peritoneal dialysis (PD) patients with respect to the changes in left ventricular structure and function. To determine characteristics of arrhythmia in patients on PD for chronic renal failure, 30 patients (18 male and 12 female; aged 54.1±13.8 years) underwent twice (interval of 20±4.1 months) ambulatory 24 hour Holter ECG monitoring. At the same time all the patients were analyzed by echocardiography and pulsed Doppler echocardiography to estimate cardiac structure and function. Ventricular arrhythmias were seen in 9 patients (30%) during the first examination and in 13 patients (43.3%) on the second. Ventricular arrhythmias were observed only in patients with left ventricular hypertrophy (LVH). Supraventricular arrhythmias were seen in 12 (40%) and 17 (56.7%) patients. The majority of these patients also had LVH, with 11/12 (91.7%) patients at the first examination and 15/17 (88.2%) at the second respectively. We conclude that the incidence of arrhythmia is primarily dependent on the presence of LVH in PD patients. It appears that peritoneal dialysis does not provoke or aggravate arrhythmia.

Independent psychometric validation of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Endometrial Cancer Module (EORTC QLQ-EN24)

The endometrial cancer (EC)-specific Quality of Life module of the European Organization for Research and Treatment of Cancer (EORTC QLQ-EN24), was developed and validated in one study. We independently validated and assessed the psychometric properties of the instrument. Two hundred and eight women with EC before surgery, during adjuvant treatment and follow-up; in three different cancer centres completed the EORTC QLQ-C30 and the EN24. The questionnaire's completion rate was 100%, except sexuality items, that were answered by 35% of patients. All item-scale correlations for the multi-item scales exceeded the .4 criterion and correlated well with their own scale, while correlations with the other scales were low. The internal consistency of all multi-item scales were satisfactory (Cronbach's alpha coefficients ranging from .77 to .97). Discriminance for single-item scales was low. The QLQ-EN24 module discriminated well between clinically different patients, and there were no differences in quality of life questionnaire scales between patients with body mass index ≤30 when compared to those with >30. This validation study supports the reliability, as well as convergent and divergent validity of the EORTC QLQ-EN24. The module is a useful instrument for the assessment of QOL in patients with EC. However, data concerning sexuality should be interpreted with caution.

Indirect methods of dried sewage sludge contamination assessments

Thermal conversion (combustion, co-combustion, gasification and pyrolysis) appears to be the most promising alternative for sewage sludge management in the future. Nevertheless, safe and ecological usage of sewage sludge as a fuel requires information about their contamination. The aim of this paper is to present the photoacoustic spectroscopy (PAS) as a good method for contamination assessments of dried sewage sludge. Two types of granular sewage sludge: Sewage sludge 1 (SS1) taken from Polish wastewater treatment plant operating in the mechanical-biological system and sewage sludge 2 (SS2) taken from mechanical-biological-chemical wastewater treatment plant with phosphorus precipitation were analysed. The spectrophotometer FTIR Nicolet 6700 equipped with photoacoustic cell (Model 300, MTEC, USA) was used. The comparison with the most popular analytical methods (GC-MS) was also done. The results of PAS studies confirm the difference between the SS1 and SS2 which is in agreement with the GC-MS analysis. Higher absorbance was observed at each wavelength characteristics for the oscillator of chemical moieties for the SS1 with respect to the SS2.

The Impact of Oxone on Disintegration and Dewaterability of Waste Activated Sludge

Biochemical parameters such as soluble chemical oxygen demand (SCOD), phosphate, ammonium nitrogen and proteins are often used to characterize the efficiency of disintegration of waste activated sludge (WAS) flocs and microorganism cells. In this study, the chemical disintegration using peroxymonosulfate (MPS, Oxone) and thermally activated MPS, were evaluated for the destruction of WAS. Our study was conducted for chemical disintegration of WAS by MPS in doses between 84.7 - 847.5 mg/g(TS) activated by temperatures of 50, 70 and 90 °C over 30 minutes. The application of these methods causes an increase in the soluble COD value and protein concentration in the supernatant. Also, they positively influence the sludge volume index (SVI) which decreased from 89.8 to 17.2 ml/g. Our research work confirmed that the application of thermally activated MPS may become a new effective way of improving sewage treatment and sewage sludge processing.

