Carcinoma e leucemia da glândula lacrimal: a raridade num caso clinico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Caracterização experimental de uma bomba ejetora

A opção de futuro incide sobre os processos de combustão em regime pobre e com baixos índices de formação de poluentes. Neste contexto, o presente trabalho estuda um ejetor de um queimador de gás propano, que equipa uma marmita utilizada para confeção de alimentos no Exército Português, para compreender o mecanismo de arrastamento de ar, com vista a identificar as causas que possam contribuir para uma diminuição da razão de equivalência da mistura ar/combustível. Estes queimadores são dispositivos de funcionamento estritamente mecânico e de conceção simples que permitem uma gama de potências caloríficas compreendidas entre 8 e 22 kW. Permitem uma boa estabilidade de chama que é um requisito fundamental de segurança. A regulação de potência é executada através de uma válvula de ajuste, contendo três posições, uma em que a alimentação se encontra cortada e as outras duas permitindo funcionar na potência mínima e máxima. De modo a efetuar o estudo do ejetor, numa primeira fase, submeteu-se o sistema a uma caracterização experimental do campo de escoamentos à entrada de ar do ejetor, a partir da técnica de diagnóstico Particle Image Velocimetry (PIV). Assim avalia-se de que forma o escoamento de ar exterior influencia o comportamento do escoamento da mistura de ar/combustível à saída do queimador. Numa segunda fase, recorre-se à técnica de diagnóstico Quimiluminescência para medição de espécies químicas, para avaliar o comportamento do ejetor a alterações de vários parâmetros, tais como caudal de combustível, área de entrada de ar e área de saída da mistura do difusor. Conclui-se que o ejetor mostrase "insensível" a alterações da área de saída e de entrada de ar, em relação ao valor médio da razão de equivalência. Porém observa-se que as misturas de ar/combustível são mais homogéneas quando as áreas de entrada, da saída e da garganta têm valores próximos.

The lacrimal system; clinical application.

Mode of access: Internet.

Clinical features and management of tumors affecting the lacrimal drainage apparatus

Purpose: To report the clinical features of a series of patients with lacrimal drainage apparatus tumors and present guidelines for management based on histopathology. Methods: A noncomparative retrospective chart review of the clinical, imaging, and pathologic findings of 37 patients presenting to four regional orbital Surgery departments with tumors affecting the lacrimal drainage apparatus between 1990 and 2004. Results: There were 37 patients, of whom 62% were male. The mean age at referral was 54 years. Epiphora, a palpable mass, and dacryocystitis were the most common presentations. Two thirds of the tumors were epithelial. with carcinomas being the most frequent (38%). followed by papillomas (27%). Lymphomas were the most common nonepithelial malignancy (30%). Epithelial tumors were more common in men (87%), whereas lymphomas were more common in women (57%). Treatment modalities included surgery, in addition to radiotherapy and/or chemotherapy and immunotherapy. Mean follow-up was 38 months. Thirty-three patients (89%) remain alive without evidence of disease and 4 patients died of recurrence and/or metastases. Conclusions: Lacrimal drainage apparatus tumors require careful initial management to ensure adequate local and systemic disease control. Atypical mucosa encountered during dacryocystorhinostomy should be biopsied and small papillomas or pedunculated tumors excised and analyzed with frozen sections. If a diffuse or infiltrative mass is encountered, it should be biopsied and managed on the basis of histopathology and extent of disease. Lymphomas should be treated according to protocols. whereas noninvasive carcinoma and extensive papillomas require complete excision of the system. Invasive disease requires en bloc excision. Long-term follow-up is essential for early detection of recurrence.

En bloc excision in malignant tumors of the lacrimal drainage apparatus

Purpose: To describe the surgical technique and results of en bloc excision in a series of patients with extensive malignant tumors of the lacrimal drainage apparatus (LDA). Methods: This was a noncomparative, retrospective chart review of the clinical and pathologic findings of 11 patients presenting with a malignant tumor affecting the LDA who underwent en bloc excision of the lacrimal system. Results: Of the 11 patients, 7 were male. The mean age at presentation was 58 years (range, 39 to 81 years), and all cases were unilateral. Histopathology revealed 4 squamous cell carcinomas, 3 transitional cell carcinomas, 2 mucoepidermoid carcinomas, and 2 melanomas. Epiphora and a mass were the most common presentations. An external lesion could be identified in 4 cases. Irrigation of the lacrimal system revealed nasolacrimal duct obstruction in 2 cases and common canaliculus obstruction in another 2 patients. The entire LDA and surrounding bony tissues were excised through a lateral rhinotomy approach. Adjuvant radiotherapy was given in 4 cases. Nine patients remain alive and well after a mean follow-up of 2 years (range, 6 months to 7 years). Three cases showed distant disease and 2 patients died of metastatic melanoma involvement. Conclusions: The use of en bloc excision as a radical treatment to remove the complete LDA and surrounding bony structures affords good local tumor control and may provide the best opportunity for enhanced patient survival.

