The impacts of intensive mining on terrestrial and aquatic ecosystems: A case of sediment pollution and calcium decline in cool temperate Tasmania, Australia.

Mining causes extensive damage to aquatic ecosystems via acidification, heavy metal pollution, sediment loading, and Ca decline. Yet little is known about the effects of mining on freshwater systems in the Southern Hemisphere. A case in point is the region of western Tasmania, Australia, an area extensively mined in the 19th century, resulting in severe environmental contamination. In order to assess the impacts of mining on aquatic ecosystems in this region, we present a multiproxy investigation of the lacustrine sediments from Owen Tarn, Tasmania. This study includes a combination of radiometric dating (14C and 210Pb), sediment geochemistry (XRF and ICP-MS), pollen, charcoal and diatoms. Generalised additive mixed models were used to test if changes in the aquatic ecosystem can be explained by other covariates. Results from this record found four key impact phases: (1) Pre-mining, (2) Early mining, (3) Intense mining, and (4) Post-mining. Before mining, low heavy metal concentrations, slow sedimentation, low fire activity, and high biomass indicate pre-impact conditions. The aquatic environment at this time was oligotrophic and dystrophic with sufficient light availability, typical of western Tasmanian lakes during the Holocene. Prosperous mining resulted in increased burning, a decrease in landscape biomass and an increase in sedimentation resulting in decreased light availability of the aquatic environment. Extensive mining at Mount Lyell in the 1930s resulted in peak heavy metal pollutants (Pb, Cu and Co) and a further increase in inorganic inputs resulted in a disturbed low light lake environment (dominated by Hantzschia amphioxys and Pinnularia divergentissima). Following the closure of the Mount Lyell Co. in 1994 CE, Ca declined to below pre-mining levels resulting in a new diatom assemblage and deformed diatom valves. Therefore, the Owen Tarn record demonstrates severe sediment pollution and continued impacts of mining long after mining has stopped at Mt. Lyell Mining Co.

Spindle cell lipoma of the parotid: fine-needle aspiration and histologic findings.

A 47-year-old man presented to the otolaryngologist with a 7-year history of a mass of the cheek. Fine-needle aspiration revealed foci of spindled cells admixed with abundant fat and myxoid material. A diagnosis of spindle cell lipoma was rendered on the resected specimen. The cytologic findings of spindle cell lipoma of the parotid gland as seen by fine-needle aspiration are presented along with the histologic correlates.

Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy in children.

The possibilities for treating children with renal stone disease by extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) have not been widely explored. We report ten children, aged between 5 and 16 years, treated by PCNL, and six children, aged between 6 and 15 years, treated by ESWL alone. A 16-year-old spina bifida child with a staghorn calculus was treated electively by a combination of the two methods. Hospital stay was 3 to 8 days for treatment by PCNL or ESWL, and was only 11 days for the combination treatment. Complete stone clearance was achieved in 12 children followed for 3 months. No significant complications occurred. ESWL and PCNL are suitable methods for the management of renal calculi in children.

Is transurethral resection of the prostate safe and effective in the over 80-year-old?

OBJECTIVE: To assess the safety and effectiveness of transurethral resection of the prostate (TURP) in patients over 80 years old. PATIENTS AND METHODS: The records of all patients over 80 years old undergoing TURP at one institution over a 3.5-year period were studied retrospectively. RESULTS: 31% of patients underwent TURP for symptoms and 68% for urinary retention. The early complication rate was 41%. The late complication rate was 22%. There were no deaths within 30 days of surgery. Of all patients, 80% were satisfied with the outcome of their operation. Of all patients with retention, 80% were able to void with small residual volumes by 6 weeks after operation. CONCLUSIONS: Although TURP in the over 80-year-old male is associated with significant morbidity, it is an effective treatment for urinary symptoms or retention. The majority of patients are able to void afterwards and are satisfied with the outcome of their surgery.

Gastric perforation secondary to metastatic carcinoma of the lung: a case report.

This is a report of a gastric perforation secondary to a metastasis from a primary squamous cell carcinoma of the lung in a 70-year-old white man who was being treated with cimetidine for a presumed benign gastric ulcer. The literature concerning bronchogenic carcinoma metastasizing to the stomach and small bowel is reviewed, and the effect of cimetdine on malignant gastric ulcers is discussed.

Partial nodular transformation of the caudate lobe of the liver presenting with ascites.

Partial nodular transformation is a rare condition which effects the perihilar portion of the liver and may cause chronic portal hypertension. This case report describes an elderly women in whom the condition was confined to the caudate lobe, which had become greatly enlarged and, by external compression of th portal vein at the hilum of the liver, had caused portal vein thrombosis and subsequent acute ascites.

Neoplastic autovagotomy causing gastric stasis.

Neoplastic autovagotomy causing atonic gastric stasis is extremely rare. Two cases are reported in which marked gastric stasis was complicated by a bezoar and a gastric volvulus respectively. Both cases were associated with a left hilar bronchial carcinoma, and malignant invasion of the vagus nerve may have been the underlying cause.

