To our knowledge there are no reports of a primary multifocal spindle cell sarcoma affecting both long bones of the lower limb in an elderly patient. An 83-year-old man presented with a progressively painful right ankle, without a history of trauma. Radiographs demonstrated a pathological fracture through a mixed lytic and sclerotic lesion in the distal tibia. Staging investigations, including bone scintigraphy and magnetic resonance imaging, revealed a second lytic lesion in the right distal femur. A provisional diagnosis of metastatic disease was favoured and intramedullary nailing was considered. However, computed tomography of the chest, abdomen and pelvis, and relevant blood tests revealed no evidence of a primary malignancy. Open biopsy of the tibial lesion showed high-grade pleomorphic spindle cells consistent with a primary bone sarcoma. The patient was treated successfully with a right trans-femoral amputation. In conclusion, we recommend early bone biopsy to allow accurate diagnosis and appropriate skeletal management in elderly patients.

Aims:  To determine whether American alligators (Alligator mississippiensis) are an unrecognized poikilothermic source of faecal coliform and/or potential pathogenic bacteria in South Carolina’s coastal waters.

Primary sarcomas in the ischiorectal fossa are occasionally reported and represent a significant challenge due to the proximity of rectum, levator muscles and pudendal neurovascular structures. We report a case in which the diagnosis changed between biopsy (desmoid tumour) and resection (malignant peripheral nerve sheath tumour), requiring a multidisciplinary surgical approach involving different sub-specialties. It also illustrates the importance of undertaking sarcoma surgery in a recognized sarcoma centre with sarcoma expertise available across a range of disciplines.

The effects of stochastic events on estuarine water quality parameters are often difficult to quantify spatially due to R S the inherent variability in these systems. The use of geographic information systems to identify spatial patterns and trends can improve such efforts. This work describes the use of geographic information systems and the Mantel Test to determine the existence of trends and the persistence of spatial patterns in the relationships between nutrients and chlorophyll a in an urbanized lagoonal estuarine system, Murrells Inlet, South Carolina. Relatively dry and wet periods were compared, the latter following several substantial precipitation events related to tropical hurricane activity in the summer of 1999. Dissolved inorganic nitrogen concentrations were elevated following the passage of Hurricane Irene, and chlorophyll a did not increase concomitantly. Orthophosphate was found to have persistently higher concentrations in the more urbanized regions of Murrells Inlet that were consistent spatially during the two sampling periods. Strong spatial and temporal correlations between chlorophyll a and dissolved silicate: dissolved inorganic nitrogen suggest a relationship between the latter ratio and the phytoplankton growth. However, there appeared to be only a tenuous relationship between chlorophyll a and dissolved inorganic nitrogen and phosphorus, both spatially and temporally, suggesting that nutrient requirements for phytoplankton growth were met by internal estuarine processes, during this time period.

Recent reports have suggested that a delay in the management of type-III supracondylar fractures of the humerus does not affect the outcome. In this retrospective study we examined whether the timing of surgery affected peri-operative complications, or the need for open reduction. There were 171 children with a closed type-III supracondylar fracture of the humerus and no vascular compromise in our study. They were divided into two groups: those treated less than eight hours from presentation to the Accident and Emergency Department (126 children), and those treated more than eight hours from presentation (45 children). There were no differences in the rate of complications between the groups, but children waiting more than eight hours for reduction were more likely to undergo an open reduction (33.3% vs 11.2%, p < 0.05) and there was a weak correlation (p = 0.062) between delay in surgery and length of operating time. Consequently, we would still recommend treating these injuries at the earliest opportunity.

Increases in contaminants associated with urban sprawl are a particular concern in the rapidly developing coastal areas of the southeastern United States. Polycyclic aromatic hydrocarbons (PAHs) are contaminants associated with vehicle emissions and runofff from impervious surfaces. Increased vehicular traffic and more impervious surfaces lead to an increased loading of PAHs into coastal estuarine systems. The phototoxic effect of PAH-contaminated sediments on a sediment-dwelling meiobenthic copepod, Amphiascus tenuiremis, was estimated in Murrells Inlet, a small, high-salinity estuary with moderate urbanization located in Georgetown and Horry Counties, South Carolina, USA. Field-determined solar ultraviolet radiation (UV) and UV extinction coefficients were incorporated into laboratory toxicity experiments, and a model was developed to predict areas of specific hazard to A. tenuiremis in the estuary. The model incorporated laboratory toxicity data, UV extinction coefficients, and historical sediment chemistry and bathymetric data within a spatial model of sedimentary areas of the estuary. The model predicted that approximately 8-16% of the total creek habitat suitable for meiobenthic copepods is at risk to photoinduced PAH toxicity. This area is in the northern, more developed part of Murrells Inlet.

