Drivers of fish choice: an exploratory analysis in Mediterranean countries.

Fish is an important source of healthy proteins and an important economic sector in Mediterranean countries. Despite the wealth of knowledge acquired in Western countries, a gap has been found in studies in developing countries, as in the Mediterranean southern shore. Therefore, we aimed to investigate consumers' perceptions of finfish attributes, with qualitative tools as focus groups, given the exploratory nature of the research. The focus groups have been held in Italy, Lebanon, Spain, and Tunisia; in each country, one was held in seaside areas and one in inland areas, in order to control for the availability of fish that shapes consumers' evaluations and expectations. The focus groups have been analysed through content and semantic analyses. Results of the study yielded main themes recurring in the discussions that have been categorized along such dimensions: (1) definition of fish products; (2) context; (3) search attributes; (4) experience attributes; and (5) credence attributes. Among attributes, the ones mostly guiding consumers' choices seem to be freshness and fish species, which are used as proxies for quality and sensory attributes. Most of the respondents preferred delicate white fish, while some exceptions were found in Tunisian respondents preferring blue fish and they also were the only ones who were not looking for convenient and already cleaned products. Trust also represented a critical element in guiding the decisions of consumers: with a lack of trust, consumers deviate from preferring local products, as noticeable especially in Lebanese respondents' opinions. Credence attributes such as animal welfare and sustainability received a minor attention from all the respondents.

Unveiling the Physics of the Mutual Interactions in Paramagnets.

In real paramagnets, there is always a subtle many-body contribution to the system's energy, which can be regarded as a small effective local magnetic field (Bloc). Usually, it is neglected, since it is very small when compared with thermal fluctuations and/or external magnetic fields (B). Nevertheless, as both the temperature (T) → 0 K and B → 0 T, such many-body contributions become ubiquitous. Here, employing the magnetic Grüneisen parameter (Γmag) and entropy arguments, we report on the pivotal role played by the mutual interactions in the regime of ultra-low-T and vanishing B. Our key results are: i) absence of a genuine zero-field quantum phase transition due to the presence of Bloc; ii) connection between the canonical definition of temperature and Γmag; and iii) possibility of performing adiabatic magnetization by only manipulating the mutual interactions. Our findings unveil unprecedented aspects emerging from the mutual interactions.

Comparison of virtual reality rehabilitation and conventional rehabilitation in Parkinson's disease: a randomised controlled trial.

OBJECTIVE: To compare a 6-week virtual reality (VR) rehabilitation programme with a conventional rehabilitation programme in patients with Parkinson's disease. DESIGN: Prospective, single-blinded, randomised controlled trial. SETTING: Outpatients. PARTICIPANTS: Fifty-one patients with Parkinson's disease were assigned at random to a VR rehabilitation programme or a conventional rehabilitation programme. INTERVENTIONS: Both programmes ran for 6 consecutive weeks, with a 40-minute session three times per week. MAIN OUTCOME MEASURES: The Balance Berg Scale (BBS) was used to measure balance. Secondary outcome measures were: Dynamic Gait Index (DGI) to evaluate ability to adapt gait to complex walking tasks; Disabilities of the Arm, Shoulder and Hand (DASH) scale to measure performance of the upper limb; and Short Form 36 (SF-36) to evaluate quality of life. RESULTS: The VR rehabilitation programme led to an increase in BBS score {45.6 [standard deviation (SD) 7.9] vs 49.2 (SD 8.1), mean difference 3.6, 95% confidence interval (CI) 1.3 to 5.9; P=0.003}, DGI score [18.7 (SD 4.7) vs 20.2 (SD 4.2), mean difference 1.6, 95% CI 0.6 to 2.5; P=0.003] and SF-36 mental composite score [37.7 (SD 11.4) vs 43.5 (SD 9.2), mean difference 5.8, 95% CI 0.4 to 11.3; P=0.037], and a decrease in DASH scale score [29.6 (SD 17.5) vs 21.6 (SD 15.1), mean difference -7.9, 95% CI -13.7 to -2.2; P=0.009]. In contrast, the conventional rehabilitation programme only led to a decrease in DASH scale score [30.3 (SD 18.1) vs 25.1 (SD 15.8), mean difference -5.2, 95% CI -8.8 to -1.5; P=0.007]. CONCLUSION: These findings suggest that rehabilitation is useful in Parkinson's disease, and the VR rehabilitation programme was more effective in determining overall improvement than the conventional rehabilitation programme. CLINICAL TRIAL REGISTRATION NUMBER: NCT02807740.

