Twin pregnancies: eating for three? Maternal nutrition update

The incidence of multifetal pregnancies has increased, mainly because of assisted reproduction treatments. This trend is reflected in increased maternal and neonatal morbidity and mortality. While the optimum maternal nutrition and weight gain patterns for singleton pregnancies is well documented, there is a paucity of information for twin pregnancies. Although it is assumed that optimum nutritional requirements and weight gains would be greater for twin than for singleton gestations, research is needed to establish the optima. This article is a collation of available recommendations for maternal nutrition and weight gain patterns in twin pregnancies.     

Fate of gasoline oxygenates in conventional and multilevel wells of a contaminated groundwater table in Düsseldorf, Germany

In a gasoline-contaminated site in Düsseldorf, Germany a two-year monitoring program was carried out to determine the presence, behavior, and fate of 12 gasoline additives in a total of 96 samples from 14 groundwater wells. The origin of contamination was suspected to be a gasoline spill at a gas station. Target compounds were methyl-tert-butyl ether (MTBE), its main degradation products, tert-butyl alcohol (TBA) and tert-butyl formate (TBF); other gasoline additives, oxygenate dialkyl ethers: Ethyl-tert-butyl ether (ETBE), tert-amyl methyl ether (TAME) and diisopropyl ether (DIPE); aromatics: Benzene, toluene, ethylbenzene and xylenes (BTEX), and other compounds causing odor problems: Dicyclopentadiene and trichloroethylene. Purge and trap coupled with gas chromatography-mass spectrometry permitted detection of ng/L concentrations. Ninety of the 96 samples analyzed contained MTBE at levels varying between 0.01 to 645 microg/L. Five contaminated hot spots were identified with levels up to U.S. Environmental Protection Agency (U.S. EPA) drinking water advisory values (20-40 microg/L) and one of them doubling Danish suggested toxicity level of 350 microg/L at a depth of 11 m. No significant natural attenuation was found in MTBE degradation, although samples with high levels of MTBE contained 0.1 to 440 microg/L of TBA. These levels were attributed to its presence in the contamination source more than MTBE degradation. tert-Butyl alcohol was found to be recalcitrant in groundwater. In all cases, BTEX were at low concentrations or not detected, showing less persistence than MTBE. The monitoring of the contamination plume showed that the distribution of the MTBE and TBA in the aquifer formed a similar vertical concentration profile that was influenced by the groundwater flow direction.     

Evaluation and prognostic of cystic renal tumors

Objetive: To evaluate the clinical and pathological characteristics of cystic renal tumors in our center.Material and methodsA retrospective review of 239 nephrectomies is performed comparing the clinical and pathological variables of cystic tumors with those of solid renal tumors. Survival outcomes are analyzed in both groups.ResultsOur experience shows that cystic renal tumors behave like solid renal tumors, with no differences in survival shown. The variables studied show statistically significant differences in histological grade and number of tumors, with cystic tumors having a lower histological grade and being more often multiple in number.ConclusionesThe behavior of cystic renal tumors is no different than that of solid renal tumors.     

Follicular carcinoma of the thyroid manifested initially as asymptomatic primary renal neoplasm

Metastases in the kidney are rare, evenmore if primary source is thyroid. We report the tenth case of metastases in the kidney from thyroid, and it is the first to be follicular type and absolutely asymptom. Sonography and computerized tomography with suspicion of renal tumour are showed in a asymtom female 75 years old. Left partial nephrectomy was perfomed, initially it has been pathologically diagnosed as renal clear cells tumour, however the definitive pathologic report showed follicular tumour of thyroid. Local and systemic stage was discovered with complementary techniques. Sources of metastases in kidney and diagnoses techniques are discussed.     

Clinical consequences of screening for prostate cancer: 15 years follow-up of a randomised controlled trial in Sweden

OBJECTIVE: To test the feasibility of a population-based prostate cancer screening programme in general practice and explore the outcome after a 15-year follow-up period. METHODS: From the total population of men aged 50-69 years in Norrk?ping (n = 9026) every sixth man (n = 1494) was randomly selected to be screened for prostate cancer every third year over a 12-year period. The remaining 7532 men were treated as controls. In 1987 and 1990 only digital rectal examination (DRE) was performed, in 1993 and 1996 DRE was combined with a test for Prostate-Specific Antigen (PSA). TNM categories, grade of malignancy, management and cause of death were recorded in the South-East Region Prostate Cancer Register. RESULTS: There were 85 (5.7%) cancers detected in the screened group (SG), 42 of these in the interval between screenings, and 292 (3.8%) in the unscreened group (UG). In the SG 48 (56.5%) of the tumours and in the UG 78 (26.7%) were localised at diagnosis (p < 0.001). In the SG 21 (25%) and in the UG 41 (14%) received curative treatment. There was no significant difference in total or prostate cancer-specific survival between the groups. CONCLUSIONS: Although PSA had not been introduced in the clinical practice at the start of the study, we were still able to show that it is possible to perform a long-term population-based randomised controlled study with standardised management and that screening in general practice is an efficient way of detecting prostate cancer whilst it is localised. Complete data on stage, treatment and mortality for both groups was obtained from a validated cancer register, which is a fundamental prerequisite when assessing screening programmes.     

The biology of non-small-cell lung cancer: identifying new targets for rational therapy

Lung cancer, and in particular non-small-cell lung cancer (NSCLC), remains the leading cause of cancer death throughout the world. Almost three decades ago, the major concern was to identify whether cisplatin or cisplatin-based chemotherapy enhanced survival in metastatic NSCLC, and whether any survival benefit compensated for cisplatin-related toxicity. Over the last 10 years, significant advances have been achieved in molecular biology, including the identification of critical genes related to the pathogenesis of NSCLC, which have formed the basis for new targeted therapeutic approaches. These new approaches include novel agents against established chemotherapeutic targets such as thymidylate synthetase as well as agents that inhibit novel targets such as growth factor receptors and proteins important in angiogenesis. With the advent of genomic technologies that can identify patterns of gene expression, the hope is that therapy will be tailored to the genetic pattern of the patients's tumor, and individualized treatments that minimize toxicity and maximize efficacy can be developed.