Multicenter study on multidisciplinary committees in advanced prostate cancer.

INTRODUCTION AND OBJECTIVE: Although Multidisciplinary Teams (MDTs) are recommended in the management of Advanced Prostate Cancer (APC), their functioning in real practice has been poorly evaluated. We carried out a multicenter study with the objective of evaluating the functioning of uro-oncology MDTs in 6 hospitals. MATERIALS AND METHODS: A descriptive cross-sectional study was performed. The level of Compliance with the Fundamental Quality Requirements (CFQR) of the MDTs was evaluated by means of a questionnaire filled out by the coordinators of the MDTs in each hospital. The information on the perspective of the members of the MDTs was evaluated through an anonymous survey. RESULTS: A high level of CFQR in MDTs was evidenced (75%), showing deficiencies in terms of protocol update, agendas, audits, and scientific production. The survey was answered by 62.32% of the 69 physicians surveyed (urologists, oncologists, radiation therapists, radiologists, and pathologists). The 88.4% consider the duration of the meetings appropriate. There are disparate opinions concerning the protection of the MDT meeting time as well as protocol update. Of the patients with APC presented at the MDTs meeting, 62,8% require intervention from two specialties. Only 50% of respondents believe that all CRPC cases are discussed and that there is a prior agenda. The decisions made by the MDTs are reflected in the clinical history in 65.1% and are binding only in 60.5% of the cases. Half of the respondents have not been trained in MDTs. Most participants (90.7%) agree on the fact that MDTs. convey benefits. CONCLUSIONS: The evaluations of the MDTs identify rectifiable deficiencies by modifying hospital inertia and care planning.

Treatment of discontinuous emission of sewage sludge odours by a full scale biotrickling filter with an activated carbon polishing unit.

A SULPHUSTM biotrickling filter (BTF) and an ACTUSTM polishing activated carbon filter (ACF) were used at a wastewater treatment plant to treat 2,432 m3·h-1 of air extracted from sewage sludge processes. The project is part of Thames Water's strategy to reduce customer odour impact and, in this case, is designed to achieve a maximum discharge concentration of 1,000 ouE·m-3. The odour and hydrogen sulphide concentration in the input air was more influenced by the operation of the sludge holding tank mixers than by ambient temperature. Phosphorus was found to be limiting the performance of the BTF during peak conditions, hence requiring additional nutrient supply. Olfactometry and pollutant measurements demonstrated that during the high rate of change of intermittent odour concentrations the ACF was required to reach compliant stack values. The two stage unit outperformed design criteria, with 139 ouE·m-3 measured after 11 months of operation. At peak conditions and even at very low temperatures, the nutrient addition considerably increased the performance of the BTF, extending the time before activated carbon replacement over the one year design time. During baseline operation, the BTF achieved values between 266-1,647 ouE·m-3 even during a 6 day irrigation failure of the biofilm.

Orbital involvement by non-Hodgkin lymphoma NK T cells.

CLINICAL CASE: The case is presented of 37 year-old male with a history of nasal obstruction with right rhinorrhea, headache, hearing loss and right exophthalmos of 4 months progression. The MRI revealed that the ethmoidal and maxillary sinuses contained inflammatory tissue extending into the orbital region. The biopsy confirmed a non-Hodgkin lymphoma of natural killer (NK) T cells. DISCUSSION: Non-Hodgkin's T NK lymphoma is a rare tumor in the orbital area that requires an early detection and multi-disciplinary care to ensure appropriate monitoring and treatment.

Synovial cysts of the temporomandibular joint: an immunohistochemical characterization and literature review.

Synovial cysts of the temporomandibular joint (TMJ) are very rare, and to date, only 12 cases of a synovial cyst in the TMJ region have been reported in the literature. In this paper, we present the clinicopathological and immunohistochemical characteristics of one such lesion affecting a 48-year-old woman, presented with a mass in the left preauricular region. We describe the usefulness of immunohistochemical analysis for recognizing the synovial lining, which allowed for clear differentiation between ganglion and synovial cysts. Immunohistochemical analyses can be used to diagnose synovial cysts with certainty; however, using at least two markers is advisable to distinguish the two existing synovial cell subtypes. Our findings indicate that synovial cysts of TMJ possess an internal lining dominated by type B (fibroblast-like) synoviocytes.

Control of VOC emissions from a flexographic printing facility using an industrial biotrickling filter.

