Mining for base metals and some critical raw materials is associated with acid, sulphate, and metal-rich waters (AMD). At the points where these waters are accumulated or discharged, the secondary minerals are precipitated, mostly iron-oxyhydroxides, forming characteristic orange sediments toxic to the environment. The sediment or sludge is prone to leaching of metals and sulphate, thus requiring proper disposal to maintain the waste stability. In this study, we assessed the AMD lake “Robule” sediment electrochemical properties and associated mineralogy in sediment microbial fuel cell (SMFC). The SEM–EDS and XRPD analysis revealed schwertmannite, jarosite, goethite and gypsum as the most abundant mineral forms with efflorescent sulphates salts precipitated on top of the air-open cathode. In the acid lake mine water dominant aquatic species are SO42−, Mg2+, AlSO4+, and Fe3+ iron mostly as various sulphate complexes. Although oxidized forms prevail in the lake water and sediment, the possibility of generating electrical current is, to our knowledge, for the first time registered for this type of mining waste. A closed-circuit voltage of 439 ± 60 mV (at 220 Ω external resistance), an average current density of 210 ± 28.6 mA/m2 and a maximal power density of 29 mW/m2 was measured. The absence of sulphide minerals suggests that the biological oxidation of organic molecules at the anode and the iron cycle drives electricity production. The stability of the SMFC environment and the absence of hydrogen sulphide build-up while generating electrical current opens new directions for sustainable management of AMD and the associated sediment.

Groundwater sources are mainly protected by implementing various preventative measures in surrounding areas. Delineation of sanitary zones is difficult task, which involves a high degree of uncertainty. Existing methods for the delineation of protection zones are designed for specific aquifer types. Different methods are applied, depending on aquifer porosity and the boundary conditions of the groundwater sources. A Time-Dependent Model (TDM) has been designed for protecting groundwater sources in hard rocks, mostly karstic, but the concept and structure of the method make it equally applicable to unconsolidated sediments. This method is based on the vulnerability assessment of groundwater sources and considers the parameters that affect the velocity and thus the travel time of water from any point on the ground surface in the source capture zone, to the intake point. The TDM was successfully tested for the protection of groundwater sources formed in intergranular aquifers, both confined and unconfined. In the case of alluvial aquifers, both (vertical and horizontal) travel time components play an important role in the protection of the groundwater source. Considering the vulnerability of the deep confined groundwater source, the vertical travel time plays the most important role which allows the reduction of the protection zones.

Remodelling of collagen fibers has been described during every phase of cancer genesis and progression. Changes in morphology and organization of collagen fibers contribute to the formation of microenvironment that favors cancer progression and development of metastasis. However, there are only few data about remodelling of collagen fibers in healthy looking mucosa distant from the cancer. Using SHG imaging, electron microscopy and specialized softwares (CT-FIRE, CurveAlign and FiberFit), we objectively visualized and quantified changes in morphology and organization of collagen fibers and investigated possible causes of collagen remodelling (change in syntheses, degradation and collagen cross-linking) in the colon mucosa 10 cm and 20 cm away from the cancer in comparison with healthy mucosa. We showed that in the lamina propria this far from the colon cancer, there were changes in collagen architecture (width, straightness, alignment of collagen fibers and collagen molecules inside fibers), increased representation of myofibroblasts and increase expression of collagen-remodelling enzymes (LOX and MMP2). Thus, the changes in organization of collagen fibers, which were already described in the cancer microenvironment, also exist in the mucosa far from the cancer, but smaller in magnitude.

Aim: Previously, it has been shown that function and distribution of vascular smooth muscle K+ channels were different in the patients with type 2 diabetes mellitus. The human saphenous vein (HSV) bypass graft has a tendency toward the development of atherosclerosis which is accelerated by diabetes. Thus, the objective of this study was to investigate the role of smooth muscle K+ channels in the effect of pinacidil on the HSV obtained from diabetic patients.