The assessment of sewage sludge gasification by-products toxicity by ecotoxicologial test

The process of gasification of sewage sludge generates by-products, which may be contaminated with toxic and hazardous substances, both organic and inorganic. It is therefore important to assess the environmental risk associated with this type of waste. The feasibility of using an ecotoxicological tests for this purpose was determined in the presented study. The applied tests contained indicator organisms belonging to various biological groups (bacteria, crustaceans, plants). The subject of the study were solid (ash, char) and liquid (tar) by-products generated during gasification (in a fixed bed reactor) of dried sewage sludge from various wastewater treatment systems. The tested samples were classified based on their toxic effect. The sensitivity of the indicator organisms to the tested material was determined. In-house procedures for the preparation for toxicity analysis of both sewage sludge and by-products generated during the gasification were presented. The scope of work also included the determination of the effect of selected process parameters (temperature, amount of gasifying agent) on the toxicity of gasification by-products depending on the sewage sludge source. It was shown that both the type of sewage sludge and the parameters of the gasification process affects the toxicity of the by-products of gasification. However, the results of toxicity studies also depend on the type of ecotoxicological test used, which is associated with a different sensitivity of the indicator organisms. Nevertheless, it may be concluded that the by-products formed during the gasification of the low toxicity sewage sludge can be regarded as non-toxic or low toxic. However, the results analysis of the gasification of the toxic sludge were not conclusive, which leads to further research needs in this area.

Dobutamine stress echocardiography in the diagnosis of asymptomatic ischemic heart disease in patients with chronic kidney disease--review of literature and single-center experience

BACKGROUND

Coronary artery disease (CAD) may be present in kidney transplant (KT) candidates without the presence of CAD clinical symptoms. This study joins an ongoing discussion about appropriate noninvasive diagnostic approaches for ischemic heart disease (IHD) assessment and patient selection for revascularization procedures. The aim of this study was to evaluate the role of dobutamine stress echocardiography (DSE) in IHD diagnosis in initially asymptomatic maintenance hemodialysis (HD) patients.

METHODS

Forty HD patients aged 52.4 ± 2.0 years, were studied for 2.5 years. At inclusion, they were free of both symptoms and history of IHD. Standard electrocardiography (ECG), chest X-ray, standard echocardiography, DSE, 24-hour Holter ECG, and Doppler ultrasonography (carotids and lower extremities) were performed. Results were analyzed according to a predefined diagnostic algorithm.

RESULTS

DSE yielded negative results in all patients. Left ventricular (LV) ejection fraction ≤ 60%, LV hypertrophy, and Holter ECG silent ischemia features were noticed in 15%, 70%, and 10% of patients, respectively. Atherosclerotic lesions in lower extremities and carotid arteries were present in 50% and 37.5% of patients, respectively. During the follow-up, 9/40 patients died, including 6 cardiovascular (CV) deaths: 2 with intermediate and 4 with high CV risk according to the proposed algorithm.

CONCLUSIONS

In asymptomatic KT candidates, not only DSE, but also other noninvasive tests (eg, echocardiography and Doppler ultrasonography of the carotid and peripheral arteries) along with a detailed profile of the remaining CV risk factors should be performed and analyzed. Defined composition of risk factors and particular changes in noninvasive tests may be an indication for coronary angiography.

Impact of peroxydisulphate on disintegration and sedimentation properties of municipal wastewater activated sludge

In the study, a thermally activated sodium peroxydisulphate (PDS; Na

Gaseous fuels production from dried sewage sludge via air gasification

Gasification is a perspective alternative method of dried sewage sludge thermal treatment. For the purpose of experimental investigations, a laboratory fixed-bed gasifier installation was designed and built. Two sewage sludge (SS) feedstocks, taken from two typical Polish wastewater treatment systems, were analysed: SS1, from a mechanical-biological wastewater treatment system with anaerobic stabilization (fermentation) and high temperature drying; and (SS2) from a mechanical-biological-chemical wastewater treatment system with fermentation and low temperature drying. The gasification results show that greater oxygen content in sewage sludge has a strong influence on the properties of the produced gas. Increasing the air flow caused a decrease in the heating value of the produced gas. Higher hydrogen content in the sewage sludge (from SS1) affected the produced gas composition, which was characterized by high concentrations of combustible components. In the case of the SS1 gasification, ash, charcoal, and tar were produced as byproducts. In the case of SS2 gasification, only ash and tar were produced. SS1 and solid byproducts from its gasification (ash and charcoal) were characterized by lower toxicity in comparison to SS2. However, in all analysed cases, tar samples were toxic.

