Acute pancreatitis after transcatheter arterial chemoembolization for liver metastases of carcinoid tumors

Acute pancreatitis is a rare side effect of non-selective transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma with an incidence ranging from 2% (clinical pancreatitis) to 40% (biological pancreatitis). This complication, due to embolization of extrahepatic arterial collaterals, has never been reported for treatment of well-differentiated endocrine carcinoma. We report here a case of acute clinical pancreatitis developing within 24 hours after a first selective TACE into the proper hepatic artery, with two peaks of hyperlypasemia, and intend to discuss its mechanism. Since it may clinically mimic a postembolization syndrome, dosage of serum pancreatic enzymes should be performed systematically in case of abdominal pain following TACE.

Clinical assessment of chest pain and guidelines for imaging

For many emergency facilities, risk assessment of patients with diffuse chest pain still poses a major challenge. In their currently valid recommendations, the international cardiological societies have defined a standardized assessment of the prognostically relevant cardiac risk criteria. Here the classic sequence of basic cardiac diagnostics including case history (cardiac risk factors), physical examination (haemodynamic and respiratory vital parameters), ECG (ST segment analysis) and laboratory risk markers (troponin levels) is paramount. The focus is, on the one hand, on timely indication for percutaneous catheterization, especially in patients at high cardiac risk with or without ST-segment elevation in the ECG, and, on the other hand, on the possibility of safely discharging patients with intermediate or low cardiac risk after non-invasive exclusion of a coronary syndrome. For patients in the intermediate or low risk group, physical or pharmacological stress testing in combination with scintigraphy, echocardiography or magnetic resonance imaging is recommended in addition to basic diagnostics. Moreover, the importance of non-invasive coronary imaging, primarily cardiac CT angiography (CCTA), is increasing. Current data show that in intermediate or low risk patients this method is suitable to reliably rule out coronary heart disease. In addition, attention is paid to the major differential diagnoses of acute coronary syndrome, particularly pulmonary embolism and aortic dissection. Here the diagnostic method of choice is thoracic CT, possibly also in combination with CCTA aiming at a triple rule-out.

PL and FTIR Absorption Study on Porous Silicon in Situ During Etching, in Oxygen Ambient, and After Chemical Oxidation

Steady state and time-resolved photoluminescence (PL) and Fourier-transform infrared (FTIR) spectroscopy have been performed in situ during etching, on “as prepared” porous Si in air under laser exposure and on chemically oxidized porous Si. We suppose that PLdegradation of “as prepared” porous Si is caused by creating non-radiative defect centers during photooxidation. Chemically oxidized porous Si shows increased PL intensity and longer recombination lifetimes as compared to non-oxidized samples. We conclude, that an oxide layer with low defect density on the inner surface of chemically oxidized porous Si reduces the non-radiative recombination rate.

Defect Distribution And Metastability in Chalcopyrite Semiconductors

Deep levels in chalcopyrite based heterojunctions are investigated by capacitance techniques. A method is presented which allows the determination of defect distributions from admittance measurements. For CuInSe2 a defect level at 280 meV above the valence band with an attempt to escape frequency of about 1011 s-1 is detected. A characteristic defect structure consisting of a shallow defect level and a broad deep structure is observed for Cu(In, Ga)Se2. The depth of the shallow defect is affected by annealing treatments which are necessary to achieve the optimum performance of the devices. CulnS2grown under an excess of CuS exhibits a high density of shallow defects whereas for Cu-poor CuInS2 defects close to midgap position with a large capture cross section are observed. These defects are metastable with respect to current injection and illumination relaxing to the equilibrium state around room temperature. The increase of the defect density after illumination results in a reduced bucking current. CV measurements can be interpreted in terms of a high density of deep states.

Transcatheter local thrombolysis in patients with extensive TIPS thrombosis

BACKGROUND

Transcatheter local thrombolytic therapy in patients with portosplanchnic venous thrombosis has been used in few cases.

CASE REPORTS

Here, we present our single-center experience with transcatheter thrombolytic therapy in three patients with extensive refractory portal and transjugular intrahepatic portosystemic shunt (TIPS) thrombosis. Thrombolytic therapy was successful for all three patients. Two patients developed minor procedure-related bleeding.

CONCLUSION

Local thrombolysis could be proposed in case of TIPS thrombosis for patients in whom the venous flow cannot be restored by using conventional anticoagulant therapy and stent mechanical revision.

Improving asthma outcomes in minority children: a randomized, controlled trial of parent mentors

OBJECTIVE

Because asthma disproportionately affects minorities, we evaluated the effects of parent mentors (PMs) on asthma outcomes in minority children.

METHODS

This randomized, controlled trial allocated minority asthmatic children to the PM intervention or traditional asthma care. Intervention families were assigned PMs (experienced parents of asthmatic children who received specialized training). PMs met monthly with children and families at community sites, phoned parents monthly, and made home visits. Ten asthma outcomes and costs were monitored for 1 year. Outcomes were examined by using both intention-to-treat analyses and stratified analyses for high participants (attending >or=25% of community meetings and completing >or=50% of PM phone interactions).

