Metastatic pheochromocytoma to liver without elevation of metanephrines and catecholamines

AbstractIntroductionMalignant pheochromocytoma represents 10% of all patients with pheochromocytoma. Of these cases, only 5–9% presents without elevation of metanephrines and catecholamines.Presentation of caseA 43-year-old female patient presented with an abdominal tumor. An exploratory laparotomy was performed and the final report was a pheochromocytoma. After ten years, multiple liver lesions were detected and surgical treatment was performed. Pathological evaluation revealed a malignant pheochromocytoma with negative margins after 5 years of follow-up without evidence of disease.DiscussionThe recurrence rate of malignant pheochromocytoma is 15–20% at ten years and a 5-year survival rate that ranges from 50% to 80%. The presence of synchronous metastases is rare (10–27%), but have been reported until 20 years later with the most common metastatic sites being the local lymph nodes, bone (50%), liver (50%) and lung (30%). The prognostic factor such as size >6cm, age over 45 years, synchronous metastasis and no tumor excision are related with poor prognosis.ConclusionSurgical treatment offers the best survival rate and the only chance of cure so far and the goal is an R0 resection as in our case. So it should be the treatment of choice

A grid based IMS learning design player: the ELeGI case study

This paper illustrates the work done and the results achieved within the ELeGI project about the orchestration and the delivery of Learning Services lying in the GRID inside an IMS Learning Design (IMS-LD) Unit of Learning and running under an enhanced version of the CopperCore Player. The added value of GRID technologies for the creation and the execution of dynamic learning experiences is evidenced as well as the experimentation performed to overcome the original IMS-LD limitation on running services is presented. The aim of the ELeGI project is to promote and support a learning paradigm centred on the knowledge construction using experiential based and collaborative learning approaches in a contextualised, personalised and ubiquitous way through the definition and implementation of a service oriented Grid based software architecture

A Grid Based IMS Learning Design Player: the ELeGI Case Study

This paper illustrates the work done and the results achieved within the ELeGI project about the orchestration and the delivery of Learning Services lying in the GRID inside an IMS Learning Design (IMS-LD) Unit of Learning and running under an enhanced version of the CopperCore Player. The added value of GRID technologies for the creation and the execution of dynamic learning experiences is evidenced as well as the experimentation performed to overcome the original IMS-LD limitation on running services is presented. The aim of the ELeGI project is to promote and support a learning paradigm centred on the knowledge construction using experiential based and collaborative learning approaches in a contextualised, personalised and ubiquitous way through the definition and implementation of a service oriented Grid based software architecture

Lithium Doping of MgAl₂O₄ and ZnAl₂O₄ Investigated by High-Resolution Solid State NMR

Lithium-doped spinels could function as solid state electrolytes in batteries in which all components have the spinel structure. In this study we prepared lithium-doped MgAl₂O₄ and ZnAl₂O₄. Advanced solid state ⁷Li, ²⁵Mg, and ²⁷Al NMR have been used to investigate the structure of these spinels and the structural changes that take place therein upon lithium doping. The spinel structure is well retained, although the amount of tetrahedral aluminum increases with increased lithium content. Using MQMAS experiments, the presence of two tetrahedral sites is discovered in both doped and undoped spinels. It is shown that the spinel structure of MgAl₂O₄ is heterogeneous, which leads to distributions in chemical shift and quadrupolar parameters. The heterogeneity is also shown in ²⁵Mg spectra obtained with the quadrupolar Carr–Purcell–Meiboom–Gill (QCPMG) and sideband selective Double Frequency Sweep-QCPMG (ssDFS-QCPMG) pulse sequences. Lithium mobility is measured using static variable temperature ⁷Li NMR experiments. A low fraction of mobile lithium was found (3–4%) for magnesium spinels. The lithium doped ZnAl₂O₄ sample shows practically no mobility. This sample has significantly less disorder and less cation site inversion than the magnesium samples