A case of acute aortic dissection type b associated with cushing's syndrome

We report a case of a 63-year-old man, with a previous history of hypertension and glucose intolerance associated troncular obesity that was emergently admitted to our Institution for evaluation of a severe, constant posterior chest pain which radiated anteriorly and dyspnoea with a suspected diagnosis of acute aortic dissection. A CT scan of thorax and abdomen demonstrated a dissection starting just below left succlavian artery and extending downward to the left renal artery, involving the celiac tripod and superior mesenteric artery. The dissection was classified as Stanford B, De Bakey III. Moreover, CT scan of abdomen revealed incidentally a left adrenal tumor of 25 mm of diameter. An emergent prosthetic graft was placed just below the origin of the left succlavian artery up-to the diaphragmatic hiatus. Furthermore, a diagnostic evaluation of the mass revealed an increase of cortisol production, and a diagnosis of Cushing's syndrome was done and the patient underwent an adrenalectomy via laparotomic approach. We report an association of acute aortic dissection of acute aortic dissection type B associated to Cushing's syndrome. Cushing's syndrome; Adrenocortical adenoma; Aortic dissection type B

Diabetes mellitus and necrotizing fasciitis – a deadly combination; case report

Necrotizing fasciitis is a rapidly destructive affliction of soft tissues, with a mortality rate that may reach 73% of the cases. It is characterized by a progressive inflammation and extended necrosis of the subcutaneous tissue and the fascia. Necrotizing fasciitis was first described in 1848, and later in 1920 Meleney identified 20 patients in China in which the infection was presumably triggered by hemolytic streptococcus, linking pathological bacteria to the condition. In 1952, Wilson coined the term necrotizing fasciitis although without successfully identifying the specific pathological bacteria involved. In most cases, both risk and aggravating factors are present, the main risk factors being diabetes mellitus, liver cirrhosis, renal failure, and immunosuppressant states. Location may vary, but most frequently the disease occurs in the limbs, the trunk, and the perineum. Treatment depends on the location and the time of diagnosis and may range from large incisions with extensive debridement to organ amputations such as those of the limbs or breasts. Treatment is complex and expensive, and besides surgery, includes the administration of broad-spectrum antibiotics, anti-inflammatory drugs, intensive therapy support, and long-term hospitalizations. The prognosis is guarded. The present case entails a 56-year old female patient who presented with many risk factors favoring the occurrence of necrotizing fasciitis, namely diabetes mellitus, liver cirrhosis (decompensated with ascites and portal encephalopathy phenomena), untreated hepatitis B infection, chronic renal failure with diabetic nephrotic syndrome, and obesity

Particularities of Hepatic Sarcoidosis

Liver sarcoidosis is usually an underdiagnosed disease, which can have severe implications in the evolution of a patient. Due to the fact that sarcoidosis is a disease based on immunological disorders, it is only natural that the liver should be one of the first organs to be affected. The imaging of liver sarcoidosis is of marked importance, especially in the differential diagnosis of the disease. While the histology aspect of sarcoidosis is relatively clear and should prompt a positive diagnosis, finding a liver granuloma in ultrasonography raises a multitude of questions and implies extensive testing for diagnosis. Furthermore, treatment of liver sarcoidosis is controversial, taking into account the possibility of developing end-stage liver disease in patients with a long history of sarcoidosis. This chapter aims to review diagnostic and treatment options for liver sarcoidosis and to determine the best management of these patients

