Environmental impacts of household appliances in Europe and scenarios for their impact reduction.

Assessing the environmental impact due to consumption of goods and services is a pivotal step towards achieving the sustainable development goal related to responsible production and consumption (i.e. SDG 12). Household appliances plays a crucial role and should be assessed in a systemic manner, namely considering all life cycle stages, technological efficiency, and affluence aspects. The present study assess the impact of such household appliances used in Europe, and tests scenarios of potential impact reduction at various scales. Life cycle assessment is applied to 14 different household appliances (ranging from dishwashers to television devices) selected to build a set of representative products, based on their economic value and diffusion in households in Europe. Related impacts are calculated with the Environmental Footprint method for calculating a Consumer Footprint "appliances" for the baseline year 2010. A number of scenarios encompassing eco-solutions on a technical level, changes in consumption pattern, behavioral changes, as well as the combination of all these aspects are run to estimate the Consumer Footprint related to household appliances for the year 2030, compared against this baseline scenario. The baseline Consumer Footprint is confirming the importance of the use phase in leading the impacts in almost all impact categories. Testing different scenarios concludes that there is a reduction of the impact for most of the categories (with up to 67% for the ozone depletion potential, and still around 35% for the global warming potential), while two of the here examined impact categories (i.e. land-use and mineral resource depletion) show an overall potential that is even negative - i.e. the results of all scenarios are higher than the ones of the 2010 baseline scenario. The increase in purchase and use of such appliances may offset energy efficiency benefits in some of the examined categories. Hence, the assessment of sustainability of appliances consumption should always include several scales, from the efficiency of the products (micro scale), to the improvement of the energy mix (meso scale), up to accounting for socio-economic drivers and patterns of consumption affecting the overall appliances stock (macro scale).

Reasoned approach to multiple osteosclerotic lesions. Combined diagnostic imaging in a case of osteopoikilosis.

The case of a female patient who had undergone mastectomy for infiltrating ductal carcinoma and come to the Orthopedics Division for lumbosacral pain unresponsive to conventional treatment is discussed. Pelvic X-ray, CT and scintigraphy were performed. The presence of multiple areas of selerosis of the pelvis and proximal femurs were documented. The differential range could be limited to osteoblastic metastasis and osteopoikilosis. The diagnosis of osteopoikilosis was established based on scintigraphy which proved the absence of uptake of the radiotracer.

Intralobar pulmonary sequestration in an elderly adult.

The case of a patient admitted to the hospital for symptoms characterized by chest pain, productive cough, fever, dyspnea resistant to antibiotic therapy is discussed. Previous plain chest X-ray performed elsewhere was suggestive of inflammotory lung consolidation. An admission chest X-ray revealed a left lower lobe density. On chest CT-angiography a lobulated mass in the posterior basal segment of the left lower lobe was visualized: the diagnosis of intralobar pulmonary sequestration (ILPS) was hypothesized.

Combined diagnostic imaging in a patient with Forestier disease and dysphagia.

The case of a patient with dysphonia and ingravescent dysphagia, associated with crises of lipothymia "ab ingestis" is discussed. ENT examination with videolaryngoscopy evidenced a swelling of the posterior hypopharyngeal wall. X-ray study of the upper digestive tract was discontinued for inhalation. The scintigraphic study of swalling documented marked alteration of the oropharyngeal phase with phenomena of post-deglutitory aspiration. CT of the cervical vertebral column documented anterior diffuse vertebral hyperostosis of C3-C6: this finding was suggestive of Forestier disease.

Combined diagnostic imaging in a patient with suspected biliary atresia.

The case of a newborn infant of 40 days of age with persistent jaundice and blood chemistry values suggestive of cholestasis is discussed. Liver and bile duct US documented missed visualization of the gallbladder. In the suspicion of biliary atresia, hepatobiliary scintigraphy was performed; it showed preserved hepatocyte function, missed visualization of the gallbladder and absence of intestinal bile flow which confirmed the diagnostic hypothesis. Based on possible diagnostic alternatives, signs perceived and interpreted, are analyzed.

