Laboratory and clinical features of tumor lysis syndrome in children with non-Hodgkin lymphoma and evaluation of long-term renal functions in survivors

OBJECTIVE

The purpose of our study is to investigate the laboratory and clinical features of tumor lysis syndrome (TLS) and acute kidney injury (AKI) in childhood non-Hodgkin lymphomas (NHL) and to reveal their impact on long term kidney function in survivors.

METHODS

Our single-center retrospective study included 107 patients (0-18 years old) with NHL who were admitted and treated at our hospital between 1998 and 2020. The relationship between TLS and age, gender, histopathological subgroup, tumor stage, lactate dehydrogenase (LDH) level at presentation, bone marrow and kidney involvement were assessed. The long-term renal functions of the patients were investigated.

RESULTS

80.3% of the patients were male with a median age of 9.8 years. The most common detected histopathological subgroup was Burkitt lymphoma. Hyperhydration with or without alkalinisation, and allopurinol were used in first-line treatment and prophylaxis of TLS. Laboratory TLS and clinical TLS was observed in 30.8% and 12.1% of patients, respectively. A significant correlation was found between young age, advanced stage, high LDH level at presentation, and TLS. AKI was observed in 12.1% of the patients. When the glomerular filtration rate values of the patients at the first and last admissions were compared after an average of 6.9 years, a mean decrease of 10 mL/min/1.73 m2 was found. It was not, however, found to be statistically significant.

CONCLUSION

Lower age, advanced stage, and high LDH level at presentation were found to be risk factors for TLS in our study. Long-term renal function loss was not observed in the survivors who received early and careful prophylaxis/treatment for TLS. The survivors are still being followed up.

Anti-tuberculosis activity of morusin: a promising flavonoid from white mulberry

BACKGROUND: TB has remained a significant public health concern from historical times to the present day. Each year, growing drug resistance problems necessitate the discovery of new drugs and drug precursors for TB treatment. Morusin is an important flavone found in the bark of white mulberry (Morus alba L.) with anti-oxidant, antimicrobial, anti-tumour, anti-inflammatory and antiallergic activity.OBJECTIVE: To determine the anti-TB efficacy of morusin on Mycobacterium tuberculosis strains.DESIGN: Anti-TB efficacy of morusin was tested on H37Ra (American Type Culture Collection [ATCC] 25177), H37Rv (ATCC 27294), ATCC 35822 (isoniazid [INH] resistant), ATCC 35838 (rifampicin [RIF] resistant), and ATCC 35820 (streptomycin [SM] resistant) standard strains and its efficacy was determined using nitrate reductase assay (NRA).RESULTS: The minimum inhibitory concentration (MIC) of morusin was tested in the range of 53.83â-"0.21 μg/ml. The MIC for H37Ra (ATCC 25177), H37Rv (ATCC 27294) and ATCC 35838 (RIF-resistant) strains were found to be 6.72 μg/ml, and this was 13.45 μg/ml for the ATCC 35822 (INHresistant) and ATCC 35820 (SM-resistant) strains.CONCLUSION: To consider morusin as a viable alternative or precursor drug for TB treatment, it is imperative to conduct an exhaustive examination of its mechanism of action and conduct in vitro studies using clinical isolates.

Coats plus syndrome: a rare cause of severe gastrointestinal tract bleeding in children - a case report

Background

Coats plus syndrome, cerebroretinal microangiopathy with calcifications and cysts, is a rare disease with autosomal recessive pattern occurring due to a mutation in CTC1, encoding conserved telomere maintenance component 1, gene. Besides retinal involvement, abnormalities in brain and osteopenia, serious life-threatening bleeding in gastrointestinal tract and portal hypertension can be observed.

Case presentation

A 6-year-old girl with Coats plus syndrome presented to the pediatric emergency department with vomiting blood and blood in stool. An upper and lower gastrointestinal endoscopy revealed esophageal varices and vascular telangiectasia in the pyloric antrum, duodenum, and colon. She received palliative care and the bleeding was stopped after receiving intravenous octreotide. She then was followed in the pediatric gastroenterology, neurology, and ophthalmology clinics. She was later hospitalized and admitted to the intensive care unit as she continued to have intermittent gastrointestinal system bleeding. She eventually died due to severe gastrointestinal system bleeding.

