Spontaneous combined rupture of a pelvicalyceal cyst into the collector system and retroperitoneal space during the acquisition of computed tomography scan images: a case report

Abstract Introduction Pelvicalyceal cysts are common findings in autopsies and can manifest with a variety of patterns. These cystic lesions are usually a benign entity with no clinical significance unless they enlarge enough to cause compression of the adjacent collecting system and consequently obstructive uropathy. Few cases of the spontaneous rupture of pelvicalyceal renal cysts have been published and to the best of our knowledge there is no report of a combined rupture to collector system and retroperitoneal space documented during a multiphase computed tomography. Case presentation We report a case of a ‘real-time’ spontaneous rupture of a pelvicalyceal cyst into the collecting system with fistulization into the retroperitoneum. The patient was a 78-year-old Caucasian man with a previous history of renal stones and a large pelvicalyceal renal cyst who was admitted to our Emergency department with acute right flank pain. A multiphase computed tomography was performed and the pre-contrast images demonstrated a right pelvicalyceal renal cyst measuring 12.0 × 6.1cm in the lower pole causing moderate dilation of the upper right renal collection system. In addition, a partially obstructive stone on the left distal ureter with mild left hydronephrosis was noted. The nephrographic phase did not add any new information. The excretory phase (10-minute delay) demonstrated a spontaneous rupture of the cyst into the pelvicalyceal system with posterior fistulization into the retroperitoneal space. Conclusion In this case study we present time-related changes of a rare pelvicalyceal cyst complication, which to the best of our knowledge has fortunately not been previously documented. Analysis of the sequential images and comparison with an earlier scan allowed us to better understand the physiopathological process of the rupture, the clinical presentation and to elaborate hypotheses for its etiopathogenesis.

DRIVING AND RESTRICTIVE FACTORS IN THE PROCESS OF KNOWLEDGE CREATION: A COMPARATIVE CASE STUDY IN BRAZILIAN TECHNOLOGY-BASED ENTERPRISES

The article aims to analyze the process of knowledge creation in Brazilian technology-based companies, using as a background the driving and restrictive factors found in this process. As the pillars of discussion, four main modes of knowledge conversion were used, according to the Japanese model: socialization, externalization, combination and internalization. The comparative case method through qualitative research was carried out in nine technology-based enterprises that had been incubated or have recently passed through the stage of incubation (so-called graduated companies) in the Technology Park of Sao Carlos, state of Sao Paulo, Brazil. Among the main results, the combination of knowledge was identified as more conscious and structured in graduated companies, in relation to incubated companies. In contrast, it was noted that incubated companies have an environment with greater opportunities for socialization, internalization and externalization of knowledge.

How far can we go in simplifying biomonitoring assessments? An integrated analysis of taxonomic surrogacy, taxonomic sufficiency and numerical resolution in a megadiverse region

The need for biodiversity conservation is increasing at a rate much faster than the acquisition of knowledge of biodiversity, such as descriptions of new species and mapping species distributions. As global changes are winning the race against the acquisition of knowledge, many researchers resort to the use of surrogate groups to aid in conservation decisions. Reductions in taxonomic and numerical resolution are also desirable, because they could allow more rapid the acquisition of knowledge while requiring less effort, if little important information is lost. In this study, we evaluated the congruence among 22 taxonomic groups sampled in a tropical forest in the Amazon basin. Our aim was to evaluate if any of these groups could be used as surrogates for the others in monitoring programs. We also evaluated if the taxonomic or numerical resolution of possible surrogates could be reduced without greatly reducing the overall congruence. Congruence among plant groups was high, whereas the congruence among most animal groups was very low, except for anurans in which congruence values were only slightly lower than for plants. Liana (Bignoniaceae) was the group with highest congruence, even using genera presence-absence data. The congruence among groups was related to environmental factors, specifically the clay and phosphorous contents of soil. Several groups showed strong spatial clumping, but this was unrelated to the congruence among groups. The high degree of congruence of lianas with the other groups suggests that it may be a reasonable surrogate group, mainly for the other plant groups analyzed, if soil data are not available. Although lianas are difficult to count and identify, the number of studies on the ecology of lianas is increasing. Most of these studies have concluded that lianas are increasing in abundance in tropical forests. In addition to the high congruence, lianas are worth monitoring in their own right because they are sensitive to global warming and the increasing frequency and severity of droughts in tropical regions. Our findings suggest that the use of data on surrogate groups with relatively low taxonomic and numerical resolutions can be a reliable shortcut for biodiversity assessments, especially in megadiverse areas with high rates of habitat conversion, where the lack of biodiversity knowledge is pervasive. (c) 2012 Elsevier Ltd. All rights reserved.

Evaluation of an educational handbook as a knowledge-acquisition strategy for mastectomized women

This descriptive, cross-sectional and quantitative study presents an analysis of knowledge acquired by mastectomized women concerning breast cancer after reading an educational handbook. The sample was composed of 125 women. Data were collected in a specialized cancer facility in three phases: preparatory, operational I and operational II. As to the knowledge acquired, the posttest showed an 11% increase in the number of correct answers compared to the pretest. The most frequent correct answer regarded a question asking the name of the surgery (97.60%) while the question concerning breast reconstruction obtained the lowest number of correct answers (58.40%). Answers to all the questions significantly improved in the posttest, with the exception of a question addressing breast reconstruction (p=0.754). The assessment of knowledge showed positive results after reading, suggesting that cognition is essential to understanding and adhering to guidance, thus the handbook is a favorable resource to be used in the rehabilitation of mastectomized women.