GUIDANCE TO THE MATERNAL, FETAL AND NEONATAL MANAGEMENT OF RESISTANCE GRAVE'S DISEASE IN PREGNANCY.

Resistant Graves' disease in pregnancy is a rare entity. The clinical situation poses immense difficulty to the treating endocrinologist and obstetrician in optimizing maternal and fetal heath. No guidelines till date are available to manage resistant Grave's disease in pregnancy. We hereby present a case series on resistant Grave's in pregnancy and our institute experience in managing this rare and challenging clinical entity. Definitive management is total thyroidectomy in second trimester. Higher doses of ATDs and betablockers may have its fetopathic effects. Use of immunosuppressive agents are not advised in pregnancy to suppress the TRAb titre. Steroid therapy may be used as an adjuvant to permissible doses of anti-thyroid medications to curb the thyrotoxicosis in pregnancy. An alternate fetal friendly ATD is not available to add on to existing ATDs. TRAb estimation in maternal blood is mandatory. Mothers need frequent monitoring of cardiac status and need to avoid factors that can cause cardiac decompensation. Fetal surveillance includes growth monitoring and biophysical profile at nearby intervals, helps to ascertain the effects of excess thyroid hormones, TRAb and anti-thyroid drugs. Immediate neonatal cord blood screening for thyroid abnormalities is necessary. Maternal and fetal management in such a clinical situation is multidisciplinary.

Práctica de la ecografía en el ámbito de las emergencias. La tozuda realidad cuando no está cerca el radiólogo / Ultrasound practice in emergency medicine. Stubborn reality when the radiologist is missing

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Robotic stereotactic treatment for malignant metastasis of solid tumour in the pancreas: A multiple case report and review of literature.

Metastatic involvement of the pancreas occurs in 5% of patients affected by advanced malignancies. Surgical resection has been reported by number of authors as a valuable option to improve disease control, in particular in patients with limited disease burden and favourable histotypes; however, the benefit of this procedure has been questioned due to patient selection, technical challenges and relevant risk of perioperative mortality and severe complications. In the present study, a cohort of surgically unfit patients affected by a solitary metastasis in the pancreas from various primary tumours received stereotactic radiotherapy with an ablative dose schedule, obtaining promising local and distant disease progression-free delay with minor toxicity. This is the first report to our knowledge on the use of ablative stereotactic radiotherapy of metastasis in the pancreatic gland.

Isquemia mesentérica: actualización de nuevas técnicas diagnósticas para una vieja enfermedad y revisión de signos radiológicos / Mesenteric ischemia: update of new diagnostic techniques for an old disease, and review of radiological signs

La isquemia mesentérica arterial aguda constituye una urgencia médica asociada a una elevada mortalidad (> 60%). Un retraso diagnóstico implicaría una evolución de la enfermedad, por lo que es importante reconocer esta entidad lo más precozmente posible. El desarrollo de las técnicas de imagen permite establecer un diagnóstico precoz mediante tomografía computarizada multidetector (TCMD) abdominopélvica con contraste intravenoso, que detecta signos radiológicos típicos como la presencia de un trombo en el interior de la arteria mesentérica superior (AMS), neumatosis intestinal y aire en el interior de la vena mesentérica superior y porta, como hallazgos compatibles con esta entidad. Es importante conocer estas nuevas aplicaciones de las técnicas de imagen, así como signos radiológicos típicos de esta enfermedad, ya que se trata de una urgencia que, en caso de confirmarse, podría llevar a la realización de una intervención quirúrgica urgente para evitar su progresión a una necrosis intestinal y posible evolución fatal (AU)

Acute arterial mesenteric ischemia is a medical emergency associated with a high rate of mortality (> 60%). A diagnostic delay may lead to disease progression, thus it is important to recognize this condition as early as possible. The development of imaging techniques, such as multidetector computed tomography (MDCT) allows an early diagnosis to be made as it detects typical radiographic signs such as, the presence of a thrombus within the superior mesenteric artery (SMA), pneumatosis in bowel loops, and air in the interior of the superior mesenteric and portal veins. It is important to know of these new imaging techniques applications and the typical radiographic signs of this disease as it is an emergency which, if confirmed, could lead to performing urgent surgery to prevent progression to intestinal necrosis and a possible fatal outcome (AU)

[Mesenteric ischemia: update of new diagnostic techniques for an old disease, and review of radiological signs]. / Isquemia mesentérica: actualización de nuevas técnicas diagnósticas para una vieja enfermedad y revisión de signos radiológicos.

