Co-composting of forest and industrial wastes watered with pig manure.

Co-composting of forest-derived wastes (chestnut forest burr, CST; scrubland biomass, SRB; industrial sludge, MDFS, from the Medium Density Fibreboard production process) watered with pig manure (PM) may constitute a feasible management technique for both solid and liquid streams. PM provided water and improved the carbon to nitrogen (C/N) ratio. Four piles of 1.8-2.4 m3 were conformed: A (SRB, with compaction bulk density), B (SRB, without compaction), C (SRB and MDFS at a volumetric ratio of 3:1) and D (CST). Thermophilic temperatures were maintained for 8 (B), 16 (A), 28 (C) and 40 (D) days. Stable compost was obtained after 35 (A, B, C) and 48 (D) days. Hygienization was only complete in piles C and D. N losses were higher in piles A (39.3%) and B (33.6%) in relation to C (17.0%) and D (8.9%) which could be attributed to the characteristics of MDFS and CST. Increasing the matrix size from 340 L to around 2000 L led to a higher intensity of the thermophilic phase. Besides, compaction significantly increased the temperature during composting. PM was added at ratios ranging from 1.8 to 2.5 L/kg dry matter, being favoured by pre-drying of solid wastes.

Healthcare and wider societal implications of stillbirth: a population-based cost-of-illness study.

OBJECTIVE: To extend previous work and estimate health and social care costs, litigation costs, funeral-related costs, and productivity losses associated with stillbirth in the UK. DESIGN: A population-based cost-of-illness study using a synthesis of secondary data. SETTING: The National Health Service (NHS) and wider society in the UK. POPULATION: Stillbirths occurring within a 12-month period and subsequent events occurring over the following 2 years. METHODS: Costs were estimated using published data on events, resource use, and unit costs. MAIN OUTCOME MEASURES: Mean health and social care costs, litigation costs, funeral-related costs, and productivity costs for 2 years, reported for a single stillbirth and at a national level. RESULTS: Mean health and social care costs per stillbirth were £4191. Additionally, funeral-related costs were £559, and workplace absence (parents and healthcare professionals) was estimated to cost £3829 per stillbirth. For the UK, the annual health and social care costs were estimated at £13.6 million, and total productivity losses amounted to £706.1 million (98% of this cost was attributable to the loss of the life of the baby). The figures for total productivity losses were sensitive to the perspective adopted about the loss of life of the baby. CONCLUSION: This work expands the current intelligence on the costs of stillbirth beyond the health service to costs for parents and society, and yet these additional findings must still be regarded as conservative estimates of the true economic costs. TWEETABLE ABSTRACT: The costs of stillbirth are significant, affecting the health service, parents, professionals, and society. PLAIN LANGUAGE SUMMARY: Why and how was the study carried out? The personal, social, and emotional consequences of stillbirth are profound. Placing a monetary value on such consequences is emotive, yet necessary, when deciding how best to invest limited healthcare resources. We estimated the average costs associated with a single stillbirth and the costs for all stillbirths occurring in the UK over a 1-year period. What were the main findings? The average cost to the National Health Service (NHS) of care related to the stillbirth and a first subsequent pregnancy was £4191 for each stillbirth. For the UK, this cost was £13.6 million annually. Clinical negligence payments to bereaved parents were estimated at £2.5 million per year. Parents were estimated to spend £1.8 million per year on funerals. The cost of workplace absence as parents cope with the effects of grief was estimated at £2476 per stillbirth. For the UK, this cost was £8.1 million annually. The loss of a baby is also the loss of an individual with the potential to become a valued and productive member of society. The expected value of an adult's lifetime working hours was taken as an estimate of this productivity loss, and was £213,304 for each stillbirth. The annual cost for all stillbirths was £694 million. We know from parents that the birth of a subsequent child in no way replaces a stillborn baby. We found that 52% of women fall pregnant within 12 months of a stillbirth. From a purely economic perspective concerned only with the number of individuals in society, babies born during this period could potentially replace the productivity losses of the stillborn baby. Adopting this approach, which we understand is controversial and difficult for bereaved parents, the expected productivity losses would be lower, at £333 million. What are the limitations of the work? For some categories, existing data were unavailable and we used clinical opinion to estimate costs. Furthermore, we were unable to quantify some indirect consequences, for example the psychological distress experienced by wider family members. What is the implication for parents? Placing a monetary value on what is for parents a profound personal tragedy may seem unkind. It is, however, unavoidable if we are to provide policy makers with vital information on the wide-ranging consequences that could be prevented through future investments in initiatives to reduce stillbirth.

