Attuazione del piano di intervento prefettizio per le sorgenti orfane presso un impianto termovalorizzatore

ATTUAZIONE DEL PIANO DI INTERVENTO PREFETTIZIO PER LE SORGENTI ORFANE PRESSO UN IMPIANTO TERMOVALORIZZATORE Autori: Fabrizio Campi, Alessandro Porta Politecnico di Milano, Dipartimento di Energia - CESNEF , via La Masa, 34 - 20156 Milano [email protected] ABSTRACT Il Decreto Legislativo n. 52 del 2007, all’art.14 comma 1, prevede che il Prefetto predisponga schemi di piano d’intervento tipo per la messa in sicurezza in caso di rinvenimento o di sospetto di presenza di sorgenti orfane nel territorio della provincia, avvalendosi del Comando dei Vigili del Fuoco, dell’Agenzia Regionale per la Protezione dell’Ambiente, dell’Azienda Sanitaria Locale e, se del caso, della Direzione Provinciale del Lavoro. Di conseguenza nel 2008 il Prefetto di Milano, come quelli di altre province, ha emanato un proprio piano di intervento, nello spirito della legge citata. Tale piano prevede che in caso di ritrovamento possano essere detentori di sorgenti orfane anche quegli impianti che, pur in assenza di uno specifico obbligo di legge, effettuano il controllo radiometrico del materiale in ingresso (ad esempio impianti di trattamento dei rifiuti urbani, termovalorizzatori, etc.) e che tali soggetti dovrebbero disporre di un esperto qualificato e di procedure di intervento per la gestione dei ritrovamenti. Poiché l’attivazione del piano di intervento può essere provocata, tra le altre situazioni, anche da rinvenimento di sorgenti orfane durante un controllo radiometrico nei carichi in ingresso, le Aziende nelle quali sono operativi sistemi per la rilevazione della radioattività nei materiali dovranno dotarsi preventivamente di procedure di emergenza e di gestione degli allarmi diversificate in funzione del rischio. Infine il Prefetto dà come indicazione che tali protocolli siano concordati con VVF, ARPA e ASL, in quanto devono prevedere, nei casi in cui non si possa escludere un pericolo per la pubblica e privata incolumità, l’attivazione immediata dei citati Enti. In questo contesto si è reso necessario applicare il Piano Prefettizio anche all’impianto Termovalorizzatore Silla 2 dell’Azienda A2A sito in Milano, che rientra nell’elenco delle aziende che effettuano controlli radiometrici sui carichi in ingresso. Ciò ha comportato la redazione di opportune procedure, con ripercussioni anche sulle strutture del sito. Nel lavoro sono illustrate le procedure adottate e gli adeguamenti strutturali messi in atto nell’ impianto

Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: A prospective randomized comparative study

Background: Acromioclavicular (AC) dislocation involves complete loss of articular contact; it is defined as chronic when it follows conservative management or unsuccessful surgical treatment. Materials and methods: The study compared the clinical and radiographic outcomes of AC joint stabilization performed in 40 patients with chronic dislocation using a biological allograft (group A) or a synthetic ligament (group B). Demographic data included: M/F: 25/15; mean age: 35 ± 3.2 years; previous surgery in 11 patients, including Weaver-Dunn (3), coracoacromial ligament repair (4), stabilization with K-wires (4). Dislocation was type III in 14 (35 %) and type IV in 26 (65 %) patients. Clinical assessment was with the Constant-Murley score (pre- and postoperative) and with the modified UCLA score. Enrollment started in January 2004 and was completed in March 2008. Patients were evaluated at 1 and 4 years. Postoperative X-rays were examined to assess joint stability in the coronal and axial planes, coracoclavicular ossification, and signs of AC joint osteoarthritis and distal clavicular osteolysis. Results: The "biological" group achieved significantly better clinical scores than the "synthetic" group at both 1 and 4 years. Poor subjective satisfaction and lower clinical scores were found in the 3 patients (1 from group A and 2 from group B) who experienced complete postoperative dislocation. No significant correlations were found with other radiographic parameters. Conclusions: The biological graft afforded better clinical and radiographic outcomes than the synthetic ligament in patients with chronic AC joint instability. Fixation to the clavicle constitutes the main weakness of both approaches and needs improving. © 2012 The Author(s)

Ossifying tendinitis of the rotator cuff after arthroscopic excision of calcium deposits: report of two cases and literature review