Acute arterial mesenteric ischemia is a medical emergency associated with a high rate of mortality (> 60%). A diagnostic delay may lead to disease progression, thus it is important to recognize this condition as early as possible. The development of imaging techniques, such as multidetector computed tomography (MDCT) allows an early diagnosis to be made as it detects typical radiographic signs such as, the presence of a thrombus within the superior mesenteric artery (SMA), pneumatosis in bowel loops, and air in the interior of the superior mesenteric and portal veins. It is important to know of these new imaging techniques applications and the typical radiographic signs of this disease as it is an emergency which, if confirmed, could lead to performing urgent surgery to prevent progression to intestinal necrosis and a possible fatal outcome.

Diagnóstico endoscópico y manejo de la esofagitis eosinofílica / Endoscopic diagnosis and management of eosinophilic esofagitis

Eosinophilic esophagitis is a clinico pathologic entity that has been increasingly recognized over the past two decades. It affects all ages, preferably men, with a history of atopy and is characterized by eating disorders, dysphagia and heartburn. It has elements in common with gastroesophageal reflux disease and the distinction between them can be a challenge for the clinician. It has several typical endoscopic features, such as longitudinal grooves, rings, plaques and stenosis, but none of them is pathognomonic of the disease. The correlation of history, endoscopic and histology are essential for a correct diagnosis. Management includes a period of use of proton pump inhibitors to rule out concomitant reflux disease. Treatment with topical corticosteroids such as fluticasone and budesonide are successful in the short term, but recurrence is common. Some cases may require endoscopic dilatation. Data is still insufficient to establish optimal management at short and long-term, therefore therapeutic decisions should be evaluated on a case-by-case basis.

La esofagitis eosinofílica es una entidad clínico patológica que ha sido reconocida en forma cada vez más frecuente en las últimas dos décadas. Afecta a todas las edades, de preferencia a hombres con antecedentes de atopia y se caracteriza por presentar trastornos alimentarios, disfagia y pirosis. Presenta elementos comunes con la enfermedad por reflujo gastroesofágico y la distinción entre ellas puede ser un desafío para el médico. Tiene varias características endoscópicas típicas, como los surcos longitudinales, anillos, placas y estenosis, pero ninguna de ellas es patognomónica de la enfermedad. La correlación de la historia, imagen endoscópica e histología son imprescindibles para el diagnóstico correcto. El manejo incluye un período de uso de inhibidores de la bomba de protones para descartar una enfermedad por reflujo concomitante. El tratamiento con corticoides tópicos como la fluticasona y budesonida da buenos resultados a corto plazo, pero la recidiva es frecuente. Algunos casos pueden requerir dilatación endoscópica. Faltan datos para establecer un manejo óptimo a corto y largo plazo, por lo que las decisiones terapéuticas deben ser evaluadas caso a caso.

Nanoscale surface photovoltage of organic semiconductors with two pass Kelvin probe microscopy.

Kelvin probe microscopy implemented with controlled sample illumination is used to study nanoscale surface photovoltage effects. With this objective a two trace method, where each scanning line is measured with and without external illumination, is proposed. This methodology allows a direct comparison of the contact potential images acquired in darkness and under illumination and, therefore, the surface photovoltage is simply inferred. Combined with an appropriate data analysis, the temporal and spatial evolution of reversible and irreversible photo-induced processes can be obtained. The potential and versatility of this technique is applied to MEH-PPV thin films. Photo-physical phenomena such as the mesoscale polymer electronic light-induced response as well as the local nanoscale electro-optical properties are studied.

AFM imaging and analysis of electrostatic double layer forces on single DNA molecules.

Electrical double layer (EDL) forces develop between charged surfaces immersed in an electrolyte solution. Biological material surrounded by its physiological medium constitutes a case where these forces play a major role. Specifically, this work is focused on the study of the EDL force exerted by DNA molecules, a standard reference for the study of single biomolecules of nanometer size. The molecules deposited on plane substrates have been characterized by means of the atomic force microscope operated in the force spectroscopy imaging mode. Force spectroscopy imaging provides images of the topography of the DNA molecules, and of the EDL force spectrum. Due to the size of the molecule being much smaller than that of the tip, both the tip-substrate and tip-molecule interactions need to be considered in the analysis of the experimental results. We solve this problem by linearly superposing the two contributions. EDL force images are presented where DNA molecules are clearly resolved. The lateral resolution of the EDL force is discussed and compared with that of the topography. The method also allows the estimation of the DNA surface charge density, thereby obtaining reasonable values.

[Results of the percutaneous retrograde embolization as the first choice in the treatment of varicocele]. / Resultados de la embolización retrógrada percutánea como primera opción en el tratamiento del varicocele.

