Acquired hepatocerebral degeneration (AHD): a peculiar neurological impairment in advanced chronic liver disease.

We discuss the case of a rare and often unrecognized neurologic syndrome, called Acquired Hepatocerebral Degeneration (AHD), observed in patients with advanced liver disease and portosystemic shunts. The clinical manifestations can be very heterogeneous and in our case included a combination of cerebellar and extrapyramidal signs, arisen in a period of few days. Brain Magnetic Resonance Imaging (MRI) showed, in T1-weighted images, diffuse bilateral hyper intensities in basal ganglia and biemispheric brain and cerebellar cortices, resembling paramagnetic deposits. No other neurological impairments, like stroke, infection or neoplasia, were found. It was excluded an episode of acute hepatic encephalopathy. We also ruled out Wilsonian degeneration, iron overload and autoimmune encephalitis and we lastly found high manganese levels as the possible cause of the brain paramagnetic deposits. Even though either serum Mn determination or its accumulation in the brain are not specific for AHD, however the chronic and progressively worsening of the neurological manifestations advocated a degenerative condition, possibly AHD. We finally opted for the early restoration of liver function by OLT, and we observed complete clinical symptoms' resolution and partial MRI reversal after a follow up of 6 months.

Two-shell structured PMAA@CeO2 nanocontainers loaded with 2-mercaptobenzothiazole for corrosion protection of damaged epoxy coated AA 2024-T3.

In this work, novel two-shell structured inhibitor-loaded poly(methacrylic acid)@cerium oxide (PMAA@CeO2) nanocontainers were synthesised and characterized. The purpose of the nanocontainers is to increase the corrosion protection provided by an epoxy coating applied to an aerospace alloy (AA 2024-T3). The (PMAA@CeO2) nanocontainers with diameters of 550 nm were synthesised by a four-step process with the method of distillation precipitation polymerization for the synthesis of the inner PMAA layer, and the sol-gel method for the development of the outer CeO2 layer. The loaded nanocontainers were characterized by scanning and transmission electron microscopies. The corrosion protection properties of the epoxy coated AA 2024-T3 with 2-mercaptobenzothiazole (2-MBT) loaded PMAA@CeO2 nanocontainers were evaluated with and without artificial scribes by electrochemical impedance spectroscopy (EIS). The results indicated that the epoxy coating containing the 2-MBT-loaded nanocontainers provided enhanced protection of the AA 2024-T3 substrate.

Duodenal ulcers preceding cervical tuberculous lymphadenitis.

Lymphadenitis is the most common presentation of extra pulmonary tuberculosis, whereas gastrointestinal localization, particularly duodenal involvement, is rare. We report a case of extra pulmonary tuberculosis with association between cervical lymphadenitis and duodenitis with multiple ulcers, not responsive to treatment with protonic pump inhibitors, in a human immunodeficiency virus-seronegative adult woman of Eritrean origin. Clinical patterns of duodenal TB, diagnostic difficulties and aetiopathogenesis are discussed according to the literature. In this case report it is suggested that tuberculous infection must be considered when duodenal ulcers fail to respond to proton pump inhibitors, especially when the patient comes from an endemic area.