Critical Congenital Heart Disease Sadly Diagnosed at Autopsy in Calabar, South-South Nigeria

Congenital heart disease (CHD) is the most common type of birth defect causing more deaths in the first year of life than any other birth defect. Medical practice in a third-world country is faced with numerous challenges, created by poor health facilities and the unavailability of basic imaging studies at the community level where the majority of the poor resides. We present a case series of 4 neonates with a ratio of 1: 3 admitted into the neonatology unit of the University of Calabar Teaching Hospital, Calabar, Nigeria. Two of the patients were delivered at home by a traditional birth attendant via spontaneous vertex delivery and the rest two were booked cases in a private and obstetric unit of the University of Calabar Teaching Hospital. Their age ranged were 18 hours to 27 days of life and their common presentation were poor sucking, difficulty in breathing, central cyanosis and failure to thrive. A fetal echocardiogram was carried out for one of the cases and there was strong clinical suspicion of congenital heart disease but the precise type is unknown. The other three could not afford the necessary investigations required. They were all oxygen-dependent till death. Pathologic-anatomic findings showed a rare Critical congenital heart defect of the univentricular heart chamber of various types for the three cases and a case of TGA. The Immediate cause of death for all four cases was congestive cardiac failure.

Thermo-kinetics of Forest Waste Using Model-Free Methods / Termocinética de residuos de bosque usando los métodos de modelo libre / Termocinética de resíduos de bosque usando métodos de modelo livre

Abstract Thermal behaviour of pine needles (Pinus Roxburghii) is examined through a thermogravimetry technique. The dried samples of pine needles undergo the non-isothermal decomposition at temperature range of 308-1173 K. The heating rates used for experimental purposes are: 5 ◦ C min-1, 10 ◦ C min-1 and 15 ◦ C min-1. Kinetic parameters of thermal decomposition reactions of pine needles are obtained through the model-free schemes. The estimated values of activation energy and frequency factor derived from Kissinger method are 132.77 kJ mol-1 and 13.15 x 107 min-1, respectively. Furthermore, the averaged values of the same kinetics parameters retrieved from the isoconversional methods are 82.38 kJ mol-1 and 74.833 kJ mol-1, 25.42 x 1013 min-1 and 13.449 x 1010 min-1, respectively. Instead of the Flynn-Wall- Ozawa (FWO) and Kissinger- Akahira- Sunrose (KAS) schemes, the kinetic parameters derived from the Kissinger method are relatively promising for the thermal decomposition process, since the kinetic parameters are highly affected by intermediate stages and overlapping of the concurrent reaction occurred during pyrolysis.

Resumen Se examina el comportamiento térmico de las agujas de pino (Pinus roxburghii) a través de la técnica de termogravimetría. Las muestras secas de las agujas de pino se someten a una descomposición no isotérmica en un rango de temperatura de 308-1173 K. Las tasas de calentamiento usadas para los propósitos experimentales son: 5 °C min-1, 10 °C min-1 y 15 °C min-1. Los parámetros cinéticos de las reacciones de descomposición térmica de las agujas de pino se obtuvieron a través de esquemas de modelo libre. Los valores estimados de la energía de activación y el factor de frecuencia derivado del método Kissinger son: 132.77 kJ mol-1 y 13.15 x 107 min-1, respectivamente. Por otra parte, los valores promediados de los mismos parámetros cinéticos recuperados por los métodos isoconversionales son 82.38 kJ mol-1 y 74.833 kJ mol-1, 25.42 x 1013 min-1 y 13.449 x 1010 min-1, respectivamente. A diferencia de los esquemas Flynn-Wall-Ozawa (FWO) y Kissinger-Akahira-Sunrose (KAS), los parámetros cinéticos derivados del método Kissinger son relativamente promisorios para los procesos de descomposición térmica, ya que estos parámetros se afectan grandemente por los estados intermedios y la superposición de la reacción concurrente que ocurre durante la pirólisis.

Resumo O comportamento térmico de agulhas de pinheiro (Pinus roxburghii) foi examinado por meio da técnica de gravimetria. As amostras secas das agulhas de pinheiro se submeteram a uma decomposição não-isotérmica em uma faixa de temperatura de 308-1173 K. As taxas de aquecimento usadas para propósitos experimentais foram: 5 °C min-1, 10 °C min-1 e 15 °C min-1. Os parâmetros cinéticos das reações de decomposição térmica das agulhas de pinheiro se obtiveram por meio de esquemas de modelo livre. Os valores estimados da energia de ativação e o fator de frequência derivado do método Kissinger são: 132.77 kJ mol-1 e 13.15 x 107 min-1, respectivamente. Adicionalmente, os valores médios dos mesmos parâmetros cinéticos recuperados pelos métodos isoconversionais são 82.38 kJ mol-1 e 74.833 kJ mol-1, 25.42 x 1013 min-1 y 13.449 x 1010 min-1, respectivamente. Diferentemente dos esquemas Flynn-Wall-Ozawa (FWO) e Kissinger-Akahira-Sunrose (KAS), os parâmetros cine'ticos derivados do método Kissinger são relativamente promissórios para os processos de decomposição térmica, já que estes parâmetros são altamente afetados pelos estados intermediários e sobreposição da reação concorrente que ocorre durante a pirólise.

