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IntroductionCritically ill surgical patients frequently develop intra-abdominal hypertension (IAH) leading to abdominal compartment syndrome (ACS) with subsequent high mortality. We compared two temporary abdominal closure systems (Bogota bag and vacuum-assisted closure (VAC) device) in intra-abdominal pressure (IAP) control.MethodsThis prospective study with a historical control included 66 patients admitted to a medical and surgical intensive care unit (ICU) of a tertiary care referral center (Careggi Hospital, Florence, Italy) from January 2006 to April 2009. The control group included patients consecutively treated with the Bogota bag (Jan 2006-Oct 2007), whereas the prospective group was comprised of patients treated with a VAC. All patients underwent abdominal decompressive surgery. Groups were compared based upon their IAP, SOFA score, serial arterial lactates, the duration of having their abdomen open, the need for mechanical ventilation (MV) along with length of ICU and hospital stay and mortality. Data were collected from the time of abdominal decompression until the end of pressure monitoring.ResultsThe Bogota and VAC groups were similar with regards to demography, admission diagnosis, severity of illness, and IAH grading. The VAC system was more effective in controlling IAP (P < 0.01) and normalizing serum lactates (P < 0.001) as compared to the Bogota bag during the first 24 hours after surgical decompression. There was no significant difference between the SOFA scores. When compared to the Bogota, the VAC group had a faster abdominal closure time (4.4 vs 6.6 days, P = 0.025), shorter duration of MV (7.1 vs 9.9 days, P = 0.039), decreased ICU length of stay (LOS) (13.3 vs 19.2 days, P = 0.024) and hospital LOS (28.5 vs 34.9 days; P = 0.019). Mortality rate did not differ significantly between the two groups.ConclusionsPatients with abdominal compartment syndrome who were treated with VAC decompression had a faster abdominal closure rate and earlier discharge from the ICU as compared to similar patients treated with the Bogota bag.

Abstract:Most water in the Paraná River drainage basin is supplied by the tropical Upper Paraná (over 60% of the total annual water discharge, 550 km 3 . The total suspended solids (TSS) load (c. 80 ð 10 6 t year 1 , however, is essentially furnished (50-70%) by the mountainous, arid and mostly sediment-mantled upper Bermejo River drainage basin. This characteristic suggests that the Paraná River solid load (TSS, 600 km upstream from the mouth) is largely recycled sedimentary material, whose discharge-weighted mean chemical index of alteration is c. 71. The extended UCCnormalized multi-elemental diagrams are similar to those of other world rivers. Nevertheless, the detailed inspection of UCC-normalized rare earth element (REE) 'spidergrams' reveals a lithological source for the Paraná River TSS that might be compatible with either tholeiitic flood basalts (widespread in the upper drainage) or with young Andean intermediate volcanic rocks. In view of the Bermejo River's dominant role as a sediment contributor, we feel that the signature preserved in the Paraná's TSS is the latter. Conversely, the Uruguay River TSS REE signature is certainly determined by the extensive weathering products of Jurassic-Cretaceous tholeiitic basalts.

Materials containing radionuclides of natural\ud origin and being subject to regulation because of their\ud radioactivity are known as Naturally Occurring Radioactive\ud Material (NORM). By following International Atomic\ud Energy Agency, we include in NORM those materials with\ud an activity concentration, which is modified by human\ud made processes. We present a brief review of the main\ud categories of non-nuclear industries together with the levels of activity concentration in feed raw materials,\ud products and waste, including mechanisms of radioisotope\ud enrichments. The global management of NORM shows a\ud high level of complexity, mainly due to different degrees of\ud radioactivity enhancement and the huge amount of worldwide\ud waste production. The future tendency of guidelines\ud concerning environmental protection will require both a\ud systematic monitoring based on the ever-increasing sampling\ud and high performance of gamma-ray spectroscopy.\ud On the ground of these requirements a new low-background\ud fully automated high-resolution gamma-ray spectrometer\ud MCA_Rad has been developed. The design of\ud lead and cooper shielding allowed to reach a background\ud reduction of two order of magnitude with respect to laboratory\ud radioactivity. A severe lowering of manpower cost is\ud obtained through a fully automation system, which enables\ud up to 24 samples to be measured without any human\ud attendance. Two coupled HPGe detectors increase the\ud detection efficiency, performing accurate measurements on\ud small sample volume (180 cm\ud 3\ud ) with a reduction of sample\ud transport cost of material. Details of the instrument calibration\ud method are presented. MCA_Rad system can\ud measure in less than one hour a typical NORM sample\ud enriched in U and Th with some hundreds of Bq kg\ud , with\ud an overall uncertainty less than 5 %. Quality control of this\ud method has been tested. Measurements of three certified\ud reference materials RGK-1, RGU-2 and RGTh-1 containing\ud concentrations of potassium, uranium and thorium\ud comparable to NORM have been performed. As a result,\ud this test achieved an overall relative discrepancy of 5 %\ud among central values within the reported uncertainty

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