The impact of slow steaming on the carriers’ and shippers’ costs: The case of a global logistics network

We propose an analytical modeling methodology for quantifying the impact of slow steaming on the carrier's voyage cost and on the shipper's total landed logistics costs. The developed methodology can be employed by a carrier and a shipper in their contract negotiations, in order for the two parties to determine how they could divide between them the savings resulted from slow steaming. We demonstrate that the impact of slow steaming and speed adjustment policies on the shippers’ total landed logistics costs tend to increase as the vessel travels towards the end of its voyage

Do the New Data on Second-Generation Drug Eluting Stents Provide Reassurance on Safety, Efficacy, Even for Off-Label Use?

In in-stent restenosis, drug-eluting stents (DES) are superior compared with bare metal stents (BMS). However, there are concerns about safety because of the reports of increased risk of late and very late stent thrombosis. Stent thrombosis remains a major pitfall in contemporary percutaneous coronary intervention (PCI), leading to high rates of death and nonfatal myocardial infarction. After the US approval of the first two DES, the sirolimus-eluting stent (Cypher) in 2003 and paclitaxel-eluting stent (Taxus) in 2004, concern was raised about the safety of the devices due to the occurrence of late and very late stent thrombosis. Pooled analyses of available randomized trails at the time, however, showed similar rates of death and myocardial infarction in patients treated with one of these DES compared to the BMS counterpart in randomized clinical trials.... (excerpt

Combined Approaches in Sialolithiasis of Major Salivary Glands

Combined (endoscopic-transcutaneous) techniques are an effective treatment for large and/or impacted stones of the major salivary glands. This approach results in high rates of symptom improvement and gland preservation. The complication rates are relatively low, further supporting the use of these techniques as an additional tool between the classic sialendoscopy and the external classic procedures of gland removal. In this chapter, we describe the combined approach for the parotid gland and the submandibular gland and finally, the retrograde sialendoscopy through the surgical field of an open approach

RAI Therapy for Graves’ Hyperthyroidism

Graves’ Disease is the most common cause of hyperthyroidism. It has multiple manifestations and it requires appropriate diagnostic and therapeutic management. Once it has been established that the patient is hyperthyroid and the cause is GD, the patient and physician must choose between three effective and relatively safe initial treatment options: antithyroid drugs (ATDs), radioiodine (RAI) therapy, or thyroidectomy. RAI has been used to treat hyperthyroidism for more than seven decades. It is well tolerated and complications are rare, except for those related to orbitopathy. Most patients are effectively treated with one therapeutic dose of I-131. The patient usually notes symptomatic improvement within 3 weeks of therapy. However, the full therapeutic effect takes 3 to 6 months because stored hormone must first be released. Radioiodine therapy may not initially be effective in up to 10% of patients. They require repeat treatment, usually with a higher administered dose

Synchronous parathyroid adenoma and thyroid papillary carcinoma: a case report

A 51-year-old female patient presented with atypical chest pain, laryngo-oesophageal reflux, increased levels of serum calcium and parathyroid hormone. Ultrasonography showed a multinodular goiter with a prominent solid nodule in the lower left thyroid lobe and a solid hypoechoic nodule outside this area

The EANM guideline on radioiodine therapy of benign thyroid disease

This document provides the new EANM guideline on radioiodine therapy of benign thyroid disease. Its aim is to guide nuclear medicine physicians, endocrinologists, and practitioners in the selection of patients for radioiodine therapy. Its recommendations on patients’ preparation, empiric and dosimetric therapeutic approaches, applied radioiodine activity, radiation protection requirements, and patients follow-up after administration of radioiodine therapy are extensively discussed.</p

The impact of depression and anxiety in prognosis of patients undergoing myocardial perfusion imaging with 99mTc tetrofosmin SPECT for evaluation of possible myocardial ischemia

Background: The goal of this study was to evaluate the prevalence of depression and anxiety in patients subjected to myocardial perfusion imaging (MPI) with 99mTc tetrofosmin stress-rest single-photon emission computer tomography (SPECT), and their impact on their cardiological events or disease. Material and Methods: Patients referred to the Nuclear Medicine Department for 99mTc tetrofosmin myocardial MPI-SPECT were asked to fulfill the Zung Self-Rating Depression Scale (ZDS) and Hamilton anxiety questionnaire (HAQ). Among 213 patients who completed the ZDS and HAQ, 80 patients (59 males and 21 females) were selected for this study because they had no known psychological disease, other disease that could influence psychological status, or use of narcotic drugs. Collected data from MPI and psychological status were subsequently analyzed. Results: Among all 80 patients, 52 patients (65%) had abnormal MPI of whom 28/52 (53.8%) exhibited either depression, anxiety or both, and 28 (35%) patients had normal MPI of whom 10/28 (35.7%) had abnormal psychological status. The higher number of patients with abnormal psychological status in association with abnormal MPI was noted predominantly in patients with previously established coronary artery disease. A correlation was also noted between obesity, cardiac heredity and depression or anxiety in patients with abnormal MPI. Conclusions: Patients that exhibit depression, anxiety, or both, have high rates of myocardial ischemia, and thus are at risk for subsequent cardiological events

The EANM guideline on radioiodine therapy of benign thyroid disease

This document provides the new EANM guideline on radioiodine therapy of benign thyroid disease. Its aim is to guide nuclear medicine physicians, endocrinologists, and practitioners in the selection of patients for radioiodine therapy. Its recommendations on patients’ preparation, empiric and dosimetric therapeutic approaches, applied radioiodine activity, radiation protection requirements, and patients follow-up after administration of radioiodine therapy are extensively discussed