Sensitivity analysis in a life cycle assessment of an aged red wine production from Catalonia, Spain

Sustainability in agriculture and food processing is an issue with a clear growing interest; especially in products were consumers have particular awareness regarding its environmental profile. This is the case of wine industry depending on grape production, winemaking and bottling. Also viticulture and generally agricultural production is significantly affected by climate variations. The aim of this article is to determine the environmental load of an aged red wine from a winery in Catalonia, Spain, over its entire life cycle, including sensitivity analysis of the main parameters related to the cultivation, vinification and bottling. The life cycle assessment (LCA) methodology is used for the environmental analysis. In a first step, life cycle inventory (LCI) data were collected by questionnaires and interviews with the winemaker, all data are actual operating data and all the stages involved in the production have been taken into account (viticulture, vinification, bottling and the disposal subsystem). Data were then used to determine the environmental profile by a life cycle impact assessment using the ReCiPe method. Annual variability in environmental performance, stresses the importance of including timeline analysis in the wine sector. Because of that this study is accompanied with a sensitivity analysis carried out by a Monte Carlo simulation that takes into account the uncertainty and variability of the parameters used. In this manner, the results are presented with confidence intervals to provide a wider view of the environmental issues derived from the activities of the studied wine estate regardless of the eventualities of a specific harvesting year. Since the beverage packaging has an important influence in this case, a dataset for the production of green glass was adapted to reflect the actual recycling situation in Spain. Furthermore, a hypothetical variation of the glass-recycling rate in the glass production completes this article, as a key variable of sensitivity analysis, in order… in order to show the potential reduction of total greenhouse gas emissions. It was found that in almost all categories the production of the glass bottles has the highest environmental impact (10%-80% depending on the impact category) followed by the viticulture stage, i.e. the agricultural activities (17%-84% depending on the impact category). The vinification step, i.e. the winemaking itself, has an almost negligible effect on the overall load (1%-5%). The sensitivity analysis showed that the results do not differ by more than ±4% from the expected values except for the water depletion indicator. With the variation of the recycling rate, it could be shown that an increase in the rate from 60% to 85% allows for a reduction of 102gCO2eq. per bottle (-11.1%). The results show that glass production causes the highest environmental load. The key parameters that determine the impact are the recycling rate and the bottle weight. A glass container deposit legislation might be a promising way to enhance the glass recycling. Lightweight bottles and alternative packaging should also be considered.

Aspergillus flavus contamination in two Portuguese wastewater treatment plants

Filamentous fungi from genus Aspergillus were previously detected in wastewater treatment plants (WWTP) as being Aspergillus flavus (A. flavus), an important toxigenic fungus producing aflatoxins. This study aimed to determine occupational exposure adverse effects due to fungal contamination produced by A. flavus complex in two Portuguese WWTP using conventional and molecular methodologies. Air samples from two WWTP were collected at 1 m height through impaction method. Surface samples were collected by swabbing surfaces of the same indoor sites. After counting A. flavus and identification, detection of aflatoxin production was ensured through inoculation of seven inoculates in coconut-milk agar. Plates were examined under long-wave ultraviolet (UV; 365 nm) illumination to search for the presence of fluorescence in the growing colonies. To apply molecular methods, air samples were also collected using the impinger method. Samples were collected and collection liquid was subsequently used for DNA extraction. Molecular identification of A. flavus was achieved by real-time polymerase chain reaction (RT-PCR) using the Rotor-Gene 6000 qPCR detection system (Corbett). Among the Aspergillus genus, the species that were more abundant in air samples from both WWTP were Aspergillus versicolor (38%), Aspergillus candidus (29.1%), and Aspergillus sydowii (12.7%). However, the most commonly species found on surfaces were A. flavus (47.3%), Aspergillus fumigatus (34.4%), and Aspergillus sydowii (10.8%). Aspergillus flavus isolates that were inoculated in coconut agar medium were not identified as toxigenic strains and were not detected by RT-PCR in any of the analyzed samples from both plants. Data in this study indicate the need for monitoring fungal contamination in this setting. Although toxigenic strains were not detected from A. flavus complex, one cannot disregard the eventual presence and potential toxicity of aflatoxins.