Hygroscopicity Study of Vitamin B12 Chemical Reference Substance / 中国药学杂志

OBJECTIVE: To investigate the hygroscopicity of vitamin B12 and the related problems of its chemical reference substance (CRS) that should be paid attention to. METHODS: UV absorption coefficient was determined at 361 nm, using water as solvent. Dynamic vapor absorption analysis (DVS) was applied to evaluate the moisture sorption trend and capacities of vitamin B12 under different humilities. RESULTS: Owing to the strong hygroscopicity of vitamin B12, deviation in the process of weighing might result in smaller UV absorption coefficient compared with the actual value, especially for dried and low moisture content raw materials in high-humidity environment. CONCLUSION: In the study of drug quality control for vitamin B12, the strong hygroscopicity of the raw material should be paid attention to, particularly in the research and application of vitamin B12 CRS.

Thermogravimetric analysis for characterization of the pellets produced with different forest and agricultural residues / Análise termogravimétrica para caracterização dos pellets produzidos com diferentes resíduos florestais e agrícolas

ABSTRACT: The pelleting of forest and agricultural materials, mainly because many residues from both industries can be used in this process, has been an alternative in obtaining added value products to energy generation. Thus, the aim of this study was to evaluate the energy quality of the pellets produced from forest and agricultural residues as raw materials and to verify the utility of the thermogravimetric analysis (TGA) and the differential thermogravimetric analysis (DTG) in characterizing the behavior of the pellets during the combustion process. Four residues were used: (1) Pinus spp. woodchips, (2) apple pruning residues, (3) aciculated dry branches of Araucaria angustifolia and (4) A. angustifolia empty-seeds. Chemical composition of the raw materials was determined and the physical and energetic properties of the pellets were analysed. Plus, the proximate analysis of the pellets was carried out. The samples were submitted to TGA with a heating rate of 20ºC min-1 from room temperature to 1000ºC, in a N2 atmosphere. The variation of chemical composition of each residue was determinant in the characterization of each stage of the thermal degradation. Stages and events of the degradation were closely linked to the chemical and energetic nature of the samples. Use of TGA to characterize the thermal degradation of the pellets produced with different forest and agricultural residues was demonstrated as an efficient technique to quantify and qualify the events that occurred in each stage of the combustion of these biofuels.

RESUMO: A peletização de resíduos florestais e agrícolas tem sido uma alternativa na obtenção de produtos com maior valor agregado para a geração de energia, pois muitos resíduos podem ser utilizados neste processo. Assim, o objetivo deste estudo foi avaliar a qualidade energética dos pellets produzidos com resíduos florestais e agrícolas como matéria-prima e verificar a viabilidade de uso da análise termogravimétrica (TGA) e análise termogravimétrica diferencial (DTG) para caracterizar o comportamento dos pellets durante o processo de combustão. Foram utilizados quatro resíduos: (1) partículas de Pinus spp., (2) resíduos de poda de maçã, (3) ramos secos aciculados de Araucaria angustifolia e (4) falhas de pinhão de A. angustifolia. Foram determinadas a composição química das matérias-primas e analisadas suas propriedades físicas e energéticas, bem como a análise imediata dos pellets. As amostras foram submetidas ao TGA com uma taxa de aquecimento de 20ºC min-1 da temperatura ambiente a 1000ºC, em atmosfera de N2. As curvas termogravimétricas permitiram a avaliação da perda de massa em função da temperatura. O DTG permitiu a avaliação da taxa de perda de massa. A variação na composição química de cada resíduo foi determinante para caracterizar cada estágio da degradação térmica. Os estágios e os eventos de degradação estavam intimamente ligados à natureza química e energética das amostras. O uso de TGA, para caracterizar a degradação térmica dos pellets produzidos com diferentes resíduos florestais e agrícolas, se mostrou eficiente para quantificar e qualificar os eventos que ocorreram em cada estágio de combustão desses biocombustíveis.

Degradation of keratin substrates by keratinolytic fungi

Background: The hydrolysis of keratin wastes by microorganisms is considered a biotechnological alternative for recycling and valorization through keratinolytic microorganisms. Despite their resistant structure, keratin wastes can be efficiently degraded by various microorganisms through the secretion of keratinases, which are promising enzymes for several applications, including detergents, fertilizers, and leather and textile industry. In an attempt to isolate keratinolytic microorganisms that can reach commercial exploitation as keratinase producers, the current work assesses the dynamics of keratin biodegradation by several keratinolytic fungal strains isolated from soil. The activity of fungal strains to degrade keratin substrates was evaluated by SEM, FTRIR-ATR spectra and TGA analysis. Results: SEM observations offered relevant information on interactions between microorganism and structural elements of hair strands. FTIR spectra of the bands at 1035­1075 cm-1 assigned to sulfoxide bond appeared because of S­S bond breaking, which demonstrated the initiation of keratin biodegradation. According to TGA, in the second zone of thermal denaturation, where keratin degradation occurs, the highest weight loss of 71.10% was obtained for sample incubated with Fusarium sp. 1A. Conclusions: Among the tested strains, Fusarium sp. 1A was the most active organism in the degradation process with the strongest denaturation of polypeptide chains. Because keratinolytic microorganisms and their enzymes keratinases represent a subject of scientific and economic interest because of their capability to hydrolyze keratin, Fusarium sp. 1A was selected for further studies.

