Malignant Clinical Course of "Proliferative" Ovarian Struma: Diagnostic Challenges and Treatment Pitfalls.

Struma ovarii (SO) is a monodermal teratoma predominantly composed of thyroid tissue (TT) showing benign, "proliferative", or malignant histology. By imaging, a 38-year-old patient with lower backache revealed a 6.2-cm vertebral lesion (L5). Core biopsy showed well-differentiated TT without features of papillary carcinoma. A 3.5-cm left ovarian mature teratoma (lacking TT) and peritoneal nodules (showing well-differentiated TT) were also identified and surgically removed. Thyroid ultrasound and cytological examination resulted negative. Four years before, left ovarian cystectomy was performed for a histologically "proliferative" SO. According to the malignant clinical course and WHO classification, this case was overall reassessed as a recurring well-differentiated follicular carcinoma arising in SO (WD-FC-SO), despite lacking malignant histological features in any specimens. Immunophenotype: TTF-1+/PAX-8+/thyroglobulin+/CK7+/chromogranin-/synaptophysin-/inhibin-/calretinin-/HNF1B-; Ki-67 index < 5%. Polymerase chain reaction analysis resulted negative for BRAFV600E mutation. The patient refused further treatments, without recurrence after 17 months. The clinical behavior of SO may be unpredictable. Histologically benign or proliferative strumas extraordinarily metastasize, while SO with malignant features may not recur. The exceptional evidence of peritoneal implants of well-differentiated TT (peritoneal strumosis) in patients with histologically benign SO represents a metastasis of WD-FC-SO (like in our case). A multidisciplinary approach including clinical, laboratory, radiologic, and histopathological data is required.

Henry's Law Constants and Vapor-Liquid Distribution Coefficients of Noncondensable Gases Dissolved in Carbon Dioxide.

The accurate determination of the solubilities of the typical impurity gases present in captured CO2 in the carbon capture, utilization, and storage chain is an essential prerequisite for the successful modeling of the CO2 stream thermodynamic properties. In this paper, Henry's law constants and the vapor-liquid distribution coefficients of six noncondensable gases, namely, N2, O2, H2, CH4, Ar, and CO, at infinite dilution in liquid CO2 are derived based on published vapor-liquid equilibrium data at temperatures ranging from the triple point (216.59 K) to the critical point (304.13 K) of CO2. The temperature dependence of Henry's law constants of the six gases is correlated using approximating functions previously proposed for aqueous solutions. A correlation that provides the best fit for the Henry constants data for all the six gases, with the accuracy (absolute average deviation %) of 4.2%, is recommended. For N2, O2, H2, Ar, and CO, the combined standard uncertainty in the derived Henry constants is less than 6%, whereas for CH4, due to a larger deviation between the utilized data, the uncertainty is less than 18%. Analysis of the temperature variation of the vapor-liquid distribution coefficient at infinite dilution shows that when all the six gases are present in the CO2 stream, separation of N2, O2, Ar, and CO from CO2 can be problematic due to their similar volatilities, while the distinct volatilities of H2 and CH4 at lower temperatures make their separation from CO2 easier.

The role of mineral and bone disorders in the development and progression of cardiac and renal pathology in patients with type 1 diabetes mellitus of long duration.

AIMS: The objective of our study was to evaluate the role of mineral and bone metabolism disorders associated with chronic kidney disease (MBD-CKD) in the development and progression of cardiac and renal pathology in patients with type 1 diabetes mellitus (T1DM) of long duration. METHODS: We investigated 96 patients with T1DM of long duration, with CKD at different stages (0-5), including patients on hemodialysis (HD) and with kidney transplantation (KT). Along with overall clinical examination, we assessed markers of MBD (calcium, phosphorus, parathormone, vitamin D, fibroblast growth factor (FGF) 23) and levels of cardiac injury marker (atrial natriuretic peptide, NT-proBNP). Multispiral computer tomography with Agatston index calculation was also included. RESULTS: Decreased kidney function was associated with increased of levels phosphorus, parathormone, FGF 23, and vitamin D deficiency, with the highest deviation from the reference ranges seen in patients on HD with a very high risk of cardiovascular events. In KT patients with satisfactory graft function, these parameters were at the same levels as in patients with CKD stages 0-4. Progression of cardiovascular pathology was accompanied by elevation of NT-proBNP levels as CKD duration increased, decreased glomerular filtration rate, and were correlated with the main parameters of mineral homeostasis. The severity of coronary arteries calcification was associated with patient age and duration of T1DM and arterial hypertension. CONCLUSIONS: Development and progression of kidney dysfunction is accompanied by MBD, a significant factor in progression of cardiac pathology, which remains a major cause of mortality in this patient population.

Forced vibrations of a bubble in a liquid-filled elastic vessel.

There is increasing demand for accurate characterization of the in vivo behavior of microbubble agents used for ultrasound imaging and therapy. This study examines bubble-vessel interaction, in particular the propagation of disturbances along the vessel wall. Finite element simulations of a 3 µm radius microbubble suspended in a viscous liquid and enclosed in a 4 µm radius elastic vessel were performed, and the results compared with existing analytical results for wave propagation in elastic liquid-filled tubes. The vessel wall was shown to have a significant effect upon the amplitude of bubble oscillation and hence acoustic radiation from it, as well as distension of the vessel wall. It was found that the most important factor was the ratio of the excitation frequency to the natural "ring" frequency of the vessel which in turn depends upon its dimensions and mechanical properties. As this ratio increases, the motion of the vessel wall becomes increasingly localized to the site of the bubble. It was also shown that the validity of the results obtained using the applied model of vessel elasticity is limited to frequencies below the ring frequency, and this should be taken into account in the development of protocols for ultrasound safety and/or therapeutic procedures.

The natural frequencies of microbubble oscillation in elastic vessels.

A theoretical model for the dynamics of a bubble in an elastic blood vessel is applied to study numerically the effect of confinement on the free oscillations of a bubble. The vessel wall deformations are described using a lumped-parameter membrane-type model, which is coupled to the Navier-Stokes equations for the fluid motion inside the vessel. It is shown that the bubble oscillations in a finite-length vessel are characterized by a spectrum of frequencies, with distinguishable high-frequency and low-frequency modes. The frequency of the high-frequency mode increases with the vessel elastic modulus and, for a thin-wall vessel, can be higher than the natural frequency of bubble oscillations in an unconfined liquid. In the limiting case of an infinitely stiff vessel wall, the frequency of the low-frequency mode approaches the well-known solution for a bubble confined in a rigid vessel. In order to interpret the results, a simple two-degree-of-freedom model is applied. The results suggest that in order to maximize deposition of acoustic energy, a bubble confined in a long elastic vessel has to be excited at frequencies higher than the natural frequency of the equivalent unconfined bubble.