Economic assessment of aerated constructed treatment wetlands using whole life costing.

There is increasing pressure on water treatment practitioners to demonstrate and deliver best value and sustainability for the end user. The aim of this paper is to evaluate the sustainability and economics, using whole life costing, of wastewater treatment technologies used in small community wastewater treatment works (WwTW) of <2,000 population equivalent (PE). Three comparable wastewater treatment technologies - a saturated vertical flow (SVF) aerated wetland, a submerged aerated filter (SAF) and a rotating biological contactor (RBC) - were compared using whole life cost (WLC) assessment. The study demonstrates that the CAPEX of a technology or asset is only a small proportion of the WLC throughout its operational life. For example, the CAPEX of the SVF aerated wetland scenario presented here is up to 74% (mean = 66 ± 6%) less than the cumulative WLC throughout a 40-year operational time scale, which demonstrates that when comparing technology economics, the most cost-effective solution is one that considers both CAPEX and OPEX. The WLC assessment results indicate that over 40 years, the SVF aerated wetland and RBC technologies have comparable net present value (NPV) WLCs which are significantly below those identified for submerged aerated filter systems (SAF) for treatment of wastewater from communities of <1,000PE. For systems designed to treat wastewater from communities of >1,000PE, the SVF aerated wetland was more economical over 40 years, followed by the RBC and then the SAF. The aerated wetland technology can therefore potentially deliver long-term cost benefits and reduced payback periods compared to alternative treatment technologies for treating wastewater from small communities.

Transitional cell carcinoma forming a perirenal cyst in a cat.

An eight-year-old, neutered male Burmese cat presented with five days vomiting and anorexia. Physical examination, clinical pathology and diagnostic imaging findings suggested a perirenal pseudocyst. After partial resection of the perirenal capsule clinical signs temporarily resolved, but the cat was euthanased 34 days postoperatively as a result of seizures and recurrence of vomiting. Postoperative histopathology showed neoplastic transitional cells within and lining the resected perirenal capsule; a diagnosis of transitional cell carcinoma was confirmed post-mortem. To the authors' knowledge, this is the first report of this presentation of transitional cell carcinoma. Transitional cell carcinoma should be a differential diagnosis for the aetiology of perirenal pseudocyst.

Treatment of acute lymphocytic leukemia by high-dose intravenous methotrexate.

A pharmacokinetic study of methotrexate levels in blood and cerebrospinal fluid was performed in 42 patients who received one or more courses of high-dose methotrexate at 500 mg/sq m infused i.v. over a 24-hr period. Methotrexate level in the lumbar cerebrospinal fluid reached 1.2 x 10(-7) M at 0.5 hr and remained constant at that level for the 1st 24 hr. Similar methotrexate levels were noted in the ventricular fluid obtained through an Ommaya device on three patients with brain tumors treated with high doses of methotrexate. Preliminary clinical results using high-dose methotrexate combined with simultaneous intrathecal methotrexate in 23 children with newly diagnosed acute lymphocytic leukemia indicate that this treatment program is safe to administer and to date appears effective in the prevention of central nervous system leukemia.

Recombinant interferon alfa given before and in combination with standard chemotherapy in children with acute lymphoblastic leukemia in first marrow relapse: a Pediatric Oncology Group pilot study.

Recombinant interferon alfa (rIFN-alpha) was given to 31 children with acute lymphoblastic leukemia (ALL) in first on-therapy marrow relapse as the sole treatment (30 megaunits/m2/d intravenously x 10 days) before standard four-drug reinduction and during multiagent continuation therapy (30 megaunits/m2 subcutaneously x 3 consecutive days every 3 weeks). After 10 days of rIFN-alpha, there were two partial remissions (PRs); seven additional patients had either greater than or equal to 25% reduction in the percentage of marrow blast cells or hypoplastic marrow. Two patients had progressive disease with an increase in leukocyte counts. All patients experienced influenza-like symptoms, and there were isolated instances of severe abdominal pain and personality change. Dose-limiting toxicity comprised grade III/IV transaminase elevation (two patients) and syncope with personality change (one patient). Twenty-three of 31 children (74%) subsequently achieved marrow remission using standard agents. One patient was taken off study during teniposide (VM-26) and cytarabine (ara-C) consolidation due to toxicity. Continuation therapy including rIFN-alpha pulse was well tolerated in the remaining children; only one patient required rIFN-alpha dosage reduction (for CNS toxicity). rIFN-alpha toxicity did not necessitate reductions in doses of standard chemotherapy agents or significant delays in therapy. Five patients remain in remission at 26+ to 36+ months; 13 patients relapsed in marrow, one in the meninges (7 months), and one in meninges, mediastinum, and lymph nodes (2 months). Two children were removed from study for marrow transplant. In summary, high-dose rIFN-alpha alone had a modest antileukemic effect. In contrast to the clinical experience with combined rIFN-alpha and chemotherapy in adults, rIFN-alpha given in a pulse-like manner throughout continuation therapy did not compromise the intensity of the standard chemotherapy regimen.