Composting of pig manure and forest green waste amended with industrial sludge.

The aim of this research was to study the composting of chestnut forest green waste (FGW) from short rotation chestnut stands amended with sludge resulting from the manufacture of Medium Density Fibreboard (MDFS) and pig manure (PM). Both FGW and MDFS presented low biodegradation potential but different characteristics in granulometry and bulk density that make its mixture of interest to achieve high composting temperatures. PM decreased the C/N ratio of the mixture and increased its moisture content (MC). Three mixtures of MDFS:FGW at volume ratios of 1:1.3 (M2), 1:2.4 (M3) and 0:1 (M4) were composted after increasing its MC to about 70% with PM. A control with food waste (OFW) and FGW (1:2.4 in volume) (M1) was run in parallel. Watering ratios reached 0.25 (M1), 1.08 (M2) 1.56 (M3) and 4.35 (M4) L PM/kg TS of added solids wastes. Treatments M2 and M3 reached a thermophilic phase shorter than M1, whilst M4 remained in the mesophilic range. After 48days of composting, temperature gradients in respect to ambient temperature were reduced, but the mineralization process continued for around 8months. Final reduction in total organic carbon reached 35-56%, depending mainly on the content in MDFS. MDFS addition to composting matrices largely reduced nitrogen losses, which range from 22% (M2) to 37% (M3) and 53% (M4). Final products had high nutrient content, low electrical conductivity and low heavy metal content which make it a valuable product for soil fertilization, right to amend in the chestnut forests and as a pillar of their sustainable management.

Registros poblacionales de cáncer: avances en Colombia, Chile y Brasil / Population-based cancer registries: progress in Colombia, Chile and Brazil

OBJETIVO : revisar los avances en materia de registros poblacionales de cáncer en Colombia, Chile y Brasil. METODOLOGIA: búsqueda de literatura en español, portugués e inglés a través de lilacs, bireme, scielo, medline, isi, y sitios web especializados. RESULTADOS Colombia cuenta con 8 registros, 4 indexados ante la iacr (10% población nacional), y 4 aún sin indexar (18% población nacional); el registro de Cali con 50 años de existencia es referente regional. Tres registros chilenos indexados cubren el 6,2% de la población nacional y dos sin indexación abarcan un 7,2% de población adicional; el Registro Nacional de Cáncer Infantil de Chile cubre el 100% de la población menor de 15 años y opera desde el año 2006. Brasil tiene registros poblacionales en 20 ciudades que cubren el 19% de la población total, y operan en integración con los registros hospitalarios. DISCUSION Y CONCLUSION la cobertura poblacional en la región es baja en comparación con Europa y Norteamérica. Se evidencian avances en los tres países, en especial por la existencia de respaldo político y normativo. Es necesario ampliar la cobertura poblacional y continuar mejorando la calidad de los datos. El uso de tecnologías informáticas favorece el desarrollo y la integración de los registros.

OBJECTIVE: to review the progress in the area of population-based cancer registries in Colombia, Chile and Brazil. METHODOLOGY an ethnographic study whose participants were 20 mothers of children with Down's syndrome. Data were collected using semi-structured interviews and field observations. Similarly, this study included a categorical analysis and a literature review. RESULTS : Colombia has 8 records, 4 of them are indexed by the iacr (10% of the national population), and 4 are still not indexed (18% of the national population). The registry of Cali city is 50 years old and is considered a regional reference. Likewise, three Chilean registries are indexed and cover 6.2% of the national population. In addition, two unindexed registries cover a further 7.2% of the Chilean population. Also, the National Childhood Cancer Registry of Chile covers 100% of the population under 15 years and operates since 2006. Brazil, in turn, has population-based registries for 20 cities which cover 19% of the total population. These registries operate jointly with hospital registries. DISCUSSION AND CONCLUSION: population coverage in the region is low compared to Europe and North America. There is evidence of progress in all three countries, particularly the existence of political and regulatory support. It is necessary to expand population coverage and further improve data quality. The use of information technologies promotes the development and integration of registries.