The ideal agent for prevention and treatment of uterine abnormal contractility has not been found. The polyphenol resveratrol possesses a wide spectrum of pharmacologic properties, but its influence on the contractility of human myometrium is not defined. The present study evaluated the effect of resveratrol on the oxytocin-induced contractions of human term pregnant myometrium in vitro and the contribution of different K+ channels to resveratrol action. Resveratrol induced a concentration-dependent relaxation of myometrium contractions (pD(2) value and maximal responses were 4.52 and 82.25%, respectively). Glibenclamide, a selective blocker of ATP-sensitive (K-ATP), iberiotoxin, a selective blockers of big-calcium sensitive (BKCa) and 4-aminopiridine, a non-selective blocker of voltage-sensitive (Kv) channels induced a significant shift to the right of the concentration-response curves of resveratrol. Inhibition achieved by 0.1 mM resveratrol was insensitive to all K+ channel blockers. A K+ channel opener, pinacidil, inhibited oxytocin-induced contractions of pregnant myometrium with comparable potency and efficacy to resveratrol (pD(2) values and maximal relaxation were 4.52 and 83.67%, respectively). Based on K+ channel opener/blocker affinities, it appears that the inhibitory response of resveratrol involves different myometrial K+ channels. When applied in high concentrations, resveratrol has an additional K+-channel-independent mechanism(s) of action. Furthermore, immunohistochemistry staining and western blot analyses detected the presence and distribution of K-ATP, BKCa and Kv channel proteins in pregnant myometrium.

BACKGROUND/AIMS:Pancreatic carcinoma is by far the most common malignancy and is the 5th most lethal cancer in the world and 40% of these carcinomas are locally advanced and unresectable at the time of presentation. Palliative surgery and chemoradiotherapy have not produced significant improvement in survival. The overall prognosis of these pancreatic cancers is poor, if left untreated without any form of palliation. Out of many palliative methods adopted for such locally advanced pancreatic carcinoma, none has shown much survival benefit. Microwave ablation is a well established and safe local ablative method for liver tumors and microwave ablation for locally advanced pancreatic tumors has been extensively used around the world. This is our largest series of microwave ablation in 15 patients with locally advanced pancreatic head carcinoma. The aim of this study was to evaluate the safety, efficacy, feasibility and complications of microwave ablation in unresectable locally advanced pancreatic carcinoma.METHODOLOGY:In total, 15 patients, from January 2004 to December 2006, were included in this study all having locally advanced pancreatic tumors which were found to be unresectable on radiological evaluation. The 15 patients (10 male and 5 female) with a mean age of 67 years were subjected to open microwave ablation after laparotomy and additional palliative procedure like biliary bypass (end-to-side hepaticojejunostomy) and gastric obstruction bypass by antecolic gastrojejunostomy was performed in 6 patients. The location of tumor was predominantly in the head and/or uncinate portion of the pancreas (n=12) and head and body (n=3). The average size of tumor was 6cm (range 4-8cm) and almost all had major regional vascular invasion on CT or MR angiogram. All tumors were histologically proven before the procedure by core needle and frozen section biopsy. Patients with distant metastasis were not included in this study.RESULTS:In all 15 patients, partial necrosis was achieved. There was no major procedure-related morbidity or mortality. Minor complications were seen in 6 out of 15 patients, mild pancreatitis (2), asymptomatic hyperamylasia (2), pancreatic ascites (1), and minor bleeding (1). All patients had close follow-up and the longest surviving patient had a follow-up of 22 months.CONCLUSIONS:Microwave ablation is a beneficial therapy as a local effective procedure which is feasible and safe with acceptable minor complications in a locally advanced pancreatic tumor which can be used as part of a palliative or multimodality treatment, however, further long-term and properly designed studies are required to prove its usefulness in achieving survival benefit.

Large patient series undergoing laparoscopic cholecystectomy fail to show anatomic variations which lead to intraoperative bleeding. Method: Cadaver material was used and corrosion casting and postmortem arteriography were employed. Results: Three types of cystic artery were devised according to the results. Type 1 normal anatomy. Type 2 more than one artery in Calots triangle and Type 3 no artery in Calots triangle. Discussion: only 40% of the second cystic artery is present in Calots triangle. The short second cystic artery is characteristic and its most often origin is from a segmental branch of the right hepatic artery. When there is no artery in Calots triangle its origin unusual, and the artery is either on the postero-lateral side of the cystic duct or it approaches the gallbladder through hepatic tissue. The specifics of MIS approach make changes in the way we understand the anatomic variations of the cystic artery. The classification is a result of practical experience and anatomical investigations.

