Crystal and Electronic Structures of A2NaIO6 Periodate Double Perovskites (A = Sr, Ca, Ba): Candidate Wasteforms for I-129 Immobilization.

The synthesis, structure, and thermal stability of the periodate double perovskites A2NaIO6 (A= Ba, Sr, Ca) were investigated in the context of potential application for the immobilization of radioiodine. A combination of X-ray diffraction and neutron diffraction, Raman spectroscopy, and DFT simulations were applied to determine accurate crystal structures of these compounds and understand their relative stability. The compounds were found to exhibit rock-salt ordering of Na and I on the perovskite B-site; Ba2NaIO6 was found to adopt the Fm-3m aristotype structure, whereas Sr2NaIO6 and Ca2NaIO6 adopt the P21/n hettotype structure, characterized by cooperative octahedral tilting. DFT simulations determined the Fm-3m and P21/n structures of Ba2NaIO6 to be energetically degenerate at room temperature, whereas diffraction and spectroscopy data evidence only the presence of the Fm-3m phase at room temperature, which may imply an incipient phase transition for this compound. The periodate double perovskites were found to exhibit remarkable thermal stability, with Ba2NaIO6 only decomposing above 1050 °C in air, which is apparently the highest recorded decomposition temperature so far recorded for any iodine bearing compound. As such, these compounds offer some potential for application in the immobilization of iodine-129, from nuclear fuel reprocessing, with an iodine incorporation rate of 25-40 wt%. The synthesis of these compounds, elaborated here, is also compatible with both current conventional and future advanced processes for iodine recovery from the dissolver off-gas.

[Pancreatico-jejunostomy in defunctionalized Roux-Y loop. An alternative for low volume hospitals]. / Pancreatoyeyunostomia en asa desfuncionalizada en Y de Roux y una alternativa para hospitales de bajo volumen.

This case is about a one obesity patient to carry out pancreaticoduodenectomy for solido pseudopapilary cyst of the pancreatic head, considerate in pancreatic surgery like high risk for to present soft pancreatic, wirsung smaller to 2mm and not bile duct dilatation .The pancreaticojejunostomy was performed end to end with invagination of the pancreatic stump with suture in tobacco bag to a defunctionalized jejunal loop Y the Roux to avoid middle alkali of the bile duct - jejunostomy.

Pancreatoyeyunostomia en asa desfuncionalizada en Y de Roux y una alternativa para hospitales de bajo volumen / Pancreatico-jejunostomy in defunctionalized Roux-Y Loop an alternative for low volume hospitals: report of a case performed at the Rebagliati Hospital

El presente caso corresponde a una paciente obesa sometida a duodenopancreatectomia por quiste solido pseudopapilar de cabeza de páncreas, considerada en cirugía pancreática como de alto riesgo por presentar páncreas blando, wirsung menor de 2 mm, y vías biliares no dilatadas. La pancreatoyeyunostomia realizada fue termino-términal con invaginación del muñón pancreático, con sutura en bolsa de tabaco para sellar la anastomosis y en asa desfuncionalizada en Y de Roux para evitar el medio alcalino de la anastomosis bilioyeyunal.

This case is about a one obesity patient to carry out pancreaticoduodenectomy for solido pseudopapilary cyst of the pancreatic head, considerate in pancreatic surgery like high risk for to present soft pancreatic, wirsung smaller to 2mm and not bile duct dilatation .The pancreaticojejunostomy was performed end to end with invagination of the pancreatic stump with suture in tobacco bag to a defunctionalized jejunal loop Y the Roux to avoid middle alkali of the bile duct û jejunostomy.

Drogas modificadoras de la artritis reumatoide, DMAR / Disease modifying antirheumatic drugs, DMARD

El nuevo paradigma terapéutico de la artritis reumatoide establece que todo paciente con actividad de la enfermedad debe recibir alguna droga modificadora de la artritis reumatoide. Estas drogas reciben este nombre ya que han demostrado en estudios clínicos controlados modificar el curso natural de la enfermedad.

Brain injury severity, litigation status, and self-report of postconcussive symptoms.

The Postconcussive Symptom Questionnaire (PCSQ) was developed to assess the symptoms associated with the controversial diagnosis of postconcussion syndrome. We examined item endorsement on the PCSQ in two groups. The first group was made up of individuals diagnosed with moderate to severe traumatic brain injury. The second group was made up of individuals meeting criteria for mild traumatic brain injury who exhibited no evidence of neurological injury. In addition, they demonstrated poor effort during neuropsychological examination. Significant differences in item endorsement were found the majority of individual items as well as on the PCSQ indices. The poor effort mild traumatic brain injury group consistently reported more symptoms with greater severity. The results raise further questions about the validity of postconcussion symptoms.

