Anoxic phases are the main N2O contributor in partial nitritation reactors treating high nitrogen loads with alternate aeration.

Partial nitritation (PN) reactors treating complex industrial wastewater can be operated by alternating anoxic-aerobic phases to promote heterotrophic denitrification via NO2(-). However, denitrification under stringent conditions can lead to high N2O production. In this study, the suitability of including anoxic phases in a PN-SBR treating real industrial wastewater was assessed in terms of process performance and N2O production. The PN-SBR was operated successfully and, when the HCO3(-):NH4(+) molar ratio was adjusted, produced a suitable effluent for a subsequent anammox reactor. 10-20% of the total influent nitrogen was removed. N2O production accounted for 3.6% of the NLR and took place mainly during the anoxic phases (60%). Specific denitrification batch tests demonstrated that, despite the availability of biodegradable COD, NO2(-) denitrification advanced at a faster rate than N2O denitrification, causing high N2O accumulation. Thus, the inclusion of anoxic phases should be avoided in PN reactors treating industrial wastewaters with high nitrogen loads.

Interactions between spatially explicit conservation and management measures: implications for the governance of marine protected areas.

Marine protected areas are not established in an institutional and governance vacuum and managers should pay attention to the wider social-ecological system in which they are immersed. This article examines Islas Choros-Damas Marine Reserve, a small marine protected area located in a highly productive and biologically diverse coastal marine ecosystem in northern Chile, and the interactions between human, institutional, and ecological dimensions beyond those existing within its boundaries. Through documents analysis, surveys, and interviews, we described marine reserve implementation (governing system) and the social and natural ecosystem-to-be-governed. We analyzed the interactions and the connections between the marine reserve and other spatially explicit conservation and/or management measures existing in the area and influencing management outcomes and governance. A top-down approach with poor stakeholder involvement characterized the implementation process. The marine reserve is highly connected with other spatially explicit measures and with a wider social-ecological system through various ecological processes and socio-economic interactions. Current institutional interactions with positive effects on the management and governance are scarce, although several potential interactions may be developed. For the study area, any management action must recognize interferences from outside conditions and consider some of them (e.g., ecotourism management) as cross-cutting actions for the entire social-ecological system. We consider that institutional interactions and the development of social networks are opportunities to any collective effort aiming to improve governance of Islas Choros-Damas marine reserve. Communication of connections and interactions between marine protected areas and the wider social-ecological system (as described in this study) is proposed as a strategy to improve stakeholder participation in Chilean marine protected areas.

Nuevos anticoagulantes orales en la prevención del ataque cerebrovascular / New oral anticoagulants in stroke prevention

Introduction: Atrial fibrillation (AF) is the most common arrhythmia. AF increases stroke risk by 5-fold and accounts for 15 percent of stroke. For more than 50 years, vitamin K antagonists were the only available oral anticoagulation. The two major classes of novel oral agents are direct thrombin inhibitors (dabigatran) and factor Xa inhibitors (apixaban or rivaroxaban). These new agents require no routine laboratory monitoring and they are administered in a fixed dose. Method: A non systematic literature review was performed. Results: We performed a critical review of articles about new oral anticoagulants in stroke prevention. We evaluated properties of these agents and we compare efficacy and safety outcomes shown in clinical trials about new oral anticoagulants in AF. Discussion: New oral anticoagulants are at least as good as warfarin at preventing stroke in patients with AF. They seem to be safer than warfarin with significantly less intracranial bleeding. Trials demonstrate dabigatran to be the most effective in decreasing ischemic strokes, apixaban superior to warfarin with statistically lower mortality, and rivaroxaban no worse than warfarin for those with higher stroke risk. Conclussion: New oral anticoagulants have several advantages in comparison with warfarin, but we need further trials to know better the efficacy and safety of these new agents.