Polenta-based snack development: from maize flour to final product by assessing structural, mechanical and sensory properties.

The aim of this paper was to study, step by step, the effect of ingredients and storage conditions on several properties of both the maize-based dough and the final product, during the new polenta-based snack food developing. Two different maize flours were characterized through water activity determination, particle size analysis, scanning electronic microscopy; then, dough made with different ratio of these were evaluated for mechanical properties and microstructure. According to the preliminary physicochemical characterization of both flour and dough, the final formulation was chosen for the polenta-based snacks. Thus, mechanical and sensory analyses, as well as microstructure determination, were performed on the final product. Results showed that the two maize flours presented different particle size distribution and gelatinization enthalpy, and affected the mechanical properties of intermediate products. The storage conditions dramatically affected the characteristics of the final products. Sensory results demonstrated that breading improves the crispness of external part but keeping creamy the product inside. The chosen approach was useful for understanding that flour particle size and storage are the critical factors that should be considered for this type of snack. The best formulation was made by mixing coarse and fine maize flours and by adding a batter.

Rendimiento diagnóstico de la histerosalpingografía por resonancia magnética: resultados iniciales / Diagnostic performance of magnetic resonance hysterosalpingography: initial results Abstract

Objetivo: Determinar el rendimiento diagnóstico de la histerosalpingografía por resonancia magnética (HSG-RM), utilizando la laparoscopia como método de referencia. Materiales y métodos: Se incluyeron 22 pacientes. A todas se les realizó una HSG-RM con un resonador 1.5 Tesla y luego una laparoscopia con cromotubación. Dos radiólogos examinaron las RM, determinando la permeabilidad tubaria por consenso. Se realizaron análisis descriptivos y de rendimiento diagnóstico. Resultados: La HSG-RM tuvo una tasa de éxito del 91%. La duración del estudio fue 49ą15 minutos, el volumen inyectado 26 ą 16 cm³ y la escala de dolor 30ą 19 de 100. La sensibilidad y especificidad de la HSG-RM fueron del 100% para la prueba de Cotte global y a la izquierda, y del 25% y 93,3% para la prueba de Cotte a la derecha, respectivamente. Hubo 2 complicaciones menores y ninguna importante. Discusión: Nuestros resultados iniciales demostraron una alta sensibilidad y especificidad. Si bien otros estudios analizaron la capacidad de la HSG-RM para evaluar la permeabilidad tubaria con buenos resultados, el uso de un patrón de referencia defectuoso dejaba margen para una duda razonable, impidiendo una recomendación basada en pruebas sólidas. Sin embargo, al cotejar nuestros resultados con los publicados, observamos un alto grado de concordancia en tanto el derrame positivo se diagnostica correctamente con una especificidad de 100% o con un porcentaje cercano a esta cifra. Conclusión: La HSG-MR es una alternativa factible y segura de la HSG convencional o virtual, la histerosonografía y la cromotubación.

Objective: To determine the diagnostic performance of magnetic resonance hysterosalpingography (MRHSG) using laparoscopic chromotubation as a method of reference. Materials and methods: Twenty-two patients were included. The MRHSG was performed in a 1.5 Tesla MR scanner. Afterwards, patients underwent laparoscopic chromotubation. MR images were examined by two trained radiologists, and tubal patency was determined by consensus. A descriptive analysis was carried out, as well as an analysis of the diagnostic performance. Results: MRHSG had a 91% success rate. Exam duration of the examination was 49ą15min, with an injected volume 26ą 16cc, and pain scale 30ą 19 out of 100. Sensitivity and specificity of MRHSG was 100% for global and left Cotte, and 25% and 93.3% for right Cotte, respectively. Only 2 minor and no major complications were observed. Discussion: The initial results of MRHSG have shown high sensitivity and specificity. Even though other studies have analysed the potential of MRHSG with good results, the use of a flawed reference standard left a margin for a reasonable doubt as regards its true potential, thus preventing a solid evidence based recommendation. Nevertheless, if our results are compared to those published, a high level of agreement is observed in that positive spillage is correctly diagnosed with specificities near or at 100%. Conclusion: MRHSG is a feasible and safe alternative to conventional or virtual HSG, ultrasound-hysterography and chromotubation.

The surgical pathology laboratory in Mwanza, Tanzania: a survey on the reproducibility of diagnoses after the first years of autonomous activity.

