Cardiopatía isquémica como forma de presentación de feocromocitoma / Ischemic cardiomyopathy as a presentation of pheocromocytoma

El feocromocitoma es una causa poco frecuente de cardiopatía isquémica. Presentamos el caso de una paciente en la que se diagnostica de un feocromocitoma a raíz de una cardiopatía isquémica con ausencia de lesiones coronarias, demostrando la importancia de tenerlo en cuenta en el diagnóstico diferencial en estos casos, sobre todo teniendo en cuenta que disponemos de un tratamiento curativo. (AU)

Pheochromocytoma is a rare cause of ischaemic heart disease. We present the case of a patient in whom pheochromocytoma was diagnosed following ischaemic heart disease with absence of coronary lesions, demonstrating the importance of taking it into account in the differential diagnosis in these cases, especially considering that curative treatment is available. (AU)

[Ischemic cardiomyopathy as a presentation of pheocromocytoma]. / Cardiopatía isquémica como forma de presentación de feocromocitoma.

Pheochromocytoma is a rare cause of ischaemic heart disease. We present the case of a patient in whom pheochromocytoma was diagnosed following ischaemic heart disease with absence of coronary lesions, demonstrating the importance of taking it into account in the differential diagnosis in these cases, especially considering that curative treatment is available.

An analytical framework on the leaching potential of veterinary pharmaceuticals: A case study for the Netherlands.

Veterinary pharmaceuticals (VPs) residues may end up on the soil via manure, and from there can be transported to groundwater due to leaching. In this study an analytical framework to estimate the leaching potential of VPs at the national scale is presented. This approach takes soil-applied VPs concentrations, soil-hydraulic and soil-chemical properties, groundwater levels, sorption and degradation of VPs into account. For six commonly soil-applied VPs in the Netherlands, we assess quantities leached to groundwater and their spatial distribution, as well as the relative importance of processes that drive leaching. Our results for VPs Oxytetracycline, Doxycycline, and Ivermectin indicate that maximum quantities that may leach to groundwater are very low, i.e. ≪1 µg/ha, hence spatial differences are not investigated. For VPs Sulfadiazine and Flubendazole we identify a few regions that are potentially prone to leaching, with leached quantities higher than 1 µg/ha. Leaching patterns of these two VPs are dominated by soil properties and groundwater levels rather than soil-applied quantities. For Dexamethasone, even though applied on the soil in much lower concentrations compared to other investigated VPs, spatially widespread leaching to groundwater is found, with leached quantities higher than 1 µg/ha. Due to the leaching affinity of Dexamethasone, variations in the soil-applied amounts have significant influence on the quantities leached to groundwater. Dexamethasone is highlighted as important for the future environmental risk assessment efforts. This study has shown that the leaching potential of VPs is not determined by one single parameter, but by a combination of parameters. This combination also depends on the compound investigated.

Signatures of Interactions in the Andreev Spectrum of Nanowire Josephson Junctions.

We performed microwave spectroscopy of an InAs nanowire between superconducting contacts implementing a finite-length, multichannel Josephson weak link. Certain features in the spectra, such as the splitting by spin-orbit interactions of the transition lines among Andreev states, have been already understood in terms of noninteracting models. However, we identify here additional transitions, which evidence the presence of Coulomb interactions. By combining experimental measurements and model calculations, we reach a qualitative understanding of these very rich Andreev spectra.

From Adiabatic to Dispersive Readout of Quantum Circuits.

Spectral properties of a quantum circuit are efficiently read out by monitoring the resonance frequency shift it induces in a microwave resonator coupled to it. When the two systems are strongly detuned, theory attributes the shift to an effective resonator capacitance or inductance that depends on the quantum circuit state. At small detuning, the shift arises from the exchange of virtual photons, as described by the Jaynes-Cummings model. Here we present a theory bridging these two limits and illustrate, with several examples, its necessity for a general description of quantum circuits readout.

Stabilization of betalains by encapsulation-a review.

Betalains are pigments that have properties that benefit health, such as antioxidant, anticancer, and antimicrobial activity, and they also possess a high ability to provide color. However, these pigments, although used as colorants in certain foods, have not been able to be potentialized to diverse areas such as pharmacology, due to their instability to physicochemical factors such as high temperature, pH changes and high water activity. For this reason, different stabilization methods have been reported. The method that has presented best results for diversifying the use of betalains has been encapsulation. Encapsulation is a method of entrapment where the objective is to protect a compound utilizing more stable matrices from encapsulation technologies. This method has been employed to provide greater stability to betalains, using different matrices and encapsulation technologies. However, a review does not exist, to our knowledge, which analyzes the effect of matrices and encapsulation technologies on betalains stabilization. Therefore, the objective of this review article was to evaluate the different matrices and encapsulation techniques that have been employed to stabilize betalains, in order to arrive at specific conclusions concerning the effect of encapsulation on their stabilization and to propose new techniques and matrices that could promote their stabilization.