Clinical Outcomes after Anatomic Repair Including Hemi-Mustard Operation in Patients with Congenitally Corrected Transposition of the Great Arteries

BACKGROUND AND OBJECTIVES: The aims of this study were to determine the early and late outcomes of anatomic repair of congenitally corrected transposition of the great arteries (ccTGA) and to evaluate effectiveness of the hemi-Mustard procedure. SUBJECTS AND METHODS: We conducted a retrospective, single-center study of patients who underwent anatomic repair for ccTGA between July 1996 and December 2013. Sixteen patients were included in the study. The median age at the time of the operation was 3.5 years (range: 0.5-29.7), and the median body weight was 13.3 kg (range: 5.8-54). The median follow-up duration was 7.7 years (range: 0.2-17.4). RESULTS: Atrial switch was achieved using the Mustard procedure in 12 patients (hemi-Mustard procedure in 11) or the Senning procedure in four patients. The ventriculoarterial procedure was performed using the Rastelli procedure in 11 patients and arterial switch in five patients. Six patients underwent tricuspid valvuloplasty. The survival rate was 93.8±6.1%. The rate of freedom from reoperation at 5 years was 92.3±7.4% in the Rastelli group. All patients except one were New York Heart Association class I. All patients except one had mild tricuspid regurgitation. CONCLUSION: Anatomic repair can be performed with a low risk of in-hospital mortality. The hemi-Mustard strategy for selected patients is one solution for reducing early mortality and morbidity, and long-term complications such as venous pathway stenosis or sinus node dysfunction.

Análisis químico elemental y de fases por medio de PIXE, DSC, TGA y DRX en MTA Angelus® y un cemento Portland blanco / Elemental chemical composition and phase analysis by means of PIXE, DSC, TGA, and DRX of MTA Angelus® and a white Portland cement

Resumen: El mineral trióxido agregado (MTA) es un cemento usado principalmente para sellar perforaciones en órganos dentales debido a que endurece en presencia de humedad, está compuesto por cemento Portland y trióxido de bismuto. Objetivo: Analizar y comparar por medio de PIXE, DSC, TGA y DRX la composición química elemental y de fases del cemento MTA Angelus® y de un cemento Portland blanco (CPB-CA). Material y métodos: MTA Angelus® blanco y un cemento Portland blanco fueron analizados con PIXE en un acelerador de partículas; el análisis de fases cristalinas se realizó por medio de DRX y contrastado los picos con los de base de datos del ICDD, el DSC se realizó en un calorímetro hasta 900 °C. Resultados: PIXE detectó como elementos de mayor porcentaje fueron aluminio, silicio y calcio para ambos cementos; habiendo diferencias en los porcentajes de azufre; el bismuto sólo se detectó en MTA Angelus®. Se detectaron como elementos traza cobre y estroncio en el MTA Angelus®, además de zirconio en CPB-CA. La relación entre silicio-calcio y silicio-aluminio en los dos cementos es similar. Se identificaron tres fases cristalinas en ambos cementos, silicato dicálcico, silicato tricálcico y aluminato tricálcico; sin embargo, se identificó Bismita en el MTA Angelus® y sulfato de calcio en forma de yeso en CPB-CA, que se logró corroborar con la ayuda de la técnica DSC. Conclusiones: Se logró observar la baja cantidad de yeso en MTA Angelus® por medio de la calorimetría. Tanto las fases cristalinas como la composición química elemental son similares en ambos cementos.

Abstract: Mineral trioxide aggregate (MTA) is a cement mainly used to seal tooth perforations; this is due to the fact that it hardens when in presence of humidity. It is composed of Portland cement and Bismuth trioxide. Objective: To analyze and compare with PIXE, DSC, TGA and DRX elementary chemical and phase composition of MTA Angelus® cement with a white Portland cement (WPC). Material and methods: MTA Angelus® white and a white Portland cement were analyzed with PIXE in a particle accelerator, phase analyses were conducted with XRD contrasting peaks with those in the ICDD database. DSC was conducted in a calorimeter up to 900 oC. Results: PIXE detected the following as greater percentage elements: aluminum, silica and calcium for both cements. Differences were found with sulfur percentages; Bismuth was only detected in MTA Angelus®. Trace elements of copper and strontium were detected in MTA Angelus® and zirconium in WPC. Relationship between silica-calcium and silica-aluminum was similar in both cements. In both cements, three crystalline phases were detected: dicalcium silicate, tricalcium silicate and tricalcium aluminate. Nevertheless, Bismite was identified in MTA Angelus® and calcium sulfate in the form of gypsum in WPC, this was corroborated with DSC technique. Conclusions: In MTA Angelus®, low gypsum amounts were observed by means of calorimetry. In both cements, crystalline phases and elemental chemical composition were similar.

