Fatal intrahepatic hemorrhage after nadroparin use for total hip arthroplasty.

Low-molecular-weight heparins have become the predominant choice for deep venous thrombosis prophylaxis and treatment. However, their use may cause bleeding complications. Intrahepatic bleeding is exceptional and only very few cases have been described. The authors present a unique case of fatal intrahepatic hematoma complicating nadroparin use in a 65-year-old woman with a hepatic cyst who was admitted to hospital for unilateral total hip arthroplasty. At autopsy, hemoperitoneum (2,000 ml of blood and clots) was evident. A ruptured sub-capsular hematoma involving the right lobe of the liver was observed. The hemorrhage within the cyst induced by the nadroparin use was likely responsible for the subsequent hepatic hematoma, liver rupture, and death. This case highlights the need for pathologists and surgeons to be aware of the possibility of intrahepatic hematoma in patients who have received low-molecular-weight heparins, undergone major surgery and present postoperative hemodynamic instability, especially in those with preoperative diagnosis of hepatic cyst.

Transhiatal laparoscopic resection of intrathoracic esophageal duplication in a 6-month-old boy.

We report the case of a 6-month-old boy known antenatally to have a mediastinal cyst. Postnatal workup showed a noncommunicating compressive cyst bound to the lower third of the native esophagus. He underwent its removal by transhiatal laparoscopy. This appears to be the first case of laparoscopic removal of a thoracic esophageal duplication cyst in a child.

Eräiden paperinvalmistuksessa käytettävien vahadispersioiden stabiilisuuden hallinta

Diplomityön tavoitteena oli selvittää millainen laaduntarkastus AKD-dispersioille tulisi suorittaa kuormien vastaanotossa ja tulisiko dispersioiden laatu tarkastaa uudelleen ennen annostelua. Tätä varten seurattiin toimituserien laadun tasaisuutta ja tarkasteltiin varastointiolosuhteiden vaikutusta dispersioiden säilyvyyteen. Lisäksi kartoitettiin dispersioiden käsittelyssä ja kartonginvalmistusprosessissa esiintyvien riskitekijöiden vaikutuksia kaupallisten dispersioiden stabiilisuuteen. Kirjallisuusosassa perehdyttiin kolloidisiin dispersioihin sekä niiden stabiilisuuteen vaikuttaviin tekijöihin. AKD-dispersiot valmistetaan emulgointitekniikoiden avulla, joten dispergointimenetelmien ohella käsiteltiin myös emulsioiden valmistamista. Lisäksi luotiin katsaus dispersioteknologian tärkeimpiin analyysimenetelmiin. Alkyyliketeenidimeerin osalta käsiteltiin emulgoinnin lisäksi vahan ja muiden lisäaineiden vaikutuksia dispersioiden stabiilisuuteen ja myös niiden merkitystä dispersioiden formuloinnissa. AKD-liimauksen osalta esiin tuotiin AKD:n tärkeimmät reaktiomekanismit, sillä ne liittyvät osittain myös dispersioiden stabiilisuuteen. Lopuksi luotiin lyhyt katsaus AKD-dispersioiden stabiilisuutta käsittelevään tutkimukseen, jota on toistaiseksi julkaistu varsin niukasti. Kokeellisessaosassa tarkastelun kohteeksi valittiin neljä kaupallista alkyyliketeenidimeerinvesidispersiota, joiden koostumus ja ominaisuudet selvitettiin perusteellisesti. Tarkoituksena oli auttaa ymmärtämään dispersioiden stabiilisuudessa mahdollisesti esiintyviä eroja. Laajamittainen dispersioiden karakterisointi näyttää olevan tarpeen ainakin otettaessa uutta AKD-laatua käyttöön, sillä dispersioiden koostumus ja ominaisuudet voivat vaihdella merkittävästi. AKD-dispersioiden laadussa esiintyi vaihtelua eri toimituserien välillä. Suurimmat vaihtelut havaittiin dispersioiden varaustiloissa ja partikkelikokojakaumissa. Laadun epätasaisuuden vuoksi vastaanottotarkastuksen merkitys korostuu. Vastaanottotarkastuksessa syytä olisi kiinnittää dispersion kuiva-ainepitoisuuden ohella sen viskositeettiin, varaustilaan, tehoainepitoisuuteen sekä rakenteeseen. Rakenteen tarkastelussa optinen mikroskooppi voi rutiininomaisessa seurannassa korvata partikkelikokojakauman määrittämisen. Varastointilämpötilan vaikutus dispersioidenlaatuun on merkittävä. Dispersiot säilyvät parhaiten viileässä, joten jos varastosäiliöissä ei ole jäähdytystä, on dispersioiden laadun tarkastus tarpeen myös ennen annostelua. Jotta dispersion kunnosta saadaan luotettava arvio, on viskositeetin määrittämiseen yhdistettävä vähintään rakenteen tarkastelu optisella mikroskoopilla. Mekaaninen rasitus voi dominoivasta stabilointimekanismistariippuen aiheuttaa dispersiossa hienoaineen muodostumista tai partikkelien flokkaantumista. Stabilointimekanismi vaikuttaa niin ikään partikkelien käyttäytymiseen korkeissa lämpötiloissa. Dispersioiden stabiilisuuden todettiin heikkenevän pH:n kohotessa emäksiselle alueelle. Elektrolyyttikonsentraatio vaikuttaa partikkelien mikroelektroforeettiseen ioniliikkuvuuteen merkittävästi. Kartonkikoneen märkäosan kemikaaleista anionisen retentioaineen (BMA) todettiin vuorovaikuttavan kationisten AKD-partikkelien kanssa selvimmin. Mikroelektroforeettisen ioniliikkuvuuden mittaaminen kiertovedessä todettiin tärkeäksi, sillä se kuvaa dispersion käyttäytymistä sen käyttöympäristössä.