The Identity of Specimens of the Anastrepha fraterculus Complex (Diptera, Tephritidae) with Atypical Aculeus Tip.

Several specimens collected in Paraguay along with Anastrepha fraterculus (sensu lato) have an aculeus tip similar to species from the fraterculus complex, but the teeth of the aculeus of these specimens are poorly defined. As Anastrepha species identification is based mostly on subtle differences in the aculeus tip, we studied these specimens with atypical aculeus tips (with poorly defined teeth) that slightly differs from the aculeus tip of species of the fraterculus complex (with well-developed blunt teeth), to determine if this is due to intraspecific variation or if it can characterize a full species. The Paraguayan specimens were separated in six groups under stereomicroscope according to variation in their aculeus tip. Specimens within each group were studied by means of morphometrics (traditional and geometric) and gene sequence analysis (COI and ITS1). Morphometric analyses were significant, but no clear groups were formed by the discriminant analyses of the aculeus and wing, and the COI and ITS1 sequence analysis clustered specimens with all six aculeus variations. Therefore, the subtle morphological differences observed in the aculeus tip of Paraguayan specimens are intraspecific variations and the Paraguayan specimens were more genetically closely related to Anastrepha sp. 3 from the fraterculus complex.

[Ablation of malignant liver tumors with radiofrequency. A series of cases in Mexico.]. / Ablación de neoplasias hepáticas malignas con radiofrecuencia. Una serie de casos en México.

BACKGROUND: Surgical resection is the treatment of choice for most of the primary and secondary liver tumors, unfortunately, many patients are not suitable for resection. Several ablative alternatives have been employed for treatment; the most commonly used has been radiofrequency ablation. OBJECTIVE: To establish the safety and results of treatment with radiofrequency ablation (RF) of malignant liver tumors. MATERIAL AND METHODS: A retrospective review of clinical files of patients with malignant hepatic tumors treated with RF was performed. Epidemiological variables, selection criteria pre- treatment and morbidity and mortality related to the procedure were analyzed. Descriptive statistics were used. RESULTS: From September 2002 to August 2006, 30 patients were treated: eighteen females and 12 males with a median age of 62 years (range 41-83 years). Histologic type was as follows: 18 hepatocellular carcinomas; 10 metastatic tumors (four breast, four colorectal and two neuro- endocrine); one gallbladder carcinoma and one peripheral cholangiocarcinoma. Indications for ablative procedure were the presence of cirrhosis, poor functional reserve, bilobar disease, proximity to major vascular structures and patients with increased operative risk. The size of the lesion range from 2 to 20 cm (mean 5.6 cm) and the median time of ablation was 30.2 min (range 5-50 min). Two minor complications (6.6%) and no operative mortality were recorded. At 18 months of follow-up, 23 patients (76.6%) are still alive and seven patients have died for tumor progression. CONCLUSION: Radiofrequency ablation is a safe procedure that allows local control of the disease with satisfactory results, when the surgical resection is not feasible.

[Electronic Apex Locator as a dental instrument].

Electronic Apex Locators (EAL) have become widely used in the last decade. The first apex locator was introduced in 1962, based on a constant electrical resistance (6.5 K.) between the oral mucosa and periodontal ligament. The first and second generations of EAL were inaccurate and could not detect the apex in the presence of conducting fluids. The third generation solved this problem by using two alternating frequencies and calculating the impedance between them. This provided reliable and accurate results in dry canals, or in the presence of blood, electrolytes or other fluid in the root canals, when the pulp was necrotic or when there was a perforation along the root. The Root ZX and Apit (Endex) are the most documented devices. The new fourth generation of apex locators is a diverse group: some use multifrequency currents, others use a "lookup matrix" rather than calculate the readings. Several of the newer EALs are smaller, and others connect to computers.

