Synthetic Antenna Functioning As Light Harvester in the Whole Visible Region for Enhanced Hybrid Photosynthetic Reaction Centers.

The photosynthetic reaction center (RC) from the Rhodobacter sphaeroides bacterium has been covalently bioconjugated with a NIR-emitting fluorophore (AE800) whose synthesis was specifically tailored to act as artificial antenna harvesting light in the entire visible region. AE800 has a broad absorption spectrum with peaks centered in the absorption gaps of the RC and its emission overlaps the most intense RC absorption bands, ensuring a consistent increase of the protein optical cross section. The covalent hybrid AE800-RC is stable and fully functional. The energy collected by the artificial antenna is transferred to the protein via FRET mechanism, and the hybrid system outperforms by a noteworthy 30% the overall photochemical activity of the native protein under the entire range of visible light. This improvement in the optical characteristic of the photoenzyme demonstrates the effectiveness of the bioconjugation approach as a suitable route to new biohybrid materials for energy conversion, photocatalysis, and biosensing.

Semiquinone oscillations as a tool for investigating the ubiquinone binding to photosynthetic reaction centers.

Semiquinone oscillations induced by light pulses in the presence of exogenous electron donors are a valuable source of information on the kinetics and thermodynamics of ubiquinone chemistry relevant to the QB site of the photosynthetic reaction center (RC). In previous attempts to achieve the quantitative interpretation of data, the ubiquinone concentration was considered constant during the experiment since it was much bigger than that of RC. In this work, we extended existing models to low ubiquinone concentrations revealing several hidden processes taking place during the ubiquinone photoreduction and enabling the evaluation of the ubiquinone binding constant K Q at the QB site. The proposed approach provides for the first time the evaluation of K Q without any preliminary treatment of ubiquinone extraction from the binding site, thereby better preserving its native structure.

Enhancing the light harvesting capability of a photosynthetic reaction center by a tailored molecular fluorophore.

Light machine: The simplest photosynthetic protein able to convert sunlight into other energy forms is covalently functionalized with a tailored organic dye to obtain a fully functional hybrid complex that outperforms the natural system in light harvesting and conversion ability.

[Hydrops of the gallbladder and hepatitis associated with scarlet fever]. / Hidrops vesicular y hepatitis asociados con escarlatina.

Hydrops of the gallbladder is a rare pediatric disease. It consists of acute distension of the gallbladder without associated congenital anomalies, biliary calculi or acute local inflammation. Although the etiology is unknown, it appears frequently associated with systemic illnesses. Hepatitis is a rare complication of scarlet fever in the pediatric population. We report a four years old girl with gallbladder hydrops and hepatitis associated to scarlet fever. To the best of our knowledge this is the first case report in the medical literature describing an association of these three conditions

LigaSure vs clamp-and-tie technique to achieve hemostasis in total thyroidectomy for benign multinodular goiter: a prospective randomized study.

