Fetal dose reduction in head and neck radiotherapy of a pregnant woman.

BACKGROUND AND PURPOSE: A pregnant woman was referred for post-operative radiotherapy of a malignant schwannoma in the head and neck region. A best-treatment plan was devised in order to minimize the fetal dose. MATERIAL AND METHODS: The fetal dose resulting from radiological examinations was determined according to international protocols, that resulting from radiotherapy was calculated according to Recommendation 36 of the American Association of Physicists in Medicine (AAPM) Task Group. Pre-treatment dosimetry was performed with an anthropomorphic phantom. Several alternative treatment plans were evaluated. The use of a multileaf collimator (MLC) and a virtual wedge (VW) was compared to cerrobend blocks (CB) and physical wedge (PW). In-vivo dosimetry was performed using a vaginal probe containing thermoluminescent dosimeters (TLD). RESULTS: The total fetal dose resulting from diagnostic and radiotherapy procedures was estimated to be 36 mGy. The technique based on MLC and VW was elected for patient treatment. Measurements for this configuration resulted in afetal dose reduction of 82%. The shielding of the patient's abdomen further reduced the fetal dose by 42%. CONCLUSION: The use of VW and MLC for the treatment of a pregnant woman is highly recommended. Each case should be individually studied with pre-treatment and in-vivo dosimetry.

Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis--the role of routine abdominal drainage.

Complicated acute appendicitis is still associated with an increased morbidity. If laparoscopy has been accepted as a valid approach, some questions remain concerning intra-abdominal abscess formation. Routine prophylactic drainage of the abdomen has been proposed. However, this practice remains a matter of debate, poorly validated in the literature. With the present study, we investigated the impact of drainage in laparoscopic appendectomy for complicated appendicitis. This is a case match study of consecutive patients operated on by laparoscopy in a single institution. One hundred and thirty patients operated for complicated appendicitis (local peritonitis without perforation, with perforation, or with periappendicular abscess) with prophylactic intraperitoneal drainage were matched one by one to 130 patients operated without drainage. Uncomplicated appendicitis and generalized peritonitis were excluded. Primary endpoint was surgical complications and secondary endpoints were transit recovery time and length of hospital stay. Patients without drain had significantly less overall complications (7.7% vs. 18.5%, p = 0.01). Moreover, the absence of drainage was of significant benefit for transit recovery time (2.5 vs. 3.5 days, p = 0.0068) and length of hospital stay (4.2 vs. 7.3 days, p < 0.0001). No benefits were observed for prophylactic drainage of the abdominal cavity during emergency laparoscopic treatment of complicated appendicitis. For this reason, this practice may be abandoned.

A new species of Giovanella Bonatto (Diptera, Calliphoridae, Mesembrinellinae) from Colombia

A new species of Giovanella Bonatto (Diptera, Calliphoridae, Mesembrinellinae) from Colombia. The Mesembrinellinae are exclusively Neotropical, with 33 nominal species distributed in nine genera. Only the genera Mesembrinella, Eumesembrinella, Huascaromusca and Laneella had until now been recorded in Colombia. In this work we present a new species of Giovanella Bonatto, 2005, genus with only one species, G. bolivar Bonatto, differing from the new species G. carvalhoi sp. nov., in the characters: legs entirely dark chestnut; thorax with dorsocentrals setae 1:2; abdomen with T5 with discal bristles poorly differentiated; T6 symmetric and paraphallus not extended and with denticules. Giovanella carvalhoi sp. nov. is from Cordillera Oriental, from the Departments of Caquetá (Amazonian foothills) and Santander, Colombia, collected between 22002400 m., and associated with decomposing organic matter. A key for the identification of males and females of the two species of Giovanella, illustrations of the genitalia and photographs of male and female of new species are also presented.

External morphology of the adult of Dynamine postverta (Cramer) (Lepidoptera, Nymphalidae, Biblidinae) and patterns of morphological similarity among species from eight tribes of Nymphalidae

External morphology of the adult of Dynamine postverta (Cramer) (Lepidoptera, Nymphalidae, Biblidinae) and patterns of morphological similarity among species from eight tribes of Nymphalidae. The external structure of the integument of Dynamine postverta postverta (Cramer, 1779) is based on detailed morphological drawings and scanning electron microscopy. The data are compared with other species belonging to eight tribes of Nymphalidae, to assist future studies on the taxonomy and systematics of Neotropical Biblidinae.

Estudio prospectivo de sintomatología visual positiva en fase aguda de ictus: incidencia y características.

