Mesothelioma and asbestosis in a young woman following occupational asbestos exposure: Short latency and long survival: Case Report

A 27-year-old female white-collar worker was diagnosed in 1998 with mesothelioma eight and one-half years following first exposure as a bystander to debris in a site in which asbestos-containing building materials were being dismantled and rebuilding work took place. Prodromal back pain had been present for a year and a half. She underwent extrapleural pneumectomy and received an intrapleural infusion of cisplatin post-operatively. Exposure to asbestos was verified by contemporary reports and lung biopsy, which demonstrated asbestos bodies and microscopic interstitial fibrosis -conforming evidence for asbestosis. The patient is alive and well 12 years after diagnosis and 14 years after onset of symptoms. The combination of an extremely short latency period and long survival following occupational exposure to asbestos dust is unique

Applying a sequential approach in order to detect and interpret a possible increased rate of myeloid malignancies in the Girona province

This thesis is aimed at demonstrating a sequential-based approach in detecting an epidemic of chronic diseases in small populations. Especially if commences at some unobserved point. Analyses encompassed registered cases of rare leukaemias occurring in the municipalities of a Spanish province (15 years). Subtle clustering was validated using a control chart (CUSCORE) that hinges on the Relative Interval statistic, a graphical display of the temporal pattern and a confirming-test. We preliminarily ascertained multiyear-standardized incidence ratios. Rates of within-clusters morphological subtypes were assessed too. Six communities registered one or more indicative clusters. Relative-Interval-based procedures unveiled temporal patterns. Detection yield proved at sub-unity annual counts in mild-intensity risks. Depictions of waiting intervals evidenced embedded huddles. Most clusters showed predominance of de novo subtypes. Aetiology hints emanated from deviations in person variables. Addressed beforehand, upon paucity of incidence, these procedures worked usefully for the ad hoc test of alarm signal, deciphering of time pattern, and cluster confirmation.Esta tesis se propone demostrar un abordaje secuencial para la detección de epidemias de enfermedades crónicas en poblaciones pequeñas. Especialmente cuando su comienzo es inobservable. Analizamos casos de leucemias raras registrados en las municipalidades de una provincia española (3 lustros). Validamos clusterizaciones solapadas mediante una carta de control (CUSCORE) apoyada en el estadístico Intervalo Relativo, la representación gráfica del patrón temporal y un test confirmante. Partimos de la valoración del ratio observados/esperados. Examinamos tasas de subtipos morfológicos intraclusters. Seis comunidades registraron uno-o-más clusters. Procedimientos basados en el Intervalo Relativo desvelaron patrones temporales. Rendimiento de detección probado ante riesgos de intensidad leve y en conteos anuales sub-unitarios. Curvas de intervalos de espera evidenciaron arracimados englobados. Preeminentemente los clústeres expusieron predominancia de subtipos de novo. Desviaciones en variables personales aportaron claves etiológicas. Estos procedimientos funcionaron como sensores fiables ad hoc de alarma, descifrando patrones temporales y confirmando clusters. Ello, ante incidencias bajas en series acometidas a-priori.Programa de Doctorat en Biologia Molecular, Biomedicina i Salu