[Improved short-term cardiovascular profile after simultaneous pancreas-kidney transplantation]

The prognosis of type 1 diabetes mellitus (T1DM) patients with chronic renal failure (CRF) improves after simultaneous pancreas-kidney (SPK) transplantation. In order to evaluate the changes in cardio-vascular risk (CVR) factors after SKP, we studied nine recipients before and 6 months after SPK. There were five females and four males, with a mean age of 37 +/- 8 years, duration of diabetes of 24 +/- 5 years, three of them before starting dialysis, and six on dialysis (hemodialysis = 5; peritoneal dialysis = 1). Before SPK, all patients received anti-hypertensive therapy (1-4 drugs; mean 2.2 +/- 0.9) and eight received statins. At 6 months after SPK, all patients were under triple immunosuppressive therapy (steroids + tacrolimus + MMF) without statins. They had normal renal function (Plasma Creatinine = 1.2 +/- 0.3 mg/dl) and pancreatic endocrine function (glycemia = 80 +/- 8 mg/dl). HbA1c decreased significantly (8.4 +/- 1.2 vs 4.7 +/- 0.6%; p < 0.007) with a value > 7% in seven patients before SPK and in none 6 months after SKP transplantation (p < 0.001). Although Body Mass Index increased (23 +/- 2 vs 25 +/- 3 kg/m2; p < 0.05), plasma triglycerides decreased (130 +/- 51 vs 88 +/- 33 mg/dl; p < 0.05), and total cholesterol, LDL-cholesterol and HDL-cholesterol were similar. Systolic and diastolic blood pressure (BP) decreased (156 +/- 7 vs 133 +/- 15; p < 0.01 and 96 +/- 7 vs 79 +/- 9; p < 0.007) with only two patients on anti-hypertensive therapy (1 drug). Likewise, before transplantation all patients were hypertensive (six grade 1 and three grade 2) while this was observed in only two at the end of follow-up (both grade 1) (p < 0.001). In conclusion, SPK transplantation with good renal and pancreatic function is associated with a short-term improvement in CVR profile.

[Pulmonary involvement due to disseminated non Hodgkin lymphoma in one patient with AIDS]

Pulmonary involvement due to disseminated non Hodgkin lymphoma (LNH), is an unusual cause of lung disease in AIDS patients. We report a 38 years old male patient, with advanced AIDS, who, in the course of three weeks, developed cough, dyspnea and fever. The chest X ray film showed diffuse thickening of the peribronchovascular connective tissue with possible mediastinal lymph node enlargement. The evolution was unfavorable with hypoxemia, severe anemia, liver damage and elevated levels of lactic dehydrogenase. The presumptive initial diagnoses were Pneumocystis carinii pneumonia, pulmonary tuberculosis with hematogenous dissemination and Kaposi sarcoma. Definitive diagnosis was made through a transbronchial biopsy performed the day before his death. The pathological and inmunohistochemical report demonstrated a highly aggressive lymphoma (lymphoblastic, B precursor). This finding was confirmed by autopsy that revealed multiple organ involvement.

Bleomycin-induced chronic lung damage does not resemble human idiopathic pulmonary fibrosis

