Nuclear magnetic moment of the 57Cu ground state

The nuclear magnetic moment of the ground state of (57)Cu(Iota(pi) = 3/2(-), T(1/2) = 196.3 ms) has been measured to be /mu((57)Cu)/ = (2.00 +/- 0.05)mu(N) using the beta-NMR technique. Together with the known magnetic moment of the mirror partner (57)Ni, the spin expectation value was extracted as <Sigmasigma(z)> = -0.078 +/- 0.13. This is the heaviest isospin mirror T = 1/2 pair above the (40)Ca region for which both ground state magnetic moments have been determined. The discrepancy between the present results and shell-model calculations in the full f p shell giving mu((57)Cu) approximately 2.4mu(N) and <Sigmasigma(z)> approximately 0.5 implies significant shell breaking at (56)Ni with the neutron number N = 28.

[Aortopulmonary fistula complicating aortic arch aneurysm]

Aortopulmonary fistulas secondary to thoracic aneurysms are difficult to diagnose and few cases are reported in the literature. We describe the case of a patient first admitted to another hospital with a diagnosis of right upper lobe pneumonia. After the patient had been a week in hospital without improving, a computed tomography scan of the chest revealed a saccular aneurysm of the aortic arch measuring 9 cm at its widest diameter. Hemodynamics and respiratory signs deteriorated a few hours after transfer to our hospital. Physical examination revealed a systolic murmur and poor peripheral perfusion. The patient was intubated and inotropic support was provided. Upon insertion of a Swan-Ganz catheter, given suspicion of septic shock, progressive elevation of mixed venous oxygen saturation was observed. Measurement of venous oxygen saturation was 74% in the right atrium and 93% in the pulmonary artery. Left-right shunt was diagnosed and an emergency aortography revealed the aortopulmonary fistula. Emergency surgery was performed with the patient in deep hypothermia and cardiocirculatory arrest. There were no adverse events, and postoperative recovery and clinical course were good.

Results of 132 hepatectomies for living donor liver transplantation: report of one death

AIMS

Liver transplant is the primary therapy for patients with end-stage liver disease. Its high success rates have lead to a broadening of the indications for liver transplantation, resulting in an increasing shortage of donors. Living donor liver transplantation has become an option to overcome waiting list mortality. We describe our experience with hepatectomy for living donor liver transplantation and report a case of death.

METHODS

Patients (n = 132) underwent hepatectomy for living donor liver transplantation from June 2000 through June 2004. A 4-phase preoperative evaluation was performed on all patients, whose ages ranged from 13 to 54 years (mean = 29.7 +/- 8.1 years). Of the 132 patients, 76 patients (57.5%) underwent left lateral segmentectomy, 33 patients (25%) underwent left lobectomy, and 23 patients (16%) underwent right hepatectomy. In 2 other patients (1.5%), a monosegment (segment II) was obtained after left lateral segmentectomy.

RESULTS

Twenty patients (15%) experienced a complication, the most common being incisional hernia, pneumonia, and biliary fistulae. On the seventh postoperative day, 1 patient developed a fatal cerebral hemorrhage while recovering from mild liver dysfunction.

CONCLUSIONS

Although living donor liver transplantation is generally safe, serious and fatal complications may occur.

Transhepatic biliary catheterization before graft implant in living donor liver transplantation

AIM

Despite the evolution in surgical technique, the biliary anastomosis remains the technical Achilles' heel of liver transplantation, especially in living donor liver transplantation. Interventional radiology or endoscopic procedures constitute the most common options to treat complications from the biliary anastomosis. We report a novel technique to prevent biliary complications following the transplant.

METHODS

During the donor procedure a wire guide was introduced in the severed duct, left or right, in retrograde fashion. The liver surface was then perforated and the wire guide exposed. A 4F catheter was then attached to the wire guide and pulled into the bile duct passing through the end-to-end duct-to-duct anastomosis or hepaticojejunostomy.

