Positive prostate biopsy following radiotherapy can predict metastasis-free survival in localized prostate cancer.

BACKGROUND/AIMS: To determine the impact of post-treatment biopsy results on 10-year metastasis-free survival (MFS), overall survival (OS) and cause-specific survival (CSS) in localized prostate cancer (PCa) patients treated with high-dose radiotherapy (RT). MATERIALS/METHODS: Retrospective analysis of 232 patients with T1c-T3bN0M0 PCa who underwent a prostate biopsy 24-36 months after high-dose RT. Biopsies were categorized as positive biopsy (PB) if H&E staining showed evidence of residual malignancy and negative biopsy (NB) if no malignant cells were present. Kaplan-Meier estimates of 10-year MFS, OS and CSS rates were calculated for each group and Cox proportional-hazards models were used to estimate the hazard ratios. The median follow-up was 124 months (range 26-267). RESULTS: Sixty-two of 232 (26.7%) patients had post-treatment positive biopsies (PB). A positive post-treatment biopsy was significantly associated with a lower 10-year MFS (78.4% vs. 95.4%, p = 0.001, HR: 3.9, 95% CI: 1.8-8.3). Although patients with PB had worse outcomes that those with NB, we could not show a statistically significant difference in OS (81.0% vs. 87.9%, p = 0.282, HR: 1.3, 95% CI: 0.7-2.3) or CSS (96.2% vs. 99.4% (p = 0.201, HR. 2.4, 95% CI: 0.6-9.7). After multivariate analysis, the strongest predictor of MFS was the post-treatment biopsy status (p < 0.001, HR: 5.4, 95% CI 2.26-12.85) followed by Gleason score (p = 0.002, HR: 2.24, 95% CI 1.33-3.79). CONCLUSION: A positive biopsy following RT can predict MFS in localized prostate cancer. These data highlight the relevance of achieving a local control and support the use of aggressive local therapeutic interventions for PCa.

Immune-related adverse events predict the therapeutic efficacy of anti-PD-1 antibodies in cancer patients.

BACKGROUND: Cancer immune therapy has shown remarkable benefit in the treatment of a range of cancer types, although it may initiate autoimmune-related disorders in some patients. We have attempted to establish whether the incidence of irAEs after the use of anti-PD-1 antibodies nivolumab or pembrolizumab in advanced malignancies is associated with anti-PD-1 treatment efficacy. PATIENTS AND METHODS: We studied patients treated with single-agent nivolumab or pembrolizumab for advanced cancer. irAEs (immune-related adverse events) were identified clinically and graded as per the Common Terminology Criteria for Adverse Events version 4.0. Efficacy was evaluated with objective response rate (ORR, immune-Response Evaluation Criteria in Solid Tumours [RECIST] criteria) progression-free survival (PFS) and overall survival (OS). Tests were performed to determine the association between irAEs and ORR, PFS or OS. RESULTS: We identified 106 patients. Primary diagnoses were lung cancer (n = 77), melanoma (n = 8), head and neck carcinoma (n = 7), renal carcinoma (n = 5), Hodgkin's lymphoma (n = 3), urothelial carcinoma (n = 3) and gallbladder adenocarcinoma, hepatocellular carcinoma and Merkel cell carcinoma (n = 1 each). IrAEs were observed in 40 patients (37.7%). The most frequent irAEs were hypothyroidism (n = 15), nephritis (n = 5) and hyperthyroidism (n = 4). Objective response was observed in 44 patients (41.5%), and median PFS was 5.5 months (0.5-31 months). Thirty-three of the 40 patients with irAEs had objective response (82.5%) in contrast with 11 of the 66 cases without irAEs (16.6%) (OR 23.5, P < 0.000001). PFS in patients with irAEs was 10 months and 3 months in those without irAEs (HR 2.2, P = 0.016). OS in patients with irAEs was 32 months and 22 in those without irAEs, without statistically significant differences. CONCLUSION: In advanced cancer treated with single-agent anti-PD-1 antibodies, patients with irAEs showed a markedly improved efficacy over patients without irAEs (ORR of 82.5% and PFS of 10 months vs ORR of 16.6% and PFS of 3 months). Future studies of anti-PD-1 immune-therapy should address this association to explore the underlying biological mechanisms of efficacy.