BACKGROUND: In 2000, an Italian non-governmental organisation (NGO) began a 9-year project to establish a surgical pathology laboratory at the Bugando Medical Centre (BMC) in Mwanza, Tanzania, a country with a low Human Development Index (HDI), and as of 2009, the laboratory was operating autonomously. The present survey aims to evaluate the reproducibility of histological and cytological diagnoses assigned in the laboratory's early years of autonomous activity. We selected a random sample of 196 histological and cytological diagnoses issued in 2010-2011 at the BMC surgical pathology laboratory. The corresponding samples were sent to Italy for review by Italian senior pathologists, who were blinded to the local results. Samples were classified into four diagnostic categories: malignant, benign, inflammatory, and suspicious. The two-observer kappa-statistic for categorised (qualitative) data was then calculated to measure diagnostic concordance between the local Tanzanian pathologists and Italian senior pathologists. The k-Cohen was calculated for concordance in the overall study sample. Concordance and discordance rates were also stratified by subset: general adult, paediatric/adolescent, and lymphoproliferative histopathological diagnoses; fluid and fine needle aspiration (FNA) cytological diagnoses; and PAP tests. Discordance was also categorised by the corresponding hypothetical clinical implications: high, intermediate, and not significant. RESULTS: Overall concordance was 85.2% (167 of 196 diagnoses), with a k-Cohen of 0.7691 (P = 0.0000). Very high concordance was observed in the subsets of adult general pathological diagnoses (90%) and paediatric/adolescent pathological diagnoses (91.18%). Concordance in the subset of PAP tests was 75%, and for fluid/FNA cytological diagnoses it was 56.52%. Concordance among 12 histological subtypes of lymphoma was 75.86%, with substantial discordance observed in the diagnosis of Burkitt lymphoma (five cases diagnosed by Italian pathologists versus 2 by local pathologists). The overall proportion of discordance with high hypothetical clinical implications was 6.1% (12 diagnoses). CONCLUSION: This blind review of diagnoses assigned in Tanzania, a country with low HDI, and in Italy, a country with a very high HDI, seemed to be a sensitive and effective method to identify areas of potential error and may represent a reference point for future, more detailed quality control processes or audits of surgical pathology services located in limited-resource regions.

Resonancia magnética de próstata: utilidad de la secuencia de difusión en la detección de isquemia postembolización en pacientes con hiperplasia prostática benigna / Magnetic resonance imaging of the prostate: usefulness of diffusion sequences in detecting postembolization ischemia in patients with benign prostatic hyperplasia

Objetivo. Analizar la utilidad de la difusión en resonancia magnética (RM) antes y después de la embolización de arterias prostáticas (EAP) en pacientes con hiperplasia prostática benigna (HPB). Material y método. Se analizaron RM pre-EAP (7-10 días) y post-EAP (30 días) en 19 pacientes con HPB tratados con EAP entre junio de 2012 y diciembre de 2013. Se utilizaron equipos de 1,5 Tesla y bobina corporal de superficie. En RM pre-EAP se registraron valores b40 media, coeficiente de difusión aparente (CDA) mínimo (mín) y máximo (máx). En RM post-EAP se determinaron b40, b400, b1000 y CDA mín, media y máx. Se comparó el comportamiento en difusión/CDA antes y después del procedimiento y en áreas sin isquemia. Se correlacionó con la disminución de volumen prostático (VP). Resultados. Se identificó isquemia con contraste en 8 pacientes (42,1%). Al comparar pacientes con isquemia vs. sin isquemia, la diferencia en b40 media (p = 0,1650) y b40 cociente (p = 0,8868) pre-EAP no fue significativa. Encontramos diferencia significativa entre valores b40 mín, b40 cociente y CDA mín de áreas isquémicas y no isquémicas del mismo paciente (p = 0,048 [b40 mín y cociente] y 0,002 para CDA mín). No se encontró una correlación significativa para b40 media (p = 0,8490) y b40 cociente (p = 0,8573) al compararla con el porcentaje de reducción de VP. Conclusión. La isquemia post-EAP genera cambios objetivos en difusión y CDA que permitirían diferenciarla de sectores no isquémicos. Futuros trabajos deberán analizar si es posible una diferenciación subjetiva mediante visualización de sectores no isquémicos y la factibilidad de reemplazar las secuencias con contraste para detectar isquemia (AU)