RESULTS

This technique was performed in six living donor grafts: one right lobe, two left lobes, and three left lateral segments. All patients had no complications from the stent placement, biliary strictures, or leaks. One developed a hepatic artery thrombosis on the posttransplant day 14 with no major biliary complications.

Pallister-Hall syndrome: Unreported skeletal features of aGLI3mutation

We describe two patients with Pallister-Hall syndrome (PHS), both with evidence of a generalized skeletal dysplasia as typified by upper and lower acromesomelic limb shortening and the previously unreported fibular hypoplasia, radio-ulnar bowing, and proximal epiphyseal hypoplasia. Genomic DNA was only available for sequencing analysis in patient 2 and the mutation, c.3386_3387delTT was detected in exon 14 of the GL13 gene. It is also possible that the findings in patient 1 represent the phenotypic expression of a novel GLI3 mutation. This report further expands the PHS phenotype and raises the possibility of specific GLI3 mutations resulting in more severe skeletal features. It also suggests that PHS should be included in the differential diagnosis of antenatally ascertained acromesomelic limb shortening and bowing with fibular hypoplasia particularly in the presence of polysyndactyly.

Establishing an islet transplantation program in a developing country

Diabetes is an emerging epidemic throughout the world. In our city alone, there are approximately 25,000 known diabetics (5% to 10% type 1) among a total population of 1.7 million inhabitants, and the incidence is increasing among all age groups. Islet transplantation is a potential treatment for type 1 diabetes mellitus. For this reason, we intended to establish an islet transplantation program. This required competent and well-trained professionals, a specially planned facility adhering to rigid regulations regarding safety and sterility, and a detailed study of the ethical laws and rules involving transplantation. In this article, we describe the process including any difficulties or barriers encountered due to limited resources in a developing country. We also describe all stages of personnel training and the necessary equipment and work area of a similar specialized center following the guidelines of the Brazilian National Agency for Health Care. Finally, we discuss our expectations for the initial phase of our islet transplantation program.

Measurement of a complete set of nuclides, cross sections, and kinetic energies in spallation of 238U 1A GeV with protons

Spallation residues and fission fragments from 1A GeV 238U projectiles irradiating a liquid hydrogen target were investigated by using the fragment separator at GSI for magnetic selection of reaction products including ray-tracing, energy-loss and time-of-flight techniques. The longitudinal-momentum spectra of identified fragments were analyzed, and evaporation residues and fission fragments could be separated. For 1385 nuclides, production cross sections down to values of 10 microb with a mean accuracy of 15%, velocities in the uranium rest frame and kinetic energies were determined. In the reaction all elements from uranium to nitrogen were found, each with a large number of isotopes.

Biochemical dynamics of spermatogenesis and oogenesis in Eledone cirrhosa and Eledone moschata (Cephalopoda: Octopoda)

The effect of spermatogenesis and oogenesis on protein, lipid, glycogen, cholesterol and energy contents, total amino acid and fatty acid profiles of Eledone cirrhosa and Eledone moschata tissues (gonad, digestive gland and muscle) was investigated. A significant (p<0.05) increase in the amino acids and protein content of the gonad throughout sexual maturation (namely in oogenesis) was observed, but the allocation of these nitrogen compounds from the digestive gland and muscle was not evident. The major essential amino acids (EAA) in the three tissues were leucine, lysine and arginine. The major nonessential amino acids (NEAA) were glutamic acid, aspartic acid and alanine. A significant increase in lipid and fatty acid contents of gonad and digestive gland was observed. There was also little evidence of accumulated lipid storage reserves being used for egg production. It seems that for egg production Eledone species use energy directly from food, rather than from stored products. Most of saturated fatty acid (SFA) content of the three tissues was presented as 16:0 and 18:0, monounsaturated fatty acid (MUFA) content as 18:1 and 20:1 and polyunsaturated fatty acid (PUFA) content as 20:4n-6, 20:5n-3 and 22:6n-3. Cholesterol and glycogen contents significantly increased in gonad and digestive gland throughout maturation while the muscle revealed no obvious pattern. If Eledone's component sterols are of a dietary origin, a considerable variation in the cholesterol content between species might be expected on the basis of the sterol composition of their prey. Although spermatogenesis and oogenesis had a significant effect (p<0.05) in gonad and digestive gland energy content, the biochemical composition of digestive gland and muscle may not be primarily influenced by sexual maturation, but rather by other biotic factors such as feeding activity, food availability, spawning and brooding.

