Surgical Approach of Synchronous Medullary Thyroid Carcinoma and Pheochromocytoma in MEN 2 Syndrome

In cases with concurrent medullary thyroid carcinoma (MTC) and pheochromocytoma, discussion regarding a one-stage versus two-stage treatment strategy approach remains open. From 1975 to 1990, 11 of 25 multiple endocrine neoplasia type 2 (MEN 2) patients presented with biendocrinopathies or triendocrinopathies synchronously. All patients were treated surgically and followed subsequently in our hospital. Of the group of nine patients with concurrent MTC and pheochromocytoma, five were treated in one-stage and four in two-stage procedures. No patient had major complications intraoperatively. For the two-stage group, the total hospital stay (preoperatively and postoperatively) averaged 35 days. For the one-stage group, the total hospital stay averaged 25 days. In patients with increased operative risks (patients with higher age and impaired physical condition or if neck surgery includes transstemal cervicomediastinal lymphadenectomy), two-stage procedures should be selected. However, in young patients with the MEN 2 syndrome or syndromes with small tumors detected by family screening, thyroidectomy, cervical lymphadenectomy, and adrenalectomy may be performed in a one-stage procedure without increasing surgically related morbidity

Integrative taxonomy clarifies the evolution of a cryptic primate clade

Global biodiversity is under accelerating threats, and species are succumbing to extinction before being described. Madagascar’s biota represents an extreme example of this scenario, with the added complication that much of its endemic biodiversity is cryptic. Here we illustrate best practices for clarifying cryptic diversification processes by presenting an integrative framework that leverages multiple lines of evidence and taxon-informed cut-offs for species delimitation, while placing special emphasis on identifying patterns of isolation by distance. We systematically apply this framework to an entire taxonomically controversial primate clade, the mouse lemurs (genus Microcebus, family Cheirogaleidae). We demonstrate that species diversity has been overestimated primarily due to the interpretation of geographic variation as speciation, potentially biasing inference of the underlying processes of evolutionary diversification. Following a revised classification, we find that crypsis within the genus is best explained by a model of morphological stasis imposed by stabilizing selection and a neutral process of niche diversification. Finally, by clarifying species limits and defining evolutionarily significant units, we provide new conservation priorities, bridging fundamental and applied objectives in a generalizable framework

Access and allocation in earth system governance: Water and climate change compared

A significant percentage of the global population does not yet have access to safe drinking water, sufficient food or energy to live in dignity. There is a continuous struggle to allocate the earth's resources among users and uses. This article argues that distributional problems have two faces: access to basic resources or ecospace; and, the allocation of environmental resources, risks, burdens, and responsibilities for causing problems. Furthermore, addressing problems of access and allocation often requires access to social processes (science, movements and law). Analysts, however, have tended to take a narrow, disciplinary approach although an integrated conceptual approach may yield better answers. This article proposes a multi-disciplinary perspective to the problem of access and allocation and illustrates its application to water management and climate change. © The Author(s) 2010

Institutional arrangements for land drainage in developing countries

The literature review on "Institutional arrangements for land drainage in developing countries" provides an overview over irrigation and drainage development, drainage problems and, in particular, displays the institutional arrangements in selected countries (Egypt, India, Peru, the Philippines and South Africa). India, the Philippines and South Africa are countries where IWMI is interested in carrying out research on the relationship between the effectiveness of institutions and performance; Egypt has developed institutions capable of addressing drainage needs; Peru is in the process of establishing Autonomous Hydrological Basin Authorities for catchment-wide management of water resources including drainage

Australian examples of residential integrated water cycle planning: accepted current practice and a suggested alternative

Australian examples of Integrated Water Cycle Planning (IWCP) for residential development demonstrate that providing multiple household-water connections is a generally accepted practice. These connections typically include a potable mains supply, a separate non-potable supply utilising reclaimed water and/or a household roofwater tank for non-potable uses. Stormwater is not fully exploited as a potential urban water source. The advent of national guidelines for using recycled water for drinking purposes is expected to simplify IWCP towards a single-line household-water supply reclaimed from a range of different sources. An IWCP approach is suggested in this paper based on a single household supply complemented by: 1) potential separation of blackwater to reduce human health risk and to enhance community acceptance of recycled water, 2) the use of water sensitive urban design requirements of storing and slowly releasing urban stormwater, and 3) taking advantage of economies of scale by integrating communal roofwater tanks into the urban stormwater system