Leiomiomas do esôfago removidos por vídeo-toracoscopia

This report describes three cases of esophageal leiomyomas successfully resected by thoracoscopy. Surgical enucleation through minimally invasive surgery is the treatment of choice for esophageal leiomyoma. The conventional approach through a formal thoracotomy has the potential of causing excessive pain and patient discomfort. Moreover, the hospital stay and the recovery period are prolonged. Indications for surgery were based mainly on the size of the mass (<4 cm) and the presence of dysphagia. In one case there was a clear suspicion of malignancy. The tumour was located in the lower thoracic esophagus (case 1), in the middle thoracic esophagus (case 2) and in the upper esophagus (case 3). The CT was useful in identifying the relationship between the lesion and the organs of the mediastinum. The barium swallow study was able to locate the lesion along the esophagus. The endosonography determined the boundaries of the lesions. A right thoracoscopic approach was undertaken. Dissection of the esophagus around its entire perimeter was never necessary because all tumours were anterior or right sided. The tumours were better grasped with a traction suture than with forceps. The hidrodissection was very helpful. The water-soluble contrast swallow, performed on the fourth postoperative day, was normal. Clinical results were satisfactory in all patients. Biopsies should never be performed when the mucosa overlying is normal.

Kierrätyspolttoainemarkkinat Euroopassa

Työn tavoitteena oli selvittää Saksan, Ruotsin ja Suomen kierrätyspolttoaineen valmistusta ja käyttöä sekä kierrätyspolttoainemarkkinoita. Kierrätyspolttoaineiden käyttöä ja valmistusta sekä kierrätyspolttoainemarkkinoita säädellään tarkastelumaissa EU-lainsäädännöllä ja kansallisilla lainsäädännöillä jätteistä, jätteenpoltosta ja materiaalikierrätyksestä sekä CEN/TC 343-toimikunnan standardeilla kiinteille kierrätyspolttoaineille. Työn johtopäätöksenä on, että kierrätyspolttoainemarkkinat ovat tarkastelumaissa hyvin ulkoapäin ohjautuvat ja markkinaehtoista tasapainoa ei ehdi syntyä. Tarkastelumaiden markkinat ovat erilaiset, Saksassa kierrätyspolttoaineiden käyttö ja valmistus on pitkälle kehittynyttä, tiheää ja monipuolista, Ruotsissa yhteisen termistön puuttuminen kertoo alan hajanaisuudesta. Saksassa ja Ruotsissa kierrätyspolttoainemarkkinoiden kasvamiseen ovat vaikuttaneet kaatopaikkakiellot. Suomessa tähän asti pelkkään rinnakkaispolttoon perustuneet kierrätyspolttoainemarkkinat ovat vasta vakiintumassa. Kierrätyspolttoainemarkkinat tulevat kansainvälistymään ja kilpailu materiaalista tulee kovenemaan. Standardien käyttöönotto tulee olemaan helpointa Suomessa, jossa kierrätyspolttoaineen standardisoinnista on kokemusta. Suomen olisi syytä ottaa jäte- ja energiahuollon ratkaisuissa huomioon eri toimintojen aiheuttamat talous- ja ympäristövaikutukset.

O uso do tubo colônico bipediculado microcirúrgico na reconstrução do esôfago

In some cases of esophageal reconstruction, it is not possible to use the gastric tube. In those cases, the second option is the reconstruction with a colonic segment. In the present paper, the authors present the use of microsurgical technique to improve vascular supply in esophageal reconstructions using the colon. Therefore, the transposed segment becomes perfused by two vascular pedicles: a proximal one and a distal one. The authors describe a case of 52 years-old patient, suffering of middle third esophagus carcinoma, who underwent a primarily esophageal resection with an unsuccessful reconstruction using gastric transposition. A new reconstruction was proposed using a bipedicle microcirurgical colonic tube, four months later. The post operative was uneventful with rehabilitation of swallowing and satisfactory recovery of nutritional state.