Angiolipoma renal con extensión tumoral a vena cava inferior y aurícula derecha / Left kidney angiomyolipoma, spreading to the renal vein, inferior vena cava and involving the heart: report of one case

El angiomiolipoma renal es un tumor benigno mesenquimático. Constituyen sólo del 2 al 6 por ciento de los tumores renales. Existen alrededor de 12 casos reportados con invasión a las venas renales y la cava inferior. En menos de 5, hay extensión de trombo tumoral hasta aurícula derecha. Objetivo: Presentar el caso clínico, manejo y evolución de una paciente con un angiomiolipoma renal con extensión tumoral a vena renal y cava inferior y que compromete la cavidad auricular derecha casi en su totalidad. Paciente y método: 50 años, sexo femenino con hallazgo del tumor por un ultrasonografía abdominal motivada por el estudio de síntomas digestivos de origen probablemente funcional. Se confirma el diagnóstico con TAC y ecocardiograma doppler. Se realiza una cirugía combinada, abdominal y esternotómica, con la ayuda de un by pass aortopulmonar. Resultados: Nefrectomia izquierda, liberación intravascular del tumor que se empuja por cava inferior y se extrae en block por la aurícula derecha. Evoluciona inicialmente en forma satisfactoria, pero desarrolla distress respiratorio con angio TAC de tórax negativo para TEP a las 48 h de la cirugía. Se inicia anticoagulación empírica con HBPM y encontrándose extubada y en buenas condiciones hace un hemoperitoneo el día 14, encontrándose hemorragia en napa en los sitios de disección previa. De alta a los 21 días. El seguimiento alejado a los 2 años revela una hernia incisional, reparada sin incidentes, y sin otras complicaciones ni signos de recidiva de patología original. Conclusión: El manejo de equipo multidisciplinario nos permitió ayudar exitosamente a esta paciente con patología rara y compleja.

Renal angiomyolipoma is an uncommon benign tumor of mesenchymal origin. In less than five of 12 cases reported with renal vein and inferior vena cava involvement the thrombus extends to the right atrium. We report a 50 years old female with a left kidney angiomyolipoma, spreading to the renal vein, inferior vena cava and involving the heart, invading the right atrium almost completely. The tumor was found during a study for abdominal pain. She underwent combined abdominal and cardiac surgery with pulmonary bypass. A left nephrectomy, cavotomy and intravascular dissection of the tumor were performed. The intravascular mass was pushed from abdomen and pulled out through the right atrium. Forty eight hours after surgery, she developed respiratory distress. A chest angio CT scan negative for pulmonary thromboembolism. However, anticoagulation with low molecular weight heparin was started due to the high risk for thromboembolism. She recovered, but 14 days after the original surgery, presented a massive hemoperitoneum. She was operated again, finding a diffuse oozing from the sites of previous dissection. The dose of anticoagulation was lowered, with a good postoperative evolution, being discharged 21 days later. After two years of follow up, she developed an incisional hernia that is repaired.

Cost-effectiveness of referral for generic care or problem-solving treatment from community mental health nurses, compared with usual general practitioner care for common mental disorders: Randomised controlled trial.

BACKGROUND: UK general practitioners (GPs) refer patients with common mental disorders to community mental health nurses. AIMS: To determine the effectiveness and cost-effectiveness of this practice. METHOD: Randomised trial with three arms: usual GP care, generic mental health nurse care, and care from nurses trained in problem-solving treatment; 98 GPs in 62 practices referred 247 adult patients with new episodes of anxiety, depression and life difficulties, to 37 nurses. RESULTS: There were 212 (86%) and 190 (77%) patients followed up at 8 and 26 weeks respectively. No significant differences between groups were found in effectiveness at either point. Mean differences in Clinical Interview Schedule - Revised scores at 26 weeks compared with GP care were -1.4 (95% CI -5.5 to 2.8) for generic nurse care, and 1.1 (-2.9 to 5.1) for nurse problem-solving. Satisfaction was significantly higher in both nurse-treated groups. Mean extra costs per patient were 283 pound (95% CI154-411) for generic nurse care, and 315 pound (183-481) for nurse problem-solving treatment. CONCLUSIONS: GPs should not refer unselected patients with common mental disorders to specialist nurses. Problem-solving should be reserved for patients who have not responded to initial GP care.

A trial of problem-solving by community mental health nurses for anxiety, depression and life difficulties among general practice patients. The CPN-GP study.