The robust growth of coastal communities in the southeastern United States is putting unique pressures on estuarine resources. Urbanization of estuarine systems may alter ecosystem function and thus affect the spatial scale and magnitude of nutrient concentrations and primary production temporally and spatially. We examined the spatial and temporal patterns of nutrient and chlorophyll a (Chl a) concentrations in two shallow well-mixed estuaries, (1) a developed estuary, Murrells Inlet (MI), South Carolina, and (2) a relatively pristine estuary, North Inlet (NI), South Carolina. The summer chlorophyll a maximum in MI was characteristically higher than in NI, which may be indicative of eutrophication. Correlations between salinity and inorganic nutrients (N and P) suggest that nutrient import from upland sources may be more pronounced in MI during stochastic precipitation events. Although inorganic nutrient concentrations between the estuaries were similar overall, during a wet period, inorganic N concentration in MI was increased to a greater extent than in NI, while only minimal increases in inorganic P were observed in both estuaries. Chlorophyll a concentrations decreased from the dry to wet period. Geographic Information System (GIS) plots of intensive spatial sampling in MI indicated spatial gradients of nutrient concentrations within this estuary that appeared to be consistent over time. These observations were investigated in more detail using regression analyses to examine the influences of coastal dilution and nutrient sources on relationships between water quality constituents. Results indicate the importance of stochastic rain events in affecting the linkages of estuarine processes to upland runoff in the urbanized estuary, MI.

Environmental monitoring is both a scientific and management imperative for effective coastal and estuarine resources research, management, and education. The establishment of monitoring programs provides for baseline studies, trend analyses, and impact assessments as related to both short-term variability and long-term change within estuarine environments. The effectiveness of these programs is dependent not only on the data collection but also on the implementation and maintenance of procedures to ensure access to high-quality data, data documentation, and derived products. Advances in information technology are improving the way resource managers and researchers can assimilate, manage, disseminate, and share environmental data and information. The Integrated Ocean Observing System (IOOS) initiative is developing an integrated national system for the United States' coastal zone built upon federal monitoring efforts and regional coastal observing systems that monitor the state and variability of the coastal waters and estuaries of the United States. The National Oceanic and Atmospheric Administration's (NOAA) National Estuarine Research Reserve System (NERRS) acknowledges the importance of long-term environmental monitoring programs and data and information dissemination via the NERRS System-Wide Monitoring Program (SWMP). Consistent with the IOOS initiative and in support of sound data-management and -dissemination practices, the NERRS SWMP has implemented and sustains procedures to manage the basic infrastructure and data protocol to support the assimilation and exchange of quality-controlled data, metadata, and information within the framework of NERRS sites, state coastal zone management programs, and NOAA/OCRM as well as other state and federally funded education, monitoring, and research programs.

Geographic Information Systems (GIS) and regression modeling techniques were used to evaluate relationships between land use and fecal pollution in Murrells Inlet, a small, urbanized, high-salinity estuary located between Myrtle Beach and Georgetown, SC. GIS techniques were used to identify and calculate land use and spatial variables to be used in a regression model. The regression analysis was performed to identify specific land-use characteristics that may influence fecal coliform densities in the estuary. The regession modeling used land-use parameters to explain the variability of fecal coliform densities measured monthly at 21 locations in the estuary over the 10-year period from 1989 to 1998. Individual regression models were generated for each season, and for a combined data set. The results of the regression analyses indicate that proximity to areas with septic tanks, and rainfall runoff from urbanized areas are important predictors of fecal coliform densities in the estuary. Sampling sites closer to areas with high densities of active septic tanks or more urbanized land uses tended to have higher fecal coliform densities. Although these results may suggest that septic tanks are a substantial human source of fecal pollution, previous research has indicated that the fecal pollution in those areas is probably not from human sources. The areas of Murrells Inlet with higher septic tank densities also are located in areas of high housing density, are in close proximity to the land-water interface, and are in the extreme upper reaches of the estuary, where flushing and dilution effects may be reduced. The higher fecal coliform densities observed at these locations may be a coincidental result of these factors and fecal deposition from pets, and not the direct result of fecal pollution input from the septic tanks.