There is evidence that early varicocele treatment decreases testicular damage. The minimally invasive techniques such as laparoscopic varicocelectomy, antegrade sclerotherapy and percutaneous retrograde embolisation, are acquiring greater significance in the treatment of this disease. Since 1994, a series of 51 children, aged 7-16 years (mean, 12.9 years), with left-sided varicocele grades 2 (47%) and 3 (53%) were treated in our institution by percutaneous retrograde embolisation using coils. The right basilica vein was the most widely used (70%) followed by the right femoral vein. Seven children (13.7%) had complications: perforation of internal spermatic vein was the most frequent and treated conservatively. No child presented hydrocele after radiological procedures. Embolisation was accomplished succesfully at the first attempt in 35 (68.6%) of the 51 children and in 45 (88.2%) after a second embolisation. The follow-up ranges from 7 months to 5 ? years (mean, 1.8 years). The patients were monitored with clinical and doppler ultrasound examination 3, 6 and 12 months after the treatment. Retrograde embolisation is a safe and efficient minimally invasive treatment for correcting varicoceles in children. We performed retrograde embolisation as first choice of varicocele treatment in children; a second embolisation or conventional surgery for primary failure or late recurrence should be considered.

Resultados de la embolización retrógrada percutánea como primera opción en el tratamiento del varicocele / Results of the percutaneous retrograde embolization as the first choice in the treatment of varicocele

Existe evidencia científica de que el tratamiento precoz del varicocele disminuye el daño testicular. Las técnicas mínimamente invasivas como la varicelectomía laparoscópica, la escleroterapia anterográda y la embolización retrógrada, están adquiriendo mayor relevancia en el tratamiento de esta patología. Entre 1994 y 2008 hemos tratado a 51niños afectos de varicocele izquierdo grado 2 (47%) y 3 (53%) mediante embolización retrógrada percutánea con coils. La edad media fue de 12,9 años (rango 7-16 años). La vena basílica derecha fue la vía de acceso más usada (70%) seguida de la femoral derecha. El seguimiento medio ha sido de 1 año y 8 meses, con un rango de 7 meses a 5 años y medio. En 7 niños (13,7%) se presentó algún tipo de complicación, siendo la más frecuente la perforación de la vena espermática con extravasación de contraste, que se trató de forma conservadora. Ningún niño presentó hidrocele tras el procedimiento radiológico. Una primera embolización resolvió el 68,6% de los varicoceles y el 88,2% tras una segunda embolización. Los controles post-embolización consistieron en una revisión clínica y la realización de eco doppler testicular al mes, tres y seis meses. La embolización retrógrada percutánea es una opción terapéutica mínimamente invasiva segura y eficaz de tratamiento del varicocele en el niño. Nosotros la indicamos como primera opción terapéutica para el tratamiento del varicocele en la edad pediátrica, reservando una segunda embolización o la varicelectomía laparoscópica para los fracasos del primer procedimiento o las recidivas (AU)

There is evidence that early varicocele treatment decreases testicular damage. The minimally invasive techniques such as laparoscopic varicocelectomy, antegrade sclerotherapy and percutaneous retrograde embolisation, are acquiring greater significance in the treatment of this disease. Since 1994, a series of 51 children, aged 7-16 years (mean, 12.9years), with left-sided varicocele grades 2 (47%) and 3 (53%) were treated in our institution by percutaneous retrograde embolisation using coils. The right basilica vein was the most widely used (70%) followed by the right femoral vein. Seven children (13.7%) had complications: perforation of internal spermatic vein was the most frequent and treated conservatively. No child presented hydrocele after radiological procedures. Embolisation was accomplished succesfully at the first attempt in 35(68.6%) of the 51 children and in 45 (88.2%) after a second embolisation. The follow-up ranges from 7 months to 5 ? years (mean, 1.8 years).The patients were monitored with clinical and doppler ultrasound examination 3, 6 and 12 months after the treatment. Retrograde embolization is a safe and efficient minimally invasive treatment for correcting varicoceles in children. We performed retrograde embolisation as first choice of varicocele treatment in children; a second embolisation or conventional surgery for primary failure or late recurrence should be considered (AU)

WSXM: a software for scanning probe microscopy and a tool for nanotechnology.

In this work we briefly describe the most relevant features of WSXM, a freeware scanning probe microscopy software based on MS-Windows. The article is structured in three different sections: The introduction is a perspective on the importance of software on scanning probe microscopy. The second section is devoted to describe the general structure of the application; in this section the capabilities of WSXM to read third party files are stressed. Finally, a detailed discussion of some relevant procedures of the software is carried out.

Jumping mode AFM imaging of biomolecules in the repulsive electrical double layer.

We present a method to image single biomolecules in aqueous media by atomic force microscope (AFM) without establishing any mechanical contact between the tip and the sample. It works by placing the feedback set point in the repulsive electrical double-layer curve just before the mechanical instability occurs. We use the jumping operation mode, where the set point is controlled at every image point and a stable imaging is achieved for several hours. This is a necessary condition for this method to be operative, otherwise the tip can fall in contact in a short time. The method is applied to image single-avidin protein molecules deposited on cleaved mica. In addition, the dependence of the height of avidin molecules as a function of ion concentration, due to differences in surface charge density of mica and avidin, is tentatively used to deduce relative values of these quantities.