Long-term monitoring programme of polychlorinated dioxins and polychlorinated furans in ambient air of Catalonia, Spain (1994-2015).

Reductions in concentrations of persistent organic pollutants were observed for polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in a comparison of two consecutive decades ending in December 31, 2015 (n = 413) and compiled from a 48-station long-term air-monitoring network in Catalonia, Spain. Reductions were observed in geometric mean concentration of total PCDD/Fs, decreasing at a rate of 11% yr-1. Results reflect the relative success of improved pollution control measures at industry and traffic locations. At traffic and industrial locations, PCDD/Fs were reduced by around 68% (from 70 to 22 fg I-TEQ/m3) and 66% (from 57 to 19 fg I-TEQ/m3), respectively. The highest concentration of 1196 fg I-TEQ/m3 was observed during the first decade at an industrial location. The highest concentration over the second decade was at a background location during winter (674 fg I-TEQ/m3). Winter observations are generally higher than those recorded in summer, as evident in an 8-year period of moderate PCDD/F levels (<250 fg I-TEQ/m3, n = 143). PCDD/F congener profiles were identified has having less chlorinated PCDD/F, indicating the presence of nearby combustion sources at selected locations. More long-term sampling campaigns, combined with network optimization and integration into a meteorological model, can offer a tool for future PCDD/Fs control measures in not only Catalonia - but also applicable to other areas.

Coexistence of marginal zone cutaneous B-cell lymphoma and classic Hodgkin disease: does a biological relationship exist?

The coexistence of non-Hodgkin lymphoma (NHL) and Hodgkin disease (HD) in the same patient, although previously reported, is very unusual. This situation is extremely rare when the first diagnosis is a cutaneous B NHL, and exceptional if there is no personal background of cytostatic treatment. We report a 44-year-old man who developed cutaneous nodules over a period of two years. A marginal zone cutaneous B-cell lymphoma was diagnosed. On staging investigation a mass in the lingual tonsil was found and excision biopsy showed a classical Hodgkin lymphoma.

Analytical approach and occurrence for the determination of mass concentration of PCDD/PCDF and dl-PCB in flue gas emissions using long-term sampling devices.

In this work, a reliable methodology for the simultaneous analysis of PCDD/PCDF and dioxin-like PCB (dl-PCB) in flue gas emissions collected using continuous sampling devices is proposed. The analytical scheme followed the minimum requirements described in the EU standard EN-1948:1,2,3,4 according to samples containing large amounts of dioxins and dl-PCBs or samples collected over a long period of time of about 4 weeks. Parameters, such as reproducibility, precision, limits of detection (LOD), limits of quantification (LOQ), extract aliquot size, analytical blanks, extraction efficiency, as well as the amount of internal standards required for an accurate determination, were assessed. The findings demonstrate the suitability of the proposed analytical scheme for the analysis of PCDD/PCDF and PCB in samples collected using long-term sampling devices. The analysis of five different 5% v/v sample aliquots reported %RSD values lower than 10% for all of the 29 congeners at both low and high levels. Similarly, %RSD values were 3.2 and 2.0 for the low level samples and 0.9 and 1.1%RSD for the high level extracts for PCDD/PCDF and dl-PCB, respectively expressed in total TEQ units. Re-extraction provided values less than 3%, expressed in TEQ. Based on blank analyses, LOD values of 100 pg I-TEQ for PCDD/PCDF and 10 pg WHO-TEQ for dl-PCB were achieved when 5% v/v aliquots were analyzed. Finally, the proposed analytical approach was tested with samples from a wide range of combustion processes such as hazardous and municipal waste incinerators, as well as cement kilns (with and without waste co-incineration).