International criteria for diagnosis, staging, and response to treatment in patients with neuroblastoma.

Neuroblastoma is one of the most common tumors in childhood. However, it often has been difficult to compare clinical and laboratory studies of this disease due to a lack of uniform criteria for diagnosis, staging, and response. An international group of conferees addressed each of these issues and reached a consensus. Specific criteria for making a diagnosis of neuroblastoma are defined. A new neuroblastoma staging system is proposed that takes into account the most important elements of current but incompatible systems. Finally, criteria for response to treatment are standardized. The criteria proposed herein represent an international consensus of essentially every major pediatric oncology group or organization in the United States, Europe, and Japan. The staging system should be referred to as the International Neuroblastoma Staging System, and the response criteria as the International Neuroblastoma Response Criteria. Implementation of these criteria will greatly facilitate the comparison of clinical and laboratory studies by different groups and countries. Furthermore, these criteria should serve as a foundation on which future modifications or improvements can be based.

Adjuvant adriamycin and cisplatin in newly diagnosed, nonmetastatic osteosarcoma of the extremity.

Twenty-two patients with newly diagnosed nonmetastatic osteosarcoma of the extremity were treated with an adjuvant chemotherapeutic regimen consisting of Adriamycin (Adria Laboratories, Columbus, Ohio) and cisplatin. Fourteen of the 22 patients remain continuously disease free for 65+ to 113+ months, with a median time on study of 70+ months. The 72-month disease-free survival estimate is 64%. Pulmonary metastases occurred in six patients, an isolated stump recurrence was seen in one patient, and one patient had a local recurrence following a limb-salvage procedure. For those patients in whom pulmonary metastases developed, the onset was late in three of six, and the number of metastases was three or fewer in all patients. Two patients with pulmonary metastases and one with a stump recurrence have apparently been salvaged, thus resulting in a 77% 72-month survival. Toxicity observed in patients treated with this regimen was in keeping with previous reports. This chemotherapeutic regimen is effective in the adjuvant therapy of nonmetastatic osteosarcoma of the extremity. It should be incorporated into other adjuvant protocols in an effort to continue to improve the outcome in patients with osteosarcoma.

The use of different induction and maintenance chemotherapy regimens for the treatment of advanced yolk sac tumors.

Four children with yolk sac tumor were treated with an aggressive combination chemotherapy program. Three children had presacral primary tumors, one having pulmonary metastases, and one had a testicular primary tumor with pulmonary metastases. Three children were treated when they had measurable disease, and one had no measurable disease. The chemotherapy program consisted of a 6-wk induction period with vincristine (VCR), cis-diamminedichloroplatinum (DDP), and bleomycin. Maintenance therapy consisted of VCR, actinomycin D, and cyclophosphamide (cytoxan) every 3-4 wk as tolerated. Treatment was discontinued after 12 mo of complete remission. All three patients with evaluable disease had a partial response (PR) to induction therapy. Two underwent surgical exploration following induction therapy, one a laparotomy and the other a thoracotomy, and were found to have only scar tissue at the sites of presumed residual disease. The third child with measurable disease progressed to a clinical complete response (CR) during maintenance therapy. Two patients have had no evidence of disease (NED) for 42+ and 41+ mo since starting therapy (28+ and 27+ mo since completing treatment). Two patients are NED 11+ and 7+ mo since starting therapy and remain on treatment. We have encountered no significant renal or pulmonary toxicity, and there have been only two hospitalizations during maintenance therapy for fever and neutropenia. These preliminary results employing different induction and maintenance chemotherapy programs and planned second-look surgical intervention appear encouraging.

