Evaluation of the Incidence of Bladder Perforation After Transurethral Bladder Tumor Resection in a Residency Setting

Purpose: To evaluate prospectively the actual bladder perforation incidence during transurethral resection of bladder tumor (TURB) performed by residents and to identify possible predisposing factors to such condition. Patients and Methods: Thirty-four patients with bladder tumor were submitted to TURB in our academic institution in April 2006, and were prospectively studied. Procedures were all done by senior residents under an attending direct supervision. All patients had a cystograms performed after the procedure by the injection of 400 mL of saline-diluted contrast solution with low-pressure infusion through the Foley catheter. The cystograms were evaluated blindly by a single radiologist. All patients were examined by cystoscopy and/or CT every 3 months for the first 2 years postoperatively. Results: The cystogram showed contrast leaking compatible with bladder perforation in 17 (50%) cases. None of the perforations were recognized intraoperatively by the surgeon. All perforations were extraperitoneal and managed conservatively. There was no significant correlation between the incidence of bladder perforation and the patient age (p = 0.508), the tumor stage (p = 0.998), the tumor grade (p = 0.833), the number of lesions (p = 0.394), and the tumor size (p = 0.651). The only factor that had impact on the development of bladder perforation was tumor localization at the bottom of the bladder (p = 0.035; OR, 6750; 95% CI, 1.14, 39.8). Conclusion: Asymptomatic perforations of the bladder wall occur very frequently after a TURB procedure performed by residents in training and, most of the time, are not noticed by the surgeon. Localization of the tumor at bladder dome was the only factor that negatively influenced perforation rates.

Greenhouse gas emissions and energy balance of palm oil biofuel

The search for alternatives to fossil fuels is boosting interest in biodiesel production. Among the crops used to produce biodiesel, palm trees stand out due to their high productivity and positive energy balance. This work assesses life cycle emissions and the energy balance of biodiesel production from palm oil in Brazil. The results are compared through a meta-analysis to previous published studies: Wood and Corley (1991) [Wood BJ, Corley RH. The energy balance of oil palm cultivation. In: PORIM intl. palm oil conference agriculture; 1991.], Malaysia; Yusoff and Hansen (2005) [Yusoff S. Hansen SB. Feasibility study of performing an life cycle assessment on crude palm oil production in Malaysia. International Journal of Life Cycle Assessment 2007;12:50-8], Malaysia; Angarita et al. (2009) [Angarita EE, Lora EE, Costa RE, Torres EA. The energy balance in the palm oil-derived methyl ester (PME) life cycle for the cases in Brazil and Colombia. Renewable Energy 2009;34:2905-13], Colombia; Pleanjai and Gheewala (2009) [Pleanjai S. Gheewala SH. Full chain energy analysis of biodiesel production from palm oil in Thailand. Applied Energy 2009;86:S209-14], Thailand; and Yee et al. (2009) [Yee KF, Tan KT, Abdullah AZ, Lee la. Life cycle assessment of palm biodiesel: revealing facts and benefits for sustainability. Applied Energy 2009;86:S189-96], Malaysia. In our study, data for the agricultural phase, transport, and energy content of the products and co-products were obtained from previous assessments done in Brazil. The energy intensities and greenhouse gas emission factors were obtained from the Simapro 7.1.8. software and other authors. These factors were applied to the inputs and outputs listed in the selected studies to render them comparable. The energy balance for our study was 1:5.37. In comparison the range for the other studies is between 1:3.40 and 1:7.78. Life cycle emissions determined in our assessment resulted in 1437 kg CO(2)e/ha, while our analysis based on the information provided by other authors resulted in 2406 kg CO(2)e/ha, on average. The Angarita et al. (2009) [Angarita EE, Lora EE, Costa RE, Torres EA. The energy balance in the palm oil-derived methyl ester (PME) life cycle for the cases in Brazil and Colombia. Renewable Energy 2009:34:2905-13] study does not report emissions. When compared to diesel on a energy basis, avoided emissions due to the use of biodiesel account for 80 g CO(2)e/MJ. Thus, avoided life Cycle emissions associated with the use of biodiesel yield a net reduction of greenhouse gas emissions. We also assessed the carbon balance between a palm tree plantation, including displaced emissions from diesel, and a natural ecosystem. Considering the carbon balance outcome plus life cycle emissions the payback time for a tropical forest is 39 years. The result published by Gibbs et al. (2008) [Gibbs HK, Johnston M, Foley JA, Holloway T, Monfreda C, Ramankutty N, et al., Carbon payback times for crop-based biofuel expansion in the tropics: the effects of changing yield and technology. Environmental Research Letters 2008;3:10], which ignores life cycle emissions, determined a payback range for biodiesel production between 30 and 120 years. Crown Copyright (C) 2010 Published by Elsevier Ltd. All rights reserved.

Therapeutic Option for Infected Urinary Tract Fistulas in Renal Transplantation

Background. Approximately 20% of urinary tract fistulas after renal allografting are complicated by urinary tract infection, which presents a therapeutic challenge. Objective. To evaluate an option for treatment of urinary tract fistulas associated with urinary tract infection and unsuitable for minimally invasive or primary surgical urinary tract repair. Patients and Methods. The study included 650 recipients who underwent transplantation over 17 years. Urinary leakage was initially treated with indwelling bladder catheterization. Patients with fistulas refractory to treatment underwent surgical intervention to repair the urinary tract. In patients who were not candidates for primary repair of the urinary tract, temporary urinary diversion was performed, rather than classic percutaneous or open nephrostomy, using a ureteral stent (ie, a 6F or 8F Foley catheter with the balloon placed inside the renal pelvis). Results. Overall, urinary leakage occurred in 36 patients (5.5%). Conservative management was successful in 14 vesical fistulas (42.4%) and no ureteral fistulas (0%). Three patients died of sepsis during conservative treatment, before the new surgical approach. Five of 36 urinary leaks (13.9%) were managed using ureteral intubation with an 8F Foley catheter, with a success rate of 80%. Conclusion. Ureteral catheterization with an 8F Foley catheter is a feasible therapeutic option to treat complicated urinary tract fistulas unsuitable for primary surgical repair of the urinary tract.

Changes in histone acetylation and methylation that are important for persistent but not transient expression of CCR4 in human CD4(+) T cells

Although regulation of CXCR3 and CCR4 is related to Th1 and Th2 differentiation, respectively, many CXCR3(+) and CCR4(+) cells do not express IFN-gamma and/or IL-4, suggesting that the chemokine receptor genes might be inducible by mechanisms that are lineage-independent. We investigated the regulation of CXCR3 versus IFNG, and CCR4 versus IL4 in human CD4(+) T cells by analyzing modifications of histone H3. In naive cord-blood cells, under nonpolarizing conditions not inducing IL4, CCR4 was induced to high levels without many of the activation-associated changes in promoter histone H3 found for both IL4 and CCR4 in Th2 cells. Importantly, CCR4 expression was stable in Th2 cells, but fell in nonpolarized cells after the cells were rested; this decline could be reversed by increasing histone acetylation using sodium butyrate. Patterns of histone H3 modifications in CXCR3(+) CCR4(-) and CXCR3(-) CCR4(+) CD4(+) T-cell subsets from adult blood matched those in cells cultured under polarizing conditions in vitro. Our data show that high-level lineage-independent induction of CCR4 can occur following T-cell activation without accessibility-associated changes in histone H3, but that without such changes expression is transient rather than persistent.