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In this paper we report a set of experiments at the wafer level regarding field-effect transistors with a graphene monolayer channel transferred on the ferroelectric HfO2/Ge-HfO2/HfO2 three-layer structure. This kind of transistor has a switching ratio of 103 between on and off states due to the bandgap in graphene induced by the ferroelectric structure. Both top and back gates effectively control the carriers' charge flow in graphene. The transistor acts as a three-terminal memristor, termed a memtransistor, with applications in neuromorphic computation.
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Rheumatologists are often confronted by patients with muscle weakness and elevated creatine kinase (CK) levels. Myositis cannot always be determined to be the cause of the complaints. This article presents two cases from our hospital where the diagnosis could only be determined by muscle biopsy. In the first case the patient presented with muscle weakness, pathological weight loss and a significant increase in CK levels. A muscle biopsy revealed an immune-mediated necrotizing myopathy (IMNM) caused by anti-3-hydroxy-3-methyl-gulatryl-CoA reductase (HMG-CoA reductase) autoantibodies due to the intake of statins. The second patient presented with cramp-like and burning muscle pain and weakness of the extremities without a relevant increase in CK level. Myoadenylate deaminase deficiency was also detected by muscle biopsy, and further confirmed by genetic testing.
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Creatina Quinasa/sangre , Debilidad Muscular , Miositis , Autoanticuerpos/inmunología , Enfermedades Autoinmunes , Humanos , Debilidad Muscular/sangre , Debilidad Muscular/diagnóstico , Enfermedades Musculares/sangre , Enfermedades Musculares/diagnóstico , Miositis/sangre , Miositis/diagnóstico , NecrosisRESUMEN
UNLABELLED: Summary BACKGROUND: This paper aims to present a "pattern" of oncosurgery solution in a case generally considered unrecoverable: intestinal occlusion in case of ovarian carcinoma and carcinomatosis. CASE REPORT: A 62-year-old female patient with ascites, carcinomatosis, unresectable pelvic tumour, and intestinal obstruction suffered a five-step oncosurgery "model": three surgical interventions overlapping chemotherapy administered via the systemic and intraperitoneal route: Step 1: colostomy and partial omentectomy; Step 2: five courses of systemic chemotherapy supported by granulocyte colony-stimulating factor; Step 3: radical surgery--total hysterectomy, bilateral adnexectomy, pelvic lymphadenectomy, omentectomy, appendectomy, pelvic peritonectomy, and hyperthermic intraperitoneal chemotherapy; Step 4: consolidation systemic chemotherapy consisting of three more similar cycles; Step 5: closure of the colostomy. Nine months after the beginning of treatment, the patient is with no evidence of disease. CONCLUSIONS: The association of surgical and oncologic treatment and the use of hyperthermic intraperitoneal chemotherapy (HIPEC) technology can solve some of these complex cases.
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Antineoplásicos/uso terapéutico , Carcinoma/terapia , Obstrucción Intestinal/cirugía , Epiplón/cirugía , Neoplasias Ováricas/terapia , Neoplasias Peritoneales/terapia , Peritoneo/cirugía , Carcinoma/complicaciones , Carcinoma/patología , Colostomía , Quimioterapia de Consolidación , Procedimientos Quirúrgicos de Citorreducción , Femenino , Humanos , Hipertermia Inducida , Histerectomía , Infusiones Parenterales , Obstrucción Intestinal/etiología , Escisión del Ganglio Linfático , Persona de Mediana Edad , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/patología , Ovariectomía , Neoplasias Peritoneales/secundario , SalpingectomíaRESUMEN
A portal vein invasion is no longer a contraindication for resection in pancreatic cancer, but increased morbidity and mortality rates can be encountered. Hereby it is presented the case of a patient diagnosed with a large adenocarcinoma of the uncinate process of the pancreas, who underwent aposterior approach pancreaticoduodenectomy, with en bloctang ential resection of the portal vein, and total mesopan creasexcision. A posterior approach allows a negative resection margins pancreaticoduodenectomy, with a good local control of the disease, despite the in creas.