Long term follow-up of interposition mesocaval shunting in portal hypertension.

The long term results of 28 interposition mesocaval shunts performed between 1971 and 1975 are analysed over a follow-up period of 5-9 years. There were 6 emergency operations and 22 elective operations, with an overall operative mortality of 14.3 per cent and a 5-year survival for the complete series of 31.5 per cent (class A patients 55.5 per cent, class B 33 per cent and class C 0 per cent). Shunt patency at 7 months was 95 per cent but by 5 years this had fallen to 53 per cent. Further variceal bleeding occurred in 6 patients (31.5 per cent) in 4 of whom shunt occlusion was confirmed.

The aetiology and investigation of haemospermia.

The cause of haemospermia was determined in 70 (86%) of 81 patients. Inflammatory lesions accounted for the bleeding in most men under 30 years of age. Neoplasia (6), trauma (3) and amyloidosis (2) of the seminal vesicle were diagnosed in the other patients. Persistent haemospermia should always be investigated since clinically unsuspected tumours may be the source of bleeding in the older age groups. Analysis of the semen, prostatic fluid and urine should be performed initially. Cystourethroscopy should then be carried out if the initial investigations are negative and, if this too is negative, vasography is indicated.

Endotoxin, prostaglandins and renal fibrin deposition in obstructive jaundice.

The delayed clearance of endotoxins in obstructive jaundice may cause renal impairment by inducing renal vasoconstriction and glomerular fibrin deposition as a consequence of intravascular coagulation. As endotoxins activate arachidonic acid metabolism we have examined the effects of selective inhibitors on mortality, plasma TXB2 and 6-oxo-PGF1 alpha production and renal fibrin deposition in rats with obstructive jaundice following endotoxin administration. Jaundiced rats had a high mortality following endotoxin--58 per cent at 4 h and 83 per cent at 24 h. Pretreatment with indomethacin 3 mg/kg i.p., dazoxiben 3 mg i.p. or prostacyclin 300 ng/kg i.v. produced significant improvements in survival. Endotoxaemia was associated with significant elevations of plasma TXB2 and early inhibition of plasma 6-oxo-PGF1 alpha generation. Renal fibrin deposition, assessed using indirect immunofluorescence and a 125I-labelled fibrinogen uptake ratio, occurred in jaundiced kidneys following endotoxin and could be prevented using indomethacin, dazoxiben and prostacylin. These results suggest that endotoxin-induced TXA2 production can cause renal fibrin deposition in obstructive jaundice, thus contributing in the pathogenesis of the renal impairment.

Radio-contrast enhancement of a urinary tract calculus.

We report the case of a woman who presented with obstruction and urosepsis of her left kidney secondary to small cystine calculi. The calculi could not be seen on initial plain abdominal X-ray. However, following percutaneous nephrostogram the calculi became more radio-dense and visible on later X-rays. Experimental enhancement of calculi has been described before but not in man. We presume that the contrast medium was adsorbed by the calculus to increase the radio-density. Further investigation of this phenomenon could prove useful in the management of complex radiolucent calculi.

Irrigation or no irrigation after transurethral prostatectomy?

Urologists remain divided as to the need for routine irrigation following transurethral prostatectomy (TURP). This randomised prospective study compared a policy of irrigation with that of no irrigation in a consecutive group of 200 patients undergoing TURP. In the irrigation group, a mean of 15 litres of irrigating fluid was used in each patient and one-third of patients required at least one bladder washout. In the no irrigation group, although two-thirds of the patients required at least one bladder washout, only one-third required more than one washout. No significant difference in blood loss, electrolyte balance, infection rate or recovery was seen in the 2 groups. This study led to a local change in practice, converting from a policy of routine irrigation to one of no irrigation.

The role of transarterial embolization in the treatment of renal cell carcinoma.

OBJECTIVE: To review the role of transarterial renal embolization in our unit, assessing the indications, tolerability and efficacy of this technique for treating renal cell carcinoma (RCC). PATIENTS AND METHODS: Thirty patients undergoing transarterial embolization between 1991 and 1999 were identified and 25 case notes analysed retrospectively. RESULTS: Most patients (14 of 25) presented with less advanced (stage I-III) RCC who were unable or unwilling to undergo radical surgery; the remainder (11) presented with advanced (stage IV) disease. The embolizing agent was ethanol, usually combined with stainless steel coils (85% of cases). Procedural pain and fever was controlled successfully. The median hospital stay associated with the procedure was 4 days. At the time of analysis six of 11 stage IV and 11 of 14 stage I-III patients were alive (median follow-up 27 and 39 months, respectively). Symptoms from the primary tumour were well controlled. Overall, 17 of 25 (68%) of patients reported no problems while three (12%) required brief hospital admission for treatment of persistent haematuria. Fourteen patients were subsequently re-staged; the primary tumour in two had increased, in seven remained unchanged and in five it decreased. No patients without metastases developed them and metastases in two patients regressed. CONCLUSION: Transarterial embolization is associated with minimal morbidity and complications, and subsequent symptom control is good. The effect of palliative embolization on RCC progression is unknown and requires prospective investigation. Presently, there is no role for cytoreductive embolization; it should be included as a treatment option in clinical trials evaluating such options in patients with metastatic RCC.