Introducción: La fibrilación auricular (FA) es la arritmia más frecuente, se asocia a un riesgo 5 veces mayor de ataque cerebrovascular (ACV), y da cuenta del 15 por ciento de los ACV isquémicos. Por más de medio siglo el tratamiento anticoagulante oral en FA ha estado limitado al uso de antagonistas de la vitamina K. Los nuevos anticoagulantes orales, se clasifican en dos categorías principales: inhibidores de la trombina como el dabigatrán y los inhibidores del factor Xa, como el apixabán y el rivaroxabán. Estos fármacos no requieren monitorización de los niveles de anticoagulación y se administran en dosis fija. Método: Revisión no sistemática de la literatura. Resultados: Se analizan de manera crítica los artículos sobre nuevos anticoagulantes orales en la prevención de ACV. Se evalúan las propiedades de estos nuevos agentes y se comparan los desenlaces de eficacia y de seguridad de los ensayos clínicos de los estos fármacos. Discusión: Los nuevos anticoagulantes orales son al menos tan efectivos que la warfarina en la prevención de ACV cardioembólico en pacientes con FA. Parecen ser más seguros con menor frecuencia de hemorragia intracranial. El dabigatrán es el más efectivo en disminuir el ACV isquémico, el apixabán es superior a la warfarina con una mortalidad significativamente inferior, y el rivaroxabán es no inferior a warfarina para pacientes con alto riesgo de ACV. Conclusión: Los nuevos anticoagulantes orales ofrecen varias ventajas en comparación a warfarina, sin embargo, se requiere se estudios adicionales para conocer más detalladamente su efectividad y perfil de seguridad.

Sobrevida global y por estadios de 137 pacientes con cáncer intraoral: experiencia del Instituto Nacional del Cáncer / Analysis of survival of 137 patients with oral cancer

Background: Oral cancer accounts for 1 percent of cancer mortality. It is more common in men but its frequency is increasing in women due to their growing smoking habits. Aim: To report the experience in the management of a cohort of patients with oral cancer. Material and Methods: Review of medical records of patients with oral cancer treated between 1989 and 2004. Demographic and clinical data were recorded and survival was determined examining death certificates or information obtained from the medical records. Results: Data from 137 patients aged 61 +/- 14 years (98 males) was analyzed. Global survival five years survival was 57 percent. Survival for stages I, II, III and IV was 86, 67, 52 and 51 percent respectively. Conclusions: The survival of these patients is very similar to that reported abroad.

El cáncer intraoral representa un 1 por ciento de la mortalidad por cáncer. Ocurre predominantemente en hombres aunque la frecuencia en mujeres se ha incrementado en los últimos 20 años debido al creciente consumo de tabaco en este grupo. Son cuadros complejos que requieren un manejo integrado de múltiples especialistas. El objetivo de este trabajo es presentar la experiencia del Instituto Nacional del Cáncer (INC) en el manejo de una cohorte de 137 casos tratados y seguidos en esta institución entre 1989 y 2004. La población tratada corresponde predominantemente a hombres (71,5 por ciento) con edad promedio de 61 años. La sobrevida global fue de 57 por ciento a 5 años, por estadíos la sobrevida fue de 86 por ciento en etapa I, 67 por ciento en etapa II, 52 por ciento en etapa III y 51 por ciento en etapa IV Estos resultados son comparables con otros centros oncológicos del extranjero y son reflejo del adecuado manejo de los pacientes.

Excision and anastomotic repair for urethral stricture disease: experience with 150 cases.

PURPOSE: To analyze the results of a series of end-to-end urethroplasties performed in our service from 1968 to 1995 and of the factors contributing to failure. MATERIAL AND METHODS: 150 men (mean age 35.9 years) with urethral stricture disease underwent excision of the stricture and end-to-end anastomosis; in 95 it was the first attempt at repair while in 55 it was a secondary attempt. Eighty-two patients (54.6%) had a trauma-related stricture; of them, 56 followed a pelvic ring fracture with posterior urethra distraction defect, 24 (16%) had inflammatory strictures, 26 (17.3%) iatrogenic, 9 (6%) congenital, and 9 (6%) of unknown etiology; 81 (54%) were located in the bulbous urethra, 9 (6%) in the penoscrotal junction and 2 (1.3%) in the penile urethra. Ninety-one (60.6%) of the strictures or obliterative defects measured between 1 and 3 cm, 42 (28%) less than 1 cm and only 16 (10.6%) more than 3 cm. A perineal approach was used in 138 of the cases, while combined abdominoperineal route was necessary in 12; of these, 5 were children. The follow-up has ranged from 6 to 168 months (mean 44.4). The results were classified as good, fair (some re-stricturing, not needing treatment) and poor (recurrence). RESULTS: One hundred and twenty-six (84%) good outcomes, 10 (6.6%) fair, 14 (9.3%) poor. The factors influencing success or failure were: (1) primary or secondary character of the operation; (2) etiology; (3) length, and (4) location. Postoperative early complications consisted of 2 wound infections and 2 hematomas; as late complications, 1 chordee, 2 incontinence, 7 erectile dysfunction (in previously potent patients). The 14 patients considered as failures were operated again, all successfully; in 4 of them, a repeat excision and end-to-end anastomosis was performed, elevating the final success rate of the series to 93.3%. CONCLUSION: Excision and anastomotic repair represent the optimal mode of stricture repair for single lesions located from the penoscrotal junction to the membranous part of the urethra.

