Acromegaly

Acromegaly is an acquired disorder related to excessive production of growth hormone (GH) and characterized by progressive somatic disfigurement (mainly involving the face and extremities) and systemic manifestations. The prevalence is estimated at 1:140,000–250,000. It is most often diagnosed in middle-aged adults (average age 40 years, men and women equally affected). Due to insidious onset and slow progression, acromegaly is often diagnosed four to more than ten years after its onset. The main clinical features are broadened extremities (hands and feet), widened thickened and stubby fingers, and thickened soft tissue. The facial aspect is characteristic and includes a widened and thickened nose, prominent cheekbones, forehead bulges, thick lips and marked facial lines. The forehead and overlying skin is thickened, sometimes leading to frontal bossing. There is a tendency towards mandibular overgrowth with prognathism, maxillary widening, tooth separation and jaw malocclusion. The disease also has rheumatologic, cardiovascular, respiratory and metabolic consequences which determine its prognosis. In the majority of cases, acromegaly is related to a pituitary adenoma, either purely GH-secreting (60%) or mixed. In very rare cases, acromegaly is due to ectopic secretion of growth-hormone-releasing hormone (GHRH) responsible for pituitary hyperplasia. The clinical diagnosis is confirmed biochemically by an increased serum GH concentration following an oral glucose tolerance test (OGTT) and by detection of increased levels of insulin-like growth factor-I (IGF-I). Assessment of tumor volume and extension is based on imaging studies. Echocardiography and sleep apnea testing are used to determine the clinical impact of acromegaly. Treatment is aimed at correcting (or preventing) tumor compression by excising the disease-causing lesion, and at reducing GH and IGF-I levels to normal values. Transsphenoidal surgery is often the first-line treatment. When surgery fails to correct GH/IGF-I hypersecretion, medical treatment with somatostatin analogs and/or radiotherapy can be used. The GH antagonist (pegvisomant) is used in patients that are resistant to somatostatin analogs. Adequate hormonal disease control is achieved in most cases, allowing a life expectancy similar to that of the general population. However, even if patients are cured or well-controlled, sequelae (joint pain, deformities and altered quality of life) often remain

Liver transplantation for hepatic epithelioid hemangioendothelioma

peer reviewedL’hémangioendothéliome épithélioïde est une affection maligne rare qui peut survenir dans le foie. Lorsque la forme est multifocale et bilobaire, la transplantation hépatique constitue le traitement curateur de cette affection. Dans cet article, les auteurs décrivent le diagnostic et le traitement d’une femme de 52 ans souffrant d’un hémangioendothéliome épithélioïde hépatique traitée par transplantation du foie

Immunological and Hematological Aspects of Hiv Infection

peer reviewe

Paradox: when a prothrombotic disorder is responsible for an upper gastrointestinal bleeding. Case report of hepatoportal sclerosis

peer reviewedVariceal bleeding is frequently the initial presentation of a previously unknown cirrhosis. Portal hypertension and its complications without liver cirrhosis should raise the possibility of presinusoidal portal hypertension, and the diagnosis of hepatoportal sclerosis. These patients need to be investigated for coagulation disorders. A hypercoagulable state is often associated. Risks and benefits of anticoagulation should be further investigated in these patients

(A)thermal migration of Ge during junction formation in s-Si layers grown on thin SiGebuffer layers

ABSTRACTSolid phase epitaxial regrowth (SPER) has been proven to be highly advantageous for ultra shallow junction formation in advanced technologies. Application of SPER to strained Si/SiGe structures raises the concern that the Ge may out diffuse during the implantation and/or anneal steps and thus reduce the strain in the top silicon layer.In the present studies we expose 8-30 nm strained silicon layers grown on thin relaxed SiGe-buffers, to implant conditions and anneal cycles, characteristic for formation of the junctions by solid phase epitaxial regrowth and conventional spike activation. The resulting Geredistribution is measured using SIMS. Based on the outdiffused Ge-profiles the Ge-diffusion coefficient has been determined in the temperature range of 800-1100C from which an activation energy of ∼ 3.6 eV can be deduced. Up to 1050 C, 10 min, even a 30 nm strained film remains highly stable and shows only very moderate outdiffusion.We also have observed a far more efficient, athermal Ge-redistribution process linked to the implantation step itself. This was studied by analysing the Ge-redistribution following an Asimplant (2-15 keV, 5 1014 – 3 1015 at/cm2). It is shown that the energy of the implant species (or more specifically the position of the damage distribution function relative to the Ge-edge) plays a determining factor with respect to the Ge-migration. For implants whereby the damage distribution overlaps with the Ge-edge, a very efficient transport of the Ge is observed, even prior to any anneal cycle. The migration is entirely correlated with the collision cascade and the resulting (forward!) Ge-recoil distribution. The scaling with dose for a given energy links the observed Ge-profile with a broadening mechanism related to the number of atom displacements induced in the sample within the vicinity of the Si-SiGe-transition.</jats:p