Conclusions

Coats plus syndrome can lead to life-threatening gastrointestinal bleeding and portal hypertension. As Coats plus syndrome is quite rare, there is little published data on this syndrome. This report presents a case of Coats plus syndrome as a rare cause of gastrointestinal bleeding and portal hypertension.

Oral health related qualıty of lıfe and dısease severıty ın autoımmune bullous dıseases

Background

There is an increased risk of long-term dental and periodontal disease in autoimmune bullous diseases (AIBD).

Aims

In this cross-sectional study, we aimed to determine whether the oral health-related quality of life status (OHRQoL) was associated with disease severity and activity in patients with AIBD.

Subjects and Methods

67 patients with AIBD were enrolled in this study. Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) was used to evaluate the disease severity. The score was categorized as a significant course (≥17) and moderate course (<17). Oral health impact profile-14 (OHIP-14) questionnaire was filled to assess the OHRQoL. Self-reported oral health status and oral lesion related pain score were also evaluated in the study group.

Results

OHIP-14 score was significantly higher in active patients (42.28 ± 13.66) than inactive patients (29.08 ± 12.25) (P = 0.004) and it was correlated with the pain score (6.33 ± 2.78; r = 0.409, P = 0.013). Furthermore, OHIP-14 score was higher in patients with a significant disease course (45.18 ± 15.08) (P = 0.010) than in patients with a moderate course (36.09 ± 9.73).

Conclusions

OHRQoL may be useful in the disease management and treatment. Since it can be affected by both presence of oral erosions and disease severity, a collaboration between dermatologists and dentists could be crucial to the disease management in AIBD.

HE4: really a novel biomarker for ovarian cancer?

Ovarian cancer forms 4% of all cancers and approximately 23% of all gynecological cancers in women and is responsible for the 47% of deaths related to cancers of the genital tract of women. Tumor markers are the biochemical substances which can be detected in the presence of tumors. Generally they are either the products of tumoral tissues or secreted from the normal cells which are in the inter- action with tumoral ones. The present authors attempted to determine the efficacy of the tumor marker CA- 125 and HE4 to differentiate the malign cases from the benign adnexal masses. A total of 76 patients with the appropriate criteria were included in the study. They were divided into three groups; healthy control group (n=3 1), ones with benign masses (n=23), and ones with malign ovarian masses (n=22). In the study, when the cut-off values were accepted as 55I U/ml for CA-125 and 150 pM for HE4 in differentiation of benign and malign groups, the sensitivity was found as 59.09%, specificity 91.3%, PPV 86.67% and NPV 70% LR = +6.8. This combination gives one false positive result to every five positive cases which were detected as high. With the combination of CA-125 and HE4, the value of sensitivity was found decreased as expected, although the value of the specificity increased.

Social skills training group with Turkish immigrants: Results of a pilot study

Introduction

Social skills training (SST) is an element of cognitive-behavioral therapy, which focuses to improve verbal-nonverbal behaviors involved in social interactions.

Aims-objectives

To assess the effectiveness of a standardised 8–sessions-SST-group therapy (Hinsch&Pfingsten) in Türkish Immigrants who have anxiety/depressive disorders.

Method

German-Turkish transations-backtranslations of contents and materials of the standardised 8–sessions-SST-group therapy were performed. These weekly eight group sessions applied by two Turkish-psychotherapists to 8 voluntary Turkish-Immigrants (F/M = 4/4, age = 50 ± 5.4), who were in treatment for anxiety/depressive disorders in our transcultural outpatient-clinic in Hannover, Germany. Symtom-Checklist-90 (SCL-90) and Insecurity Questionnaire (I-Q) administered before and after the treatment programm. Seven patients completed pre-post scales.

Results

Table 1 presents the scale scores. There was no significant improvement in global-symptom-severity and insecurity-profiles after the SST. One of the psychotherapists and one of the patients were interviewed to discuss qualitatively possible reasons of that.