The anatomical features of splenic segmental vessels in 102 human spleen autopsy specimens were analyzed. Methods applied were corrosion casting and post-mortem arteriography. The superior terminal splenic branch divided extracapsularly into 2.8+/-0.9 (range 2-5) and the inferior terminal splenic branch into 2.3+/-0.75 (range 2-5) branches per sample. The extracapsular lengths of the segmental branches ranged from 4.0 to 16.7 mm and the calibers from 0.4 to 2.2 mm. Superior polar arteries occurred in 31.3% and inferior polar arteries in 20.6% of cases. Their average extracapsular lengths were 39 mm and 31 mm, respectively. In conclusion, segmental splenic arteries have an extrasplenic origin and course, with an average length and caliber that allow surgical access and ligation, in order to achieve segmental dearterialization for hemostasis purposes and splenic preservation.

UNLABELLED:The bowel diverticulitis is a complication of diverticulosis, occuring in 35% patients in 20 years after diagnosis. The study purpose was analysis of the results published in world literature.METHOD:Double blind electronic search of several databases using key words: diverticulitis, laparoscopy.RESULTS:11 studies with 415 patients that satisfy the criteria were selected. AGE: 62.7 + 14.2. Hinchey stadiums: I, IIa i IIb of these 44% I and 28% IIa i Iib each. Operative time: 197.4 +/- 49.6 min. Conversions: 11.7 +/- 10.1 (0 - 38.9%). Protective stoma: 5.5%. Bowel sounds: 2.3 - 3.2 postoperative day. Oral feeding: 2.6-5 postoperative day. Hospitalization: 6.1 2.1 dana. Anastomotic dehiscence: 2.8%, wound infection: 7.3%, iatrogen rectum perforation with stapler: 3.3%, bleeding: 3.5%, ileus: 4.4%, reoperation rate: 4.7%.CONCLUSION:Sigmoid resection with or without a protective "loop" ileostomy is technically feasable by minimally invasive surgical technique, with an acceptable ratio of benefits and complications.

The study concern was to establish the position of cystic duct incision/division in circumstances of laparoscopic cholecystectomy. Seventy consecutive human cadavers were dissected. Corrosion casting (50) and post-mortem cholangiography (20) were employed. Cystic duct length was 34.6 mm, and in 88.6% cases its length was 1-5 cm. Mean cystic duct diameters next to the gallbladder neck, within the valve and 5 mm proximal to the junction with the common hepatic duct were 1.95, 0.42 and 1.85 mm, respectively. Lateral cysto-hepatic junction was identified in 78.6%, spiral in 10% and parallel in 10%. In 90% cases the cysto-hepatic junction is within 4 cm of the hepatic duct junction. One case (1.43%) of cystic duct entering the right hepatic duct was identified. The valve of Heisteri consisted of three spiral turns in 73% of the cases with a range from 0 to 5. In 3/70 specimens the spiral valve did not exist.

The authors present a 51-year-old patient with a severe case of gas-producing phlegmone following incision of a perianal abscess. Early diagnosis and extensive surgical excision during the first 12 hours from the onset of symptoms are crucial. Treatment of sepsis complicated by multiple organ failure: lung insufficiency (respiratory distress requiring mechanical ventilation), kidney insufficiency (requiring rehydration, furosemid, manitol), circulation (blood derivatives, saline, colloid solutions, cardio tonics, anti-arrhythmic drugs) and liver must be aggressive. Hyperbaric oxygen therapy is essential with repeated identification of aerobic and anaerobic bacteria (hemoculture, tissue sample, wound swab), their sensitivity to antibiotics and repeated surgical debridement of the wound. Following this treatment the patient was transferred to plastic surgery where Thiersh transplants covered skin defects. He survived with an abdominal wall hernia due to a team effort and aggressive multidisciplinary treatment by the general surgeon, anesthesiologist, hyperbaric medicine specialist, microbiologist and plastic surgeon. He refused hernia repair.

