Synthese, Kristallstrukturen und magnetische Eigenschaften von komplexen Halogeniden der Lanthanide mit Trimethylpyridinium- und Dimethylpyridiniumkationen

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Intraoperative Near-Infrared Autofluorescence and Indocyanine Green Imaging to Identify Parathyroid Glands: A Comparison

Objective. To investigate the feasibility of near-infrared autofluorescence (AF) and indocyanine green (ICG) fluorescence to identify parathyroid glands intraoperatively. Methods. Fluorescence imaging was carried out during open parathyroid and thyroid surgery. After visual identification, parathyroid glands were exposed to near-infrared (NIR) light with a wavelength between 690 and 770 nm. The camera of the Storz (R) NIR/ICG endoscopic system used detects NIR light as a blue signal. Therefore, parathyroid AF was expected to be displayed in the blue color channel in contrast to the surrounding tissue. Following AF imaging, a bolus of 5 mg ICG was applied intravenously. ICG fluorescence was detected using the same NIR/ICG imaging system. Well-vascularized parathyroid glands were expected to show a strong fluorescence in contrast to surrounding lymphatic and adipose tissue. Results. We investigated 78 parathyroid glands from 50 patients. 64 parathyroid glands (82%) displayed AF showing the typical bluish violet color. 63 parathyroid glands (81%) showed a strong and persistent fluorescence after application of ICG. The sensitivity of identifying a parathyroid gland by AF was 82% (64 true positive and 14 false negative results), while ICG imaging showed a sensitivity of 81% (63 true positive and 15 false negative results). The Fisher exact test revealed no significant difference between both groups at p < 0.05. Neither lymph nodes nor adipose tissue revealed substantial AF or ICG fluorescence. Conclusion. AF and ICG fluorescence reveal a high degree of sensitivity in identifying parathyroid glands. Further, ICG imaging facilitates the assessment of parathyroid perfusion. However, in the current setting both techniques are not suitable as screening tools to identify parathyroid glands at an early stage of the operation

Natural history, clinical pattern, and surgical considerations of pneumatosis intestinalis

<p>Abstract</p> <p>Objective</p> <p>Pneumatosis intestinalis has been increasingly detected in recent years with the more frequent use of computed tomography for abdominal imaging of the intestine. The underlying causes of the gas found during radiographic studies of the bowel wall can vary widely and different hypotheses regarding its pathophysiology have been postulated. Pneumatosis intestinalis often represents a benign condition and should not be considered an argument for surgery. However, it can also require life-threatening surgery in some cases, and this can be a difficult decision in some patients.</p> <p>Methods</p> <p>The spectrum of pneumatosis intestinalis is discussed here based on various computed tomographic and surgical findings in patients who presented at our University Medical Centre in 2003-2008. We have also systematically reviewed the literature to establish the current understanding of its aetiology and pathophysiology, and the possible clinical conditions associated with pneumatosis intestinalis and their management.</p> <p>Results</p> <p>Pneumatosis intestinalis is a primary radiographic finding. After its diagnosis, its specific pathogenesis should be ascertained because the appropriate therapy is related to the underlying cause of pneumatosis intestinalis, and this is sometimes difficult to define. Surgical treatment should be considered urgent in symptomatic patients presenting with an acute abdomen, signs of ischemia, or bowel obstruction. In asymptomatic patients with otherwise inconspicuous findings, the underlying disease should be treated first, rather than urgent exploratory surgery considered. Extensive and comprehensive information on the pathophysiology and clinical findings of pneumatosis intestinalis is provided here and is incorporated into a treatment algorithm.</p> <p>Conclusions</p> <p>The information presented here allows a better understanding of the radiographic diagnosis and underlying aetiology of pneumatosis intestinalis, and may facilitate the decision-making process in this context, thus providing fast and adequate therapy to particular patients.</p

A pitfall of bilateral inferior petrosal sinus sampling in cyclic Cushing's syndrome

Background: Clinical care of patients with cyclic Cushing's syndrome (CS) is challenging. Classical pitfalls include incorrect subtyping, unnecessary surgical procedures and delayed definite treatment. Case presentation: A 43-year-old female suffered from a rapidly cycling ectopic CS. She experienced six cycles of severe hypercortisolism within a 2 year period (maximum plasma cortisol 5316 nmol/L, normal range 124.2-662.4 nmol/L; maximum urinary free cortisol 79,469 nmol/24 h, normal range < 414 nmol/24 h) lasting 2-9 weeks. The episodes were associated with pronounced hypokalemia (lowest K+ value recorded 2.4 mmol/l) and progressive signs and symptoms of CS. A bilateral inferior petrosal sinus sampling (BIPSS) performed during a trough phase was false positive for pituitary ACTH overproduction resulting in unnecessary transsphenoidal surgery while a second BIPSS performed during an active phase was indicative for ectopic CS. The 18F-DOPA PET/CT showed a pancreatic lesion, which was subsequently partially removed. Surprisingly, the histopathology was conclusive for ACTH-positive lymph node metastasis located in the retro-duodenal tissue of an occult neuroendocrine tumor WHO grade II. The primary tumor has not been identified so far and, because of the persistent hypercortisolism, the patient underwent bilateral adrenalectomy. Two years later, ACTH levels started to increase progressively. Percutaneous biopsy of a newly identified suspected lesion in the fifth thoracic vertebra revealed a metastasis with positive staining for ACTH, synaptophysin and chromogranin A. Therapy with carboplatin and etoposide was started and, since then, the patient underwent 12 cycles of chemotherapy. Conclusions: We report the challenging case of a rapidly cycling CS secondary to ACTH-secreting neuroendocrine intestinal tumor of unknown primary. We highlight the importance of performing diagnostic tests only during the phases of active cortisol secretion and as soon as first symptoms appear to avoid pitfalls