Diurnal changes in storage carbohydrate metabolism in cotyledons of the tropical tree Hymenaea courbaril L. (Leguminosae)

The cotyledons of Hymenaea courbaril store large amounts of xyloglucan, a cell wall polysaccharide that is believed to serve as storage for the period of seedling establishment. During storage mobilisation, xyloglucan seems to be degraded by a continuous process that starts right after radicle protrusion and follows up to the establishment of photosynthesis. Here we show evidence that events related to the hydrolases activities and production (α-xylosidase, β-galactosidase, β-glucosidase and xyloglucan endo-β-transglucosilase) as well as auxin, showed changes that follow the diurnal cycle. The period of higher hydrolases activities was between 6pm and 6am, which is out of phase with photosynthesis. Among the enzymes, α-xilosidase seems to be more important than β-glucosidase and β-galactosidase in the xyloglucan disassembling mechanism. Likewise, the sugars related with sucrose metabolism followed the rhythm of the hydrolases, but starch levels were shown to be practically constant. A high level of auxin was observed during the night, what is compatible with the hypothesis that this hormone would be one of the regulators of the whole process. The probable biological meaning of the existence of such a complex control mechanism during storage mobilisation is likely to be related to a remarkably high level of efficiency of carbon usage by the growing seedling of Hymenaea courbaril, allowing the establishment of very vigorous seedlings in the tropical forest.

Purification of bovine pancreatic glucagon as a by-product of insulin production

A process for purifying bovine pancreatic glucagon as a by-product of insulin production is described. The glucagon-containing supernatant from the alkaline crystallization of insulin was precipitated using ammonium sulfate and isoelectric precipitation. The isoelectric precipitate containing glucagon was then purified by ion-exchange chromatography on Q-Sepharose FF, gel filtration on Sephadex G-25 and ion-exchange chromatography on S-Sepharose FF. A pilot scale test was performed with a recovery of 87.6% and a purification factor of 8.78 for the first chromatographic step, a recovery of 75.1% and a purification factor of 3.90 for the second, and a recovery of 76.2% and a purification factor of 2.36 for the last one. The overall yield was 50%, a purification factor of 80.8 was obtained and the fraction containing active glucagon (suitable for pharmaceutical preparations) was 84% pure as analyzed by HPLC

Amifostine (WR-2721), a cytoprotective agent during high-dose cyclophosphamide treatment of non-Hodgkin's lymphomas: a phase II study

Clinical trials indicate that amifostine may confer protection on various normal tissues without attenuating anti-tumor response. When administered prior to chemotherapy or radiotherapy, it may provide a broad spectrum of cytoprotection including against alkylating drugs. The mechanism of protection resides in the metabolism at normal tissue site by membrane-bound alkaline phosphatase. Toxicity of this drug is moderate with hypotension, nausea and vomiting, and hypocalcemia being observed. We report a phase II study using amifostine as a protective drug against high-dose cyclophosphamide (HDCY) (7 g/m2), used to mobilize peripheral blood progenitor cells (PBPC) and to reduce tumor burden. We enrolled 29 patients, 22 (75.9%) affected by aggressive and 7 (24.1%) by indolent non-Hodgkin's lymphoma (NHL), who were submitted to 58 infusions of amifostine and compared them with a historical group (33 patients) affected by aggressive NHL and treated with VACOP-B followed by HDCY. The most important results in favor of amifostine were the reduction of intensity of cardiac, pulmonary and hepatic toxicity, and a significant reduction of frequency and severity of mucositis (P = 0.04). None of the 29 patients died in the protected group, while in the historical group 2/33 patients died because of cardiac or pulmonary toxicity and 2 patients stopped therapy due to toxicity. Amifostine did not prevent the aplastic phase following HDCY. PBPC collection and hematological recovery were adequate in both groups. The number of CFU-GM (colony-forming units-granulocyte/macrophage) colonies and mononuclear cells in the apheresis products was significantly higher in the amifostine group (P = 0.02 and 0.01, respectively). Side effects were mild and easily controlled. We conclude that amifostine protection should be useful in HDCY to protect normal tissues, with acceptable side effects.