Background: Perceptions of the environment and physical activity have been associated using survey methods, yet little is known about the validity of environmental surveys. In this study, perceptions of the environment at neighborhood and community levels were assessed (1) to determine validity by comparing respondent perceptions to objective measures and (2) to determine test-retest reliability of the survey.Methods: A telephone survey was administered to a stratified sample of Sumter County, South Carolina adults. Respondents' home addresses were mapped using a geographic information system (GIS) (n = 1112). As an indicator of validity, kappa statistics were used to measure agreement between perceptions and objective measures identified at neighborhood and community levels using GIS. A second survey in an independent sample (n = 408) assessed test-retest reliability.Results: When assessing perceptions of environmental and physical activity in a defined geographic area, validity and reliability for neighborhood survey items were kappa = -0.02 to 0.37 and rho = 0.42 to 0.74, and for community survey items were kappa = -0.07 to 0.25 and rho = 0.28 to 0.56.Conclusions: Although causality between perception of access and safety and actual physical activity level cannot be assumed, those meeting national physical activity guidelines or reporting some physical activity demonstrated greatest agreement with access to recreation facilities, while those not meeting the guidelines demonstrated greater agreement with safety of recreation facilities. Factors such as distance and behavior may explain differences in perceptions at neighborhood and community levels. Using local environments with short distances in survey methods improves validity and reliability of results.

Loading of bioavailable phosphorus, traditionally measured as soluble reactive phosphorus (SRP), contributes to the eutrophication of aquatic ecosystems. However, polyphosphates are also bioavailable but escape detection by the standard method used for measuring SRP. 31 P nuclear magnetic resonance spectrometric analysis of sediment extracts and enzymatic assay of surface waters reveal heretofore unreported presence of pyrophosphate (Ppi) in coastal wetlands. We show that the accumulation of Ppi (the smallest chemical form of polyphosphate) in coastal wetlands is related to human impact and can occur in quantities that exceed that of SRP. We further demonstrate that Ppi is readily utilized by microbes in coastal wetland sediments in the presence of nitrogen and carbon and can serve as a reservoir of orthophosphate. Thus, Ppi accumulation in estuaries will subsidize the in situ biogeochemical phosphorus cycle. This has important ecological implications for trophic responses and estuarine productivity.

Infection and prevalence of Perkinsus marinus (Dermo), a common protozoan pathogen of the oyster (Crassostrea virginica), are commonly correlated with temperature and salinity. However, these factors do not account for all infection variability. Other factors such as watershed dynamics or anthropogenic disturbances may play a role. Geographic Information System (GIS) technology applying land use and anthropogenic activity was used to document Dermo infections in two South Carolina coastal estuaries. Kriging analysis was used to calculate disease prevalence from sample sites to the estuary as a whole. Results indicate that land use patterns may affect the distribution of the disease.

The complexity and severity of ecological impacts associated with coastal development demand that resource managers explore new spatial analytical techniques combined with multidisciplinary scientific expertise for proactive coastal zone management. Arising from these environmental concerns and the identified need for adequate databases and integrated models, a long-term study of the impacts of urbanization on localized estuaries of the South eastern United States was initiated in 1990. A goal of this study was to examine the role of Geographic Information Processing (GIP) to integrate data and scientific expertise for the identification, assessment, and modeling of anthropogenic and physiographic relationships within estuaries. This goal is being achieved through the implementation and utilization of a multi-agency Geographic Information System (GIS) and the development and validation of spatially explicit models. This work presents spatial modeling efforts that incorporate land use and land cover characteristics with fisheries data to assess and predict the impacts of anthropogenic and natural influences on key species that inhabit critical estuarine wetlands and streams. A spatial assessment of two small, high-salinity estuaries suggests that upland development adjacent to critical estuarine habitat limits the population size and distribution of adult and larval grass shrimp (Palaemonetes pugio (Holthuis)). Modeled spatial distributions of adult populations suggest the existence of estuarine ‘deserts’ — wetlands and stream reaches adjacent to commercial and residential land use void of natant fauna. This paper's approach is being developed for coastal resource managers to predict the impact of proposed landscape modifications prior to occurrence of changes.