The study of an industrial unit of biotrickling filter for the treatment of the exhaust gases of a flexographic facility was investigated over a 2-year period with the objective to meet the volatile organic compound (VOC) regulatory emission limits. Increasing the water flow rate from 2 to 40 m(3) h(-1) improved the performance of the process, meeting the VOC regulation when 40 m(3) h(-1) were used. An empty bed residence time (EBRT) of 36 s was used when the inlet air temperature was 18.7 °C, and an EBRT as low as 26 s was set when the inlet temperature was 26.8 °C. During this long-term operation, the pressure drop over the column of the bioreactor was completely controlled avoiding clogging problems and the system could perfectly handle the non-working periods without VOC emission, demonstrating its robustness and feasibility to treat the emission of the flexographic sector.

Influence of ground tire rubber on the transient loading response of a peat biofilter.

The effect of using ground tire rubber (GTR) as an adsorptive material in the removal of a 2:1:1 weight mixture of n-butyl acetate, toluene and m-xylene by using a peat biofilter under different intermittent conditions was investigated. The performance of two identical size biofilters, one packed with fibrous peat alone and the other with a 3:1 (vol) fibrous peat and GTR mixture, was examined for a period of four months. Partition coefficients of both materials were measured. Values of 53, 118 and 402 L kg(-1) were determined for n-butyl acetate, toluene and m-xylene in peat, respectively; and values of 40, 609 and 3035 L kg(-1) were measured for the same compounds in GTR. Intermittent load feeding of 16 h per day, 5 days per week working at an EBRT of 60 s and an inlet VOC concentration of 0.3 g C m(-1), resulted in removal efficiencies higher than 90% for both biofilters, indicating that the addition of GTR did not adversely affect the behavior of the bioreactor. Full removal of n-butyl acetate was obtained for both biofilters. GTR improved the removal of the aromatics in the first part of the biofilter, facilitating lower penetration of the toluene and m-xylene into the bed. A 31-day starvation period was applied and intermittent operation subsequently restarted. In both biofilters, high removal efficiencies after a re-acclimation period of two days were achieved. A shock loading test related to 1-h peaks of three- and four-fold increases in its baseline concentration (0.30 g C m(-3)) was applied in both biofilters. For the biofilter packed with the peat and GTR mixture, attenuation greater than 60% was observed in the maximum outlet concentration when compared to the biofilter packed with peat alone.

Cryo-scanning electron microscopy and light microscopy for the study of fungi interactions.

The application of the cryo-scanning electron microscopy and light microscopy for the study of the interactions at different environmental conditions between Penicillium oxalicum and Fusarium verticillioides is described. A dual microculture was developed for the light microscopy analysis of the interaction. The microscope and macroscopic examinations were compared. Analysis of Petri plates revealed that F. verticillioides was a competitor for space and nutrients while P. oxalicum was a mycoparasite under the microscopic observations.

Study of the interactions between Penicillium oxalicum Currie & Thom and Alternaria alternata (Fr. ) Keissler

The aim of this research was the analysis of the possible antagonistic effect of Penicillium oxalicum over the pathogen rice fungus A. alternata under different conditions of temperature, water activity and culture media. The macroscopic study of the dual growth revealed that according to the Index of Dominance P. oxalicum was more competitive that A. alternata at 25ºC whereas at 15ºC was this species. Microscopic analysis showed that P. oxalicum was a mycoparasite of A. alternata at all conditions tested. The antagonist penetrated into A. alternata and disintegrated its conidiophores and conidia. The results suggests that P. oxalicum may be a possible biological control agent of the rice pathogens in a future.

Study of the interactions between penicillium oxalicum currie & thom and alternaria alternata (fr.) keissler.

The aim of this research was the analysis of the possible antagonistic effect of Penicillium oxalicum over the pathogen rice fungus A. alternata under different conditions of temperature, water activity and culture media. The macroscopic study of the dual growth revealed that according to the Index of Dominance P. oxalicum was more competitive that A. alternata at 25°C whereas at 15°C was this species. Microscopic analysis showed that P. oxalicum was a mycoparasite of A. alternata at all conditions tested. The antagonist penetrated into A. alternata and disintegrated its conidiophores and conidia. The results suggests that P. oxalicum may be a possible biological control agent of the rice pathogens in a future.