Vegetal products used in dermatological practice

INTRODUCERE Cel mai mare organ al corpului uman, pielea, menţine un echilibru între diverși parametri ai organismului și este prima barieră care ne apără împotriva agresiunii factorilor externi, cum ar fi agentii infectioși: bacterii, paraziţi, virusuri. SCOPUL LUCRĂRII Cercetarea produselor vegetale, plantelor medicinale și a principiilor active utilizate în practica dermatologică. MATERIALE ȘI METODE Studiul și sinteza articolelor știinţifice privind utilizarea produselor vegetale și plantelor medicinale în practica dermatologică. REZULTATE În practica dermatologică se utilzează pe larg produsele vegetale cu conţinut de poliholozide ce pot fi aplicate local, sub formă de cataplasme, pentru umectarea tegumentelor, ca emolient: Plantaginis majoris folia (Plantago major L.); Lini semina (Linum usitatissimum L.), Echinaceae herba (Echinacea purpurea L.) Produsele vegetale bogate în vitamine au rol de a stimula regenerarea și epitelizarea rănilor, intensifică metabolismul glicoproteidelor, inhibă procesele inflamatorii, infiltraţia leucocitară și cresc activitatea fagocitară: Calendulae flores (Calendula officinalis L.); Bidentis herba (Bidens tripartita L.); Gnaphalii uliginosi herba (Gnaphalium uliginosum L.); Hippophaes rhamnoides fructus (Hippophae rhamnoides L.).Oleum Hippophaes manifestă acţiune antiinflamatoare, iar în asociere cu rostopasca este utilizat în tratamentul dermatozelor și micozelor. Acţiunea cicatrizantă și antiinflamatoare a uleurilor volatile se datorează compușilor care stimulează aparatul reticulo-endotelial prin histamina eliberată din ţesut și proprietăţi antibacterine: Chamomillae flores (Chamomilla recutita L.); Salviae folia (Salvia officinalis L.). Din grupul alcaloizilor, extractele din părţi aeriene de rostopască: Chelidonii herba (Chelidonium majus L.) au efecte cicatrizante și pot fi utilizate în tratarea rănilor, psoriazisului prin coptizină, iar rădăcinile de tătăneasa: Symphyti radices (Symphytum officinale L.) se utilizează ca consolidant și cicatrizant prin conţinut de alantoină. CONCLUZII. Produsele vegetale sunt utilizate în practica dermatologică prin conţinut bogat de mucilagii cu prorpietăţi emoliente, produse vitaminizante regeneratoare, uleiuri volatile cu proprietăţi antihistaminisce și antibacteriene, produse vegetale cu conţinut de alcaloizi cu proprietăţi cicatrizante. Complexitatea leziunilor, precum și multitudinea de soluţii terapeutice disponibile, crează noi provocări cărora farmacistul urmează să le facă faţă.INTRODUCTION The largest organ of the human body, the skin, maintains a balance between various parameters of the body and is the first barrier that protects us against the aggression of external factors, such as infectious agents: bacteria, parasites, viruses. THE AIM OF THE STUDY Research of vegetal products, medicinal plants and active principles used in dermatological practice. MATERIALS AND METHODS Study and synthesis of scientific articles on the use of vegetal products and medicinal plants in dermatological practice. RESULTS In dermatological practice are widely used vegetal products containing polyholosides that can be applied locally, in the form of poultices, to moisturize the skin, as an emollient: Plantaginis majoris folia (Plantago major L.); Flaxseed (Linum usitatissimum L.), Echinaceae herba (Echinacea purpurea L.) Vitamin-rich vegetal products have the role of stimulating wound regeneration and epithelialization, intensifying glycoprotein metabolism, inhibiting inflammatory processes, leukocyte infiltration and increasing phagocytic activity: Calendulae flores (Calendula officinalis L.); Bidentis herba (Bidens tripartita L.); Gnaphalii uliginosi herba (Gnaphalium uliginosum L.); Hippophaes rhamnoides fructus (Hippophae rhamnoides L.). Oleum Hippophaes has an anti-inflammatory action, and in combination with Celandine is used in the treatment of dermatoses and fungal infections. The healing and anti-inflammatory action of essential oils is due to compounds that stimulate the reticuloendothelial apparatus through histamine released from the tissue and antibacterial properties: Chamomillae flores (Chamomilla recutita L.); Salviae folia (Salvia officinalis L.). From the group of alkaloids, extracts from aerial parts of Celandine: Chelidonii herba (Chelidonium majus L.) have healing effects and can be used to treat wounds, psoriasis by coptisyne, and Comfrey roots: Symphyti radices (Symphytum officinale L.) are used as a strengthening and healing remedy thanks to its allantoin content. CONCLUSIONS Vegetal products are used in dermatological practice thanks to their rich content of mucilages with emollient properties, regenerating vitamin products, essential oils with antihistaminic and antibacterial properties, vegetal products with alkaloids with healing properties. The complexity of the lesions, as well as the multitude of therapeutic solutions available, create new challenges that the pharmacist will have to face

Investigation of erosion behavior of EB-PVD-TBCs and sacrificial coatings after CMAS infiltration