Assessment of polychlorinated dibenzo-p-dioxin and dibenzofuran emissions from a hazardous waste incineration plant using long-term sampling equipment.

The aim of this work is to evaluate the performance of a continuous monitoring system for the analysis of the mass concentration of PCDD/Fs from stationary sources. Data was acquired from a modern, state of the art, hazardous waste thermal treatment plant for a period of more than 2 years using a commercial available continuous monitoring system. The study consisted of a total of 16 samples, collected in periods from 1 week to 2 months resulting in an average of 360 m³ sampled flue gas per sample. The study showed the system was able to confirm that for a period of more than 2 years the plant was complying with the limit of 0.1 ng I-TEQ/Nm(3). In addition, the data showed the typical fingerprint of such installations which is useful for example in impact studies. Long-term samples were compared to five short-term samples (6 h) collected every 6 months during the study period. Principal component analysis was applied to PCDD/Fs obtained data as useful statistical tool to find out trends and similarities between different samples. Improvement in terms of representativeness of data was achieved through continuous assessment since the starts of the project. The obtained data was further used to determine the emission factor for this activity and the total annual PCDD/Fs release to the atmosphere.

Quantitative (1) H MR spectroscopic imaging of the prostate gland using LCModel and a dedicated basis-set: correlation with histologic findings.

Proton magnetic resonance spectroscopic imaging ((1) H-MRSI) has been advocated as a valuable tool for prostate cancer diagnosis. However, a barrier to widespread clinical use of this technique is the lack of robust quantification methods that yield reproducible results in an institution-independent manner. The main goal of this study was to develop a standardized and fully automated approach (LCModel-based) for quantitative prostate (1) H-MRSI. To this end, a dedicated basis set was constructed by the combination of simulated (citrate, Cit; choline, Cho, and creatine, CR) and experimentally acquired (spermine, Spm) spectra. The overlapping Spm, Cho, and Cr could be resolved and quantified individually, thus allowing for the independent assessment of glandular (Cit and Spm) and proliferative (Cho) components. Several metabolite ratios were calculated and compared to the histologic findings of prostatectomy specimens from 10 prostate cancer patients with Gleason scores (3 + 3) and (3 + 4). The Cho mole fraction and the Cho/(Cit + Spm) ratio were found to best discriminate between prostate cancer and healthy tissue. The comparison between the quantitative MRSI results and the histologic findings suggests that no correlation exists between the detected metabolic alterations and the Gleason score of low-grade tumors.

Tumores neuroectodérmicos primitivos periféricos de localización en el área orocervical: presentación de dos casos clínicos / Peripheral primitive neuroectodermal tumors located in orocervical area: presentation of two clinical cases

Introducción: Los tumores neuroectodérmicos primitivos (PNET, de primitive neuroectodermaltumors) son una familia de neoplasias malignas de células pequeñas y redondas, quederivan de la cresta neural. Se distinguen tres tipos: PNET del sistema nervioso central,PNET del sistema nervioso autónomo y PNET periféricos. Los más frecuentes dentro delgrupo de PNET periféricos son el neuroepitelioma periférico y el sarcoma de Ewing, que seconsideran la misma neoplasia pero con diferente grado de diferenciación.Casos clínicos: Presentamos dos casos de PNET periféricos, uno de aparición en la regióncervical y otro originado en el cóndilo mandibular.Discusión: Los PNET son neoplasias muy raras y altamente agresivas. En todos ellos aparecencélulas redondas pequeñas poco diferenciadas y una traslocación cromosómica característicadel gen EWS. En general se considera que tienen un pronóstico desfavorable.Además, la baja frecuencia de estos tumores, así como la escasez de casos publicados hacendifícil valorar el tratamiento más adecuado(AU)