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Adenocarcinoma/cirugía , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía , Vena Porta/cirugía , Adenocarcinoma/patología , Carcinoma Ductal Pancreático/cirugía , Femenino , Humanos , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias Pancreáticas/patología , Pancreaticoduodenectomía/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Osteonecroses (ON) are a serious problem after anti-leukaemic treatment in childhood and critically depend on treatment intensity. We analysed ON incidence, risk factors and outcome in patients (pts) from our institution treated according to the CoALL 07-03 trial. METHODS: Between 01.09.2003 and 31.12.2009, 124 children aged 1-18 years were treated, 22 pts with ON (ARCO I-IV) were assessed by retrospective chart review. Follow-up data were collected as of March 2013. RESULTS: 5-year cumulative incidence of ON grade I-IV was 25%. Median age at ALL diagnosis with vs. without ON was 11 years vs. 4.4 years. In logistic multivariate regression analysis, age was the only independent risk factor for ON (p<0.01). 90.9% of the pts with ON presented with ≥2 bilaterally affected joints, most frequent the weight-bearing joints (95.5%). 77.2% developed ON ≥°III acc. to ARCO. 36.4% underwent core decompression, one patient bilateral total hip arthroplasty. As of March 2013, 12 pts still presented with ON-induced symptoms. DISCUSSION: Our data suggest an overall high incidence of ON in pts treated according to trial CoALL 07-03. Cumulative steroid dose in trial CoALL 07-03 was small, thus, the high CI might be triggered by other treatment-related and study population based risk factors. CONCLUSION: ON are a serious problem concerning long-term sequelae with major impact on activities of daily living. Further prospective evaluation is urgently needed to develop risk-adapted diagnostic strategies and preventive and interventional approaches for high-risk pts.
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Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Osteonecrosis/inducido químicamente , Osteonecrosis/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Adolescente , Factores de Edad , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Niño , Preescolar , Ensayos Clínicos como Asunto , Estudios Transversales , Dexametasona/administración & dosificación , Dexametasona/efectos adversos , Esquema de Medicación , Femenino , Alemania , Humanos , Incidencia , Lactante , Masculino , Osteonecrosis/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
PURPOSE: To present a rare clinical case of a subocclusive syndrome caused by recurrence of a left Bockdalek hernia, with emphasis on the radiological diagnosis and surgical treatment. The current paper presents a 36 year old female with past surgical history of Bockdalek hernia repaired 7 years ago using a diaphragmorrhaphy by thoraco-abdominal approach who presented with a subocclusive syndrome and epigastric pain. Upper endoscopy showed a duodenal ulcer positive for H. pylori. Initial abdominal CT scan was read as negative. On a closer evaluation of the CT images, a small Bockdalek hernia was appreciated, with the elevation of the left colic angle through the diaphragm. Given the occlusive symptoms, the patient underwent surgical treatment with diaphragmorrhaphy and alloplasty with polypropylene mesh, using an open approach. Postoperatively, the patient had a favourable course, being discharged home two days later. To date, there are 173 cases of Bockdalek hernia in the the medical literature, but none with a recurrence. Bockdalek hernia is a rare disease, with non-specific symptoms. It has a broad differential diagnosis that may delay early identification and management. The surgical treatment, either open or laparoscopic, must follow the current recommendations of the surgical societies, including mesh alloplasty to prevent recurrences.