Suppression of Nigrospora oryzae (Berk. & Broome) Petch by an aggressive mycoparasite and competitor, Penicillium oxalicum Currie & Thom.

The objective of this research was to study by means of different techniques, the interaction between Penicillium oxalicum and Nigrospora oryzae under different temperatures (15 and 25 degrees C), water activities (0.95, 0.98, and 0.995) and culture media (rice and rice extract agar). In dual culture, P. oxalicum was dominant over N. oryzae in spite of presenting in the majority of cases, lower growth rates. The microscopic study revealed that P. oxalicum is a powerful mycoparasite, which attacks the conidiophores and the spores of N. oryzae, not only surrounding them, but also penetrating, deforming, destroying and developing reproductive structures inside them. The antagonist did not change its way of performance in the different tested conditions. Water activity and temperature showed a significant effect on fungus growth.

In vitro biocontrol analysis of Alternaria alternata (Fr.) Keissler under different environmental conditions.

The species Trichoderma harzianum was analyzed as possible biocontrol agent of Alternaria alternata under different environmental conditions (water activity and temperature). The strains were analyzed macroscopically to obtain the Index of Dominance. The analysis was completed using two microscopic techniques. T. harzianum showed dominance on contact over A. alternata at all testing temperatures and water activities tested except at 0.95 a(w) and 15 degrees C, at which T. harzianum inhibited A. alternata at a distance. Biocontrol was governed by different mechanisms such as competition for space and nutrients, mycoparasitism, and possible antibiosis. Temperature and water activity significantly influenced fungal growth rate.

Obstructive uropathy in a HIV+ infant under indinavir treatment.

The case is presented of a 10-year-old HIV+ male with renoureteral pain, who developed an obstructive uropathy with renal function impairment and required endoscopic placement of a ureteral stent. Certain aspects of the epidemiology, clinical presentation, diagnosis, treatment and prevention are discussed.

Renal donor implication in the origin of BK infection: analysis of genomic viral subtypes.

UNLABELLED: BK virus (BKV) reactivation in immunocompromised kidney transplant patients can produce a tubulointerstitial nephropathy (BKVN). Molecular tools that test for DNA-BKV provide early detection and assist in management, but some aspects of the pathogenesis of this infection, such as donor causality, remain unclear. MATERIALS AND METHODS: Between November 2004 and January 2006, 55 Spanish kidney donors were studied for BK infection. A quantitative PCR assay was performed on urine and serum to detect BKV. To determine the origin of the viral infection, a transcription control region of the BK polymorphism sequence was designed to identify the viral subtype. RESULTS: Fifteen of 55 (27%) donors were BK-PCR positive: 13 in urine and 2 in serum and urine. Moreover, monitoring of recipient pairs detected BK-PCR positivity in 14 of 73 recipients. We studied eight BK-PCR positive recipients (corresponding to four pairs) and their respective donors. The same viral genome was observed in the four pairs, namely, the A250-1-a, WW-like, AS, and JL genotypes. Interestingly, one of the four pairs showed the donor and the two recipients to display exactly the same JL genotype. CONCLUSION: On the basis of our preliminary results analyzing the molecular fingerprints of donor and recipient pairs, we have presented new data implicating the donor, in at least some cases, as the source of BK infection.

[Small cell carcinoma of the urinary bladder in a young man. A case report and literature review]. / Carcinoma vesical de células pequeñas en un varón joven. Presentación de un caso y revisión de la literatura.

Small cell carcinoma of the bladder is a rare entity characterized by an aggressive clinical behaviour with a high incidence of systemic metastases. We report a case of small cell carcinoma of the bladder in a young man. The primary local tumour was treated by radical surgery, pelvic radiation therapy and polychemotherapy according CDDP protocol. The patient died six months after surgery because disease progression. We also review and update the literature concerning this infrequently tumour.

[Comparison of diferents suburethral slings for the treatment of stress urinary incontinence]. / Estudio comparativo de diferentes procedimientos de sling suburetral para el tratamiento de la incontinencia urinaria de esfuerzo.

