Twofold π-Extension of Polyarenes via Double and Triple Radical Alkyne peri-Annulations: Radical Cascades Converging on the Same Aromatic Core.

A versatile synthetic route to distannyl-substituted polyarenes was developed via double radical peri-annulations. The cyclization precursors were equipped with propargylic OMe traceless directing groups (TDGs) for regioselective Sn-radical attack at the triple bonds. The two peri-annulations converge at a variety of polycyclic cores to yield expanded difunctionalized polycyclic aromatic hydrocarbons (PAHs). This approach can be extended to triple peri-annulations, where annulations are coupled with a radical cascade that connects two preexisting aromatic cores via a formal C-H activation step. The installed Bu3Sn groups serve as chemical handles for further functionalization via direct cross-coupling, iodination, or protodestannylation and increase solubility of the products in organic solvents. Photophysical studies reveal that the Bu3Sn-substituted PAHs are moderately fluorescent, and their protodestannylation results in an up to 10-fold fluorescence quantum yield enhancement. DFT calculations identified the most likely possible mechanism of this complex chemical transformation involving two independent peri-cyclizations at the central core.

Nonglomic tumors of the jugular foramen: differential diagnosis and prognostic implications.

OBJECTIVE: Tumors of the jugular foramen are notably rare, and the majority of them arise from the glomic tissue of the jugular vein. There are other tumors that do not originate from that tissue, and these are called the nonglomic tumors. This report includes a series of patients with nonglomic tumors of the jugular foramen to analyze their biological and radiological behavior and the clinical outcomes of patients. METHODS: Patients with tumors of the jugular foramen other than chemodectomas were included for the present series. All of the patients were subjected to a protocol that included imaging studies and a complete clinical evaluation. Surgery was planned and performed by a multidisciplinary team using the following approaches: retrosigmoid, infratemporal fossa, and zygomatic-transmandibular. Depending on the precise diagnosis and surgical outcomes, radiotherapy or radiosurgery were indicated. The average follow-up period was 5 years. RESULTS: Thirty patients with nonglomic tumors were included: 18 schwannomas, 6 meningiomas, 5 chordomas, and 1 metastatic carcinoma. The patients with chordomas had the most severe clinical manifestations, and the chordomas were the largest and most invasive tumors that destroyed the jugular foramen contour on imaging studies. Schwannomas presented a more benign clinical evolution and enlarged (but did not destroy) the jugular foramen contour. Two patients died (chordomas) during the follow-up because of tumor activity. CONCLUSIONS: The most common nonglomic tumor of the jugular foramen was the schwannoma, which was the lesion with the best surgical prognosis. Chordoma is a rare and highly destructive tumor that has a notably high recurrence index.

Acromegaly: role of surgery in the therapeutic armamentarium.

Acromegaly is a complex disease that requires the intervention of a multidisciplinary team. The most frequent clinical manifestations are growing of distal parts of the body and some areas of the face. Patients may also present arterial hypertension, diabetes mellitus, colonic polyps, cardiomegaly, neurological and endocrine changes secondary to the presence of a GH-secreting tumor in pituitary or extrapituitary origin, or eutopic hypothalamic GHRH hypersecretion and peripheral GHRH hypersecretion. Surgery is the first treatment used for most patients, regardless of the cause. In the great majority of cases, pituitary tumor can be removed through a transsphenoidal approach. Craniotomy is reserved for those cases with giant tumors, particularly when they grow toward the middle or posterior cranial fossa. Best surgical results are obtained when the tumor is confined into the sella turcica or if it has a regular suprasellar extension. When the disease cannot be controlled with surgery, medical treatment is indicated. Somatostatin analogues are included as the first line of medication, followed by dopamine agonist and growth hormone receptors antagonists. Radiation therapy can be also indicated in two main forms for residual tumor with medically refractory patients: radiosurgery for small tumors or fractionated stereotactic radiotherapy for larger ones.

Diaphragma sellae: a surgical reference for transsphenoidal resection of pituitary macroadenomas.

OBJECTIVE: To classify patterns of descent of the diaphragma sellae (DS) to the sella turcica after transsphenoidal resection of pituitary macroadenomas and to determine whether there is any correlation between type of descent and volume or growth pattern of the tumor, as well as the presence of any postoperative hormone alteration, cerebrospinal fluid leak, and/or residual tumor. METHODS: One hundred patients with pituitary macroadenomas in which microsurgical transsphenoidal approach was indicated were prospectively included. We classified patterns of descent of the DS into four types: type A: symmetrical descent with a central fold corresponding to the pituitary stalk; type B: asymmetrical with a lateralized fold; type C: symmetrical and uniform descent without any fold; and type D: minimal or no descent in absence of visible residual tumor. A correlation was made between these types of descent and clinical and radiological findings. RESULTS: The largest tumors were types A and B; endocrine deficit was more frequent in types A and C, whereas the possibility of residual tumor was more elevated in types B and D. No statistically significant differences were found regarding tumor morphology and cerebrospinal fluid leakage. CONCLUSIONS: Our results suggest that pattern of descent of the DS may serve as a reference to determine the risk of leaving residual tumor as well as the possibility of developing postoperative endocrine deficit. It is apparent that tumor volume, more than morphology, is the main factor determining type of descent of the DS.