HYPOTHESIS: Occurrence of adverse effects and advantages of the LigaSure diathermy system (or LigaSure vessel sealing system) in total thyroidectomy have not been tested in prospective randomized studies comparing its use with that of the time-saving clamp-and-tie technique to ligate and divide thyroid vessels. The effectiveness of LigaSure in achieving vessel division and hemostasis remains dependent on vessel diameter, and the risk of damage to adjacent structures cannot be completely excluded. We tested the hypothesis that use of LigaSure compared with the clamp-and-tie technique can significantly and conveniently reduce operative time without increasing postoperative complications in patients undergoing total thyroidectomy for benign multinodular goiter. DESIGN: Prospective randomized study. SETTING: Regional hospital. PATIENTS: Two hundred consecutive patients with benign multinodular goiter undergoing total thyroidectomy performed by 1 of 3 surgeons. INTERVENTIONS: According to a randomized sequence, total thyroidectomy was performed in 100 patients using LigaSure and in 100 patients using the clamp-and-tie technique. MAIN OUTCOME MEASURES: End points of the study included the comparative evaluation of postoperative complications, need for parathyroid gland autotransplantation, operative time, and time to hospital discharge. Preoperative, postoperative (24 hours), and 6-week follow-up serum Ca(++) levels are also reported and compared. RESULTS: The postoperative complication rate was 35% overall, including all transient postoperative disturbances. The incidence of cervical hematomas was 2%, but 3 patients (1.5%), 1 in the LigaSure group and 2 in the clamp-and-tie group, required repeat operations because of respiratory tract obstruction. The incidence of permanent complications was 2.5% overall, including 3 patients (1.5%) with permanent hypocalcemia and 2 patients (1%) with permanent recurrent nerve lesions. No statistical difference in the incidence of complications was found between the 2 study groups. Similarly, no difference was found in mean hospitalization time and need for parathyroid gland autotransplantation. Preoperative, postoperative, and 6-week follow-up mean serum Ca(++) levels were not statistically different in the 2 study groups and in the subset of patients undergoing parathyroid gland autotransplantation. Mean operative time was significantly shorter in the LigaSure group, although the mean difference between the 2 study groups was minimal (7.4 minutes). Concomitantly, there was an additional cost of 45euro (US $57.40) per operation using LigaSure. CONCLUSION: The use of LigaSure is equally as safe and effective at vessel division and homeostasis as the clamp-and-tie technique, with a statistically significant (although minimal) decrease in mean operative time. Because of this minimal decrease in operative time, use of LigaSure would allow more patients to undergo total thyroidectomy each year, which would eventually help to offset its higher cost.

Hematoma traumático del psoas / Psoas traumatic hematoma

Los hematomas del psoas se suelen observar en pacientes con hemofilia u otras discrasias sanguíneas y como complicaciónde tratamientos anticoagulantes. Con menor frecuencia se pueden ver en personas sanas, debido a la rotura traumática del músculo. Por similares causas se producen hematomas del músculo ilíaco. La parálisis del nervio femoral es la complicación más grave y frecuente de ambas afecciones. Es habitual denominar a estos cuadros como hematomas del iliopsoas y considerarlos en conjunto por las características anatómicas, etiológicas, patológicas y clínicas que presentan. Describimos el caso de un niño de 12 años y 8 meses de edad, sin coagulopatíaconocida, que padeció un hematoma del psoas de origentraumático(AU)

Hematoma traumático del psoas / Psoas traumatic hematoma

Los hematomas del psoas se suelen observar en pacientes con hemofilia u otras discrasias sanguíneas y como complicaciónde tratamientos anticoagulantes. Con menor frecuencia se pueden ver en personas sanas, debido a la rotura traumática del músculo. Por similares causas se producen hematomas del músculo ilíaco. La parálisis del nervio femoral es la complicación más grave y frecuente de ambas afecciones. Es habitual denominar a estos cuadros como hematomas del iliopsoas y considerarlos en conjunto por las características anatómicas, etiológicas, patológicas y clínicas que presentan. Describimos el caso de un niño de 12 años y 8 meses de edad, sin coagulopatíaconocida, que padeció un hematoma del psoas de origentraumático(AU)

Hematoma traumático del psoas / Psoas traumatic hematoma

Los hematomas del psoas se suelen observar en pacientes con hemofilia u otras discrasias sanguíneas y como complicaciónde tratamientos anticoagulantes. Con menor frecuencia se pueden ver en personas sanas, debido a la rotura traumática del músculo. Por similares causas se producen hematomas del músculo ilíaco. La parálisis del nervio femoral es la complicación más grave y frecuente de ambas afecciones. Es habitual denominar a estos cuadros como hematomas del iliopsoas y considerarlos en conjunto por las características anatómicas, etiológicas, patológicas y clínicas que presentan. Describimos el caso de un niño de 12 años y 8 meses de edad, sin coagulopatíaconocida, que padeció un hematoma del psoas de origentraumático

Quality of life and predictors of long-term outcome in patients undergoing open Nissen fundoplication for chronic gastroesophageal reflux.

