Prenatal diagnosis of congenital diaphragmatic hernia: Timing of visceral herniation and outcome

Ultrasonographic prenatal diagnosis of congenital diaphragmatic hernia is well established, but the correlation of prenatal detection with clinical outcome remains unclear. We report our experience with 15 cases of prenatally diagnosed congenital diaphragmatic hernia. Seven fetuses were detected at 14–16 weeks' gestation; two with a normal sonographic study at 15 and 16 weeks' gestation showed visceral herniation at 21 and 23 weeks, respectively. In the remaining six cases, a diaphragmatic hernia was found at ultrasonography after 24 weeks' gestation, while previous sonographic studies had been normal. All seven fetuses in whom a diaphragmatic hernia was diagnosed before 16 weeks' gestation were aborted; four of them had severe malformations or karyotype abnormalities. The two neonates who were diagnosed at 21 and 23 weeks' gestation died after surgical repair. In contrast, all six infants whose visceral herniation was diagnosed after 24 weeks of gestation, and whose sonographic studies at 15–23 weeks had been normal, are alive and well after corrective surgery. The results of this series suggest that the timing of visceral herniation into the thoracic cavity is a major indicator of the prognosis of these fetuses and that herniation that occurs after 25 weeks of gestation carries a favourable clinical outcome. Normal sonographic studies during the first half of pregnancy do not exclude the subsequent development of congenital diaphragmatic hernia, raising questions about the advisability of repeat examinations at later stages of gestation.     

Ultrasound observation of amnion dysmorphism at 14.5–16 weeks

The presence of chorio-amniotic separation and amnion anomalies was recorded in 9500 patients referred for vaginal ultrasound examination at 14.5–16 weeks' gestation. In all patients with a change in the amnion, a search for fetal anomalies was performed and pregnancy outcome was checked. Amnion dysmorphism was observed in 30 cases. The main findings were a floating membrane which changed its configuration when the uterus was tilted and multiple intrauterine amniotic sheets. In no case was attachment of the fetus to the membranes noted. There was no fetal abnormality and pregnancy outcome was favourable in all patients. In conclusion, ultrasound visualization of amnion dysmorphism in early pregnancy is not associated with an adverse pregnancy outcome.     

Prenatal diagnosis of ventricular septal defect and overriding aorta at 14 weeks' gestation,using trans vaginal sonography

Two fetuses with heart abnormalities were detected by transvaginal sonography at 14 weeks of gestation. In the first fetus, a ventricular septal defect and an overriding aorta were detected and a diagnosis of tetralogy of Fallot was suggested. In addition, cystic hygroma and omphalocoele were visualized and the cytogenetic study revealed trisomy 18. In the second fetus, ventricular septal defect, pericardial effusion, and omphalocoele were detected.     

Lessons learned and success of initiatives to rehabilitate degraded forests in Guangdong Province,China

The harvesting of communal natural resources by ‘outsiders’ (i.e. harvesters from other villages or towns) was investigated in ten rural villages in South Africa. Participatory Rural Appraisal (PRA) techniques were used to collect data in focus groups in each village. A case study quantifying the outflow of fuelwood was also conducted in one of the villages. Harvesting by outsiders was reportedly widespread and, in the case of fuelwood, a cause for concern. Of 13 recorded resources, the three most commonly harvested by outsiders were fuelwood, plants for traditional medicine and river sand for brick-making. An increase in harvesting by outsiders over the last decade was widely reported. This was related to socio-economic changes, largely associated with the first democratic elections in 1994. Key socio-economic drivers of this increased harvesting were: 1) the breakdown of institutional control of resources, 2) rising unemployment, and 3) a pervasive sense of entitlement associated with new-found political freedom and democracy. Evidence suggests that the increased harvesting by outsiders is a reality, rather than a xenophobic accusation, and that it poses a threat to the sustainability of communal resources in rural areas. This is discussed within the context of South Africa as a society in transition.     

Chemical fractionation of phosphorus in stabilized biosolids

Three chemicals-ferrous sulfate (FeSul), calcium oxide (CaO), and aluminum sulfate (alum)-were applied at different rates to stabilize P in fresh, anaerobically digested biosolids (FBS) obtained from an activated sewage treatment plant. A modified Hedley fractionation procedure was used to assess P forms in these sludge-borne materials and in a biosolids compost (BSC) prepared from the same FBS. Each biosolids material exhibited a unique pattern of P distribution among fractions. The most available P forms, namely: (i) water-soluble P (WSP); (ii) membrane-P; and (iii) NaHCO(3)-P, were stabilized by small rates of each of the chemicals; but the P transformation into more stable forms depended on the type of chemical added. The stabilized P forms were enhanced by high rates of CaO and FeSul, but were reduced by high rates of alum. The organic P (P(o)) in the first three fractions of the FeSul- and alum-stabilized biosolids was enhanced by the chemical addition, and P(o) transformation from NaOH-P(o) into NaHCO(3)-P(o) was found in calcium-stabilized biosolids. A positive relationship was found between NaHCO(3)-P(o) and the NaHCO(3)-extracted organic C in all chemically stabilized biosolids. One-step extraction by NaHCO(3) or NaOH underestimated P extraction compared to the stepwise extraction. The reported results are consistent with solid-state P speciation reported earlier and contribute important information for optimizing biosolids stabilization to reduce P loss after incorporation in soils and for maximizing soil capacity to safely store pre-stabilized biosolids.     