Introduction: Peripheral primitive neuroectodermal tumors (PNET) are a family of smallroundcell tumors of presumed neuroectodermal origin. This broad family can besubdivided into three major groups: PNET from the central nervous system, PNET from theautonomic nervous system or peripheral PNET. Ewing’s sarcoma and peripheralneuroepitelioma, the two most frequently encountered members of the peripheral PNET family, are considered to represent a spectrum according to the extent of neuroectodermaldifferentiation, ranging from the least differentiated (Ewing’s sarcoma) to the mostdifferentiated (peripheral neuroepithelioma).Case report: We present a patient with a peripheral neuroectodermal tumor located in the neckand another one with a peripheral neuroectodermal tumor of the mandibular condyle.Discussion: Peripheral neuroectodermal tumors are a very rare and aggressive tumors. Theycharacteristically reveal the presence of small round cells and a translocation of the geneEWS. The prognosis in overall is very poor. Due to the small numbers of cases publishedthe best treatment is not well defined(AU)

Uncertainty assessment of polychlorinated dibenzo-p-dioxins and dibenzofuran and dioxin-like polychlorinated biphenyl analysis in stationary source sample emissions in accordance with the impending European standard EN-1948 using fly ashes.

The analysis of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and dioxin-like polychlorinated biphenyls (dl-PCBs) present in stack gas emissions and solid residues from incinerators will be mandatory in the foreseeable future. European standard EN-1948 is in the process of being updated through the addition of a new Part 4 related to the analysis of the 12 dl-PCBs. Therefore, either a comprehensive and reliable method capable of analyzing all of these 29 compounds (12 dl-PCBs and 17 2,3,7,8-PCDD/Fs) needs to be developed, or the existing PCDD/F analytical procedure must be adapted to include the dl-PCBs. This study has taken the latter approach of modifying PCDD/F methodology and in particular the fractionation step, by isolating dioxins and dl-PCBs into separate fractions ready for high resolution gas chromatography coupled to high resolution mass spectrometry (HRGC/HRMS) analysis. Results obtained from the analysis of Certified Reference Materials (CRM-490 and CRM-615) and fly ashes from the European Committee for Standardization (CEN) intercalibration study demonstrated that the proposed methodology is appropriate to determine the dl-PCBs in accordance with the impending European standard EN-1948. Uncertainty values obtained during the validation of the analytical methodology were 13% total I-TEQ (International Toxic Equivalent) for PCDD/Fs and 31% total WHO-TEQ (World Health Organization Toxic Equivalent) in the case of dl-PCBs. In addition, 'real' samples such as emissions and fly ashes were successfully analyzed following the proposed analytical method.

Pérdidas de nitrógeno y balance nitrogenado en pacientes con infarto maligno de la arteria cerebral media y sometidos a hipotermia moderada (32-33 ºC) / Nitrogen losses and nitrogen balance in patients with malignant infarction of the median cerebral artery submitted to moderate hypothermia (32-33 ºC)