Endoscopic and symptoms analysis in Mexican patients with irritable Bowel syndrome, dyspepsia, and gastroesophageal reflux disease.

The aim of this study was to analyze the data of endoscopy and symptoms in 118 Mexican patients with irritable bowel syndrome (IBS), dyspepsia, non-erosive reflux disease (NERD) and erosive esophagitis (EE). IBS criteria were fulfilling for dyspepsia patients in 47%, for NERD in 48%, and for EE patients in 48% of cases. Esophagitis was present in 42% of patients with IBS and in 45% of patients with dyspepsia. A higher prevalence of hiatus hernia was found in EE vs. NERD. Heartburn and acid eructation were associated with the presence of esophagitis; acid eructation, regurgitation and nocturnal pain with duodenitis; and heartburn and regurgitation with hiatus hernia. Males more frequently reported: mucus in feces, abdominal distension, nausea and gastritis; and women more frequently reported esophagitis and duodenitis. Patients with NERD (OR 2.54, 95% CI 1.08 to 5.99, p=0.04), tenesmus and early satiety, and men had an increase risk for reporting hard or lumpy stools. In conclusion, nearly half of the Mexican patients with NERD, EE and dyspepsia fulfill criteria for IBS. A large number of symptoms were correlated with endoscopy, which can be used to improve the indication of the endoscopy and its implementation in clinical studies.

Endoscopic and symptoms analysis in Mexican patients with irritable Bowel syndrome, dyspepsia, and gastroesophageal reflux disease

The aim of this study was to analyze the data of endoscopy and symptoms in 118 Mexican patients with irritable bowel syndrome (IBS), dyspepsia, non-erosive reflux disease (NERD) and erosive esophagitis (EE). IBS criteria were fulfilling for dyspepsia patients in 47 percent, for NERD in 48 percent, and for EE patients in 48 percent of cases. Esophagitis was present in 42 percent of patients with IBS and in 45 percent of patients with dyspepsia. A higher prevalence of hiatus hernia was found in EE vs. NERD. Heartburn and acid eructation were associated with the presence of esophagitis; acid eructation, regurgitation and nocturnal pain with duodenitis; and heartburn and regurgitation with hiatus hernia. Males more frequently reported: ucus in feces, abdoinal distension, nausea and gastritis; and oen ore frequently reported esophagitis and duodenitis. Patients with NERD (OR 2.54, 95 percent CI 1.08 to 5.99, p=0.04), tenesmus and early satiety, and men had an increase risk for reporting hard or lumpy stools. In conclusion, nearly half of the Mexican patients with NERD, EE and dyspepsia fulfill criteria for IBS. A large number of symptoms were correlated with endoscopy, which can be used to improve the indication of the endoscopy and its implementation in clinical studies.

O objetivo deste estudo foi analisar os dados de endoscopia e sintomas de 118 pacientes mexicanos com síndrome do intestino irritável (IBS), dispepsia, doença do refluxo não-erosiva (NERD) e esofagite erosiva (EE). Os pacientes com IBS preencheram os critérios para dispepsia em 47 por cento, para NERD em 48 por cento, e para pacientes EE em 48 por cento dos casos. Esofagite estava presente em 42 por cento dos pacientes com IBS e em 45 por cento dos pacientes com dispepsia. A maior prevalência de hérnia de hiato foi encontrada na EE em comparação com NERD. Azia e eructação ácida foram associadas à presença de esofagite; eructação ácida, regurgitação e dor noturna, com duodenite; e azia e regurgitação com hérnia de hiato. Os homens relataram mais frequentemente sintomas como muco nas fezes, distensão abdominal, náuseas e gastrite, enquanto que as mulheres mais frequentemente relataram esofagite e duodenite. Os pacientes com NERD (OR 2,54, IC 95 por cento 1,08-5,99, p = 0,04), apresentaram tenesmo e saciedade precoce, e os homens tiveram um risco aumentado relacionado a fezes endurecidas ou fragmentadas. Em conclusão, quase metade dos pacientes mexicanos com NERD, EE e dispepsia preenchem os critérios para a IBS. Um grande número de sintomas foi correlacionado com a endoscopia, esta correlação pode ser utilizada para aumentar a indicação da endoscopia e sua aplicação em estudos clínicos.