Combined external-endonasal approach for complete excision of the lacrimal drainage apparatus

Purpose: The purpose of this study was to describe a new surgical technique for the complete excision of the lacrimal drainage apparatus (LDA) that combines external and endoscopic approaches. Methods: This study involved a noncomparative, retrospective chart review of the clinical and pathological findings of four patients presenting with LDA papillomas who underwent a combined open and endonasal excision of the lacrimal system. Results. Of the four patients, three were male. The mean age at referral was 41 years, and all cases were unilateral. Histopathology revealed two transitional cell papillomas, one squamous cell papilloma, and one combined transitional/squamous papilloma. Epiphora and an external lesion were the main complaints at presentation. Nasolacrimal duct obstruction was present in all four patients. Papilloma virus infection was suggested in two cases and was confirmed in the only patient who had recurrence. CT identified a solid enhancing mass in two cases. The surgical approach in all cases was performed with the patient under general anesthetic supplemented with infiltration of local anesthesia with vasoconstriction. The lacrimal sac was exposed as per an external dacryocystorhinostomy with biopsy collection from the lacrimal sac lumen to confirm the diagnosis prior LDA excision. The superior aspect of the LDA was isolated by using lacrimal probes in each canaliculus to stabilized parallel incisions and careful dissection toward the common canaliculus until they met the medial aspect of the lacrimal sac. The sac was then separated from the periosteum from the medial orbital wall, using sharp dissection. Finally, an endoscopic dissection of the lower end of the nasolacrimal duct released the most inferior aspect of the LDA, allowing the surgeon to pull and excise the complete system from the external wound. Conclusions: Extensive LDA papillomas required complete excision of the drainage system to prevent recurrence and/or malignant transformation. The use of a combined approach through an open excision of the superior part of the LDA in conjunction with the direct manipulation of the nasolacrimal duct guided by the nasal endoscope facilitates the complete excision of the system for extensive benign lesions.

A study of the effects of orally administered female hormones on the volume and composition of lacrimal fluid related to the toleration of corneal contact lenses

This study was designed to evaluate the effects of certain orally active contraceptive steroids on the eye, related to the tolerance of a corneal contact lens. An oestrogen, ethinyloestradiol BP. 0.05 mg, a progestogen, norethisterone acetate BP. 2.50 mg and a control tablet (vitamin C, 50 mg) were utilised. The effect of these preparations on corneal curvature, lacrimal fluid volume and protein composition and directly on corneal lens tolerance was monitored in a group of 23 volunteer patients. The progestogen was found to produce a significant (P≥ 0.05) decrease in tear volume as measured by a 3 minute Schirmer test. A smaller volume reduction was observed with ethinyloestradiol. A normal cornea appears unaffected, within the measurement limits available, by the use of either hormone. However, in the presence of a corneal lens, oestrogen was found to induce substantial corneal steepening, indicative of tissue oedema, during the initial 2-3 weeks of medication. Progestogen occasionally produced a similar effect, which could recur with either hormone shortly after the end of the treatment period. A new method of acrylamide gel electrophoresis was developed for examination of the protein concentration and composition of lacrimal fluid. This allowed much greater resolution of microquantities of unconcentrated fluid than anything previously reported. Quantitation by densitometry has permitted the recording of medication and lens-induced changes in the protein pattern. Tear albumin has been shown to differ from serum albumin and to consist of up to 3 subfractions, 7 further protein fractions may also be resolved. The concentration and probable origin of these proteins have been established and the overall effects of hormone administration described. Individual idiosyncratic responses are also discussed. The study has established tbenature of some effects of contraceptive steroids on the anterior eye, and the probable reasons for resultant corneal lens intolerance.

Otimização dos parâmetros de um modelo de bomba em sistemas de bombeio centrífugo submerso

One of several techniques applied to production processes oil is the artificial lift, using equipment in order to reduce the bottom hole pressure, providing a pressure differential, resulting in a flow increase. The choice of the artificial lift method depends on a detailed analysis of the some factors, such as initial costs of installation, maintenance, and the existing conditions in the producing field. The Electrical Submersible Pumping method (ESP) appears to be quite efficient when the objective is to produce high liquid flow rates in both onshore and offshore environments, in adverse conditions of temperature and in the presence of viscous fluids. By definition, ESP is a method of artificial lift in which a subsurface electric motor transforms electrical into mechanical energy to trigger a centrifugal pump of multiple stages, composed of a rotating impeller (rotor) and a stationary diffuser (stator). The pump converts the mechanical energy of the engine into kinetic energy in the form of velocity, which pushes the fluid to the surface. The objective of this work is to implement the optimization method of the flexible polyhedron, known as Modified Simplex Method (MSM) applied to the study of the influence of the modification of the input and output parameters of the centrifugal pump impeller in the channel of a system ESP. In the use of the optimization method by changing the angular parameters of the pump, the resultant data applied to the simulations allowed to obtain optimized values of the Head (lift height), lossless efficiency and the power with differentiated results.