Desconocemos los mecanismos fisiopatológicos subyacentes a la aparición de alucinaciones/alucinosis visual en pacientes con ictus, su incidencia, características y valor predictivo topográfico o pronóstico. En este trabajo estudiamos prospectivamente 78 pacientes con ictus isquémico/hemorrágico agudo y ausencia de enfermedad neurodegenerativa/psiquiátrica basal o clínica alucinatoria previa, administrándoles cuestionario estandarizado sobre alucinaciones/alucinosis visual y realizándoles prueba de neuroimagen. Un subgrupo de pacientes también cuenta con EEG y evaluación neuropsicológica. La incidencia de alucinaciones/alucinosis fue del 16,7%, siendo la mayoría imágenes complejas, con presentación precoz y curso autolimitado. Se asoció con lesiones occipitales, defecto campimétrico inicial, y alteraciones del sueño entre otras variables.

Aspectos biológico - pesqueros del Camaroncito Rojo Pleuroncodes monodon (M Edwards, 1837) en el litoral peruano

Se analizaron algunos parámetros poblacionales de 11 583 ejemplares del Pleuroncodes monodon (CRUSTACEA: ANOMURA: GALAYHEIDAE) distribuidos en 5 860 (52%) ejemplares machos y 5723 (48%) ejemplares hembras, las muestras se obtuvieron de los lances de comprobación de los cruceros de evaluación tanto para recursos pelágicos y demersales ejecutados por el Instituto del Mar del Perú (IMARPE) entre febrero y noviembre del 2001, la zona de estudio estuvo comprendida entre Puerto Pizarro (03°29,1’ S; 80°23,0’ W) hasta Los Palos (18°20,18’ S; 70°22,5’ W). La presencia del Pleuroncodes monodon respecto a su distribución batimétrica abarcó entre 1,5 y 300 m. De profundidad. La distribución total de tallas fluctuó entre 6,0 y 42,4 mm de longitud cefalotoráxica (Lc) y entre 6,0 y 41,1 mm de Lc para machos y hembras respectivamente. Por estaciones la estructura por tallas fue variable denotándose dos marcados grupos de talla, predominando un primer grupo los denominados ”juveniles” de (de 6 hasta 20 mm de Lc), sin embargo aquellos ejemplares con longitud cefalotoráxica menor a los 13 mm se registraron mayormente en las estaciones de verano y primavera, mientras un segundo grupo perteneciente a los de talla intermedia denominados “adultos jóvenes” registrados en todas las estaciones. Su distribución horizontal fue mayormente costera; aunque su presencia fue hasta más de las 50 millas náuticas (mn) de la costa; sin embargo los mayores registros de este recurso fue dentro de las 25 mn de la costa, en cuanto a los ejemplares “juveniles” su presencia fue marcada dentro de las 10 mn de la costa. La composición sexual de la población muestreada varió durante el periodo de estudio obteniéndose una razón promedio de 1,02 (machos/hembras). Además se encontraron hembras con huevos en todo el periodo de estudio, sin embargo los altos porcentajes de hembras ovígeras se registraron entre las estaciones de invierno (70%) y primavera (68%) del total. La talla de madurez sexual en las hembras fue de 18,8 mm Lc, mientras que el primer desove en 17,4 mm de Lc. Al registrarse hembras ovígeras en todo el año, existe un periodo anual de postura (liberación de los huevos eclosionados), detectándose éste en la estacón de primavera. La relación longitud cefalotoráxica vs Fecundidad, está determinada por la ecuación: NHT 0,1899 Lc2,9883 Además se analizaron los siguientes parámetros: largo cefalotoráxico, peso total, peso del abdomen, características de los huevos. Complementándose tales evaluaciones con determinaciones de áreas de distribución y concentración, así como la relación de los factores: abióticos (temperaturas, salinidad y oxígeno) y bióticos en relación a predadores y competidores dentro de la cadena trófica.

Positive contrast MR-lymphography using inversion recovery with ON-resonant water suppression (IRON).

