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Astrid Berena Herrera Lopez,1 Carlos A Torres-Duque,2 Alejandro Casas Herrera,3 María Patricia Arbeláez,4 Horacio Riojas-Rodríguez,5 José Luis Texcalac-Sangrador,6 Néstor Y Rojas,7 Laura Andrea Rodriguez-Villamizar8 1Facultad de Medicina, Universidad de los Andes, Bogotá D.C, Colombia, Universidad de Antioquia, Medellín, Antioquia, Colombia; 2CINEUMO, Fundación Neumológica Colombiana, Bogotá, Colombia; 3AIREPOC Programa, Fundación Neumológica Colombiana, Bogotá, Colombia; 4Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Antioquia, Colombia; 5Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México; 6Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Ciudad de México, México; 7Departamento de Ingeniería Química y Ambiental, Universidad Nacional de Colombia, Bogotá, Colombia; 8Departamento de Salud Pública, Escuela de Medicina, Universidad Industrial de Santander, Bucaramanga, ColombiaCorrespondence: Astrid Berena Herrera Lopez, Email ab.herrera@uniandes.edu.co; astrid.herreral@udea.edu.coBackground: Exacerbations of chronic obstructive pulmonary disease (COPD-E) have been associated with levels of air pollution. The occurrence of COPD-E is associated with increased mortality in this population.Purpose: To determine the association between long-term exposure to PM2.5 and NO2, and the frequency of COPD-E in patients belonging to AIREPOC, an institutional integrated care program for COPD in Bogota, Colombia.Patients and Methods: Retrospective cohort study included patients with COPD living in Bogotá, between 2018 and 2021, who received health care in the AIREPOC program. Each patient´s home address was geolocated. Information from local air quality network stations was used to estimate daily and annual mean PM2.5 and NO2 exposure level for each patient using the inverse distance squared weighted regression (IDWR) method. The effect of PM2.5 and NO2 concentrations categorized at 15 μg/m3 and 25 μg/m3 respectively on the frequency of COPD-E was estimated using a zero-truncated negative binomial model adjusted for potential confounders. Goodness-of-fit was assessed by residuals.Results: During the observation period, 580 COPD-E occurred in 722 patients. Significant associations were found between COPD-E and NO2 concentrations ≥ 25 μg/m3 (incidence density ratio, RDI: 1.29, 95% CI: 1.02– 1.67) after adjustment for sun exposure, COPD severity, depression, and ambient humidity. No association was found between the frequency of COPD-E and PM2.5 concentrations ≥ 15μg/m3.Conclusion: Prolonged exposure to high levels of NO2 increases the frequency of COPD exacerbations in patients residing in Bogotá. These results highlight the importance of strengthening air quality control measures and educating people with COPD to know and interpret the local air quality indices and to follow the recommendations derived from its alterations. Keywords: air pollution, long-term effect, chronic obstructive pulmonary disease, COPD exacerbations, negative binomial regression truncated at zero

Peliosis hepatis is a rare lesion characterized by blood-filled cavities randomly distributed in the liver. It has been associated with the administration of medications such androgen-anabolic steroids, estrogens, oral contraceptives, and azathioprine. Its diagnosis is most reliably obtained by arteriogram and liver biopsy. Treatment consists of the discontinuance of those medications known to induce liver changes. Surgical treatment is reserved for those cases where a concomitant neoplasm or aneurysm is found.

A case of malignant testicular tumor which originated in the Sertoli cells is reported. Metastases were studied by aortography and computerized axial tomography. The tumor presented no clinical evidence of hormonal activity and a long recurrence-free survival.

A patient with clinical signs of complete intestinal obstruction was found at celiotomy to have a loop of small intestine caught in the narrow opening of a defect located in the transverse peritoneal fold of the urinary bladder and extending into the retrovesical space. This report aims at bringing attention to internal retrovesical hernias, an entity scarcely mentioned in the literature, as a possible cause of small bowel obstruction.

Our observations indicate that the menopausal status of a patient, the anatomic location or the histologic differentiation of a primary adenocarcinoma of the colorectal area does not seem to affect the incidence of ovarian metastases. Tumors initially classified as Dukes' B2 and, later, associated with ovarian metastases have consistently poorer prognosis. The reason that ovarian metastases attain a relatively large size, while other metastatic foci remain small, is unknown. Regardless of the surgical findings, patients with ovarian metastases from a primary adenocarcinoma of the colorectal area tend to have short survival with widespread distribution of the tumors at death. This would suggest that these metastases occur primarily by the hematogenous route rather than by an orderly invasion to contiguous structures and draining lymph nodes. Patients with resectable solitary ovarian metastases and prospectives of cure must be a rare event in carcinoma of the colon and rectum.

Ten percent of pheochromocytomas are found in extra-adrenal locations and are called paragangliomas. In recent years we have had the opportunity to study two patients with malignant paragangliomas of the organ of Zuckerlandl. Only 13 cases of such neoplasms have been reported previously. Our cases are of interest because of their features of recurrence, distant metastases, response to adjuvant therapy, and long survival.

The three cases herein reported concern metachronous ovarian metastases from primary adenocarcinomas of the colon associated with mesothelial cysts. Although the etiology of these cysts remains obscure, the cases were of interest because the cysts did not contain tumor cells despite the intimate relationship to the tumor. Metastases were localized to the ovary and were resectable. All signs and symptoms disappeared, affording excellent palliation and an extended survival.

A proposed classification system for liver metastasis from colorectal carcinoma is presented. This proposed system utilizes the prognostic factors of the extent of hepatic involvement by metastasis at the time of laparotomy, performance status, preoperative serum alkaline phosphatase level, and the presence or absence of extrahepatic intraabdominal disease at the time of laparotomy. Because of the several different modes of treatment for liver metastasis from colorectal carcinoma, it is necessary that a liver classification system be adopted so that different treatment groups will be comparable. The proposed system utilizes the extent of hepatic involvement by metastasis at laparotomy with a division into three subsets of patients described by a Roman numeral. Roman numeral I represents less than or equal to 25 per cent involvement of the liver by metastasis; Roman numeral II represents greater than 25 per cent but less than or equal to 50 per cent involvement by liver metastasis, and Roman numeral III represents greater than 50 per cent involvement by liver metastasis. An Arabic subscript number is used to describe the patients' performance status. Alkaline phosphatase levels are described by a subscript letter with a representing less than two times normal alkaline phosphatase, b representing greater than two times, but less than four times normal levels, and c representing greater than four times normal levels. At the time of laparotomy extrahepatic intra-abdominal disease is represented by the superscript letter E.