OBJECTIVES: To compare the results of the different procedures of sling suburetral used in our service (TVT, Sparc, IVS, Obtape and Monarc) for the treatment of the female urinary incontinence. MATERIAL AND METHODS: 96 patients retrospective analysis affects of female urinary incontinence and subjected to different procedures of sling suburethral without tension. The half age: 56.1 +/- 10.7 years. 75 patients were intervened by means of procedures retropubics (48 TVT, 17 Sparc, 10 IVS) and 21 with obturators (10 Obtape, 11 Monarc). The half time of pursuit: 26.3 +/- 12.7 months (29.4 months for the methods retropubics and 11.7 for the obturators). The analyzed variables were: age, obesity, grade of previous incontinence, type of used procedure, time of pursuit, and previous surgical procedures. We compare the complications and the results obtained with the different ones technical. RESULTS: the cure percentage was of 95.7%. 7 patients presented complications: one intestinal perforation, two bladders perforations, one erosion of vaginal wall, three incontinences of novo urgency. In 6 cases the stress incontinence persists. When analyzing the association between the diverse variables and the success, we appreciate that the variables with value presage were the age and the obesity (P < 0.05) not observing relationship with the technique employeed. CONCLUSIONS: The existence of multiple surgical approachs and a varied auxiliary materials allow each surgeon to choose that with the one that is more familiarized and comfortable without, seemingly, influence it in the results.

[Treatment of males with post-prostatectomy stress urinary incontinence by a mesh anchored to the ischio-pubic bones]. / Tratamiento de la incontinencia urinaria de esfuerzo post-prostatectomía radical mediante malla anclada a ramas isquiopubianas.

We presented the results of an alternative in the treatment of the stress urinary incontinence of male radical postprostatectomy. Is a technique of renewed interest in the last years, cradle in the procedure of Stamey, consisting of placing an on guard suburetral polypropylene mesh, anchored by means of screws to the isquiopubian branches. We have applied the procedure in 4 patients and with stress urinary incontinence of long evolution. After an average pursuit of 12.5 months, two patients present total continence, one has improved significantly and in the other the incontinence persists. There have been no postoperating complications nor rejection of the mesh. From these preliminary results and the reviewed bibliography, we thought that this technique can constitute an alternative to the artificial urinary sphincter, dices its clinical results, its facility of execution, the good tolerance and his low cost.

[Predictive value of progression of muscularis mucosae and percentage G3 cells in vesical TIG3 tumours]. / Valor predictivo de progresin de la muscularis mucosae y del porcentaje de células G3 en tumores vesicales T1G3.

INTRODUCTION AND OBJECTIVE: Vesical tumor T1G3 constitutes the border between the superficial tumor and the infiltrante tumor. Some of these tumors do not respond to BCG and progress, with cystectomy that present poor results, patients who would benefit from a precocious and aggressive treatment if we could identify them in an preinvasive stage. New predictive factors try to select to these tumors, being little the works that consider anatomo-pathological meticulous study (substanding of the T1 in T1a and T1b and percentage of present G3 cells in the tumor). Our objective is to analyze the value of these anatomo-pathological considerations like predictive factors of progression. MATERIAL AND METHODS: Retrospective study of a series of 91 patient affection of vesical tumor T1G3 with initial treatment by means of RTU and BCG. We analyzed 12 variables. The new predictive factors: the level of invasion respect to muscularis mucosae and the percentage of G3 cells. By means of logistic regression analisys we establish the independent pronostic factors for tumoral progression. RESULTS: A total of 31 patients presented infiltration of detrusor, passing away 17 of tumoral cause, after an average time of pursuit of 57.8 +/- 28.2 months. In 8 cases (9%) the substanding could not be determined. The rate of progression for T1a tumors was of 20% (8/40) and for T1b 53% (23/43). Presented independent predictive value of progression the multiplicity (odds: 7.26), the size (odds: 2.14), the presence of Cis (odds: 1.42) and the subestanding (odds: 6.81). CONCLUSION: The substanding is a predictive factor of progression clinically useful in vesical tumors T1G3, reason why we considered habitual clinical introduction.

[Prognostic value for progression of the regulating proteins of the cellular cycle in PT1G3 bladder tumours]. / Valor pronóstico de progresión de las moléculas reguladoras del ciclo celular en tumores vesicales T1G3.

