Combating cyanobacterial proliferation by avoiding or treating inflows with high P load—experiences from eight case studies

Increased external nutrient loads of anthropogenic origin, especially those of phosphorus (P), were one of the major causes of eutrophication during the first half of the twentieth century in Europe. They led to deterioration of lake ecosystems, particularly including noxious blooms of (potentially toxic) cyanobacteria. From the 1970–1980s, strategies to decrease the phosphorus loads from sewage were increasingly implemented, among them are the ban of phosphates in detergents, the expansion of sewer systems and improvement in wastewater treatment to remove nutrients. Case studies of eight lakes, whose response to point source reduction of phosphorus was observed over decades, show that a pronounced reduction of the phosphorus load from point sources can be achieved either by the diversion of inflows carrying high loads, by upgraded sewage treatment, or by phosphorus precipitation in the major tributary directly before its inflow into the water body. Outcomes demonstrate that in order to effectively control cyanobacterial blooms, the measures taken need to reduce in-lake concentrations of total phosphorus below 20–50 µg L−1, with this threshold varying somewhat between lakes depending in particular on hydromorphological and biological conditions. Whether and when load reduction succeeds in controlling cyanobacteria depends primarily on the load remaining after remediation and on the water residence time

Renal cancer and pneumothorax risk in Birt-Hogg-Dubé syndrome; an analysis of 115 FLCN mutation carriers from 35 BHD families

Background: Birt-Hogg-Dubé (BHD) syndrome is an autosomal dominant condition caused by germline FLCN mutations, and characterised by fibrofolliculomas, pneumothorax and renal cancer. The renal cancer risk, cancer phenotype and pneumothorax risk of BHD have not yet been fully clarified. The main focus of this study was to assess the risk of renal cancer, the histological subtypes of renal tumours and the pneumothorax risk in BHD. Methods: In this study we present the clinical data of 115 FLCN mutation carriers from 35 BHD families. Results: Among 14 FLCN mutation carriers who developed renal cancer 7 were <50 years at onset and/or had multifocal/bilateral tumours. Five symptomatic patients developed metastatic disease. Two early-stage cases were diagnosed by surveillance. The majority of tumours showed characteristics of both eosinophilic variants of clear cell and chromophobe carcinoma. The estimated penetrance for renal cancer and pneumothorax was 16% (95% minimal confidence interval: 6-26%) and 29% (95% minimal confidence interval: 9-49%) at 70 years of age, respectively. The most frequent diagnosis in families without identified FLCN mutations was familial multiple discoid fibromas. Conclusion: We confirmed a high yield of FLCN mutations in clinically defined BHD families, we found a substantially increased lifetime risk of renal cancer of 16% for FLCN mutation carriers. The tumours were metastatic in 5 out of 14 patients and tumour histology was not specific for BHD. We found a pneumothorax risk of 29%. We discuss the implications of our findings for diagnosis and management of BHD

Crioablación laparoscópica de las pequeñas masas renales

To review the current status of cryoablation of small renal masses and to preliminary report our experience at the AMC. Material and methods: A bibliographic search was conducted (PubMed/Medline/Embase) and the most important series were analyzed. Our series includes 13 patients with a solitary small renal mass treated by Laparoscopic assisted Cryoblation with fine cryoprobes (1,5 cm diameter). Postoperative follow-up was done by means of CT and/or MRI every three months during the first year and every 6 months during the second year. Results: There are no randomized trials comparing Cryoblation of renal masses

Crioablación laparoscópica de las pequeñas masas renales

To review the current status of cryoablation of small renal masses and to preliminary report our experience at the AMC. Material and methods: A bibliographic search was conducted (PubMed/Medline/Embase) and the most important series were analyzed. Our series includes 13 patients with a solitary small renal mass treated by Laparoscopic assisted Cryoblation with fine cryoprobes (1,5 cm diameter). Postoperative follow-up was done by means of CT and/or MRI every three months during the first year and every 6 months during the second year. Results: There are no randomized trials comparing Cryoblation of renal masses

Nephron-sparing surgery and percutaneous biopsies in renal-cell carcinoma : a global impression among endourologists

Background and Purpose: On the one hand, nephron-sparing surgery (NSS) in small renal tumors is a safe and effective alternative to radical nephrectomy. On the other hand, the role of preoperative percutaneous needle biopsies (PNB) remains controversial. The purpose of this study was to evaluate the global current use of NSS in the treatment of renal-cell carcinoma (RCC) and the use of PNB among endourologists. Materials and Methods: One thousand questionnaires were distributed during the 23rd World Congress of Endourology and SWL. Six questions regarding NSS and two questions regarding PNB were presented. Two hundred twenty-two questionnaires were returned. Results: Of the respondents, 86.6% perform NSS for small renal tumors, whereas 13.4% perform only radical nephrectomies; 7.5% will consider NSS only in patients with a solitary kidney, and 0.5% will never consider NSS. The techniques for NSS, in descending order of preference, are partial nephrectomy, enucleation, cryoablation, radiofrequency ablation, and high-intensity focused ultrasound. The mean and maximum diameter of the tumor in patients with a normal contralateral kidney for which the urologists perform NSS is 4.0 cm. For a centrally located tumor, NSS is an option for 27.2% of the respondents. Regarding PNB in patients with suspicion of RCC, 55.9% of respondents never obtain renal biopsies in the preoperative assessment and 41.8% obtain them only in rare cases. The majority (90%) prefer histologic over cytologic biopsies. Conclusions: Nephron-sparing surgery is evolving to a global worldwide standard treatment for small renal tumors. Percutaneous needle biopsy remains a highly debated procedure