Incidental lymphadenopathy in renal transplantation.

INTRODUCTION: Iliac lymphadenectomy is performed to provide anastomotic access during the vascular implantation procedure in renal transplantation. Iliac lymph nodes (LNs) are often enlarged, but there are no standardised guidelines for the management of incidentally enlarged LNs during transplantation. We aimed to evaluate histological findings of LNs sent for examination at our unit. METHODS: Patients were evaluated in two distinct date cycles. In the first cycle, lymphadenectomy and histological assessment were performed at the discretion of the transplanting surgeon. In the second cycle, all incidentally enlarged LNs were sent for histological assessment, regardless of size. RESULTS: In the first cycle (n = 76), 11 patients (14.47%) had incidentally enlarged iliac LNs on lymphadenectomy and histology showed only reactive changes. In the second cycle (n = 165), eight patients (4.85%) had incidentally enlarged LNs on lymphadenectomy. One patient was found to have mature B cell chronic lymphocytic leukaemia. The patient was referred to haematology and a "watch and wait" approach was taken, with the patient still alive at last follow-up (511 days post-transplantation). DISCUSSION: There are currently no published guidelines on the management of incidentally enlarged iliac LNs during transplantation. Current literature suggests that clinically significant lymphadenopathy needs to be investigated in all patients. Based on our centre's experience of a 5.26% (1 in 19) positive pathological LN sampling, we recommend that all incidental LNs with suspicious features and/or that are greater than 10mm in diameter should be considered for histological, microbiological and molecular assessment as appropriate.

Organically bound tritium (OBT) activity concentrations in surface soil at the Chalk River Laboratories, Canada.

Canadian Nuclear Laboratories (CNL)'s Chalk River Laboratories (CRL) site is home to a large nuclear research complex in Canada. CRL's air tritium releases amount to about 1015 Bq/year. The objective of the study was to characterize the spatial footprint of the 60 years of tritium atmospheric releases in surface soil by measurement of organically bound tritium (OBT). Soil OBT activity concentrations were of particular interest because soil represents a long-term tritium reservoir that can act as a historical record of tritium releases into the environment. Soil samples to a 5 cm depth were collected within the CRL site from 2012 to 2014. Each sample was analyzed for tritiated water (HTO) and OBT activity concentrations. The highest HTO and OBT measurements obtained during this study were 154.0 ±â€¯7.8 Bq/L and 180.9 ±â€¯37.3 Bq/L, respectively. A developed OBT map indicated that retained tritium in soil was not related to the distance of sources-term but it was related to the prevailing wind direction.

Effects of in situ exposure to tritiated natural environments: A multi-biomarker approach using the fathead minnow, Pimephales promelas.

Aquatic ecosystems are chronically exposed to radionuclides as well as other pollutants. Increased concentrations of pollutants in aquatic environments can present a risk to exposed organisms, including fish. The goal of this study was to characterize the effects of tritium, in the context of natural environments, on the health of fathead minnow, Pimephales promelas. Fish were exposed to tritium (activity concentrations ranging from 2 to 23,000Bq/L) and also to various concentrations of several metals to replicate multiple-stressor environments. Fish were exposed for 60days, then transferred to the tritium background site where they stayed for another 60days. Tritium, in the forms of tritiated water (HTO) and organically bound tritium (OBT), and a series of fish health indicators were measured in fish tissues at seven time points throughout the 120days required to complete the exposure and the depuration phases. Results showed effects of environmental exposure following the increase of tritium activity and metals concentrations in water. The internal dose rates of tritium, estimated from tissue HTO and OBT activity concentrations, were consistently low (maximum of 0.2µGy/h) compared to levels at which population effects may be expected (>100µGy/h) and no effects were observed on survival, fish condition, gonado-somatic, hepato-somatic, spleno-somatic and metabolic indices (RNA/DNA, proteins/DNA and protein carbonylation (in gonads and kidneys)). Using multivariate analyses, we showed that several biomarkers (DNA damages, MN frequency, gamma-H2AX, SFA/MUFA ratios, lysosomal membrane integrity, AChE, SOD, phagocytosis and esterase activities) were exclusively correlated with fish tritium internal dose rate, showing that tritium induced genotoxicity, DNA repair activity, changes in fatty acid composition, and immune, neural and antioxidant responses. Some biomarkers were responding to the presence of metals, but overall, more biomarkers were linked to internalized tritium. The results are discussed in the context of multiple stressors involving metals and tritium.

Changes in HTO and OBT activity concentrations in the Perch Lake aquatic ecosystem.

Perch Lake, a small shallow shield lake located on the Chalk River Laboratories (CRL) site, contains elevated levels of tritium due to inputs from a nearby nuclear waste management area. The releases have been going on for many years but tritium levels in Perch Lake have been gradually decreasing since about year 2000. Lake water, sediments, aquatic plants, clams and fish were collected during the summer and fall of 2003 and 2013 at three locations in the lake. HTO activity concentrations were measured in all samples and OBT activity concentrations were measured in sediments, plants, clams and fish. In 2003, 2013, HTO activity concentrations in lake water were roughly uniform in time and space, except close to the shoreline where concentrations were fluctuating according to stream water and groundwater tritium levels in streams entering the lake. HTO activity concentrations of biota were similar to concentrations in lake water at the site where they were collected. OBT activity concentrations in biota were not always correlating with the lake water HTO levels. OBT to HTO ratios were found to be less than 1 for aquatic plants, around 1 for clams and fish and above 1 for birds reared on the shore of the lake.

Determination of changes to TFWT and OBT concentrations in potatoes and Swiss chard as a result of preparation for human consumption.

Ingestion is one of the most important pathways to consider for calculating tritium dose to human beings. The objective of this study is to determine changes to TFWT and OBT concentrations in food as a result of its preparation for consumption. The contribution of OBT to the total tritium dose can be reduced by the oxidation of OBT during food preparation. The results show that preparation for consumption can result in reductions of up to 46% in TFWT concentration and 54% in OBT concentration in potato, and 22% in TFWT concentration and 57% in OBT concentration in Swiss chard.

Drive-through deliveries: in support of federal legislation to mandate insurer coverage of medically sound minimum lengths of postpartum stay for mothers and newborns.

President Clinton signed the Newborns' and Mothers' Health Protection Act of 1996 into law on September 26, 1996. The Act requires insurers that provide maternity benefits to cover medically sound minimum lengths of inpatient, postpartum stays according to the joint guidelines of the American Academy of Pediatrics and the American College of Obstetrics and Gynecology. This Note discusses the historical context in which the necessity for passage of protective legislation arose, the interplay between state and federal statutes that created the need for federal legislation to provide desired protections for postpartum patients, and examines the provisions of the Act. This Note endorses the Newborns' and Mothers' Health Protection Act of 1996 as federal legislation necessary to protect postpartum patients from medically inappropriate insurer mandates while still allowing medical providers and their patients flexibility in medical decision making in the postpartum period.