BACKGROUND: Long-term outcome of antireflux operations as well as pre- and postoperative parameters able to predict their clinical results are still controversial. The aim of the present study was to evaluate long-term quality of life of patients undergoing open fundoplication for chronic GERD and to investigate pre- and early postoperative functional parameters possibly related to persistence or recurrence of symptoms. METHODS: A cohort of 25 patients who underwent open Nissen fundoplications was reviewed for an evaluation of long-term residual symptoms and quality of life at an average follow-up of more than 10 years. Clinical evaluation was performed by using a symptom-specific score (DeMeester's score), 3 health-related quality of life scores, a GERD-specific (GERD-HRQL score) score, and 2 generic scores (SF-36) evaluating physical and psychological well-being. Subjective satisfaction grade of the patients was also investigated. In addition, a univariate analysis is provided, according to the long-term presence or absence of residual symptoms (120.6-month follow-up), taking into account pre- and postoperative (6-month follow-up) data of endoscopy, 24-hour pH monitoring, stationary manometry, and gastric-emptying test. RESULTS: Persistence or recurrence of GERD-specific symptoms (heartburn and regurgitation) were reported by 8 patients (32%); 2 patients (8%) were reoperated on for persistent dysphagia, whereas 17 patients (68%) were asymptomatic. GERD-HRQL and SF-36 scores displayed significant postoperative improvement, which continued in long-term follow-up. Twenty patients (80%) had repeat fundoplication. Among tested parameters, only postoperative mean supine esophageal clearance and gastric emptying half-time, although on average improved significantly after the antireflux procedure, differed significantly in long-term asymptomatic and symptomatic subgroups. In long-term asymptomatic patients, postoperative (6 month) mean supine esophageal clearance was 0.8 +/- 0.3 minutes (P = .011) and 2.4 +/- 0.2 minutes in symptomatic patients. Postoperative (6 month) mean gastric emptying half-time of long-term asymptomatic patients was 93.3 +/- 8.9 minutes, whereas in symptomatic patients it was 127.5 +/- 14.3 minutes (P = .047). CONCLUSIONS: Patients undergoing Nissen fundoplication had a satisfactory long-term quality of life. Clinical results did not deteriorate over time and showed to be related to postoperative esophageal clearance and gastric emptying, which could be regarded as early postoperative predictors of long-term clinical outcome.

Lymph node metastasis from gastric carcinoid tumors occurring concomitantly with gastric adenocarcinomas and atrophic gastritis.

We describe a case of gastric carcinoids concomitant with gastric adenocarcinoma in a 50-year-old woman affected by atrophic gastritis. Number and size of the lesions, pathological examinations, and underlying gastric disease all indicated low-risk carcinoids. Nevertheless, when R1 gastrectomy was carried out, an unsuspected lymph node metastasis from carcinoid was found along the lesser curvature. The same occurrence is reported in several cases of the literature, which suggests that the association of gastric carcinoid to adenocarcinoma could point to the malignant nature of carcinoid, apart from underlying gastric disease and tumor characteristics.

Laparoscopic palliative gastrojejunostomy for advanced recurrent gastric cancer after Billroth I resection.

Palliative surgery for advanced gastric cancer has equivocal results. Laparoscopy is likely to provide some advantage compared to open procedures. We present a case of laparoscopic gastrojejunostomy for advanced gastric cancer, which recurred after Billroth I resection. Reproducing the results of the early experiences so far reported in the literature, laparoscopy provided us with the accurate staging of the disease along with the opportunity, at the same time, to perform a palliative procedure, avoiding laparotomy. Operative results were good, vomiting was relieved, and the patient was able to cope with his disease until death eventually occurred after 6 months.

Prospective evaluation of ultrasonography plus MIBI scintigraphy in selecting patients with primary hyperparathyroidism for unilateral neck exploration under local anaesthesia.