Successful treatment of a large symptomatic lymphocyst with percutaneus drainage and repeated iodopovidone sclerotherapy

The objective of the case report was to present an easy and safe method for treatment of a large, persistent lymphocyst, through a procedure performed in an ambulatory setting. The patient diagnosed with large (1,800 mi), symptomatic (pains, renal insufficiency) lymphocyst after lymphadenectomy for cervical cancer, was successfully treated with percutaneous drainage (using vascular drains) and five sessions of sclerotherapy with 10% iodopovidone, performed in ambulatory settings. The method was minimally invasive, safe, and effective in management of symptomatic lymphocyst.

Microscopic study of right fibrous annulus

The term annulus fibrous is still used in anatomical and clinical terminology but does not exist in anatomical nomenclature. This structure is proposed as an anatomical substrate for circus movement of excitation. Multiple cardiac damage after blunt chest trauma is rare, but usually affects the septal part of the right fibrous annulus. Histological observation confirms the results of our previous macroscopic study and shows that the most stable part of fibrous annulus is the septal part and the region of anterior angle of the right ventricle, and the most labile parts are the lateral and posterior angles of the right ventricle and the posterior part of the fibrous annulus. Our histological study shows that the right fibrous annulus is a heterogeneous structure and may play a role in changes of shape of the right atrio-ventricular ostium during human life.

The relationship between the membranous part of the interventricular septum and the septal part of the attachment of the tricuspid valve in adult human hearts

The membranous septum is a difficult structure to demonstrate in vivo. It is possible to measure its dimensions in a cadaver after the introduction of light into the aorta, but difficult to do so otherwise. The present study was performed on a group of 107 formalin-fixed adult hearts from both sexes and 18-90 years of age. The hearts were divided into groups depending on sex and age. The length of the septal part of the attachment of the tricuspid valve was divided by the length of the supravalvular part of the membranous interventricular septum.

Morphometric features of the right atrioventricular orifice in adult human hearts

The normal data of the tricuspid valve complex is of great clinical importance in the light of progress in cardiosurgery and the development of novel operating techniques. A range of measurements for the right atrioventricular orifice in 96 human adult hearts was examined by means of anatomical dissection, inspection, examination, and statistical analyses. The length of the attachment of the anterior leaflet increased significantly between group I (aged 18-40 years) and group II (aged 41-64 years) in women only. In men there were no significant differences in this parameter between any of the three age groups. In addition, the attachment length of the posterior leaflet in women increased statistically in the second age group. In men, in contrast, the attachment length of the posterior leaflet did not increase significantly between the first and second age groups and became significantly larger only in oldest age group, consisting of men aged over 65. No statistically significant differences between the three age groups were found for the attachment length of the septal leaflet (p>0.05). In female hearts significant increases in the frontal and sagittal dimensions of the tricuspid valve orifice were observed between the second age group and the group aged over 65. In male hearts both the frontal and sagittal dimensions increased significantly with advanced age. The right atrioventricular orifice expressed as the ellipse area was statistically greater than the triangular area (p<0.01) in each age group. It should be noticed that both areas increased significantly during ageing. This study has demonstrated that the shape of the right atrioventricular orifice evolves during life, from a triangular shape to a more elliptical shape.

The morphometry of the accessory leaflets of the tricuspid valve in a four cuspidal model

The tricuspid valve is of great importance because of the progress made in operative techniques and invasive cardiology accidents. This structure is more differentiated during evolution than the mitral valve. Accessory leaflets, their frequency and role are still controversial, despite the fact that they have been known from the beginning of the 20th century. The number of leaflets in the tricuspid valve grows in an evolutionary line, but the rules governing their appearance are still not known. The samples were taken from a group of 107 human adult hearts. The four-cuspidal form of the tricuspid valve was used as the simplest model to show the appearance of accessory leaflets for anatomical and statistical examination. On the basis of the results of this study we conclude that the separation of accessory leaflets is a complex process.