Psychoherapist

I think patients were not comfortable with many pencil-paper homeworks. Daily-life-examples were too close to German culture. Therefore it's crucial to culturally modify the sessions.

Patient

I found the sessions-homeworks strict and different from my thinking style and culture.

Conclusions

Qualitative data of this study stated that no improvement may be caused by eurocentristic nature of the psychotherapeutic approach. Berry (2006) suggested that such interventions may generate/exacerbate acculturative-stress and may not be beneficial for the patient. Further studies should investigate effectiveness of culturally-modified SST in Turkish immigrants.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Clinical Significance of Intraoperative Frozen Section Analysis of Pancreatic Cancer Surgical Margin at the Time of Pancreaticoduodenectomy

BACKGROUND

Today, in the management of pancreas cancers, achieving an R0 resection is one of the most powerful independent predictors of long-term survival. The aim of this study is to assess the clinical significance of intraoperative frozen section analysis of the pancreatic surgical margin for pancreatic cancer during pancreaticoduodemectomy.

MATERIAL AND METHODS

We conducted a retrospective analysis of prospectively collected data of 37 patients who were operated for pancreatic head cancer and who were evaluated for surgical margin by frozen section analysis intraoperatively, between September 2013 and August 2014 in our center. The intraoperative biopsy reports were compared with final pathological reports.

RESULTS

The mean age of the patients was 64.55(19-82) years (range), the mean tumor size was 3.96(1.16-6.25) cm (range) and the mean harvested lymph node number was 18.52(9-45) (range). In the intraoperative frozen section, one patient was positive for surgical margin (%2.7) who underwent total or complementary pancreatectomy.

CONCLUSION

To secure a tumor-free margin by frozen section, intraoperatively, may increase R0 resection rate in pancreas cancers. The preoperative estimation of tumor margin by endoscopic ultrasonography, computerized tomography or magnetic resonance imaging mostly correlate with intraoperative findings, however in suspected cases intraoperative frozen section for margin determination should be performed.

Laparoscopic versus open appendectomy: where are we now?

PURPOSE

Although the advantages of laparoscopic procedures has been well studied over the last two decade, laparoscopic appendectomy could not to be a standard therapy due to some disadvantages such as longer operative time and higher cost.The objective of our study is to re-evaluate the outcomes of laparoscopic versus open appendectomy with current data.

METHODS

Between January 2012 and July 2012, the data of the patients who had appendectomy were recorded prospectively. Patients' demographics, duration of procedure, length of hospital stay, need of analgesics, postoperative visual analogue scale scores and morbidity were assessed.

RESULTS

Of 241 patients, 120 (49.8%) underwent open and 121(50.2%) laparoscopic appendectomy. The operating time was similar for both groups (p=0.855). The visual analog scale scores of 1st (p=0.001), 6th (p=0.001) and 12th (p=0.028) hours were higher in open the appendectomy group. The total need of analgesics significantly was higher in open group (p=0.001).There was no statistical difference in terms of total morbidity rate between open and laparoscopic appendectomy groups (p=0.617).

CONCLUSION

Two operative techniques are similar in terms of length of hospital stay, operative time, and postoperative complications. Laparoscopic appendectomy reduces the need for analgesics and visual analog scale scores; therefore,it should be considered as the gold standard for surgical treatment of acute appendicitis.

A reliable pancreaticojejunal anastomosis with V-Loc 180 wound closure device for soft pancreatic stump

BACKGROUND/AIMS

Although mortality rates decreased in recent years, pancreaticoduodenectomy is still associated with high morbidity rates. Pancreatic fistula is the leading cause of morbidity after pancreaticojejunal anastomosis and commonly occurs in soft pancreas. The objective of this study is to compare outcomes of conventional modified invaginated end to side pancreaticojejunostomy with a new practical method using V-Loc 'rM 180 wound closure device in soft pancreas.

METHODOLOGY

Between December 2011 and August 2013, a total of 90 pancreaticoduodenectomy procedures were performed in our hospital. 28 of them were defined as soft pancreas according to attending surgeon and included in this study. Patients were divided into two groups consecutively and analysed for postoperative pancreatic fistula (POPF) rate, length of stay, operation time, cost and particular duration of anastomosis. Pancreatic fistulas were classified according to International Study Group on Pancreatic Fistula (ISGPF) definition.