Objetivos: La inducción de hipotermia moderada en pacientes con infarto de la arteria cerebral media (ACM) puede ocasionar alteraciones metabólicas y nutricionales. En la actualidad se desconoce cuál es el mejor método para realizar la valoración nutricional en este grupo de población. El objetivo del presente estudio fue valorar la utilidad del balance nitrogenado en el seguimiento de pacientes con infarto de la ACM y sometidos a hipotermia moderada (32-33 ºC) mediante enfriamiento intravascular, en la Unidad de Cuidados Neurocríticos de un hospital de tercer nivel. Material y métodos: Se diseñó un estudio retrospectivo en el que se incluyeron pacientes con infarto de la ACM de los que se recogieron variables biodemográficas, clínicas, de hipotermia y nutricionales. Del mismo modo se realizó el seguimiento prospectivo de un paciente con infarto de la ACM e hipotermia inducida, recogiendo las mismas variables en distintos tiempos de su evolución clínica. Resultados: En la serie retrospectiva se incluyeron 6 pacientes con infarto de ACM sometidos a hipotermia moderada durante un periodo promedio de 12 días (intervalo 9-15). Se constataron pérdidas de nitrógeno (media 9,9 g) inferiores a las que cabría esperar en pacientes críticos durante la fase aguda. En el seguimiento prospectivo del paciente con infarto maligno de la ACM desde día 1 hasta día 22 tras la aplicación de la hipotermia se observaron, al igual que en la serie de pacientes anteriormente descrita, valores bajos de nitrógeno eliminado durante la fase de hipotermia inducida que se elevaron posteriormente cuando el paciente recuperó la normotermia. El nitrógeno eliminado promedio durante el periodo de hipotermia fue de 10,7 g y presentó una elevación hasta 27,3 g durante el periodo normotérmico (día 17). Conclusiones: Estos resultados sugieren que la supresión metabólica inducida por la hipotermia moderada es clínicamente relevante y que, por lo tanto, la determinación del balance nitrogenado no parece ser una herramienta útil en el seguimiento nutricional de este tipo de pacientes (AU)

Objectives: Induction of moderate hypothermia in patients with median cerebral artery (MCA) infarction may produce metabolic and nutritional impairments. Currently, we do not know which is the best method to carry out nutritional assessment in this population group. The aim of the present study was to assess the usefulness of nitrogen balance in the follow-up of patients with MCA submitted to moderate hypothermia (32-33 ºC) by means of intravascular cooling at the Neurocritical Patients Unit at a tertiary hospital. Material and methods: We designed a retrospective study including patients with MCA infarction of whom we gathered bio-demographical, clinical, hypothermia, and nutritional variables. Similarly, we carried out a prospective follow-up of a patient with MCA infarction and induced hypothermia, gathering the same variables at different time points of his clinical course. Results: Six patients with MCA infarction submitted to moderate hypothermia for a mean duration of 12 days (interval 9-15) were included in the retrospective series. We observed that nitrogen losses (mean 9.9 g) were lower than those previously thought for critical patients during the acute phase. During the prospective follow-up of the patient with malignant infarction of the MCA from day 1 to day 22 after the application of hypothermia, low levels of nitrogen losses were similarly observed during the phase of induced hypothermia, which increased later on when the patient recovered normothermia. The mean nitrogen expenditure during the period of hypothermia was 10.7 g and increased up to 27.3 g during the normothermia period (day 17). Conclusions: These results suggest that moderate hypothermia-induced metabolic suppression is clinically relevant and thus the determination of nitrogen balance does not seem to be a useful tool in the nutritional followup of this type of patients (AU)

[Nitrogen losses and nitrogen balance in patients with malignant infarction of the median cerebral artery submitted to moderate hypothermia (32-33 degrees C)]. / Pérdidas de nitrógeno y balance nitrogenado en pacientes con infarto maligno de la arteria cerebral media y sometidos a hipotermia moderada (32-33 degrees C).

OBJECTIVES: Induction of moderate hypothermia in patients with median cerebral artery (MCA) infarction may produce metabolic and nutritional impairments. Currently, we do not know which is the best method to carry out nutritional assessment in this population group. The aim of the present study was to assess the usefulness of nitrogen balance in the follow-up of patients with MCA submitted to moderate hypothermia (32-33 degrees C) by means of intravascular cooling at the Neurocritical Patients Unit at a tertiary hospital. MATERIAL AND METHODS: We designed a retrospective study including patients with MCA infarction of whom we gathered bio-demographical, clinical, hypothermia, and nutritional variables. Similarly, we carried out a prospective follow-up of a patient with MCA infarction and induced hypothermia, gathering the same variables at different time points of his clinical course. RESULTS: Six patients with MCA infarction submitted to moderate hypothermia for a mean duration of 12 days (interval 9-15) were included in the retrospective series. We observed that nitrogen losses (mean 9.9 g) were lower than those previously thought for critical patients during the acute phase. During the prospective follow-up of the patient with malignant infarction of the MCA from day 1 to day 22 after the application of hypothermia, low levels of nitrogen losses were similarly observed during the phase of induced hypothermia, which increased later on when the patient recovered normothermia. The mean nitrogen expenditure during the period of hypothermia was 10.7 g and increased up to 27.3 g during the normothermia period (day 17). CONCLUSIONS: These results suggest that moderate hypothermia-induced metabolic suppression is clinically relevant and thus the determination of nitrogen balance does not seem to be a useful tool in the nutritional followup of this type of patients.