RESULTS

Patients were randomly assigned to PMs (n = 112) or the control group (n = 108). In intention-to-treat analyses, intervention but not control children experienced significantly reduced rapid-breathing episodes, asthma exacerbations, and emergency department (ED) visits. High participants (but not controls or low participants) experienced significantly reduced wheezing, asthma exacerbations, and ED visits and improved parental efficacy in knowing when breathing problems are controllable at home. Mean reductions in missed parental work days were greater for high participants than controls. The average monthly cost per patient for the PM program was $60.42, and net savings of $46.16 for high participants.

CONCLUSIONS

For asthmatic minority children, PMs can reduce wheezing, asthma exacerbations, ED visits, and missed parental work days while improving parental self-efficacy. These outcomes are achieved at a reasonable cost and with net cost savings for high participants. PMs may be a promising, cost-effective means for reducing childhood asthma disparities.

Tripodal Binding Units for Self-Assembled Monolayers on Gold: A Comparison of Thiol and Thioether Headgroups

Whereas thiols and thioethers are frequently used as binding units of oligodentate precursor molecules to fabricate self-assembled monolayers (SAMs) on coinage metal and semiconductor surfaces, their use for tridentate bonding configuration is still questionable. Against this background, novel tridentate thiol ligands, PhSi(CH(2)SH)(3) (PTT) and p-Ph-C(6)H(4)Si(CH(2)SH)(3) (BPTT), were synthesized and used as tripodal adsorbate molecules for the fabrication of SAMs on Au(111). These SAMs were characterized by X-ray photoelectron spectroscopy (XPS) and near edge X-ray absorption fine structure (NEXAFS) spectroscopy. The PTT and BPTT films were compared with the analogous systems comprised of same tripodal ligands with thioether instead of thiol binding units (anchors). XPS and NEXAFS data suggest that the binding uniformity, packing density, and molecular alignment of the thiol-based ligands in the respective SAMs is superior to their thioether counterparts. In addition, the thiol-based films showed significantly lower levels of contamination. Significantly, the quality of the PTT SAMs on Au(111) was found to be even higher than that of the films formed from the respective monodentate counterpart, benzenethiol. The results obtained allow for making some general conclusions on the specific character of molecular self-assembly in the case of tridentate ligands.

Urban minority children with asthma: substantial morbidity, compromised quality and access to specialists, and the importance of poverty and specialty care

BACKGROUND

Asthma disproportionately affects minorities, but not enough is known about morbidity and specialist access in asthmatic minority children.

OBJECTIVE

To examine asthma morbidity and access to specialty care in urban minority children.

METHODS

A consecutive series was recruited in 2004-2007 of urban minority children 2 to 18 years old seen for asthma in four emergency departments (EDs) or admitted to a children's hospital. Outcomes assessed included asthma symptom and attack frequency; missed school and parental work; asthma ED visits and hospitalizations; severity of illness; and asthma specialty care.

RESULTS

Of 648 children assessed, 220 were eligible. The mean age was 7 years; 68% were poor, 83% had Medicaid, 84% were African-American, and 16% were Latino. Sixty-eight percent of children were not in excellent/very good health, 73% had persistent asthma (moderate/severe = 52%), and only 44% had asthma care plans. The mean number of asthma attacks in the past year was 12, and of monthly daytime and nighttime asthma symptoms, is 12 and 12, respectively. The mean annual number of asthma doctor visits was 6; of ED asthma visits, 3; hospitalizations, 1; missed school days, 7; and missed parent work days, 6. Eighty-three percent of children have no asthma specialist, and 62% use EDs as the usual asthma care source. Poor children were less likely than the non-poor to have asthma specialists (13 vs. 26%; p < 0.03). African-Americans were more likely than Latinos to use EDs for usual asthma care (68% vs. 44%; p < 0.01). In multivariable analyses, poverty was associated with greater odds and having an asthma care plan with lower odds of an asthma attack in the past year; poverty also was associated with half the odds of having an asthma specialist. African-American children were significantly more likely to report the ED as the usual source of asthma care, and having an asthma specialist and male gender were associated with greater odds of having an asthma care plan.

CONCLUSIONS

Urban minority children with asthma average 1 asthma symptom daily, 1 exacerbation monthly, and 7 missed school days, 6 missed parental work days, 3 ED visits, and 1 hospitalization yearly; most receive their usual asthma care in EDs and have no asthma care plan or asthma specialist. Urban minority asthmatic children need interventions to reduce morbidity and improve access to specialists and asthma care plans, especially among the poor and African-Americans.

