Can adrenal incidentalomas be safely observed?

We currently recommend excision of adrenal incidentalomas > or = 4 cm in size and all hormonally active tumors. The optimal management and follow-up of smaller nonfunctioning tumors are controversial. The aim of this study was to determine the clinical outcome of a well defined population of patients with incidentalomas followed without operative intervention. The study group comprised 231 patients, identified from the records of abdominal or thoracic computed tomographic (CT) scans performed between 1985 and 1989. The primary outcome variable analyzed was survival. Follow-up was obtained by office records, telephone contact, or letter. There were 101 male and 130 female patients with a mean age at diagnosis of 64 years (range 5-86 years). Most adrenal tumors were unilateral (right 113; left 98); 20 were bilateral. Mean tumor size was 2 cm (range 1-6 cm). In nine (4%) patients the tumor was > or = 4 cm. Follow-up [mean 7 years; range 1 month (patient died) to 11.7 years] was complete in 224 (97%) patients. Ninety-one (39%) patients had one or more additional CT scans performed during the follow-up period, with only four patients demonstrating a > 1 cm increase in the size of the adrenal mass. Surgical excision of these four lesions identified benign pathology. Eighty-one (35%) patients died of conditions unrelated to adrenal pathology. No patient developed subsequent adrenal hyperfunction or adrenal malignancy. Within the context of our guidelines, conservative management of adrenal incidentalomas considered benign or nonfunctioning at diagnosis is appropriate. Additional information provided by repeat CT scanning appears to confer limited benefit. This study does not support laparoscopic removal of small, nonfunctional adrenal tumors, as has been suggested.     

Accuracy of single-photon emission computed tomography myocardial perfusion imaging in patients with stents in native coronary arteries

Strategies to noninvasively evaluate patients after coronary stenting have not been evaluated. To determine the accuracy of single-photon emission computed tomography (SPECT) myocardial perfusion imaging in patients after coronary stenting, 209 patients who had undergone stenting followed by late stress SPECT myocardial perfusion imaging were evaluated. Quantitative coronary angiography was performed in 33 patients following SPECT imaging. SPECT restenosis was defined as a reversible or fixed defect within the stented vascular territory. Angiographic restenosis was examined using 2 definitions: total area narrowing > or =50% or > or =70% of the stent site or stented artery. The SPECT and angiographic findings were concordant in 22 of 33 stented vascular territories using the 50% definition of restenosis and in 29 of 33 stented territories using the 70% definition. Use of the 70% definition of restenosis resulted in improved accuracy of SPECT to detect a significant stenosis in the stented artery. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SPECT were 95%, 73%, 88%, 89%, and 88% respectively. In patients with positive SPECT scans, the most significant stenosis in the stented artery was outside the stent site in 50% of cases. SPECT imaging appears to be accurate to predict significant stenosis in the stented artery, although the most severe stenosis is frequently distant from the stent site.     

Management of chylothorax

BACKGROUND: Chylothorax is a rare primary or secondary condition the optimum management of which remains uncertain. METHODS: Twenty cases of chylothorax, including ten of primary chylothorax and ten secondary to either malignancy, subclavian vein thrombosis or lymphangioma treated between 1956 and 1986 have been reviewed. RESULTS: Open pleurectomy was the most successful treatment in preventing reaccumulation of the effusion. Three patients had thoracic duct-azygous vein anastomoses, but all anastomoses were probably occluded within a year of surgery. Three patients have been lost to follow-up and five died within 2 years of their treatment, but 12 patients were alive and free from an effusion 3-22 years after treatment. CONCLUSION: Patients with chylothorax should undergo lymphangiography to identify the cause and site of the lymphatic abnormality. Conservative treatment is successful in some patients but should be abandoned if the fluid loss exceeds 1.5 l/day for more than 5-7 days in an adult or more than 100 ml/day in a child. Parietal pleurectomy is the most successful treatment when no distinct chylous leak can be identified. Less commonly, an isolated chylous leak either in the chest or in the abdomen may be identified and this should be treated by direct ligation.     