[Gastrointestinal inflammatory fibroid polyps. Clinical characteristics and follow-up in a series of 26 patients]. / Pólipo fibroide inflamatorio gastrointestinal. Características clínicas y seguimiento de una serie de 26 pacientes.

INTRODUCTION: Inflammatory fibroid polyp (IFP) is a protuberant lesion, located near the muscularis mucosae and composed of a proliferation of fusiform cells and conjunctive fibers surrounding capillaries and a variable inflammatory infiltrate. It is believed to be a poorly controlled inflammatory repair response. Our aim was to study the clinical, pathological and follow-up characteristics of a series of patients with IFP. PATIENTS AND METHOD: We studied 26 IFPs from 25 patients (16 women and 9 men) registered between 1985 and 2001 in a specific register of 3 centers in the city of Gerona (Spain). The variables analyzed were age, sex and clinical presentation, IFP localization and size, mucosal characteristics and associated disease, as well as follow-up information. Routine statistical analyses were performed. RESULTS: IFPs were antral in 16 patients, ileal in 7, jejunal in 2 and colonic in the remaining patient. Size determined whether they were symptomatic (35 +/- 13.6 mm) or asymptomatic (8.4 +/- 6.3 mm). Gastric polyps were significantly smaller than intestinal polyps. Symptomatic polyps (5 out of 16 gastric polyps and 9 out of 10 intestinal polyps) predominated in women and occurred at a significantly lower age than asymptomatic polyps (59.2 versus 74.1 years). Most gastric IFPs were associated with chronic atrophic gastritis while only one ileal polyp was associated with Meckels diverticulum. The mean length of follow-up was 60.6 months and, except in one patient who underwent incomplete resection, no recurrences of IFP were observed. CONCLUSION: IFP is a heterogeneous entity, depending on age at presentation, sex, size and location in the digestive tract. IFP does not recur after resection. The association of gastric IFP and chronic atrophic gastritis could suggest a modulatory effect of the mucosa on IFP growth.

Pólipo fibroide inflamatorio gastrointestinal. Características clínicas y seguimiento de una serie de 26 pacientes / Gastrointestinal inflammatory fibroid polyps. Clinical characteristics and follow-up in a series of 26 patients

