Organic compounds in water extracts of coal: links to Balkan endemic nephropathy.

The Pliocene lignite hypothesis is an environmental hypothesis that has been proposed to explain the etiology of Balkan endemic nephropathy (BEN). Aqueous leaching experiments were conducted on a variety of coal samples in order to simulate groundwater leaching of organic compounds, and to further test the role of the Pliocene lignite hypothesis in the etiology of BEN. Experiments were performed on lignite coal samples from endemic BEN areas in Romania and Serbia, and lignite and bituminous coals from nonendemic regions in Romania and the USA. Room temperature, hot water bath, and Soxhlet aqueous extraction experiments were conducted between 25 and 80 °C, and from 5 to 128 days in duration. A greater number of organic compounds and in higher concentrations were present in all three types of leaching experiments involving endemic area Pliocene lignite samples compared to all other coals examined. A BEN causing molecule or molecules may be among phenols, PAHs, benzenes, and/or lignin degradation compounds. The proposed transport pathway of the Pliocene lignite hypothesis for organic compound exposure from endemic area Pliocene lignite coals to well and spring drinking water, is likely. Aromatic compounds leached by groundwater from Pliocene lignite deposits in the vicinity of endemic BEN areas may play a role in the etiology of the disease. A better understanding of organic compounds leached by groundwater from Pliocene lignite deposits may potentially lead to the identification and implementation of effective strategies for the prevention of exposure to the causative agent(s) for BEN, and in turn, prevention of the disease.

Correction to: Abstracts : 31st European Congress of Pathology.

In E-Poster Sessions of the published abstract, the authors' affiliations as well as the abstract text were incorrectly presented. The correct abstract and the author's affiliations are shown in full in this article.

Spinal cord damage in surgery of the abdominal aorta.

The incidence, etiology, and clinical manifestations of spinal cord damage after abdominal aortic operations and abdominal aortography are defined on grounds of the authors' experience and of a survey of the pertinent literature. In the authors' experience the incidence of cord damage was 0.25% (three of 3,164) after abdominal aortic operations and 0.01% (two of 17,494) after abdominal aortography. As regards postoperative cord complications in the authors' series, they occurred only in cases of aneurysm, were 10 times more common in ruptured than in unruptured aneurysms, and the neurological loss usually was complete flaccid paraplegia (five of eight or 62%) with high mortality (three of eight or 38%), and rare partial (two of eight or 25%) or complete (one of eight or 13%) recovery. Recovery was more likely the lesser than neurological loss. The cause of postoperative spinal cord damage was ischemia resulting from the interruption of a critical radicular artery at the lower thoracic or high lumbar vertebral levels in the presence of anomalously located greater radicular or infrarenal radicular arteries. High aortic clamping and hypotension increased the probability of this occurrence, which essentially was unpredictable and, therefore, unavoidable. In postartographic cases the cord damage is more variable in its extent, and its cause is a chemical insult brought about by flooding the anterior spinal artery with contrast medium to which the patient probably is hypersensitive. In both groups treatment of the established clinical picture (paraplegia) is confined to support and rehabilitation.

Anastomotic aneurysms after vascular reconstruction: problems of incidence, etiology, and treatment.

To gain a better understanding of the pathogenesis, natural history, therapeutic response, and the potential of prevention of anastomotic aneurysms in general and those following aortofemoral interventions in particular, we have reviewed 4,214 reconstructive vascular operations performed in the past 15 years during which procedures (prosthetic bypass, autogenous vein graft, and endarteriectomy) of fairly uniform technical details have been used. Among these operations representing 9,561 anastomotic sites, we encountered 205 anastomic aneurysms, a per site incidence of 1.7 percent. By far the most common site of occurrence was the femoral artery following Dacron bypass procedures, with a per site incidence of 3.0 percent. The lowest rate of incidence was observed after endarteriectomies, regardless of anatomic location (0.4 percent). The most frequent causative factor was found to be structural deficiency of the parent artery, which accounted for 30.7 percent of the aneurysmal lesions. Other etiological agents, in order of importance, were arterial hypertension, mechanical stress, defect of the graft material, and noninfective healing complications. The therapeutic approach was an aggressive one and only patients with prohibitive operative risks were treated conservatively. In the elective surgical cases the rate of good results was 81.6 percent, with no operative deaths.

Popliteal arterial aneurysms. Their natural history and management.

Eighty-seven popliteal aneurysms in 62 patients, of which 50 were treated surgically, were reviewed and their clinical characteristics summarized. The need for alertness in the clinical detection of these lesions was stressed. Because complications, namely thrombosis and embolization, were frequent (23% in the total group, 36% in the surgical group), we recommend surgical treatment not only in all symptomatic but also in asymptomatic aneurysms larger than 2 cm in diameter; nonsurgically treated cases must be followed up carefully. With this aggressive approach, no lives and only two limbs were lost (one in a case of irreversible gangrene of the foot). Of the two surgical techniques described, the bypass procedure with autogenous vein graft is, because of its simplicity, given preference over resection with graft.

Secondary arterial repair. The management of late failures in reconstructive arterial surgery.

The incidence and success of secondary operations after reconstructive arterial surgery were studied in a series of 4,247 cases of aneurysmal and occlusive arterial disease. Postoperative complications requiring secondary operations occurred, in order of frequency, as the result of defective healing (including infection), deterioration of the arterial implant, and degenerative arterial changes in the site of surgical intervention. A large variety of surgical techniques were used for correction, such as total replacement, segmental resection and replacement, remote bypass, thrombectomy, and partial excision and reanastomosis. Wth the exception of complications due to infection, the results of repair were good in 60% to 90% of the various categories; only 40% of the infected grafts could be managed without the loss of life or limb. The results appear to justify the trend noted in recent years to a more aggressive use of secondary, salvage operations.

Translumbar aortography: a study of its safety and usefulness.

We reviewed that clinical courses of 14,550 patients in whom translumbar aortography was performed. The principal aim of the survey was to determine the incidence of major and fatal complications attributable to this diagnostic study, as an index of its safety. We found that in this group, seven major (0.05%) and two fatal (0.014%) complications occurred. The corresponding incidences for transfemoral catheter aortography reported in the literature were found to be 1.34% and 0.06%, respectively. Translumbar aortography, when performed under the proper indications and appropriate conditions, has a degree of safety equal to or greater than that of transfemoral catheter aortography, and its diagnostic reliability within its technical scope is high.

Congenital arteriovenous anomalies of the limbs.

Observations in 33 patients with congenital arteriovenous fistulas described ten years ago have been extended with the addition of 49 other cases; the clinical, pathologic, and roentgenographic characteristics of these lesions in the entire group of 82 patients have been summarized. The findings in the entire group over the additional observation period have confirmed the conclusions previously reached, namely, that (1) these clinically extremely varied lesions have a unitary (developmental) cause; (2) for rational management, angiographic investigation is indispensable to establish their extent and complexity; (3) with few exceptions, their radical cure by surgical means is impossible; and (4) the large majority of patients do well on a carefully supervised conservative regimen, with surgical intervention reserved for individually defined instances.