Objective. To analyze the usefulness of diffusion magnetic resonance (MR) sequences before and after prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH). Material and methods. We analyzed MR studies done before (7-10 days) and after (30 days) PAE in 19 patients with BPH treated with PAE between June 2012 and December 2013. We used 1.5 Tesla scanners with body surface coils. In pre-PAE MR studies, we recorded mean b40 values and minimum (min) and maximum (max) apparent diffusion coefficient (ADC) values. In post-PAE MR studies, we recorded b40, b400, and b1000 values and min, mean, and max ADC values. We compared diffusion behavior/ADC before and after PAE and areas without ischemia. We correlated these with decreased prostatic volume (PV). Results. We identified ischemia with contrast in 8 (42.1%) patients. No significant difference was found in mean b40 (p= 0.1650) or in the b40 ratio (p= 0.8868) between patients with ischemia and those without before PAE. Min b40, b40 ratio, and min ADC values differed significantly between ischemic areas and nonischemic areas within patients [p= 0.048 (b40 min and ratio) and p= 0.002 (min ADC)]. No significant correlation was found between the percentage decrease in PV and mean b40 (p= 0.8490) or b40 ratio (p = 0.8573). Conclusion. Post-PAE ischemia generates objective changes in diffusion and ADC values that enable ischemic sectors to be differentiated from nonischemic sectors. Future studies should analyze whether it is possible to subjectively differentiate between these areas through the visualization of nonischemic sectors and the feasibility of replacing them with contrast to detect ischemia (AU)

[Magnetic resonance imaging of the prostate: usefulness of diffusion sequences in detecting postembolization ischemia in patients with benign prostatic hyperplasia]. / Resonancia magnética de próstata: utilidad de la secuencia de difusión en la detección de isquemia postembolización en pacientes con hiperplasia prostática benigna.

OBJECTIVE: To analyze the usefulness of diffusion magnetic resonance (MR) sequences before and after prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: We analyzed MR studies done before (7-10 days) and after (30 days) PAE in 19 patients with BPH treated with PAE between June 2012 and December 2013. We used 1.5 Tesla scanners with body surface coils. In pre-PAE MR studies, we recorded mean b40 values and minimum (min) and maximum (max) apparent diffusion coefficient (ADC) values. In post-PAE MR studies, we recorded b40, b400, and b1000 values and min, mean, and max ADC values. We compared diffusion behavior/ADC before and after PAE and areas without ischemia. We correlated these with decreased prostatic volume (PV). RESULTS: We identified ischemia with contrast in 8 (42.1%) patients. No significant difference was found in mean b40 (p= 0.1650) or in the b40 ratio (p= 0.8868) between patients with ischemia and those without before PAE. Min b40, b40 ratio, and min ADC values differed significantly between ischemic areas and nonischemic areas within patients [p= 0.048 (b40min and ratio) and p= 0.002 (min ADC)]. No significant correlation was found between the percentage decrease in PV and mean b40 (p= 0.8490) or b40 ratio (p=0.8573). CONCLUSION: Post-PAE ischemia generates objective changes in diffusion and ADC values that enable ischemic sectors to be differentiated from nonischemic sectors. Future studies should analyze whether it is possible to subjectively differentiate between these areas through the visualization of nonischemic sectors and the feasibility of replacing them with contrast to detect ischemia.

Cistitis enfisematosa en varón no diabético / Emphysematous cystitis in a non-diabetic male

La cistitis enfisematosa es una entidad infrecuente que se presenta como complicación de las infecciones urinarias. Se caracteriza por la presencia de gas intravesical y/o intraparietal, producto de la fermentación bacteriana. Más de la mitad de los casos aparecen en pacientes inmunocomprometidos o con historia de diabetes mellitus mal controlada. Afecta predominantemente al sexo femenino y la magnitud del cuadro clínico es variable. Comunicamos un caso de cistitis enfisematosa en un paciente sin compromiso inmunológico ni diabetes, detallando la presentación clínica, las características imagenológicas y la conducta terapéutica de esta entidad poco común...

