An indigestion or a viral gastritis, or not?

Case report: An 18 mth old boy was sent to the Emergency Room of the Jessa Hospital (Hasselt, Belgium) because of persistent vomiting. The clinical examination was without particularities, except for a runny nose. The diagnosis of indigestion or (viral) gastritis was made. Patient was sent home. He was represented at the ER five days later. He stopped vomiting for 3 consecutive days after his first hospital visit, but started to vomit again the last 2 days, the last night even two times with bilious vomiting. His appetite was decreased since one week. The infant was not comfortable during abdominal palpation. This finding led to the decision for further investigations. An abdominal ultrasound showed air superposition in the epi- and mesogastrium. There were no signs of intussusception. An abdominal X-ray was performed (fig 1). Answer and discussion: The abdominal X-ray showed a corpus alienum, presumably magnets, in the mesogastrium and free air under the right diaphragm (fig. 1). An abdominal CT-scan could not visualise whether the magnets were situated in- or outside the intestinal lumen. At laparoscopy, clitted small intestinal loops with multiple perforation sites were detected as well as a purulent peritonitis in the left fossa iliaca (fig. 2). Magnets were removed. Perforations were sutured. Postoperatively augmentin was given. Patient recovered completly. can attract each other through the intestinal wall, get stuck and pinch the digestive tract causing major and sometimes life-threatening intestinal perforation (1). Endoscopical or surgical removal can be performed, based on location and complications (2,3).

Long-term stability of isolated advancement genioplasty, and influence of associated risk factors: A systematic review.

The aim of this review was to investigate the skeletal and soft tissue stability of isolated advancement genioplasty after more than 1 year, and to observe the influence of associated risk factors. A literature search was performed on PubMed, Web of Science, Embase, ScienceDirect, and Cochrane. Only studies with at least 10 patients who underwent an isolated advancement genioplasty, and with a follow-up period of at least 1 year, were included. Of the 2224 records initially identified, eight articles met the eligibility criteria. The mean age of the total study population was 23 years and ranged from 19.1 to 26.5 years in the individual studies. The average surgical advancement at pogonion was 8.2 mm and ranged from 6.2 to 11.7 mm in the individual studies. After 1 year, the horizontal hard tissue relapse at the level of pogonion varied from 0.1 to 2.1 mm. In two studies, this was reported as statistically significant. Regarding the soft tissue, the horizontal relapse varied from 0.3 to 2.9 mm, which was also considered statistically significant in two studies. Isolated advancement genioplasty was found to be a predictable and stable orthognathic procedure in the sagittal plane at both soft and hard tissue levels. The amount of relapse was not associated with the fixation method or with the amount of surgical advancement.

Probing Magnetism in 2D Molecular Networks after in Situ Metalation by Transition Metal Atoms.

Metalated molecules are the ideal building blocks for the bottom-up fabrication of, e.g., two-dimensional arrays of magnetic particles for spintronics applications. Compared to chemical synthesis, metalation after network formation by an atom beam can yield a higher degree of control and flexibility and allows for mixing of different types of magnetic atoms. We report on successful metalation of tetrapyridyl-porphyrins (TPyP) by Co and Cr atoms, as demonstrated by scanning tunneling microscopy experiments. For the metalation, large periodic networks formed by the TPyP molecules on a Ag(111) substrate are exposed in situ to an atom beam. Voltage-induced dehydrogenation experiments support the conclusion that the porphyrin macrocycle of the TPyP molecule incorporates one transition metal atom. The newly synthesized Co-TPyP and Cr-TPyP complexes exhibit striking differences in their electronic behavior, leading to a magnetic character for Cr-TPyP only as evidenced by Kondo resonance measurements.

Self-doping of ultrathin insulating films by transition metal atoms.

Single magnetic Co atoms are deposited on atomically thin NaCl films on Au(111). Two different adsorption sites are revealed by high-resolution scanning tunneling microscopy (STM), i.e., at Na and at Cl locations. Using density functional based simulations of the STM images, we show that the Co atoms substitute with either a Na or Cl atom of the NaCl surface, resulting in cationic and anionic Co dopants with a high thermal stability. The dependence of the magnetic coupling between neighboring Co atoms on their separation is investigated via spatially resolved measurement of the local density of states.

MR enterography in children with Crohn disease: results from the Belgian pediatric Crohn registry (Belcro).