Template bleeding time and PFA-100 have low sensitivity to screen patients with hereditary mucocutaneous hemorrhages: comparative study in 148 patients

OBJECTIVES AND PATIENTS

We compared the template bleeding time (BT) and closure time (CT) in the PFA-100 as screening tests in 148 consecutive patients with unequivocal mucocutaneous bleeding and positive family history.

EXCLUSION CRITERIA

drug intake, concomitant diseases including minor infections, low platelet count, diseases of secondary hemostasis.

RESULTS

Type 1 von Willebrand disease (VWD-1) was diagnosed in 26 patients, primary platelet secretion defect (PSD) in 33, VWD-1 + PSD in nine, whereas 80 patients did not comply with the criteria for known hemostatic disorders (UD, unknown diagnosis). BT and CT were prolonged in 35.8% and 29.7% of all the patients, respectively (P = 0.23). Sensitivity increased to 48% if an abnormality of BT and/or CT was considered. Same comparisons for BT and CT in each diagnostic category were, respectively: 42 vs. 61.5% in VWD-1 (P = 0.18), 42 vs. 24% in platelet secretion defects (P = 0.11), 67 vs. 89% in VWD-1 + PSD (P = 0.50), and 27.5 vs. 15% in UD (P = 0.06).

CONCLUSION

Both tests were relatively insensitive and not significantly different in detecting incoming patients with mucocutaneous hemorrhages. In patients with VWD-1, the PFA-100 performed slightly better, whereas the opposite occurred in those patients with platelet secretion defects. In the UD group, both tests lost sensitivity, but the BT detected 1.8 times more patients than the PFA-100. Given the large proportion of undiagnosed bleeders and the overall low sensitivity of these tests, clinical decisions still rely on the medical history and etiological diagnosis of the bleeding disorder.

Voluminoso hamartoma hipotalámico en un niño de 5 meses: Epilepsia y cirugía

The authors report the case of 5-month-old boy with a hypothalamic hamartoma and persistent gelastic seizures in spite of a wide combination of different antiepileptic drugs. It was decided to carry out only partial removal of the tumor for decompression and to decreasing the activity of the epileptogenic focus. Surgical therapy revealed as a valid option in the treatment of the uncontrollable gelastic seizures.

Experimental indications for the response of the spectators to the participant blast

Precise momentum distributions of identified projectile fragments, formed in the reactions 238U+Pb and 238U+Ti at 1A GeV, are measured with a high-resolution magnetic spectrometer. With increasing mass loss, the velocities first decrease as expected from previously established systematics, then level off, and finally increase again. Light fragments are on the average even faster than the projectiles. This finding is interpreted as the response of the spectators to the participant blast. The reacceleration of projectile spectators is sensitive to the nuclear mean field and provides a new tool for investigating the equation of state of nuclear matter.

[Cranial Procedures without shaving. A 1-year experience at the Hospital São João. ]

Scalp shaving has been a ritual usually said to make easier orientation and surgical access and also to prevent local infection. However, this last aspect has been challenged in several publications and progressive evidence on favourable psychological effects of non-shaved patients has accumulated. The authors review 328 intracranial surgeries performed without scalp shaving from 1 October 1999 to 30 September 2000 in the Department of Neurosurgery of Hospital de S.João. All patients were included except those undergoing approaches, such as transphenoidal external ventricular drainages, removal of collocated non-organic materials and surgery for infections. The technique was implemented in patient having CSF shunting only during the second half of the study period. Antibiotic prophylaxis was the same previously used in the Department. The infection rate was 1.82%. The authors comment the disadvantages and benefits of the technique, remarking positive psychological effects for the patient.