Administration of bleomycin into the lungs of experimental animals has been utilized as a model to understand human pulmonary fibrosis. Most of the studies, however, have focused on early stages of the lung reaction. We hypothesized that chronic stages of the model may not mimic idiopathic pulmonary fibrosis, since in preliminary studies, lung volume and compliance were not decreased. Eight male Sprague-Dawley rats receiving intratracheal bleomycin (0.5 U/100 g body weight) underwent measurement of FRC, inspiratory capacity, and lung compliance 120 d later. Lung histologic changes were evaluated using light microscopy. Eight rats without intervention served as controls. Results show that our model, in early stages, has histologic changes no different from those previously described elsewhere. In chronic stages, however, the model does not behave as a restrictive syndrome: FRC is normal or increased, whereas lung compliance is normal. Focal peribronchiolar inflammation and fibrosis associated with paracicatricial emphysematous changes are the main histologic features of long-term lung remodeling after bleomycin. We conclude that while the chronic stages of the model may be informative in understanding mechanisms of fibrosis, care should be taken not to extrapolate to human idiopathic pulmonary fibrosis. We speculate that the model might resemble a particular subgroup of human interstitial lung disease, namely, those involving peribronchiolar structures.

The use of Monte-Carlo simulation techniques for risk assessment: study of a municipal waste incinerator

The incremental lifetime risks due to polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) for the residents living in the surroundings of a municipal solid waste incinerator (MSWI) have been assessed. Two different pathways of exposure to PCDD/Fs, ingestion through the diet and exposure from MSWI emissions, were compared. Monte-Carlo simulations were carried out to obtain variability and uncertainty propagation The joint analysis of uncertainty and variability included a sensitivity analysis that identified the contribution to variance by different inputs. In general terms, PCDD/F ingestion through the diet contributed with more than 99% of the total risk, whereas direct exposition to PCDD/F emissions from the MSWI was less than 1% The results show that the median (50% percentile) of non-carcinogenic risk due to PCDD/Fs in the population living in the surroundings of the MSWI was 0.72 and the ratio of the 95th percentile and fifth percentile was about 2. With respect to the total carcinogenic risk, the median increment in individual lifetime was 7.90 x 10(-5) while the ratio between the 95th percentile and the fifth percentile was about 1.5. In this analysis, a sequential structural decomposition of the relationships between the input variables has been used to partition the variance in the output (risk) in order to identify the most influential contributors to overall variance among them.

[Bleeding gastric ulcers and acute hepatitis: 2 simultaneous adverse reactions due to nimesulide in a case]

A 66 year-old obese woman with arthrosis, self-medicated with oral nimesulide, 200 mg daily. After 6 weeks she developed nausea, jaundice and dark urine. Two weeks later she had recurrent hematemesis and was hospitalized. Besides obesity and anemia her physical examination was unremarkable. An upper GI endoscopy revealed 3 acute gastric ulcers and a 4th one in the pyloric channel. Abdominal ultrasonogram showed a slightly enlarged liver with diffuse reduction in ecogenicity; the gallbladder and biliary tract were normal. Blood tests demonstrated a conjugated hyperbilirubinemia (maximal total value: 18.4 mg/dl), ALAT 960 U/l, ASAT 850 U/l, GGT 420 U/l, alkaline phosphatases mildly elevated, pro-time 49% and albumin 2.7 mg/dl. Serum markers for hepatitis A, B and C viruses were negative. ANA, AMA, anti-SmA, were negative. Ceruloplasmin was normal. A liver biopsy showed bridging necrosis and other signs of acute toxic liver damage. Gastric ulcers healed after conventional treatment and hepatitis subsided after 2 months leaving no signs of chronic liver damage. The diagnosis of toxic hepatitis due to nimesulide was supported by the time-course of drug usage, sex, age, absence of other causes of liver disease, a compatible liver biopsy and the improvement after drug withdrawal. Peptic ulcers or toxic hepatitis have been previously described as independent adverse reactions in patients taking nimesulide or other NSAIDs but their simultaneous occurrence in a single patient is a unique event that deserves to be reported.

Polybrominated diphenyl ethers detected in human adipose tissue from Spain

Polybrominated diphenyl ethers (PBDEs) were detected in 13 human adipose tissue samples from Spain, 3 women and 10 men. Tetra-, penta- and hexabrominated diphenyl ethers were determined at ng/g lipid (ppb) level in all the samples. The average TeBDE level was 1.36 ng/g, the average PeBDE was 0.93 ng/g and the HxBDE 1.83 ng/g. Human adipose tissue levels of PBDE obtained in the current samples from Spain are comparable with the tissue levels reported in recent Swedish investigations.