Effects of submaximal exercise with water ingestion on intraocular pressure in healthy human males

The effects of exercise and water replacement on intraocular pressure (IOP) have not been well established. Furthermore, it is not known whether the temperature of the fluid ingested influences the IOP response. In the present study we determined the effect of water ingestion at three temperatures (10, 24 and 38ºC; 600 ml 15 min before and 240 ml 15, 30 and 45 min after the beginning of each experimental session) on the IOP of six healthy male volunteers (age = 24.0 ± 3.5 years, weight = 67.0 ± 4.8 kg, peak oxygen uptake (VO2peak) = 47.8 ± 9.1 ml kg-1 min-1). The subjects exercised until exhaustion on a cycle ergometer at a 60% VO2peak in a thermoneutral environment. IOP was measured before and after exercise and during recovery (15, 30 and 45 min) using the applanation tonometry method. Skin and rectal temperatures, heart rate and oxygen uptake were measured continuously. IOP was similar for the right eye and the left eye and increased post-water ingestion under both exercising and resting conditions (P<0.05) but did not differ between resting and exercising situations, or between the three water temperatures. Time to exhaustion was not affected by the different water temperatures. Rectal temperature, hydration status, heart rate, oxygen uptake, carbon dioxide extraction and lactate concentration were increased by exercise but were not affected by water temperature. We conclude that IOP was not affected by exercise and that water ingestion increased IOP as expected, regardless of water temperature.

The role of the vagus nerve in hypertonic resuscitation of hemorrhagic shocked dogs

Previous studies have suggested a critical role for the vagi during the hypertonic resuscitation of hemorrhagic shocked dogs. Vagal blockade prevented the full hemodynamic and metabolic recovery and increased mortality. This interpretation, however, was challenged on the grounds that the blockade also abolished critical compensatory mechanisms and therefore the animals would die regardless of treatment. To test this hypothesis, 29 dogs were bled (46.0 ± 6.2 ml/kg, enough to reduce the mean arterial pressure to 40 mmHg) and held hypotensive for 45 min. After 40 min, vagal activity was blocked in a reversible manner (0ºC/15 min) and animals were resuscitated with 7.5% NaCl (4 ml/kg), 0.9% NaCl (32 ml/kg), or the total volume of shed blood. In the vagal blocked isotonic saline group, 9 of 9 dogs, and in the vagal blocked replaced blood group, 11 of 11 dogs survived, with full hemodynamic and metabolic recovery. However, in the hypertonic vagal blocked group, 8 of 9 dogs died within 96 h. Survival of shocked dogs which received hypertonic saline solution was dependent on vagal integrity, while animals which received isotonic solution or blood did not need this neural component. Therefore, we conclude that hypertonic resuscitation is dependent on a neural component and not only on the transient plasma volume expansion or direct effects of hyperosmolarity on vascular reactivity or changes in myocardial contraction observed immediately after the beginning of infusion.

Response of the arterial blood pressure of quadriplegic patients to treadmill gait training

Blood pressure pattern was analyzed in 12 complete quadriplegics with chronic lesions after three months of treadmill gait training. Before training, blood pressure values were obtained at rest, during treadmill walking and during the recovery phase. Gait training was performed for 20 min twice a week for three months. Treadmill gait was achieved using neuromuscular electrical stimulation, assisted by partial body weight relief (30-50%). After training, blood pressure was evaluated at rest, during gait and during recovery phase. Before and after training, mean systolic blood pressures and heart rates increased significantly during gait compared to rest (94.16 ± 5.15 to 105 ± 5.22 mmHg and 74.27 ± 10.09 to 106.23 ± 17.31 bpm, respectively), and blood pressure decreased significantly in the recovery phase (86.66 ± 9.84 and 57.5 ± 8.66 mmHg, respectively). After three months of training, systolic blood pressure became higher at rest (94.16 ± 5.15 mmHg before training and 100 ± 8.52 mmHg after training; P < 0.05) and during gait exercise (105 ± 5.22 mmHg before and 110 ± 7.38 mmHg after training; P < 0.05) when compared to the initial values, with no changes in heart rate. No changes occurred in blood pressure during the recovery phase, with the lower values being maintained. A drop in systolic pressure from 105 ± 5.22 to 86.66 ± 9.84 mmHg before training and from 110 ± 7.38 to 90 ± 7.38 mmHg after training was noticed immediately after exercise, thus resulting in hypotensive symptoms when chronic quadriplegics reach the sitting position from the upright position.