The morphology and distribution of the tendinous chords and their relation to the papillary muscles in the tricuspid valve of the human heart

The tendinous chords of the tricuspid valve are the predominant type of connection between the papillary muscles and the tricuspid valve. Studies describing the evolutionary line of these connections are well known. The flexibility of particular leaflets of the tricuspid valve varies, as does the tension of the blood stream in particular cusps. The present study was performed on a group of 96 formalin-fixed adult human hearts, which ranged in age from 18 to 90 years and gave no evidence of congenital malformations or pathological changes. The valves were divided into five types according to earlier studies and analysis was made in terms of these types. The tendinous chords and their ramifications were counted. The surfaces of particular leaflets were measured. The ratio of marginal to ventricular leaflets was counted for each type of leaflet in particular types of valves. The parts of the main leaflets supported by specific papillary muscles were counted for types 1, 2 and 3. The number of tendinous chords decreased in leaflets in particular types of tricuspid valve, but the ratio of chords attached to the margins and ventricular surfaces was similar. The number of chords for the surface of leaflets (measured in mm2) was similar in particular types of valve for all cusps. The most differentiated were commissural chords in all types of valve. The ratio of chords attached to the margins and ventricular surfaces does not depend on the surface area of the leaflets.

Renal transplantation in dialysis patients with the history of coronary artery bypass grafting and cardiac valve replacement

Death with a functioning kidney is the most frequent cause of graft failure. Cardiovascular disease is the most frequent cause of death after renal transplantation. Therefore, prior to grafting, it is mandatory to diagnose and treat coronary artery disease and heart valve impairment. Transplantation is the best option for renal replacement therapy as far as the quality of life and life expectancy are concerned, although patients with such comorbidities may experience a higher short-term mortality risk. The objective for this study was to analyze both short- and long-term results of patients after coronary artery bypass grafting (CABG) or cardiac valve replacement (CVR). The cardiac surgery recipient group (CSR) included 16 patients (15 men, 1 woman) aged from 44 to 73 (mean 54.9 +/- 7.8) years. CABG was performed in 13/16 patients, and CVR in 3/16. The rest of our patients were treated as a comparative noncardiac surgery recipient (non-CSR) group. It consisted of 422 patients (264 men, 158 women) aged from 14 to 68 years (mean 43.2 +/- 12.9). The comparison revealed that graft function estimated at 1 year after transplantation was not different: serum creatinine concentrations of 1.7 +/- 0.2 and 1.6 +/- 0.5 mg/dL in CSR and non-CSR, respectively. One-year patient survival in the CVR group of 93.8% was slightly worse than that in the non-CSR group (97.9%), but death-censored 1-year graft survivals were comparable in both groups (93.8% vs 92%). Urinary tract and cytomegalovirus infections were the most common complications in the CSR group. One patient lost his graft in month 3(rd) due to many serious infectious complications. One patient died at the end of 12 months as a result of a cardiovascular event (1/16). Our single-center results confirm that transplantation in patients after CABG or CVR is a safe procedure; therefore, such patients should be referred into the waiting list.

The connection between the papillary muscles and leaflets of the tricuspid valve

The tricuspid valve is more differentiated during evolutionary development than the mitral valve. In birds it is a muscular structure joined directly to the papillary muscles, although the mitral valve of birds resembles that of mammals. There have been well-known studies describing the evolutionary line of connection of the tricuspid valve with the papillary muscles. The present study was performed on a group of 107 formalin-fixed adult human hearts. The valves and papillary muscles were classified according to a scheme for human hearts drawn up earlier. The types of connection between leaflets of the tricuspid valve and the papillary muscles were classified according to a scheme drawn up earlier for vertebrates. We observed 3 types of connection between leaflets of the tricuspid valve and the papillary muscles in the group studied. The muscular and membranous connections were not linked with any one type of tricuspid valve. Atypical forms of distribution of the tendinous chords of the right ventricle were observed. It was found that valves with a higher number of leaflets were (with the exception of type 0) provided with a smaller number of tendinous chords. Atavistic features and atypical forms of distribution of the tendinous chords are present in a small percentage of samples of the human right valvular apparatus.

The morphology of the right atrioventricular valve in the adult human heart

Studies of the morphometry and normal anatomy of the tricuspid valve are in constant demand. Knowledge of the morphology of the normal tricuspid valve may be useful, for example in the context of the transfer of a leaflet of the tricuspid valve for repair or insufficiency of the mitral valve, in repair of the tricuspid valve after blunt chest trauma and in other surgical techniques of this region. In this study, performed in a group of 107 formalin-fixed adult human hearts, we attempted to assess the form and number of the main and accessory cusps in the tricuspid valve. Rare anatomical variants of the tricuspid valve were found. Using a planimeter we evaluated the surface area of the tricuspid valve and particular leaflets. With the help of a Vernier scale we measured the length and height of individual leaflets of the tricuspid valve and the length of the commissures. No differences were found between the length of the anterior and septal leaflets. The posterior leaflet was the shortest, while the anterior leaflet was the widest and had the largest surface area. The posterior leaflet was wider than the septal leaflet and had the smallest surface area. No differences were found between the main and accessory leaflets in the length of the commissures.