Síntesis y caracterización de la mezcla polipropileno-poliestireno expandido (icopor) reciclado como alternativa para el proceso de producción de autopartes / Synthesis and characterization of expanded mixed polystyrene - polypropylene (styrofoam) recycled as an alternative for production process of autoparts

En el proceso de fabricación de autopartes se incluye el polipropileno (PP) como materia prima principal y la fibra de vidrio como insumo para la producción de ventiladores utilizados en los sistemas de refrigeración de los automotores. Los estándares de fabricación deben garantizar la resistencia de los productos en condiciones a las que estarán sometidos dentro del motor. Para lograrlo, el polipropileno es mezclado con fibra de vidrio en el proceso de inyección para aumentar la resistencia y la dureza del producto final, debido a que está expuesto a cambios de temperatura, choques con otras piezas, desgaste e impactos inesperados en el vehículo. Este estudio sintetizó y caracterizó un material obtenido a partir de la mezcla polipropileno puro-poliestireno expandido (EPS) (icopor) reciclado como una alternativa de aprovechamiento para el icopor dentro del proceso de fabricación de autopartes a modo de sustituto de la fibra de vidrio en el proceso de producción, siguiendo pasos como el tamizaje de los tamaños de material, la mezcla de los mismos, la obtención de probetas y la realización de ensayos mecánicos y térmicos. El objetivo fue comparar las propiedades mecánicas y térmicas del material obtenido (PP-EPS) con el material actualmente utilizado (PP-fibra de vidrio) para el que no se tenían estudios previos y de esta forma determinar la viabilidad de incorporación de un residuo a un proceso productivo y evitar su disposición directa favoreciendo el reciclaje del mismo. Las mezclas se caracterizaron mediante ensayos de tensión-deformación, dureza Shore A y análisis termogravimétrico (TGA) de los cuales se obtuvo favorecimiento en las propiedades térmicas y reducción de la resistencia mecánica en el uso de icopor, resaltando por supuesto el ahorro significativo en el cambio de insumos del proceso productivo.

Polypropylene (PP) as main raw material and fiberglass as input for the production of fans used in the cooling systems of motor is included in the process of manufacturing parts. Manufacturing standards must guarantee the resistance of the product in conditions that will be subject within the engine. To achieve this, the polypropylene is mixed with fiberglass in the injection process to increase the strength and hardness of the final product, as it is exposed to temperature changes, impacts with other parts, wear and unexpected impacts on the vehicle. This study synthesized and characterized a material obtained from the pure-polypropylene blend expanded polystyrene (EPS) (polystyrene) recycling as an alternative use for polystyrene in the auto parts manufacturing process as a substitute for fiberglass production process, following steps as screening media sizes, the mixture thereof, and obtaining specimens performing mechanical and thermal tests. The aim was to compare the mechanical and thermal properties of the material obtained (PP-EPS) with the material currently used (PP-fiberglass) for which they had no previous studies and thus determine the feasibility of incorporating a waste to a production in order to avoid direct disposal and thus promote the recycling process itself. The blends were characterized by stress-strain tests, Shore A hardness and thermogravimetric analysis (TGA) of which was obtained favoring the thermal properties and mechanical strength reduction in the use of polystyrene, of course emphasizing the significant savings in change of inputs in the production process.

An Asymptomatic Double Outlet Right Ventricle (DORV).

We report a case of DORV in an 18-year-old female patient presented to NIMS Medical College and Hospital with unrelated symptoms of urinary tract infection. Diagnosis of this case is made by 2D-echocardiography with cardiologist consultation.

Arterial Switch Operation (Jatene Procedure) for Posterior TGA (Transposition of the Great Arteries) Type Double Outlet Right Ventricle / 日本心臓血管外科学会雑誌

We report a rare case of double outlet right ventricle (DORV) with sub-pulmonary type ventricular septal defect (VSD). The great arteries were almost side-by-side, and the ascending aorta was located slightly posterior to the right of the pulmonary artery. We performed complete repair at the age of 25 days. Intra-cardiac rerouting (VSD closure) was carried out through the tricuspid valve. Arterial switch procedure was performed without the Lecompte maneuver. His postoperative course was uneventful and he was discharged 19 days after the operation without any complications.

Thermal analysis on phase sensitive granisetron in situ forming implants.

In this study effect of gamma irradiation sterilization and storage conditions on thermal properties of phase sensitive granisetron in situ forming implant (ISFI) was investigated. ISFI was prepared by mixing Poly (DLlactide- co-glycolide) (PLGA) with dimethylsulfoxide (DMSO) : propylene carbonate (PC) (1:1) solvent combination then granisetron HCl was added and homogenized. Following application of gamma irradiation, ISFI was stored at 25 °C for 4 months. Differential Scanning Calorimeter (DSC) measurements and Thermogravimetric Analysis-Differential Thermal Analysis (TGA-DTA) were carried out on fresh, irradiated and aged forms of granisetron ISFI. According to DSC, TGA and TGA-DTA thermograms and mass loss results application of gamma irradiation and storage of irradiated ISFI at 25 °C for 4 months have not significant effect on thermal stability of ISFI.