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Enfermedades del Colon/etiología , Enfermedades del Colon/cirugía , Hernia Diafragmática/complicaciones , Hernia Diafragmática/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Mallas Quirúrgicas , Adulto , Enfermedades del Colon/diagnóstico , Diagnóstico Diferencial , Femenino , Hernia Diafragmática/diagnóstico , Humanos , Obstrucción Intestinal/diagnóstico , Polipropilenos , Enfermedades Raras , Procedimientos de Cirugía Plástica/métodos , Recurrencia , Resultado del TratamientoRESUMEN
UNLABELLED: BACKROUNDS/AIMS: Surgery remains the single hope for long-term survival long-term survival in pancreatic head carcinoma. Portal vein invasion is no longer a contraindication for resection but could be technically challenging. The aim of the present study is to emphasize the advantages of the posterior approach in duodenopancreatectomy with portal vein resection. METHODS: The present series includes 16 patients with duodenopancreatectomy and portal/superior mesenteric vein resection and reconstruction duodenopancreatectomy invading the venous axis, performed from 2004 to 2011, and representing one author's experience. RESULTS: A lateral resection with direct suture was performed in 10 patients and the length of the resected venous wall was less than 1.2 cm. A segmental resection was performed in six patients and the length of resected vein did not exceed 3 cm (range, 1.5 - 3 cm). All venous resection extremities were cancer-free at final pathological report. Eleven patients were considered as R0 resection while 5 patients were assessed as R1 at final pathological examination. Postoperative morbidity consisted of: 3 patients with postoperative pancreatic fistulae (grade A - 2 patients; grade C - 1 patient, requiring second look laparotomy for peri-pancreatic abscesses) and 5 patients with delayed gastric emptying grade B. CONCLUSION: Portal/superior mesenteric vein resection during duodenopancreatectomy is safe and it is facilitated by the posterior approach. Moreover, the posterior approach facilitates total mesopancreas excision during duodenopancreatectomy for pancreatic head cancer, a technical feature that appears to be associated with an increased rate of negative resection margins.
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Carcinoma/cirugía , Venas Mesentéricas/cirugía , Fístula Pancreática/cirugía , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/métodos , Vena Porta/cirugía , Carcinoma/mortalidad , Carcinoma/patología , Humanos , Venas Mesentéricas/patología , Invasividad Neoplásica , Fístula Pancreática/diagnóstico , Fístula Pancreática/etiología , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Pancreaticoduodenectomía/efectos adversos , Vena Porta/patología , Reoperación , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIM: the paper presents a rare case of metachronous gastric metastasis of uterine cervix cancer, clinically manifested through severe pyloric stenosis. METHOD: 49-year-old patient, operated on in January 2009, with uterine cervix cancer (Squamous cell carcinoma T2bN1M0), is hospitalized in August 2011 with pyloric stenosis: epigastric pains, abundant, stasis, late postprandial emesis, significant weight loss, stomach form visible upon abdomen inspection. Endoscopy: antral stenosis with intact gastric mucosa, and CT-scan: circumferential intramural gastric tumor, stomach dilated in the upper part, lack of cleavage between the tumor and the liver bed of the gall bladder. CEA increased to 13,78 (below 5), CA 19-9 slightly increased 29.9 (below 27). The case is considered as a second neoplasia and a D2 subtotal gastrectomy was performed, with 1 positive ganglion out of 27 on block with atypical hepatectomy of segments 4-5 for liver invasion, the final mounting being Y Roux. RESULTS: The histopathological examination shows a gastric metastasis of squamous carcinoma, of uterine cervix origin, the invaded perigastric ganglion having the same aspect of uterine cervix carcinoma. The post-surgery evolution was favorable, under chemo radiotherapy the patient being alive without relapse at 9 months post-surgery. CONCLUSION: In the literature there are 2 more cases of gastric metastasis of uterine cervix carcinoma, and 4 of uterine carcinoma without topographic indication, but without the histological documentation of the tumor filiation, without data related to resecability or follow-up, the case at hand being, from this perspective, the first documented resectable metachronous gastric metastasis from a cervix uteri carcinoma.
