Stereotactic Body Radiotherapy for Kidney Cancer: Ready for Prime Time?

The standard treatment for renal cell carcinoma (RCC) is surgery. However, a number of patients will not be candidates for surgical treatment or will reject this therapeutic approach. Therefore, alternative approaches are required. Historically, radiotherapy has been considered an ineffective treatment for RCC due to the radioresistance of renal tumour cells to conventional fractionation and the increased rate of toxicity. Stereotactic body radiotherapy (SBRT) is a radiotherapy technique that provides a non-invasive ablative treatment with remarkable rates of local control in both primary tumours and metastases in several locations, with a low associated morbidity due to the highly conformal dose and the use of image-guided techniques. Current evidence shows that a higher dose per fraction, achieving a higher biological effective dose, can overcome the radioresistance of RCC cells. Therefore, SBRT, as well as the combination of SBRT and new emerging immune therapies, has a potential role in the local treatment of primary RCC and oligometastatic RCC patients.

Production levels and health status in Iberian piglets at weaning.

The aim of this study was to describe the postweaning growth of Iberian piglets and its relationship with the occurrence of diarrhea. To assess these factors in response to different weaning ages, a total of 360 pure-breed Iberian piglets were studied. Three trials were conducted with 120 piglets from 24 litters randomly assigned to be weaned at 28 or 42 d of age (12 litters and 60 piglets each). In each trial and from each weaning age, 4 groups of 15 piglets were assembled with different sexes and sizes (3 litters by group and 5 animals from each litter; 12 replicates and 180 piglets/weaning age). The duration of study period was 42 d and all animals were weighed weekly from 21 to 63 d of age. Food intake and fecal consistency were examined with the same frequency. General linear models and chi-square procedure was used with SPSS statistical package to perform the analysis with a confidence interval of 95% (P < 0.005). Pearson and Spearman analyses were conducted to examine relationships between variables. At the beginning (P = 0.798) and end of the study (P = 0.450) there were no significant differences between piglet weights. After weaning, there were differences in food intake and in conversion rates (P < 0.001), but there were no differences in ADG for the whole study period (P = 0.335). All groups experienced a similar decline in production rates during the first week after weaning and similar recovery times during the next weeks. Both weaning groups had a similar overall prevalence (P = 0.044) and incidence of diarrheal onset (P = 0.467), and regression analysis showed relationships between postweaning diarrhea and the overall prevalence of piglets before weaning (P < 0.01) and food intake during first week postweaning (P < 0.01). Therefore, weaning age has a similar influence on postweaning growth and on postweaning diarrhea in Iberian piglets.

Monoclonal free light chains can be found in heavy chain diseases.

Heavy chain diseases (HCDs) are rare B-cell lymphoproliferative neoplasias characterized by the production of a monoclonal component consisting of a truncated monoclonal Ig heavy chain without the associated light chain. Among them, patients with gamma-HCD are so rare that no more than 150 cases can be found in the literature. In this paper, we report one additional case: an 83-year-old man with a gamma-HCD, in whom a kappa light chain component was detected in the serum by using the serum free light-chain assessment and in addition monoclonal kappa cytoplasmic expression was detected in bone marrow plasma cells by flow cytometric analysis. In the work-up of the patient, the underlying anatomopathological lymphoproliferative disease corresponded to a lymphoplasmacytic lymphoma, as it is stated in the current World Health Organization classification (2008), with both lymphadenopathic and bone marrow infiltration. As in other cases, several autoimmune manifestations (antiphospholipidic syndrome and immune thrombocytopenia) were present during the course of the disease in this patient. This case report illustrates a new case of gamma-HCD, in which serum free light-chain analysis and flow cytometry represented a valuable tool for diagnosis, a finding that could be very important for the future management of these patients.

Projections from the inferior colliculus to the tectal longitudinal column in the rat.