Bedside transthoracic 2D echo-guided blade atrial septostomy: First reported case in the Philippines

A nonrestrictive interatrial communication is mandatory in some patients with complex cyanotic heart disease. Up to the present time, Park blade atrial septostomy with a Park blade catheter is performed only under fluoroscopic guidance. We successfully monitored only under transthoracic 2-dimensional (2D) echocardiography (TTE), in a 7-week-old infant with d-Transposition of Great Arteries (d-TGA), a restrictive patent foramen ovale (PFO), and small ventricular septal defect (VSD), who presented with severe hypoxemia. TTE confirmed the position of the blade before and during pullback to the right atrium, followed by balloon septoplasty. There was an adequate enlargement of the interatrial communication with subsequent improvement in the oxygenation of the infant. This is the first reported case of the performance of blade atrial septostomy as a bedside TTE guided procedure here in the Philippines.

The mechanism and the kinetics of thermal decomposition of brivudine / 中国药学杂志

OBJECTIVE: To understand the thermal stability, mechanism and kinetics of thermal decomposition of brivudine (BVDU). METHODS: The thermal decomposition process of BVDU was studied by means of thermogravimetry (TG), differential scanning calorimetry (DSC), and thermogravimetric analysis coupled with Fourier transform infrared spectroscopy (TGA-FTIR). The infrared spectra of BVDU, its gaseous products and remainders of thermal decomposition at various temperatures were determined. The molecular bond orders were calculated by GAMESS program of quantum chemistry, and the mechanism of the thermal decomposition of BVDU is discussed. The parameters of thermal decomposition kinetics, such as activation energy Es and pre-exponential factor A, were obtained by using Ozawa method. The prospective lifetime of BVDU was estimated by using Dakin equation. RESULTS: The thermal decomposition of BVDU is a three-stage process. Disconnection of the C-N bond between thymine ring and tetrahydrofuran ring occurrs in the initial step of the decomposition. In nitrogen atmosphere, the average Ea and A of the first stage are 171.1 kJ·mol-1 and 2.630×10 min-1 respectively. In air atmosphere, the corresponding Ea and A are 152.9 kJ·mol-1 and 1.660×10 min-1 respectively. CONCLUSION: The thermal property of BVDU is quite stable in the routine temperature.

Asociación de carcinoma papilar de tiroides y enfermedad de Graves: Inesperada evolución y eficacia de la dosis ablativa con tirotrofina recombinante humana (rhTSH) / Association of Papillary Thyroid Carcinoma and Graves' Disease: Unexpected Development and Efficiency of Ablative Dose with Recombinant Human Thyrotropin (rhTSH)

El carcinoma diferenciado de tiroides (CDT) asociado a enfermedad de Graves (EG) es una asociación relativamente rara, ocurriendo en el 0,3 % al 9,8 % de los pacientes operados por EG. Se presenta el caso de un paciente con EG y CDT de tiroides con características evolutivas y terapéuticas peculiares. Varón de 22 años que consultó por obesidad. Peso: 116,4 kg, Talla: 1,73 m, BMI: 38,9, clínicamente eutiroideo, con palpación tiroidea dificultosa por grosor de cuello. Análisis iniciales: T3, T4 y TSH dentro de rango normal y ecografía tiroidea con nódulo hipoecoico en lóbulo derecho (LD) de 11 x 10 mm. Se le solicitó punción aspirativa con aguja fina (PAAF) bajo guía ecográfica. Vuelve a los 4 meses con cuadro clínico de hipertiroidismo. Análisis: T3: 557 ng/dL, T4: 18,8 mcg/dL, T4 L: 3,73 ng/dL, TSH: < 0,01 μUI/mL, ATPO: 186 UI/mL, ATG: 965 UI/mL. La citología mostró: "Hallazgos citológicos vinculables con carcinoma papilar (CP) tiroideo". Centellograma tiroideo: "Nódulo integrado en LD". Es tratado con metimazol y se opera a los 2 meses: "Tiroidectomía total"; cuya anatomía patológica (AP) reveló un "CP variante folicular en lóbulo derecho y zona de CP variante clásica en lóbulo izquierdo". A los 35 y 60 días de operado (sin instaurar levotiroxina): presenta TSH <0,1 μUI/ml con T3 y T4 normales. Clínicamente eutiroideo, con palpación de cuello normal. Tomografía axial computada (TAC) de tórax: "Normal". Ecografía de cuello: "Lodge tiroidea bilateral libre". TRab 29 % (V.N. hasta 15 %). Centellograma tiroideo con Tc99m: "Captación patológica en región cervical media e inferior derecha y cervical inferior izquierda". Se reopera a los 4 meses de la primera cirugía (Cx). Se resecó proliferación epitelial en región de mediastino superior". AP: "Ganglio con infiltración de CP variante folicular". Análisis a los 40 días de la 2° Cx: TSH: 2,3 μUL/ml, T4 L: 0,82 ng/dL, tiroglobulina (Tg): 4,7 ng/mL. TAC de cuello y de tórax normales. Captación de I131: 1 h: 8 %, 24 h: 12 % y centellograma con 7,4 MBq de I131 "Múltiples áreas de fijación del trazador en cuello". Resonancia magnética nuclear (RMN) de cuello sin contraste: "Imagen redondeada de 10 mm a nivel paratraqueal derecha". Se logra hacer dosis ablativa con 0,9 mg de rhTSH con 200 mCi de I131, alcanzando una TSH >100 μUI/ml. A los 6 meses de la DT (sin levotiroxina): TSH >100 μUI/ml, Tg: 13,81 ng/mL, ATG: 431 UI/mL. Rastreo con 2 mCi: "Aumento patológico del radioyodo solo a nivel de la articulación esternoclavicular derecha". RMN de cuello: "Imagen en región pretraqueal derecha de menor tamaño que la anterior". Se le indicó DT de 150 mCi de I131. Posteriormente requirió 2 DT de I131 más. En la actualidad, a 4 años de la primera operación, el paciente se halla en buen estado general, con Tg negativa, con ATG en disminución franca y rastreo corporal de I131 negativo y sin signos de persistencia o recidiva de la enfermedad. Conclusiones: Varón obeso de 22 años portador de un CP de tiroides concomitante con la instalación de un hipertiroidismo por EG, con ATG positiva. Se resalta: 1) La importancia de la evaluación ecográfica inicial de un paciente con EG, 2) Tejido neoplásico residual ganglionar después de 2 Cx, efectuada por cirujano experimentado, suficientemente funcionante como para impedir elevación significativa de TSH y permitir dosis ablativa de I131; 3) Agresividad local del tumor demostrado por infiltración ganglionar y tejidos adyacentes; 4) TAC y ecografía de cuello que no pudieron identificar restos en cuello y efectividad, en cambio, de la RMNde cuello sin contraste y del centellograma tiroideo con Tc99m; 5) Eficaz utilización de la dosis ablativa con rhTSH.