RESULTS

1 grade A and 2 grade B fistulas appeared in V-Loc group (Group 1), whereas 1 grade A, 2 grade B and 1 grade C fistulas appeared in conventional anastomosis group (Group 2).

CONCLUSIONS

Pancreaticojejunostomy with V-Loc suture is a convenient method in soft pancreas and can be performed safely.

Results by treatment modalities in multifocal/multicentric breast cancer: Retrospective analysis of 162 patients

266

Background: The prognostic value of multifocal, multicentric breast cancer is still not well known. Although some studies have suggested that it is associated with a worst prognosis some have not suggest. We evaluated the effect of treatment modalities on overall survival and disease-free survival in breast cancer.

Methods: One hundred and sixty two women with multifocal multicentric breast cancer diagnosed at our oncology center between January 2004 and December 2010 were retrospectively evaluated. Multifocality was defined as the presence of 2 or more foci of the tumor clearly separated in the same breast. Multicentricity was defined as the presence of 2 or more foci at different quadrants. Patients received neoadjuvant chemotherapy were excluded.

Results: Median age of 162 women was 48 y ± 13,63 y. Eighty two of 162 patients were treated with breast-conserving surgery and 80 were treated with mastectomy. Radiotherapy was added to adjuvant therapy to patients with 4 or more positive axillary nodes and/or treated with breast conserving surgery. Three (1.8%) patients were excluded because of bilateral cancer and 1 (0.6%) was excluded because of Tx tumor. Eleven of 162 (6.7%) patients were not seen after surgery so data about adjuvant treatment was not known. Fifty of 147 patients were stage III, 68 were stage II and 30 were stage I. 27 (17.2%) patients received anthracycline based chemotherapy, 30 (20.3%) patients received hormonotherapy and 91 (56.1%) patients received taxane based chemotherapy. Trastuzumab added to the treatment at all patients, if HER2 neu-positive. Median follow up was 41 ± 4.1 (72-9 months) months. 30 systemic diseases at 24 patients were seen on follow up. 18 patients were in taxane group, 4 patients were in anthracycline group, 2 patients were in hormonotheraphy group. Nine patients were died in taxane group, 1 died in anthracycline group and 1 died in hormonotherapy group.

Conclusions: Our retrospective analysis showed worst prognosis at taxane group but; patients with positive lymph nodes and perinodal invasion gets taxane based treatments. This retrospective analysis showed that systemic recurrence and survival in multifocal breast cancer are similar with unifocal disease.

Gallbladder motor function in patients with different thyroid hormone status

Hypothyroidism and hyperthyroidism are known to affect cholesterol metabolism, bile acid synthesis and bile content. There are previous studies reporting increased prevalence of gallstone and common bile duct stone formation in hypothyroidism. The aim of this study was to compare gallbladder (GB) motor function between euthyroid, hypothyroid and hyperthyroid subjects by conventional ultrasonography. Eighteen euthyroid, 14 hypothyroid and 20 hyperthyroid, age, sex and body mass index matched subjects were included in the study. Etiology of hypothyroidism comprised of thyroidectomy, Hashimoto's thyroiditis and previous radioactive iodine therapy. Hyperthyroid group included patients with toxic nodular goitre and Graves' disease. Patients who have diseases or are under drug treatment known to affect biliary function were not included in the study. Fasting and post-stimulus GB volumes were measured by real-time conventional ultrasonography and computer unit (Aloka UST-979, 3.5 mHz electronic convex probe, Japan). No significant differences were noted for fasting, post-stimulus GB volumes and GB ejection fraction between euthyroid, hypothyroid and hyperthyroid subjects. Measuring GB motility accurately is not straightforward because besides being not static during fasting, after a meal, intermittent emptying and refilling of GB occurs. Ultrasonography is affected by GB filling and measures "net" GB emptying. Although cumbersome, additional evaluation with cholescintigraphy which detects "absolute" GB emptying and is not affected by GB filling may provide complete assessment of motor function and may be more informative in evaluating subjects with different thyroid hormone status.