We have used the anterograde tracer Phaseolus vulgaris-leucoagglutinin (PHA-L) to study with albino rats the projections from the inferior colliculus (IC) to the tectal longitudinal column (TLC), a newly discovered nucleus that spans the midbrain tectum longitudinally, on each side of the midbrain, immediately above the periaqueductal gray matter. We studied the projections of the medial IC, which includes the classical central nucleus (CNIC) and the dorsal cortex (DCIC), and those of the lateral IC, equivalent to the classical external cortex (ECIC). Following unilateral injections of PHA-L into the medial IC, numerous terminal fibers are labeled bilaterally in the TLC. The ipsilateral projection is denser and targets the entire nucleus, whereas the contralateral projection targets significantly only the caudal half or two-thirds of the TLC. Fibers from the medial IC reach the TLC by two routes: as collaterals of axons that travel in the commissure of the IC and as collaterals of thick ipsilateral colliculogeniculate axons; the latter travel through the deep superior colliculus on their way to the TLC. Within the TLC, individual IC fibers tend to run longitudinally. The injection of PHA-L into the lateral IC indicates that this subdivision sends a weak, bilateral projection to the TLC whose trajectory, morphology and distribution are similar to those of the projection from the medial IC. These results demonstrate that all subdivisions of the IC send projections to the TLC, suggesting that the IC may be one of the main sources of auditory input to this tectal nucleus.

Connections of the superior paraolivary nucleus of the rat: projections to the inferior colliculus.

GABAergic neurotransmission contributes to shaping the response properties of inferior colliculus (IC) neurons. In rodents, the superior paraolivary nucleus (SPON) is a prominent and well-defined cell group of the superior olivary complex that sends significant but often neglected GABAergic projections to the IC. To investigate the trajectory, distribution and morphology of these projections, we injected the neuroanatomical tracer biotinylated dextran amine into the SPON of albino rats. Our results demonstrate that: (1) the SPON innervates densely all three subdivisions of the ipsilateral IC: central nucleus (CNIC), dorsal cortex (DCIC) and external cortex (ECIC). The SPON also sends a sparse projection to the contralateral DCIC via the commissure of the IC. (2) SPON axons are relatively thick (diameter >1.2 microm), ascend to the midbrain tectum in the medial aspect of the lateral lemniscus, and, for the most part, do not innervate the nuclei of the lateral lemniscus. (3) SPON fibers ramify profusely within the IC and bear abundant en passant and terminal boutons. (4) The axons of neurons in discrete regions of the SPON form two laminar terminal plexuses in the ipsilateral IC: a medial plexus that spans the CNIC and DCIC parallel to the known fibrodendritic laminae of the CNIC, and a lateral plexus located in the ECIC and oriented more or less parallel to the surface of the IC. (5) The projection from SPON to the ipsilateral IC is topographic: medial SPON neurons innervate the ventromedial region of the CNIC and DCIC and the ventrolateral region of the ECIC, whereas more laterally situated SPON neurons innervate more dorsolateral regions of the CNIC and DCIC and more dorsomedial regions of the ECIC. Thus, SPON fibers follow a pattern of distribution within the IC similar to that previously reported for intracollicular and corticocollicular projections.

Hepatomegalia por depósito de glucógeno hepático y diabetes mellitus tipo 1 / Hepatomegaly due to glycogen storage disease and type 1 diabetes mellitus

Los pacientes diabéticos tipo 1 con mal control metabólico pueden desarrollar hepatomegalia secundaria al depósito de glucógeno intrahepático. Si además presentan hipertransaminasemia, dislipemia, rasgos cushingoides, y retraso del crecimiento y del desarrollo puberal podemos hablar de síndrome de Mauriac. Este síndrome es frecuente y reversible con la optimización del tratamiento insulínico. Presentamos 3 adolescentes diabéticos tipo 1 de larga evolución con mal control metabólico que manifestaron hepatomegalia, hipertransaminasemia y dislipemia con funcionalismo hepático normal. Uno de ellos presentó retraso de crecimiento y otro hipogonadismo hipogonadotropo. Las ecografías hepáticas mostraron glucogenosis. El cuadro revirtió en todos ellos con la optimización de la insulinoterapia manteniendo controles glucémicos normales en el plazo de 2 semanas. La etiología del síndrome Mauriac es controvertida pues tanto la hiperglucemia mantenida como la hiperinsulinización producen glucogenosis. La hipercortisolemia también (fruto de la cetosis o hipoglucemia) y además produce retraso de crecimiento y del desarrollo puberal