Ten-year survival and cost following breast cancer recurrence: estimates from SEER-medicare data.

OBJECTIVE: A variety of pharmacologic therapies are available or in development for the prevention of breast cancer recurrence. Assessing the value of these treatments is compromised by a paucity of data on the impact of recurrence on economic costs and survival. The purpose of this study was to shed light on these issues. METHODS: We conducted a retrospective analysis of linked SEER-Medicare data. All patients in the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) registry who were diagnosed with nonmetastatic breast cancer during 1991-1993 were identified, and their subsequent Medicare claims were scanned for evidence of further breast cancer events (local or distant recurrence, contralateral breast cancer). Medicare claims were then scanned from the time of the event through 2002 to assess patterns of survival and costs. RESULTS: We identified 10,798 patients in SEER who were diagnosed with nonmetastatic breast cancer during 1991-1993, including 1833 who subsequently had another breast cancer event (local recurrence, 958; distant recurrence, 622; contralateral breast cancer, 253). Median survival was 37 months and 8 months among patients with local and distant recurrence, respectively; 53% of patients with contralateral breast cancer remained alive after all the data were censored at 97 months. Expected 10-year costs (2004 US$, discounted 3%) attributable to distant recurrence, local recurrence, and contralateral breast cancer were $11,450 (SE 2056), $19,596 (SE 1754), and $19,183 (SE 4131), respectively. CONCLUSION: Breast cancer recurrence and contralateral breast cancer lead to substantial increases in costs, amounting to approximately $11,000-19,000 over 10 years depending on type. The impact of these events on survival also varies considerably by type.

[Morbidity and mortality rates in relation to the "surgeon factor" after duodenopancreatectomy]. / Morbilidad y mortalidad postoperatorias de acuerdo al "factor cirujano" tras duodenopancreatectomía.

OBJECTIVES: The present study was designed to determine whether the surgeon factor has an independent effect on morbidity and mortality rates after duodenopancreatectomy. MATERIAL AND METHOD: Between October 2002 and December 2006, we performed a study of 119 patients who underwent duodenopancreatectomy. The surgeons were divided into 3 groups according to the number of interventions they performed each year: a low volume group (three Whipple procedures per year), a medium volume group (four to 10 Whipple procedures per year) and a high volume group (> 10 Whipple procedures per year). RESULTS: The morbidity rate was higher in the low volume group (82%) than in the high volume group (35%). Length of hospital stay was clearly longer in the low and medium volume groups (27 days, and 21 days) than in the high volume group (17 days). Comparison of the results of the 3 groups revealed that the group performing three or less interventions per year (low volume) had the highest mortality rate (47%), while the group performing more than 10 interventions per year (high volume) had a very low mortality rate (4%). CONCLUSIONS: We found that the volume-to-surgeon ratio was inversely proportional to morbidity, length of hospital stay, return to oral intake, and mortality rates. Therefore, increasing surgical volume could improve morbidity and mortality rates.

Morbilidad y mortalidad postoperatorias de acuerdo al “factor cirujano” tras duodenopancreatectomía / Morbidity and mortality rates in relation to the "surgeon factor" after duodenopancreatectomy

Objetivos. El presente estudio está diseñado para determinar si hay un efecto independiente en la morbilidad y la mortalidad operatoria luego de la duodenopancreatectomía tomando en cuenta el factor cirujano. Material y método. Durante el período comprendido entre octubre de 2002 y diciembre de 2006 se realizó un estudio sobre 119 pacientes, a quienes se les realizó una duodenopancreatectomía. Se dividió a los cirujanos según el número de pacientes operados por año en 3 grupos, de bajo volumen (hasta 3 Whipple por año), mediano volumen (más de 3 hasta 10 Whipple por año) y alto volumen (> 10 Whipple por año). Resultados. La morbilidad fue mayor en el grupo de bajo volumen (82%) en comparación con el de alto volumen (35%). La estancia hospitalaria fue marcadamente mayor en los grupos de bajo y mediano volumen (27 días y 21 días) en comparación con el grupo de alto volumen en que fue de 17 días. Cuando se compararon los resultados de los 3 grupos, se evidenció que el grupo que tuvo 3 o menos cirugías por año (bajo volumen) presentó la tasa más alta de mortalidad (47%), mientras que el grupo de más de 10 cirugías por año (alto volumen) presentó una mortalidad muy baja (4%). Conclusiones. Encontramos que la relación volumen/ cirujano era inversamente proporcional a la morbilidad, estancia hospitalaria, reinicio de la vía oral y mortalidad. Por lo que podríamos suponer que el volumen quirúrgico podría mejorar la morbilidad y la mortalidad (AU)