Human T-cell leukemia-associated cell surface glycoprotein GP37: studies with three monoclonal antibodies and a rabbit antiserum.

Three monoclonal antibodies (mAbs), termed SN2, SN2a and SN2b, were used in the present work to study a human T-cell leukemia-associated cell surface glycoprotein, GP37. Strong specificity of mAbs SN2, SN2a and SN2b for T leukemia cells was demonstrated by radioimmunoassay and fluorescence-activated cell sorter (FACS) analysis. GP37 was not detected on normal human peripheral blood lymphocytes, purified normal T-cells, normal thymocytes nor normal bone marrow cells. Furthermore, GP37 was barely detectable on phytohemagglutinin (PHA)- and Concanavalin A (Con A)-activated T-cells. The results indicate clinical utility of these mAbs. Competitive binding experiments show that the epitopes recognized by SN2 and SN2a are sufficiently close to each other to allow complete reciprocal inhibition of binding whereas the epitopes recognized by SN2 and SN2b are less close to allow only partial reciprocal binding inhibition. The biochemical nature of antigenic determinants defined by these mAbs was studied by treating T leukemia cells with trypsin, chymotrypsin, thermolysin, neuraminidase and mixed glycosidases. The results suggest that the antigenic determinants defined by these mAbs all consist of the protein moiety of the glycoprotein GP37. No significant antigenic modulation was observed when T leukemia cells were reacted with SN2. In a sequential immunoprecipitation experiment, a 125I-labeled leukemia antigen preparation was first treated with a rabbit anti-T leukemia antiserum. The latter had been prepared by immunizing a rabbit with a partially purified human T leukemia antigen preparation and showed a good specificity for T leukemia cells. Subsequent treatment of the labeled antigen preparation with SN2 showed that SN2 antigen had been precleared. Thus, both mouse mAb SN2 and the rabbit anti-T leukemia antiserum react with the same GP37 molecule.

The significance of the ratio of blood to marrow hematopoietic progenitors (CFU-GM and CFU-GEMM) in relation to disease state of patients with acute lymphoblastic leukemia.

We studied a total of 143 patients with 231 assays of CFU-GM, of these, 45 patients were studied with 58 simultaneous assays of CFU-GEMM in an attempt to correlate progenitor colony growth with disease state. Blood and marrow leukocytes were cultured in a standard methylcellulose culture system using normal human leukocyte colony stimulating activity. Results are expressed as natural logarithm of the ratio of blood colonies to marrow colonies. A high ratio of blood to marrow (greater than 1) was seen in active disease while a low ratio occurred during remission. Eighty-seven per cent of CFU-GM matched pair samples with active disease had high ratios while less than 1% of remission samples were high. In addition, patients with suspected relapse or relapse up to 14 months after this test often had high ratios indicating this test could be of prognostic value. It is not known if this effect of ALL is unique to ALL or if it occurs as a reaction to any hematopoietic stress.

Alpha-streptococcal septicemia in leukemic children treated with continuous or large dosage intermittent cytosine arabinoside.

During a 2-year period after the introduction of an intensive chemotherapeutic protocol, alpha-hemolytic streptococci accounted for 75% of all episodes of sepsis among children with acute nonlymphocytic leukemia at our institution. Only one case had occurred in the previous 8 years. Fourteen of 15 episodes of streptococcal sepsis occurred after therapy with either continuous or large dosage intermittent cytosine arabinoside. Eleven episodes occurred at two specific treatment points. Septic episodes were complicated by shock (2 of 15), encephalopathy (2 of 15), pneumonia (3 of 15) and death (1 of 15). Oral mucosal lesions may provide a portal of entry for alpha-hemolytic streptococci. These data suggest that children receiving continuous or large dosage intermittent cytosine arabinoside for treatment of acute nonlymphocytic leukemia may be at increased risk for alpha-hemolytic streptococcal sepsis. Empiric antimicrobial therapy in these children when febrile and neutropenic should include antibiotics effective against alpha-hemolytic streptococci.

