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.     

Diagnosis of cardiac defects: where we've been,where we are and where we're going

There has been tremendous development in the field of prenatal diagnosis of cardiac disease in the last 30 years. Early work centered on the technical aspects of providing an accurate assessment of cardiac structure and function. Techniques of fetal cardiac screening have been developed and utilized throughout the world. More recently, investigators have begun to explore the ramifications of fetal cardiac diagnosis by assessing measures of outcome. In this article, the field of fetal echocardiography, as a screening tool for identifying congenital heart disease, and its impact on disease outcome is reviewed. Copyright © 2002 John Wiley & Sons, Ltd.     

Planning‐level source decay models to evaluate impact of source depletion on remediation time frame

A recent United States Environmental Protection Agency (US EPA) Expert Panel on Dense Nonaqueous Phase Liquid (DNAPL) Source Remediation concluded that the decision‐making process for implementing source depletion is hampered by quantitative uncertainties and that few useful predictive tools are currently available for evaluating the benefits. This article provides a new planning‐level approach to aid the process. Four simple mass balance models were used to provide estimates of the reduction in the remediation time frame (RTF) for a given amount of source depletion: step function, linear decay, first‐order decay, and compound. As a shared framework for assessment, all models use the time required to remediate groundwater concentrations below a particular threshold (e.g., goal concentration or mass discharge rate) as a metric. This value is of interest in terms of providing (1) absolute RTF estimates in years as a function of current mass discharge rate, current source mass, the remediation goal, and the source‐ reduction factor, and (2) relative RTF estimates as a fraction of the remediation time frame for monitored natural attenuation (MNA). Because the latter is a function of the remediation goal and the remaining fraction (RF) of mass following remediation, the relative RTF can be a valuable aid in the decision to proceed with source depletion or to use a long‐term containment or MNA approach. Design curves and examples illustrate the nonlinear relationship between the fraction of mass remaining following source depletion and the reduction in the RTF in the three decay‐based models. For an example case where 70 percent of the mass was removed by source depletion and the remediation goal (C_g/C₀) was input as 0.01, the improvement in the RTF (relative to MNA) ranged from a 70 percent reduction (step function model) to a 21 percent reduction (compound model). Because empirical and process knowledge support the appropriateness of decay‐based models, the efficiency of source depletion in reducing the RTF is likely to be low at most sites (i.e., the percentage reduction in RTF will be much lower than the percentage of the mass that is removed by a source‐depletion project). Overall, the anticipated use of this planning model is in guiding the decision‐making process by quantifying the relative relationship between RTF and source depletion using commonly available site data. © 2005 Wiley Periodicals, Inc.     

Treatability of nonylphenol ethoxylate surfactants in on-site wastewater disposal systems.

The fate of nine-mole nonylphenol ethoxylate (NPE9) discharged to an on-site wastewater disposal (septic) system was the focus of a 2-year investigation. Known amounts of NPE9-based detergent were metered daily into the plumbing at a single-family household. The ethoxylate-containing wastewater was discharged to the highly anoxic environment of a 4500-L septic tank before distribution to the oxic subsurface via 100 m of leach line. After 180 days of injecting detergent to the septic system, periodic soil pore water and/or groundwater samples were collected and analyzed for nonylphenol ethoxylates (NPEs), nonylphenol ether carboxylates, and nonylphenol. The NPE9 and degradation intermediates that were measured were reduced by 99.99% on a molar basis. An 18% reduction in molar concentration within the septic tank was observed. This was followed by a further 96.7% reduction of molar concentration within the leach lines. As the pore water migrated through the vadose zone, an additional 99.69% reduction in molar concentration was measured between the bottom of the leach lines (leach line effluent) and the lowest vadose zone monitoring location. The results obtained from these analyses indicate that degradation of the surfactant occurs within the anoxic portion of the disposal system with continued rapid biodegradation in the oxic unsaturated zone. Only trace amounts of degradation residuals were detected in soil pore water. The concentration and distribution of various degradation intermediates with respect to location, time, and ambient physical conditions were evaluated. Rapid and systematic degradation of NPE in on-site wastewater disposal systems was documented.     

The relationship between environmental management strategies and environmental compliance at Marine Corps installations

Environmental compliance requirements periodically impact the military's ability to use all installation resources. In response, environmental management strategies have been developed to ensure compliance and allow site closure. This study examines the relationship between environmental management strategies and environmental compliance at U.S. Marine Corps (USMC) installations via analysis of environmental compliance audit scores. Five environmental scores of interest from 1998 to 2004 audits—which include total compliance, total management, audit management, policy management, and training management—were subjected to statistical analysis. Results showed the USMC met environmental compliance and management standards, despite limited resources. High management strategy scores were moderately correlated with high total compliance scores. Total management scores improved over time, and noncompliance was most often associated with a lack of resources and plans. © 2006 Wiley Periodicals, Inc.