Liver Transplantation for Fulminant Hepatic Failure Due to Heat Stroke: A Case Report

Heat stroke is a condition caused by an excessive increase in body temperature in a relatively short period of time, and is clinically characterized by central nervous system dysfunction, including delirium, seizures, coma, and severe hyperthermia. In this context, the resulting fulminant hepatic failure makes liver transplant the best choice when there are no guarantees of better results with conservative treatment. We present our experience in this case, possible alternative choices, and the current role of liver transplantation in the resolution of fulminant liver failure due to heat stroke. CASE REPORT: We report the case of a 32-year-old man with a history of malabsorption syndrome and unconfirmed celiac disease controlled with a gluten-free diet, who, while working on a typical summer midday in southern Spain (approximately 40°C), abruptly presented with loss of consciousness, coma, and a temperature of 42°C, as well as seizures at the initial medical assessment that subsided after the administration of diazepam. On the third day, the patient presented with multiple organ dysfunction syndrome, requiring mechanical ventilation, hemodialysis, and inotropic support. He did not improve with the support of conservative treatment, therefore it was decided to perform an urgent liver transplant, after which he recovered completely. CONCLUSIONS: Liver transplantation should be a main choice of treatment for cases in which, despite intensive medical treatment, there is still clinical and analytical evidence of massive and/or irreversible hepatocellular damage.

Remediation trials for hydrocarbon-contaminated sludge from a soil washing process: evaluation of bioremediation technologies

The usual fate of highly contaminated fine products (silt-clay fractions) from soil washing plants is disposal in a dump or thermal destruction (organic contaminants), with consequent environmental impacts. Alternative treatments for these fractions with the aim of on-site reuse are needed. Therefore, the feasibility of two technologies, slurry bioremediation and landfarming, has been studied for the treatment of sludge samples with a total petroleum hydrocarbon (TPH) content of 2243 mg/kg collected from a soil washing plant. The treatability studies were performed at the laboratory and pilot-real scales. The bioslurry assays yielded a TPH reduction efficiency of 57% and 65% in 28 days at the laboratory and pilot scale, respectively. In the landfarming assays, a TPH reduction of 85% in six months was obtained at laboratory scale and 42% in three months for the bioremediation performed in the full-scale. The efficiency of these processes was evaluated by ecotoxicity assessments. The toxic effects in the initial sludge sample were very low for most measured parameters. After the remediation treatments, a decrease in toxic effects was observed in earthworm survival and in carbon mineralisation. The results showed the applicability of two well known bioremediation technologies on these residues, this being a novelty.

Correlation between physicochemical and ecotoxicological approaches to estimate landfill leachates toxicity

Leachates from municipal solid waste (MSW) landfills may contain a huge diversity of contaminants; these wastewaters should be considered as potentially hazardous complex mixtures, representing a potential environmental risk for surface and groundwater. Current MSW landfill wastes regulatory approaches deem exclusively on the physicochemical characterization and does not contemplate the ecotoxicological assessment of landfill leachates. However, the presence of highly toxic substances in consumer products requires reconsideration on the need of more specific ecotoxicological assessments. The main aim of this study was to evaluate the toxicity of different MSW landfill leachates using a battery of toxicity tests including acute toxicity tests with Daphnia magna and the anuran Xenopus laevis and the in vitro toxicity test with the fish cell line RTG-2. The additional objective was to study the possible correlation between physicochemical properties and the toxicity results obtained for untreated landfill leachates. The results showed that the proposed test battery was effective for the ecotoxicological characterization of MSW landfill leachates. A moderate to strong correlation between the measured physicochemical parameters and the calculated toxicity units was detected for all toxicity assays. Correlation factors of 0.85, 0.86 and 0.55 for Daphnia, Xenopus and RTG-2 tests, respectively, were found. The discriminant analysis showed that certain physicochemical parameters could be used for an initial categorization of the potential aquatic acute toxicity of leachates; this finding may facilitate leachates management as the physicochemical characterization is currently the most common or even only monitoring method employed in a large majority of landfills. Ammonia, alkalinity and chemical oxygen demand (COD), together with chloride, allowed a proper categorization of leachates toxicity for up to 75% of tested samples, with a small percentage of false negatives.