OBJECTIVES: To compare the effectiveness of community mental health nurse (CMHN) problem-solving and generic CMHN care, against usual general practitioner (GP) care in reducing symptoms, alleviating problems, and improving social functioning and quality of life for people living in the community with common mental disorders; and to undertake a cost comparison of each CMHN treatment compared with usual GP care. DESIGN: A pragmatic, randomised controlled trial with three arms: CMHN problem-solving, generic CMHN care and usual GP care. SETTING: General practices in two southern English counties were included in the study. CMHNs were employed by local NHS trusts providing community mental health services. PARTICIPANTS: Participants were GP patients aged 18--65 years with a new episode of anxiety, depression or reaction to life difficulties and had to score at least 3 points on the General Health Questionnaire-12 screening tool. Symptoms had to be present for a minimum of 4 weeks but no longer than 6 months. INTERVENTIONS: Patients were randomised to one of three groups: (1) CMHN problem-solving treatment, (2) generic CMHN treatment, or (3) usual GP care. All three groups of patients remained free to consult their GPs throughout the course of the study, and could be prescribed psychotropic drug treatments. MAIN OUTCOME MEASURES: Patients were assessed at baseline, and 8 weeks and 26 weeks after randomisation. The primary outcome measure was psychological symptoms measured on the Clinical Interview Schedule -- Revised. Other measures included social functioning, health-related quality of life, problem severity and satisfaction. The economic outcomes were evaluated with a cost--utility analysis. RESULTS: Twenty-four CMHNs were trained to provide problem-solving under supervision, and another 29 were referred patients for generic support. In total, 247 patients were randomised to the three arms of the study, referred by 98 GPs in 62 practices. All three groups of patients were greatly improved by the 8-week follow-up. No significant differences were found between the groups at 8 weeks or 26 weeks in symptoms, social functioning or quality of life. Greater satisfaction with treatment was found in the CMHN groups. CMHN care represented a significant additional health service cost and there were no savings in sickness absence. CONCLUSIONS: The study found that specialist mental health nurse support is no better than support from GPs for patients with anxiety, depression and reactions to life difficulties. The results suggest that healthcare providers could consider adopting policies of restricting referrals of unselected patients with common mental disorders to specialist CMHNs, although there may be other roles in primary care that CMHNs could play effectively. Further research should address the predictors of chronicity in common mental disorders and target extra treatment. More research is also needed into the effectiveness and cost-effectiveness of problem-solving treatment for other disorders, of facilitated self-help treatments for common mental disorders and of CMHN care for people with severe and enduring mental illnesses, as well as the prevention of mental disorders.

[Diffuse pulmonary ossification associated with idiopathic pulmonary fibrosis]. / Osificación pulmonar difusa asociada a fibrosis pulmonar idiopática.

Diffuse pulmonary ossification is a rare entity that presents with the formation of mature bone in the pulmonary parenchyma and is associated with diffuse and chronic lung disease, heart disease, or other system disorders. Diffuse pulmonary ossification is usually a postmortem finding by the pathologist. In the case we report, the diagnosis was established by open lung biopsy. The patient was a 79-year-old man with dyspnea, dry cough, and weight loss. He had been a smoker. A chest x-ray revealed reticulonodular bilateral pulmonary infiltrates. Computed tomography revealed interstitial disease predominantly in the septum with multiple cavitations that tended to form honeycomb patterns. Pleural thickening, retraction of the parenchyma, and bilateral fibrosis were also visible. A clinical diagnosis of interstitial fibrosis was established and the patient s course was unfavorable. An open lung biopsy was performed. The lung tissue specimens revealed zones with collapsed alveoli and others with emphysema, some of which produced secretion and erythrocytic extravasation. Interstitial vascular congestion was apparent; bronchioles presented mononuclear and some polymorphonuclear inflammatory infiltrates. Noteworthy was the presence of predominantly interstitial, multicentric foci of osseous trabeculae --some of which included adipose bone marrow. Diffuse pulmonary ossification is usually an incidental finding in autopsies of patients with a history of diffuse chronic pulmonary disease, but it is an unusual diagnosis in living patients. Diffuse pulmonary ossification is of no prognostic significance in pulmonary fibrosis. It is a marker of the chronicity and/or severity of the fibrosis.

[Characterization of patients with suspected diagnosis of dengue in the outbreak of 1997]. / Caracterización de pacientes con diagnóstico presuntivo de dengue en el brote epidémico del año 1997.