Embolización prostática: un nuevo campo de actuación de la radiología intervencionista

Objetivos: Presentar nuestra experiencia inicial con la embolización prostática como tratamiento para la hiperplasia prostática benigna (HPB) desde la perspectiva técnica, y establecer la contribución del Diagnóstico por Imágenes. Materiales y métodos: Dieciséis pacientes con trastornos del tracto urinario inferior debidos a HPB realizaron embolización prostática. Todos respondieron cuestionarios específicos para determinar la severidad de la sintomatología y su impacto en la calidad de vida y función eréctil. Además, fueron evaluados con ecografía y resonancia magnética de pelvis, flujometría urinaria y antígeno prostático específico (PSA) antes y 30 días después del procedimiento. Resultados: La embolización fue exitosa en todos los pacientes (10 en forma bilateral y 6 en unilateral). El tiempo medio de duración del procedimiento fue de 82 minutos y el de la radioscopia de 38,5 min. Todos los procedimientos se llevaron a cabo en forma ambulatoria, con un tiempo medio de estancia hospitalaria de 6,4 h. El consumo medio de contraste radiológico fue de 175 ml. A los 30 días se verificó una reducción media de volumen prostático del 21%. Adicionalmente, se constató una mejoría clínica caracterizada, en promedio, por una disminución de 8 puntos en el cuestionario que mide los síntomas prostáticos, de 2 puntos en el cuestionario que calcula la calidad de vida y de 4 puntos en el cuestionario que sondea la función eréctil. La flujometría mejoró un 39% y el PSA se redujo un 26%. No hubo complicaciones mayores y solo se observaron efectos adversos menores en 9 pacientes. Conclusión: La embolización prostática para el tratamiento de la HPB demostró ser segura y eficiente en esta serie preliminar de pacientes.(AU)

Purposes: To present the initial experience with prostatic embolization as an alternative treatment for benign prostatic hyperplasia (BPH) from a technical perspective to establish the contribution provided by diagnostic imaging. Materials and methods: Sixteen patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent prostatic embolization. All patients were evaluated with specific questionnaires to determine the severity of symptoms, impact on quality of life and erectile function, ultrasound and MRI of the pelvis, urinary flowmetry and PSA before and 30 days after the procedure. Results: Embolization was successful in all patients; in 10 cases the procedure was performed bilaterally and in six, only one side was embolized. The average time for completion of the procedure was 82 minutes and the average fluoroscopy time was 38.5 minutes. All procedures were performed on an outpatient basis with an average hospital stay of 6.4 hours. The mean contrast medium used was 175 ml. At 30 days there was a mean reduction on prostate volume of 21%. Clinical improvement was characterized by a mean 8-point improvement on IPSS, 2 points on QOL and 4 points on IIEF. The uroflowmetry improved 39% and PSA dropped 26%. No major complications that implied unscheduled hospitalization or performing additional surgical procedures were seen. Minor adverse events were verifi ed in 9 patients. Conclusion: The initial results of prostatic embolization as an alternative treatment for BPH indicate that it is a safe and effective procedure to be consolidated as a new field of action of interventional radiology.(AU)

Embolización prostática: nuevo campo de actuación radiología intervencionista / Prostate embolization: a new field of action interventional radiology

Presentar nuestra experiencia inicial con la embolización prostática como tratamiento para la hiperplasia prostática benigna (HPB) desde la perspectiva técnica, y establecer lacontribución del Diagnóstico por Imágenes. Materiales y métodos: Dieciséis pacientes con trastornos del tracto urinario inferior debidos a HPB realizaron embolización prostática. Todos respondieron cuestionarios específicos para determinar la severidad de la sintomatología y su impacto en la calidad de vida y función eréctil. Además, fueron evaluados con ecografía y resonancia magnética de pelvis, flujometría urinariay antígeno prostático específico (PSA) antes y 30 días después del procedimiento. Resultados: La embolización fue exitosa en todos los pacientes (10 en forma bilateral y 6 enunilateral). El tiempo medio de duración del procedimiento fue de 82 minutos y el de la radioscopia de 38,5 min. Todos los procedimientos se llevaron a cabo en forma ambulatoria, con un tiempo medio de estancia hospitalaria de 6,4 h. El consumo medio de contraste radiológico fue de 175 ml. A los 30 días se verificó una reducción media de volumen prostático del 21%. Adicionalmente,se constató una mejoría clínica caracterizada, en promedio, por una disminución de 8 puntos en el cuestionario que mide los síntomas prostáticos, de 2 puntos en el cuestionarioque calcula la calidad de vida y de 4 puntos en el cuestionario que sondea la función eréctil. La flujometría mejoró un 39% y el PSA se redujo un 26%. No hubo complicaciones mayores y solo seobservaron efectos adversos menores en 9 pacientes. Conclusión: La embolización prostática para el tratamiento de la HPB demostró ser segura y eficiente en esta serie preliminar de pacientes...