The significance of a small, level-3 'semi evacuation' hospital in a terrorist attack in a nearby town

Terrorist attacks can occur in remote areas causing mass-casualty incidents MCIs far away from level-1 trauma centres. This study draws lessons from an MCI pertaining to the management of primary and secondary evacuation and the operational mode practiced. Data was collected from formal debriefings during and after the event, and the medical response, interactions and main outcomes analysed using Disastrous Incidents Systematic Analysis through Components, Interactions and Results (DISAST-CIR) methodology. A total of 112 people were evacuated from the scene-66 to the nearby level 3 Laniado hospital, including the eight critically and severely injured patients. Laniado hospital was instructed to act as an evacuation hospital but the flow of patients ended rapidly and it was decided to admit moderately injured victims. We introduce a novel concept of a 'semi-evacuation hospital'. This mode of operation should be selected for small-scale events in which the evacuation hospital has hospitalization capacity and is not geographically isolated. We suggest that level-3 hospitals in remote areas should be prepared and drilled to work in semi-evacuation mode during MCIs.     

Analysis of radiation hazards to personnel on marine platforms

The large number of radio frequency (RF) transmitters employed in modern marine platforms requires that they operate in mutual coexistence while posing no danger to operators and equipment despite the limited available physical space. A key to the successful system integration is the control of the electromagnetic environment on the ships’ topsides, which might pose radiation hazards (RADHAZ) to personnel (HERP). HERP are caused by transmitter antenna installations that generate intentional EM radiation in excess of the safe levels in zones of personnel activity. Radiation safety to personnel is achieved when the average radiation power density is below the permissible exposure limits (PEL) for HERP at locations of personnel activity and medical equipment operation. This paper describes the analysis tools and techniques for the evaluation of HERP on marine platforms. The same approaches could be employed in the analysis of land site antenna deployment scenarios.     

Graphical Presentation of 50/60 Hz Magnetic Field Contours as an Engineering Tool for Minimizing ELF Fields

Summary Since IARC classified ELF magnetic field as Possibly Carcinogenic to Human the fear from 50/60 Hz magnetic field exposure had been increased to the state of public “panic”. Subsequently, environment quality preservation organizations increased their pressure on their government to adopt the “precautionary principle” and to reduce the allowable ELF Magnetic Field exposure to much lower values than are recommended by ICNIRP-1998. As an example the present Environmental Ministry in Israel recommendation is to lower the ELF Field exposure to 10 mG averaged over 24 h. As a result of this stringent exposure guideline imposed by the government, electrical engineers who are involved in the deployment and installation of large and medium electrical utilities, such as overhead power lines, transformers, UPS systems, electrical public transportation, switching stations, etc., are much more aware to the need to employ special measures and methods for reducing the magnetic fields that might be emitted from such utilities. There are few computer codes that are capable of analyzing with great accuracy magnetic and electric fields surrounding single phase and three phase electrical utilities in a 3-D system. The best presentations of the analysis results are by equi-value contours depicting electric and magnetic fields. This graphical presentation is a powerful design tool that enables better deployment and installation design aided to reduce the magnetic field emissions from high-power electrical utilities. This paper describes the various types of graphical presentations available for ELF field contours, the dependent and independent variants and parameters, magnetic field animation for optimization of power line installation and routing, and finally an example that demonstrates the usefulness of the graphical presentation tools.     

The significance of early second-trimester sonographic detection of minor fetal renal anomalies

A study of 6350 consecutive transvaginal ultrasound examinations was performed as part of a routine fetal evaluation. Twenty-one cases (0.33 per cent) of early second-trimester sonographic detection of minor renal abnormalities (unilateral renal agenesis, pelvic kidney, and double collecting system) are presented. The sonographic diagnosis was made at 14–18 weeks of pregnancy and confirmed, in all of the 21 fetuses, postnatally or by post-mortem. A high incidence of associated fetal anomalies (24 per cent) and parental renal abnormalities (14 per cent) was demonstrated. Transvaginal sonography was found to be a useful tool for diagnosing these renal anomalies as early as 14 weeks of pregnancy. The likelihood of various associated anomalies and long-term implications on renal function raise questions concerning the prenatal management of such patients.     

Prenatal diagnosis of cystic fibrosis: Ultrasonographic appearance of meconium ileus in the fetus

Four often fetuses carrying a risk of 1:4 for cystic fibrosis were found to have low levels of microvillar enzymes in the amniotic fluid obtained between 17 and 18 weeks' gestational age. On sonography performed prior to the amniocentesis, three fetuses showed enlarged bowel loops. At autopsy, meconium ileus was detected. Enlarged bowel loops are a sign which has not been described previously so early in pregnancies.