A cost/effective screening method for assessing the toxicity of nutrient rich effluents to algae

Screening whole effluent toxicity tests are cost/effective methods for detecting the presence of toxic concentrations of unknown pollutants, but the application must solve the problem associated with the effect of high and variable concentrations of nutrients in the effluent on the results of algal toxicity tests. This work proposes a cost/effective test, based on three dilution levels measured at a single point time and a discriminant model for establishing if this kind of complex samples, with difficult interpretation of dilution-response curves, should be considered toxic to algae. This procedure identified properly around 85% of the samples considered toxic by expert judgement.

Occurrence of pharmaceutically active compounds in surface waters of the Henares-Jarama-Tajo River system (Madrid, Spain) and a potential risk characterization

The Henares-Jarama-Tajo river system is the largest drainage basin in the Province of Madrid, Spain. This area is characterized by the presence of intensive urban and industrial activities influenced by a continental Mediterranean climate with rainfalls presenting substantial fluctuations along the different seasons. This research aimed to monitor seasonal variations in concentrations of 22 pharmaceutically active compounds (PhACs) in this river system and to establish the potential risk of sublethal effects on aquatic organisms. A total of 10 sampling sites were selected along the river system with samples collected in each of the four seasons during a year-round schedule. Most of the PhACs detected were present in sampling sites downstream in the vicinity of the most populated cities (i.e. Madrid, Guadalajara and Alcalá de Henares). Only two PhACs, fluoxetine and paraxantine, were detected in all sites regardless of the season, and showed median (+/- interquartile range) concentrations of 21.4 (+/-31.2) ng L(-1) and 8.5 (+/-5.3) ng L(-1), respectively. Other PhACs were detected with a frequency >80% and included, caffeine, diphenylhydantoin, hydrochlorotiazide, ibuprofen, ketoprofen, diclofenac, sulfamethoxazole, atenolol, naproxen, carbamazepine and propanolol. Seasonal variations were observed with the highest concentrations in December and the lowest in September. By combining measured environmental concentrations with toxicity data (either publicly available or obtained experimentally in our laboratory), and by calculating an Maximum Risk Index (MaxRI) that each combination of PhACs should have for non exceeding the risk threshold, a high potential for long-term risk (MaxRI<10) was estimated for most of the sampling sites and sampling dates. This research allowed the characterization of the potential risk for each of the PhACs to exert sublethal effects on aquatic organisms using acute screening methods, justifying the need for chronic data in order to refine the risk of these compounds to aquatic organisms.

A new method for total mercury and methyl mercury analysis in muscle of seawater fish

In this work we have developed a cost-effective method for the analysis of methyl mercury (MeHg) in seawater fish muscle. The novelty of this method lies in the use of microwave-assisted extraction with acidic solution (HCl), addition of toluene, and subsequent extraction with cysteine acetate solution where only MeHg is present because of its affinity for cysteine groups. MeHg in cysteine phase and total mercury in the homogenate muscle tissue were determined using a direct Hg analyzer (DMA-80). Validation, precision, and accuracy of the method were evaluated and monitored with a tuna fish certified reference material (CRM 463) containing MeHg.

Sewage sludge applied to agricultural soil: Ecotoxicological effects on representative soil organisms

Application of sewage sludge to agricultural lands is a current practice in EU. European legislation permits its use when concentrations of metals in soil do not increase above the maximum permissible limits. In order to assess the fate and the effects on representative soil organisms of sewage sludge amendments on agricultural lands, a soil microcosm (multi-species soil system-MS3) experiment was performed. The MS3 columns were filled with spiked soil at three different doses: 30, 60 and 120tha(-1) fresh wt. Seed plants (Triticum aestivum, Vicia sativa and Brassica rapa) and earthworms (Eisenia fetida) were introduced into the systems. After a 21-d exposure period, a statistically significant increase for Cd, Cu, Zn and Hg concentrations was found for the soils treated with the highest application rate. Dose-related increase was observed for nickel concentrations in leachates. Plants and earthworm metal body burden offer much more information than metal concentrations and help to understand the potential for metal accumulation. Bioaccumulation factor (BAF(plant-soil)) presented a different behavior among species and large differences for BAF(earthworm-soil), from control or sewage-amended soil, for Cd and Hg were found. B. rapa seed germination was reduced. Statistically significant decrease in fresh biomass was observed for T. aestivum and V. sativa at the highest application rate, whereas B. rapa biomass decreased at any application rate. Enzymatic activities (dehydrogenase and phosphatase) as well as respiration rate on soil microorganisms were enlarged.