Monitoring metals in the vicinity of a municipal waste incinerator: temporal variation in soils and vegetation

The aim of this study was to determine the temporal variation in the concentrations of arsenic (As), beryllium (Be), cadmium (Cd), chromium (Cr), manganese (Mn), mercury (Hg), nickel (Ni), lead (Pb), tin (Sn), thallium (Tl), vanadium (V) and zinc (Zn) in soil and vegetation near an old municipal solid waste incinerator (MSWI). In October 1997, 24 soil and 24 herbage samples were collected at the same sampling points in which samples were also taken in October 1996. With the exception of an increase in the levels of Be and Ni, no significant differences in soils between both surveys were found; only Cr and V (decreases) and Hg (increase) showed significant variations in herbage samples during the last year. The concentrations of most elements in soil and vegetation samples collected near the MSWI are within the ranges previously reported for soil and vegetation in the vicinity of MSWIs.

[Treatment of idiopathic pulmonary fibrosis with colchicine]

BACKGROUND

Experimental and clinical evidences suggest that colchicine can be effective in the treatment of patients with idiopathic pulmonary fibrosis.

AIM

To assess the effect of colchicine in the treatment of idiopathic pulmonary fibrosis.

PATIENTS AND METHODS

Patients with clinically diagnosed idiopathic pulmonary fibrosis were treated with colchicine in doses of 0.5 to 1 mg/day, according to tolerance and followed for periods ranging from 7 to 40 months. The clinical and radiological score reported by Watters et al was used for the longitudinal assessment of patients. Maintenance or improvement in forced vital capacity and maintenance or decrease in alveolar arterial O2 gradient during follow up, were considered as positive therapeutic responses.

RESULTS

Seventeen patients (10 male, aged 61 to 81 years old) were studied. Their basal score for dyspnea was 5.8 (over 20), for the chest X ray examination was 2.4 (over 3) and for CT scan was 2.8 (over 3). Basal FVC was 77% of predicted value (range 51-108%), basal FEV, was 82% (range 59-117%) and FEV1/FVC was 0.82 (range 0.68-0.95). PaO2 at rest was 78 mm Hg (ranges 63-97). Alveolar-arterial PO2 gradient was 16 mm Hg (range 5-31.6) at rest and 31 mm Hg (range 5.7-51.4) after exercise. Six patients (35%) had a positive response to therapy.

CONCLUSIONS

The response rates of these patients to colchicine are at least similar to those obtained with steroids, but with less side effects.

[Evaluation of treatment with cyclosporine in three patients with pulmonary fibrosis]

There are few reports on the use of cyclosporine in idiopathic pulmonary fibrosis, in experimental animals or humans. We report three patients with advanced pulmonary fibrosis in whom steroid therapy failed and that received cyclosporine in a dose of 3 to 5 mg/kg for three to five months. One patient developed systemic hypertension that subsided reducing the dose of cyclosporine. No positive changes in dyspnea were obtained and pulmonary function tests deteriorated during the treatment period. We conclude that cyclosporine treatment had no clinical benefit in these patients with pulmonary fibrosis.

Leiomyosarcoma of the prostate. Report of 23 cases

BACKGROUND

Leiomyosarcoma of the prostate is a rare neoplasm that accounts for less than 0.1% of prostate malignancies. Previous reports of this neoplasm consisted of single case studies or small series, often combined with cases of rhabdomyosarcoma. The relationship of prognosis with histologic and immunohistochemical findings has not, to the authors' knowledge, been described in a large series of cases, and the efficacy of various treatments is uncertain.

METHODS

The authors undertook a clinicopathologic study of all cases of prostate leiomyosarcoma observed at their institution from 1929 to 1994. Twenty-three cases were retrieved from the files of the Department of Pathology, Mayo Clinic (Rochester, MN), and clinical follow-up was available for 14. Immunohistochemical studies, including actin, desmin, S-100 protein, keratin, and vimentin were performed for 18 cases.