Introduction: Differentiated thyroid cancer (DTC) associated with Graves' disease (GD) is a relatively rare disease, occurring in 0.3 % to 9.8 % of GD patients. Some studies suggest an increased aggressiveness of DTC in GD patients, apparently related to thyroid stimulating antibodies. We report the case of a patient with DTC and GD, describing his peculiar evolution. Case report: 22-year-old male who presented with obesity. History of a cousin with DTC and grandmother and mother with goiter. Physical examination: Weight: 116.4 kg, height: 1.73 m, BMI: 38.9. Clinically euthyroid. Thyroid palpation was difficult due to his thick neck. Initial analysis: T3, T4 and TSH within normal range. Thyroid ultrasound (US) showing 11 x 10 mm hypoechoic nodule in right lobe (RL). US-guided fine-needle aspiration (FNA) was requested. Four months later, the patient returned with clinical symptoms of hyperthyroidism (diarrhea, palpitations, insomnia, tremors, cramps and difficulty walking). Laboratory: T3: 557 ng/dl, T4: 18.8 mcg/dl, FT4: 3.73 ng/dl, TSH <0.01 μIU/mL, TPOA: 186 IU/mL, TGA: 965 IU/mL. US-guided FNA: "Cytological findings are related to papillary thyroid cancer". Thyroid Scan: "Diffuse enlargement of the gland, "warm" nodule in RL". 131I uptake was: 1st hour: 12 %, 24 hours: 58 %. He received methimazole 20 mg daily. He was operated on 2 months later ("total thyroidectomy"). Pathology: "Follicular variant of papillary thyroid carcinoma in right lobe and classical variant of papillary carcinoma in area of the left lobe". Thirty-five days after surgery (S) (without levothyroxine): TSH <0.01 μIU/mL, Tyroglobulin (Tg) 32.1 ng/mL. Sixty days after S: TSH <0.1 μIU/mL, FT4 1.2 ng/dL, T3 1.3 ng/dL. Clinically euthyroid with normal neck palpation. Chest Computed axial tomography (CT): "Normal". US of the neck: "Bilateral thyroid lodge is free". Ninety days later: TSH 0.32 μIU/mL, TRAb 29 % (normal: until 15 %). Thyroid Scan with 99mTc pertechnetate: "Pathological uptake in middle and lower cervical region right and left lower neck." He was reoperated on 4 months after his initial S: "Resection of epithelial proliferation with thyroid aspect in superior mediastinum region". Pathology: "Node with extensive infiltration of neoplastic proliferation of follicular variant of papillary carcinoma with areas of connective tissue infiltrated periganglionar of papillary thyroid cancer". Lab 40 days after the second surgery: TSH 2.3 μIU/mL, FT4 0.82 ng/dL, Tg 4.7 ng/mL. Neck and chest CT showed neither pathological lesions nor lymphadenopathy. 131I uptake with 7.4 MBq was: 1st hour: 8 % and 24 hours: 12 %. Neck Scan: "Multiple areas of tracer fixation in the neck". No pathological signs on neck palpation. Ablative dose of 7.4 GBq of 131I was performed to the patient, previously using rhTSH (two doses of 0.9 mg), reaching TSH >100 μIU/mL. Scan post ablative dose: "Important focus on right paratracheal region." Neck MRI showed: "Absence of thyroid gland. Rounded image of about 10 mm at right paratracheal level". The patient initiates suppressive therapy with levothyroxine (LT4). Six months after ablation therapy (without LT4): TSH >100 μIU/mL, Tg: 13.8 ng/mL, TGA: 431 IU/mL. Body Scan with 2 mCi: "Pathological focus of radioiodine behind the right sternoclavicular joint". New neck MRI: "Image in right pretracheal region smaller than the previous study". The patient received 5.55 GBq of 131I. The same radioiodine treatment was repeated 8 months later. At present, 4 years after the patient's initial surgery, he is in good general health, performing his normal activities, with TGA in sharp decline, negative 131I body scan and without signs of persistent or recurrent disease. Conclusions: We report a case of follicular variant papillary TC associated with GD with concomitant development of hyperthyroidism, with positive TGA, in a 22-year-old obese man. Highlights: 1) The importance of initial US exploration in a patient with GD, 2) Residual neoplastic lymph node tissue after 2 S, performed by an experienced surgeon, with enough functioning tissue to prevent a significant elevation of TSH and allow 131I ablative therapy, 3) Tumor local aggressiveness shown by adjacent tissues and lymph node infiltration, 4) Failure to identify residues in the neck by CT and US; instead, effectiveness of the neck MRI without contrast and 99mTc thyroid scan, 5) Effective use of ablative radioiodine therapy with rhTSH.