Intracerebral alveolar echinococcosis.

There are two species of the genus Echinococcus, Echinococcus multilocularis (also called alveolar hydatid) and Echinococcus granulosus, characterized by distinct growth features in humans. The main endemic regions for human alveolar echinococcosis (AE) caused by E. multilocularis are Central Europe, Russia, Turkey, Japan, China, eastern France and North America. Human echinococcosis is usually caused by an intrahepatic growth of parasitic larvae. Cerebral occurrence of E. multilocularis disease is rare, accounting for only 1% of cases, and is generally considered to be fatal. This report presents two cases of intracerebral E. multilocularis disease which occurred in two infected patients with AE pulmonary metastases. The anatomical and clinical features are discussed. Our retrospective survey would indicate that surgical treatment should be envisaged whenever possible.

Review. Characterization and selection of hexaploid wheats containing resistance to Heterodera avenae or Mayetiola destructor introgressed from Aegilops

Cereal cyst nematode (CCN, Heterodera avenae) and Hessian fly (HF, Mayetiola destructor) are two major pests affecting wheat crops worldwide including important cereal areas of Spain. Aegilops ventricosa and Ae. triuncialis were used as donors in a strategy to introduce resistance genes (RG) for these pests in hexaploid wheat (Triticum aestivum L.). Two 42 chromosomes introgression lines have been derived from Ae. ventricosa: H-93-8 and H-93-33 carrying genes Cre2 and H27 conferring resistance to CCN and HF, respectively. Line TR-3531 with 42 chromosomes has been derived from Ae. triuncialis and carries RGs conferring resistance for CCN (Cre7) and for HF (H30). Alien material has been incorporated in lines H-93 by chromosomal substitution and recombination, while in line TR-3531 homoeologous recombination affecting small DNA fragments has played a major role. It has been demonstrated that Cre2, Cre7, H27 and H30 are major single dominant genes and not allelic of other previously described RGs. Biochemical and molecular-biology studies of the defense mechanism triggered by Cre2 and Cre7 have revealed specific induction of peroxidase and other antioxidant enzymes. In parallel to these basic studies advanced lines carrying resistance genes for CNN and/or HF have been developed. Selection was done using molecular markers for eventually «pyramiding» resistance genes. Several isozyme and RAPD markers have been described and, currently, new markers based on transposable elements and NBS-LRR sequences are being developed. At present, two advanced lines have already been included at the Spanish Catalogue of Commercial Plant Varieties.