INTRODUCCIÓN: El pólipo fibroide inflamatorio (PFI) es una lesión protuberante que se localiza cerca de la muscularis mucosae y está constituida por una proliferación de células fusiformes y fibras conjuntivas alrededor de los capilares y un infiltrado inflamatorio variable. Se considera una reacción inflamatoria reparadora mal controlada. El objetivo de este trabajo ha sido estudiar las características clínicas, anatomo-patológicas y de seguimiento de una serie de pacientes con PFI.PACIENTES Y MÉTODO: Se han estudiado 26 PFI (25 pacientes:16 mujeres y 9 varones) recogidos entre los años 1985 y2001 en un registro específico de 3 centros de la ciudad de Girona. Las variables analizadas fueron la edad, el sexo y la presentación clínica, la localización y el tamaño del PFI, las características de la mucosa y las enfermedades asociadas, así como información del seguimiento. Se realizaron las pruebas estadísticas habituales. RESULTADOS: El PFI fue antral en 16 casos, ileal en 7, yeyunalen 2 y colónico en el restante. Su tamaño condicionó su carácter sintomático (35 ± 13,6 mm) o asintomático (8,4 ±6,3 mm). Los pólipos gástricos fueron significativamente más pequeños que los intestinales. Los pólipos sintomáticos(5 de 16 gástricos y 9 de 10 intestinales) predominaron en mujeres y en edades significativamente inferiores que los asintomáticos (59,2 frente a 74,1 años). La mayoría delos PFI gástricos se asociaron a gastritis crónica atrófica, mientras que sólo un PFI ileal lo hizo a divertículo de Meckel. El seguimiento medio fue de 60,6 meses y, salvo en un caso de resección incompleta, no se constató recidiva del PFI. CONCLUSIÓN: El PFI es una entidad heterogénea según la edad de presentación, el sexo de los pacientes, su tamaño y la localización en el tubo digestivo. Tras la resección, el PFI no recidiva. La asociación de los PFI gástricos a gastritis crónica atrófica podría apuntar a un efecto modulador de la mucosa sobre el crecimiento del PFI

INTRODUCTION: Inflammatory fibroid polyp (IFP) is a protuberant lesion, located near the muscularis mucosae and composed of a proliferation of fusiform cells and conjunctive fiberssurrounding capillaries and a variable inflammatoryin filtrate. It is believed to be a poorly controlled inflammatory repair response. Our aim was to study the clinical, pathological and follow up characteristics of a series of patients with IFP.PATIENTS AND METHOD: We studied 26 IFPs from 25 patients(16 women and 9 men) registered between 1985 and 2001 ina specific register of 3 centers in the city of Gerona (Spain).The variables analyzed were age, sex and clinical presentation, IFP localization and size, mucosal characteristics and associated disease, as well as follow-up information. Routine statistical analyses were performed. RESULTS: IFPs were antral in 16 patients, ileal in 7, jejunal in 2and colonic in the remaining patient. Size determined whether they were symptomatic (35 ± 13.6 mm) or asymptomatic (8.4 ±6.3 mm). Gastric polyps were significantly smaller than intestinal polyps. Symptomatic polyps (5 out of 16 gastric polyps and9 out of 10 intestinal polyps) predominated in women and occurred at a significantly lower age than asymptomatic polyps(59.2 versus 74.1 years). Most gastric IFPs were associated with chronic atrophic gastritis while only one ileal polyp was associated with Meckel’s diverticulum. The mean length of follow up was 60.6 months and, except in one patient who underwent in complete resection, no recurrences of IFP were observed. CONCLUSION: IFP is a heterogeneous entity, depending on age at presentation, sex, size and location in the digestive tract. IFP does not recur after resection. The association of gastric IFP and chronic atrophic gastritis could suggest a modulatory effect of the mucosa on IFP growth

[Progressive deterioration in an elderly patient]. / Deterioro progresivo en paciente anciano.

Vasculitis is diagnosed with increasing frequency in the elderly. We hereby present the case of an 84-year-old male, who had weight loss, low-degree fever, anemia and epigastric pain. After 14 days of study with the tentative diagnosis of digestive neoplasia, a progressive renal insufficiency was detected. This clinical picture was secondary to ANCA-positive vasculitis. The case poses the differential diagnosis of non-oliguric acute renal failure (FRA) in elder people and the systematics of the study of renal insufficiency in individuals with previously unknown renal function. Also, this patient's history emphasizes the importance of acute deterioration of renal function as a guiding symptom for orienting the interpretation of clinical data. In the present case, a diagnostic hypothesis based only in the pursue of an occult digestive tumor misguided the attention from the main cause of the disease.

