Rapid and radical amniodrainage in the treatment of severe twin–twin transfusion syndrome†

We have evaluated the role of a rapid and radical method of amniodrainage in the treatment of severe twin–twin transfusion. The outcome of 15 patients with severe twin–twin transfusion for which a amniodrainage was performed by means of a vacuum bottle system was compared with the outcome of 15 patients with a similar condition, matched for gestational age at the time of the initial procedure and drained using a standard procedure. In the study group the amniodrainage ended when no amniotic fluid could be aspirated, whereas the women in the standard group were drained with a syringe system and the fluid was removed until the deepest amniotic fluid pool was <8 cm. At the initial procedure, the mean volume of amniotic fluid drained was significantly (p<0.05) higher (3252 vs 2153 ml) and the length of the procedure significantly (p<0.001) shorter (21 vs 41 min) in the study group than in the standard group. The mean post-procedure amniotic fluid index was significantly (p<0.001) smaller (2.9 vs 7.7 cm) after radical amniodrainage than after the standard amniodrainage. The mean number of procedures was significantly (p<0.001) lower (1.5 vs 5.6) in the study group compared to the standard group. In the study group the mean placental thickness increased significantly (p<0.001) from 9 mm before the procedure to 49 mm after, and the overall perinatal survival rate was 80% and the proportion of pregnancies with at least one survivor was 93%. The present data indicate that early, rapid and radical amniodrainage is an effective and low-cost therapy for severe twin–twin transfusion syndrome. Compared to the standard amniodrainage technique it also appears to reduce the need for multiple procedures. Copyright © 2001 John Wiley & Sons, Ltd.     

MINIMIZING THE IMPACT OF URBANIZATION ON LONG TERM RUNOFF1

Increasing concern about the problems caused by urban sprawl has encouraged development and implementation of smart growth approaches to land use management. One of the goals of smart growth is water resources protection, in particular minimizing the runoff impact of urbanization. To investigate the magnitude of the potential benefits of land use planning for water resources protection, possible runoff impacts of historical and projected urbanization were estimated for two watersheds in Indiana and Michigan using a long term hydrological impact analysis model. An optimization component allowed selection of land use change placements that minimize runoff increase. Optimizing land use change placement would have reduced runoff increase by as much as 4.9 percent from 1973 to 1997 in the Indiana study watershed. For nonsprawl and sprawl scenarios in the Michigan watershed for 1978 to 2040, optimizing land use change placement would have reduced runoff increase by 12.3 percent and 20.5 percent, respectively. The work presented here illustrates both an approach to assessing the magnitude of the impact of smart growth and the significant potential scale of smart growth in moderating runoff changes that result from urbanization. The results of this study have significant implications for urban planning.     

Role of amniotic fluid interphase fluorescence in situ hybridization (FISH) analysis in patient management

We retrospectively reviewed 309 amniotic fluid interphase fluorescence in situ hybridization (FISH) analyses performed from October 1995 to June 1999 to assess the role of interphase FISH in the management of patients at increased risk for fetal aneuploidies. Gestational age and indications for amniocentesis, clinical interventions after FISH results, as well as interventions after final culture reports were analyzed. There were 244 (79%) normal, 50 (16%) abnormal and 15 (5%) inconclusive FISH results. There were no false-positive or false-negative results, but there were nine (3%) clinically significant chromosomal abnormalities not detectable by FISH. Of the 50 women with abnormal FISH results, 26 (52%) elected to terminate the pregnancy prior to the availability of the standard chromosome analysis. In two of the fetuses with trisomy 21 no abnormalities were reported by ultrasound examination. Our experience indicates that interphase FISH results played an important role in decision making, especially for pregnancies close to 24 weeks' gestation. Standard karyotype analysis is still required for detection of chromosome abnormalities not detectable by interphase FISH techniques and for clarification of unusual or inconclusive FISH results. Copyright © 2001 John Wiley & Sons, Ltd.     