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Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/secundario , Estenosis Pilórica/diagnóstico , Estenosis Pilórica/etiología , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/secundario , Neoplasias del Cuello Uterino/patología , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Quimioterapia Adyuvante , Terapia Combinada/métodos , Femenino , Estudios de Seguimiento , Gastrectomía , Humanos , Persona de Mediana Edad , Invasividad Neoplásica , Estenosis Pilórica/cirugía , Radioterapia Adyuvante , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/terapia , Resultado del Tratamiento , Neoplasias del Cuello Uterino/complicaciones , Neoplasias del Cuello Uterino/terapiaRESUMEN
AIM: This paper aims to present the initial experience of the I-st Surgery Clinic Târgu Mures in laparoscopic sleeve gastrectomy, stressing the technical aspects of surgery and postoperative immediate and late results. METHOD: Started in 2008, I Surgery Clinic's experience includes 11 cases of laparoscopic sleeve gastrectomy, pursued between 5 and 10 months postsurgery.The group is structured as follows: 80% female, aged between 13 and 55 years, average BMI 46, with limits between 35 and 72. Surgical technique was unitary, 10 of 11 cases beeing performed by the same team. RESULTS: Surgergical results were excellent: 0 conversions, 0 bleeding, 0 fistulas, 0 missfire. Average hospitalisation was of 48 hours postsurgery. EWL overall 68%, with limits between 50%, in 2 cases (initial BMI 70) and 100%--1 case (initial BMI 35). Life threatening morbidity--0.0 mortality, average BAROS score 6.7. CONCLUSION: GLL is a well standardized, secure, efficient, applicable with good results in all categories of patients with morbid obesity.
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Gastrectomía/métodos , Gastroplastia , Laparoscopía , Obesidad Mórbida/cirugía , Adolescente , Adulto , Cirugía Bariátrica/métodos , Índice de Masa Corporal , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Rumanía , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Pérdida de PesoRESUMEN
We report significant photoelectrochemical activity of Y-doped BiFeO3 (Y-BFO) epitaxial thin films deposited on Nb:SrTiO3 substrates. The Y-BFO photoanodes exhibit a strong dependence of the photocurrent values on the thickness of the films, and implicitly on the induced epitaxial strain. The peculiar crystalline structure of the Y-BFO thin films and the structural changes after the PEC experiments have been revealed by high resolution X-ray diffraction and transmission electron microscopy investigations. The crystalline coherence breaking due to the small ionic radius Y-addition was analyzed using Willliamson-Hall approach on the 2θ-ω scans of the symmetric (00 l) reflections and confirmed by high resolution TEM (HR-TEM) analysis. In the thinnest sample the lateral coherence length (Lâ¥) is preserved on larger nanoregions/nanodomains. For higher thickness values L⥠is decreasing while domains tilt angles (αtilt) is increasing. The photocurrent value obtained for the thinnest sample was as high as Jph = 0.72 mA/cm2, at 1.4 V(vs. RHE). The potentiostatic scans of the Y-BFO photoanodes show the stability of photoresponse, irrespective of the film's thickness. There is no clear cathodic photocurrent observation for the Y-BFO thin films confirming the n-type semiconductor behavior of the Y-BFO photoelectrodes.