Aero-engines operating in sand laden environments often encounter severe problems with thermal barrier coatings (TBCs) due to erosion damage. Since the turbine entry temperatures are raising, the life-time of TBC coatings as well as its thermal conductivity are additionally influenced by molten sand (calcium-magnesium-alumino-silicate/ CMAS). Few attempts have been made in understanding the combined impact of both erosion and CMAS effects [1,2]. Wellman and Nicholls [1] have found that a fully CMAS infiltrated electron-beam physical vapor deposited (EB-PVD) TBC behaves like a continuum during erosion and slightly improves its erosion behavior under room temperature compared to pure TBC. Development of CMAS resistant coatings has been a hot topic for the last two decades and one of the proposed method is the application of sacrificial oxide layers such as Al2O3, MgO, Sc2O3 et al. [3], on top of the TBCs. These sacrificial layers chemically react with the CMAS and modify the melting temperature or the viscosity of CMAS and thus the infiltration of CMAS into the TBC is inhibited. Since both damage mechanisms (erosion and corrosion) occur parallel and competitively in a turbine, this study focuses on deeper understanding of the erosion behavior of CMAS-infiltrated 7wt.-% yttria stabilized zirconia (7YSZ) TBCs. 400 µm thick 7YSZ coatings with two different microstructures were produced by EB-PVD. Additionally, sacrificial Al2O3 coatings were also applied on the top of 7YSZ by means of suspension plasma spraying (SPS) and suspension high velocity oxy-fuel spraying (SHVOF) using water-based suspensions. CMAS infiltration experiments were carried out at 1250 °C using different CMAS compositions and different infiltration times. Erosion tests were realized at room temperature in an in-house erosion test rig and evaluated partly by confocal microscopy. Microstructural examinations as well as crack identification before and after testing were carried out using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). Infiltrated TBCs behaved as a continuum material during erosion exposure which lead mainly to surface spallation. Furthermore, the CMAS infiltration in the TBCs and partly the sintering effect at 1250 °C lead to a network of vertical cracks. These vertical cracks are weak areas where severe erosion occurs. The different TBC microstructures, infiltration times and CMAS compositions strongly influence the erosion behavior of the TBC. In case of alumina top coats the microstructure and especially the presence of porosity in the coating has strongly influenced the CMAS infiltration depth, the erosion behavior, and the stability of the entire coating system. [1] R.G. Wellman, J.R. Nicholls, Erosion, corrosion and erosion–corrosion of EB PVD thermal barrier coatings, Tribology International. 41 (2008) 657–662. doi:10.1016/j.triboint.2007.10.004. [2] S. Rezanka, D.E. Mack, G. Mauer, D. Sebold, O. Guillon, R. Vaßen, Investigation of the resistance of open-column-structured PS-PVD TBCs to erosive and high-temperature corrosive attack, Surface and Coatings Technology. 324 (2017) 222–235. doi:10.1016/j.surfcoat.2017.05.003. [3] A.K. Rai, R.S. Bhattacharya, D.E. Wolfe, T.J. Eden, CMAS-Resistant Thermal Barrier Coatings (TBC), International Journal of Applied Ceramic Technology. 7 (2010) 662–674. doi:10.1111/j.1744-7402.2009.02373.x

Investigation of CMAS resistance of SPS- and SHVOF-alumina topcoats on EB-PVD 7YSZ layers