PURPOSE: To investigate the utility of inversion recovery with ON-resonant water suppression (IRON) to create positive signal in normal lymph nodes after injection of superparamagnetic nanoparticles. MATERIALS AND METHODS: Experiments were conducted on six rabbits, which received a single bolus injection of 80 mumol Fe/kg monocrystalline iron oxide nanoparticle (MION-47). Magnetic resonance imaging (MRI) was performed at baseline, 1 day, and 3 days after MION-47 injection using conventional T(1)- and T(2)*-weighted sequences and IRON. Contrast-to-noise ratios (CNR) were measured in blood and in paraaortic lymph nodes. RESULTS: On T(2)*-weighted images, as expected, signal attenuation was observed in areas of paraaortic lymph nodes after MION-47 injection. However, using IRON the paraaortic lymph nodes exhibited very high contrast enhancement, which remained 3 days after injection. CNR with IRON was 2.2 +/- 0.8 at baseline, increased markedly 1 day after injection (23.5 +/- 5.4, P < 0.01 vs. baseline), and remained high after 3 days (21.8 +/- 5.7, *P < 0.01 vs. baseline). CNR was also high in blood 1 day after injection (42.7 +/- 7.2 vs. 1.8 +/- 0.7 at baseline, P < 0.01) but approached baseline after 3 days (1.9 +/- 1.4, P = NS vs. baseline). CONCLUSION: IRON in conjunction with superparamagnetic nanoparticles can be used to perform 'positive contrast' MR-lymphography, particularly 3 days after injection of the contrast agent, when signal is no longer visible within blood vessels. The proposed method may have potential as an adjunct for nodal staging in cancer screening.

Intel·ligència competitiva en la gestió de recursos de talent (RRT)

Les organitzacions afronten una nova era industrial, la era de la Societat del Coneixement. Als recursos clàssics necessaris per mantenir-se competitiu en un mercat cada cop més exigent (RRHH, recursos naturals, recursos financers, etc.), s'hi ha afegit el recurs del coneixement, associat a les persones que tenen la capacitat d'aportar un elevat valor afegit a les organitzacions. Aquestes persones amb aptitud, actitud i sensibilitat per actuar amb intel·ligència són recursos de talent (RRT) i han de considerar-se un factor clau per qualsevol organització. L'estudi dut a terme sobre l'estat de l'art de la gestió de RRT evidencia la manca d'estratègies en aquest sentit. A més a més, s'han detectat alguns aspectes millorables en l'actual percepció entre informació-empresa. Per tots aquests motius, s'ha dut a terme una nova proposta per entendre la relació informacióempresa i s'ha desenvolupat un model de vigilància de RRT, que hauria de quedar integrat en l'estratègia de Gestió del Coneixement de qualsevol organització. L'estudi inclou també la presentació d'algunes eines de vigilància d'informació, fent incís en les eines de cerca d'informació a Internet, per la seva creixent rellevància. Aquesta nova situació industrial presentarà noves oportunitats de negoci relacionades amb la gestió de RRT, així com obrirà possiblement nous debats ètics sobre la conveniència o no, d'entendre les persones com a un recurs més per a les organitzacions.

Tabagisme, obésité et diabète: une interaction cliniquement importante [Smoking, obesity and diabetes: a clinically important interaction].

Smoking, obesity and diabetes are among the leading cause of premature death worldwide. Smokers have globally a lower body weight compared with non smokers but they tend to accumulate more fat in the abdomen. Most smokers gain weight when they quit smoking, however this does not seem to diminish the health benefits associated with smoking cessation. Smoking increases the risk of developing type 2 diabetes. Among people with diabetes, smoking significantly increases the risks of complications and mortality. Interventions with pharmacologic help should be offered to all smokers, with or without diabetes, in order to increase smoking cessation rates and limit weight gain.

Identificação e implicações para a conservação do solo das fontes de sedimentos em bacias hidrográficas

Os sedimentos oriundos de áreas agrícolas são importante fonte de poluentes para os ecossistemas aquáticos. Existem várias fontes de sedimentos na escala de uma bacia hidrográfica rural, como lavouras, pastagens, florestas, rede fluvial e estradas. Cada uma tem características diferentes na magnitude de contribuição e potencial de contaminação. Identificar a origem dos sedimentos é fundamental na compreensão da taxa de emissão de sedimentos e no manejo dos sedimentos erodidos na escala de bacia. Este trabalho foi desenvolvido com o propósito de identificar as principais fontes de sedimentos de duas bacias rurais de cabeceira no Sul do Brasil, as quais são representativas do sistema agrário e das características fisiográficas da região. A metodologia utiliza a comparação entre os solos de diferentes fontes e os sedimentos em suspensão, usando traçadores naturais. A análise discriminante encontrou um grupo de variáveis capazes de distinguir as fontes de sedimentos. Com base na análise de classificação, as contribuições relativas de cada fonte nas bacias de Agudo e Arvorezinha foram, respectivamente: lavouras (68,3 e 55,5 %), estradas (28,1 e 37,6 %) e rede fluvial (3,6 e 6,9 %). Os resultados mostram que, além da contribuição predominante das lavouras, as erosões nas estradas e na rede fluvial contribuem significativamente para produção total de sedimentos nas bacias, demonstrando a importância dessa informação para controle da erosão do solo e manejo dos sedimentos na escala de bacia hidrográfica.