Objectives. The present study was designed to determine whether the surgeon factor has an independent effect on morbidity and mortality rates after duodenopancreatectomy. Material and method. Between October 2002 and December 2006, we performed a study of 119 patients who underwent duodenopancreatectomy. The surgeons were divided into 3 groups according to the number of interventions they performed each year: a low volume group (three Whipple procedures per year), a medium volume group (four to 10 Whipple procedures per year) and a high volume group (> 10 Whipple procedures per year). Results. The morbidity rate was higher in the low volume group (82%) than in the high volume group (35%). Length of hospital stay was clearly longer in the low and medium volume groups (27 days, and 21 days) than in the high volume group (17 days). Comparison of the results of the 3 groups revealed that the group performing three or less interventions per year (low volume) had the highest mortality rate (47%), while the group performing more than 10 interventions per year (high volume) had a very low mortality rate (4%). Conclusions. We found that the volume-to-surgeon ratio was inversely proportional to morbidity, length of hospital stay, return to oral intake, and mortality rates. Therefore, increasing surgical volume could improve morbidity and mortality rates (AU)

Cost-effectiveness of switching to exemestane after 2 to 3 years of therapy with tamoxifen in postmenopausal women with early-stage breast cancer.

OBJECTIVES: Data from the Intergroup Exemestane Study (IES) suggest that switching to the aromatase inhibitor, exemestane, after 2 to 3 years of tamoxifen therapy prolongs disease-free survival versus continuing on tamoxifen therapy. We sought to evaluate the cost-effectiveness of this management strategy. METHODS: A Markov model was developed to predict patients' transitions across various health states based on treatment strategy (continuing tamoxifen vs. switching to exemestane), breast cancer status (no recurrence, local or distant recurrence, contralateral breast cancer), and other related health events (osteoporosis, endometrial cancer, death). Rates of disease-related events (recurrence and contralateral breast cancer) were estimated using data from the IES. Survival and lifetime medical-care costs by type of disease-related event were estimated using SEER-Medicare data. The model was used to estimate direct costs (in 2004 US dollars), life expectancy, quality-adjusted life-years (QALYs), and incremental cost-effectiveness. RESULTS: Switching to exemestane versus continuing tamoxifen therapy was associated with increased disease-free survival (181 vs. 172 months), QALYs (12.21 vs. 11.89), and net discounted lifetime costs of cancer care ($12,124 vs. $7724 per patient). The incremental cost-effectiveness ratio of exemestane was $20,100 per QALY gained (95% confidence interval: $12,100, $59,000). Sensitivity analyses showed that results were robust to plausible variations in recurrence rates, costs, and utilities. CONCLUSIONS: Switching postmenopausal early-stage breast cancer patients to exemestane after 2 to 3 years of tamoxifen appears to be a cost-effective treatment strategy versus completing a 5-year course of tamoxifen.

[Solid pseudopapilar pancreatic tumors: report of 7 cases and review of the literature]. / Tumores sólidos pseudopapilares de páncreas: reporte de 7 casos y revisión de la literatura.

INTRODUCTION: The cystic tumors of the pancreas represent an uncommon entity and the less frequent type among them is the solid pseudopapillary tumor of the pancreas. Its main difference lies in the fact that this type of tumor is more frequent in young patients. Solid pseudopapillary tumors are generally tumors of large size and the majority of them have a benign behavior. MATERIAL AND METHOD: During a period of three years, seven patients with this neoplasia underwent surgery. Six patients (86%) were females and just one was a male, all of them between the ages of 11 and 37. None of these cases showed metastasis and there were no signs of malignancy reported in the pathological anatomy. The average tumor size was 8 cm and the head of the pancreas was the most frequent location (57%). Of the resections performed in these patients, three were middle pancreatectomies, two were distal pancreatectomies one was a duodenopancreatectomy and one was duodenum preserving head resection of the pancreas. DISCUSSION: The solid pseudopapillary tumors are uncommon tumors which are generally benign or premalignant neoplasias. Nevertheless, 9% of them can behave like carcinomas; therefore, these tumors should not be ignored.

Evaluation of top, angle, and side cleaned FIB samples for TEM analysis.