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Cancer treatments can have significant cardiovascular adverse effects that can cause cardiomyopathy and heart failure with reduced survival benefit and considerable decrease in the use of antineoplastic therapy. The purpose of this study is to assess the role of TLR2 and TLR4 gene expression as an early marker for the risk of doxorubicin-induced cardiomyopathy in correlation with early diastolic dysfunction in patients treated with doxorubicin. Our study included 25 consecutive patients who received treatment with doxorubicin for hematological malignancies (leukemia, lymphomas or multiple myeloma), aged 18-65 years, with a survival probability>6 months and with left ventricular ejection fraction>50%. Exclusion criteria consisted of the following: previous anthracycline therapy, previous radiotherapy, history of heart failure or chronic renal failure, atrial fibrillation, and pregnancy. In all patients, in fasting state, a blood sample was drawn for the assessment of TLR2 and TLR4 gene expression. Gene expression was assessed by quantitative reverse transcription PCR (qRT-PCR) using blood collection, RNA isolation, cDNA reverse transcription, qRT-PCR and quantification of the relative expression. At enrollment, all patients were evaluated clinically; an ECG and an echocardiography were performed. The average amount of gene expression units was 0.113 for TLR4 (range 0.059-0.753) and 0.218 for TLR2 (range 0.046-0.269). The mean mRNA extracted quantity was 113 571 ng/µl. As for the diastolic function parameters, criteria for diastolic dysfunction were present after 6 months in 16 patients (64%). In these patients, the mean values for TLR4 were 0.1198625 and for TLR2 were 0.16454 gene expression units. As for the diastolic function parameters, criteria for diastolic dysfunction were present after 6 months in 16 patients (64%). In these patients, the mean value for TLR2 was 0.30±0.19 and for TLR4 was 0.15±0.04. The corresponding values for the patients who did not develop diastolic dysfunction were 0.16±0.07 for TLR2 (P=0.01) and 0.11±0.10 for TLR4 (P=0.2). Our study suggests that TLR4 and TLR2 expression is higher in patients under doxorubicin therapy who develop diastolic dysfunction. This may suggest a predisposition to myocardial involvement, a higher sensitivity to doxorubicin cardiac effects.
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Biomarcadores de Tumor/genética , Técnicas de Laboratorio Clínico/métodos , Doxorrubicina/efectos adversos , Receptor Toll-Like 2/genética , Receptor Toll-Like 4/genética , Adolescente , Adulto , Anciano , Antibióticos Antineoplásicos/efectos adversos , Biomarcadores de Tumor/sangre , Cardiotoxicidad/diagnóstico , Cardiotoxicidad/etiología , Cardiotoxicidad/genética , Diagnóstico Precoz , Femenino , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Corazón/efectos de los fármacos , Corazón/fisiopatología , Neoplasias Hematológicas/sangre , Neoplasias Hematológicas/tratamiento farmacológico , Neoplasias Hematológicas/genética , Humanos , Masculino , Persona de Mediana Edad , Miocardio/metabolismo , Miocardio/patología , Receptor Toll-Like 2/sangre , Receptor Toll-Like 4/sangre , Adulto JovenRESUMEN
The authors present the case of a 64 years woman with a choledochal cyst along with a complex malformation of both intra and extrahepatic bile ducts. The patient was admitted with a diagnosis of acute and underestimated cholecystitis, which was in fact a real acute severe suppurated angiocolitis located at the cystic cavity level along with severe hepato-renal failure. As long as the choledochal cyst evolves as a stand-alone entity, it can frequently be associated with other malformations of the bile ducts--such as choledochal duct stenosis or abnormal connection of the common hepatic duct with pancreatic ducts. The main dilatation was engulfing the whole common bile duct with a fusiform aspect, and the cranial end is opening into a long hepatic duct from which were emerging several biliary segments branches, for both hepatic lobes. This aspect of a multistage convergence with four branches which is opening into a long hepatic bile duct and then in the choledochal cyst, represents an unusual malformation which does not respect the rules described by former published authors.
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Conductos Biliares Extrahepáticos/anomalías , Conductos Biliares Intrahepáticos/anomalías , Quiste del Colédoco/diagnóstico , Quiste del Colédoco/cirugía , Conductos Biliares Extrahepáticos/cirugía , Conductos Biliares Intrahepáticos/cirugía , Colangiografía , Quiste del Colédoco/diagnóstico por imagen , Quiste del Colédoco/patología , Drenaje , Femenino , Hepatectomía , Humanos , Yeyunostomía , Persona de Mediana Edad , Reoperación , Resultado del TratamientoRESUMEN
Although lots of modern surgical and imaging techniques have been developed and last generation antibiotics are in use, the difficulties in the diagnosis and treatment of hepatic abscesses are still a rather sombre reality. Our research concerning 14 patients submitted to surgery within the last ten years can be thought of as a record, considering the poor number of cases in the last decades. So, our study also includes the possible clinical or imaging errors, the technical details of the surgery, the attitude towards the abscess cavity and the still obscure etiology in most of the cases. The correlation between the surgical risk and the rest of the hepatic volume, evaluated by computed scanning technique, represents another objective of this paper. In the large or in the multiple disseminated abscesses, the small area of the remaining functional hepatic tissue, was correlated to the postoperative slow or even bad evolution in two cases. The radiological, ultrasound and scanner control showing the reducing or disappearing of the abscess cavity after drainage in all the cases, represent an argument of the correct therapeutic approach.