Postoperative dysphagia versus neurogenic dysphagia: scintigraphic assessment.

In order to differentiate the features of dysphagia that occur after supraglottic horizontal laryngectomy from those that occur during neurologic diseases, we divided 38 subjects into 3 groups and submitted them to oropharyngoesophageal scintigraphy. Group 1 (control group) included 15 healthy volunteeers; group 2 comprised 8 patients who had residual dysphagia at least 1 year after supraglottic laryngectomy; and group 3 included 15 patients with various neurologic and neuromuscular disorders. In group 1, the mean values (+/- 2 SD) of selected semiquantitative parameters were consistent with those reported in the literature for normal subjects. In group 2, oral, pharyngeal, and esophageal transit times were not significantly altered, and moderate tracheobronchial post-deglutitive aspiration was present (maximum value, 6.7%; mean value, 2.04%). The pharyngeal retention index was significantly increased (p = .0003) as compared to normal subjects in all cases (maximum value, 40%; mean value, 23%) and was associated in all cases with slight but consistent post-deglutitive aspiration. In group 3, the oral and esophageal phases were significantly prolonged and the retention indices were significantly increased. Statistical analysis documented a significant increase in oral transit time (p = .003), esophageal transit time (p = .01), oral retention index (p = .006), pharyngeal retention index (p = .0007), and esophageal retention index (p = .009) as compared to normal subjects. The swallowing pattern was also altered by 1) an early loss of the bolus from the oral cavity; 2) bolus fragmentation due to double or triple deglutition, reduced lingual propulsion, or the return of a small part of the bolus into the oral cavity during deglutition; and/or 3) double pharyngeal peaks in the activity-time curves. Tracheobronchial aspiration (maximum value, 90%; mean value, 9.70%) was present in some cases, mainly in patients affected by post-stroke dysphagia. On the basis of the obtained results and considering the low doses of radiation delivered to the patient (0.043 Gy), the limited invasiveness, and the excellent patient tolerance, scintigraphy appears to be clinically valid in the functional study of swallowing and in identifying different deglutition disorders.

Diagnostic imaging of hyaline membrane disease.

The case of a premature infant with hyaline membrane disease (respiratory distress syndrome) is discussed. On chest X-ray reduced volume and transparency of both lungs with ground-glass appearance and presence of bilateral air bronchogram was visualized. These findings are analyzed with respect to possible diagnostic alternatives.

Post-processing of digital images.

Post-processing of bi- and three-dimensional images plays a major role for clinicians and surgeons in both diagnosis and therapy. The new spiral (single and multislice) CT and MRI machines have allowed better quality of images. With the associated development of hardware and software, post-processing has become indispensable in many radiologic applications in order to address precise clinical questions. In particular, in CT the acquisition technique is fundamental and should be targeted and optimized to obtain good image reconstruction. Multiplanar reconstructions ensure simple, immediate display of sections along different planes. Three-dimensional reconstructions include numerous procedures: multiplanar techniques as maximum intensity projections (MIP); surface rendering techniques as the Shaded Surface Display (SSD); volume techniques as the Volume Rendering Technique; techniques of virtual endoscopy. In surgery computer-aided techniques as the neuronavigator, which with information provided by neuroimaging helps the neurosurgeon in simulating and performing the operation, are extremely interesting.

Combined diagnostic imaging of upper gastrointestinal tract in a patient with dysphagia and suspected gastroesophageal reflux disease (GERD).

The case of a patient with intermittent dysphagia and suspected GERD is discussed. Pharyngoesophageal scintigraphy was performed. Reflux test was negative. To better define the lesion and establish the diagnosis the study was completed with an X-ray of the upper digestive tract. The finding of a barium collection and a tear in the posterior wall of the pharyngoesophageal tract was suggestive of the diagnosis of Zenker's pseudodiverticulum.

Radio-guided surgery for lymph node recurrences of differentiated thyroid cancer.

