Esophagogastric junction morphology assessment by high resolution manometry in obese patients candidate to bariatric surgery.

INTRODUCTION: Obesity is a strong independent risk factor of gastroesophageal reflux disease (GERD) symptoms and hiatal hernia development. Pure restrictive bariatric surgery should not be indicated in case of hiatal hernia and GERD. However it is unclear what is the real incidence of disruption of esophagogastric junction (EGJ) in patients candidate to bariatric surgery. Actually, high resolution manometry (HRM) can provide accurate information about EGJ morphology. Aim of this study was to describe the EGJ morphology determined by HRM in obese patients candidate to bariatric surgery and to verify if different EGJ morphologies are associated to GERD-related symptoms presence. METHODS: All patients underwent a standardized questionnaire for symptom presence and severity, upper endoscopy, high resolution manometry (HRM). EGJ was classified as: Type I, no separation between the lower esophageal sphincter (LES) and crural diaphragm (CD); Type II, minimal separation (>1 and < 2 cm); Type III, >2 cm separation. RESULTS: One hundred thirty-eight obese (BMI>35) subjects were studied. Ninety-eight obese patients referred at least one GERD-related symptom, whereas 40 subjects were symptom-free. According to HRM features, EGJ Type I morphology was documented in 51 (36.9%) patients, Type II in 48 (34.8%) and Type III in 39 (28.3%). EGJ Type III subjects were more frequently associated to Symptoms than EGJ Type I (38/39, 97.4%, vs. 21/59, 41.1% p < 0.001). CONCLUSIONS: Obese subjects candidate to bariatric surgery have a high risk of disruption of EGJ morphology. In particular, obese patients with hiatal hernia often refer pre-operative presence of GERD symptoms. Testing obese patients with HRM before undergoing bariatric surgery, especially for restrictive procedures, can be useful for assessing presence of hiatal hernia.

Solidification of Cd-bearing zeolitic tuff by reaction with lime.

This article aims to find a reliable procedure by which to remove Cd(2+) from water and store it safely. The proposed procedure includes Cd(2+) uptake by a zeolitic tuff, a natural cation exchanger, followed by stabilization of the contaminated solid in a hardened lime matrix. Several tuff-lime pastes were examined and their safety tested by cation leaching and mechanical strength measurement. It was demonstrated that a very cheap mixture, containing only 10% lime, is able to safely retain the harmful cation and may be disposed of in a segregated landfill.

An unconventional method for the recovery of caustic soda from spent Al-rich pickling solutions.

This work presents an unconventional procedure for the recovery of spent Al-rich caustic soda solutions from the pickling of dies for the production of aluminium extrusions. Caustic soda was regenerated at roughly 70%, by precipitating aluminate, after addition of a silica source, in the form of zeolite A, a microporous material that is widely used in many technological sectors. It was shown that the process is reliable and can be repeated for several cycles, provided the concentration of the caustic soda solution is suitably restored. The by-product obtained, zeolite A, proved to be a high-grade material with performance as a cation exchanger and physical sorbent that is certainly comparable to that reported in literature (e.g., cation exchange capacity equal to 5.14 meq g(-1) vs. 5.48 meq g(-1) and water vapour adsorption capacity of 26.5% vs. 27.6% at 16 torr and 298 K). The economics of the process, although not examined yet, would appear generally favourable, considering that zeolite A is a valuable by-product which widely covers the costs for the recovery of the spent solutions. There are, therefore, significant prospects for the use of zeolite A, particularly as a builder in detergent formulation.

Safe immobilization of Cr(III) in heat-treated zeolite tuff compacts.

The possibility to remove chromium ions from a simulated electroplating wastewater by a discontinuous ion-exchange process based on phillipsite-rich Neapolitan yellow tuff (NYT) has been investigated. The immobilization of the pollutant cation in the resulting sludge through a heat-treatment has been realized, demonstrating that compacts made of Cr-loaded NYT powder, fired at temperatures of 1000 degrees C or over, are safe materials with negligible Cr3+ leaching. The set up overall process allows, in addition, a volume reduction of the waste with associated lower disposal costs or, better, the obtainment of a ceramic material, whose physical and mechanical properties are comparable to those of similar ordinary ceramics, such as bricks. In summary, the proposed strategy looks at the polluted sludge as a resource to be exploited, instead of a dangerous material to safely dispose of.