INTRODUCTION: Magnetic Resonance enterography (MRE) is an imaging modality avoiding ionizing radiation and the discomfort associated with enteroclysis. The results of MRE at diagnosis in the patients of the Belgian pediatric Crohn registry (Belcro) are compared to endoscopical and histological results. METHODS: Results of MRE, endoscopy and histology were obtained from the medical charts and assigned to one of the following segments: jejunum, ileum, ascending colon, transverse colon, descending colon or rectosigmoid. MRE images were reviewed in a blinded way by 4 radiologists with specific interest in pediatric MRE. RESULTS: From the Belcro registry, twenty-two patients underwent a MRE during their work-up for Crohn disease. The results of endoscopy, histology and MRE were concordant (either all negative or positive) in the ileum in 16/18 patients and in the rectosigmoid, descending colon, transverse colon and ascending colon in resp 9, 8, 8 and 8/22 patients. In the non-concordant cases (MRE colon negative but endoscopy and/or histology positive), MRE could not reflect the subtle endoscopic or histologic lesions such as erosions that were described.In 4 cases where ileocaecal valve intubation was impossible ileal MRE findings were abnormal. MRE detected ileal stenosis, jejunal lesions and fistula in resp 4/22, 3/22 en 2/22 patients. The 100% and 75% interobserver agreement was resp 50-82% and 773-100% according to the different intestinal segments. CONCLUSIONS: MRE is a promising imaging modality avoiding radiation in Crohn disease. It should probably become the technique of first choice for the evaluation of extensive small bowel disease in children with Crohn disease.

Structural identification of caged vanadium doped silicon clusters.

The geometry of cationic silicon clusters doped with vanadium, Si(n)V(+) (n=12-16), is investigated by using infrared multiple photon dissociation of the corresponding rare gas complexes in combination with ab initio calculations. It is shown that the clusters are endohedral cages, and evidence is provided that Si(16)V(+) is a fluxional system with a symmetric Frank-Kasper geometry.

Takotsubo cardiomyopathy or apical ballooning: a case report and a short literature study.

Takotsubo cardiomyopathy is an important differential diagnosis in patients with an acute coronary syndrome. This syndrome is typically characterized by a reversible contractile dysfunction of the left ventricular myocardium without any obstructive etiological coronary disease. This is not a rare entity in acute settings and a better knowledge of the syndrome could result in a heightened alertness and a higher detection. We present a case of takotsubo showing the importance of cardiac MRI in the differential diagnosis and reviewed the present literature concerning this syndrome and the usefulness of MRI in the detection.

Combining tiotropium and salmeterol in COPD: Effects on airflow obstruction and symptoms.

BACKGROUND: Clinical information on 24-h spirometric efficacy of combining tiotropium and salmeterol compared to single-agent therapy is lacking in patients with COPD. METHODS: A randomized, double-blind, four-way crossover study of 6-week treatment periods comparing combination therapy of tiotropium 18 microg plus qd or bid salmeterol 50 microg versus single-agent therapy. Serial 24-h spirometry (FEV(1), FVC), effects on dyspnea (TDI focal score) and rescue salbutamol use were evaluated in 95 patients. RESULTS: Tiotropium plus qd salmeterol was superior to tiotropium or salmeterol alone in average FEV(1) (0-24h) by 72 mL and 97 mL (p<0.0001), respectively. Compared to this qd regimen, combination therapy including bid salmeterol provided comparable daytime (0-12h: 12 mL, p=0.38) bronchodilator effects, but significantly more bronchodilation during the night-time (12-24h: 73 mL, p<0.0001). Clinically relevant improvements in TDI focal score were achieved with bronchodilator combinations including salmeterol qd or bid (2.56 and 2.71; p<0.005 versus components). Symptom benefit of combination therapies was also reflected in less need for reliever medication. All treatments were well tolerated. CONCLUSION: Compared to single-agent therapy, combination therapy of tiotropium plus salmeterol in COPD provided clinically meaningful improvements in airflow obstruction and dyspnea as well as a reduction in reliever medication.

Tuberculous arthritis of the finger: a forgotten disease.

We present a case of a 64-year-old man from Belgian origin with a chronic painful swelling of the third finger. A chronic arthritis from atypical germ was suspected at the third metacarpo-phalangeal joint on the plain radiography, ultrasonography and MR examination. A few months later, he developed thoracic back pain. Plain radiographs, a Technetium-99m bone scan and MR examination of the thoracic spine revealed a spondylodiscitis of the dorsal spine. A tuberculous origin was found on the biopsy of the affected dorsal vertebral bodies D9 and D10 as suspected on the first imaging examinations of the finger. Besides the patient was found to be HIV-positive. This case shows that it is important to think of musculoskeletal tuberculosis particularly in high-risk persons because if left untreated, it can be devastating.

Isomorphous substitution in bimetallic oxide clusters.

The geometric and electronic structure of bimetallic oxide clusters is studied as a function of their composition with gas phase vibrational spectroscopy. Infrared multiple photon dissociation spectra of titanium-vanadium oxide cluster anions are measured in the 500 to 1200 wave number range and assigned on the basis of harmonic frequencies calculated using density functional theory. Singly substituted (V(2)O(5))(n-1)(VTiO(5))(-) (n=2-4) cluster anions are shown to form polyhedral caged structures similar to those predicted for their isoelectronic counterparts, the neutral (V(2)O(5))(n) clusters. Upon systematic exchange of V by Ti atoms in V(4-n)Ti(n)O(-)(10) (n=1-4), the structure does not change. The stress induced by the isomorphous substitution results in an increased number of unpaired electrons (n-1) for the Ti-rich systems, leading to a quartet ground state for Ti(4)O(-)(10).