We discuss splenic salvage by lobe/segment dearterialization, without resection, after intraoperative trauma, and present two cases. We performed a retrospective analysis of 163 patients in whom the colon splenic flexure was mobilized. Patients with ileo-rectal anastomosis or urgent cases were excluded. Surgical operations included left hemicolectomy and anterior resection of the rectum. Splenic procedures were splenorrhaphy, dearterialization and splenectomy. Spleen lesions occurred in 4 (2.45%) cases. One capsular tear was managed with splenorrhaphy. Three mechanical lesions to capsula and tissue of the inferior pole were managed by either splenectomy (the first case) or dearterialization. Overall mortality in the series was 4.3%. Among the patients with splenic procedures, the splenectomized patient died due to pulmonary embolism. The two cases treated by inferior splenic branch and inferior polar artery ligature are presented. In operative trauma to the inferior splenic pole, bleeding can be controlled by lobe/segment dearterialization and by methods of local hemostasis in most cases.

While performing laparoscopic cholecystectomy we noticed lateral branches of the cystic artery as well as arterial bleeding from the gallbladder bed. In order to establish the nature of these blood vessels we undertook a corrosion cast study. The features analyzed were their frequency of occurrence, caliber and length. The research was performed on 50 human autopsy specimens of the liver with the hepatoduodenal ligament. Lateral branches of the cystic artery that irrigate a part of the anteromedial segment of the right liver lobe were observed in 10% cases. Anastomotic bridges between the cystic artery and the arterial system of the liver were observed in 12% cases.

In order to obtain good results in laparoscopic surgery the surgeon should be well trained and experienced and the equipment perfect. The recent innovation in laparoscopic surgery is the ultrasonically activated scalpel. Scissors make the working part of scalpel with one hand vibrating 55,000 Hz in a second. The effect reflects in braking hydrogen links and denaturation of proteins in instant haemostasis and coagulation in blood vessels, and there is no need of tying them up. Practically, there is no damaging of the surrounding tissues. The technique is easy to use. When performing laparoscopic vaginal hysterectomy and adnexectomy the ligamentum infundibulopelvicum and ligamentum rotundum are cut, and there the blood vessels are not thicker than 3 millimeters. As these ligaments are easy to reach with ultrasonically activated scalpel, we can say that this instrument is the ideal option for laparoscopic vaginal hysterectomy.

The authors are discussing the advantages of the laparoscopically assisted vaginal hysterectomy over the traditional vaginal method, comparing two groups of patients operated in both techniques. In 30 patients from the first group the traditional vaginal hysterectomy have been performed as part of the operation needed in order to change their sex. 20 patients from the second group have been operated, due to different indications, by laparoscopically assisted vaginal hysterectomy. Comparing the indications, the operation itself and the results in postoperative treatment the authors concluded that, for the laparoscopically assisted vaginal hysterectomy the indications are more numerous, practically there are no contraindications, the operation itself is easier, because all abdominal organs are visible on the screen. As for the results after the operation, they are almost identical in both groups. The only advantage of the traditional method is that, sometimes, the operation itself does not last long. The greatest benefit of laparoscopic assisted vaginal hysterectomy is the potential to convert what would have been an abdominal hysterectomy into a vaginal hysterectomy. The authors unanimously concluded that only experienced surgeons can perform both operations.

Histoquantitative methods were applied to study the changes of splenic structure and proportions of splenic tissue compartments in cisplatin-treated (6 mg/kg body wt) male Wistar rats. Six days after treatment the significant reduction of volume density of white pulp was observed, which was due to the very prominent decrease of volume density of follicles. The volume density of periarteriolar lymphatic sheaths did not change substantially. Volume density of the marginal zone was also significantly reduced. A significant increase of volume density of connective tissue was observed. Morphometrical parameters of the follicles were also markedly altered: the number of follicles per mm2 of spleen section area, the numerical density of the follicles in the spleen, and the total number of the follicles were significantly reduced.