RESULTS

Patients ranged in age from 41 to 78 years, with a mean of 61 years. Presenting symptoms included urinary obstruction (100%), perineal pain (25%), burning on ejaculation (7%), and weight loss (7%). The neoplasms ranged from 3.3 to 21 cm (mean, 9 cm) in greatest dimension and were often associated with necrosis. Seven tumors were Grade 2, 10 Grade 3 and 6 Grade 4 (Broders' grading system; scale, 1-4). Mitotic figure counts varied from 2 to 24 per 10 high power fields. Fifteen of 15 (100%) cases were immunoreactive for vimentin, 10 of 16 (63%) were immunoreactive for actin, and 3 of 15 (20%) were weakly reactive for desmin. Keratin expression was observed in 4 of 15 cases (27%), and S-100 protein was negative in all cases. Treatment varied, and usually included a combination of radiation therapy, chemotherapy, and radical prostatectomy or cystoprostatecomy. Follow-up ranged from 2 to 72 months, with a mean of 19 months. Ten patients died from tumor 3 to 72 months (mean, 22 months) after diagnosis. Four patients were alive, including three with residual tumor and one without evidence of tumor at 2, 4, 30, and 4.5 months, respectively. Local recurrence occurred in 10 of 11 patients, including 5 who had gross residual tumor present after surgery. Metastases developed up to 40 months after surgery (mean, 10.3 months), and most frequently involved the lungs.

CONCLUSIONS

These findings indicate that prostate leiomyosarcoma has a varied histologic appearance ranging from spindled cell neoplasm reminiscent of smooth muscle to pleomorphic sarcoma. Epithelioid features may be present. Most tumors are immunoreactive with antibodies to vimentin and actin, and reactivity with antikeratin antibodies does not exclude the diagnosis of leiomyosarcoma. Prostate leiomyosarcoma has a poor prognosis, although the length of survival is variable. Radical surgery was the treatment of choice in the current series, but complete excision was difficult in most cases and did not result in cure.

[Gastric cavernous hemangioma as a cause of upper digestive hemorrhage]

Upper digestive bleeding caused by an isolated gastric hemangioma is a rather rare occurrence, even in cases of Osler-Weber-Rendu syndrome. The case reported here, which brings to 40 the number reported in the world literature, is that of a 68-year-old patient who presented with upper digestive bleeding. Endoscopy led us to suspect a hemangioma due to the abnormally large lesion, a suspicion that was confirmed preoperatively through arteriography, which detected a hypervascular mass of 6 x 4 cm dependent on the gastroduodenal artery. This finding was in turn confirmed by the surgical intervention. Diagnostic difficulties based on barium studies, endoscopy and surgical exploration have meant that preoperative diagnosis has been rare in the cases published to date. We consider that a more liberal use of arteriography could reverse this tendency, as indeed our case has shown. Furthermore, we feel that arteriography is indicated in cases of upper digestive bleeding of obscure origin, which might be due to small angiomas that may be overlooked in other diagnostic tests.

Pneumococcal antigen detection in bronchoalveolar lavage fluid from patients with pneumonia

BACKGROUND

Pneumococcal pneumonia can be diagnosed by the detection of capsular antigen in sputum, serum, pleural fluid, or urine using countercurrent immunoelectrophoresis and latex agglutination. In addition, quantitative cultures of bronchoalveolar lavage (BAL) fluid are also reliable for establishing the aetiology of pneumonia. This study investigated the value of rapid detection of pneumococcal antigen in BAL fluid from patients with pneumonia.

METHODS

Pneumococcal antigen was detected by countercurrent immunoelectrophoresis and latex agglutination. Patients were grouped according to BAL quantitative culture results into pneumococcal pneumonia (n = 24), other known aetiology (n = 18), and unknown aetiology (n = 17). Thirteen patients with interstitial lung disease and without pneumonia served as a control group.