Tumor fibroso solitario del lóbulo caudado del hígado / Solitary fibrous tumor of the liver caudate lobe

Introduction: Solitary fibrous tumor of the liver (SFTL) constitutes such a rare finding that it has been published only as case reports and to the present date there are only 45 cases published in English medical literature. This article describes the case of a patient treated at our institution with SFTL. Case report: A male 59-years-old patient was diagnosed with a SFTL incidentally found in a computed abdominal tomography taken by another causes, tumor was originating from the caudate lobe. The patient was asymptomatic. At surgery, the tumor was observed originating directly from the caudate lobe through a pedicle measuring approximately 3 cm. The tumor was resected sectioning its implantation pedicle and ligating all arterial, venous and biliary vessels. The SFTL was well encapsulated, measured 15 x 9 x 6 cm and weighted 794 g. The histological diagnosis was a SFTL and was confirmed by immunohistochemistry with monoclonal antibodies that reacted positively to CD34 and vimentin and negatively to CD117, S100, smooth-muscle α-actin and desmin. Conclusions: SFTL is an uncommon tumor. The present case is the first reported in Chilean medical literature and presented all the habitually described radiologic, surgical and pathological characteristics.

Introducción: El tumor fibroso solitario del hígado (TFSH) constituye un hallazgo tan raro que se ha publicado únicamente como reportes de caso y hasta el presente se encontraron sólo 45 casos publicados en la literatura inglesa. El presente artículo describe el caso de un paciente que fue tratado en nuestra institución por un TFSH. Reporte de caso: Paciente masculino de 59 años de edad al que, en una tomografía abdominal computarizada que se tomó por otras causas, se encontró en forma incidental un gran tumor hepático localizado en el lóbulo caudado del hígado. El paciente no refería síntomas relacionados con el tumor. En la cirugía se observó que el tumor se originaba directamente del lóbulo caudado al cual lo unía un pedículo de aproximadamente 3 cm de diámetro transverso. Se seccionó el tumor desde su base de implantación en el hígado ligándose los vasos arteriales y venosos así como los conductos biliares que se encontraron. Este medía 15 x 9 x 6 cm y pesaba 794 g, se encontraba bien encapsulado. El diagnóstico histológico fue el de un TFSH, el cual se confirmó mediante inmunohistoquímica con anticuerpos monoclonales que resultaron positivos para CD34 y vimentina en las células tumorales y negativos para CD117, S100, α-actina de músculo liso y desmina. Conclusiones: El TFSH es un tumor raro. El presente caso de un TFSH es el primero reportado en la literatura médica chilena y presentó las características radiológicas, quirúrgicas y patológicas habitualmente descritas en estos casos.

Coherent manipulation of Andreev states in superconducting atomic contacts.

Coherent control of quantum states has been demonstrated in a variety of superconducting devices. In all of these devices, the variables that are manipulated are collective electromagnetic degrees of freedom: charge, superconducting phase, or flux. Here we demonstrate the coherent manipulation of a quantum system based on Andreev bound states, which are microscopic quasi-particle states inherent to superconducting weak links. Using a circuit quantum electrodynamics setup, we performed single-shot readout of this Andreev qubit. We determined its excited-state lifetime and coherence time to be in the microsecond range. Quantum jumps and parity switchings were observed in continuous measurements. In addition to having possible quantum information applications, such Andreev qubits are a test-bed for the physics of single elementary excitations in superconductors.

Respuesta inflamatoria postoperatoria en pacientes con cáncer gástrico resecado / Postoperative inflammatory response in patients with gastric cancer submitted to total and partial distal gastrectomy

Introduction: The removal of the stomach causes an acute inflammatory response. In some cases this response is exaggerated due to complications. The main purpose of this study was to describe the expected inflammatory response to gastrectomy. Methods: This is a prospective analysis of consecutive patients submitted to gastrectomy for gastric cancer. For analytical purposes, the cohort was divided in complicated and uncomplicated patients. Uncomplicated patients were further divided in total gastrectomy and partial gastrectomy. The main outcome measure was to compare the inflammatory response of uncomplicated and complicated patients. The secondary outcome measure was to compare the inflammatory response of uncomplicated patients submitted to total and partial gastrectomy along the timeline. Results: Preoperative values were similar between groups. At 24 h after gastrectomy, complicated patients showed significantly higher values for D-dimer, CRP and WBC. Further analysis comparing uncomplicated patients showed normal preoperative values and a mild elevation of inflammatory parameters which was similar in both groups of patients. Conclusions: The expected systemic inflammatory response to partial or total gastrectomy was mild. Elevations of inflammatory values were shown early by complicated patients, constituting reliable parameters to identify postoperative inflammatory complications.