Resultados inmediatos y alejados del switch arterial en pacientes condextrotransposición de grandes arterias: experiencia de 20 años / Early and late results of the switch operation for d-transposition of the great vessels. clinical experience in 108 patients operated on between 1992 and 2012

Objetivos: Comunicar los resultados de la operación de switch arterial en pacientes portadores de dextro Transposición de Grandes Arterias (D-TGA) y evaluar su evolución en el tiempo. Pacientes y Método: Estudio retrospectivo de pacientes sometidos a switch arterial entre mayo de 1992 y noviembre de 2012. Se comparó período 1 (1992 a 2002) con período 2 (2003 a 2012). Se definió D-TGA simple aquella sin lesiones asociadas y D-TGA compleja aquella con asociación de comunicación interventricular o coartación aórtica. Resultados: Un total de 108 pacientes componen la serie, 44 en el período 1 y 64 en el período 2, sin diferencias demográficas y anatómicas entre ambos períodos. Setenta tenían D-TGA simple y 38 D-TGA compleja. La mortalidad operatoria en el período 1 fue 33% versus 8,4 por ciento en el período 2 (p< 0.025); hubo tendencia a mayor mortalidad en pacientes con anatomía coronaria compleja. Se observó una disminución del riesgo relativo de mortalidad de 68,7 por ciento en el período 2. El 28,7 por ciento presentaron complicaciones postoperatorias, sin diferencias entre ambos períodos. Un paciente falleció en forma alejada. La mediana de seguimiento fue de 60 meses y la supervivencia de 84,25 por ciento a 10 y 20 años. Se realizaron 16 re intervenciones, principalmente plastías percutáneas de ramas pulmonares. La mayoría de los pacientes se mantenían asintomáticos. La mortalidad operatoria de los últimos 5 años fue 2,6 por ciento. Conclusiones: La mortalidad operatoria ha disminuido significativamente a lo largo de 20 años; persiste un mayor riesgo en ciertos patrones de anatomía coronaria. La supervivencia alejada y libre de reintervenciones es muy favorable.

Aim: to report the results of the arterial Switch operation in patients with D-transposition of the great vessels (D-TGA) and to evaluate their late course. Patients and Methods: A retrospective review of the clinical data on patients consecutively operated on for D-TGA using the switch procedure. Results obtained in patients operated on between 1992 and 2002 (Period 1) were compared to those obtained in patients undergoing their operation between 2013 and 2012. Patients with D-TGA and no complications were compared to those who had interventricular septal defect or aortic coarctation associated their TGA. Results: 44 patients belonged in Period 1 and 64 in Period 2 (total 108). Demographic and anatomical characteristics were similar in both periods. Simple D-TGA was present in 70 patients and complex D-TGA in 38. Operative mortality was higher in Period 1 compared to Period 2 (33 per cent vs. 8.4 percent, p<0.025). A higher, albeit not statiscally significant mortality was observed in patients with complex as opposed to simple D-TGA. A 68.7 per cent relative reduction mortality risk was observed in Period 2. Complications developed in 28.7 per cent of patients, with no difference between periods. Only 1 patient died during late follow up. Median follow up was 60 months and survival rate was 84.3 percent at 10 y 20 years. Sixteen patients required re-intervention, mainly to perform percutaneous plastic procedures on pulmonary artery branches. Most patients had an asymptomatic course during follow up. Surgical mortality for the last 5 years was 2.6 percent. Conclusion: surgical mortality for the arterial switch operation in patients with D-TGA has significantly decreased along a 20 year period. An increased surgical risk persists for patients with certain forms of coronary artery anomalies. Late survival free of re-intervention was the rule in these patients.

Extra corporeal membrane oxygenation after pediatric cardiac surgery: A 10 year experience.

Indications for extra corporeal membrane oxygenation (ECMO) after pediatric cardiac surgery have been increasing despite the absence of encouraging survival statistics. Modification of ECMO circuit led to the development of integrated ECMO cardiopulmonary bypass (CPB) circuit at the author's institute, for children undergoing repair of transposition of great arteries among other congenital heart diseases (CHD). In this report, they analyzed the outcome of children with CHD, undergoing surgical repair and administered ECMO support in the last 10 years. The outcome was analyzed with reference to the timing of intervention, use of integrated ECMO-CPB circuit, indication for ECMO support, duration of ECMO run and the underlying CHD. The results reveal a significantly improved survival rate with the use of integrated ECMO-CPB circuit and early time of intervention rather than using ECMO as a last resort in the management. The patients with reactive pulmonary artery hypertension respond favorably to ECMO support. In all scenarios, early intervention is the key to survival.