Serum leptin levels, skin leptin and leptin receptor expression in psoriasis

BACKGROUND

Recent studies support the relation of psoriasis with obesity and cardiovascular disease. Leptin, a peptide hormone secreted predominantly from adipose tissue, is involved in the regulation of energy intake and expenditure. Recently, it has been shown to have several immunological effects including induction of proinflammatory cytokine production.

OBJECTIVES

To investigate the possible role of leptin in psoriasis pathogenesis.

METHODS

Forty-three patients with psoriasis, 10 diseased and 10 healthy controls with normal body mass index were included. Serum fasting leptin levels of the study group were examined by enzyme-linked immunosorbent assay. Tissue leptin and leptin receptor expression of both patients and controls were investigated by immunohistochemistry.

RESULTS

Serum leptin levels, tissue leptin and leptin receptor expression were significantly higher in patients with severe psoriasis than patients with mild-moderate psoriasis and controls (P < 0.05). Serum leptin levels showed a positive correlation with Psoriasis Area and Severity Index and involved body surface area in patients with psoriasis. In addition, serum leptin levels, tissue leptin and leptin receptor expression showed a positive correlation with disease duration in patients with psoriasis (P < 0.01, r = 0.979; P < 0.01, r = 0.691; P < 0.01, r = 0.428, respectively).

CONCLUSIONS

We assume that leptin might serve as a marker of severity in psoriasis and also may be a pathogenetic cofactor contributing to chronicity of the disease. Consequently, its role in obesity and cardiovascular disease in patients with psoriasis deserves to be studied. In addition, drugs targeting the proinflammatory effects of leptin may be a new adjuvant therapeutic approach in psoriasis.

Pediatric diffuse lipoblastomatosis of the foot -- a case report and review of the literature

Diffuse lipoblastomatosis is a rare lipomatous tumor of infancy that derives from fetal-embryonal fat. It usually affects infants and children and presents as a superficial mass that extends from the subcutis to the underlying muscle in the upper or lower extremities. In spite of its benign nature, the tumor may behave in a locally aggressive manner and invade the surrounding tissues. A case of isolated diffuse lipoblastomatosis of a 5-year-old boy in the plantar aspect of his right foot that has not been documented in that area before is described. The clinical and radiological presentation and histologic evaluation of diffuse lipoblastomatosis are discussed, in order to make a differential diagnosis between this rare tumor and other soft tissue tumors. In addition, the treatment principles of the tumor are described. This case demonstrates that diffuse lipoblastomatosis can be difficult to diagnose without histologic evaluation and, once diagnosed, should be treated by adequate surgical excision in order to prevent recurrence.

[Hepatic hydrothorax]

Hepatic hydrothorax is a rare complication of portal hypertension secondary to liver cirrhosis affecting approximately 5-10% of cirrhotic patients with ascites. Hepatic hydrothorax results from an accumulation of fluid migrating through a diaphragmatic defect from the abdominal cavity into the pleural cavities. The effusion of hepatic hydrothorax is typically transudative whereas the effusion of spontaneous bacterial empyema (SBEM) is exudative. The clinical management of hepatic hydrothorax is equivalent to that of ascites. Patients with persistent hepatic hydrothorax despite fluid and sodium restriction as well as the use of maximally tolerable doses of diuretics and repeated thoracentesis are considered to have refractory hepatic hydrothorax. SBEM is a frequent underlying condition. SBEM occurs in up to 13% of patients with hepatic hydrothorax and should be treated by antibiotic therapy. Refractory hydrothorax is observed in 10% of patients with hepatic hydrothorax. These patients should be considered for transjugular intrahepatic portal systemic shunt (TIPS) placement which is the most effective option for refractory hepatic hydrothorax with response rates ranging up to 80% in most studies. Suitable patients with hepatic hydrothorax should be considered as candidates for liver transplantation. TIPS may help to bridge the time to liver transplantation.

