Shifting Ground: Landscape-Scale Modeling of Biogeochemical Processes under Climate Change in the Florida Everglades.

Scenarios modeling can be a useful tool to plan for climate change. In this study, we help Everglades restoration planning to bolster climate change resiliency by simulating plausible ecosystem responses to three climate change scenarios: a Baseline scenario of 2010 climate, and two scenarios that both included 1.5 °C warming and 7% increase in evapotranspiration, and differed only by rainfall: either increase or decrease by 10%. In conjunction with output from a water-use management model, we used these scenarios to drive the Everglades Landscape Model to simulate changes in a suite of parameters that include both hydrologic drivers and changes to soil pattern and process. In this paper we focus on the freshwater wetlands; sea level rise is specifically addressed in prior work. The decreased rainfall scenario produced marked changes across the system in comparison to the Baseline scenario. Most notably, muck fire risk was elevated for 49% of the period of simulation in one of the three indicator regions. Surface water flow velocity slowed drastically across most of the system, which may impair soil processes related to maintaining landscape patterning. Due to lower flow volumes, this scenario produced decreases in parameters related to flow-loading, such as phosphorus accumulation in the soil, and methylmercury production risk. The increased rainfall scenario was hydrologically similar to the Baseline scenario due to existing water management rules. A key change was phosphorus accumulation in the soil, an effect of flow-loading due to higher inflow from water control structures in this scenario.

Impact of the axillary nodal status on sentinel node mapping in breast cancer and its relevance for technical proceeding.

OBJECTIVE: The aim of this study is to analyze whether the axillary status influences the lymphatic mapping procedure in malignant breast disease and whether clinically relevant consequences for the technique of Sentinel Node (SN) biopsy may be drawn from this information. MATERIALS AND METHODS: SN biopsy was performed in 150 consecutive patients using a combination of the radioguided and the blue-dye technique. Axillary status was compared with the number of detected nodes. In cases of numerous nodes with tracer uptake, the radioactivity of each radiolabeled node was measured separately in a dose calibrator. We analyzed whether an increased tracer uptake could possibly indicate a 'true' or 'dominant' SN. Blue dye uptake was registered and compared with radioactivity. The findings were related to the histologic results. RESULTS: In patients with a positive axillary status, significantly more radiolabeled nodes were detected than in node negative patients (median 3 vs. 2; p < 0.001). In 54/86 patients with numerous SNs a 'dominant' node with at least twice the radioactivity than other marked nodes could be identified (62.8%). From 26 cases with axillary involvement, 20 patients (76.9%) were identified by the 'dominant' and the remaining six women (23.1%) by others than the seemingly leading SN. CONCLUSION: Axillary lymph node involvement influences the drainage pattern in breast cancer. Patients with numerous SNs have an increased risk of axillary involvement. A high tracer uptake does not permit the identification of a 'true' SN. A lack of surgical accuracy may lead to pitfalls if the axilla is not screened carefully for all radioactive nodes.

Results of a standardized protocol for sentinel node imaging in breast cancer with Tc-99m labeled nanocolloidal albumin.

AIM: Of this study was to evaluate the results of a standardized protocol for sentinel node (SN) detection in breast cancer using Tc-99m labeled nanocolloidal albumin and a combined intra- and subdermal injection technique. METHODS: One hundred and fifty-five women with proven breast cancer (disease stages Tis-T2) were included. Four injections of 10 to 15 MBq of Tc-99m nanocolloid in 0.1 ml physiologic saline were administered intra- and subdermally at the 3, 6, 9 and 12 o'clock positions in the skin overlying the tumor. Planar scintigraphic images in lateral and anterior projections were obtained once between 2.5 and 18 hours after tracer administration. Guided by a gamma probe, all radioactive lymph nodes in the axilla were resected, then complete dissection followed. RESULTS: In 151 of the 155 women (97.4%), nodal tracer uptake (range 1-7 foci, average 2.2) was scintigraphically revealed. In one of these cases, drainage was only to the internal mammary lymphatic chain. Three of the 4 women with detection failure presented with histologically proven tumor infiltration of the lymphatics and axillary involvement. In 49 of the patients with visualized axillary lymph nodes (32.7%), at least one SN was metastatic. In 21 cases, this SN was the only positive node. The remaining 101 patients with negative SN included 4 cases with axillary involvement. The sensitivity of the SN with respect to the histological status of the entire axilla was thus 92.5%, the negative predictive value was 96.0%. The overall accuracy of the method was 97.3%. There was a significant difference between the number of totally detected radioactive nodes in the groups with and without nodal metastases (3.49 vs. 2.57, p < 0.01). CONCLUSION: The described protocol represents an easy reproducible and reliable method for SN detection in breast cancer that additionally allows flexible timing of surgery. Further, we found evidence that the number of scintigraphically visualized nodes also reflects the histological status of the axilla.

Development of the parafollicular cells in recurrent goiter.