Valoración no invasiva de la sobrecarga hepática de hierro en pacientes con hemocromatosis

Nuestro objetivo es analizar el metabolismo y la fisiopatología del depósito de hierro, describir la utilidad de la resonancia magnética (RM) con el empleo de secuencias específicas en la estimación de la sobrecarga hepática de hierro y evaluar las diferentes patologías que la generan en el abdomen, señalando también sus formas de presentación en la RM. La sobrecarga de hierro en el hígado puede ser consecuencia de un trastorno genético (hemocromatosis primaria) o estar relacionada con múltiples transfusiones o enfermedades crónicas, como aumento de la absorción, mielodisplasia, talasemia, etc. (hemocromatosis secundaria). La RM es un método no invasivo que permite detectar la sobrecarga de hierro y monitorear el tratamiento luego del diagnóstico, evitando la repetición de biopsias. Esto se debe a las propiedades paramagnéticas del hierro, cuya acumulación en los tejidos provoca distorsión local en los campos magnéticos, con disminución de la señal en los órganos afectados de forma proporcional a la cantidad de hierro depositado. La RM convencional con secuencias en fase y fuera de fase detecta el depósito de hierro en el hígado, bazo y páncreas, aunque las formas leves pueden pasar inadvertidas si no se utilizan secuencias más sensibles, como las de eco de gradiente. Estas, según la técnica de Gandon et al., permiten estimar cuantitativamente la severidad. El depósito de hierro puede tener un patrón retículo-endotelial (secundario a múltiples transfusiones con depósito en hígado, bazo y médula ósea sin daño tisular), parenquimatoso (hígado y páncreas) o mixto. La RM es fundamental en el diagnóstico de la hemocromatosis, especialmente en la fase subclínica. Contribuye a definir la severidad de la sobrecarga de hierro hepático y a valorar la respuesta al tratamiento, evitando procedimientos invasivos.(AU)

Our purpose is to analyze the metabolism and pathophysiology of iron deposition, to describe the usefulness of magnetic resonance imaging (MRI) in the estimation of hepatic iron overload using specific sequences, and to review the different pathologies leading to iron overload of the abdominal organs and its presentation in MRI. Iron overload in the liver may be due to a genetic condition (primary hemo chromatosis), or due to multiple blood transfusions and chronic diseases like increased absorption, myelodysplasia, thalassemia, etc. (secondary hemochromatosis). MRI is a noninvasive method to detect the presence of iron overload and to monitor treatment after diagnosis, avoiding repeated biopsies. This is due to the paramagnetic properties of iron accumulation in the tissues causing local distortion in the magnetic field. This phenomena is seen as a reduction of the MRI signal in the affected organs, being directly proportional to the amount of iron deposited. The conventional in phase and out of phase MRI sequences can show iron deposition in liver, spleen and pancreas, although milder forms may go undetected if more sensitive sequences, like gradient echo sequence, are not used, according to the technique proposed by Gandon et al., which can estimate quantitatively the severity of iron deposition. Iron deposition can show a reticuloendothelial type pattern (secondary to multiple transfusions where iron deposits in the liver, spleen and bone marrow without tissue damage), a parenchymal pattern (involving the liver and pancreas) and a mixed pattern. MRI has a fundamental role in the diagnosis of hemochromatosis, especially in subclinical phase. It helps to stratify the severity of hepatic iron overload and assess response to treatment, avoiding invasive procedures.(AU)

Hemangioendotelioma epitelioide hepático: un desafío diagnóstico para el médico radiólogo

Presentamos el caso de una paciente derivada a nuestra institución por presentar un cuadro clínico de dolor abdominal de más de un año de evolución, asociado al hallazgo de múltiples lesiones hepáticas sólidas, sugestivas de metástasis. Tras la biopsia percutánea, se diagnosticó hemangioendotelioma epitelioide hepático. Describimos las características clínico-imagenológicas de este tumor, aportando un nuevo caso de hemangioendotelioma epitelioide hepático, y analizamos los distintos hallazgos en los métodos de estudio por imágenes. Dado que se trata de una entidad poco frecuente en la que hay que pensar cuando se detectan lesiones hepáticas múltiples, es importante reconocerla e incluirla en el diagnóstico diferencial de las metástasis hepáticas.(AU)

