[en] Intraductal papillary mucinous neoplasm (IPMN) is known to arise from intraductal proliferation of mucinous cells with findings of marked dilatation of the biliary or pancreatic duct. There are reports of the metastasis and extension of pancreatic IPMN. However, cases of biliary IPMN with direct metastasis, or metastasis to distant locations, are rare. We present a case of metastasis of biliary IPMN with unexpected direct extension into the thoracic cavity, and we attempt to account for the mechanism of this extension

[en] Intracranial lipoma is a rare entity, accounting for less than 0.5% of intracranial tumors, which usually develops in the callosal cisterns. We report a case of lipoma with an unusual location; in the high parietal convexity combined with massive calcification, and no underlying vascular malformation or congenital anomaly.

[en] The thermodynamic parameters for the interaction of metal ions with dibenzo-16-crown-5 and its derivatives have been determined by solution calorimetry in methanol at 25 .deg. C. Thermodynamics properties of log K, ΔH, and TΔS have been determined for the complexation of metal cations by dibenzo-16-crown-5 and its derivatives. Dibenzo-16-crown-5 and its derivatives have been studied as metal cations carrier in bulk liquid membrane (BLM) and supported liquid membrane (SLM) system. Ag⁺ has been much more transported using dibenzo-16-crown-5 derivatives as carriers and several other metal cations have been small transported using carrier in BLM and SLM system. Ligand structure, the length of side arm, donor atom, stability constant, and carrier concentration are also important parameters in the transport of cations

[en] 

Objective

To evaluate the impact of subcutaneous tunneling on peripherally inserted central catheter (PICC) placement in terms of central line–associated bloodstream infections (CLABSIs).

Methods

Our dual-facility central institutional review board approved this retrospective study. We compared 302 of 327 consecutive recipients (mean age [± SD], 68.0 ± 15.9 years; men, 134; women, 168) of tunneled PICCs (October 2017 to May 2018) with 309 of 328 consecutive recipients (mean age, 68.7 ± 14.6 years; men, 142; women, 167) of conventional PICCs (April 2016 to September 2017). Tunnels were made near puncture sites (~ 1 in. away) using hemostats or puncture needles. In each group, procedure times and rates of complications, including CLABSI, entry-site infection, dislocation, thrombophlebitis, and occlusion, were examined. Risk factors for CLABSI were analyzed via logistic and Cox regression models.

Results

Subcutaneous tunnels were achieved in all patients, enabling successful peripheral vein cannulations. Group procedure times were similar (p = 0.414). CLABSI proved to be significantly less frequent after tunneling (8/6972 catheter-days) than after conventional (28/7574 catheter-days) PICC placement (adjusted hazard ratio = 0.328; 95% confidence interval, 0.149–0.721). Other risk factors (i.e., age, gender, comorbidity, PICC duration, veins, hospital stay, and intensive care unit stay) showed no significant correlations with CLABSI.

Conclusions

Compared with conventional means, a subcutaneous tunneling approach for PICC placement significantly reduces the rate of CLABSI.

Key Points

• Subcutaneous tunnels created to place peripherally inserted central catheters significantly reduced catheter-associated bloodstream infections.

• Subcutaneous tunnel creation did not significantly prolong procedural time.

• There were no subcutaneous tunnel-related complications.