Copeptin is associated with kidney length, renal function, and prevalence of simple cysts in a population-based study.

Arginine vasopressin (AVP) has a key role in osmoregulation by facilitating water transport in the collecting duct. Recent evidence suggests that AVP may have additional effects on renal function and favor cyst growth in polycystic kidney disease. Whether AVP also affects kidney structure in the general population is unknown. We analyzed the association of copeptin, an established surrogate for AVP, with parameters of renal function and morphology in a multicentric population-based cohort. Participants from families of European ancestry were randomly selected in three Swiss cities. We used linear multilevel regression analysis to explore the association of copeptin with renal function parameters as well as kidney length and the presence of simple renal cysts assessed by ultrasound examination. Copeptin levels were log-transformed. The 529 women and 481 men had median copeptin levels of 3.0 and 5.2 pmol/L, respectively (P<0.001). In multivariable analyses, the copeptin level was associated inversely with eGFR (β=-2.1; 95% confidence interval [95% CI], -3.3 to -0.8; P=0.002) and kidney length (β=-1.2; 95% CI, -1.9 to -0.4; P=0.003) but positively with 24-hour urinary albumin excretion (β=0.11; 95% CI, 0.01 to 0.20; P=0.03) and urine osmolality (β=0.08; 95% CI, 0.05 to 0.10; P<0.001). A positive association was found between the copeptin level and the presence of renal cysts (odds ratio, 1.6; 95% CI, 1.1 to 2.4; P=0.02). These results suggest that AVP has a pleiotropic role in renal function and may favor the development of simple renal cysts.

Comparison between Radiographic (2-dimensional and 3-dimensional) and Histologic Findings of Periapical Lesions Treated with Apical Surgery.

INTRODUCTION: The aim of this study was to evaluate the concordance of 2- and 3-dimensional radiography and histopathology in the diagnosis of periapical lesions. METHODS: Patients were consecutively enrolled in this study provided that preoperative periapical radiography (PR) and cone-beam computed tomographic imaging of the tooth to be treated with apical surgery were performed. The periapical lesional tissue was histologically analyzed by 2 blinded examiners. The final histologic diagnosis was compared with the radiographic assessments of 4 blinded observers. The initial study material included 62 teeth in the same number of patients. RESULTS: Four lesions had to be excluded during processing, resulting in a final number of 58 evaluated cases (31 women and 27 men, mean age = 55 years). The final histologic diagnosis of the periapical lesions included 55 granulomas (94.8%) and 3 cysts (5.2%). Histologic analysis of the tissue samples from the apical lesions exhibited an almost perfect agreement between the 2 experienced investigators with an overall agreement of 94.83% (kappa = 0.8011). Radiographic assessment overestimated cysts by 28.4% (cone-beam computed tomographic imaging) and 20.7% (periapical radiography), respectively. Comparing the correlation of the radiographic diagnosis of 4 observers with the final histologic diagnosis, 2-dimensional (kappa = 0.104) and 3-dimensional imaging (kappa = 0.111) provided only minimum agreement. CONCLUSIONS: To establish a final diagnosis of an apical radiolucency, the tissue specimen should be evaluated histologically and specified as a granuloma (with/without epithelium) or a cyst. Analysis of 2-dimensional and 3-dimensional radiographic images alike results only in a tentative diagnosis that should be confirmed with biopsy.