Thermal barrier coatings (TBCs) undergo severe degradation by interaction with molten calcium-magnesium-aluminum-silicate (CMAS) minerals that are found mainly in volcanic ashes (VA) or desert sands. After the infiltration of the CMAS, chemical reactions, diffusion and phase transformation can lead to residual stress, cracks and spallation and thus significantly shorten the life-time of the components. As the state-of-the-art material 7 wt.-% Y2O3 stabilized ZrO2 (7YSZ) offers limited resistance to the CMAS attack, development of CMAS-resistant TBCs has undergone intense research during the last decades. One of the proposed approaches is the application of a sacrificial layer on top of the TBC which reacts with the molten CMAS/VA to crystalline phases and in this way inhibits further infiltration by sealing the gaps and pores. Al2O3 is one candidate for such a sacrificial layer which exhibits good CMAS resistance by formation of arresting phases. However, EB‑PVD Al2O3-topcoats suffer locally from cracks that arise from crystallization and sintering shrinkage, thereby providing only a discontinuous protection against CMAS infiltration due to their characteristic morphology. Even though the alumina is a candidate material, the coating density and the arrangement of porosity has been found to be a critical factor for restricting CMAS infiltration. In this work alumina coatings were sprayed on top of EB‑PVD 7YSZ TBCs using suspension plasma spraying (SPS) and suspension high velocity oxygen fuel spraying (SHVOF) starting from an aqueous suspension containing fine dispersed Al2O3 (d50 about 2.3 µm). The spray parameters were optimized in order to produce Al2O3 topcoats with homogeneous distributed porosity from very porous (porosity about 30 %) to denser (porosity about 10-15 %). These coatings were tested under CMAS attack by performing infiltration experiments at 1250 °C for different time intervals from 5 min to 10 hours. One Island volcanic ash from the Eyjafjallajökull volcano (IVA) and two types of synthetic CMAS compositions were tested in this study. The infiltration kinetics and reaction products were studied by SEM, energy-dispersive spectroscopy (EDS) and x-ray diffraction (XRD). It was observed that the microstructure and especially the presence of the porosity in the Al2O3 coatings strongly influenced the CMAS infiltration kinetics. Due to its high and non-uniform porosity, CMAS/VA melt infiltrated the 100 µm thick, very porous alumina SPS‑coating inhomogeneously and reached the subjacent 7YSZ layer already after one hour of annealing at 1250°C. Additionally, it was found that the infiltration kinetics varies also with the chemical composition of the CMAS/VA. Different crystalline phases such as anorthite, spinel or others were formed as reaction products of the SPS‑Alumina-TBC with the CMAS/VA-melt. The exact phases and its location depend on the used CMAS/VA composition. Furthermore, the annealing time has a major influence on the presence of the various phases. The infiltration kinetics of the SHVOF‑coatings was different due to a change in morphology. The current experiments clearly demonstrate that CMAS/VA mitigation depends on the interplay between morphology of the coating which dictates the driving force for infiltration, the reaction speed between alumina and the deposit, and the deposit chemistry

Hydro-physical characterization of soils under the Restinga Forest

Knowledge of the hydraulic properties of the soil is of crucial importance to an understanding of the interactions between vegetation, soil and water. There is little information available about the hydraulic properties of Podzol soils found in tropical regions. The aim of this study was to present the soil morphology and hydraulic properties of a toposequence situated in a permanent plot at the Ilha do Cardoso State Park (Cananéia, SP, Brazil). Ultradetailed soil maps were used to define a toposequence inside the permanent plot. Five profiles, representing the main types of soil, were opened along the toposequence, in which Podzols are dominant. The levels of bulk density, sand content, porosity and permeability in these soils were all high. Consequently, these soils have a high level of hydraulic conductivity with low water retention. This behavior undergoes an alteration in the Bh and Bs horizons due to the accumulation of organic and metallic compounds and a changing structure that modifies the pore distribution. Furthermore, the characterization of the hydro-physical functioning of soils in natural environments is an important source of encouragement to further investigative study of soil water dynamics and its relationship to the native vegetation

Influence of feedstock and thermal spray process on the phase composition of alumina coatings and their sliding wear.

Suspension thermal spraying is an emerging coating technology that enables the deposition of dense-structured ceramic coatings. As wear resistance is a main application field of alumina (Al2O3) coatings, this study aimed to evaluate the dry reciprocating sliding wear resistance of suspension sprayed high velocity oxy-fuel (S-HVOF) alumina coatings and to compare it with atmospheric plasma sprayed (APS) and HVOF coatings. Coatings were analyzed in the as-sprayed state and post-treated at 910 °C (hot isostatically pressed, HIPed) conditions. Wear tests were conducted using a tribometer, following the ASTM G133-02 standard and a sintered WC-6 wt.% Co ball as the counterbody. Coating characterization was done using scanning electron microscopy, X-ray diffraction and nanoindentation technique. Results indicate that the HVOF, HVOF-HIP and S-HVOF coatings had a high α-Al2O3 content, whereas the APS and APS-HIP coatings had a high γ-phase content together with high porosity. Sliding wear resistance was an order of magnitude higher for the S-HVOF and HVOF coatings than the APS and APS-HIPed coatings. This difference in wear performance was attributed to the high nanohardness, elastic modulus, dense microstructure and relatively high α-Al2O3 content in the HVOF, S-HVOF and HVOF-HIP coatings. Results are discussed in terms of the wear mechanism and structure-property relationship