Preparation and characterization of peppermint oil-β-cyclodextrin polymer microsphere inclusion compound / 中草药

Objective: To optimize the including preparation for peppermint oil-β-cyclodextrin polymer (β-CDP) microsphere inclusion compound. Methods: Peppermint oil-β-CDP microsphere inclusion compound was prepared by using co-precipitation. The preparation process was optimized through the L9(34) orthogonal test design and regression analysis. Peppermint oil-β-CDP microsphere inclusion compound was characterized by infrared (IR) spectroscopy, thermogravimetric analysis (TGA), and X-ray diffraction (XRD). Results: The best technological condition was A 2B2C1D3, and the order of the influence factors was the proportion of β-CDP microsphere and water > the percentage of peppermint oil in β-CDP microsphere > inclusion temperature > inclusion time. The formation of peppermint oil β-CDP microspheres inclusion compound was proved by the results of IR, XRD, TGA analyses. Conclusion The method is reasonable and feasible.

Thermal behavior of direct resin composites: glass transition temperature and initial degradation analyses / Comportamento térmico de resinas compostas de uso direto: temperatura de transição vítrea e temperatura de degradação inicial

PURPOSE: The association of direct resin composites with simple thermal treatments may improve the mechanical properties of these materials. However, the ideal temperature for heat application depends on the thermal behavior of each material, such as glass transition (Tg) and initial degradation temperatures. To propose a heat treatment methodology, this study evaluated the thermal behavior of five commercial direct resin composites using differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA). METHODS: Photo-irradiation was achieved in cylindrical specimens (3×2 mm) using a photo-activator source (600 mW/cm² for 40 s). Thermal analyses were performed by DSC and TGA using a temperature range from 25 ºC to 900 ºC. RESULTS: Tg values obtained by DSC were 130.6 ºC for FillMagic, 129 ºC for Glacier, 143.5 ºC for Te-Econom, 147.5 ºC for Prisma APH and 143.7 ºC for Natural Look. A moderate weight loss began at around 270 ºC for all materials, which represented the initial degradation temperature. Conclusion: Regarding the heat treatment itself, it was concluded that the effective temperature for heat treatment is material dependent.

OBJETIVO: A associação de resinas compostas de uso direto com tratamentos térmicos pode melhorar as propriedades mecânicas destes materiais. No entanto, a temperatura ideal de aplicação está na dependência do comportamento térmico individual, como a temperatura de transição vítrea (Tg) e a temperatura inicial de degradação. Com o objetivo de propor uma metodologia de aplicação do tratamento térmico, o objetivo deste trabalho foi caracterizar cinco resinas compostas de uso direto usando calorimetria exploratória diferencial (DSC) e termogravimetria (TGA). METODOLOGIA: Corpos-de-prova cilíndricos (3×2 mm) foram fotoirradiados utilizando um aparelho de fotopolimerização (600 mW/cm² - 40s). As análises térmicas foram realizadas nas temperaturas de 25 ºC a 900 ºC. RESULTADOS: Os valores de Tg após análise de DSC foram: 130,6 ºC para FillMagic, 129 ºC para Glacier, 143,5 ºC para Te-Econom, 147,5 ºC para Prisma APH e 143,7 ºC para Natural Look. Para todos os materiais estudados a degradação iniciou-se por volta de 270 ºC. CONCLUSÃO: Considerando a aplicação do tratamento térmico em resinas compostas de uso direto, é possível sugerir que a temperatura efetiva é dependente do material em uso.

Caracterização físico-química do extrato fluido e seco por nebulização de Symphytum officinale L. / Phisycal chemistry characterization of fluid and dry nebulization extract of Symphytum officinale L.

O artigo reporta a obtenção do extrato fluido de Symphytum officinale L., e posterior secagem por nebulização, e a caracterização físico-química por técnicas termogravimétricas, espectroscópicas e cromatográficas. O adjuvante de secagem utilizado foi hidroxietilcelulose na concentração de 1,5 por cento. Foi observado que o processo de secagem por nebulização, nas condições operacionais estabelecidas, não influenciou as características dos constituintes do extrato seco em relação ao extrato fluido pelas técnicas utilizadas.

This work reports the obtaining of the Symphytum officinale L. fluid extract dried by spray-drying and its physicochemical characterization by thermogravimetric analysis, spectroscopic and chromatographic techniques. Hydroxyethylcellulose at 1,5 percent was used as technological adjuvant. We observed that the drying process by spray-dryer, on the established operational conditions, did not have influence in the characteristics of the dry extract constituents in relation to the fluid extract by the used techniques.

Prosthetic Valve Replacement in Corrected Transposition with Severe Tricuspid Valve Dysfunction / 日本心臓血管外科学会雑誌

Tricuspid valve regurgitation, which is a main complication of corrected transposition of the great arteries (C-TGA), greatly influences prognosis like atrioventricular block, but there are many differing openions concerning the treatment of this condition childhood. In 2 cases of C-TGA (S. L. L.) without other cardiac anomalies, we performed tricuspid valve replacement for severe valve dysfunction.