Low expression of APAF-1XL in acute myeloid leukemia may be associated with the failure of remission induction therapy

Apoptotic protease activating factor 1 (APAF-1) has a critical role in the regulation of apoptosis. In the present study, the mRNA expression analysis of different APAF-1 transcripts (APAF-1S, APAF-1LC, APAF-1LN, and APAF-1XL) was analyzed in bone marrow samples from 37 patients with acute myeloid leukemia (newly diagnosed, with no previous treatment). APAF-1XL and APAF-1LN transcripts (with and without an extra WD-40 repeat region, respectively) were detected in all samples, although the major form expressed was APAF-1XL in 65% of the samples (group 1), while 35% of the samples expressed primarily APAF-1LN (group 2). Only 46% of the patients presented complete remission in response to remission induction therapy (represented by less than 5% marrow blasts and hematological recovery), all but 2 cases being from group 1, 21.6% did not attain complete remission (only 1 case from group 1), and 32.4% of the patients died early. Lower expression of APAF-1XL (APAF-1XL/APAF-1LN ratio <1.2) was associated with a poor response to therapy (P = 0.0005, Fisher exact test). Both groups showed similar characteristics regarding white blood cell counts, cytogenetic data or presence of gene rearrangements associated with good prognosis as AML1-ETO, CBFB-MYH11 and PML/RARA. Since it has been shown that only the isoforms with the extra WD-40 repeat region activate procaspase-9, we suggest that low procaspase-9 activation may also be involved in the deregulation of apoptosis and chemotherapy resistance in acute myeloid leukemia.

Diabetic retinopathy is associated with early autonomic dysfunction assessed by exercise-related heart rate changes

Diabetic retinopathy has been associated with cardiac autonomic dysfunction in both type 1 and type 2 diabetes mellitus (DM) patients. Heart rate (HR) changes during exercise testing indicate early alterations in autonomous tonus. The aim of the present study was to investigate the association of diabetic retinopathy with exercise-related HR changes. A cross-sectional study was performed on 72 type 2 and 40 type 1 DM patients. Autonomic dysfunction was assessed by exercise-related HR changes (Bruce protocol). The maximum HR increase, defined as the difference between the peak exercise rate and the resting rate at baseline, and HR recovery, defined as the reduction in HR from the peak exercise to the HR at 1, 2, and 4 min after the cessation of the exercise, were determined. In type 2 DM patients, lower maximum HR increase (OR = 1.62, 95%CI = 1.03-2.54; P = 0.036), lower HR recovery at 2 (OR = 2.04, 95%CI = 1.16-3.57; P = 0.012) and 4 min (OR = 2.67, 95%CI = 1.37-5.20; P = 0.004) were associated with diabetic retinopathy, adjusted for confounding factors. In type 1 DM, the absence of an increase in HR at intervals of 10 bpm each during exercise added 100% to the odds for diabetic retinopathy (OR = 2.01, 95%CI = 1.1-3.69; P = 0.02) when adjusted for DM duration, A1c test and diastolic blood pressure. In conclusion, early autonomic dysfunction was associated with diabetic retinopathy. The recognition of HR changes during exercise can be used to identify a high-risk group for diabetic retinopathy.

Flow in porous media of oil-water systems

Fluid flow behaviour in porous media is a conundrum. Therefore, this research is focused on filtration-volumetric characterisation of fractured-carbonate sediments, coupled with their proper simulation. For this reason, at laboratory rock properties such as pore volume, permeability and porosity are measured, later phase permeabilities and oil recovery in function of flow rate are assessed. Furthermore, the rheological properties of three oils are measured and analysed. Finally based on rock and fluid properties, a model using COMSOL Multiphysics is built in order to compare the experimental and simulated results. The rock analyses show linear relation between flow rate and differential pressure, from which phase permeabilities and pressure gradient are determined, eventually the oil recovery under low and high flow rate is established. In addition, the oils reveal thixotropic properties as well as non-Newtonian behaviour described by Bingham model, consequently Carreau viscosity model for the used oil is given. Given these points, the model for oil and water is built in COMSOL Multiphysics, whereupon successfully the reciprocity between experimental and simulated results is analysed and compared. Finally, a two-phase displacement model is elaborated.