Retentiojärjestelmän optimointi kartonkikoneella

Diplomityössä tutkittiin kartonkikoneen retentiojärjestelmää ja eri mahdollisuuksia retention ja vedenpoiston tehostamiseen. Tavoitteena oli parantaa etenkin runkokerroksen retentiota ja vedenpoistoa. Työssä testattiin kilpailevan kemikaalitoimittajan mikropartikkelia kartonkikoneella. Lisäksi runkokerroksessa testattiin retentiotärkkelyksen vaikutus kartongin palstaumislujuuteen, suoritettiin käytössä olevan mikropartikkelin annostuksen optimointi sekä testattiin alunan käyttöä retentioainesysteemin tehoaineena. Kirjallisuusosassa tarkasteltiin pinta- ja kolloidikemian perusteita, retentioainejärjestelmiä ja niissä käytettäviä kemikaaleja sekä retentioaineilla tehtävään flokkaukseen vaikuttavia tekijöitä. Laboratoriokokeilla tutkittiin kokeellisessa osassa eri mikropartikkelijärjestelmien toimivuutta kartonkikoneen eri kerroksien massoilla. Toimivimmaksi osoittautuneella mikropartikkelilla suoritettiin pilot-koeajo runkokerroksen massalla. Lisäksi suoritettiin toinen pilot-koeajo, jossa tutkittiin mikropartikkelin vaikutuksia saostuman aiheuttajana. Pilot-koeajoissa saavutettiin samat retentiotasot kuin referenssisysteemillä lähes puolet pienemmällä kemikaalin kulutuksella. Kartongin laatuominaisuuksista huokoisuus, formaatio ja AKD-liiman retentio muuttuivat viiraretention mukaan. Saostumakoeajossa ei todettu retentioaineen vaikuttavan saostumien syntyyn. Täyden mittakaavan koeajossa tarkoituksena oli testata kilpailevan mikropartikkelin toimivuus kartonkikoneella. Koeajossa etsittiin optimaalinen mikropartikkelin annostus eri kerroksiin. Pintakerroksen tuhkaretentio nousi hiukan ja vedenpoisto parani. Runko- ja taustakerroksessa saavutettiin samat retentiotasot sekä vedenpoistot. Samat retentiotasot saavutettiin n. 25 % pienemmällä mikropartikkelin kulutuksella. Kartongin laatuominaisuuksista seurattiin palstautumislujuutta, formaatiota ja AKD-liiman retentoitumista. Kartongin palstautumislujuus heikkeni. Vastaavasti runko- ja taustakerroksen AKD-liiman retentio oli hiukan korkeampi koeajetulla mikropartikkelilla. Formaatiossa ei tapahtunut merkittäviä muutoksia. Jatkokokeet tehtiin kartonkikoneen runkokerroksessa. Kokeissa todettiin retentiotärkkelyksen vaikuttavan kartongin palstautumislujuuteen. Käytössä olevan mikropartikkelin annostelun optimointikokeissa ei saavutettu parannusta retentioon eikä vedenpoistoon. Mikropartikkelilla saavutetaan tietty retentiotaso, jonka jälkeen sillä ei ole enää vaikutusta retentiotasoon. Alunan annostelukokeissa ei alle yksi kg/t annosmäärällä ole vaikutusta retentioon ja vedenpoistoon.

Different locations of dermoid cysts in the orbital region.

BACKGROUND: Dermoid cysts are frequent unilateral congenital benign tumors that can be found at different locations throughout the body. In the orbital region, dermoid cysts occur predominantly in the supero-temporal quadrant. However, different orbital locations are possible, making this entity an important differential diagnosis for orbital tumors. PATIENTS AND METHODS: We retrospectively reviewed the charts of 23 consecutive patients operated in our institution between 2005 and 2014 for orbital tumors that were diagnosed as congenital dermoid or epidermoid cysts. RESULTS: There were 21 dermoid and 2 epidermoid cysts. The median age at surgery time was 7 years (range 1-41). There were 15 females and 8 males. Eleven cysts were located supero-temporally (47.8%), seven supero-medially (30.4%), two temporally (8.7%), one at the frontal bone (4.4%) and two in the fossa of the lacrimal gland (8.7%). The mean cyst diameter was 13.1 mm±5.0 (SD). None had signs of malignant disease. No recurrence was observed after complete excision. CONCLUSION: Dermoid cysts of orbital region are mostly located in the supero-temporal quadrant. However, other orbital locations are possible and dermoid cysts must thus be considered in the differential diagnosis of any mass in the orbital region.

When the spleen meets the fetus.

Patient's first pregnancy was complicated by mild thrombocytopenia caused by a 13-cm splenic cyst, who delivered vaginally without complication. Risks and management of maternal splenic cysts in pregnancy and delivery are reviewed here.