TEM specimens of a LaAlO(3)/SrTiO(3) multilayer are prepared by FIB with internal lift out. Using a Ga(+1) beam of 5 kV, a final cleaning step yielding top, top-angle, side, and bottom-angle cleaning is performed. Different cleaning procedures, which can be easily implemented in a dual beam FIB system, are described and compared; all cleaning types produce thin lamellae, useful for HRTEM and HAADF-STEM work up to atomic resolution. However, the top cleaned lamellae are strongly affected by the curtain effect. Top-angle cleaned specimens show an amorphous layer of around 5 nm at the specimen surfaces, due to damage and redeposition. Furthermore, it is observed that the LaAlO(3) layers are preferentially destroyed and transformed into amorphous material, during the thinning process.

Tumores sólidos Pseudopapilares de páncreas: reporte de 7 casos y revisión de la literatura / Solid Pseudopapillary pancreatic tumors: report of 7 cases and review of the Literature

Introducción: Los tumores quísticos del páncreas representan una entidad poco común, la variedad menos frecuente dentro de estos tumores es el tumor sólido pseudopapilar del páncreas. Su diferencia principal radica en que se presenta más frecuente en pacientes jóvenes. Son tumores generalmente de gran tamaño siendo la mayoría de ellos de comportamiento benigno. Material y método: Durante un periodo de tres años se han operado a 7 pacientes con esta neoplasia. Seis pacientes (86) fueron de sexo femenino y uno solo fue de sexo masculino, las edades fluctuaron desde los 11 a los 37 años, en ningún caso se encontraron metástasis o en la anatomía patológica se reportaron signos de malignidad. El promedio del tamaño tumoral fue de 8 cm y la localización más frecuente fue la cabeza de páncreas (57), realizándose tres pancreatectomias medias, dos pancreatectomias distales una duodenopancreatectomia, y una resección de cabeza de páncreas con preservación de duodeno. Discusión: Los tumores sólidos pseudopapilares son poco frecuentes generalmente se tratan de neoplasias benignas o pre malignas pero en un 9 pueden comportarse como carcinoma por lo cual estos tumores no pueden ser ignorados.

Introduction: The cystic tumors of the pancreas represent an uncommon entity and the less frequent type among them is the solid pseudopapillary tumor of the pancreas. Its main difference lies in the fact that this type of tumor is more frequent in young patients. Solidpseudopapillary tumors are generally tumors of large size and the majority of them have a benign behavior. MATERIAL AND METHOD: During a period of three years, seven patients with this neoplasia underwent surgery. Six patients (86 per cent) were females and just one was a male, all of them between the ages of 11 and 37. None of these cases showed metastasis and there were no signs of malignancy reported in the pathological anatomy. The average tumor size was 8 cm and the head of the pancreas was the most frequent location (57 per cent). Of the resections performed in these patients, three were middlepancreatectomies, two were distal pancreatectomies one was a duodenopancreatectomy and one was duodenum preserving head resection of the pancreas. DISCUSSION: The solid pseudopapillary tumors are uncommon tumors which are generally benign orpremalignant neoplasias. Nevertheless, 9% of them can behave like carcinomas; therefore, these tumors should not be ignored.

[Surgical treatment of giant serous cystadenoma of pancreas: report of two cases]. / Tratamiento quirúrgico de los cistoadenoma serosos gigantes del páncreas reporte de dos casos.

INTRODUCTION: The cystic tumor of the pancreas is a relatively uncommon entity. There are different types of pancreatic cystic tumors and they all exhibit different degrees of malignancy. These tumors represent 1% of all primary pancreatic tumors and only 15% of the cystic lesions. The serous cystadenomas (SCA) are mostly benign lesions with an average size of 4 cm; nevertheless, in some rare cases these are giant lesions, generally larger than 15 cm. Sometimes these tumors produce a symptomatology caused by the compression of neighboring structures, therefore they are generally operable. MATERIAL AND METHOD: During the period from June 2004 to June 2005, the 3A II unit of the Edgardo Rebagliati Martins Hospital operated on two cases of giant serous cystadenomas of the pancreas, one located in the tail of the pancreas and the other in the head of the pancreas, with an average size of 16 cm. DISCUSSION: The giant SCAs of the pancreas are rarely seen lesions that, according to different authors, are usually larger than 10 to 15 cm. in diameter. These lesions do not represent a diagnosis problem and are generally operable since they produce a symptomatology by compression. The surgical resection can be complicated due to their large size and to the considerable neovascularization.