Cardiovascular Effects of Successful Renal Transplantation: A 30-Month Study on Left Ventricular Morphology, Systolic and Diastolic Functions

The purpose of this study was to determine the effects of a successful renal transplantation on left ventricular (LV) morphology, systolic and diastolic function. Forty-three renal transplant patients prospectively studied by echocardiography (30 months follow-up) were divided into two groups. The first echocardiographic examination was performed 3.0 +/- 2.8 months after renal transplantation in group I (11 men, 12 women); and 34.4 +/- 29.1 months after transplant in group two (9 men, 11 women). We noticed the following changes in blood pressure (BP): group 1 systolic BP reduction (from 140.5 +/- 23.6 to 126 +/- 6.8 mmHg; P < .01), and pulse pressure reduction (from 59.5 +/- 14.9 to 47.5 +/- 9.8 P < .05); group 2, diastolic BP acceleration (from 78.4 +/- 8.7 to 84 +/- 6.9 mmHg, P < .05). LV mass index decreased in group 1 (from 126.4 +/- 18.0 g/m2 to 104.6 +/- 15.9 g/m2, P < .05). The incidence of LV hypertrophy (LVH) decreased in group 1 from 70% to 40% (P < .05). Only one parameter of systolic function-end systolic stress-significantly decreased in both groups: group 1 from 78 +/- 11 to 61 +/- 12 g/cm2; group 2 from 63.8 +/- 9.0 to 55.1 +/- 9.0 g/cm2, P < .05). The pattern of mitral inflow changed: in group 1, the normal pattern decreased from 30% to 20% and the restrictive pattern increased from 0% to 10%; in group 2, the normal mitral inflow pattern decreased from 60% to 20% and abnormal relaxation type increased from 40% to 80%. Regression of LVH after renal transplant improved LV geometry and systolic function. Despite better systolic function a progression of LV diastolic dysfunction was noticed, which might be explained by cyclosporine treatment. Renal transplantation exerted a beneficial impact on cardiomyopathy manifested by LVH and systolic dysfunction.

Surgical pelvic packing as a means of controlling massive intraoperative bleeding during pelvic posterior exenteration--a case report and review of the literature

This is a report of a case of gynecological hemorrhage after a posterior pelvic exenteration in patients with vulvar cancer treated by temporary pelvic packing at the Department of Gynecology of the Medical University in Gdańsk. The packing was successful and the sponges were removed after 24 h. Twenty-eight days after the operation, the patient was transferred to the Department of Radiotherapy for supplementary treatment. In patients with severe intraoperative hemorrhage, intra-abdominal packing has been successful as a mode of treatment.

Surgical pelvic packing as a means of controlling massive intraoperative bleeding during pelvic posterior exenteration – a case report and review of the literature

This is a report of a case of gynecological hemorrhage after a posterior pelvic exenteration in patients with vulvar cancer treated by temporary pelvic packing at the Department of Gynecology of the Medical University in Gdańsk. The packing was successful and the sponges were removed after 24 h. Twenty-eight days after the operation, the patient was transferred to the Department of Radiotherapy for supplementary treatment. In patients with severe intraoperative hemorrhage, intra-abdominal packing has been successful as a mode of treatment.

[Effectiveness of antiviral treatment of patients with chronic hepatitis C (a Polish multicenter study)]

Interferon alpha (INF) is routine treatment in patients with chronic hepatitis C. Many controlled investigations were evaluated to establish the optimal schedule of treatment with sustained virological and biochemical response. Recently, multicentre meta-analyses suggest that combination therapy (INF + Ribavirin) was more effective than treatment with interferon alone. The aim of this study was to compare the efficacy of four schedules of antiviral treatment in 445 patients with chronic hepatitis C. Combination therapy (INF + Ribavirin) given for 6 mo. and monotherapy (INF) for 18 mo. were more effective than interferon alone given for 6 mo. Treatment with INF alone for 6 mo. was demonstrated to be insufficient.

Two cases of postpartum cardiomyopathy initially misdiagnosed for pulmonary embolism

PURPOSE

To underline the crucial role of urgent echocardiography in the differential diagnosis of acute respiratory and/or circulatory failure in the postpartum period.