Magnetic resonance imaging findings of disc-related epidural cysts in nonsurgical and postoperative microdiscectomy patients

OBJECTIVE: To demonstrate five discal cysts with detailed magnetic resonance imaging findings in nonsurgical and following postoperative microdiscectomy. MATERIALS AND METHODS: Five discal cysts in four patients who underwent magnetic resonance imaging were found through a search in our database and referral from a single orthopedic spine surgeon. Computed tomography in two cases and computed tomography discography in one case were also performed. RESULTS: Five discal cysts were present in four patients. Three patients had no history of previous lumbar surgery and the other patient presented with two discal cysts and recurrent symptoms after partial laminectomy and microdiscectomy. All were oval shaped and seated in the anterior epidural space. Four were ventrolateral, and the other one was centrally positioned in the anterior spinal canal. One showed continuity with the central disc following discography. Three were surgically removed. CONCLUSION: Magnetic resonance imaging can easily depict an epidural cyst and the diagnosis of a discal cyst should be raised when an homogeneous ventrolateral epidural cyst contiguous to a mild degenerated disc is identified.

Prenatal diagnosis of Beckwith-Wiedemann syndrome by two- and three-dimensional ultrasonography

Beckwith-Wiedemann syndrome is a genetic syndrome characterized by macroglossia, omphalocele, fetal gigantism and neonatal hypoglycemia. The authors report a case of Beckwith-Wiedemann syndrome diagnosed in a 32-year-old primigravida in whom two-dimensional ultrasonography revealed the presence of abdominal wall cyst, macroglossia and polycystic kidneys. Three-dimensional ultrasonography in rendering mode was of great importance to confirm the previous two-dimensional ultrasonography findings.

The carpal boss: a review of different sonographic findings

Carpal boss is an uncommon condition whose incidence is underestimated and that is frequently confused with other causes of development of tumor-like lesions on the dorsum of the wrist. From the clinical point of view, the main obstacle to its recognition is the nonspecificity of symptoms, frequently attributed to dorsal ganglion cysts, since both conditions share a similar location on the dorsum of the wrist. The assessment by ultrasonography allows for a correct diagnosis and appropriate management, with better chances of resolution of the clinical complaint and lower probability of iatrogenic worsening of the lesion. The present review is aimed at describing the different sonographic findings of carpal boss.

Retrospective clinicopathological study of 418 odontogenic cysts

Objectives: To determine the relative incidence of odontogenic cysts and to identify the main clinicopathological features among patients treated in the Oral Surgery Department of the Dental Clinic of the University of Barcelona (Spain). Study design: A retrospective observational study was made of 418 odontogenic cysts diagnosed in 380 patients included in the database of 1235 histopathological diagnoses. The subjects were treated in the Master degree program of Oral Surgery and Implantology of the University of Barcelona in the period 1997-2006. The following variables were recorded: gender, age, clinical characteristics of the lesions (size and location), radiological features, duration, treatment, complications and relapses. A descriptive analysis was made of the study variables, using the SPSS version 15.0. Results: The incidence of odontogenic cysts was 33.8%. The mean patient age at appearance of the lesion was 42 years (range 7-83). The cysts were slightly more prevalent in males (58.4%). The lesion size ranged from 2-60 mm, with a mean size of 18.4 mm. The most frequent diagnosis was radicular cyst (50.2%). The most common location of the odontogenic cysts was in the mandible (61.5%), particularly the lower third molar region (36.8%). Conclusions: The most frequently diagnosed lesion was the radicular cyst. Odontogenic cysts were seen to be slightly more prevalent in males, and showed a high mandibular incidence. Knowledge of the biological and histological behavior of odontogenic cysts and their frequency are key aspects for ensuring early detection and adequate treatment.

O pKa de indicadores ácido-base e os efeitos coloidais

An experiment is proposed that can be included in undergraduate courses of chemistry. The subject is the acidity of organic compounds, which are employed as pH indicators, particularly in acid-base titrations. The indicators used are methyl orange, bromophenol blue and bromocresol green in aqueous medium. The influence of colloidal systems on the equilibrium is evaluated by the pKa. The colloids employed are surfactants like sodium dodecyl sulfate, cetyl-trimethylammonium bromide and a polymeric non-ionic F127 (pluronics). The effect of stabilization promoted by the system on the acidic or basic structureof the indicator establishes the action mechanism of the colloid on the pKa values.