Deterioro progresivo en paciente anciano / Vasculitis in an elderly patient

Las vasculitis son un cuadro de diagnóstico cada vez más frecuente en pacientes ancianos. Presentamos un caso con aspectos diagnósticos relevantes. Se trata de un varón de 84 años con pérdida de peso, febrícula, anemia y epigastralgia, al que tras 14 días de estudio de neoplasia digestiva, se le detecta insuficiencia renal progresiva, debida a vasculitis con ANCA positivos. El caso plantea el diagnóstico diferencial del fracaso renal agudo (FRA) no oligúrico en ancianos, la sistemática de estudio de la insuficiencia renal en un paciente con función renal previa desconocida y se enfatiza en la importancia del deterioro de la función renal de manera aguda como síntoma guía a la hora de orientar la historia clínica. En este caso un planteamiento encaminado a la búsqueda de un tumor subyacente como causa de su sintomatología, hizo obviar otros datos a tener en cuenta (AU)

Vasculitis are diagnosed with increasing frequency in the elderly. We hereby present the case of an 84-year-old male, who had weight loss, low-degree fever, anemia and epigastric pain. After 14 days of study with the temptative diagnosis of digestive neoplasia, a progressive renal insufficiency was detected. This clinical picture was secondary to ANCA positive vasculitis. The case poses the differential diagnosis of non-oliguric acute renal failure (FRA) in elder people and the systematics of the study of renal insufficiency in individuals with previously unknown renal function. Also, this patient’s history emphasizes the importance of acute deterioration of renal function as a guiding symptom for orienting the interpretation of clinical data. In the present case, a diagnostic hypothesis based only in the pursue of an occult digestive tumor has misguided the attention from the main cause of the disease (AU)

Dioxin abatement strategies and mass balance at a municipal waste management plant.

Since the thermal management of municipal solid waste (MSW) is considered to be one of the major sources of polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs), the purpose of this study was to show the results of a dioxin abatement program performed in the municipal waste incineration (MWI) plant of Tarragona (NE Spain). Previously, stack gas emission levels of PCDDs/PCDFs around 3.26 ng I-TEQ/Nm3 were determined when the gas-cleaning system consisted only of an electrostatic precipitator (ESP). Decreased levels, below 0.1 ng I-TEQ/ Nm3, were observed when a new air pollution control system was installed. This new system was improved by the injection of activated carbon, which helped to lower the levels of PCDDs/PCDFs to around 0.01 ng I-TEQ/Nm3. Considering the absence of a particular impact on herbages, soils, and ambient air around the plant, as reported in previous works, and the hypothesis that a modern installation could become a sink for dioxins instead of a source, a dioxin mass balance was evaluated. The study compared in a large-scale MWI plant the levels of PCDDs/PCDFs of all input and output contributors (MSW, ambient air, stack gas emission, fly ash, and slag) forming part of the inventory collected in various monitoring campaigns. The findings revealed a remarkable homogeneity in output values (between 1.19 and 2.62 ng I-TEQ/yr) in contrast to the large variability observed in input values. In the first sampling campaign, the dioxin content in MSW was around 64.15 ng I-TEQ/kg, and a negative balance of 7.68 g I-TEQ/yr was calculated. However, in the latest campaign, levels were about 2.36 ng I-TEQ/kg MSW, resulting in a positive balance of 2.28 g I-TEQ/yr.

Dioxin mass balance in a municipal waste incinerator.

A dioxin mass balance in an Spanish municipal waste incinerator (MWI) is presented. Input and output inventories from two sampling collection episodes including the analysis of PCDD/PCDF in urban solid waste (USW), stack gas emissions, fly ash and slag are reported. In one collection the levels of USW were around 8 pg I-TEQ/g and non-thermal destruction was observed overall. In the other collection the levels of USW were higher (around 64 pg I-TEQ/g) and the dioxin balance revealed a thermal destruction. Analysis of the different waste materials (textile, organic, plastic, wood and paper) was performed separately and the textile samples presented the highest levels.