RESULTS

In patients with pneumococcal pneumonia, antigen was detected by countercurrent immunoelectrophoresis in 50% and by latex agglutination in 54% of cases. In patients with pneumonia of unknown aetiology pneumococcal antigen was detected by latex agglutination in 53% of cases. Antigen was not detected in patients with pneumonia of other known aetiology or in control patients, yielding a specificity of 100%.

CONCLUSIONS

In patients with pneumococcal pneumonia requiring fibreoptic bronchoscopy detection of pneumococcal antigen in BAL fluid may rapidly and accurately confirm the aetiology. Furthermore, in nearly half the cases of pneumonia of unknown aetiology antigen can be detected, suggesting that Streptococcus pneumoniae is a major causative agent in such patients.

[Volvulus of the transverse colon: a rare cause of intestinal obstruction]

Volvulus of the transverse colon is rare, given its short and fixed mesentery and the normal fixation of the hepatic and splenic flexures of the colon. The case reported herein brings the total of reported cases to 72. Various predisposing factors have been identified, most notably congenital abnormalities, physiologic disturbances and mechanical obstruction; in our case these three factors were present. The possible role of colonoscopy in diagnosis and/or therapy is unclear. In our patient, colonoscopy proved to be of no use for diagnosis or treatment.

Acute fatty liver of pregnancy: a clinical study of 12 episodes in 11 patients

Twelve episodes of acute fatty liver of pregnancy (AFLP) were diagnosed in 11 patients during the past 18 years in a general hospital in Santiago, Chile, with a prevalence of 1 per 15,900 deliveries. Acute fatty liver of pregnancy started between the 31st and 38th weeks of pregnancy, with malaise, vomiting, jaundice, and lethargy as the main clinical manifestations. Polydipsia (in nine episodes) and skin pruritus (in seven episodes) were unusual clinical findings. In two patients, pruritus started two and four weeks before AFLP, suggesting that an intrahepatic cholestasis of pregnancy preceded AFLP in those patients. Considering the current prevalence of both diseases in Chile, their association should be considered fortuitous. In another patient, two consecutive pregnancies were affected by AFLP, raising to three the number of reported patients with recurrent AFLP. In 11 episodes, liver biopsies supported the diagnosis of AFLP by showing small and midsized vacuolar cytoplasmic transformation as the most prominent histopathological feature. Positive intracellular fat staining was found in the four samples analysed. Studies by electron microscopy showed megamitochondria with paracrystalline inclusions in four samples. All the mothers survived, but fetal mortality was 58.3%. Several extrahepatic complications delayed maternal recovery for up to four weeks after delivery. This study confirms an improvement in maternal prognosis in AFLP, discusses the possibility of an epidemiological association with intrahepatic cholestasis of pregnancy, and increases the number of patients reported with recurrent AFLP.

Diagnostic fiberoptic bronchoscopy in patients with community-acquired pneumonia. Comparison between bronchoalveolar lavage and telescoping plugged catheter cultures

We compared the diagnostic value of quantitative cultures of bronchoalveolar lavage (BAL) and telescoping plugged catheter (TPC) samples in 40 patients with moderately severe community-acquired pneumonia (CAP). None had received antibiotics previously. BAL quantitative cultures were performed in 13 control patients without pneumonia. In 28 (70 percent) patients, TPC cultures yielded > or = 10(3) cfu/ml of a pathogenic bacterium in pure culture. In 27 of these cases and in four additional cases, BAL cultures yielded > or = 10(3) cfu/ml. BAL cultures from the control group were sterile in seven cases, yielded normal flora in three cases, and yielded microorganisms thought to be not significant in two cases. Microbiologic agreement was reached by both TPC and BAL for 32 (84 percent) of 38 microorganisms recovered. Quantitative cultures from both techniques correlated very well (r = 0.71, p < 0.0001). We conclude that both TPC and BAL have similar accuracy to determine etiologic diagnosis of CAP. There was good qualitative and quantitative agreement between both techniques.

