Pancreatic Ductal Adenocarcinoma Associated with Autoimmune Pancreatitis

Autoimmune pancreatitis (AIP), in contrast to other benign chronic pancreatic diseases, can be cured with immunosuppressant drugs, thus the differentiation of AIP from pancreatic cancer is of particular interest in clinical practice. There is the possibility that some patients with AIP may develop pancreatic cancer, and this possibility contributes to increasing our difficulties in differentiating AIP from pancreatic cancer. We herein report the case of a 70-year-old man in whom pancreatic adenocarcinoma and AIP were detected simultaneously. We must carefully monitor AIP patients for the simultaneous presence of pancreatic cancer, even when a diagnosis of AIP is confirmed

The influence of intra-daily activities and settings upon weekday violent crime in public space in Manchester, UK

People ebb and flow across the city. The spatial and temporal patterning of crime is, in part, reflective of this mobility, of the scale of the population present in any given setting at a particular time. It is also a function of capacity of this population to perform an active role as an offender, victim or guardian in any specific crime type, itself shaped by the time-variant activities undertaken in, and the qualities of, particular settings. To this end, this paper explores the intra-daily influence of activities and settings upon the weekday spatial and temporal patterning of violent crime in public spaces. This task is achieved through integrating a transient population dataset with travel survey, point-of-interest and recorded crime data in a study of Great Manchester (UK). The research deploys a negative binomial regression model controlling for spatial lag effects. It finds strong and independent, but time-variant, associations between leisure activities, leisure settings and the spatial and temporal patterning of violent crime in public space. The paper concludes by discussing the theoretical and empirical implications of these findings

Hérnias intra-raquidianas dos discos intervertebrais lombares: resultados da excisão em 128 casos

O tratamento cirúrgico das hérnias de discos intervertebrals lombares tem indicações precisas e os resultados dependem de condições que devem ser convenientemente satisfeitas. Nos casos em que só existe sintomatologia dolorosa subjetiva que não regride com o tratamento conservador, a intervenção cirúrgica deve ser condicionada à comprovação diagnóstica mediante um dado objetivo, qual seja a radiologia contrastada, que não só informa quanto à existência e situação de prolapso discal, como permite o diagnóstico diferencial com outras afecções. Nos casos em que, além da sintomatologia dolorosa subjetiva, existem sintomas objetivos sensitivos e/ou motores, indicando sofrimento das raízes raquidianas, o tratamento cirúrgico tem indicação absoluta, devendo o ato operatório ser precedido de exame radiológico contrastado. Não deve haver qualquer contemporização no ato cirúrgico quando a sintomatologia plurirradicular e de caráter agudo fizer suspeitar da ocorrência de retropulsão maciça de discos intervertebrals. Quanto à tática cirúrgica, deve ser feita laminectomia parcial unilateral quando o prolapso discai ocupar situação póstero-lateral, na altura dos espaços Lv4-Lv5 e LV5-Sv1 quando o prolapso estiver situado em níveis mais altos ou quando estiver em situação mediana ou, mesmo, quando se tratar de herniações bilaterais de um mesmo disco intervertebral, deve ser feita a laminectomia total, para evitar trações exageradas sôbre as raízes raquidianas, trações que podem ocasionar seqüelas sensitivo-motoras irreversíveis. O cirurgião deve considerar que seu alvo principal é suprimir as causas de compressão de raízes raquidianas; para isso, deve excisar o disco intervertebral herniado e, eventualmente, fazer a exérese de bordas escleróticas das vértebras; a excisão do disco lesado deve ser tão completa quanto possível, mediante curetagem, para evitar recidivas. Quando a herniação discai estiver situada no buraco de conjugação, deve ser feita a facetectomia, sendo a intervenção completada com artródese para imobilização. Para a exposição de hérnia discai, a bainha durai da raiz raquidiana deve sempre ser deslocada para a linha mediana, qualquer que seja a situação do prolapso, pois, dêsse modo, são diminuídas as possibilidades de lesões traumáticas da raiz que está sendo manipulada. Fragmentos livres de disco intervertebral no espaço epidural devem ser extirpados; o cirurgião deve ter presente a possibilidade da existência de tais fragmentos em níveis situados imediatamente acima ou abaixo do disco herniado. A rizotomia posterior deve ser praticada quando existir fibrose intensa da bainha durai de raízes raquidianas e, eventualmente, quando a excisão da hérnia discai não fôr julgada satisfatória; a rizotomia posterior deve ser feita, também, tôdas as vêzes em que a reparação de uma lesão acidental da bainha de uma raiz raquidiana não tenha sido satisfatória. A electrocoagulação do ligamento longitudinal posterior, visando à destruição da maior parte do nervo sinuvertebral de Luschka, deve complementar a operação para diminuir a persistência ou a incidência de lombalgias. A hemostasia deve ser perfeita para diminuir a formação de tecido cicatricial, causa de sintomatologia dolorosa no pós-operatório. Com êsse mesmo intuito deve ser interposta lâmina de esponja de gelatina isolando a bainha durai da raiz raquidiana das formações circunvizinhas. Neste trabalho são apresentados os resultados obtidos em 128 casos, escolhidos entre 571 pacientes operados de hérnias intra-raquidianas de discos intervertebrals lombares; êstes 128 casos foram selecionados por terem seguimento de um ano, no mínimo, para permitir boa avaliação dos resultados. Foram considerados como bons tão sòmente os resultados obtidos nos pacientes que, um ano após a intervenção cirúrgica, não apresentavam qualquer sintoma objetivo ou subjetivo decorrente da afecção (100/128 casos, ou sejam 78,1%); como regulares, aquêles em que houve apenas melhoras (14/128 casos, ou sejam 10,9%); como maus aquêles em que os pacientes não foram beneficiados com a intervenção (14/128 casos, ou sejam 10,9%). Dentro de criteriosas indicações, as hérnias intra-raquidianas de discos intravertebrais lombares devem ser tratadas com métodos cirúrgicos; salvo casos excepcionais, tais operações devem ser feitas por neurocirurgiões