Treatment of urethral hemangioma by selective arterial embolization.

Control of significant hematuria by embolization of angiographically demonstrated vascular malformations of the prostatic and membranous urethra is reported in a patient with multiple diffuse superficial hemangiomas.

A prospective randomized trial of interstitial radiofrequency therapy versus transurethral resection for the treatment of benign prostatic hyperplasia.

OBJECTIVE: To carry out a prospective randomized trial comparing interstitial radiofrequency therapy (IRFT) with transurethral resection of the prostate (TURP) in the treatment of bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia. PATIENTS AND METHODS: The change in detrusor pressure at maximum flow (PdetQmax) was chosen as the primary measure of outcome but the symptom score, Qmax and residual volume were also measured. Patients with urodynamic evidence of BOO were randomized to receive IRFT (n = 25) or TURP (n = 25); the urodynamics were repeated 6 months after treatment. RESULTS: There was a statistically significant reduction in PdetQmax at 6 months for TURP (P < 0.001) and IRFT (P < 0.01) although the change seen in the latter group was probably not clinically relevant. Nevertheless, a clinically relevant reduction in symptom score occurred in both groups. Both techniques were associated with a low morbidity. CONCLUSION: IRFT is a cheap and safe technique which may be useful in the treatment of lower urinary tract symptoms in certain groups of patients in whom symptomatic improvement is a priority rather than objective outcome. The underlying mechanism for this symptomatic improvement is at present unclear.

Interstitial radiofrequency therapy of the prostate: results of a pilot study.

PURPOSE: We assessed the feasibility of using interstitial radiofrequency therapy for benign prostatic hyperplasia (BPH) in 50 patients. MATERIALS AND METHODS: Therapy was given using a standard diathermy unit as the radiofrequency generator and a disposable needle electrode. The main outcome measure was improvement in symptoms assessed by symptom scores. RESULTS: Patients with bothersome symptoms or acute retention showed clinically significant improvements in symptom score, while those with chronic retention did not. There were no serious complications. CONCLUSIONS: Interstitial radiofrequency therapy may be effective for symptomatic BPH. Further studies with long-term objective data are under way to assess its role in the management of BPH.

Transballoon cystometry: a new technique to assess detrusor function after urinary retention.

OBJECTIVE: To validate a new urodynamic technique to assess detrusor function in patients presenting with acute urinary retention, using the balloon channel of their Foley catheter (transballoon cystometry), and to use the technique to assess patients presenting in acute retention. PATIENTS AND METHODS: The technique of transballoon cystometry is described and validated in vitro using a specially constructed water manometer, and in vivo on five patients who had a suprapubic catheter in addition to the urethral Foley catheter. Fifty-two patients presenting in acute retention underwent transballoon cystometry one week after catheterization; they were divided according to their clinical presentation into uncomplicated acute retention (41 patients) and acute-on-chronic retention (11 patients). The results from transballoon cystometry were compared between these groups. RESULTS: The pressure recorded through the balloon channel was equal to that recorded through the lumen of the catheter, both in vitro and in vivo. Patients with acute-on-chronic retention had a larger volume at first sensation, a larger maximum cystometric capacity, higher end-filling pressure and lower maximum detrusor pressure during isometric contraction than patients in uncomplicated retention. CONCLUSION: Transballoon cystometry is accurate and easy to perform. The clinical distinction between uncomplicated acute retention and acute-on-chronic retention was supported by the urodynamic data. This test could be used before surgery to identify patients with detrusor failure.

Treatment of hilar carcinoma by bile drainage combined with internal radiotherapy using 192iridium wire.

Eighteen patients with a cholangiocarcinoma involving the hilum of the liver, and one patient with a carcinoma of the gall bladder causing obstruction of the common hepatic duct, have been treated with bile drainage using a U-tube (8 patients) or a percutaneous transhepatic catheter (11 patients) followed by internal radiotherapy with 192iridium wire. The median survival is 11 months, and 9 patients (47 per cent) have survived for 12 months or longer. The addition of internal radiotherapy may be beneficial to patients with hilar cholangiocarcinoma causing biliary obstruction in whom bile drainage can be established.

Hepatic dysfunction in renal carcinoma.

In a retrospective review of 81 patients with renal carcinoma 34 (42%) had abnormalities of one or more liver function tests. Fifteen patients (18.5%) had abnormalities of 3 or more liver function tests but without evidence of hepatic metastases. There was a significant association between these patients and the presence of fever, anaemia, weight loss and a raised ESR (P less than 0.001) compared with those whose liver function was normal. Following nephrectomy, liver function returned to normal in 5 patients. Median survival in these patients was 35 months, whilst in those whose liver function remained abnormal the median survival was 8 months (P less than 0.01).