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Thorium concentrations at Kirtland Air Force Base training sites in Albuquerque, NM, have been previously described; however, the mechanisms of thorium migration were not fully understood. This work describes the processes affecting thorium mobility in this semiarid soil, which has implications for future remedial action. Aqueous extraction and filtration experiments have demonstrated the colloidal nature of thorium in the soil, due in part to the low solubility of thorium oxide. Colloidal material was defined as that removed by a 0.22-microm or smaller filter after being filtered to nominally dissolved size (0.45 microm). Additionally, association of thorium with natural organic matter is suggested by micro- and ultrafiltration methods, and electrokinetic data, which indicate thorium migration as a negatively charged particle or anionic complex with organic matter. Soil fractionation and digestion experiments show a bimodal distribution of thorium in the largest and smallest size fractions, most likely associated with detrital plant material and inorganic oxide particles, respectively. Plant uptake studies suggest this could also be a mode of thorium migration as plants grown in thorium-containing soil had a higher thorium concentration than those in control soils. Soil erosion laboratory experiments with wind and surface water overflow were performed to determine bulk soil material movement as a possible mechanism of mobility. Information from these experiments is being used to determine viable soil stabilization techniques at the site to maintain a usable training facility with minimal environmental impact.

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OBJECTIVES: The benefit of antibiotic prophylaxis in percutaneous endoscopic gastrostomy is controversial. The aim of this study is to determine whether prophylactic antibiotic treatment with Cefazolin reduces the incidence of peristomal infection after percutaneous endoscopic gastrostomy. METHODS: Of the 131 hospitalized or nursing home patients referred for percutaneous endoscopic gastrostomy, 115 were enrolled in a prospective randomized double-blind placebo controlled trial. Sixty-one (group 1) were randomized in a double-blind fashion and received either Cefazolin or saline pregastrostomy. Fifty-four patients (group 2) were on antibiotics for prior medical indications pregastrostomy. Patients had their peristomal area evaluated on a daily basis for 1 wk after gastrostomy. Erythema and exudate were scored on a scale from 0 to 4; induration was scored on a scale of 0 to 3; a maximum score of 8 or higher or the presence of pus was criteria for infection. RESULTS: Wound infection occurred in 4 of 30 (13%) participants receiving Cefazolin and in 6 of 31 (19%) participants receiving saline (p > 0.5). In the 54 patients on antibiotics for prior indications, wound infection was observed in 2 subjects (3%). This finding was a significant difference when compared with the placebo group (p < 0.02). CONCLUSIONS: A single dose of Cefazolin prophylaxis does not reduce the overall peristomal wound infection in percutaneous endoscopic gastrostomy. Patients receiving prior extended antibiotic therapy have fewer peristomal wound infections.

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Bile peritonitis (BP) is a rare but acute and serious condition that may be associated with high mortality. BP results from generalized or localized leakage of bile into the peritoneal cavity. At best, radiologic studies may be suggestive of BP. We observed a spectrum of cytologic findings in aspirated peritoneal fluids (PF) from 3 patients with BP. Occasional bile pigment-laden macrophages, extracellular lakes of green stringy material admixed with variable numbers of histiocytes, mesothelial cells, and acute and chronic inflammatory cells, were seen. Numerous candida were present in one case. To the best of our knowledge, this is the first report describing the cytologic features of BP. Cytology is a simple, rapid, and cost-effective means of examining PF, and can therefore play a significant role in establishing the diagnosis of BP. Early recognition of BP can result in rapid, therapeutic intervention that may prevent significant morbidity and mortality.

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Hepatorenal syndrome (HRS), a functional renal failure associated with severe liver disease, is believed to result from diminished effective arterial volume and altered renal hemodynamics. Death is almost inevitable after its development and therapeutic options are limited. Surgical shunts carry an increase in morbidity and mortality, and peritoneovenous shunts are frequently complicated by infection and coagulopathy. We report a case of hepatorenal syndrome successfully treated with transjugular intrahepatic portosystemic shunt (TIPS). This is an unusual therapeutic option for HRS and may lead to future indications for TIPS.

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Omeprazole is a new hydrogen-potassium adenosine triphosphatase antagonist with indications for severe reflux esophagitis and Zollinger-Ellison syndrome. Side effects involving the liver have consisted of minimal elevations of hepatocellular enzymes with higher dosages. We present what we believe is the first reported case of fulminant hepatic failure related to omeprazole.

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