Jejunal Stricture: single manifestation of Crohn’s Disease

A 60 year-old male patient was admitted to our institution referring repeated episodes of abdominal cramps and distention, weight loss, fatigue and anorexia. Abdominal radiogram showed dilatation of small bowel loops with few gas-fluid level

Chronic gastric volvulus

A 65-year-old male patient presented to the emergency room with dyspnoea

Dysphagia lusoria

We report a case of a 23-year-old female, with a complaint of dysphagia for solid food in the past one mouth. A barium oesophagography when done showed, in the upper third of the thorax, the presence of a linear extrinsic compression in the posterior wall, running cephalad from the left to the right. The diagnosis of dysphagia lusoria was proposed

Generation of road accident risk maps

http://citta-conference.fe.up.pt/editions/2013Knowing the factors that affect the likelihood of an accident occurrence has been increasingly challenging to the researchers given the huge social and financial costs that derive from road accidents. In Portugal, developments in this area have mainly involved interurban roads studies. However, according to ANSRi, about 70% of Portuguese road accidents occur in urban spaces, a trend common to most European countries. The lack of national or local information systems containing geo-referenced road accidents, geometric characteristics of roads, among others, hamper the creation of tools that help to assess the risk of exposure at a micro level, i.e. road intersections. The weaknesses mentioned above led us towards the implementation of models in a GIS-based environment in order to estimate the frequency of accidents for urban areas according to several breakdowns: road element, type of accident and the inclusion of explanatory variables related to road environment. One of the challenges faced by researchers when applying these models is the absence of data or its poor quality. Therefore, it is necessary to cross and analyse information from different sources, such as traffic variables (from model transportation planning), digital cartographic data, and other geometric variables, that may not be obtained in a direct way (e.g. using OpenStreetMap or Google Maps). In a further step, the estimation models will be programmed and applied according to the type of road element (e.g. intersections, roundabouts, segments). Finally, new information will be generated with all inputted data: a digital map with the number of accidents per road element. Such figures will need to be converted into something more meaningful for potential users, such as levels/categories (e.g. high, medium and low risk of exposure), which can be mapped. This paper proposes a methodology for automatic generation of road accident maps with those levels/categories. Thus, maps will serve as a decision support tool not only to insurers (who are likely to tax drivers more effectively, according to their exposure to risk), but also to drivers themselves (through generation of alarms that will allow them to tailor their driving performance), envisaging road safety improvement

Maturity-Onset Diabetes of the Young: a Type of Diabetes Still Underdiagnosed in Clinical Practice

O termo MODY (Maturity Onset Diabetes of the Young) surgiu pela primeira vez nos anos 60, englobando um grupo de doenças monogénicas de transmissão autossómica dominante e apresentação clássica em adolescentes ou adultos jovens. A diabetes tipo MODY constitui cerca de 1-2% de todos os diagnósticos de diabetes na Europa. Atualmente encontram-se caracterizados 14 genes responsáveis por esta patologia, os quais resultam em apresentações clínicas muito heterogéneas, sendo as mais comuns mutações nos genes da glucocinase (MODY 2) e Hepatocyte Nuclear Factor 1α/4α (MODY 3 e MODY 1). Os doentes podem apresentar ou não sintomatologia clássica da diabetes e um dos grandes desafios é o diagnóstico diferencial com a diabetes tipo 1 e tipo 2, pelas características fenotípicas sobreponíveis. Neste sentido, o teste genético afigura-se como muito importante, na medida em que fornece não só uma vantagem terapêutica (doentes com MODY 1 e MODY 3 erradamente diagnosticados como diabetes tipo 1 poderão abandonar a terapêutica com insulina de forma segura, uma vez que apresentam elevada sensibilidade ao tratamento com sulfonilureias), como também uma determinação do prognóstico e necessidade de vigilância de complicações microvasculares e extra-pancreáticas (o MODY 5 tem elevada incidência de patologia renal não-diabética), passando pela orientação de familiares e decisão acerca de instituição de terapêutica durante a gravidez. Esta revisão pretende reunir e resumir a informação existente acerca dos subtipos de MODY já conhecidos, diagnóstico diferencial, complicações e terapêutica, bem como a importância do teste genético e implicações desta patologia no feto.info:eu-repo/semantics/publishedVersio

Water enema computed tomography (WE-CT) in the local staging of low colorectal neoplasms: comparison with transrectal ultrasound

BACKGROUND: To determine the accuracy of computed tomography performed with a water enema application (WE-CT) in the local staging of low colorectal neoplasms and to compare the results with those of transrectal ultrasonography (TRUS). METHODS: Forty patients with low colorectal tumors were evaluated prospectively by CT with the simultaneous administration of a lukewarm rectal enema (0.5-1.5 L). Thin slices (5 mm) and intravenous application of iodinated contrast media were routinely used. TRUS was performed in 18 patients. Tumor size, location, and staging according to the TNM classification of the UICC were registered. Tumors were classified as or 5 mm in diameter was seen (reading A); N+ if at least one peritumoral node > or = 5 mm or three peritumoral nodes < 5 mm were identified (reading B). RESULTS: For the tumor staging, WE-CT showed a sensitivity of 90%, a specificity of 73%, a positive predictive value (PPV) of 90%, a negative predictive value (NPV) of 73%, and an accuracy of 85%. For TRUS, the results were sensitivity of 73%, specificity of 29%, PPV of 62%, NPV of 40%, and an accuracy of 39%. Concerning nodal staging with WE-CT, results were superior when reading A was used: sensitivity = 84%, specificity = 83%, PPV = 73%, NPV = 91%, and accuracy = 84%. TRUS showed a sensitivity of 29%, specificity of 100%, PPV of 100%, NPV of 67%, and an accuracy of 71%. CONCLUSION: WE-CT is a reliable technique for the local staging of low colorectal tumors that can be superior to TRUS. For diagnosis of peritumoral metastatic lymph nodes on WE-CT, the 5-mm diameter cutoff value is the most appropriate size criterion

Liquid mixtures involving hydrogenated and fluorinated alcohols: thermodynamics, spectroscopy, and simulation

This article reports a combined thermodynamic, spectroscopic, and Computational study on the interactions and structure of binary mixtures of hydrogenated and fluorinated substances that simultaneously interact through strong hydrogen bonding. Four binary mixtures of hydrogenated and fluorinated alcohols have been studied, namely, (ethanol + 2,2,2-trifluoroethanol (TFE)), (ethanol + 2,2,3,3,4,4,4-heptafluoro-1-butanol), (1-butanol (BuOH) + TFE), and (BuOH + 2,23,4,4,4-heptafluoto-1-butanol). Excess molar volumes and vibrational spectra of all four binary mixtures have been measured as a function of composition at 298 K, and molecular dynamics simulations have been performed. The systems display a complex behavior when compared with mixtures of hydrogenated alcohols and mixtures of alkanes and perfluoroalkanes. The combined analysis of the results from different approaches indicates that this results from a balance between preferential hydrogen bonding between the hydrogenated and fluorinated alcohols and the unfavorable dispersion forces between the hydrogenated and fluorinated chains. As the chain length increases, the contribution of dispersion increases and overcomes the contribution of H-bonds. In terms of the liquid structure, the simulations suggest the possibility of segregation between the hydrogenated and fluorinated segments, a hypothesis corroborated by the spectroscopic results. Furthermore, a quantitative analysis of the infrared spectra reveals that the presence of fluorinated groups induces conformational changes in the hydrogenated chains from the usually preferred all-trans to more globular arrangements involving gauche conformations. Conformational rearrangements at the CCOH dihedral angle upon mixing are also disclosed by the spectra