Impact of Ramadan on demographics and frequencies of disease-related visits in the emergency department

Summary The objective of this study was to determine whether Ramadan is changing frequencies and demographics of visits due to certain diseases. Data obtained from the charts of the adult patients admitted into the emergency department (ED) due to 10 predetermined entities between 2000 and 2004 were analysed. Demographic variables analysed separately for certain entities visiting the ED in Ramadan were not found to be different from visits in other times of year. Visit frequencies for hypertension and uncomplicated headache in Ramadan were significantly higher than in non-Ramadan months (chi(2) test, p = 0.015 for hypertension, p < 0.001 for uncomplicated headache). Mean age of the patients admitted to the ED due to diabetes-related conditions in Ramadan was significantly lower than in pre- and post-Ramadan months (59.91 +/- 14.60 and 62.11 +/- 14.61, respectively) (Mann-Whitney U-test, p = 0.032). The patients with diabetes presenting in Ramadan were found significantly younger than their peers in the rest of the year. For other diseases, Ramadan does not appear to be a risk factor.

Colonic metastasis from squamous carcinoma of the lung: report of a case and review of the literature

We describe a rare case with metastatic involvement of the gastrointestinal tract (colonic metastasis) secondary to lung cancer. After diagnostic work-up, a left hemicolectomy was performed. Patient has been alive and healthy 9 months after operation. We report the first case with the longest survival period after the diagnosis of metastasis, although the symptomatic gastrointestinal metastases from lung cancer generally follow a poor prognosis because of their advanced state and multiplicity.

Massive lower gastrointestinal bleeding in typhoid fever

Typhoid fever is an infectious disease that is usually treated medically and rarely needs surgical intervention. In this paper, we report three cases of severe colonic involvement in salmonella infection in patients traveling in or coming from endemic areas, resulting in ulceration and massive anorectal bleeding.

Nachweis von SLA/LP-Autoantikörpern bei Patienten mit primär biliärer Zirrhose als Marker für eine sekundäre autoimmune Hepatitis (Overlapsyndrom)

BACKGROUND AND OBJECTIVE

The aim of this study was to evaluate whether the presence of SLA/LP-autoantibodies in PBC-patients gives evidence for a secondary AIH, also called AIH/PBC-overlap-syndrome.

PATIENTS AND METHODS

Out of 233 consecutive patients with PBC who had been followed between October 1980 and April 2000, we evaluated the data of anti-SLA/LP-positive patients and compared them to patients with an anti-SLA/LP-negative AIH/PBC overlap syndrome as well as to patients with a classical course of AIH and PBC.

RESULTS

In total we could identify nine PBC patients with anti-SLA/LP antibodies (six women/three men) or 3.9% of the study population, Anti-SLA/LP-positive PBC patients were slightly younger at diagnosis in comparison to anti-SLA/LP-negative PBC-patients (49.9 vs. 53.2 years). Transaminases and gamma-globulins were significantly higher in anti-SLA/LP-positive PBC-patients in comparison to anti-SLA/LP-negative PBC-patients (mean: 235 vs. 55 IU/l and 27.6 vs. 19.5 g/l). Anti-SLA/LP-positive patients significantly more frequently had an HLA-type that is characteristic for AIH (B8; DR3; DR4). Immunosuppressive therapy reduced inflammatory activity and cholestasis significantly. Relapses were frequent after reduction or discontinuation of immunosuppressive therapy.

CONCLUSION

The presence of SLA/LP autoantibodies in PBC patients has a high specificity for a secondary AIH (AIH/PBC overlap syndrome). These patients have a good response to immunosuppressive therapy. The autoantibody profile and immunogenetics may help in future to identify PBC patients that benefit most from immunosuppressive therapy.

The long-term evolution of and transport processes in a self-sustained final cover on waste deposits

A new principle for confinement of waste based on a self-sustained seal is presented. The top cover is considered to consist of two main layers; an organic carbon rich surface layer that is able to support vegetation and an inorganic layer beneath it. The function of the cover is to mitigate oxidation and acidification of landfilled waste and hence the release of toxic metals. It is suggested that forest soil formation and soil development could prove to be valuable information sources for the study of the long-term behaviour of a final cover on waste deposits. Since the cover is expected to develop in northern temperate climate the focus is on Spodosol soil. A number of simulations of the long-term behaviour of the final self-sustained landfill cover are made, including the rates of influx of oxygen into the cover. A cover having a large portion of organic matter compared with a cover with no organics can considerably decrease the oxygen concentration and thus the influx of oxygen into a landfill. The calculated oxygen intrusion rate for the former case is of the order of 0.05 kg m(-2) year(-1). Degradation of the organics produces acids. Our simulations indicate that the pH-buffering capacity of the mineral layer, represented by calcite and primary rock minerals, will last for many thousands of years.

