[Radiological diagnostic approach to idiopathic interstitial pneumonias: findings in high resolution computed tomography]. / Aproximación al diagnóstico radiológico de las neumonías intersticiales idiopáticas. Hallazgos en tomografía computarizada de alta resolución.

A review is presented on the histological and radiological findings in idiopathic interstitial pneumonias, which are included among the diffuse parenchymal lung diseases. Although they may affect other compartments, the lung interstitium is the initial substrate of the parenchymal lesion due to different patterns of inflammation and fibrosis. The current classification, proposed in 2002 as an international multidisciplinary consensus document promoted by the American Thoracic Society and the European Respiratory Society, includes 7 conditions. Based on histological criteria, each histological pattern is associated with an image pattern. They are a group of conditions of unknown origin with common characteristics and differential features that enable them to be individualised as diseases with a different prognosis and treatment. They are rare as idiopathic forms, but share a morphological substrate with other more common diseases of unknown cause, which means they have to be excluded to reach a definitive diagnosis. For this reason it is important that the radiologist is familiar with their characteristic imaging findings.

Prospectus of waste stabilization ponds in Ceará, Northeast Brazil.

WSP technology has been used in Ceará, Northeast Brazil, since middle 1970s. There are presently 96 ponds plants and most of them are comprised by single cells (40%) and series of 3 ponds (35%). They were under loaded due to incomplete house connections to the sewerage network and low per capita wastewater contributions. Highest removal rates of organic material, ammonia and faecal coliform were found in 3 pond series. Faecal coliform removal was in accordance with the literature and series of ponds reached numbers ≤10(5) cells/100 ml. In series with 4 and 5 ponds FC was below 10(3) cells/100 ml. Ammonia removal varied from 30 to 80% and total phosphorus the removal was not significant. An increase in the number of maturation ponds enhances nutrient and coliform removal. Up-grading schemes should be investigated as well as effluent reuse potential.

Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: results from the electronic Schizophrenia Treatment Adherence Registry (e-STAR).

BACKGROUND: The electronic Schizophrenia Treatment Adherence Registry (e-STAR) is a prospective, observational study of patients with schizophrenia designed to evaluate long-term treatment outcomes in routine clinical practice. METHODS: Parameters were assessed at baseline and at 3 month intervals for 2 years in patients initiated on risperidone long-acting injection (RLAI) (n=1345) or a new oral antipsychotic (AP) (n=277; 35.7% and 36.5% on risperidone and olanzapine, respectively) in Spain. Hospitalization prior to therapy was assessed by a retrospective chart review. RESULTS: At 24 months, treatment retention (81.8% for RLAI versus 63.4% for oral APs, p<0.0001) and reduction in Clinical Global Impression Severity scores (-1.14 for RLAI versus -0.94 for APs, p=0.0165) were significantly higher with RLAI. Compared to the pre-switch period, RLAI patients had greater reductions in the number (reduction of 0.37 stays per patient versus 0.2, p<0.05) and days (18.74 versus 13.02, p<0.01) of hospitalizations at 24 months than oral AP patients. CONCLUSIONS: This 2 year, prospective, observational study showed that, compared to oral antipsychotics, RLAI was associated with better treatment retention, greater improvement in clinical symptoms and functioning, and greater reduction in hospital stays and days in hospital in patients with schizophrenia. Improved treatment adherence, increased efficacy and reduced hospitalization with RLAI offer the opportunity of substantial therapeutic improvement in schizophrenia.

[Delays in the diagnosis of lung cancer]. / Demoras diagnósticas en el cáncer del pulmón.

OBJECTIVE: To study the clinical and demographic factors associated with delays in the diagnosis of lung cancer. PATIENTS AND METHODS: A 2-year prospective study of patients admitted to the respiratory medicine ward with a suspected diagnosis of lung cancer. We studied demographic factors, health care received, place of residence, and delays in carrying out diagnostic procedures. The following diagnostic time periods were defined: consultation (from first symptom to first medical visit), middle period (from first medical visit to hospital admission) and diagnostic (from hospital admission to histological diagnosis and clinical staging). RESULTS: One hundred thirteen patients with a mean age of 65 years (range, 36-90), 103 men and 10 women, were studied. The most frequent symptoms leading to consultation were coughing (10.6%), hemoptysis (19.5%), chest pain (26.5%), and shortness of breath (9.7%). First visits were to a primary care physician for 72%, to the hospital emergency room for 22%, or to a pulmonologist for 6%. Forty-four percent of the patients visited the doctor 2 or 3 times. The mean SD, numbers of days for the different time periods were as follows: consultation, 30.3 60; diagnosis, 18.6 19; middle period 37.9 63. The mean total time from first symptom to diagnosis was 85.7 87 days. The middle period, the time in hospital until diagnosis, and the total time were shorter when patients were referred by the primary care physician to the emergency room or were directly admitted to the hospital (P<.001). Only 25.7% of the staged lung cancers were operable. CONCLUSIONS: Delays in lung cancer diagnosis are long. The attitudes of primary care physicians and their relations with specialized care providers are crucial for reducing delays.

Abrus and ricinus ingestion: management of three cases.

Three instances of toxic bean ingestion, all in the course of 1 week in the St. Louis area, have led us to submit this article. One case of jequirty bean (Abrus precatorius L.) and two of castor bean (Ricinus communis L.) were treated at Cardial Glennon Memorial Hospital for Children during the third week of August in 1979. These seeds contain phytotoxins which are among the most potent toxic principles known to man.