The neurogenic bladder: medical treatment

Neurogenic bladder sphincter dysfunction (NBSD) can cause severe and irreversible renal damage and bladder-wall destruction years before incontinence becomes an issue. Therefore, the first step in adequate management is to recognize early the bladder at risk for upper- and lower-tract deterioration and to start adequate medical treatment proactively. Clean intermittent catheterization combined with anticholinergics (oral or intravesical) is the standard therapy for NBSD. Early institution of such treatment can prevent both renal damage and secondary bladder-wall changes, thereby potentially improving long-term outcomes. In children with severe side effects or with insufficient suppression of detrusor overactivity despite maximal dosage of oral oxybutynin, intravesical instillation is an effective alternative. Intravesical instillation eliminates systemic side effects by reducing the first-pass metabolism and, compared with oral oxybutynin, intravesical oxybutynin is a more potent and long-acting detrusor suppressor. There is growing evidence that with early adequate treatment, kidneys are saved and normal bladder growth can be achieved in children so they will no longer need surgical bladder augmentation to achieve safe urinary continence in adolescence and adulthood

Biomarkers of hepatic injury and function in neonatal hypoxic ischemic encephalopathy and with therapeutic hypothermia

Therapeutic hypothermia (TH) is now provided as standard care to infants with moderate-severe hypoxic ischemic encephalopathy (HIE). The role of TH in limiting neuronal injury is well recognized, but its effect on hepatic injury which occurs frequently in neonatal HIE is not known. Our objective was to characterize biomarkers of liver injury and function in the setting of neonatal HIE and to describe whether HIE severity and provision of TH influence these hepatic biomarkers. We performed a multicenter retrospective study and compared hepatic biomarkers obtained during the first postnatal week, according to the severity of HIE and whether treated with TH. Of a total of 361 infants with HIE, 223 (62%) received TH and 138 (38%) were managed at normal temperature. Most hepatic biomarkers and C-reactive protein (CRP) were significantly associated with the severity of HIE (p<0.001). Infants treated with TH had lower peak Alanine aminotransferase (ALT) concentrations (p=0.025) and delay in reaching peak CRP concentration (p<0.001).  Conclusion: We observed a significant association between the clinical grade of HIE and biomarkers of liver metabolism and function. Therapeutic hypothermia was associated with delayed CRP responses and with lower ALT concentrations and so may have the potential to modulate hepatic injury

springs, southern Turkey

The Dalaman and Koycegiz thermal springs are from karstic limestones belonging to Upper Cretaceous to Burdigalian Beydaglan autochthon and Carboniferous to Lutetian Lycian nappes. They have measured temperatures of 24- 41 degrees C, specific electrical conductivities of 14,310-45,600 mu S/cm, and are dominated by Na (1550-8500 mg/kg) and Cl (2725-15,320 mg/kg). The heat source of the geothermal systems of the area is tectonic related and the occurrence of the thermal springs is related to the young normal faults. Meteoric waters and seawaters recharge the reservoir rocks, are heated at depth with increasing geothermal gradient, and move up to the surface through the fractures and faults by convection trend and emerge as thermal springs. While thermal waters move up to the surface, they mix with different proportions of seawater and cold fresh waters. The seawater contribution to the thermal waters varies from 24% to 78%. Lake waters in the area are connected with thermal waters. Consequently, their chemical composition is influenced by the chemistry of thermal waters. Chemical equilibrium modelling based on measured outlet temperatures and measured pH shows that all the waters are oversaturated with respect to quartz and K-mica and undersaturated with respect to AI(OH)(3), anorthite, gypsum, siderite and SiO2(a). Albite, alunite, aragonite, Ca-montmorillonite, calcite, chalcedony, chlorite, dolomite, Fe(OH)(3)(a), fluorite, gypsum, illite, K-feldspar, kaolinite and sepiolite minerals are mostly oversaturated or undersaturated. Mineral saturation studies of the thermal springs indicate that dolomite, chalcedony and quartz are most likely to cause scaling at outlet conditions. Assessments from various chemical geothermometers, and Na-K-Mg ternary and mineral equilibrium diagrams suggest that the reservoir temperature is around 65-90 degrees C. The temperatures obtained from quartz, quartz-steam loss, Mg/Li geothermometers and mineral equilibrium diagrams give the most reasonable results. (c) 2005 Elsevier Ltd. All rights reserved

the Alasehir-Kavaklidere area (Manisa-Turkey)

Alasehir graben is located in the southern edge of the Gediz graben, which is an important graben for geothermal activity. Thermal waters are hosted by Menderes massif metamorphic rocks, which are made of gneisses, schists and marbles. Impermeable clayey units of the neogene sediments are cap rocks of the geothermal system. Presence of geothermal waters is closely related to normal fault systems and graben tectonic. Meteoric waters recharging the reservoir rocks are heated at depth with geothermal gradient. The AK-2 and KG-1 wells have the third and fourth highest temperatures of Turkey, respectively. Reservoir temperatures of the geothermal system are estimated to vary between 125 and 225 degrees C by mineral equilibria geothermometer, vary between 160 and 240 degrees C by Giggenbach triangular diagram and vary between 150 and 250 degrees C by silica enthalpy-mixture model. Cold water contributions to thermal waters vary from 75 to 95%. Na-HCO(3) water type is dominant for thermal water. Major reaction of the thermal water to change facies is softening reaction. The temperatures obtained from silica enthalpy model, mineral equalibria geothermometers, Na/K, Na/Li geothermometers are more useful than others in the study area. Scaling tendencies of the thermal water are examined. The major environmental problem in the groundwater is high boron concentration which is harmful for agricultural irrigation

field (Manisa, Turkey)

The town of Salihli is situated in Gediz Graben in the western Anatolia. This region is important in terms of industry, mining, geothermal energy, water sources, and agricultural production. Geothermal flow and anthropogenic activities in Salihli threaten the surrounding environment due to the contamination of cold groundwater, surface water, and soil. The goal of the present study is to determine the environmental effects of the geothermal and anthropogenic activities in Salihli on soil, stream sediments, and water. Stream sediments and farm soil have been contaminated by substances derived from geothermal and industrial effluents. To this end, the quality review of the water was completed and the heavy metal levels in stream sediment samples were measured to determine the extent of contamination. The elements As, B, Br, Fe, and Ni are the major contaminants present in surface water and groundwater in the study area. The concentrations of these elements excess tolerance limits of international water standards. Gibbsite, K-mica, kaolinite, sepiolite, halite, sulfur, willemite, and Pb(OH)(2) might be precipitated as scales at low temperatures on the soil; this could be interpreted as a resultant from soil contamination. The concentrations of 17 elements (As, Ba, B, Cd, Co, Cr, Cu, Fe, Hg, Li, Mo, Mn, Ni, Pb, Sb, Sr, and Zn) were measured in samples from stream sediments and surface soils. In the study area, especially geothermal and anthropogenic activities give rise to environmental pollution