INTRODUCTION AND OBJECTIVE: Bladder tumor T1G3 constitutes the group of superficial tumors more aggressive. New prognostic factors in the field of the cytogenetics and molecular biology have been analyzed, with often contradictory results, being little the specific works in tumors T1G3. Our objective is to determine if in this group of tumors the immunohistochemical markers present predictive value of clinically useful progression, and therefore with validity to indicate more suitable a precocious therapeutic attitude. MATERIAL AND METHODS: Retrospective study of a series of 83 patients affected of bladder tumor T1G3, on which we analyzed a total of 14 variables; between the new predictive factors: the immunohistochemical determination of regulating proteins of the cellular cycle: p53, p21 and bcl-2, as well as the Ki-67 protein like marker of cellular proliferation. By means of logistic regression analysis we establish the independent prognostic variables for tumorlike progression. RESULTS: The cut point established for Ki67 and p53 was 40% of inmmunomarked cells, 20% for p21 and 10% for Bcl-2. The univariant analysis showed different rates from progression and free times of progression based on the immunohistochemistry of Ki67 and p53: nevertheless, the logistic regression demonstrated that single the immunohistochemistry of p53 presented independent predictive value. CONCLUSIONS: The determination of p53 presents predictive value of clinically useful progression in bledder tumors T1G3, so that its determination can constitute a essential factor in the strategies of treatment of these tumors.

[Urological attendance in the Integral Health Center "Alto Palancia": model of primary-specialized integration and unique consultation]. / La asistencia urológica en el Centro Sanitario Integral "Alto Palancia": modelo de integración primaria-especializada y consulta única.

INTRODUCTION AND OBJECTIVE: The progressive increase in the demand of urological attendance demands to establish new welfare models that avoid the saturation of consultations and improve the quality in the attention to the user. The objective of this work is to analyze the improvement of the welfare activity developed in Integral the Sanitary Center Alto Palancia, after the restoration of new welfare models based on integration between Attention Primary and Specialized and the putting in practice of the denominated Unique Consultation. MATERIAL AND METHODS: We analyzed the characteristics of the Center, functions and activity of the specialty developed during year 2002. We described to the application of the model of Unique Consultation and the elements of integration with Primary Attention. We analyzed the improvement of the activity through indicators, that we compared with preceding years. In order to determine the degree of satisfaction of the users we made a survey of opinion of patients and/or taken care of relatives in the Center under the new welfare models. Finally we analyzed the advantages that the applied process presents for the patient and the own sanitary institution. RESULTS: 42% of patients have been taken care of by means of the model of Unique Consultation, being the predominant pathology the HBP in the man and the ITUs in the woman. The time of delay for first visit has been reduced from 49 days in single December 2001 to 3 in December 2002. Single 7.7% of patients discharged from the hospital for pursuit by Primary Attention have been sent again to the specialist. The time that the urólogo dedicates to consultations has reduced in a 29%, being this time dedicated to the accomplishment smaller surgery and final reconnaissances (echography, urodynamic studies and others). The opinion survey has shown a satisfaction of the user very elevated. CONCLUSION: The model of Integral Attention Primary-Specialized and the putting in practice of Unique Consultation applicable to the specialty of Urology, increasing the quality perceived by the user and with evident advantages for the Sanitary Organization.

Ameloblastoma. Diagnosis by means of FNAB. Report of two cases.

INTRODUCTION: Ameloblastomas are the most frequent odontogenic tumors of the maxilla. In spite of their benign cytohistological appearance, they behave as invasive recurring tumors, with the possibility of metastasis. FNAB is a rapid, bloodless test that provides a pre-surgical diagnosis, thus, on occasions avoiding the need for diagnostic biopsies. We present the cytological characteristics of two cases of jugal recurrences of mandibular ameloblastomas diagnosed by FNAB, as well as their cytohistological correlation. CLINICAL CASES: Two patients, a 36-year-old woman, and a 62-year-old male who both attended with mandibular swelling of a few months evolution. In both cases the first diagnostic approximation was the histological study of the tumoral mass, together with the radiological studies. Following therapeutic extirpation both cases recurred. The diagnosis of the recurrences was established cytologically by means of FNAB. The cytologic smears revealed a granular background with isolated macrophages and giant multinucleate cells and an abundant epithelial cellularity of basaloid appearance arranged in cohesive groups forming images of peripheral palidasing, as well as small groups of squamous metaplastic cells. DISCUSSION: FNAB is considered to be a rapid, bloodless and reliable method for the diagnosis of ameloblastoma. The cytology of these tumors reveals components of the lesion that, in general, are sufficient for the diagnosis of ameloblastoma, especially in cases of recurrence.