Role of diameter differences among follicles in selection of a future dominant follicle in mares

Follicles > or = 5 mm were ablated in pony mares by a transvaginal ultrasound-guided technique on Day 10 (ovulation = Day 0). Follicle emergence (at 15 mm, experiment 1; at 6 mm, experiment 2) and development of the new wave was monitored by transrectal ultrasound. Deviation was defined as the beginning of a marked difference in growth rates between the two largest follicles. In experiment 1, mares were grouped (n = 4 per group) into controls, ablation-controls (ablations at Day 10 only), and a two-follicle model (periodic ablation sessions so that only the two largest follicles developed). There were no significant indications that the two-follicle model altered follicle diameters, growth rates, or time intervals of the two retained follicles at or between events (follicle emergence, deviation, and ovulation). In experiment 2, the two-follicle model (n = 14) was used for follicle and hormonal characterization and hypothesis testing, without the tedious and error-prone necessity for tracking many (e.g., 20) individual follicles. The future dominant follicle emerged a mean of 1 day earlier (p < 0.008) than the future subordinate follicle, the growth rates for the two follicles between emergence and deviation (6 days later) did not differ, and the dominant follicle was larger at the beginning of deviation (23.1 +/- 0.8 mm versus 19.6 +/- 0.9 mm; p < 0.0001). Mean FSH and LH concentrations increased (p < 0.05) concomitantly from emergence of the future dominant follicle and peaked 3 days later when the follicle was a mean of 13 mm. Thereafter, the two hormones disassociated until ovulation: FSH decreased and LH increased. Results supported the hypothesis that the future dominant follicle has an early size advantage over future subordinate follicles and indicated that the advantage was present as early as 6 days before deviation.     

Carbon nanotubes: are they dispersed or dissolved in liquids?

Carbon nanotubes (CNTs) constitute a novel class of nanomaterials with remarkable applications in diverse domains. However, the main intrincsic problem of CNTs is their insolubility or very poor solubility in most of the common solvents. The basic key question here is: are carbon nanotubes dissolved or dispersed in liquids, specifically in water? When analyzing the scientific research articles published in various leading journals, we found that many researchers confused between "dispersion" and "solubilization" and use the terms interchangeably, particularly when stating the interaction of CNTs with liquids. In this article, we address this fundamental issue to give basic insight specifically to the researchers who are working with CNTs as well asgenerally to scientists who deal with nano-related research domains.Among the various nanomaterials, CNTs gained widespread attention owing to their exceptional properties, good chemical stability, and large surface area [1,2]. CNTs are extremely thin tubes and feature an extremely enviable combination of mechanical, thermal, electrical, and optical properties. Their size, shape, and properties construct them as prime contenders for exploiting the growth of a potentially revolutionary material for diverse applications.Nevertheless, the main intrinsic drawback of CNTs is their insolubility or extremely poor solubility in most of the common solvents due to their hydrophobicity, thus creating it tricky to explore and understand the chemistry of such material at the molecular level and device applications. Though diverse approaches [3] have been introduced to improve the dispersion of CNTs in different solvents including water, challenges still remain in developing simple, green, facile, and effective strategies for a large-scale production of CNT dispersions. To this end, in many studies a wide range of agents have been used. To give a few examples: solvents [4], biopolymers [5], and surfactants [6]. Meanwhile, when analyzing the scientific research articles published in various leading journals, regarding the dispersion of CNTs, it is really puzzling owing to the usage of different terminologies with respect to the dispersion of CNTs. Most of the studies indicated "dispersion"; however, considerable quantities of articles were published with the term "solubilization", which can be evidently seen from the literature analysis [7]. Hence, many researchers confound "dispersion" and "solubilization" and use the terms interchangeably, especially when describing the interaction of CNTs with solvents. Many scientists have mentioned that CNTs can be "solubilized in water or organic solvents" by means of polymers and/or surfactants, which is ambiguous. It is evident that there is, as a result of that, a lot of confusion regarding this fundamental matter. The basic and fundamental key question here is: are CNTs dissolved or dispersed in a liquid?Basically, "dispersion" and "solubilization" are different phenomena. Dispersion and solubilization can be defined as "a system, in which particles of any nature (e.g., solid, liquid, or gas) are dispersed in a continuous phase of a different composition (or state)" [8] and a "process, by which an agent increases the solubility or the rate of dissolution of a solid or liquid solute" [9], respectively. Hence, in general, the dispersion of solute particles in solvents leads to the formation of colloids or suspensions, and solutions may be obtained as a result of solubilization of solute molecules or ions in the specified solvent. Furthermore, dispersion is mostly related to solute particles, whereas solubility or solubilization is generally connected with solute molecules or ions.The main differences between a colloid and a solution are: A solution is homogenous and remains stable and does not separate after standing for any period of time. Further it cannot be separated by standard separation techniques such as filtration or centrifugation. A solution looks transparent and it can transmit the light. Also, solutions contain the solute in a size at the molecular or ionic level, typically less than 1 nm or maximum a few nm in all dimensions. A colloid is a mixture with particles sizes between 1 and 1000 nm in at least one dimension. It is opaque, non-transparent, and the particles are large enough to scatter light. Colloids are not as stable as solutions and the dispersed particles (comparatively larger-sized particles) may be conveniently separated by standard separation techniques such as (ultra)centrifugation or filtration. Frequently, dispersed particles in colloidal systems may slowly agglomerate owing to inter-particle attractions over prolonged periods of time and, as a result, colloidal dispersions may form flocs or flakes.As far as CNTs are concerned, even though the diameter of the tubes is in the nanometer range (approximately between 0.4 and 3 nm for single-walled carbon nanotubes, and 1.4 and 100 nm for multi-walled carbon nanotubes) [10], their length can be up to several micrometers to millimeters. Further, it is a well-known fact that CNTs are not equal in size with respect to both diameter and length. Hence, the result of dispersion techniques mostly used and adopted to produce well-dispersed CNTs in either aqueous and/or organic media are typically dispersions of differently sized tubes. Consequently, based on the definition [6,7] and the abovementioned points, the mixture of CNTs and water or organic solvents, whether in the presence or non-presence of dispersing agents such as surfactants or polymers, is just a colloidal dispersion and not a solution. Figure ​Figure11 shows the schematic illustration for the formation of dispersed CNTs in a liquid with the aid of a dispersing agent. Simultaneously, the dispersion can result in a debundling or individualization of the bundled CNTs.Open in a separate windowFigure 1Schematic showing the transition of the bundled to the individualized, dispersed state of carbon nanotubes in a liquid with the aid of a dispersing agent.Therefore, "solubilization" is a process to achieve a stable solution, whereas "dispersion" is a form of colloidal system. Here we conclude that the mixture obtained by using CNTs and a liquid medium (water or organic solvents) with or without surfactants or polymers is a dispersion of CNTs in the medium, but not a solution. Further, in our opinion, one cannot solubilize CNTs in water or organic solvents. Hence, we recommend to restrict the use of the term "solubilization" or "solution," instead we should use the term "dispersion" or "colloid," when dealing with CNTs. Further, we think that this should be also applicable for nanoparticles of comparable dimensions such as metal and metal oxide nanoparticles, polymer nanoparticles, etc., if the criteria of the definitions given above are fulfilled.In short, the term "dispersion" should exclusively be used as far as CNTs are concerned, and the use of the term "solution" should be avoided or restricted.     