Genitourinary malakoplakia.

Between 1973 and 1991, 13 patients with malakoplakia (MKP) have been diagnosed and treated. The lesions involved all sites in the genitourinary tract; 2 patients had multiple and 11 had single lesions. Treatment was based on 2 criteria: (a) pharmacological treatment with trimethoprim-sulphamethoxazole and/or ascorbic acid and/or bethanechol chloride; (b) excision of the MKP lesion either endoscopically or by open surgery. Two patients died (1 from multiple MKP and the other from a myocardial infarct); the remainder did well. The pathogenic, diagnostic and therapeutic aspects of the disease are discussed.

[Necrotizing vasculitis in the bladder]. / Vasculitis necrotizante localizada en vejiga.

The necrotizing lesion that affects the small and medium-sized arteries, commonly known as polyarteritis nodosa (PAN), usually have a systemic and variable involvement. Urothelial involvement at the level of the two ureters has been rarely described. We report a case of necrotizing vasculitis localized to the bladder that had manifested clinically as gross hematuria.

[A Foley-type catheter with a steerable tip]. / Sonda de tipo Foley con extremo dirigido.

Permanent bladder catheterization for medical or social reasons increases the risk of complications, especially urinary infection. We evaluated the usefulness of the balloon catheter with a steerable intravesical tip in reducing the volume of residual urine between the bladder neck and the balloon of the conventional Foley catheter. The results show that this new catheter affords no additional advantage over the conventional catheter.

[The imaging diagnosis of adrenal tumors]. / Diagnóstico por imagen de los tumores suprarrenales.

From 1967 to 1991 we have diagnosed and treated 73 adrenal tumors in 63 patients: 12 pheochromocytomas, 24 adrenal cortical adenomas, 15 hyperplasias, 16 carcinomas, 3 myelolipomas, 2 cysts and 1 neuroblastoma. We conducted a retrospective study to analyze the preoperative images obtained by different diagnostic techniques and attempted to correlate tumor size and site with the results of the histological analysis of the surgical specimen. Nephrotomography with pneumoretroperitoneum and IV Nephrotomography were useful in detecting the increase of the size of the gland in 10 of 25 cases submitted to these procedures (40%). Arteriography as second or third technique of choice confirmed the presence of an adrenal tumor in 15 of the 21 cases evaluated by this procedure (70%). US and CT detected 94% (31/33) and 100% (33/33) of the cases, respectively. Fourteen cases were incidentally discovered by CT (7) and US (7). A direct relationship between tumor size and degree of malignancy could be established since the carcinomas had a mean diameter of 7 cm (range 5 to 12 cm). Concerning the histologic nature of the disease, specific images were found in 3 cases of adrenal myelolipoma (hyperechoic on US and of low density similar to fat on CT) and 2 cysts (anechoic with posterior band evidenced on us and liquid on CT). Radioisotopes were also utilized for tumor localization and there was positive uptake of I-131-IMBG in 2 cases of adrenal pheochromocytoma; 1 extra-adrenal (left lateral aortic paraganglioma) and 1 case of malignant adrenal pheochromocytoma with metastasis to the lungs.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacillus Calmette-Guerin versus doxorubicin versus thiotepa: a randomized prospective study in 202 patients with superficial bladder cancer.