Ossifying tendinitis (OT) is a type of heterotopic ossification, characterized by deposition of hydroxyapatite crystals in a histologic pattern of mature lamellar bone. It is usually associated with surgical intervention or trauma and is more commonly seen in Achilles or distal biceps tendons, and also in the gluteus maximus tendon. To our knowledge, there is no description of OT as a complication of calcifying tendinitis of the rotator cuff. In this report, we describe two cases in which the patients developed an OT of the supraspinatus after arthroscopic removal of calcium deposits. The related literature is reviewed

Arthroscopic treatment of early glenohumeral arthritis

Background: The articular cartilage of the shoulder is not endowed with intrinsic repair abilities, so the detection of chondral lesions during arthroscopy may indicate that additional articular procedures are needed. The aim of the current study was to evaluate the benefits of arthroscopy in patients with early shoulder arthritis, and to assess which clinical and radiological features are correlated with better arthroscopic outcomes. Materials and methods: Out of a total of 2,707 shoulders, 61 arthroscopies were performed on patients aged 30-55 years suffering from a painful early arthritic shoulder. We performed a retrospective study of 47 of those 61 patients with osteoarthritis at Samilson-Prieto stage I or II. SST and Constant score were used as outcome measures. Arthroscopic circumferential capsulotomy was performed to release the soft tissues and increase the joint space. Glenoid chondral lesions were caregorized according to location (anterior, posterior, centered) and size (small, large, total) and treated with microfractures; in the last 11 patients, we placed a engineered hyaluronic acid membrane, Hyalograft® C, on the surface of the glenoid. Postoperative care included mobilization the day after surgery, with the arm protected in a sling for two weeks. Follow-up examinations were performed at 3, 6, 12, and 24 months after surgery. The clinical and radiographic data collected were compared with those obtained at the last examination. Results: The mean Constant score increased from 43.8 points to 79.1, and the mean SST score increased from 4.9 points to 9.4 points. Clinical outcomes improved significantly in 44 patients (93.6 %). The three patients (6.4 %) with the lowest scores showed progression of arthritis. Age, gender, glenohumeral distance, and presence of engineered hyaluronic acid membrane were not related to clinical scores. Recovery of range of motion as well as small and centered cartilage lesions were statistically associated with improved outcome. Conclusion: The main finding was that soft tissue procedures (including capsulotomy and synovectomy) associated with glenoid microfractures are only suitable for patients with early arthritis and preserved humeral head shape, particularly in cases with small and centered glenoid cartilage lesions. © 2012 The Author(s)

Anterior Glenoid Rim Fracture Following Use of Resorbable Devices for Glenohumeral Stabilization

Background Resorbable anchors are widely used in arthroscopic stabilization of the shoulder as a means of soft tissue fixation to bone. Their function is to ensure repair stability until they are replaced by host tissue. Complications include inflammatory soft tissue reactions, cyst formation, screw fragmentation in the joint, osteolytic reactions, and enhanced glenoid rim susceptibility to fracture. Purpose To evaluate resorption of biodegradable screws and determine whether they induce formation of areas with poor bone strength that may lead to glenoid rim fracture even with minor trauma. Study Design Case series; Level of evidence, 4. Methods This study evaluated 12 patients with anterior shoulder instability who had undergone arthroscopic stabilization with the Bankart technique and various resorbable anchors and subsequently experienced redislocation. The maximum interval between arthroscopic stabilization and the new dislocation was 52 months (mean, 22.16 months; range, 12-52 months). The mean patient age was 31.6 years (range, 17-61 years). The persistence or resorption of anchor holes; the number, area, and volume of osteolytic lesions; and glenoid erosion/fracture were assessed using computed tomography scans taken after redislocation occurred. Results Complete screw resorption was never documented. Osteolytic lesions were found at all sites (mean diameter, 5.64 mm; mean depth, 8.09 mm; mean area, 0.342 cm2; mean volume, 0.345 cm3), and all exceeded anchor size. Anterior glenoid rim fracture was seen in 9 patients, even without high-energy traumas (75% of all recurrences). Conclusion Arthroscopic stabilization with resorbable devices is a highly reliable procedure that is, however, not devoid of complications. In all 12 patients, none of the different implanted anchors had degraded completely, even in patients with longer follow-up, and all induced formation of osteolytic areas. Such reaction may lead to anterior glenoid rim fracture according to the literature and as found in 75% of the study patients with local osteolysis (9/12). Reducing anchor number and/or size may reduce the risk of osteolytic areas and anterior glenoid rim fracture