Comparison of tiotropium once daily, formoterol twice daily and both combined once daily in patients with COPD.

This study compared the bronchodilator effects of tiotropium, formoterol and both combined in chronic obstructive pulmonary disease (COPD). A total of 71 COPD patients (mean forced expiratory volume in one second (FEV1) 37% predicted) participated in a randomised, double-blind, three-way, crossover study and received tiotropium 18 microg q.d., formoterol 12 microg b.i.d. or both combined q.d. for three 6-week periods. The end-points were 24-h spirometry (FEV1, forced vital capacity (FVC)) at the end of each treatment, rescue salbutamol and safety. Compared with baseline (FEV1 prior to the first dose in the first period), tiotropium produced a significantly greater improvement in average daytime FEV1 (0-12 h) than formoterol (127 versus 86 mL), while average night-time FEV1 (12-24 h) was not different (tiotropium 43 mL, formoterol 38 mL). The most pronounced effects were provided by combination therapy (daytime 234 mL, night-time 86 mL); both differed significantly from single-agent therapies. Changes in FVC mirrored the FEV1 results. Compared with both single agents, daytime salbutamol use was significantly lower during combination therapy (tiotropium plus formoterol 1.81 puffs.day(-1), tiotropium 2.41 puffs x day(-1), formoterol 2.37 puffs x day(-1)). All treatments were well tolerated. In conclusion, in chronic obstructive pulmonary disease patients, tiotropium q.d. achieved a greater improvement in daytime and comparable improvement in night-time lung function compared with formoterol b.i.d. A combination of both drugs q.d. was most effective and provided an additive effect throughout the 24-h dosing interval.

Heavy-metal concentrations in female laying great tits (Parus major) and their clutches.

Egg laying may be an additional excretory pathway for heavy metals available to laying female birds. In this study, we examined the relationships between tissue concentrations (both internal organs and feathers) of 10 breeding female great tits (Parus major) and the concentrations in their eggs. We also investigated differences in metal concentrations (Ag, Al, As, Cd, Co, Cr, Cu, Hg, Mn, Ni, Pb, Zn) among eggs as a result of the laying order of the eggs. Heavy-metal concentrations in internal tissues were highest in bone (Cr, Ni, Pb, Zn), kidney (Cd), liver (Cu), blood (Al, As, Co, Hg), and intestine (Ag, Mn). In the egg contents, relatively high concentrations of the essential elements Cr, Co, Cu, Mn, Ni, and Zn were found. In eggshells, concentrations of Ag, Al, As, Co, Cr, and Ni were high compared with internal tissue concentrations. Metal concentrations in the egg contents and eggshells were poorly correlated with metal concentrations in internal tissues and feathers; significant positive correlations were found only for cadmium and lead. We found few significant differences in metal concentrations among eggs, and none were according to the laying order of the eggs. The egg volume tended to decrease significantly as egg laying progressed. Our results seem to suggest that no special sampling strategies (e.g., sampling the first egg or pooling eggs from one clutch) are required for most metals.

Quenching of the magnetic moment of a transition metal dopant in silver clusters.

Single magnetic atoms embedded in a nonmagnetic host exhibit the Kondo effect in the bulk limit, while in very small molecules the magnetic atom is hardly affected by the matrix. In a combined theoretical (density functional theory) and experimental (photofragmentation and mass spectrometry) study we consider the intermediate case of nanometer sized transition-metal-doped silver clusters. In particular, we provide experimental evidence for enhanced stability of the cobalt-doped silver cluster Ag10Co+ and show theoretically that it has a symmetric endohedral geometry with a closed 18-electron singlet electronic shell structure. This implies that the magnetic moment on the cobalt atom is quenched.

Ventricular fibrillation in hypercalcaemic crisis due to primary hyperparathyroidism.

We report the case of a 64-year-old man who presented with severe hypercalcaemia secondary to primary hyperparathyroidism. Soon after admission he developed ventricular fibrillation with no other cause than this severe hypercalcaemia. Although the occurrence of cardiac arrhythmias in hypercalcaemia is widely known, ventricular fibrillation has never been described before.

Extremely stable metal-encapsulated AlPb10+ and AlPb12+ clusters: mass-spectrometric discovery and density functional theory study.

We report the experimental discovery of extremely stable metal-encapsulated superatom clusters of a group IVA element: AlPb+10 and AlPb+12. Ab initio density functional geometry optimizations at the B3LYP/LANL2DZ level result in a perfect icosahedron with an exceptionally large HOMO-LUMO gap of 3.1 eV for AlPb+12, and a related structure with D(4d) symmetry for AlPb+10, with a HOMO-LUMO gap of 2.6 eV. Their high stability is attributed to the reinforcing influence of the most favorable closed-packed structure and optimally filled electron shells.