Central Nervous System (CNS) Involvement in Acute Nonlymphocytic Leukemia (ANLL).

The incidence of central nervous system (CNS) involvement and effects of therapy were reviewed in 42 consecutive pediatric patients with acute nonlymphocytic leukemia (ANLL). The morphology of ileukemic cells was considered M1 in 13, M2 in 7, M3 in 5, M4 in 8, and M5 in 9. Two patients with M5 morphology presented with CNS disease at diagnosis. Systemic Ara-C treatment was included as a mainstay of remission induction and maintenance program for all patients. With the exception of the M5 group, none of the patients received direct CNS prophylactic therapy. There was a 0% incidence of CNS relapse: in this group of patients. Median duration of remission for all patients (excluding the M5 group) was 33 months. This experience may indicate that systemic treatment with Ara-C may provide some degree of CNS prophylaxis in ANLIL.

Bilateral choroidal neonatal neuroblastoma.

We treated a bilateral, well-differentiated neuroblastoma of the choroid in a patient who had congenital abdominal neuroblastoma. Although orbital metastasis of neuroblastoma is common, intraocular metastasis is not. In our patient, there was no amplification of the N-myc oncogene in the tumor of either eye. This is consistent with early-stage primary neuroblastoma. Histologically, the tumors were identical in each eye and well differentiated with Homer Wright rosettes; most neuroblastoma metastases have few rosettes and are composed of more undifferentiated, anaplastic cells. We believe that our patient had bilateral primary tumors and not metastatic tumors.

Primitive neuroectodermal tumors of childhood. An approach to therapy.

Primitive neuroectodermal tumors are found in the cerebrum of children and young adults. The are clinically highly malignant and have rapid course from diagnosis to death. Their microscopic pathology reveals 90% to 95% nondifferentiation, frequent mitoses, and small dark cells with no observable cytoplasm. This paper discusses the treatment of three children with this tumor with a combination of surgery irradiation, and combination chemotherapy. The results of this approach are compared with previous reports in the literature. The average survival in this series is 24 months versus approximately 8 months reported in the literature.

Aneurysmal bone cyst: report of a case mimicking orbital tumor.

Aneurysmal bone cysts are rare bone tumors which normally affect the vertebral region or long bones. Involvement of facial bones is uncommon. Although nonneoplastic, these lesions are expansile and may cause local destruction of bone and soft tissues. When making the diagnosis, it is imperative to consider the clinical, radiologic, and histologic features of the entity to avoid confusion with other possibly malignant giant cell tumors. We report an unusual case involving the orbit in a 2 1/2-year-old girl.

The effect of silver impregnation of surgical scrub suits on surface bacterial contamination.

Silver-impregnated fabrics are widely used for their antibacterial and antifungal effects, including for clinical clothing such as surgical scrub suits (scrubs). This study investigated whether silver impregnation reduces surface bacterial contamination of surgical scrubs during use in a veterinary hospital. Using agar contact plates, abdominal and lumbar areas of silver-impregnated nylon or polyester/cotton scrubs were sampled for surface bacterial contamination before (0 h) and after 4 and 8h of use. The number of bacterial colonies on each contact plate was counted after 24 and 48 h incubation at 37°C. Standard basic descriptive statistics and mixed-effects linear regression were used to investigate the association of possible predictors of the level of bacterial contamination of the scrubs with surface bacterial counts. Silver-impregnated scrubs had significantly lowered bacterial colony counts (BCC) at 0 h compared with polyester/cotton scrubs. However, after 4 and 8h of wear, silver impregnation had no effect on BCC. Scrub tops with higher BCC at 0 h had significantly higher BCC at 4 and 8h, suggesting that contamination present at 0 h persisted during wear. Sampling from the lumbar area was associated with lower BCC at all three time points. Other factors (contamination of the scrub top with a medication/drug, restraint of patients, working in the anaesthesia recovery area) also affected BCC at some time points. Silver impregnation appeared to be ineffective in reducing bacterial contamination of scrubs during use in a veterinary hospital.