Long-term processes in waste deposits

A conceptual model, which is a unitary and continuous description of the overall processes in waste deposits, has been developed. In the model the most important processes governing the long-term fate of organic matter in landfills and the transport and retention of toxic metals are included. With the model as a base, a number of scenarios with different levels of complexity have been defined and studied in order to carry out long-term assessments of the chemical evolution in waste deposits for industrial and municipal solid waste containing much organic matter and the leaching of toxic metals. The focus of the modelling has been to quantify the important processes occurring after the methane production phase has ceased, i.e. during the humic phase. The scenarios include the main mechanisms based on various transport processes as well as different landfill constructions, e.g. binding capacities of sulfides and humic substances. They also include transport mechanisms by which the reactant oxygen can intrude into a deposit, sorption capacities of hydrous ferric oxides, and pH-buffering reactions, etc. Scoping calculations have shown that the binding capacity of humic substances is sufficient to bind all toxic metals (Cd, Cr, Pb, Zn and Hg). In addition, the humics could also bind a smaller part of Ca, Fe and Al, provided much of the organic waste remain as humic substances. Sulfides on the other hand can bind approximately twice the amount of all toxic metals. The binding capacity of hydrous ferric oxides, which can be formed by oxidation reactions during the humic phase, is estimated to be three times the total content of metals that can sorb on hydrous ferric oxides. In the studied landfill the pH-buffering capacity, primarily represented by calcite, is estimated to be 1 mol/kg dry waste. Quantifications indicate that the alkalinity of the wastes is high enough to buffer the acidity produced by the oxidation of sulfides and by the degradation of organic matter, as well as that added by acid precipitation. Therefore, the main conclusion is that higher remobilisation rates of heavy metals due to lowering of pH are not expected for many thousands of years.

Ileal and colonic contractions by endothelin-1 in experimentally induced paralytic ileus in rats

The aim of the present study was to investigate the effect of endothelin-1 on the isolated distal ileum and proximal colon in an experimentally induced ileus in rats. Ileal and colonic contractions by endothelin-1, acetylcholine alone and with endothelin-1 were recorded both in normal and experimentally induced paralytic ileus in rats. In the control group, all the responses to acetylcholine were found to be potentiated significantly when used together with endothelin-1 but in paralytic ileus group, no detectable change was observed in the responses of the amine after administration of acetylcholine together with endothelin-1. This study indicates that endothelin-1 might have an effect on gastrointestinal motility and postoperative paralytic ileus.

Long-term fate of organics in waste deposits and its effect on metal release

The long-term chemical evolution in waste deposits and the release of toxic metals was investigated. The degradation of organic matter and hence the potential efflux of heavy metals in a long-term perspective was studied by defining some scenarios for waste deposits containing organic compounds, different longevity and functions of covers and different water and air intrusion rates. The scenarios were based on various transport processes as well as different landfill constructions. The rates of influx of oxygen into both saturated and partially saturated landfills have been estimated. Each scenario takes the form of a mathematical model. The starting point for all the studied cases is the humic phase, i.e. the phase after the methane production has stopped. Based on the different cases studied, it appeared that landfills where the waste is below the water table could have advantages over the other cases. Recognizing that this option is not accepted in most countries we, nevertheless, suggested it should be reevaluated. The main conclusion is that the degradation of humic matter and hence the release of toxic metals can be substantially decreased if potential build-up of hydraulic gradients are avoided and if the landfill is located below the water surface. A conceivable alternative construction would be to place it in a depression--either natural or artificial--and to construct it so that under normal conditions it would always be water-saturated.

