Sialoadenitis aguda por administración de contraste yodado / Acute sialadenitis by iodine contrast medium administration

La sialoadenitis aguda es una reacción adversa muypoco frecuente a la administración de contraste yodado,que causa una inflamación autolimitada de las glándulassalivales. Su patogenia no está bien establecida, aunque la insuficiencia renal puede ser un factor de riesgo.El diagnóstico es inicialmente clínico, y debe realizarsediagnóstico diferencial con angioedema, infecciones y litiasis. Ningún tratamiento o profilaxis ha demostrado beneficio hasta el momento. Aunque tiene buen pronóstico,en algunos casos se han descrito complicaciones.Presentamos el caso de un varón de 68 años que presentó inflamación de las glándulas salivales submandibulares tras la realización de una tomografía computariza-da abdominal con administración de contraste yodado.Dado el uso creciente de contrastes yodados en pruebasde imagen y técnicas intervencionistas, es importante conocer posibles reacciones adversas como esta entidad.(AU)

Acute iodide sialadenitis is a rare adverse reactionto iodinated contrast that causes self-limited salivarygland swelling. Its pathogenesis is still unclear, althoughkidney failure may be a risk factor. The diagnosis isinitially clinical but angioedema, infections and lithiasis should be included in the differential diagnosis. Notreatment or prophylaxis was proven to be beneficial.Although its prognosis is benign, associated complications have been reported.We report a case of 68-year-old man with swelling ofthe submandibular salivary glands after the administration of iodine-based contrast media during an abdomi-nal computed tomography examination. Because of thewidespread use of iodinated contrast enhanced imaging and interventional techniques, clinicians should beaware of this issue.(AU)

[Acute sialadenitis by iodine contrast medium administration].

Acute iodide sialadenitis is a rare adverse reaction to iodinated contrast that causes self-limited salivary gland swell-ing. Its pathogenesis is still unclear, although kidney failure may be a risk factor. The diagnosis is initially clinical but angioedema, infections and lithiasis should be included in the differential diagnosis. No treatment or prophylaxis was proven to be beneficial. Although its prognosis is benign, associated complications have been reported. We report a case of 68-year-old man with swelling of the submandibular salivary glands after the administration of iodine-based contrast media during an abdominal computed tomography examination. Because of the widespread use of iodinated contrast enhanced imaging and interventional techniques, clinicians should be aware of this issue.

Metabolic adjustment upon repetitive substrate perturbations using dynamic 13C-tracing in yeast.

BACKGROUND: Natural and industrial environments are dynamic with respect to substrate availability and other conditions like temperature and pH. Especially, metabolism is strongly affected by changes in the extracellular space. Here we study the dynamic flux of central carbon metabolism and storage carbohydrate metabolism under dynamic feast/famine conditions in Saccharomyces cerevisiae. RESULTS: The metabolic flux reacts fast and sensitive to cyclic perturbations in substrate availability. Compared to well-documented stimulus-response experiments using substrate pulses, different metabolic responses are observed. Especially, cells experiencing cyclic perturbations do not show a drop in ATP with the addition of glucose, but an immediate increase in energy charge. Although a high glycolytic flux of up to 5.4 mmol g DW-1  h-1 is observed, no overflow metabolites are detected. From famine to feast the glucose uptake rate increased from 170 to 4788 µmol g DW-1  h-1 in 24 s. Intracellularly, even more drastic changes were observed. Especially, the T6P synthesis rate increased more than 100-fold upon glucose addition. This response indicates that the storage metabolism is very sensitive to changes in glycolytic flux and counterbalances these rapid changes by diverting flux into large pools to prevent substrate accelerated death and potentially refill the central metabolism when substrates become scarce. Using 13C-tracer we found a dilution in the labeling of extracellular glucose, G6P, T6P and other metabolites, indicating an influx of unlabeled carbon. It is shown that glycogen and trehalose degradation via different routes could explain these observations. Based on the 13C labeling in average 15% of the carbon inflow is recycled via trehalose and glycogen. This average fraction is comparable to the steady-state turnover, but changes significantly during the cycle, indicating the relevance for dynamic regulation of the metabolic flux. CONCLUSIONS: Comparable to electric energy grids, metabolism seems to use storage units to buffer peaks and keep reserves to maintain a robust function. During the applied fast feast/famine conditions about 15% of the metabolized carbon were recycled in storage metabolism. Additionally, the resources were distributed different to steady-state conditions. Most remarkably is a fivefold increased flux towards PPP that generated a reversed flux of transaldolase and the F6P-producing transketolase reactions. Combined with slight changes in the biomass composition, the yield decrease of 5% can be explained.

[Modeling a clinical process for differentiated thyroid cancer health care in Hospital Base Valdivia, Chile]. / Modelamiento del proceso clínico para manejo de usuarios con cáncer tiroideo diferenciado en el Hospital Base Valdivia, Chile.

OBJECTIVE: To design a clinical process model in the management of differentiated thyroid cancer in order to improve accessibility to this treatment. MATERIAL AND METHODS: Based on modified Participatory Action Research, a model design process was conducted using a literature review and meetings with organisations committed to the redesigning process, and to agree an improved and feasible process. RESULTS: The process map was constructed by participatory action including, characterisation of the value chain, fault detection in the flow of the process, relevant documents and process for proposing modifications and approvals necessary for this purpose. Links were established between the main process and the support and strategic processes. The participatory model helped to cut the waiting times for diagnosis and treatment of this disease from 12 to 4 months. CONCLUSIONS: For each unit to be able to fully visualise the map of the process and understand their contribution as a set of integrated contributions and not fragmented, helps in the comprehensive management of patients and operation processes based on the hierarchical and dominant organisational model in Chilean hospitals. To analyse and remodel clinical processes by participatory action helps to limit failures in the fluidity of care of the patients, by presenting each participating unit with a general view of the process, the problems, and the possible solutions. Furthermore, this approach helps to clarify the process in order to make it more efficient, to harmonise relationships, and to improve coordination in order to optimise patient care.

Interaction of storage carbohydrates and other cyclic fluxes with central metabolism: A quantitative approach by non-stationary 13C metabolic flux analysis.

13C labeling experiments in aerobic glucose limited cultures of Saccharomyces cerevisiae at four different growth rates (0.054; 0.101, 0.207, 0.307 h-1) are used for calculating fluxes that include intracellular cycles (e.g., storage carbohydrate cycles, exchange fluxes with amino acids), which are rearranged depending on the growth rate. At low growth rates the impact of the storage carbohydrate recycle is relatively more significant than at high growth rates due to a higher concentration of these materials in the cell (up to 560-fold) and higher fluxes relative to the glucose uptake rate (up to 16%). Experimental observations suggest that glucose can be exported to the extracellular space, and that its source is related to storage carbohydrates, most likely via the export and subsequent extracellular breakdown of trehalose. This hypothesis is strongly supported by 13C-labeling experimental data, measured extracellular trehalose, and the corresponding flux estimations.