Ecotoxicological assessment of doxycycline in aged pig manure using multispecies soil systems

This paper assesses the ecotoxicity of the antibiotic doxycycline in aged spiked pig manure using a multispecies soil system (MS 3) covering plants, earthworms and soil microorganisms. The study reproduced realistic exposure conditions, as well as higher exposure doses covering the uncertainty factors typically employed for covering interspecies variability. MS 3, consisting of columns of natural sieved soil assembled with earthworms and seeds from three plant species, were employed. Pig manure was spiked with doxycycline (75 or 7500 microg/ml), aged for 15 days under aerobic/anaerobic conditions and added on top of the soil columns (120 ml/column, equivalent to 220 kgN/ha). Water and doxycycline free manure were used as negative controls. Doxycycline (7500 microg/ml) solution was used as a positive control. No effects on plants or earthworms were observed. Significant effects on soil phosphatase activity, indicating effects on soil microorganisms, were observed at the highest exposure dose, affecting all soil layers in the doxycycline-solution-treated MS 3 (positive control) but only the top layer in the spiked pig manure system. Chemical analysis confirmed the different behavior of doxycycline in both systems (with and without manure) and those effects were observed in soil with measured concentrations over 1 mg/kg soil. The detection of doxycycline in leachates revealed a potential mobility. Leachate concentrations were similar for doxycycline solution and spiked manure treatments.

Modelling the absorption and desorption of cadmium on paper pulp using kinetic approaches

The presence of toxic metals on paper pulp and the migration of these metals to food from the food package is receiving significant attention. The final exposure levels for consumers depend on two main processes. First the potential of metals to bind paper pulp during manufacture. Second, the metal potential to migrate from paper to food during storage and use. Binding and unbinding processes are modelled for cadmium kinetics through kinetic approaches. The cadmium concentration in paper pulp is estimated from the cadmium concentration in the water-pulp liquor during manufacture, the temperature, and contact time. Two food simulants have been employed for desorption studies, water and acetic solution (3%, w/w). As expected, under acidic conditions desorption is total and rapid (close to 100% desorption reached in a few minutes). However, the desorption of cadmium into the neutral food simulant depends on the initial cadmium concentration in the paper pulp, temperature and contact time. Surface response curves for each combination are presented. Temperature did not affect cadmium binding, but played a significant role for the desorption processes into the neutral food simulant. The proposed equations offer a good fitting of the experimental values, with p < 0.001 and residuals within a factor of 3 for over 99% of the measured data. These models allow estimations of the expected exposure levels in consumers, on the basis of manufacture and use conditions. Linking the expected exposure with toxicity thresholds, such as the admissible daily intake (ADI), would allow a scientific assessment of the maximum acceptable cadmium levels in water-pulp liquors during manufacture and in the final paper pulp on the basic of the use patterns of each food packaging material.

Binding of cadmium on raw paper pulp. Relationship between temperature and sorption kinetics

Several assays have been carried out in order to study in detail the cadmium mobility from water to virgin pulp as previous step of cadmium mobility description from paper into food. Virgin pulp has been immersed in different concentration aqueous solutions at several temperatures and during short and long time. The absorbed cadmium amounts have been measured by atomic absorption spectroscopy. For a long time, the temperature of storage is not an important factor except during the first 3 h. In general, percentage of migrated cadmium into pulp is between 30% and 90% of initial charge. Kinetic equation of cadmium mobility has been described employing statistics methods with a very good correlation.

Toxicological characterisation of sludge from sewage treatment plants using toxicity identification evaluation protocols based on in vitro toxicity tests

The ecotoxicological characterisation of complex mixtures, such as sludge from sewage treatment plants, is complex. Toxicity identification evaluation (TIE) protocols, developed by the United States Environmental Protection Agency (US EPA); to identify toxic pollutants in complex effluents, are useful tools in this context; to solve the difficulties in assessing unknown organic pollutants by analytical methods, the usefulness of bioassays to detect the relevant (toxic) organic compounds present in complex samples, and the possibilities of in vitro cytotoxicity tests as screening tools, offers a profitable combination. The sludge obtained from a sewage treatment plant was extracted by acetonitrile using a microwave extractor and fractionated in an HPLC system. The toxicity of every fraction was assayed using a RTG-2 cytotoxicty test, based on the fibroblastic RTG-2 fish cell line (ATCC, CCL N. 55). At exponential growth, three endpoints, beta-galactosidase activity, culture viability assayed by the neutral red assay (NR) and inhibition of growth rate using the FRAME KB protein assay (KBP), were used. By plotting the toxicity of each fraction vs elution time, the corresponding "toxicograms" were built. The UV and fluorescence chromatograms are compared to the three toxicograms (one for each toxicity endpoint).