OBJECTIVE: To provide more data for the discussion on whether thyroid hormones, iodide and other factors controlling the thyroid also influence the parafollicular (PF) cells, as the answer is of great importance for optimization of the medical treatment of medullary thyroid carcinoma (MTC) after surgery. DESIGN: We compared the density of the PF cells in patients who underwent surgery for the second time due to recurrent goiter with that in normal-sized thyroid glands after the first operation. METHODS: In 20 patients with only one operation, all specimens were taken from morphologically and functionally normal lobular thyroid parenchyma. The second group consisted of 30 patients who had already undergone a nearly total resection of at least one thyroid lobe several years before. Then another surgery of the same side was performed due to recurrent goiter. Immunohistochemical staining of the PF cells was performed using primary antibodies to calcitonin and chromogranin. RESULTS: An average of 78 PF cells (median 12.5) was found in the sections with the highest density of the first group. The average number of PF cells in the second group was just 5 (median 0). The Wilcoxon test revealed a highly significant difference in the total PF cell content between the groups (P < 0.001). CONCLUSIONS: Our study suggests that the stimulating factors that lead to growth of the thyroid parenchyma do not influence the PF cells. Hence a non-suppressive thyroid hormone replacement seems to be sufficient after resection of an MTC.

Lymphoscintigraphic sentinel node imaging and gamma probe detection in breast cancer with Tc-99m nanocolloidal albumin: results of an optimized protocol.

PURPOSE: The purpose of this study was to aid in the standardization of lymphoscintigraphy for detecting the sentinel node (SN) in breast cancer using Tc-99m-labeled nanocolloidal albumin. MATERIALS AND METHODS: One hundred twenty-three women with proved breast cancer were enrolled. Four injections of 10 to 15 MBq (0.27 to 0.41 mCi) Tc-99m nanocolloid in 0.1 ml physiologic saline were administered intra- and subdermally at the margin of the skin overlying the tumor. Planar scintigraphic images in the lateral and anterior projections were obtained 2.5 to 18 hours after tracer administration. With a gamma probe used as a guide, all radioactive lymph nodes in the axilla were resected. Complete dissection then followed. RESULTS: In 116 of the 123 (94%) women, axillary nodal tracer uptake was revealed. Six of the 7 women in whom detection failure occurred had histologically proved tumor infiltration of the lymphatics and axillary involvement. In 36 (31%) of the patients with visualized lymph nodes, the SN was metastatic. The remaining 80 patients with negative SN included three cases with axillary involvement. The sensitivity of the SN with respect to the histologic status of the entire axilla thus was 92.3%, and the negative predictive value was 96.3%. The overall accuracy of the method was 97.4%. The number of hot nodes in women with and without axillary involvement was significantly different. CONCLUSIONS: The described protocol represents an easily reproduced and reliable method for SN detection in breast cancer. Furthermore, the number of visualized axillary nodes reflects the histologic status of the axilla.

[Early manifestation of polycystic kidney changes in tuberous sclerosis]. / Ein frühes Auftreten polyzystischer Nierenveränderungen bei tuberöser Sklerose.

Tuberous sclerosis (McKusick number: 19110) is well documented as an inheritable autosomal dominant disorder. On the occasion of results of an autopsy of a male fetus (1950 g, 29th gestational week) we report on the very early onset of a giant cell astrocytoma (microcalzified focally) and a cystic kidney disorder which in association with this phacomatosis is described first for this age. Thus, based on sonography there is a new differential diagnosis for the weighty prenatal diagnosis of a "Potter syndrome" or of "cystic kidneys". Moreover, on a chromosomal level we discuss possible connections between tuberous sclerosis and distinct forms of autosomal dominant polycystic kidney disease, ADPKD.

A modified technique for the production of an arterio-venous shunt in sheep, allowing a comparison of biocompatibility of synthetic materials.

Polytetrafluorethylene (PTFE) prostheses were implanted in 12 sheep as a shunt between the carotid artery and the jugular vein using an end-to-side anastomosis technique. This technique allows repeated tests of the pharmacological and toxicological safety of artificial kidney units after both single and multiple administration. Furthermore, it enables the investigation of detoxification of compounds via dialysis, thus contributing to drug safety. Implantation of the prosthesis was uncomplicated. Connection to the extracorporeal circulation was achieved via catheters and maintained using a pump with an output of up to 300 ml/min. This enabled maintenance of extracorporeal circulation for several hours without clinical impairment to the animals. The AV-shunts remained functional for between 8 and 253 days (mean 112.3 days).

Cardiac transplantation in a neonate with endocardial fibroelastosis.

An investigational orthotopic cardiac transplantation was performed to manage subendocardial fibroelastosis in a neonate. No unmanageable technical complications arose from the transplantation. Postoperative observation showed the infant developed normally except for moderate cerebral palsy.

Primary cardiac tumors--clinical experiences and late results in 48 patients.