We report a case of a patient referred to our institution presenting with 1 year of abdominal pain, associated to the finding of multiple solid liver lesions suggestive of metastases. Diagnosis of hepatic epithelioid hemangioendothelioma was performed after percutaneous liver biopsy. We describe clinical and imaging features of this tumor. Imaging findings are analized, providing a new case of hepatic epithelioid hemangioendothelioma. Since this is a rare entity that must be taken into account when multiple liver lesions are detected, it is important to recognize it and include it in the differential diagnosis of liver metastases.(AU)

Valoración no invasiva de la sobrecarga hepática de hierro en pacientes con hemocromatosis / Noninvasive assessment of hepatic iron overload in patients with hemochromatosis

Nuestro objetivo es analizar el metabolismo y la fisiopatología del depósito de hierro, describir la utilidad de la resonancia magnética (RM) con el empleo de secuencias específicas en la estimación de la sobrecarga hepática de hierro y evaluar las diferentes patologías que la generan en el abdomen, señalando también sus formas de presentación en la RM. La sobrecarga de hierro en el hígado puede ser consecuencia de un trastorno genético (hemocromatosisprimaria) o estar relacionada con múltiples transfusiones o enfermedades crónicas, como aumento de la absorción, mielodisplasia, talasemia, etc. (hemocromatosis secundaria). La RM es un método no invasivo que permite detectar la sobrecarga de hierro y monitorear el tratamiento luego del diagnóstico, evitando la repetición de biopsias. Esto se debe a las propiedades paramagnéticas del hierro, cuya acumulación en los tejidos provoca distorsión local en los campos magnéticos, con disminución de la señal en los órganos afectados de forma proporciona la la cantidad de hierro depositado. La RM convencional con secuencias en fase y fuera de fase detecta el depósito de hierro en el hígado, bazo y páncreas, aunque las formas leves pueden pasar inadvertidas si no se utilizan secuencias más sensibles, como las de eco de gradiente. Estas, según la técnica de Gandon et al., permiten estimar cuantitativamente la severidad. El depósito de hierro puede tener un patrón retículo-endotelial (secundario a múltiples transfusiones con depósito en hígado, bazo y médula ósea sin daño tisular), parenquimatoso (hígado y páncreas) o mixto. La RM es fundamental en el diagnóstico de la hemocromatosis, especialmente en la fase subclínica.Contribuye a definir la severidad de la sobrecarga de hierro hepático y a valorar la respuesta al tratamiento, evitando procedimientos invasivos.

Our purpose is to analyze the metabolism and pathophysiology of iron deposition, to describe the usefulness of magnetic resonance imaging (MRI) in the estimation of hepatic iron overload using specific sequences, and to review the different pathologies leading to iron overload of the abdominal organs and its presentation in MRI.Iron overload in the liver may be due to a genetic condition (primary hemo chromatosis), or due to multiple blood transfusions and chronic diseases like increased absorption, myelodysplasia, thalassemia, etc. (secondary hemochromatosis).MRI is a noninvasive method to detect the presence of iron overload and to monitor treatment after diagnosis, avoiding repeated biopsies. This is due to the paramagnetic properties of iron accumulation in the tissues causing local distortion in the magnetic field. This phenomena is seen as a reduction of the MRI signal in the affected organs, being directly proportional to the amount of iron deposited.The conventional in phase and out of phase MRI sequences can show iron deposition in liver, spleen and pancreas, although milder forms may go undetected if more sensitive sequences, like gradient echo sequence, are not used, according to the technique proposed by Gandon et al., which can estimate quantitatively the severity of iron deposition.Iron deposition can show a reticuloendothelial type pattern (secondary to multiple transfusions where iron deposits in the liver, spleen and bone marrow without tissue damage), a parenchymal pattern (involving the liver and pancreas) and a mixed pattern.MRI has a fundamental role in the diagnosis of hemochromatosis, especially in subclinical phase. It helps to stratify the severity of hepatic iron overload and assess response to treatment, avoiding invasive procedures.

Hemangioendotelioma epitelioide hepático: un desafío diagnóstico para el médico radiólogo / Hepatic epithelioid hemangioendothelioma: a diagnostic challenge for the radiologist

Presentamos el caso de una paciente derivada a nuestra institución por presentar un cuadro clínico de dolor abdominal de más de un año de evolución, asociado al hallazgo de múltiples lesiones hepáticas sólidas, sugestivas de metástasis. Tras la biopsia percutánea, se diagnosticó hemangioendotelioma epitelioide hepático. Describimos las características clínico-imagenológicas de este tumor, aportando un nuevo caso de hemangioendotelioma epitelioide hepático, y analizamos los distintos hallazgos en los métodos de estudio por imágenes. Dado que se trata de una entidad poco frecuente en la que hay que pensar cuando se detectan lesiones hepáticas múltiples, es importante reconocerla e incluirla en el diagnóstico diferencial de las metástasis hepáticas.

