Bile duct stones, strictures and iatrogenic lesions: studies on early diagnosis and treatment.

Aims: This study was carried out to investigate the role of common liver function tests, and the degree of common bile duct dilatation in the differential diagnosis of extrahepatic cholestasis, as well as the occurrence, diagnosis and treatment of iatrogenic bile duct injuries. In bile duct injuries, special attention was paid to gender and severity distribution and long-term results. Patients and methods: All consecutive patients with diagnosed common bile duct stones or malignant strictures in ERCP between August 2000 and November 2003. Common liver function tests were measured in the morning before ERCP on all of these 212 patients, and their common bile duct diameter was measured from ERCP films. Between January 1995 and April 2002, 3736 laparoscopic cholecystectomies were performed and a total of 32 bile duct injuries were diagnosed. All pre-, per-, and postoperative data were collected retrospectively; and the patients were also interviewed by phone. Results: Plasma bilirubin proved to be the best discriminator between CBD stones and malignant strictures (p≤0.001 compared to other liver function tests and degree of common bile duct dilatation). The same effect was seen in Receiver Operating Characteristics curves (AUC 0.867). With a plasma bilirubin cut-off value of 145 μmol/l, four out of five patients could be classified correctly. The degree of common bile duct dilatation proved to be worthless in differential diagnostics. After laparoscopic cholecystectomy the total risk for bile duct injury was 0.86%, including cystic duct leaks. 86% of severe injuries and 88% of injuries requiring operative treatment were diagnosed in females. All the cystic duct leakages and 87% of the strictures were treated endoscopically. Good long-term results were seen in 84% of the whole study population. Conclusions: Plasma bilirubin is the most effective liver function test in differential diagnosis between CBD stones and malignant strictures. The only value of common bile duct dilatation is its ability to verify the presence of extrahepatic cholestasis. Female gender was associated with higher number of iatrogenic bile duct injuries, and in particular, most of the major complications occur in females. Most of the cystic duct leaks and common bile duct strictures can be treated endoscopically. The long-term results in our institution are at an internationally acceptable level.

Treatment of NI-containing acidic mine waters with calcite side-stones

Acid mine drainage (AMD) presents a serious problem for the environment for the massive formation of acidic leachates containing heavy metals. The present work deals with the AMD treatment using neutralizing limestone side-products. The conventional methods for prevention, mitigating and control of AMD formation are described. The experimental testing of Nordkalk Oy calcite-containing side-stones for acid neutralizing and removal of nickel from solutions presents the research objective. The batch experiments in acid neutralizing with subsequent metal content analysis were carried out. The results showed the dependence of pH on the dose of neutralizing material and the exposure time. The nickel removal, unlike iron, within the pH range from 1.2 to 6.0 appeared to be inadequate. The further research on nickel co-precipitation with iron and aluminium may appear to be necessary together with testing of alkalinity strengthening materials.

Katepillarista kauppakassiin : product placement suomalaisessa tv-ohjelmatuotannossa

Product placement has become more and more common in Finnish television programmes lately. Product placement, as with the whole of the television industry, is strictly regulated and monitored by law. Surreptitious advertising, sponsorship, cooperative partnerships and product placement are often confused with each other. Partially these activities are interpenetrative. Present legislation doesn't recognise product placement, therefore it doesn't have any specific position in law, thus causing problems. Product placement in domestic tv-programmes is still relatively modest. More extensive activity is perceivable at the movies where the restrictions are considerably more liberal. In the United States, product placement is a part of a production's budget. Pressure to increase financing has grouwn in both Finland and Europe. There has been considerable preparation in advance of a new television directive in the European Union which would allow more liberal advertising and product placement as a part of financing tv-programmes. The proposal for a new directive is currently only on its first round so product placement probably won't become better defined in law in the near future. Finnish television producers were interviewed as part of the research for this thesis, in order to clarify product placement position and usage in domestic televion programmes. Surreptitious advertising, sponsorship, different kinds of cooperative partnerships and the need for guidance were also discussed in the course of the themed interviews. Even though product placement does not currently play a significant part in the financing of a production, there are certainly pressures in that direktion. In the field of television, the legal boundaries of product placement are presently being explored in order to assess its position as a part of budgeting and covering expenses.