We reviewed the medical histories of the 778 patients admitted to the Military Hospital of Santiago de Cuba with presumptive diagnosis of dengue which was clinically and epidemiologically confirmed in 423 on discharge and in 24 patients from the clinical epidemiological and immunological viewpoints. From the total number of patients we selected 54 having alert signs, who were classified by age, sex, clinical manifestations and development since they arrive at the Emerging Department at 8, 24 and 72 h later and at 5 days. Data were manually and automatically processed with an ACER-500 computer. The disease was predominant in males under 50 years of age and, in one third of the patients with the alert signs, the disease was immunologically verified. The more acute clinical picture was observed between 8 h and 24 h of the process but there was no death by this cause.

Tumor de pelvis renal / Renal pelvis tumor

Los tumores primarios de la pelvis renal son relativamente raros y no alcanzan el 5 por ciento de los tumores renales. De estos el 90 por ciento corresponden a tumores de células transicionales. La presentación clínica es inespecífica. El estudio imagenológico más usado es la pielografía endovenosa y el ultrasonido; pero el TAC permite una mejor evaluación local y regional del tumor. En esta revisión del tumor de células transicionales de la pelvis renal enfatizamos en los hallazgos radiológicos, estadios y tratamientos

Cutaneous leishmaniasis in south-eastern Paraguay: a study of an endemic area at Limoy.

An epidemiological study was performed on leishmaniasis in a newly established community in south-eastern Paraguay. 149 persons, of 172 inhabitants, were thoroughly examined by clinical, parasitological and immunological (leishmanin skin test) examinations. 88 of those examined (59%) were clinically positive for dermal and nasal (mucosal) lesions or dermal scars, while 74 (50%) were positive by the leishmanin test. Of the 88 persons, 66 (75%) were positive for both leishmanial (dermal and nasal) signs and skin test; these subjects were therefore considered to be leishmaniasis patients. Most of the patients (60%) had a single dermal lesion. Among the 66 leishmaniasis patients, serious mucosal (nasal septum) lesions were observed in the 41 subjects: 2 had destruction of the septum, 8 had ulceration and 31 had erythema. In this community the persons with dermal and/or nasal problems had been treated with meglumine antimonate (Glucantime), without any precise diagnosis having been made by parasitological or immunological examination. The socio-economical and socio-medical points of view aspects are discussed.

[Intrahemorrhagic esophagogastroduodenofibroscopy. Survey in the city of Rosario]. / Esofagogastroduodenofibroscopias intrahemorrágicas. Encuesta en la ciudad de Rosario.

1.897 patients with upper gastrointestinal bleeding (UGIB) were studied and the cause was diagnosed in 1.756 (92.6%). The most frequently found pathology was the acute bleeding gastropathy (24.5%). Considering the gastric duodenal and anastomotic ulcer as a whole, in 47.5% of the cases the ulcer was observed. Both pathologies together make out that 72 out of 100 patients with UGIB have bleeding due to an ulcer or gastritis. It comes out that the low incidence of neoplasy as a consequence of UGIB and that the 31% of the diagnosed pathology could not have been diagnosed by X-ray.

Esofagogastroduodenofibroscopias intrahemorrágicas. Encuesta en la ciudad de Rosario. / [Intrahemorrhagic esophagogastroduodenofibroscopy. Survey in the city of Rosario]

1.897 patients with upper gastrointestinal bleeding (UGIB) were studied and the cause was diagnosed in 1.756 (92.6

). The most frequently found pathology was the acute bleeding gastropathy (24.5

). Considering the gastric duodenal and anastomotic ulcer as a whole, in 47.5

of the cases the ulcer was observed. Both pathologies together make out that 72 out of 100 patients with UGIB have bleeding due to an ulcer or gastritis. It comes out that the low incidence of neoplasy as a consequence of UGIB and that the 31

of the diagnosed pathology could not have been diagnosed by X-ray.

Esofagogastroduodenofibroscopias intrahemorrágicas. Encuesta en la ciudad de Rosario / [Intrahemorrhagic esophagogastroduodenofibroscopy. Survey in the city of Rosario]

1.897 patients with upper gastrointestinal bleeding (UGIB) were studied and the cause was diagnosed in 1.756 (92.6

). The most frequently found pathology was the acute bleeding gastropathy (24.5

). Considering the gastric duodenal and anastomotic ulcer as a whole, in 47.5

of the cases the ulcer was observed. Both pathologies together make out that 72 out of 100 patients with UGIB have bleeding due to an ulcer or gastritis. It comes out that the low incidence of neoplasy as a consequence of UGIB and that the 31

of the diagnosed pathology could not have been diagnosed by X-ray.