We report a case of a patient referred to our institution presenting with 1 year of abdominal pain, associated to the finding of multiple solid liver lesions suggestive of metastases. Diagnosis of hepatic epithelioid hemangioendothelioma was performed after percutaneous liver biopsy.We describe clinical and imaging features of this tumor. Imaging findings are analized, providing a new case of hepatic epithelioid hemangioendothelioma. Since this is a rare entity that must be taken into account when multiple liver lesions are detected, it is important to recognize it and include it in the differential diagnosis of liver metastases.

Gaussianity revisited: exploring the Kibble-Zurek mechanism with superconducting rings.

In this paper we use spontaneous flux production in annular superconductors to shed light on the Kibble-Zurek (KZ) scenario. In particular, we examine the effects of finite size and external fields, neither of which is directly amenable to the KZ analysis. Supported by 1D and 3D simulations, the properties of a superconducting ring are seen to be well represented by analytic Gaussian approximations which encode the KZ scales indirectly. Experimental results for annuli in the presence of external fields corroborate these findings.

Parathyroid hormone response to severe vitamin D deficiency is sex associated: an observational study of 571 hip fracture inpatients.

OBJECTIVES: To investigate the association between sex and parathyroid hormone response to severe vitamin D deficiency after hip fracture. DESIGN: Cross-sectional study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: 571 consecutive inpatients with hip fracture and severe vitamin D deficiency (serum 25-hydroxyvitamin D < 12ng/ml), without hypercalcemia or estimated glomerular filtration rate (GFR) < 15ml/min. MEASUREMENTS: In each patient we assessed PTH (by two-site chemiluminescent enzyme-labelled immunometric assay), 25-hydroxyvitamin D (by immunoenzymatic assay), albumin-adjusted total calcium, phosphate, magnesium, and creatinine 21.3 ± 6.1 (mean ± SD) days after fracture occurrence. Functional level was assessed using the Barthel index. PTH response to vitamin D deficiency was classified as either secondary hyperparathyroidism (serum PTH >75pg/ml) or functional hypoparathyroidism, i.e., inappropriate normal levels of PTH (≤75pg/ml). RESULTS: Among the 571 patients, 336 (59%) had functional hypoparathyroidism, whereas 235 (41%) had secondary hyperparathyroidism. PTH status was significantly different between sexes (p=0.003): we found functional hypoparathyroidism in 61% of women and 43% of men (secondary hyperparathyroidism in 39% of women and 57% of men). The significance of the between-sex difference was maintained after adjustment for age, estimated GFR, phosphate, albumin-adjusted total calcium, albumin, Barthel index scores, 25-hydroxyvitamin D, and hip fracture type (either cervical or trochanteric). The adjusted odds ratio was 1.85 (95%CI from 1.09 to 3.13; p=0.023). CONCLUSIONS: Data shows that PTH response to vitamin D deficiency was sex-associated following a fracture of the hip. The higher prevalence of secondary hyperparathyroidism may play a role in the known prognostic disadvantage found in hip-fracture men.

Pulmonary intravascular lymphoma detected by FDG PET-CT: a case report.

Intravascular lymphoma is a rare subtype of extranodal Non-Hodgkin's lymphoma. Its prognosis is poor in a high percentage of cases due to its insidious appearance and low clinical suspicion. Its diagnosis is usually only reached after an autopsy. It may affect different organs as a whole or only one organ. It is extremely rare that the lung is the only damaged organ. Its diagnosis depends of the clinician's suspicion and proper evaluation with imaging studies as well as correct selection of the organ to be biopsied. When detected on time, the treatment of choice is a combination of a series of chemotherapy associated to a monoclonal antibody (anti-CD20). We present the case of a male patient who underwent a positron emission tomography-computed tomography with 2-[F-18]-fluoro-2 deoxy-D-glucose (FDG) due to symptoms suggestive of a lymphoproliferative disease with no clear structural abnormalities. The images led to a diagnosis of pulmonary intravascular large B cell lymphoma.