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Absceso Hepático/cirugía , Adulto , Anciano , Drenaje/métodos , Femenino , Hepatectomía , Humanos , Laparoscopía/métodos , Absceso Hepático/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , UltrasonografíaRESUMEN
The authors discuss about 68 celioscopy antireflux procedures, carried out for transhiatal hernia accompanied by gastroesophageal reflux, during a period of 8 years, between 1996 and 2003. The aim of this research is a clinical and technical comparative study, in fact between the posterior total or partial fundoplication and the anatomical procedures. In order to have a complete evaluation of the risks and results, the authors discuss the indications of each procedure, a series of specific intra and postoperative complications, including conversions and reinterventions, for each procedure. The authors also refer to the difficulty degree, the time required for each procedure, to find out the ways of improving these parameters. Although the number of patients is quite small, in this experience, posterior fundoplication seems easier and safer, whenever possible. The Nissen procedure, which technique is more laborious, seems to offer a better postoperative evolution and more long - lasting results in time.
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Fundoplicación/métodos , Reflujo Gastroesofágico/cirugía , Hernia Hiatal/cirugía , Laparoscopía , Reflujo Gastroesofágico/complicaciones , Hernia Hiatal/complicaciones , Humanos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIM: A theoretical dosimetry-based model was applied to estimate the lowest effective radioiodine activity for thyroid remnant ablation of low-risk differentiated thyroid cancer patients. PATIENTS, METHODS: The model is based on the distribution of the absorbed (radiation) dose per administered radioiodine activity and the absorbed dose threshold of 300 Gy for thyroid remnants, the level believed to destroy most thyroid remnants. For this purpose, ¹²4I PET/CT images of 49 thyroidectomised patients were retrospectively analysed to measure the distribution of the (average) absorbed doses to thyroid remnant per administered ¹³¹I activity. The fraction of thyroid remnants that received at least 300 Gy was determined for standard activities between 0.37 and 5.55 GBq. The lower activity was considered to be equally effective to that obtained with higher activity if the (absolute) fraction difference was below 5%. RESULTS: A total of 62 thyroid remnants were included. The medians and ranges (in parentheses) for the absorbed dose per unit 131I activity were 359 Gy/GBq (34 to 1825 Gy/GBq). The fractions of thyroid remnants receiving more than 300 Gy at different therapy activities (within parentheses) were 60% (1.11 GBq), 76% (1.85 GBq), 79% (2.22 GBq), and 81-82% for activities between 2.59 and 3.70 GBq. The therapy activity of 1.11 GBq is considerably less effective than that of 1.85 or 2.22 GBq; therapy activities were equally effective in the range between 2.22 to 3.70 GBq. CONCLUSION: On the basis of the model and the patients' data included, the lowest effective therapy activity appears to be approximately 2.2 GBq to ablate thyroid remnants. The results of this study may help to guide the design of prospective clinical studies.