Роль таможенных органов в обеспечении экономической безопасности России

Актуальность выбранной темы дипломной работы определена имеющимися на данном этапе проблемами в обеспечении экономической безопасности, а также необходимостью совершенствования работы таможенных органов с целью повышения уровня экономической безопасности, так как это является стратегической целью таможенных органов России.Объектом исследования является сфера экономической безопасности России.Целью работы является определение роли таможенных органов в обеспечении экономической безопасности России.The research urgency is determined by the problems at the current stage in ensuring economic security, as well as the need to improve the work of customs authorities in order to improve the level of economic security, since this is a strategic goal of the Russian customs authorities.Object of a research is the sphere of economic security of the Russian Federation. The purpose of graduate qualification work is definition of the place of customs authorities of the Russian Federation in ensuring economic security of the state

Bis(2,4,6-trimethyl­pyridinium) hexa­chloridoplatinate(IV)

The asymmetric unit of the title compound, (C8H12N)2[PtCl6], contains one independent protonated 2,4,6-trimethyl­pyridinium cation and one half of a centrosymmetric [PtCl6]2− anion. The Pt ion has an almost ideal octa­hedral coordination. In the crystal structure, intra­molecular N—H⋯Cl and inter­molecular C—H⋯Cl hydrogen bonds result in the formation of a supra­molecular structure

Tissue engineered constructs based on SPCL scaffolds cultured with goat marrow cells : functionality in femoral defects

This study aims to assess the in vivo performance of cell–scaffold constructs composed of goat marrow stromal cells (GBMCs) and SPCL (a blend of starch with polycaprolactone) fibre mesh scaffolds at different stages of development, using an autologous model. GBMCs from iliac crests were seeded onto SPCL scaffolds and in vitro cultured for 1 and 7 days in osteogenic medium. After 1 and 7 days, the constructs were characterized for proliferation and initial osteoblastic expression by alkaline phosphatase (ALP) activity. Scanning electron microscopy analysis was performed to investigate cellularmorphology and adhesion to SPCL scaffolds. Non-critical defects (diameter 6 mm, depth 3 mm) were drilled in the posterior femurs of four adult goats from which bone marrow and serum had been collected previously. Drill defects alone and defects filled with scaffolds without cells were used as controls. After implantation, intravital fluorescence markers, xylenol orange, calcein green and tetracycline, were injected subcutaneously after 2, 4 and 6 weeks, respectively, for bone formation and mineralization monitoring. Subsequently, samples were stained with L´evai–Laczk´o for bone formation and histomorphometric analysis. GBMCs adhered and proliferated on SPCL scaffolds and an initial differentiation into pre-osteoblasts was detected by an increasing level of ALP activity with the culture time. In vivo experiments indicated that bone neoformation occurred in all femoral defects. The results obtained provided important information about the performance of SPCL–GBMC constructs in an orthotopic goat model that enabled future studies to be designed to investigate in vivo the functionality of SPCL–GBMC constructs in more complex models, viz. critical sized defects, and to evaluate the influence of in vitro cultured autologous cells in the healing and bone regenerative process.Marcia T. Rodrigues acknowledges the Portuguese Foundation for Science and Technology (FCT) for her PhD scholarship (Grant No. SFRH/BD/30745/2006). This work was partially supported by the European Union-funded STREP Project HIPPOCRATES (Grant No. NMP3-CT-2003-505758) and was carried out under the scope of the European NoE EXPERTISSUES (Grant No. NMP3-CT-2004-500283)

Giant primary adrenal hydatid cyst presenting with arterial hypertension: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>A primary hydatid cyst of the adrenal gland is still an exceptional localization. The adrenal gland is an uncommon site even in Morocco, where echinococcal disease is endemic.</p> <p>Case presentation</p> <p>We report the case of a 64-year-old Moroccan man who presented with the unusual symptom of arterial hypertension associated with left flank pain. Computed tomography showed a cystic mass of his left adrenal gland with daughter cysts filing the lesion (Type III). Despite his negative serology tests, the diagnosis of a hydatid cyst was confirmed on surgical examination. Our patient underwent surgical excision of his left adrenal gland with normalization of blood pressure. No recurrence has occurred after 36 months of follow-up.</p> <p>Conclusion</p> <p>There are two remarkable characteristics of this case report; the first is the unusual location of the cyst, the second is the association of an adrenal hydatid cyst with arterial hypertension, which has rarely been reported in the literature.</p