CLINICAL FEATURES

A 24-yr-old woman was admitted to the intensive care unit (ICU) with a preliminary diagnosis of pulmonary embolism (PE) one week after Cesarean section. Neither computerized tomography nor Doppler sonography showed any signs of deep venous thrombosis or PE. In the ICU she required intubation and ventilatory support for acute respiratory and circulatory failure. Bedside echocardiography revealed features of left ventricular failure. A diagnosis of postpartum cardiomyopathy (PPCM) was made, appropriate treatment instituted and the patient soon improved. A 29-yr-old, previously healthy primipara presented at the Maternity Clinic on the fourth postpartum day complaining of increasing dyspnea and fatigue. Within eight hours she required intubation, ventilatory support and subsequent defibrillation due to cardiac arrest. She was transferred to the ICU with a preliminary diagnosis of PE. She developed pulmonary edema followed by cardiac arrest with successful resuscitation. Bedside echocardiography revealed a left ventricular ejection fraction below 30% with an increased systolic diameter of the left ventricle, restrictive diastolic abnormalities and no signs of pulmonary hypertension. Peripartum cardiomyopathy was diagnosed and supportive treatment for heart failure was instituted.

CONCLUSION

It is possible to misdiagnose postpartum cardiomyopathy for PE. An error in diagnosis is life-threatening for the patient. Echocardiography is a valuable tool in the differential diagnosis. As a noninvasive procedure, it should be performed at the bedside as soon as possible to institute proper treatment and to avoid potentially fatal errors.

Interrelationship between cardiac structure and function and incidence of arrhythmia in peritoneal dialysis patients

Cardiovascular complications in patients with end-stage renal disease requiring dialytic therapy are frequent and account for approximately 40% of all deaths in these patients. The aim of this study was to analyze the occurrence of cardiac arrhythmia in peritoneal dialysis (PD) patients with respect to the changes in left ventricular structure and function. To determine characteristics of arrhythmia in patients on PD for chronic renal failure, 30 patients (18 male and 12 female; aged 54.1+/-13.8 years) underwent twice (interval of 20+/-4.1 months) ambulatory 24 hour Holter ECG monitoring. At the same time all the patients were analyzed by echocardiography and pulsed Doppler echocardiography to estimate cardiac structure and function. Ventricular arrhythmias were seen in 9 patients (30%) during the first examination and in 13 patients (43.3%) on the second. Ventricular arrhythmias were observed only in patients with left ventricular hypertrophy (LVH). Supraventricular arrhythmias were seen in 12 (40%) and 17 (56.7%) patients. The majority of these patients also had LVH, with 11/12 (91.7%) patients at the first examination and 15/17 (88.2%) at the second respectively. We conclude that the incidence of arrhythmia is primarily dependent on the presence of LVH in PD patients. It appears that peritoneal dialysis does not provoke or aggravate arrhythmia.

MediLink: a wearable telemedicine system for emergency and mobile applications

The practical needs of the medical professional faced with critical care or emergency situations differ from those working in many environments where telemedicine and mobile computing have been introduced and tested. One constructive criticism of the telemedicine initiative has been to question what positive benefits are gained from videoconferencing, paperless transactions, and online access to patient record. With a goal of producing a positive answer to such questions an architecture for multipurpose mobile telemedicine applications has been developed. The core technology is based upon a wearable personal computer with a smart-card interface coupled with speech, pen, video input and wireless intranet connectivity. The TransPAC system with the MedLink software system is designed to provide an integrated solution for a broad range of health care functions where mobile and hands-free or limited-access systems are preferred or necessary and where the capabilities of other mobile devices are insufficient or inappropriate. Structured and noise-resistant speech-to-text interfacing plus the use of a web browser-like display, accessible through either a flatpanel, standard, or headset monitor, gives the beltpack TransPAC computer the functions of a complete desktop including PCMCIA card interfaces for internet connectivity and a secure smartcard with 16-bit microprocessor and upwards of 64K memory. The card acts to provide user access control for security, user custom configuration of applications and display and vocabulary, and memory to diminish the need for PC-server communications while in an active session. TransPAC is being implemented for EMT and ER staff usage.