Patients with type 1 diabetes and poor metabolic control can develop hepatomegaly due to intrahepatic glycogen deposition. If these patients also have elevated liver enzymes, dyslipidemia, cushingoid features and delayed growth or sexual maturation, Mauriac syndrome can be diagnosed. This disorder is common and reversible with optimization of insulin therapy. We report three adolescents with type 1 diabetes and a long-standing history of poor glycemic control, who developed hepatomegaly, elevated liver enzymes and dyslipidemia with preserved liver function. One of these patients also had delayed growth and another had hypogonadotropic hypogonadism. Liver ultrasound showed changes suggestive of glycogenosis. In all three patients, optimization of insulin therapy achieved good glycemic control and reversed the manifestations within 2 weeks. The etiology of Mauriac syndrome is controversial since both prolonged hyperglycemia and hyperinsulinization produce glycogen accumulation in the liver. Hypercortisolism (due to ketosis or hypoglycemia) contributes to glycogen storage and also causes growth and sexual maturation delay

Combined post-ozonation and biological treatment of recalcitrant wastewater from a resin-producing factory.

In this study, effluent from the biological treatment of wastewater from a resin-producing factory containing recalcitrant compounds was ozonated under different conditions. Afterwards, the biodegradability of the ozonated effluent was studied under anoxic conditions. The post-ozonation of the industrial effluent was performed using a wide range of ozone doses, from 1.8 to 29.5 mg L(-1)min(-1). After the biological treatment of the ozonated effluent, organic carbon and nitrogen removals from 27 to 97% and from 27 to 80%, respectively, were achieved. The effect of the contact time was studied at a constant ozone dose of 13.0+/-1.2 mg L(-1)min(-1) and contact times ranging from 30 to 180 min. In this case, organic carbon removals from 55 to 100% and organic nitrogen removals from 41 to 77% were obtained after biological treatment.

Plasma cell granuloma of the hypothalamic region.

Two patients suffering from diabetes insipidus, with additional symptoms of impaired vision and signs of panhypopituitarism and increased intracranial pressure, showed a normal sella tursica in the X-ray examination of the skull but large, dense space-occupying lesions in the hypothalamus on CT scans of the brain. NMR performed in one patient disclosed suprasellar growth of a hypothalamic lesion. Proliferation of lymphoplasmocytes and mature plasma cells was seen by light microscopic and electromicroscopical examination of biopsy samples in both cases; histiocytes and multinucleated giant cells were absent; tuberculosis, syphilis and sarcoidosis were ruled out by appropriate tests. Plasma cells exhibited polyclonal immunoglobulin expression as revealed by immunocytochemistry using the PAP method. Taken together these features are typical of plasma cell granuloma. Transitory remission after radiotherapy was obtained in one patient.

Potentialization of the lactoperoxidase system for preservation of raw milk in the tropics.

The antimicrobial ability of the lactoperoxidase system was increased by the addition of larger amounts of the thiocyanate and hydrogen peroxide at levels above those suggested by other authors. Results of laboratory and field trials revealed that the potentialized system was able to preserve poor-quality raw milk for longer periods of time, at "tropical" temperatures, than when used as recommended previously. It was possible to preserve some milks at 20 degrees C for more than one day, without diminishing their overall quality. At 36 degrees C, the milks did not show acidity development for about 10 hours. Tests conducted under real collection and transportation conditions validated these findings. It was therefore proved that the system can be used practically and that its bactericidal/bacteriostatic effect on the spoilage flora of milk can be increased in order to overcome the particularly adverse conditions of milk handling in the tropics.

Potentialization of the lactoperoxidase system for preservation of raw milk in the tropics

Se aumentó la capacidad antimicrobiana del sistema lactoperoxidas, mediante la adición de tiocianato y peróxido de hidrógeno en cantidades mayores a las sugeridas por otros autores. Los resultados de laboratorio y las pruebas de campo revelaron que por otros autoes. Los resultados de laboratorio y las pruebas de campo revelaron que el sistema potencializado pudo preservar leches de baja calidad microbiológica, a temperaturas "tropicales" por períodos más largos que al usarlo como se recomienda en la literatura. Se pudo conservar leches a 20-C por más de un día, sin menoscabo de su calidad general. A 36-C, las leches no acusaron desarrollo de acidez durante el término de 10 horas. Las pruebas realizadas en condiciones reales de recolección y transporte validaron los resultados de laboratorio. Se logró así probar que el sistema lactoperoxidasa es viable de uso en la práctica, y que su poder bactericida/bacteriostático sobre la flora deterioradora de la leche puede aumentarse a fin de superar las condiciones especialmente adversas que involucra el menejo de la leche en los trópicos