Achondrogenesis Type 1B.

DISEASE CHARACTERISTICS: Clinical features of achondrogenesis type 1B (ACG1B) include extremely short limbs with short fingers and toes, hypoplasia of the thorax, protuberant abdomen, and hydropic fetal appearance caused by the abundance of soft tissue relative to the short skeleton. The face is flat, the neck is short, and the soft tissue of the neck may be thickened. Death occurs prenatally or shortly after birth. DIAGNOSIS/TESTING: The diagnosis of ACG1B rests on a combination of clinical, radiologic, and histopathologic features. SLC26A2 (DTDST) is the only gene known to be associated with ACG1B. Molecular genetic testing is available on a clinical basis. MANAGEMENT: Treatment of manifestations: palliative care for liveborn neonates. GENETIC COUNSELING: ACG1B is inherited in an autosomal recessive manner. At conception, each sib of a proband with ACG1B has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Once an at-risk sib is known to be unaffected, the risk of his/her being a carrier is 2/3. Carrier testing for at-risk relatives and prenatal testing for pregnancies at increased risk are possible if both disease-causing alleles in the family are known and the carrier status of the parents has been confirmed. Ultrasound examination after 14-15 weeks' gestation can be diagnostic.

Adsorção de fósforo em sedimentos e sua relação com a ação antrópica

A avaliação do teor de P total e solúvel nas águas superficiais é insuficiente para o diagnóstico do seu potencial poluidor. O objetivo deste trabalho foi avaliar as frações de P e as propriedades relacionadas com a liberação de P de sedimentos erodidos de unidades paisagísticas com diferentes graus de ação antrópica. As amostragens de água+sedimentos foram realizadas em duas unidades paisagísticas de uma sub-bacia da pequena bacia hidrográfica do Arroio Lino, Agudo, RS, Brasil. Avaliaram-se pH, concentração de sedimentos, C orgânico total, granulometria, Fe extraído por DCB (Fe d) e oxalato (Fe ox), P solúvel (Ps), P total (Pt), P particulado biodisponível (Ppb), P particulado potencialmente biodisponível (Pppb) e teor de fosfato dessorvido com água destilada (Q0). Foram estimadas a capacidade máxima de adsorção de fosfato (Pmax), a concentração de equilíbrio de fosfato (CEP) e a constante relacionada com a energia de ligação de fosfato (k). Sedimentos erodidos de áreas mais antropizadas, comparativamente às áreas menos antropizadas, apresentaram: maior concentração de Pt, Pppb e menor quantidade de Ppb; maior Pmax e valor de k dessorveram menores quantidades de P em água destilada e mantiveram menor CEP, indicando maior potencial poluidor, especialmente em ambientes semelhantes.

Clinical value of immunoscintigraphy in colorectal carcinoma patients: a prospective study.

Fifty-seven patients with suspected CEA-producing tumors were studied prospectively by radioimmunoscintigraphy (RIS) using a 123I-labeled anti-CEA monoclonal antibody (MAb) (essentially the F(ab')2 or Fab fragments) and emission computed tomography (ECT). Results of RIS were compared to those of a comprehensive diagnostic study. Final diagnosis was based on surgery, biopsy and autopsy (n = 39) or follow-up findings (n = 18). Three groups of patients were defined: Group A with suspected primary tumors (n = 11), Group B with probable (n = 19) and Group C with questionable (n = 27) tumor relapse. Eighty-eight per cent, 93% and 71% of the anatomic regions studied were correctly identified as being involved, and 97%, 97%, and 87% as being free from tumor in Groups A, B, and C, respectively. In the 27 patients from Group C with no definite diagnosis of relapse, and in whom diagnosis was most difficult, 38 tumor sites were involved. Of these, 21 were detected by both prospective RIS and repeated comprehensive study, six by RIS only and seven by conventional methods only. Four sites remained undetected by both approaches. Ten of the 21 lesions were detected by RIS more than 1 mo earlier than by any other method. Among the seven tumor sites detected by other diagnostic modalities only, three were identified at the time of RIS and four became positive more than 6 mo later. Overall diagnosis was entirely correct in 30, partially correct in 16 and incorrect in six patients studied. RIS with ECT and 123I-labeled anti-CEA MAb allows early detection of recurrence or metastasis of colorectal cancer. It thus contributes to reduced delay between diagnosis and treatment.