The objectives of this study were to assess the reliability of radio-iodine (131I) and a gamma probe for radio-guided surgery (RGS) to detect and then radically dissect lymph node recurrences (LNRs) in 10 patients with differentiated thyroid cancer (DTC). The major inclusion criterion was the presence of an iodine-positive LNR after previous total thyroidectomy and at least two ineffective 131I treatments. The protocol was designed as follows. Day 0: all patients were hospitalized and received 3.7 GBq of 131I in the hypothyroid condition. Day 3: presurgery whole-body scan with a therapeutic dose (TxWBS). Day 5: neck surgery using a gamma probe (Navigator GPS, AutoSuture, Italy), recording the absolute counts and the lesion/background (L/B) counts ratio. Day 7: post-surgery TxWBS performed using the remaining radioactivity. The presurgery TxWBS was positive in all patients, and the post-surgery TxWBS showed a negative pattern in 7 of 10 patients, suggesting the efficacy of the surgical procedure in most of the patients. After RGS the mean decrease in the absolute counts and the L/B counts ratio were 77.6% (52.7% minimum, 94.6% maximum) and 77.4% (52.3% minimum, 94.8% maximum), respectively. After operation the surgeon judged the procedure to be decisive in two patients, favorable in six, and irrelevant in two. The final histologic examination showed the presence of 78 lymph node metastases (mean of 8 per patient). There were 33 neoplastic lesions found by both TxWBS and gamma probe evaluations; 41 were shown only by gamma probe, and 4 were negative by both TxWBS and gamma probe evaluations. This protocol permitted us to look for neoplastic foci with high sensitivity and specificity, and we were able to remove lymph node metastases resistant to radioiodine therapy at a single session. The protocol also allowed detection of some additional tumoral foci in sclerotic areas or behind vascular structures that are difficult to identify and were not seen at the presurgery TxWBS evaluation. However, because of the possible false-negative results, complete excision must be undertaken in high risk patients with a local recurrence to eradicate the largest number of lymph nodes, independent of the counts measured by the gamma probe.

Selective intracoronary injection of sestamibi to detect myocardial viability: Prediction of perfusion and contractile recovery after percutaneous transluminal coronary angioplasty.

BACKGROUND: The main limitation of myocardial single photon emission computed tomography (SPECT) in detecting hibernating myocardium is the poor delivery of radiotracers in hypoperfused areas supplied by severely stenotic coronary arteries. Increasing local availability of radiotracers by intracoronary injection might represent an attractive solution. The hypothesis that the intracoronary administration of sestamibi could improve myocardial SPECT accuracy in detecting hibernating myocardium was addressed in this pilot study. METHODS AND RESULTS: Seven patients with prior myocardial infarction and severe stenosis of the infarct-related artery underwent myocardial SPECT after intracoronary injection of technetium 99m sestamibi immediately before percutaneous transluminal coronary angioplasty (PTCA). Wall motion and perfusion were evaluated, before and 1 month after PTCA, by 2-dimensional echocardiography and rest-redistribution thallium 201 SPECT. A "low-flow area" was identified on the pre-PTCA Tl-201 SPECT image as the area with less than 50% of maximum radiotracer uptake. Changes in wall motion and perfusion in the low-flow area were compared with results of intracoronary sestamibi imaging. On a pixel-by-pixel analysis, intracoronary sestamibi predicted perfusion recovery within the low-flow area with a 91% sensitivity, a 78% specificity, and an 82% overall accuracy. Only in the 5 patients with an extent of sestamibi uptake greater than one third of the low-flow area was an improved regional and global left ventricular wall motion observed after PTCA (wall motion score index decreased from 1.95 +/- 0.28 to 1.60 +/- 0.34, P =.007; left ventricular ejection fraction increased from 42% +/- 7% to 49% +/- 7%, P =.001; asynergic segments in the low-flow area decreased from 3.6 +/- 0.9 to 1.8 +/- 1.5, P =.021). CONCLUSIONS: In patients with prior myocardial infarction and severe stenosis of the infarct-related artery, sestamibi uptake after intracoronary administration identified viable myocardium that was undetected after rest-redistribution thallium SPECT but capable of clinically significant contractile improvement after revascularization.