BACKGROUND: Unilateral neck exploration (UNE) is currently replacing conventional bilateral neck exploration with cervicotomy for the surgical treatment of primary hyperparathyroidism (PHPT). However, many concerns still exist about the indications and the effectiveness of this minimally invasive approach. METHODS: Prospective evaluation of operative results in consecutive patients having indications for UNE on the basis of strict selection criteria consisting of ultrasound-MIBI agreement in adenoma localization, absence of thyroid disease, and psychological suitability for undergoing a procedure under local anesthesia. No intraoperative confirmation study was adopted. RESULTS: Among 149 consecutive PHPT patients, 45 (30.2%) had indications for UNE. No operative morbidity or mortality was observed. Mean operative time for the UNE procedure was 42 minutes (range 25 to 57). Conversion to general anesthesia was chosen for 5 patients (11.1%), whereas conversion to bilateral neck exploration was chosen for 3 patients (6.6%). For the UNE procedure, the success rate was as high as 91.7%. When the only factor indicated UNE, ultrasound-MIBI localization agreement had low sensibility (44.1%) and specificity (55.6%) but a high positive predictive value (91.1%). CONCLUSIONS: We concluded that UNE performed under local anesthesia, without intraoperative confirmation studies, could be considered a safe and effective approach to treating patients with PHPT, but we regret the low rate of patients selected for this procedure because of the low sensitivity of the imaging-inclusion criterion.

A primary pancreatic carcinoid tumour with unusual clinical complaints: A case report.

BACKGROUND: Unless metastatic or compressing the pancreatic duct, carcinoid of the pancreas are asymptomatic showing normal levels of serotonine and its metabolites in plasma and urine, thus resulting in delayed diagnosis and a consequent poor prognosis. However, if resection is timely accomplished, no local recurrence might be encountered and a normal survival might be expected in the absence of metastatic disease. CASE PRESENTATION: The reported case of pancreatic carcinoid tumour in a 62-year-old woman reporting only atypical symptoms consisting of intermittent epigastric pain and nausea. Urinary 5-hydroxyindolacetic acid levels were within normal limits and only a slight elevation of serum serotonine level was detected on admission. After tumour localisation with endoscopic ultrasonography, left splenopancreasectomy with splenic, celiac and hepatic lymphadenectomy was carried out. CONCLUSION: The role of endoscopic ultrasonography in early detection and precise localisation of pancreatic carcinoids, as well as the role of somatostatin-receptor scintigraphy with 111Indium labelled pentreotide in excluding distant metastases, are confirmed. The radical resection with lymphadenectomy is recommended in order to have a precise histological examination and detect occult lymph node metastases.

A new method of packaging cocaine for international traffic and implications for the management of cocaine body packers.

Clinical outcome of cocaine body packers is considered to be unpredictable and there are no clear guidelines for the management of these patients. Their surveillance in casualty wards, where they are usually admitted during evacuation of the packets, can be very difficult. The authors refer to a new type of cocaine packet, allowing these patients to be managed with a more conservative approach than in the past, and report their experience with 161 body packers, observed from January 1999 to December 2000. They adopted a surveillance protocol providing only minimal medical intervention. Among 161 body packers, 142 (88.2%) evacuated the ingested packets without significant symptomatology. Warning symptoms were present in 19 (11.8%) patients. Three patients (1.9%) presented with marked anxiety but none had cocaine in the urine sample. Fifteen (9.3%) body packers complained of colicky pain, and all underwent plain X-ray studies of the abdomen. Ten (6.2%) of them without radiologic signs of intestinal occlusion recovered with food deprivation and medical treatment, while five (3.1%) underwent laparotomy, three patients (1.9%) for gastric occlusion and two (1.2%) for ileal occlusion. Only one patient (0.6%) had warning symptoms and a urine screen positive for cocaine metabolites. In three cases of gastric occlusion, a gastrotomy was accomplished. In two cases of ileal occlusion, and in the patient with cocaine intoxication, packets were milked into the cecum, and some into the descending colon and rectum, until anal expulsion, by gentle pulling. Type 4 packets represent a new method of cocaine packaging, carrying the possibility of treating these body packers more conservatively than those transporting previous type of packets. Surgical approach to intestinal occlusion also may be conservative, because distal propulsion of the packets can be accomplished without entering the intestine.

Problemas diagnósticos en dos niños con enfermedad respiratoria / Diagnostic dilemmas in 2 children with respiratory disease

Se describen dos niños con enfermedad respiratoria, en quienes se presentaron dificultades para llegar al diagnóstico causal

Problemas diagnósticos en dos niños con enfermedad respiratoria / Diagnostic dilemmas in 2 children with respiratory disease

Se describen dos niños con enfermedad respiratoria, en quienes se presentaron dificultades para llegar al diagnóstico causal