Mediterranean diet, but not red wine, is associated with beneficial changes in primary haemostasis

OBJECTIVE

(1) To compare the effect of an alcohol-free Mediterranean-type diet (MD) and a high-fat diet (HFD) on variables of primary haemostasis (bleeding time, plasma von Willebrand factor and platelet aggregation/secretion). (2) To test whether red wine supplementation modified these variables, independently of the diet.

DESIGN, SUBJECTS AND INTERVENTION

Controlled prospective intervention study. Two groups, each consisting of 21 healthy male university students (22+/-3.4 y), received either MD or HFD during 90 days. Between days 30 and 60, both diets were supplemented with 240 ml/day of red wine. Baseline (T0) and T30, T60 and T90-day samples were drawn. Bleeding time was measured before (day 30) and after (day 60) wine supplementation. No drop out from the study was experienced.

SETTING

University campus and outpatient nutrition clinic.

RESULTS

All baseline (day 0) variables did not differ significantly between study groups. On day 30, individuals on MD had significantly higher levels of plasma beta-carotene, folate, ascorbate, and eicosapentaenoic acid in plasma lipid fractions, than those on HFD. Total plasma cholesterol, HDL and LDL did not change significantly in either study group at any time point. After 30 days on each diet, individuals on MD had longer bleeding time (BT) than those on HFD (7.6+/-2.8 vs 5.8+/-1.7 min; P=0.017). BT did not change significantly after I month of wine supplementation (7.1+/-2.0 vs 5.5+/-2.0 min, respectively). Plasma von Willebrand factor (vWF : Ag) on day 0 was 89+/-40 and 111+/-70% in MD and HFD groups, respectively (P=0.21). These values did not change significantly at 30, 60 or 90 days. MD intake was associated with an increase in platelet serotonin secretion (P=0.02) and a marginal increase in platelet aggregation after stimulation with epinephrine (P=0.07). Wine intake resulted in a marginal decrease in platelet (14)C-5-HT secretion with 4 micro M ADP (P=0.07). However, both platelet aggregation and secretion were consistently increased when using collagen as agonist (1 and 2 micro g/ml, P=0.01).

CONCLUSION

The longer BT in individuals on MD, obtained independently of red wine, denotes less interaction of platelets with the vascular wall, which could be beneficial from the point of view of cardiovascular (CV) risk. This effect is not explained by changes in the measured haemostatic determinants of BT (plasma vWF, ex vivo platelet function), and might be attributed to other as yet unknown vascular factors. Moderate consumption of red wine results in a significant increase in ex vivo platelet aggregation and secretion after stimulation with collagen. This observation contradicts previous reports, although further studies are required to elucidate the influence of this finding on CV risk.

Construction of a system for the access, storage and exploitation of data and medical images generated in radiology information systems (RIS)

We present the analysis, design and implementation of a system that allows specialists at a medical centre to recuperate and manage information produced by computers that generate medical diagnosis images. The main objective of the system is to define an architecture that provides doctors with an easy and centralized access to any information they may need, and to allow users to access this information from the computers at the hospital itself as well as from remote locations, which then require telemedicine sessions. The architecture is built according to a layered and modular methodology, which provides high scalability and interoperability with other information systems (HIS, RIS, etc). All the information is stored in a database: not only the various image studies of the patient, but also all data concerning the diagnosis and any comments the specialist may have made. We have also incorporated tools that are not usually found in conventional systems (image segmentation, advanced visualization, etc), but that help the specialist with the decision-making process.

Palliative cancer patients and their families on the Internet: motivation and impact

Increasingly, palliative patients and their families are going online. A series of cases are presented to explore the reasons they go online and the effects of their online activity, both harmful and beneficial. This paper highlights the need to take this growing phenomenon and its effects on patient care seriously, and identifies key areas that need to be explored further.