Effect of phase maldistribution on performance of two-phase catalytic monolith reactor and its comparison with trickle bed reactor

Monolith reactors are widely considered as an alternative to the conventional trickle bed reactor. For the commercial deployment of monolith reactors, comparative performance studies are required. Reliable comparative and performance studies require a detailed understanding of the effect of phase distribution/maldistribution on the performance studies. In this work, performance and comparative studies were carried out in a relatively large column that was 4.8 cm in diameter. Experiments were performed in the same conditions that were used in studies for which phase distribution data were available. Since the properties of the catalyst used were different in both the reactors, the apparent kinetics were studied to facilitate the comparison. The hydrogenation of alpha-methyl styrene (AMS) was used as a test reaction. From the performance studies, it was found that the effect of maldistribution on the performance was stronger than the catalyst availability. From the comparative studies, it was found that the monolith reactor with maldistributed flow conditions provides higher productivity than the trickle bed reactor.     

Activation of protein kinase C modulates cell-cell and cell-substratum adhesion of a human colorectal carcinoma cell line and restores 'normal' epithelial morphology

Abnormal cell adhesion is an important contributing factor in invasion and metastasis. Here, we show that morphologically 'normal' cell-cell and cell-substratum adhesion can be restored to a poorly differentiated carcinoma cell line by activation of protein kinase C (PKC). This cell line, VACO 10MS, grows as multicellular aggregates loosely attached to the substratum. The phorbol ester 12-O-tetradecanoylphorbol-13-acetate (TPA, 7.5 nM) induces rapid adhesive changes with 2 components. First, within 15 min of TPA the cells become closely apposed, an event resembling the 'compaction' seen in the mouse early embryo. Next, over 2 hr, the cells spread, forming a monolayer. We show that compaction depends on extracellular calcium, E-cadherin-mediated adhesion and F-actin but not on protein synthesis, microtubules or substratum adhesion. By contrast, cell spreading is independent of cadherin and extracellular Ca2+ but involves the formation of focal contacts containing alpkha(v) integrin. TPA treatment causes rapid translocation of PKC-alpha to the insoluble fraction. During compaction, actin- and PKC-alpha-containing lamellae form over the entire aggregate surface, those adjacent to the substratum appearing to initiate spreading. Compaction does not involve increased phosphorylation of the cadherin/catenin complex. We conclude that activation of PKC-alpha restores 'normal' morphology to these poorly differentiated cells. Our results are of general interest in relation to the regulation of cell adhesion and, through further investigation, may lead to identification of novel targets for therapeutic suppression of invasion and metastasis.