Rapid and cost-effective multiparameter toxicity tests for soil microorganisms

Three biochemical parameters, DNA quantification in soil samples and two enzymatic activities, beta-galactosidase and dehydrogenase have been assessed as potential end-points for the use in cost-effective toxicity tests on soil microorganisms. The assessment included the development of a classical dose-response 24-h assay and the incorporation of measurements of the effects on microbial activities in soil column leaching studies and multispecies miniaturised terrestrial systems (MTS). Four different chemicals, copper, a new herbicide, thiabendazole and fenthion were studied. A rapid fluorescence DNA quantification technique did not produce adequate responses. The efforts to quantify DNA after extraction and clean-up procedures failed due to the presence of humic acids. From the protocol of the technique one could see that the technical procedure is time-consuming and expensive and, for this reason, not suitable for use as a parameter in rapid and cost-effective tests. However, the enzymatic activities showed their potential as toxicity end-points. Copper produced a concentration/response inhibition of beta-galactosidase and dehydrogenase with EC50 values of 78.39 and 24.77 mg Cu/kg soil, respectively. In the soil column study, these endpoints allowed the measurement of the microbial activities through the column. The effects of the new herbicide on beta-galactosidase and dehydrogenase activities were statistically significant for the highest application dose (40 g/ha). Thiabendazole affected the microbial activity when mixed within the soil, but no effects were observed when this fungicide was applied on the soil surface. Fenthion produced effects when applied either in the soil or on the soil surface. These results can be explained by the low mobility of thiabendazole. The results show the capabilities of these biochemical parameters to be included as endpoints in cost-effective bioassays.

Ecological risk assessment of pesticides in the Mediterranean region. The need for crop-specific scenarios

The risk assessment procedures of pesticides in the European Union are mostly based on worst-case scenarios developed for central and northern European conditions. From the point of view of Mediterranean conditions, these assessment procedures are not always appropriate, and therefore the development of specific scenarios is required. There are differences not only in meteorological data (temperature, solar irradiation, or rainfall volume and annual distribution) between these countries, but also in farm distribution, crop characteristics, soil or sediment properties and surface or groundwater characteristics. These differences are more evident for the typical crops of the southern countries, such as olive groves, vineyards, citrus or rice fields, and in these cases more realistic estimates of exposure are required. Our proposal includes the development of new criteria to improve the ecological risk assessment process for the conditions of the Mediterranean region, and the justification of this need.

Assessing the potential hazard of chemical substances for the terrestrial environment. Development of hazard classification criteria and quantitative environmental indicators

Hazard assessment constitutes an essential tool in order to evaluate the potential effects of chemical substances on organisms and ecosystems. It includes as a first step, hazard identification, which must detect the potential dangers of the substance (i.e. the kind of effects that the substance may produce), and a second step to quantify each danger and to set the expected dose/response relationships. Hazard assessment plays a key role in the regulation of chemical substances, including pollution control and sustainable development. However, the aquatic environment has largely received more attention than terrestrial ecosystems. This paper presents the extrapolation of several basic concepts from the aquatic to the terrestrial compartment, and suggests possibilities for their regulatory use. Two specific proposals are discussed. The first focuses on the scientific basis of the hazard identification-classification criteria included in the EU regulations and their extrapolation to the terrestrial environment. The second focuses on the OECD programme for environmental indicators and the development of a soil pollution pressure indicator to quantify the potential hazards for the soil compartment and its associated terrestrial ecosystem related to the toxic chemicals applied deliberately (i.e. pesticides) or not (i.e. heavy metals in sludge-based fertilisers; industrial spills) to the soil.