To see for myself: informed consent and the culture of openness

Informed consent needs to be practised within a culture of openness if it is to enhance public trust in medical procedures around death. Openness should entail patients not just receiving information from doctors, but also having the right to see certain medical procedures. This article proposes in particular that it would be desirable for the public to be allowed to attend an autopsy of a person they do not know. Evidence from the UK, where members of the public may go backstage to witness the process of cremation, the other technical process in which dead bodies are violently but legitimately assaulted, suggests benefits from a policy of openness. When a family consents to cremation in Britain, their consent is only minimally informed, but the system has nothing to hide, and trust is high. This suggests that the opportunity for lay people also to witness certain medical procedures might do more to restore public trust in medical procedures around death than a narrow interpretation of informed consent in which information is controlled by the profession.

Guidelines on good clinical laboratory practice: bridging operations between research and clinical research laboratories

A set of Good Clinical Laboratory Practice (GCLP) standards that embraces both the research and clinical aspects of GLP were developed utilizing a variety of collected regulatory and guidance material. We describe eleven core elements that constitute the GCLP standards with the objective of filling a gap for laboratory guidance, based on IND sponsor requirements, for conducting laboratory testing using specimens from human clinical trials. These GCLP standards provide guidance on implementing GLP requirements that are critical for laboratory operations, such as performance of protocol-mandated safety assays, peripheral blood mononuclear cell processing and immunological or endpoint assays from biological interventions on IND-registered clinical trials. The expectation is that compliance with the GCLP standards, monitored annually by external audits, will allow research and development laboratories to maintain data integrity and to provide immunogenicity, safety, and product efficacy data that is repeatable, reliable, auditable and that can be easily reconstructed in a research setting.

The small-scale urban reservoir fisheries of Lago Paranoá, Brasília, DF, Brazil

In many cases in large urban centers, which have appropriate waterbodies, small-scale fisheries are the only source of cheap protein for the poor. In Lago Paranoá, located in Brasília, the capital city of Brazil, fishing was studied by conducting interviews with 53 fishers filling in logbooks from March, 1999 to March, 2000 in three fishing communities. The fishers come from the poorest towns around Brasília, known as satellite-towns. They have been living there on average for 21.7 years (s = 9.6 years), their families have 4.9 members (s = 3.6) on average and 44.2% do not have a basic education. However, such characteristics are similar to the socioeconomic indices of the metropolis where they live. In spite of being illegal between 1966 and 2000, fishing generated an average monthly income of U 239.00 dollars (s = U 171.77 dollars). The Nile Tilapia Oreocrhromis niloticus is the main captured species (85% of a total number of landings in weight of 62.5 t.). Fishing is carried out in rowing boats, individually or in pairs. The fishing equipment used are gillnets and castnets. Gillnets were used actively, whereby the surface of the water is beaten with a stick to drive Tilapias towards nets as they have the ability to swim backwards. This fishing strategy was used in 64.7% of the fisheries, followed by castnets (31.1%) and by gillnets which were used less (4.2%). The fish is sold directly in the streets and fairs of the satellite-towns to middlemen or to bar owners. Three communities have different strategies in terms of fishing equipments, fishing spots and commercialization. Consequently, there are statistically significant differences in relation to the monthly income for each one of these communities.

Zufallsbefund beidseitiger zentraler Lungenembolien bei kardialer Computertomographie zur Klärung einer Koronaranomalie

HISTORY

A 42 year-old man reported transient breathlessness and chest pain on the first day after a four-hour flight. During the following five months the symptoms recurred four times. After another episode he went to an outpatient department for further assessment.

INVESTIGATIONS

Blood tests demonstrated slightly elevated LDH (343 U/l) and also a minor increase of the D-dimers (710 microg/l). Hypercholesterolemia was also found (LDL-cholesterol 180 mg/dl). The rest of the blood tests, including the cardiac enzymes, were within normal limits. The electrocardiogram (ECG) showed sinus rhythm, heart rate 85 bpm and pre-terminal T-negativity in the precordial leads V1 to V3. Resting echocardiography and chest X-ray showed no significant abnormalities. The exercise ECG demonstrated no further ECG changes. However, because of the symptoms and a cardiovascular risk profile (family history, hypercholesterolemia and smoking) a coronary angiography was performed, which excluded coronary artery disease but revealed a so-called "right-sided single coronary artery", the left and right coronary arteries originating with a common stem from the right sinus of valsalva. To define the exact course of the left main coronary artery (whether in front of the pulmonary artery, between the two great arteries, retroaortic or septal) a contrast-enhanced cardiac computed tomography (CT) was performed, which demonstrated an anomalous position of the left main coronary artery in front of the pulmonary artery. Bilateral pulmonary embolism was an additional and unexpected finding.

TREATMENT AND COURSE

Oral anticoagulation was initiated after a coagulopathy had been excluded. The ultrasonography of the leg did not demonstrate any thrombosis. There was no evidence of malignant disease.

CONCLUSION

Mild symptoms and absence of right heart congestion do not exclude pulmonary embolism. Depending on the symptoms and history, pulmonary thrombembolism has to be considered, especially if cardiac or extra-cardiac causes have been eliminated. The diagnostic method of choice for the detection or exclusion of pulmonary embolism is contrast-enhanced multi-slice spiral CT.