Pleomorphic ("dedifferentiated") chondrosarcoma. Report of a case initially examined by fine needle aspiration biopsy

Fine needle aspiration (FNA) biopsy of a predominantly radiolucent, destructive lesion of the right distal femoral metaphysis of a 69-year-old man produced smears containing spindle-shaped cells with cytologic features consistent with a malignant fibrous histiocytoma. This initial diagnosis was supported by immunoperoxidase staining, which was strongly positive for vimentin and alpha-1-antichymotrypsin, focally positive for S-100 protein and negative for desmin, muscle-specific actin, keratin, carcinoembryonic antigen and epithelial membrane antigen. Subsequent surgical resection revealed a lesion with a predominance of malignant fibrous histiocytoma-type regions; however, focal microscopic areas contained a low-to-medium-grade cartilaginous component. The final diagnosis rendered was thus pleomorphic or so-called "dedifferentiated" chondrosarcoma. This rare lesion should be included in the differential diagnosis of malignant spindle-cell lesions of bone assessed by FNA biopsy.

Fine needle aspiration cytology of papillary endometrioid carcinoma of the prostate. The grooved nucleus as a cytologic marker

The fine needle aspiration (FNA) cytologic findings of an endometrioid carcinoma of the prostate are presented, along with the histologic, immunohistochemical and endoscopic features. Cystoscopy of an elderly male patient with hematuria and symptoms of bladder outlet obstruction showed the delicate papillary growths at the verumontanum that are characteristic of this lesion. Transrectal FNA of the prostate produced samples that included clusters of malignant cells with crowding and overlapping of hyperchromatic nuclei containing prominent nucleoli and a loss of polarization and cohesion. Many of the groups of tumor cells suggested papillary structures. A novel finding in the aspirate was a grooved nucleus in 10% of the tumor cells. Immunohistochemical staining of biopsy sections of the papillary growths for prostate-specific antigen was strongly positive. It is important to recognize this variant of prostatic carcinoma since its behavior and response to therapy are not yet established.

[Pulmonary endometriosis. Clinical case]

Pulmonary endometriosis is a rare entity and there is little information regarding its treatment. We report a young female who developed hemoptysis in coincidence with menstruation. Pelvic endometriosis was confirmed histologically and pulmonary endometriosis was inferred. Treatment with Danazol led to suppression of both menstruation and hemoptysis, thus confirming the clinical diagnosis.

[Wegener's granulomatosis: clinical and pathological report of 22 cases]

We report clinical and pathologic findings in 22 patients with Wegener's granulomatosis collected from 1966 to 1989. Ten cases were analyzed retrospectively. Organs affected included the lungs (n = 18), upper airways (16), kidneys (15), musculo-skeletal system (10), eyes (8), skin (7) and ear (5). Clinical manifestations of airway involvement included nasal obstruction, dysphonia and epistaxis. Lung involvement was evident in chest X-rays in 18 patients, 14 with a nodular aspects. Histologic study in 14 of these patients showed necrotizing and granulomatous vasculitis. Clinical evidence of nephropathy was evident in 15 patients and led to rapidly progressive renal failure in 8. Biopsy in this group (n = 14) revealed focal glomerulonephritis in 6 and diffuse disease in 8. Overall, 13 patients died: 5 without diagnosis, 4 from renal failure, 2 from sepsis, 1 from a lymphoma developing 3 years after immune suppressive therapy and 1 from unknown causes. Among survivors, one received a renal transplant and one remains in chronic dialysis. The diagnosis of Wegener's granulomatosis is therefore based on clinical findings including rhino pharyngeal, pulmonary and renal manifestations.

[Perforated duodenal ulcer in children]

We face a case of duodenal ulcer perforation a nine year old child who's diagnosis was not detected before operating. This is an unusual case and it is not normally observed in the differential diagnosis of the acute abdominal pain in the infancy. The lack of the radiological signs of perforation contributed to the diagnosis mistake before operating.