We report the second interim analysis of data from a randomized prospective trial comparing the prophylactic effect of 15 courses of 50 mg. doxorubicin, 50 mg. thiotepa or 150 mg. bacillus Calmette-Guerin instilled intravesically against recurrences and progression of superficial transitional cell bladder cancer. Of 202 enrolled patients 176 currently are evaluable with a mean follow-up of 3 years (range 3 to 97 months). The number of patients with recurrences was significantly lower in the bacillus Calmette-Guerin arm (9 of 67) compared to the doxorubicin (23 of 53, p equals 0.002) and thiotepa (20 of 56, p equals 0.003) arms. The over-all recurrence index per 100 patient-months also was lower for the bacillus Calmette-Guerin versus the thiotepa and doxorubicin groups (0.53 versus 1.55 and 1.7, respectively). Bacillus Calmette-Guerin also was superior in preventing recurrences and progression of high risk tumors, that is stage T1, grade 3 or multiple growths, associated or not with carcinoma in situ. In the stage T1 category 19 of 32 (60%) tumors recurred under treatment with doxorubicin, 11 of 33 (33%) with thiotepa and 6 of 49 (12%) with bacillus Calmette-Guerin. Toxicity to intravesical bacillus Calmette-Guerin was higher compared to the other drugs but it was not limiting: bladder irritability and malaise occurred in 42% of the patients, granulomatous cystitis in 16.4% and bladder contraction in 1.4% (1 of 64). The latter complication occurred in a patient whose stage T1m grade 2 tumors had recurred 3 times, who underwent 3 transurethral bladder resections within 15 months and who had received thiotepa for 4 months after having been removed from the study 11 months after entry. Three patients in the doxorubicin group (5.6%) underwent radical cystectomy for local urothelial progression. One patient (1.8%) in the same group died of distant progression. Our preliminary results suggest that at the dose, periodicity and duration used in the study bacillus Calmette-Guerin is significantly superior to the chemotherapeutic agents doxorubicin and thiotepa for the prophylaxis of recurrence and retardation of progression in superficial transitional cell bladder tumors.

[Management of injury of the solitary kidney]. / Conducta ante el traumatismo en riñón único.

Two cases of renal trauma are described herein. The diagnostic work up revealed the patients had solitary kidney. Trauma was classified as grade 1 and 2 and a conservative approach was adopted. The patient with grade 2 trauma was submitted to surgery one month following treatment. Preservation of the renal unit was achieved in both patients. Patient follow up at 16 years revealed no complications or sequelae from the injury. The diagnostic and therapeutic aspects of renal trauma in patients with solitary kidney are discussed.

[Evaluation of extravesical ureteroneocystostomy in kidney transplantation]. / Evaluación de la ureterocistoneostomía extravesical en el trasplante renal.

The present study evaluates extravesical ureteroneocystostomy, the technique used for reconstruction of the urinary tract in 120 kidney transplants. The urological complications ascribable to this technique were observed in 10% (12/120) and consisted of urinary extravasation (10), and ureteric obstruction (2). The treatment of the foregoing complications, which was successful in 8 cases, is described. The indications and advantages afforded by this technique in renal transplantation are discussed.

Intravesical therapy comparing BCG, adriamycin, and thiotepa in 200 patients with superficial bladder cancer: a randomized prospective study.

This report presents the second interim analysis of data from a randomized prospective trial that compares the prophylactic effect of 15 intravesical instillations of 50 mg Doxorubicin (ADM), 50 mg of Thiotepa (TTPA), or 150 mg of Bacillus Calmette-Guérin (BCG) against recurrence and progression of superficial transitional cell bladder cancer. Of 202 enrolled patients, 176 patients are currently evaluable after a mean follow-up of 3 years (range, 3-97 months). The number of patients with recurrence was significantly lower in the BCG group (9/67) than in the ADM group (23/53, p = 0.002) or the TTPA group (20/56, p = 0.003). The overall recurrence index per 100 patient-months was also significantly lower for the BCG group (BCG vs. ADM, p = 0.07; BCG vs. TTPA, p = 0.001; TTPA vs. ADM, not significant). BCG was superior in preventing recurrence and progression of high risk tumors (T1, G2-3, multiple growth, and tumors associated with carcinoma in situ). The recurrence in this group of high risk tumors was for ADM treated patients 12/17, for TTPA treated patients 10/17 and for BCG treated patients 5/23 (BCG vs. ADM, p = 0.002; BCG vs. TTPA, p = 0.016; TTPA vs. ADM, not significant). Toxicity of intravesical BCG was higher than that of the other drugs, but not limiting the treatment. Bladder irritability occurred in 42% of the patients, granulomatous cystitis in 16.4%, and bladder contraction in 1.5% of the patients. Two patients of the ADM group (2/53 = 3.8%) underwent radical cystectomy for local urothelial progression. One patient (1.9%) in the same group died of distant metastases. The preliminary results suggest that BCG is significantly superior to the chemotherapeutic agents ADM and TTPA when used as an adjuvant intravesical therapy in superficial bladder cancer.