A system dynamic model for the assessment of different exposure routes in aquatic ecosystems

With the exception of a limited number of highly persistent lipophilic pollutants, waterborne exposure is considered the most relevant exposure route for aquatic organisms, and even the only relevant exposure route in lower tier assessment, while the potential for bioaccumulation is only evaluated as secondary poisoning for birds and mammals. In addition, some evaluations consider that only the dissolved fraction is bioavailable for pelagic organisms. The lack of easy and cost-effective assessment methods is probably the main reason to disregard the contribution of other routes. This paper presents a system dynamics model that estimates the time-dependent accumulation of toxic chemicals through the food chain, and has also the potential to include the exposure from sediment. The generic ecosystem includes a primary producer and three levels of consumers, represented by unicellular algae, cladoceran invertebrates, cladoceran-eating fish and fish-eating fish, respectively. Nevertheless, the model, built using Microsoft Excel software, allows any number of levels and ecological-exposure relationships. The results obtained for four illustrative pollutants demonstrate that factors such as the binding to algae and other edible particles or food chain exposure for lipophilic non-persistent chemicals may constitute significant exposure routes. The current low tier European ecological risk assessment guidelines do not cover these aspects, and therefore may under estimate the real risk for both aquatic organisms and their predators. The model includes a simplified worst-case alternative that normally can be calculated using the existing information. Under a tiered approach, the simplified alternative is proposed to trigger the need of the toxicokinetics assays required to perform the complete time-dependent calculation.

Sublethal effects of repeated intraperitoneal cadmium injections on rainbow trout (Oncorhynchus mykiss)

Acute and chronic effects of cadmium have been widely described for different aquatic organisms and exposure routes. However, there is clearly a lack of information on the potential of cadmium to cause genotoxic effects. This work presents genotoxic and nongenotoxic parameters analyzed in cadmium-exposed rainbow trout. The assessment was performed for sublethal levels after long-term exposure using six intraperitoneal injections of 0.5 mg/kg (Day 1), 1 mg/kg (Days 3, 7 and 11), and 2 mg/kg (Days 15 and 19) to allow precise estimation of the dose. Cadmium accumulation in target tissues, essential metal mobilization by cadmium at the subcellular and tissue levels, and induction of metallothioneins were selected as exposure and effect parameters. Induction of micronuclei and variation in DNA content (expressed as variation coefficient in the G1 phase of the cell cycle) in blood cells, determined by flow cytometry, were selected as biomarkers for genotoxic effects. Cadmium accumulation, induction of metallothioneins, and mobilization of essential metals at the subcellular level were observed in different organs in response to cadmium exposure. The highest metallothionein induction was observed in liver, reaching 270+/-90 nmol/g wet tissue in treated fish versus 2.68+/-1.1 nmol/g wet tissue in controls. The highest cadmium accumulation was also observed in the liver (27.8+/-9.5 microgram Cd/g wet wt in treated animals versus 1.0+/-1.7 in the control group). However, no genotoxic effects were observed in blood cells. The frequency of micronuclei was 0.012+/-0.008 for the control group and 0.013+/-0.021 for treated animals. The variation coefficient of G1-phase nuclei was 3.61+/-0.66 and 3.22+/-0.29 for control and cadmium-exposed groups, respectively. Thus, it is concluded that under the experimental conditions employed here, treatment of rainbow trout with cadmium chloride at doses that produce significant toxicological alterations at the tissue and subcellular levels does not provoke observable alterations in the genotoxic parameters considered in this study.

Toxicity identification evaluations for the investigation of fish kills: a case study

A large fish-kill was observed in the river Tajo during the Spring-Summer of 1991. The mortality was first detected between Aranjuez and Toledo, affecting several fish species. Then it was slowly going downstream, affecting only carp (Cyprinus carpio), reaching the Spanish-Portuguese border several months later. Short-term toxicity tests on Daphnia magna and in vitro cytotoxicity tests on RTG-2 cells were used as toxicity monitoring systems in water samples and different water fractions. The fish kill was associated to the outbreak of infectious diseases, spring viremia of carp and saprolegniosis, related to an increase in the fish's susceptibility due to the presence of a toxic chemical. Bioassay-directed sample fractionations allowed to detect a toxic chemical. HPLC-MS identified the compound as dehydroabietic acid, a resin acid previously described immunotoxic.

[Induction of components of the natural precipitation system (GANS) and another antibody after alloimmunization with serum or egg yolk in fowl]

Detailed analysis was performed in 17 selected serums obtained through alloimmunization of 64 receptors (cocks and hens, WP X RIR hybrids) of type 0 in the GANS system. The serum or egg yolk from hens of type A or B in the GANS system, used for immunization, was applied in five intramuscular injections with or without using Freund's complete adjuvant. It was found out that substance A GANS was present in 16 serums of the total number of those which were examined, so that in the receptors the application of serum or yolk changed the type of the GANS system from original 0 into type A, irrespective of the type of donor. Further, seven serums were found to contain another antibody, reacting in precipitation with the serum fraction which is only present in laying hens and probably has not the character of an allotype.