Tratamiento quirúrgico de los cistoadenoma serosos gigantes del páncreas reporte de dos casos / Surgical treatment of the giant serous cystoadenoma of the pancreas reports of two cases

Introducción: Los tumores quísticos del páncreas son una entidad poco común que reúnen a distintas variedades. Las cuales presentan diferentes grados de malignidad. Estos representan el 1 por ciento de todos los tumores primarios del páncreas y solo el 15 por ciento de las lesiones quísticas. Los cistoadenomas serosos (SCA) son lesiones casi siempre benignas con un tamaño promedio de 4 cm sin embargo en muy raros casos existen lesiones gigantes generalmente mayores de 15 cm, estos tumores algunas veces producen una sintomatología causada por la comprensión de estructuras vecinas por lo que generalmente son quirúrgicos. Material y método: Durante el periodo comprendido entre Junio del 2004 a Junio del 2005 se operaron en el servicio 3A II del Hospital Edgardo Rebagliati Martins dos casos de cistoadenomas serosos gigantes del páncreas uno localizado en la cola del páncreas y otro en la cabeza con un tamaño promedio de 16 cm. Discusión: Los SCA gigantes del páncreas son lesiones muy poco frecuentes generalmente mayores de 10 a 15 cm. de diámetro de acuerdo a los diferentes autores, estas lesiones no presentan un problema diagnóstico, siendo generalmente quirúrgicas ya que producen sintomatología por comprensión. La resección quirúrgica puede ser complicada debido al gran tamaño y a la neovascularización importante que presentan.

Introduction: The cystic tumor of the pancreas is a relatively uncommon entity. There are different types of pancreatic cystic tumors and they all exhibit different degrees of malignancy.These tumors represent 1 per cent of all primary pancreatic tumors and only 15 per cent of the cystic lesions. The serous cystadenomas (SCA) are mostly benign lesions with an average size of 4 cm; nevertheless, in some rare cases these are giant lesions, generally larger than 15 cm. Sometimes these tumors produce a symptomatology caused by the compression of neighboring structures, therefore they are generally operable.MATERIAL AND METHOD: During the period from June 2004 to June 2005, the 3A II unit of the Edgardo RebagliatiMartins Hospital operated on two cases of giant serous cystadenomas of the pancreas, one located in the tail of the pancreas and the other in the head of the pancreas, with an average size of 16 cm. DISCUSSION: The giant SCAs of the pancreas are rarely seen lesions that, according to different authors, are usually larger than 10 to 15 cm. in diameter. These lesions do not representa diagnosis problem and are generally operable since they produce a symptomatology by compression. The surgical resection can be complicated due to their large size and to the considerable neovascularization.

[Transduodenal ampullectomy: an useful alternative for the treatment of Vater's ampulla lesions. Case reports of an unfrecuent surgical technique]. / Ampulectomía transduodenal una alternativa útil para el tratamiento de las lesiones de la ampolla de Vater: reporte de casos de una técnica raramente utilizada.

The Vater's ampulla neoplasias are not very frequent lesions. The ampullectomy consists on the total resection of the Vater's ampulla and part of the duodenal wall with the later reconstruction and anastomosis of the common bile duct and the Wirsung's duct to the duodenum. The local resection of the ampulla is an alternative to the duodenopancreatectomy that has to be taken into account, especially in benign lesions as in the case of adenomas of the Vater's ampulla. Here we describe two cases one with adenoma of the Vater's ampulla, with a high degree dysplasia, who first underwent an ampullectomy and finally ended up in a duodenopancreatectomy due to the infiltration of the adenoma into the edge of section and other case of Lymphangioma of Vater's ampulla with no infiltration in the edge of section.

Validación de la versión en español del "Health Utility Index" (Torrence) para la estimación de calidad de vida / Validation of the spanish version of \"Health Utility Index\" (Torrence) for the estimation of quality of life

Debido a la escasez en español de instrumentos que permitan medir la calidad de vida relacionada con salud (CVRS), se dicidió traducir y adaptar el "Health Utility Index" ("HUI") a nuestro medio. Se tomaron 60 pacientes de la consulta externa de reumatología del Hospital San Juan de Dios a los cuales se le aplicó nuestra versión en español del "HUI", posterior a lo cual se le pidió a cada uno de ellos que calificara su dolor musculoesquelético en una escala visual análoga (EVA), con el propósito de establecer la validez de criterio. Mediante de un análisis de correlación estadística se encontró una relación inversamente proporcional entre dolor y el valor de utilidad con un coeficiente de Pearson de -0,6 (p<0,01); es decir a mayor dolor, menor CVRS. Con el presente estudio queda validada la versión en español de este instrumento que nos permite medir la CVRS en nuestros pacientes.