Treatment of clavicle fractures

Clavicle fractures are very common injuries in adults (2-5%) and children (10-15%) (1) and represent the 44-66% of all shoulder fractures (2). Despite the high frequency the choice of proper treatment is still a challenge for the orthopedic surgeon. With this review we wants to focus the attention on the basic epidemiology, anatomy, classification, evaluation and management of surgical treatments in relationship with the gravity of injuries. Both conservative and surgical management are possible, and surgeons must choose the most appropriate management modality according to the biologic age, functional demands, and type of lesion. We performed a review of the English literature thought PubMed to produce an evidence-based review of current concept and management of clavicle fracture. We finished taking a comparison with our survey in order to underline our direct experience

Characterization of Removable Coatings for Graphite-moderated Nuclear Reactors Decommissioning

In this study the behavior and characteristics of two removable coatings to be deposited on a nuclear grade graphite substrate were analyzed, with the aim to evaluate their possible application on graphite bricks during dismantling operations of graphite-moderated nuclear reactors.Indeed, nowadays many shut-down reactors are still in decommissioning phase, and effective measures should be taken to guarantee safe dismantling operations. One option could be the use of coating application techniques, which mitigate the risk of graphite dusts spreading and loose contamination, protecting clean surfaces.Tested coatings, both polymeric mixtures, were selected according to their previous application history, availability in commerce and easiness in handling, whereas substrates used were non-irradiated nuclear Virgin Atcheson Graphite Ordinary Temperature (AGOT) graphite samples from L-54M Politecnico di Milano research reactor, which is in decommissioning phase. Thermal characterization of the coatings was carried out before deposition using a Thermogravimetric and Differential Thermal Analysis (TGA-DTA) equipment, tests were performed to obtain a preliminary estimation of the drying time and degradation conditions. After deposition, mechanical properties, such as hardness, of the coating were assessed. The preliminary experimental campaign showed that coating painting could be a feasible option to prevent the spread of highly contaminated graphite dusts during decommissioning of graphite components of nuclear reactors, thus ensuring clean and safe working conditions

Comparison of Intralesional Hyaluronic Acid vs. Verapamil for the Treatment of Acute Phase Peyronie's Disease: A Prospective, Open-Label Non-Randomized Clinical Study

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dosimetry methods in boron neutron capture therapy

Dosimetry studies have been carried out at thermal and epithermal columns of LVR- 15 research reactor for investigating the spatial distribution of gamma dose, fast neutron dose and thermal neutron fluence. Two different dosimetry methods, both based on solid state detectors, have been studied and applied and the accuracy and consistency of the results have been inspected. One method is based on Fricke gel dosimeters that are dilute water solutions and have good tissue equivalence for neutrons and also for all the secondary radiations produced by neutron interactions in tissue or water phantoms. Fricke gel dosimeters give the possibility of separating the various dose contributions, i.e. the gamma dose, the fast neutron dose and the dose due to charged particles generated during thermal neutron reactions by isotopes having high cross section, like 10B. From this last dose, thermal neutron fluence can be obtained by means of the kerma factor. The second method is based on thermoluminescence dosimeters. In particular, the developed method draw advantage from the different heights of the peaks of the glow curve of such phosphors when irradiated with photons or with thermal neutrons. The results show that satisfactory results can be obtained with simple methods, in spite of the complexity of the subject. However, the more suitable dosimeters and principally their utilization and analysis modalities are different for the various neutron beams, mainly depending on the relative intensities of the three components of the neutron field, in particular are different for thermal and epithermal columns

Tamoya haplonema (Cnidaria: Cubozoa) from uruguayan and adjacent waters: oceanographic context of new and historical findings

New records of the cubozoan jellyfish Tamoya haplonema in Uruguayan waters are reported together with historical records for the region, and associated with the oceanographic conditions at the moment of the finding. Occurrences of the species are mainly associated with positive Sea Surface Temperature Anomalies especially during summer months when the intrusion of warm oceanic waters to the Uruguayan coastline is stronger. This was particularly strong during 2012–2013, when a dry period enhanced this scenario. This species is the only cubozoan present in Uruguay, with a sporadic occurrence and so far has no appreciated negative effects on public health. However, from observed increasing frequency of positive temperature anomalies it would be reasonable to predict a future southward shift in the latitudinal distribution of T. haplonema. In this context, occurrence of this toxic species along Uruguayan coastal waters must be considered with particular attention to the potential negative impact on tourism and on general public health