Introducción: La extirpación del estómago produce una respuesta inflamatoria aguda. En algunos casos esta respuesta es exagerada debido al desarrollo de complicaciones. El objetivo general del presente estudio es el de describir la respuesta inflamatoria esperable en pacientes sometidos a gastrectomía. Métodos: Análisis prospectivo de pacientes consecutivos sometidos a gastrectomía por cáncer gástrico. La cohorte se analizó dividida en pacientes sin complicaciones y pacientes que sufrieron complicaciones. Los pacientes sin complicaciones fueron además divididos en pacientes sometidos a gastrectomía total y parcial. El objetivo principal fue comparar la respuesta inflamatoria de pacientes complicados con pacientes sin complicaciones. El objetivo secundario fue comparar la respuesta inflamatoria de los pacientes no complicados sometidos a gastrectomía total con los pacientes sometidos a gastrectomía parcial. Resultados: Los valores de los exámenes preoperatorios fueron similares entre todos los grupos. A las 24 h después de la gastrectomía, los pacientes complicados mostraron valores significativamente mayores de la proteína C reactiva, leucocitos y dímero-D. El análisis comparativo de los pacientes sin complicaciones, sometidos a gastrectomía total y parcial, mostró una moderada elevación de los parámetros inflamatorios, la cual fue similar en ambos grupos. Conclusiones: La respuesta inflamatoria esperable a la gastrectomía total o parcial es moderada. Los pacientes que sufrieron complicaciones mostraron precozmente una importante elevación de sus parámetros inflamatorios lo que permite sospechar el desarrollo de complicaciones postoperatorias.

Tumor sólido pseudopapilar del páncreas en la IV región / Solid-pseudopapillary tumor of pancreas

Introduction: The solid-pseudopapillary tumor of pancreas (STP) is a low-grade malignant neoplasm. In Chile, 21 cases have been reported since 2008, most of them treated in Santiago. The present series contributes to the national case-load and has the purpose to describe the experience with this uncommon neoplasm in the IV Region. Patients and Methods: From January 2004 to March 2014, a total of 38 benign and malignant pancreatic neoplasms have been informed in the data-base of our Regional Pathology Service. We selected the biopsies informed as STP and 5 cases (13 percent) were found. The clinical records of these patients were retrospectively reviewed. The results were reported using descriptive statistics with central tendency measures and dispersion. Results: Most patients were women with a mean age of 44.8 years. All patients were studied with either abdominal ultrasound; computed tomography or magnetic resonance. In 2 patients the STP was located in the pancreatic tail, and they were submitted to distal pancreatectomy. The other 3 patients had the STP in the pancreatic head and were resolved by pancreatoduodenectomy. All tumors were confirmed by immunohistochemistry. Late follow-up showed malignant behavior in 1 patient while the other 4 patients are currently free of disease. Conclusions: The general characteristics of STP in the IV Region are similar to what is currently known. They present a high incidence compared with the habitually published incidence.

Introducción: El tumor sólido pseudopapilar del páncreas (TSP) es una neoplasia con bajo potencial maligno. En Chile se han reportado 21 casos desde el año 2008, 18 de ellos tratados en instituciones de Santiago. La presente serie además de contribuir a la casuística nacional, tiene como objetivo la descripción de la experiencia de la IV Región con el manejo de estos tumores. Pacientes y Métodos: Entre enero de 2004 y marzo de 2014 se informaron 38 biopsias de tumores pancreáticos benignos y malignos en la base de datos del Servicio de Patología Regional. Se seleccionaron las biopsias informadas como TSP, las que constituyen 5 casos (13 por ciento) y se revisaron las fichas clínicas en forma retrospectiva. Para el informe de los resultados se utilizó estadística descriptiva con medidas de tendencia central y dispersión. Resultados: El promedio de edad fue 44,8 años, siendo la mayoría mujeres. Los pacientes fueron estudiados con ecografía, tomografía computarizada y resonancia magnética. En 2 pacientes el TSP se localizaba en la cola del páncreas, estos pacientes fueron sometidos a pancreatectomía distal. En los otros 3 casos el TSP se encontraba en la cabeza del páncreas y fueron resueltos mediante pancreatoduodenectomía. Los TSP fueron confirmados por inmunohistoquímica. El comportamiento posterior fue benigno en 4 casos y maligno en 1 caso. Conclusiones: Las características de los TSP en la IV Región son similares a las conocidas y presentan una alta incidencia comparada con la habitualmente reportada.

