Iodine, a Mild Reagent for the Aromatization of Terpenoids.

Efficient procedures based on the use of iodine for the aromatization of a series of terpenoids possessing diene and homoallylic or allylic alcohol functionalities are described. Different examples are reported as a proof-of-concept study. Furthermore, iodine also proved to mediate the dehydrogenation of testosterone.

Homocoupling versus reduction of radicals: an experimental and theoretical study of Ti(III)-mediated deoxygenation of activated alcohols.

A detailed experimental and theoretical study corroborates that the reductive deoxygenation of activated (allylic or benzylic) alcohols with excess Ti(III) proceeds via an allyl(benzyl)-radical and allyl(benzyl)-Ti, which is protonated, regioselectively in the case of allylic derivatives. The H atom of the newly formed C-H bond in the product originates from the -OH group of the starting material. The deoxygenation of lithium alkoxides or alcohols by using 1.0 mol of Ti(III) leads to the corresponding dimerization products in good yields. An excellent agreement with the experimental data was obtained by using a reaction kinetics simulator to discriminate between competing reactions.

Multiple congenital ectatic and fusiform arterial aneurysms associated with lower limb hypoplasia.

Aneurysmal disease is uncommon in children, and its presence often leads to suspicion of genetic disorders (Loeys-Dietz syndrome, Marfan syndrome, Ehlers-Danlos syndrome, tuberous sclerosis), trauma, and infection. We describe the case of a newborn boy with generalized left lower limb hypoplasia associated with diffuse areas of arteriectasis combined with areas of stenosis and fusiform aneurysms of the iliac, femoral, and popliteal arteries. No additional vascular territories were affected. The patient was asymptomatic, and no therapeutic intervention has been considered. Numerous complementary imaging and laboratory examinations failed to establish a definitive diagnosis. This collection of findings has not been previously reported.

Clinical and radiologic manifestations of congenital extrahepatic portosystemic shunts: a comprehensive review.

Congenital extrahepatic portosystemic shunt (CEPS) is a rare condition in which the portomesenteric blood drains into a systemic vein, bypassing the liver through a complete or partial shunt. Most often, the diagnosis is made primarily with Doppler ultrasonography. Computed tomographic angiography and magnetic resonance angiography are used for further classification of the shunt and assessment of accompanying anomalies. Conventional angiography is necessary when results of the other tests disagree or are inconclusive. CEPS is classified into two types according to the pattern of anastomoses between the portal vein and systemic vein. In type 1, intrahepatic portal venous supply is absent; in type 2, intrahepatic portal venous supply is preserved. Type 1 usually occurs in girls with associated malformations, such as situs ambiguous with polysplenia and congenital heart defects. Associated anomalies are less frequent in type 2, and symptoms usually develop later without a gender preference. Hepatic encephalopathy and liver dysfunction are possible complications of both types and usually develop during adulthood. Both types are also associated with regenerative hepatic nodules. The clinical setting and imaging appearance of these nodules can help one avoid misdiagnosis. Definitive treatment of CEPS is determined by the type of shunt. Liver transplantation is the only effective treatment for symptomatic type 1 CEPS; surgical closure or embolization of the shunt is the therapeutic approach for type 2.

Mild hydronephrosis in newborns and infants: can ultrasound predict the presence of vesicoureteral reflux.

The objective of our study was to determine the significance of mild hydronephrosis in newborns and infants as an indicator of vesicoureteral reflux (VUR). The voiding cystourethrography (VCUG) of 573 patients aged 0-18 months with mild, sonographically detected hydronephrosis were reviewed for VUR. Patients with secondary reflux or anomalies making an exact reflux grading impossible were excluded. Normal kidneys, contralateral to hydronephrotic ones, were included. Each kidney was considered separately, forming a total of 1,146 renal units. Mild hydronephrosis was defined as an anteroposterior diameter of the renal pelvis of 0.5-1.5 cm without caliectasis. The International Grading System was used to grade VUR. Seven hundred and thirty-six kidneys had mild hydronephrosis. VUR occurred in 189 out of 736 (25.7%) of these kidneys, and in 108 out of 410 (26.3%) non-distended kidneys, contralateral to hydronephrotic ones (p=0.806). No statistical differences in the frequency of VUR and dilatation were found between the subgroups of patients with and without infection, except for a higher grade of reflux in the group with infection. The frequency of VUR in mildly dilated kidneys was not significantly different from that in non-distended ones. There was a poor correlation between VUR and mild hydronephrosis. The latter should not be considered in itself an indication for VCUG in asymptomatic neonates and infants.

Pediatric liver transplantation: a pictorial essay of early and late complications.