Lower intracellular concentration of cryoprotectants after vitrification than after slow freezing despite exposure to higher concentration of cryoprotectant solutions.

STUDY QUESTION: What is the intracellular concentration of cryoprotectant (ICCP) in mouse zygotes during vitrification (VIT) and slow-freezing (SLF) cryopreservation procedures? SUMMARY ANSWER: Contrary to common beliefs, it was observed that the ICCP in vitrified zygotes is lower than after SLF, although the solutions used in VIT contain higher concentrations of cryoprotectants (CPs). WHAT IS KNOWN ALREADY: To reduce the likelihood of intracellular ice crystal formation, which has detrimental effects on cell organelles and membranes, VIT was introduced as an alternative to SLF to cryopreserve embryos and gametes. Combined with high cooling and warming rates, the use of high concentrations of CPs favours an intracellular environment that supports and maintains the transition from a liquid to a solid glass-like state devoid of crystals. Although the up-to-date publications are reassuring in terms of obstetric and perinatal outcomes after VIT, a fear about exposing gametes and embryos to high amounts of CPs that exceed 3-4-fold those found in SLF was central to a debate initiated by advocates of SLF procedures. STUDY DESIGN, SIZE, DURATION: Two experimental set-ups were applied. The objective of a first study was to determine the ICCP at the end of the exposure steps to the CP solutions with our VIT protocol (n = 31). The goal of the second investigation was to compare the ICCP between VIT (n = 30) and SLF (n = 30). All experiments were performed in triplicates using mouse zygotes. The study took place at the GIGA-Research Institute of the University of Liege. PARTICIPANTS/MATERIALS, SETTING, METHODS: Cell volume is modified by changes in extracellular osmolarity. Hence, we estimated the final ICCP after the incubation steps in the VIT solutions by exposing the cells to sucrose (SUC) solutions with defined molarities. The ICCP was calculated from the SUC concentration that produced no change in cell volume, i.e. when intra- and extracellular osmolarities were equivalent. Cell volume was monitored by microscopic cinematography. ICCP was compared between SLF and VIT based on the principle that a high ICCP lowers the probability of (re)crystallization during warming but increases the probability of over-swelling of the cell due to fast inflow of water. The survival rates of mouse zygotes after SLF or VIT were compared using either (i) various warming rates or (ii) various concentrations of SUC in the warming dilution medium. MAIN RESULTS AND THE ROLE OF CHANCE: The ICCP in mouse zygotes during the VIT procedure prior to plunging them in liquid nitrogen was approximately 2.14 M, i.e. one-third of the concentration in the VIT solution. After SLF, the warming rate did not affect the zygote survival rate. In contrast, only 3/30 vitrified zygotes survived when warmed slowly but as many as 30/30 zygotes survived when warming was fast (>20 000 degrees C/min). Vitrified zygotes showed significantly higher survival rates than slow-frozen zygotes when they were placed directly in the culture medium or in solutions containing low concentrations of SUC (P < 0.01). These two experiments demonstrate a lower ICCP after VIT than after SLF. LIMITATIONS, REASONS FOR CAUTION: The results should not be directly extrapolated to other stages of development or to other species due to possible differences in membrane permeability to water and CPs. WIDER IMPLICATIONS OF THE FINDINGS: The low ICCP we observed after VIT removes the concern about high ICCP after VIT, at least in murine zygotes and helps to explain the observed efficiency and lack of toxicity of VIT. STUDY FUNDING / COMPETING INTEREST(S): The study was funded by the FNRS (National Funds for Scientific Research). The authors declare that they have no competing interests

The prognostic relevance of tumor hypoxia markers in resected carcinoma of the gallbladder

International audienceIntratumoral hypoxia has been suggested to drive more aggressive tumor behavior. Our aim was to define whether markers of tumor hypoxia are predictors of outcome in patients with gallbladder carcinoma