The effects of captopril and naloxone on restraint-cold-stress- and ethanol-induced gastric lesions in rats

1. This study was undertaken to investigate the effect of captopril (1 microgram/kg or 1 mg/kg, i.p.) on the actions of naloxone (5 mg/kg, i.p. in gastric ulceration induced by ethanol and restraint-cold-stress. 2. Neither naloxone (5 mg/kg, i.p.) nor captopril (1 mg/kg, i.p.) alone induced any change in the indices of the ulcer in either group. 3. Captopril at a lower dose (1 microgram/kg, i.p.), when combined with naloxone (5 mg/kg, i.p.), significantly reduced cumulative ulcer length only in the ethanol-treated group (from 54.9 +/- 7.2 mm to 22.5 +/- 6.2 mm). 4. However, a high dose of captopril (1 mg/kg) plus naloxone pretreatment caused a significant reduction in both ethanol (from 54.9 +/- 7.2 mm to 24.9 +/- 6.5 mm) and restraint-cold-stress (from 19.0 +/- 3.0 mm to 5.3 +/- 1.0 mm)-induced ulcer formation. 5. Acetylsalycilic acid, when used together with captopril, increased the ulcer formation induced by stress. 6. Naloxone, by increasing the release of prostaglandins, has been shown to prevent ulcer formation induced by several noxious stimuli. 7. Therefore, the effect of the combination might be due to the synergistic interaction of both drugs on prostaglandin synthesis.

The cytoprotective effect of iloprost against carbon tetrachloride induced necrosis in rat liver

The aim of this study was to investigate the cytoprotective effect of Iloprost on the liver against carbon tetrachloride induced necrosis. The serum histamine-like activity was found to be increased when compared with that of controls after treatment with carbon tetrachloride for 18 weeks while prostaglandin E2- and leukotriene C4-like activities were unchanged. After pretreatment with Iloprost for 18 weeks the increased activity of histamine was found to be unchanged while prostaglandin E2-like activity was increased. It is concluded that Iloprost protects the liver against carbon tetrachloride-induced damage and reduces the level of histamine that has a role in the pathogenesis of portal hypertension.

The effects of indomethacin, NDGA, allopurinol and superoxide dismutase on prostaglandin E2 and leukotriene C4 levels after mesenteric ischemia-reperfusion injury

In this study, the changes of arachidonic acid metabolites after an ischemia-reperfusion (I/R) period are investigated. The cyclooxygenase and lipoxygenase metabolites were found to be significantly increased after a 45 min period of ischemia followed by 5 min of reperfusion. Prostaglandin E2 (PGE2)- and leukotriene C4 (LTC4)-like activities did not change in the ischemic period, but they both increased after reperfusion. A cyclooxygenase inhibitor indomethacin and lipoxygenase inhibitor nordehydroguaretic acid (NDGA) decreased PGE2- and LTC4-like activities, respectively, while allopurinol and superoxide dismutase (SOD) decreased both activities. According to our results, it can be assumed that free oxygen radicals are responsible for the elevation of PGE2- and LTC4-like activities and both of these arachidonic acid metabolites and free oxygen radicals are the main necrotizing agents in ischemia-reperfusion induced damage.

The effects of prostacyclin analogue ZK 36374 and thromboxane synthetase inhibitor UK 38485 on mesenteric ischemia in guinea pigs

The effects of ZK 36374, a prostacyclin analogue and UK 38485, a thromboxane synthetase inhibitor were studied in guinea pigs after performing mesenteric arterial occlusion. In this study, while ZK 36374 significantly lowered the alkaline phosphatase and creatine phosphokinase values two hours after mesenteric arterial occlusion when compared with the control group (p less than 0.005), UK 38485 did not induce any change. In guinea pigs, when given together, ZK 36374 and UK 38485 lowered the enzyme levels to preligation values and the difference was nonsignificant (p greater than 0.1). The histopathologic investigation of the small intestine after giving ZK 36374 and UK 38345 together revealed minimal changes. These findings stress the importance of preserving the PGI2 levels in the PGI2/TXA2 ratio in preventing the increase of lysosomal enzyme levels and histopathologic changes after mesenteric arterial occlusion in guinea pigs.