Orthotopic liver transplantation is currently the treatment of choice in patients with end-stage liver disease for which no other therapy is available. In children, segmental liver transplantation with living donor, reduced-size cadaveric, and split cadaveric allografts has become an important therapeutic option. However, the resulting expansion of the donor pool has increased the risk for postoperative vascular and biliary complications, which affect children more frequently than adults. Early recognition of these complications requires radiologic evaluation because their clinical manifestations are frequently nonspecific and vary widely. Doppler ultrasonography (US) plays the leading role in the postoperative evaluation of pediatric patients. Current magnetic resonance (MR) imaging techniques, including MR angiography and MR cholangiography, may provide a wealth of pertinent information and should be used when findings at US are inconclusive. Computed tomography is a valuable complement to US in the evaluation of complications involving the hepatic parenchyma as well as extrahepatic sites and is commonly used to guide percutaneous aspiration and fluid collection drainage. Familiarity with and early recognition of the imaging appearances of the various postoperative complications of pediatric liver transplantation are crucial for graft and patient survival.

Hidronefrosis leve en neonatos y lactantes: ¿puede predecirse la presencia de reflujo vesicoureteral? / Slight hydronephrosis in newborns and breast-fed Infants: can the presence of vesicoureteral reflux be predicted?

Objetivo: El propósito de este estudio fue determinar el valor de la hidronefrosis leve o moderada, detectada mediante ecografía, en recién nacidos y lactantes como indicador de reflujo vesicoureteral (RVU) y evaluar la necesidad de realizar cistouretrografía miccional (CUMS) en estos pacientes. Material y métodos: Se revisaron las CUMS de 237 pacientes (174 niños y 63 niñas, con edades comprendidas entre 0 y 18 meses) con hidronefrosis leve detectada por ecografía, para valorar la presencia de RVU primario. Los pacientes con reflujo secundario o los que presentaban anomalías que imposibilitaban la graduación exacta del reflujo se excluyeron; sin embargo, cuando se observó reflujo en un riñón normal, contralateral al riñón con hidronefrosis, se incluyó en el estudio. Para el análisis estadístico de los datos, cada riñón se consideró por separado, sumando un total de 474 riñones. Se diagnosticó hidronefrosis leve cuando se observó un diámetro anteroposterior de la pelvis renal de 0,5-1,5 cm. Para la graduación del reflujo en la CUMS se utilizó el sistema internacional. Resultados: De las 474 unidades renales evaluadas, 306 mostraron hidronefrosis leve en la ecografía. Sólo 98 de éstas (32 por ciento) presentaron reflujo (14 grado I, 50 grado II, 32 grado III y 2 grado IV). La ecografía fue normal (no mostró hidronefrosis) en 52 unidades renales con reflujo (31 por ciento), contralaterales al riñón hidronefrótico, a pesar de que 38 de estas unidades tenían reflujo grado II o superior. La ecografía mostró hidronefrosis leve en 208 riñones que no tenían reflujo en la CUMS (68 por ciento).Conclusiones: No hubo diferencias significativas en la incidencia de RVU entre los riñones con o sin hidronefrosis. La hidronefrosis leve se correlaciona escasamente con la presencia y el grado de reflujo en neonatos y lactantes y, por tanto, no debe considerarse una indicación para realizar CUMS (AU)

Utilidad del Doppler color y pulsadoen la valoración de los shunts portosistémicosquirúrgicos en la edad pediátrica / Usefulness of color and pulsed Dopplers in the evaluation of surgical portosystemic shunts in pediatric patients

Los shunts portosistémicos se realizan para paliar la hipertensión portal sintomática o para descomprimir la vascularización hepática en pacientes con síndrome de Budd-Chiari. La mayoría de los shunts portosistémicos quirúrgicos pueden estudiarse adecuadamente mediante ecografía complementada con Doppler color y pulsado si se comprende la hemodinámica de los procedimientos quirúrgicos. Este artículo muestra la utilidad y limitaciones de la ecografía duplex Doppler en la evaluación de los shunts portosistémicos realizados a pacientes pediátricos. El Doppler pulsado proporciona información sobre la naturaleza y dirección del flujo sanguíneo y el Doppler color es capaz de mostrar directamente el shunt y, en la mayoría de los casos, permite localizar las anastomosis. Los tipos de shunts que se muestran incluyen esplenorenal proximal y distal, portocava y mesocava. Se ilustran los tipos de conexiones vasculares y se muestra la dirección posquirúrgica esperable del flujo en los vasos sanguíneos implicados. Se discute la técnica ecográfica y los criterios para determinar la permeabilidad vascular.Así mismo se enfatizan las ventajas, limitaciones y dificultades diagnósticas de las distintas modalidades del Doppler (AU)

Heterotopic gastric mucosa involving the gallbladder and biliary tree.

A case of heterotopic gastric mucosa in the common bile duct, cystic duct and gallbladder is reported in a 3-year-old girl with abdominal pain and jaundice. Abdominal US and CT showed dilatation of the biliary tree and a well-defined mass in the common bile duct that narrowed its lumen. The gallbladder was contracted in both examinations. The common bile duct and the gallbladder were resected and a choledochojejunostomy was performed. Although gastric heterotopy has been described throughout the entire length of the gastrointestinal tract, it is a very uncommon finding in the gallbladder and extremely rare in the biliary tree. A firm diagnosis of gastric heterotopia is based on the presence of fundal mucosa replete with parietal and chief cells. To our knowledge, this is the fifth reported case of heterotopic gastric tissue within the common bile duct, and the first to describe the US and CT findings. A relevant literature review and brief outline of the histological and radiological features are included in the discussion.