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Radioisótopos de Yodo/administración & dosificación , Modelos Biológicos , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador/métodos , Neoplasias de la Tiroides/radioterapia , Adolescente , Adulto , Anciano , Niño , Simulación por Computador , Relación Dosis-Respuesta en la Radiación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasia Residual , Radiofármacos/administración & dosificación , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Resultado del Tratamiento , Adulto JovenRESUMEN
Being often biliary contaminated and suppurative, the hydatid hepatic cyst is in fact a real parasitic abscess. So far its surgical approach represents the only credible possibility of treatment. Authors impart their experience regarding the external drainage of the restant posthydatid cavity, by using a completely extraperitoneal way of bringing out the drain, by means of the round ligament, an original method conceived and put into practice by Prof. D. Burlui in 1968. This technique is simple, without risks or complications, possible for most of the parasite hepatic locations, especially for the central segments, for which this method is superior to other surgical procedures. The greatest advantage of the extraperitoneal transomphalic route of the drain is the absence of the peritoneal losses and so the impossibility of biliary leakage occurrence. The radiological and the ultrasonic controls confirm the reduction and finally total fibrosis and disappearance of the remaining cavity, about two months after the surgery. In this moment the drainage may be suppressed. In December 2001, we added to this method an other original variant: the coelioscopic approach of the extraperitoneal transomphalic drainage of the restant posthydatid cavity, representing the aim of this paper.
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Equinococosis Hepática/cirugía , Laparoscopía , Ligamentos , Ombligo , Femenino , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The transomphalic and then the transligamentary extraperitoneal drainage imagined by D. Burlui and its multiple use in the liver and the biliary tract surgery, is well known. Concerning the hepatic hydatid cysts, the drainage of the remaining cavity by the round ligament way is possible for most of the locations of the parasite, but it is less performed in the right liver lateral segments locations, too far situated, and also in the left liver locations. On the other hand, this specific method implies to place the drainage tube using the round ligament "in situ ", normally placed and inserted. We encountered an extremely large hydatid cyst of the left hepatic lobe, adherent to the anterior and posterior abdominal wall, spleen, stomach, pancreas and large bowel, which required to extend the incision to the left and make the necessary segmentation of the round ligament at its hepatic insertion. After pericystotomy and the evacuation of the cyst, the remaining cavity drainage was performed through the same round ligament whose free end was tightly fixed to the partial pericystotomy border. This transposition allowed the exteriorisation of the drainage tube in the same way as for the transligamentary and total extraperitoneal original method.
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Drenaje/métodos , Equinococosis Hepática/terapia , Ligamentos , Ombligo , Animales , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Encefalopatías/genética , Encefalopatías/terapia , Moléculas de Adhesión Celular Neuronal/genética , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Encefalopatías/inmunología , Corea/genética , Corea/inmunología , Corea/terapia , Disfunción Cognitiva/genética , Disfunción Cognitiva/inmunología , Disfunción Cognitiva/terapia , Humanos , Masculino , Persona de Mediana Edad , FenotipoRESUMEN
Several dermal substitutes for skin grafting are now commercially available, although their performance still needs improvement. Most artificial dermises have a lower take rate than autologous grafts and require more time for sufficient vascular ingrowth to overlay the skin graft. Herein we characterize new two-dimensional scaffolds for tissue-engineering applications, which were fabricated by two-photon polymerization (2PP) of ormosils hybrid materials. For the 2PP experiments, a Ti:sapphire laser was used to induce the photopolymerization. In this study we showed that the polymeric structures with controlled architectures produced via 2PP could be used as scaffolds for the in vitro culture and proliferation of human dermal fibroblasts. Fluorescence microscopy revealed that the fibroblasts' orientation was guided by the scaffold geometry, consisting of ormosils lines or grids. This 'dermal equivalent' was investigated for its ability to accommodate epidermal cells. To evaluate this interaction, two experimental approaches were hence used: (a) fibroblast-melanocyte co-cultures; and (b) fibroblast-keratinocyte organotypic cultures. During their growth on ormosil scaffolds, productive interaction of fibroblasts with both epidermal cell types was found. Moreover, this pseudo-dermis was shown to support the growth of keratinocytes for up to 8 days after their seeding.