Laparoscopic management of iatrogenic lesions

Purpose: To present our series of patients who underwent laparoscopic correction of iatrogenic lesions and a review of the literature.Patients and Methods: We evaluated 23 patients who underwent laparoscopic correction of iatrogenic lesions. Thirteen patients had open surgery, 6 had an endoscopic procedure, and 4 had a laparoscopic approach as the first surgical procedure. Vesicovaginal fistulas (VVF) developed in seven patients after open abdominal hysterectomies, and 1 patient presented with a VVF after ureterolithotripsy. A urethral cutaneous fistula developed in one patient after a laparoscopic resection of endometriosis nodules, and 1 patient presented with a ureterovaginal fistula after a perineoplasty. Three patients presented with encrusted ureteral stents after ureterolithotripsy. Ureteral stenosis developed in seven patients: three after open abdominal surgery, three after ureteroscopy, and one after pyeloplasty. One patient had a ureteral injury during laparoscopic partial nephrectomy, and two patients had bowel injuries after a tension-free vaginal tape procedure and a laparoscopic radical prostatectomy.Results: All patients underwent laparoscopic correction of the iatrogenic injuries. One patient had an early recurrence of a VVF, and one patient had a recurrence of a ureteral stenosis. There was one conversion to open surgery because of technical difficulties and one major bleeding event that necessitated blood transfusion. A lower limb compartmental syndrome developed in one patient.Conclusion: Despite the small number of patients and different types of surgeries performed, laparoscopic management of iatrogenic lesions seems to be feasible and safe in experienced hands. Its precise role in the management of this stressful condition still needs to be determined.

An intelligent system for pavement management

This paper describes a method for the evaluation of pavement condition through artificial neural networks using the MLP backpropagation technique. Two of the most used procedures for detecting the pavement conditions were applied: the overall severity index and the irregularity index. Tests with the model demonstrated that the simulation with the neural network gives better results than the procedures recommended by the highway officials. This network may also be applied for the construction of a graphic computer environment.

Management of Osteonecrosis of the Jaws in Patients With History of Bisphosphonates Therapy

Bisphosphonates are compounds used in the treatment of various metabolic and malignant bone diseases. The relation between the use of bisphosphonates and ostenonecrosis of the jaws as an adverse effect of the drug has been intensely discussed during the last few years, and up to this moment, there is no consensus concerning an ideal treatment modality for this condition. Nevertheless, there is an agreement among researchers that the standard goal for controlling jaw osteonecrosis is to prevent it. Otherwise, the rationale for a randomized controlled trial is that current treatment has proven to be suboptimal, and no consensus has been reached yet on the best strategies to repair the exposed bone once bone necrosis is developed. This article is focused on reporting a case of moderate osteonecrosis of the upper jaw induced by bisphosphonates and discusses a possible role for surgical debridement associated to platelet-rich plasma, hyperbaric oxygen therapy, and the cessation of the bisphosphonate use in managing this type of lesion. Moreover, the dentist, the oral surgeon, and the oncologist need to work together to reach better outcomes.

High condylectomy procedure: A valuable resource for surgical management of the mandibular condylar hyperplasia

Condylar hyperplasia is an overdevelopment of the condyle, which may manifest unilaterally or bilaterally. This pathological condition can lead to facial asymmetry, malocclusion, and dysfunction of the temporomandibular joint. The etiology and pathogenesis of condylar hyperplasia remain uncertain, but it has been suggested that its etiology may be associated with hormonal factors, trauma, and hereditary hypervascularity, affecting both genders. The diagnosis is made by clinical examination, and radiological imaging, and additionally, bone scintigraphy, is a fundamental resource for determining whether the affected condyle shows active growth. Patients with active condylar hyperplasia management have better results when they are subjected to the high condylectomy procedure. The authors report a case in a 20-year-old female subject with unilateral active condylar hyperplasia who was treated by high condylectomy. The patient has been followed up for 4 years without signs of recurrence and with good functional stability of the occlusion. © 2013 by Mutaz B. Habal, MD.

Nursing regimens: Effects on body condition, return to postpartum ovarian cyclicity in Santa Ines ewes, and performance of lambs

The effects of nursing regimens on the body condition, onset of ovarian cyclicity postpartum and weaning weight of lambs were assessed in Santa Ines ewes. Thirty-two ewes were blocked according to parity, number of lambs, and body weight at lambing and within each block randomly allocated to treatments: continuous nursing (CN), controlled nursing (CN2) with two daily feedings for an hour after the 10th day postpartum, or early weaning (EW) with total separation from the lambs after the 10th day. The animals were evaluated from the 12th day postpartum until the first estrus or until 60th day. The dry matter and nutrients intake did not differ among treatments ( P>. 0.05) but did differ over time ( P<. 0.01). The weight, body condition score, serum concentrations of non-esterified fatty acids and prolactin, the percentages of ewes in estrus, of ewes that ovulated within 60th day and had ovulation silent, the period from lambing to estrus, ovulation and follicle with a diameter ≥5. mm and the maximum follicular diameter did not differ ( P>. 0.05) among the treatments. The percentage of ovulation until 30th day was greater ( P<. 0.05) in the EW group. The percentage of short luteal phases was higher in the CN2 and EW groups ( P=0.07) and normal luteal phases were higher in the CN group ( P=0.01). Lamb weight weaning was lower in the EW group ( P<. 0.05). It is possible to use CN to obtain lambing periods less than eight months in Santa Ines ewes, with the advantages of simpler management and higher lamb weaning weights. © 2013 Elsevier B.V.

Measuring Knowledge Management: A Strategic Approach to Library Information Services

In the study of theoretical trends in Administration, the management of information follows the development of theories of Administration; constant-adaptations are suffered. Information Science area understands and concerns itself with the changes wrought in these endeavour of the knowledge society as new forms of communication and integration. The libraries interact in ways that maximize access to information and facilitate the improvement on their structural environment as strategic approach for your services. The research aims at identifying the requirements and specifications of an information system for knowledge management in the public’s library environment and proposes to achieve a pre-defined structure for the implementation of administration management. The research is conducted with public’s library of the metropolitan region of the North’s Portugal. Portugal libraries are institutions that operate in the social process of their communities reflecting the society and its organic sphere of informational performance. These libraries have developed the organizational theories to make a framework easily for effective management practices and have been using their produced knowledge in the optimization of their actions. In the improvement of systems, theoretical administrative trends become management decisions and result in the ultimate success of the organization. In order to achieve its objectives the study verified an economy based on knowledge management, and its production emphasizes the human capital that permeates the condition of the information in support for the development of communities.

Differential environmental impacts on small and medium size rivers from center of São Paulo State, Brazil, and regional management perspectives

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)