Between 1971 and 1987 48 patients (35 female and 13 male) underwent operations at the Department of Cardiovascular Surgery, Justus-Liebig-University Giessen, for primary cardiac tumors. The age of the patients ranged from 21 to 71 years. Clinical symptoms were congestive heart failure, cardiac murmurs and findings similar to mitral stenosis, chest pain, arrhythmias, arterial embolism, myocardial infarction and pericarditis. 39 of the tumors were benign and 9 were malignant. Diagnosis was confirmed by echocardiography and/or cineangiocardiography. The left atrium was most commonly involved, followed by the right atrium. Surgery was performed in all cases using cardiopulmonary bypass. Benign tumors were totally removed, including attachment to the atrial septum or the free wall. In one case the tumor resection was carried out by autotransplantation of the heart. During the perioperative period we lost one of the 39 patients with benign tumors due to low cardiac output. Observing a mean follow up period of 48 months, no recurrence of tumors was noted and all patients are doing well now. The malignant neoplasms could not be removed completely, and in 4 cases only a reduction of the tumor mass was possible. Three of the 9 patients died during the postoperative period. Only one patient survived longer than 48 months. Whereas surgical therapy of malignant cardiac tumors is still a matter of discussion based upon these discouraging results, benign or semimalignant cardiac neoplasms have a very favourable prognosis when the surgical intervention can be performed prior to the occurrence of severe complications, such as congestive heart failure and arterial embolism.(ABSTRACT TRUNCATED AT 250 WORDS)

Laser-assisted trachea anastomoses in dogs.

Tracheal anastomoses are known to be related to special surgical risks. We performed laser-assisted trachea anastomoses in 10 Beagle dogs, using an Argon-laser system and a handheld quarz fiber for energy transmission. All animals showed an uneventful postoperative course without signs of infection, air-leakage or respiratory impairment. Pathologic examination revealed no significant stenosis but a normal reconstruction of the tracheal endothelium and a normal woundhealing with only an increased connective tissue reaction. Because of the lower tensile strength of laser-assisted anastomoses in general, three adapting absorbable sutures should be left in situ to increase the resistance against mechanical stress. Under these circumstances laser-assisted anastomoses seem to be a promising additional method in the field of tracheal reconstruction and transplantation.

Myxoma of the aortic valve in a child.

Myxomas are predominantly located in the right on left atrium. We report an unusual case of a myxoma adherent to the aortic valve. The child presented with symptoms of subaortic stenosis. By invasive methods a tumor was diagnosed located at the aortic valve. After surgical removal the child recovered soon and is doing well. According to our knowledge this is the first report of a myxoma of the aortic valve.

[Screening and detection of tetrazepam and its major metabolites]. / Screening und Nachweis von Tetrazepam und seinen Hauptmetaboliten.

The paper describes a screening procedure for 7-Chloro-1,3-dihydro-1-methyl-5-(cyclohexene-1-yl)-2H-1,4-benzodiazepine -2-one (Tetrazepam, Musaril) and other important analytical data (TLC, GLC, UV-, IR-, and mass spectra).

[Screening, detection and biotransformation of lormetazepam, a new hypnotic agent from the 1,4-benzodiazepine series (author's transl)]. / Screening, Nachweis und Biotransformation von Lormetazepam, einem neuen Hypnotikum aus der Reihe der 1,4-Benzodiazepine.

The paper describes a screening procedure for 7-chloro-5-(2-chlorphenyl)-3-hydroxy-1-methyl-2,3-dihydro-1H-1,4-benzodiazepin- 2-one (lormetazepam, Noctamid) and other important analytical data (TLC, GLC, UV-, IR- and mass spectra) of this new benzodiazepine derivative. Screening results after a single p.o. dose of 1 mg lormetazepam (Noctamid-1) are also reported.

[Triiodothyronine, reverse-triiodothyronine, thyroxine, resin-triiodothyronine-uptake and protein bound jodide in the fluid of thyroid cysts (author's transl)]. / Trijodthyronin, Reverse-Trijodthyronin, Thyroxin, Trijodthyroninbindung und proteingebundenes Jod in Flüssigkeiten von Strumapseudozysten.

T3, rT3, T4, PBI and the saturation of T3-T4-binding proteins in yellow and brown cyst fluids of nontoxic goiters differ from the values in sera. In the brown cyst fluids, resulting from a hemorrhage, T3, rT3, T4, PBI and T3 U are significantly higher than in sera and no correlation could be found with the values in sera. In the yellow cyst fluids T3 and T3 U are significantly higher then in sera, T4 is lower, PBI and rT3 do not differ from the values in sera. Only T3 and rT3 are not correlated. Various reasons for higher concentrations of hormones in the cyst fluid such as destruction of thyroid follicles and lymphvessels, a high protein concentration and direct secretion of hormones and iodoproteins from thyroid tissue in the cyst wall into the cyst fluid are taken into consideration. As these hormones in the cyst fluid may be absorbed, the results are also of clinical value.