Intra-articular administration of an antibody against CSF-1 receptor reduces pain-related behaviors and inflammation in CFA-induced knee arthritis.

Several studies have shown that blockade of colony stimulating factor-1 (CSF-1) or its receptor (CSF-1R) inhibits disease progression in rodent models of rheumatoid arthritis (RA); however, the role of the CSF-1/CSF-1R pathway in RA-induced pain and functional deficits has not been studied. Thus, we examined the effect of chronic intra-articular administration of a monoclonal anti-CSF-1R antibody (AFS98) on spontaneous pain, knee edema and functional disabilities in mice with arthritis. Unilateral arthritis was produced by multiple injections of complete Freund's adjuvant (CFA) into the right knee joint of adult male ICR mice. CFA-injected mice were then treated twice weekly from day 10 until day 25 with anti-CSF-1R antibody (3 and 10 µg/5 µL per joint), isotype control (rat IgG 10 µg/5 µL per joint) or PBS (5 µl/joint). Knee edema, spontaneous flinching, vertical rearing and horizontal exploratory activity were assessed at different days. Additionally, counts of peripheral leukocytes and body weight were measured to evaluate general health status. Intra-articular treatment with anti-CSF-1R antibody significantly increased horizontal exploratory activity and vertical rearing as well as reduced spontaneous flinching behavior and knee edema as compared to CFA-induced arthritis mice treated with PBS. Treatment with this antibody neither significantly affect mouse body weight nor the number of peripheral leukocytes. These results suggest that blockade of CSF-1R at the initial injury site (joint) could represent a therapeutic alternative for improving the functional disabilities and attenuating pain and inflammation in patients with RA.

Resección mixta laparoscópica y endoscópica de un tumor del estroma gastrointestinal de la unión gastroesofágica / Resection of a gastrointestinal stromal tumor of the gastroesophagic junction using a mixed laparoscopic-endoscopic technique

Introduction: The ideal treatment for non-disseminated gastrointestinal stromal tumors (GIST) of the stomach is the local surgical resection. The laparoscopic approach has been validated showing its safety without compromising the oncological principles. The localization on the gastroesophagic junction is a specific situation on gastric GIST, mainly for submucosal tumors arising over the lesser curvature. Wedge resection of these tumors is technically demanding and has been associated to surgical complications and late development of stenosis and gastroesophageal reflux. For these reasons a mixed technique combining endoscopic and laparoscopic approaches has been developed. Herein we report a patient with an endophytic gastric GIST located on the gastroesophageal junction operated on with this technique. Clinical Case: A female 37-years old patient with a submucosal tumor of the gastroesophagic junction was submitted to laparoscopic surgery. During the surgical act the difficulty to continue with the laparoscopic resection became evident and the intragastric resection assisted with endoscopy was undertaken. The technique and the surgical outcomes are described. Conclusion. The intragastric approach for submucosal tumors located over the gastroesophagic junction is safe and relatively simple. This technique is widely described in the medical literature and its indications validated.

Introducción. El tratamiento de elección para los tumores localizados del estroma gastrointestinal (GIST) del estómago es la resección quirúrgica local. Se ha demostrado la seguridad de la técnica laparoscópica sin compromiso de los principios oncológicos. Un problema específico está constituido por los GIST de la unión esófago-gástrica, principalmente los tumores de crecimiento intramural que se localizan en la curvatura menor. La resección en cuña de estos tumores no sólo es técnicamente demandante, sino que se asocia a complicaciones quirúrgicas y al desarrollo de estenosis de la unión gastroesofágica o a reflujo gastroesofágico por la extensa destrucción de la anatomía. Por estas razones se desarrolló una técnica mixta combinando el abordaje laparoscópico y endoscópico. En el presente reporte, describimos el caso de una paciente con un GIST gástrico endofítico de la unión esófago-gástrica que fue operado mediante esta técnica. Caso clínico: Paciente femenino de 37 años de edad, en la que se diagnostica un tumor de la unión esófago-gástrica. Ante la sospecha de un posible GIST gástrico se decide el abordaje laparoscópico, durante la cirugía se evidencia la dificultad de la resección laparoscópica por lo que se intenta la resección intragástrica asistida con endoscopia. Se describe la técnica y los resultados de la cirugía. Conclusiones. El abordaje intragástrico de tumores submucosos de la unión esófago-gástrica es seguro y relativamente simple. Esta técnica se encuentra ampliamente descrita en la literatura y sus indicaciones están validadas.