A rat model of gingivoperiosteoplasty

The ability to avoid a subsequent bone graft makes the use of gingivoperiosteoplasty (GPP) at the time of cleft lip repair an attractive technique. The use of GPP, in combination with presurgical orthodontics, has been shown to result in successful bony union in the majority of patients. However, secondary bone grafting is still necessary in 30% to 40% of patients due to persistent alveolar bony defects. The elucidation of methods to improve the success rates of these procedures has been hampered by the lack of reproducible animal models. The purpose of this study was, therefore, to develop a rodent model of GPP that would facilitate the investigation of methods to improve osteogenesis in alveolar defects. We report a surgically produced rat model (9 x 5 x 3-mm alveolar defect) that is reproducible, inexpensive (relative to large-animal models), and simple technically. In addition, healing in this model occurs in a predictable manner during a 12-week period, thus enabling analysis of methods designed to accelerate or facilitate osseous regeneration.

[Carcinoid: unusual clinical course]

Carcinoid is a slowly developing neuroendocrine tumour. It appears with frequency of 1.5/100,000 persons. Usually it is localized in appendix, small intestine, rectum and bronchi. Clinical sings. of carcinoid syndrome develop in only 10% cases of tumour. We present three cases of carcinoid: the first one with evidences of heart insufficiency, the second one with evidences of colon cancer, the third one coexisting with Graves-Basedow disease.

Regional differentiation of rat cranial suture-derived dural cells is dependent on association with fusing and patent cranial sutures

A significant body of literature supports a role for the dura mater underlying cranial sutures in the regulation of sutural fate. These studies have implicated regional differentiation of the dura mater based on association with fusing and patent rat cranial sutures. The purpose of these experiments was to isolate and characterize dural cells associated with fusing (posterior frontal) and patent (sagittal) rat cranial sutures. Six-day-old rats were killed, and the dura mater underlying the posterior frontal and sagittal sutures was harvested. Dural cells were briefly trypsinized and allowed to reach confluence. Two litters (10 animals per litter) were used for each set of experiments. Cells were harvested after the first and fifth passages for analysis of vimentin and desmoplakin expression (characteristic of human meningeal cells), cellular proliferation, density at confluence (a measure of cellular contact inhibition), and alkaline phosphatase production. In addition, bone nodule formation and collagen I production were analyzed in first passage cells. The results indicate that suture-derived dural cells can be established and that these cells coexpress vimentin and desmoplakin. In addition, it is demonstrated that first-passage sagittal suture-derived dural cells proliferate significantly faster and have decreased cellular contact inhibition than posterior frontal suture-derived cells (p < 0.01). Finally, it is shown that suture-derived dural cells have osteoblast-like properties, including alkaline phosphatase production, collagen I expression, and bone nodule formation in vitro. The possible mechanisms by which regional differentiation of suture-derived dural cells occur are discussed.

Adenovirus-mediated gene therapy of osteoblasts in vitro and in vivo

Modulation of biological pathways governing osteogenesis may accelerate osseous regeneration and reduce the incidence of complications associated with fracture healing. Transforming growth factor beta1 (TGF-beta1) is a potent growth factor implicated in the regulation of osteogenesis and fracture repair. The use of recombinant proteins, however, has significant disadvantages and has limited the clinical utility of these molecules. Targeted gene therapy using adenovirus vectors is a technique that may circumvent difficulties associated with growth factor delivery. In this study, we investigate the efficacy of replication-deficient adenoviruses containing the human TGF-beta1 and the bacterial lacZ genes in transfecting osteoblasts in vitro and osseous tissues in vivo. We demonstrate that adenovirus-mediated gene therapy efficiently transfects osteoblasts in vitro with the TGF-beta1 virus causing a marked up-regulation in TGF-beta1 mRNA expression even 7 days after transfection. Increased TGF-beta1 mRNA expression was efficiently translated into protein production and resulted in approximately a 46-fold increase in TGF-beta1 synthesis as compared with control cells (vehicle- or B-galactosidase-transfected). Moreover, virally produced TGF-beta1 was functionally active and regulated the expression of collagen IalphaI (5-fold increase) and the vascular endothelial growth factor (2.5-fold increase). Using an adenovirus vector encoding the Escherichia coli LacZ gene, we demonstrated that adenovirus-mediated gene transfer efficiently transfects osteoblasts and osteocytes in vivo and that transfection can be performed by a simple percutaneous injection. Finally, we show that delivery of the hTGF-beta1 gene to osseous tissues in vivo results in significant changes in the epiphyseal plate primarily as a result of increased thickness of the provisional calcification zone.