Choosing an appropriate soil-gas survey method

Three types of soil-gas surveys were performed over the same location at an industrial facility. The surveys performed were (1) a passive technique using buried collectors, (2) an active technique in which samples were collected in the field by pumping with subsequent analysis at a field laboratory, and (3) a screening technique that employed a hand-held survey instrument. Each of the surveys had desirable features, but there was considerable variability in the quality of data obtained, cost, and ease of performance. The passive and active surveys provided excellent detection limits, but the passive technique does not provide data in real time. The active survey was also time-consuming and required an analytical chemist in the field. Neither the active nor the passive survey were able to delineate the plume of contaminated groundwater. Consequently, the results from the rapid and inexpensive reconnaissance technique provided functionally equivalent data.Publication No. 3672, Environmental Sciences Division, ORNL.Operated by Martin Marietta Energy Systems, Inc. for the U.S. Department of Energy under Contract No. DE-AC05-840R21400.     

Estimating catchment nutrient flow with the HBV-NP model: sensitivity to input data

The dynamic catchment model HBV-N has been further developed by adding routines for phosphorus transport and is now called the HBV-NP model. The model was shown to satisfactorily simulate nutrient dynamics in the R?nne? catchment (1,900 km2). Its sensitivity to input data was tested, and results demonstrated the increased sensitivity to the selection of input data on a subcatchment scale when compared with the catchment scale. Selection of soil and land use databases was found to be critical in some subcatchments but did not have a significant impact on a catchment scale. Although acceptable on a catchment scale, using templates and generalization, with regards to emissions from point sources and rural households, significantly decreased model performance in certain subcatchments when compared with using more detailed local information. A division into 64 subcatchments resulted in similar model performance at the catchment outlet when compared with a lumped approach. Adjusting the imported matrixes of the regional leaching of nitrogen, from agricultural land, against mean subcatchment water percolation did not have a significant impact on the model performance.     

A carbon budget of a small humic lake: an example of the importance of lakes for organic matter cycling in boreal catchments

Lakes play an important role in the cycling of organic matter in the boreal landscape, due to the frequently high extent of bacterial respiration and the efficient burial of organic carbon in sediments. Based on a mass balance approach, we calculated a carbon budget for a small humic Swedish lake in the vicinity of a potential final repository for radioactive waste in Sweden, in order to assess its potential impact on the environmental fate of radionuclides associated with organic matter. We found that the lake is a net heterotrophic ecosystem, subsidized by organic carbon inputs from the catchment and from emergent macrophyte production. The largest sink of organic carbon is respiration by aquatic bacteria and subsequent emission of carbon.dioxide to the atmosphere. Although the annual burial of organic carbon in the sediment is a comparatively small sink, it results in the build-up of the largest carbon pool in the lake. Hence, lakes may simultaneously disperse and accumulate organic-associated radionuclides leaking from a final repository.     

Enantiomeric ratios as an indicator of exposure processes for persistent pollutants in human placentas

The enantiomeric ratios (ER) of alpha-HCH and o,p'-DDT ((+)-isomer concentration/(-)-isomer concentration) and o,p'-DDD (first eluting enantiomer/second enantiomer) were investigated in 112 human placentas from Finnish boys collected 1997-2001. Both o,p'-DDD and alpha-HCH showed changes in their ER depending on the total concentration of the compound in the sample. Their ERs are approaching a value close to racemic mixture (ER=1) at high concentrations. At low concentrations they often differ from 1. The relationship between concentration and ER is clearly identified and it has been shown that it is not affected by analytical uncertainty. This relationship appears to be important for assessing tissue- and species-specific exposure and risk and it may indicate whether net uptake or metabolic activity is dominant in exposure for the resulting exposure of the enantiomers.     

Estimation of doses received in a dry-contaminated residential area in the Bryansk region, Russia, since the Chernobyl accident

In nuclear preparedness, an essential requirement is the ability to adequately predict the likely consequences of a major accident situation. In this context it is very important to evaluate which contributions to dose are important, and which are not likely to have significance. As an example of this type of evaluation, a case study has been conducted to estimate the doses received over the first 17 years after the Chernobyl accident in a dry-contaminated residential area in the Bryansk region in Russia. Methodologies for estimation of doses received through nine different pathways, including contamination of streets, roofs, exterior walls, and landscape, are established, and best estimates are given for each of the dose contributions. Generally, contaminated soil areas were estimated to have given the highest dose contribution, but a number of other contributions to dose, e.g., from contaminated roofs and inhalation of contaminants during the passage of the contaminated plume, were of the same order of magnitude.