Superconducting atomic contacts inductively coupled to a microwave resonator.

We describe and characterize a microwave setup to probe the Andreev levels of a superconducting atomic contact. The contact is part of a superconducting loop inductively coupled to a superconducting coplanar resonator. By monitoring the resonator reflection coefficient close to its resonance frequency as a function of both flux through the loop and frequency of a second tone we perform spectroscopy of the transition between two Andreev levels of highly transmitting channels of the contact. The results indicate how to perform coherent manipulation of these states.

Exciting Andreev pairs in a superconducting atomic contact.

The Josephson effect describes the flow of supercurrent in a weak link-such as a tunnel junction, nanowire or molecule-between two superconductors. It is the basis for a variety of circuits and devices, with applications ranging from medicine to quantum information. Experiments using Josephson circuits that behave like artificial atoms are now revolutionizing the way we probe and exploit the laws of quantum physics. Microscopically, the supercurrent is carried by Andreev pair states, which are localized at the weak link. These states come in doublets and have energies inside the superconducting gap. Existing Josephson circuits are based on properties of just the ground state of each doublet, and so far the excited states have not been directly detected. Here we establish their existence through spectroscopic measurements of superconducting atomic contacts. The spectra, which depend on the atomic configuration and on the phase difference between the superconductors, are in complete agreement with theory. Andreev doublets could be exploited to encode information in novel types of superconducting qubits.

Evidence for long-lived quasiparticles trapped in superconducting point contacts.

We have observed that the supercurrent across phase-biased, highly transmitting atomic size contacts is strongly reduced within a broad phase interval around π. We attribute this effect to quasiparticle trapping in one of the discrete subgap Andreev bound states formed at the contact. Trapping occurs essentially when the Andreev energy is smaller than half the superconducting gap Δ, a situation in which the lifetime of trapped quasiparticles is found to exceed 100 µs. The origin of this sharp energy threshold is presently not understood.

Asymmetric noise probed with a josephson junction.

Fluctuations of the current through a tunnel junction are measured using a Josephson junction. The current noise adds to the bias current of the Josephson junction and affects its switching out of the supercurrent branch. The experiment is carried out in a regime where switching is determined by thermal activation. The variance of the noise results in an elevated effective temperature, whereas the third cumulant, related to its asymmetric character, leads to a difference in the switching rates observed for opposite signs of the current through the tunnel junction. Measurements are compared quantitatively with recent theoretical predictions.

Phase controlled superconducting proximity effect probed by tunneling spectroscopy.

Using a dual-mode STM-AFM microscope operating below 50 mK we measured the local density of states along small normal wires connected at both ends to superconductors with different phases. We observe that a uniform minigap can develop in the whole normal wire and in the superconductors near the interfaces. The minigap depends periodically on the phase difference. The quasiclassical theory of superconductivity applied to a simplified 1D model geometry accounts well for the data.

Measurement of the current-phase relation of superconducting atomic contacts.

We have probed the current-phase relation of an atomic contact placed with a tunnel junction in a small superconducting loop. The measurements are in quantitative agreement with the predictions of a resistively shunted SQUID model in which the Josephson coupling of the contact is calculated using the independently determined transmissions of its conduction channels.

Crossover from Josephson to multiple Andreev reflection currents in atomic contacts.

The basic current-carrying mechanism through a superconducting weak link embedded in a resistive environment undergoes a continuous crossover, as the voltage increases, from Josephson Cooper pair transfer exciting electromagnetic modes in the environment to multiple Andreev reflections leading to the creation of quasiparticles. We corroborate these ideas through measurements of the dc current-voltage characteristics of superconducting atomic contacts containing channels of arbitrary and adjustable transmission. We present a simple model, in the spirit of the classical resistively shunted junction model, that accounts well for the observed characteristics.

Superconducting atomic contacts under microwave irradiation.

We have measured the effect of microwave irradiation on the dc current-voltage characteristics of superconducting atomic contacts. The interaction of the external field with the ac supercurrents leads to replicas of the supercurrent peak, the well-known Shapiro resonances. The observation of supplementary fractional resonances for contacts containing highly transmitting conduction channels reveals their nonsinusoidal current-phase relation. The resonances sit on a background current which is itself deeply modified, as a result of photon-assisted multiple Andreev reflections. The results provide firm support for the full quantum theory of transport between two superconductors based on the concept of Andreev bound states.