Storm water runoff volumes, flow rates and sediment loads from a forested watershed and an urbanized watershed draining into adjacent estuaries were compared using the distributed parameter (grid cell) agricultural nonpoint source runoff (AGNPS) model. The comparisons were based on 10 simulated rainfall events. Effects of impervious surfaces on runoff and sediment transport were also investigated with the model. The 38 ha forested watershed, representing undeveloped land in coastal South Carolina, was covered with mixed second-growth hardwoods and pines with interspersed cypress wetlands. The urbanized watershed was 15 ha of single-family residential and commercial land and included a four-lane interstate highway segment. Both watersheds had sandy soils and low stream bed slopes ( < 0.5%). This paper shows that the model equations, although intended for agricultural watersheds, also applied to forested and urban land use. The hydrologic submodel was calibrated with 10 rain events ranging from 19–102 mm total rainfall. Simulation results indicated runoff volume was on average 5.5 × (±2.7) and sediment yield 5.5 × (±2.3) greater from the urban watershed than from the forested watershed. The ratio of rainfall volume to runoff volume was on average 14.5% higher in the urban watershed compared to the forested watershed. In the AGNPS model, runoff volumes were governed by the total impervious area and were independent of other impervious surface spatial characteristics (size, shape, location, contiguity). Simulation results indicated eroded sediment from both watersheds originated predominantly within the channels. Adding simulated impervious surface area increased runoff volumes linearly and peak flow rates exponentially, flow rates and sediment loads were controlled by impervious surface spatial characteristics. Maximum sediment loads from the urban watershed occurred when disconnected patches of impervious surface covered 35% of the watershed. Maximum differences between the forested and urban watersheds occurred at low rainfall depths ( < 75 mm). Future nonpoint source runoff modelling should incorporate ground water dynamics, the spatial and temporal variability of rainfall, and accumulation and wash-off of specific pollutants.

Geostatistical methods are becoming an essential tool for understanding the spatial distribution of biological and chemical species in estuaries. At the heart of these methods are the spatial prediction/mapping methods known as “kriging”; these can construct statistically optimal predictions for data at unobserved locations using a relatively small, spatially explicit sample. The prediction at any given location is a weighted average of the sample values, where the weights depend on the distances between the sample sites and the target location. For most geostatistical settings, distances are computed “as the crow flies”, i.e. Euclidean distance. For measurements made in estuarine streams, however, intuition suggests that distances between sites should be measured “as the fish swims”, i.e. the length of the shortest in-water path between two sites. Our study evaluated the relative accuracy of eight kriging methods for predicting contaminant and water quality variables measured in an urbanized estuary in South Carolina. The eight methods were defined by all combinations of three factors, each at two levels: (a) Distance metric (Euclidean vs. in-water); (b) semivariogram type (spherical vs. linear) and (c) model trend component (distance to the inlet mouth; without vs. with). For four of the eight variables studied, the in-water distances provided prediction accuracy improvement on the order of 10–30% of prediction error variance. In two of these cases, the improvement only occurred when in-water distances were used together with a model trend component. Choice of semivariogram did not have much effect on prediction accuracy. Although the overall improvement in prediction accuracy was unpredictable and modest, considering the additional difficulties associated with in-water distances, the results suggest that the integration of Geographic Information System (GIS)-based network analysis with kriging using in-water distances merits further research.

Increasing urbanization of coastal areas is an important concern in the Southeastern United States where small, high-salinity, sensitive estuaries have been targeted for development over the next two decades. This is a particularly acute problem in coastal South Carolina which is dependent on tourism and traditional fishing and shellfish harvesting activities. Accelerated coastal development and the continued influx of people into the coastal zone of South Carolina have increased the pressures on the limited coastal resources. These continuing pressures threaten the salt marsh estuaries, which are highly vulnerable to commercial; industrial, and residential activities in addition to physiographic changes brought on by tides, winds and storms. The complexity and severity of environmental problems associated with coastal growth have been the impetus for many agencies and organizations to explore the use of new spatial analytical techniques as a means of obtaining timely and valid information which will aid problem solving and assist with effective coastal zone management. In response to these environmental concerns and the need for better databases and integrated spatial models for supporting sustainable coastal development in the Southeastern United States, a six-year study of the impacts of urbanization on small, high-salinity estuaries was initiated in 1990. An overall goal of the Urbanization and Southeastern Estuarine Systems (USES) project is utilizing Geographic information Processing (GIP) to integrate data and scientific expertise for the identification, assessment, and modeling of relationships within coastal estuaries and impacts associated with urbanization and natural activities. This goal is being achieved through the continued development and utilization of the multi-agency Coastal Geographic Information System (C-GIS) and the development and validation of spatially explicit models. These models can be used to develop and apply a vulnerability index to coastal areas that, based on such factors as land use and land cover characteristics, receiving waters, and socioeconomic conditions, suggest different vulnerabilities to natural and anthropogenic influences.