Production of magnesium carbonates from serpentinites for CO2 mineral sequestration : optimisation towards industrial application

Global warming is one of the most alarming problems of this century. Initial scepticism concerning its validity is currently dwarfed by the intensification of extreme weather events whilst the gradual arising level of anthropogenic CO2 is pointed out as its main driver. Most of the greenhouse gas (GHG) emissions come from large point sources (heat and power production and industrial processes) and the continued use of fossil fuels requires quick and effective measures to meet the world’s energy demand whilst (at least) stabilizing CO2 atmospheric levels. The framework known as Carbon Capture and Storage (CCS) – or Carbon Capture Utilization and Storage (CCUS) – comprises a portfolio of technologies applicable to large‐scale GHG sources for preventing CO2 from entering the atmosphere. Amongst them, CO2 capture and mineralisation (CCM) presents the highest potential for CO2 sequestration as the predicted carbon storage capacity (as mineral carbonates) far exceeds the estimated levels of the worldwide identified fossil fuel reserves. The work presented in this thesis aims at taking a step forward to the deployment of an energy/cost effective process for simultaneous capture and storage of CO2 in the form of thermodynamically stable and environmentally friendly solid carbonates. R&D work on the process considered here began in 2007 at Åbo Akademi University in Finland. It involves the processing of magnesium silicate minerals with recyclable ammonium salts for extraction of magnesium at ambient pressure and 400‐440⁰C, followed by aqueous precipitation of magnesium in the form of hydroxide, Mg(OH)2, and finally Mg(OH)2 carbonation in a pressurised fluidized bed reactor at ~510⁰C and ~20 bar PCO2 to produce high purity MgCO3. Rock material taken from the Hitura nickel mine, Finland, and serpentinite collected from Bragança, Portugal, were tested for magnesium extraction with both ammonium sulphate and bisulphate (AS and ABS) for determination of optimal operation parameters, primarily: reaction time, reactor type and presence of moisture. Typical efficiencies range from 50 to 80% of magnesium extraction at 350‐450⁰C. In general ABS performs better than AS showing comparable efficiencies at lower temperature and reaction times. The best experimental results so far obtained include 80% magnesium extraction with ABS at 450⁰C in a laboratory scale rotary kiln and 70% Mg(OH)2 carbonation in the PFB at 500⁰C, 20 bar CO2 pressure for 15 minutes. The extraction reaction with ammonium salts is not at all selective towards magnesium. Other elements like iron, nickel, chromium, copper, etc., are also co‐extracted. Their separation, recovery and valorisation are addressed as well and found to be of great importance. The assessment of the exergetic performance of the process was carried out using Aspen Plus® software and pinch analysis technology. The choice of fluxing agent and its recovery method have a decisive sway in the performance of the process: AS is recovered by crystallisation and in general the whole process requires more exergy (2.48–5.09 GJ/tCO2sequestered) than ABS (2.48–4.47 GJ/tCO2sequestered) when ABS is recovered by thermal decomposition. However, the corrosive nature of molten ABS and operational problems inherent to thermal regeneration of ABS prohibit this route. Regeneration of ABS through addition of H2SO4 to AS (followed by crystallisation) results in an overall negative exergy balance (mainly at the expense of low grade heat) but will flood the system with sulphates. Although the ÅA route is still energy intensive, its performance is comparable to conventional CO2 capture methods using alkanolamine solvents. An energy‐neutral process is dependent on the availability and quality of nearby waste heat and economic viability might be achieved with: magnesium extraction and carbonation levels ≥ 90%, the processing of CO2‐containing flue gases (eliminating the expensive capture step) and production of marketable products.

Estado e economia na Coreia do Sul - do Estado desenvolvimentista à crise asiática e à recuperação posterior

The State and the economy in South Korea: from the developmentist state to the Asian crisis and later recovery. The article focuses on the institutions of South Korean capitalism and on the interactions between the state and the economy. The economic model in South Korea was characterized by a very interventionist state, which played a very active role in the process of industrialization. However, South Korea suffered a severe crisis in 1997, attributed by many authors to the distortions inherent to strong state intervention. The article shows that the crisis was a result of the combination between internal economic fragilities and a rapid process of financial deregulation, which undermined the state's capacity of control. The crisis, nevertheless, does not disqualify the role of the national institutions in the very successful process of industrialization. Despite the reforms, the Korean capitalism conserves much of the previous model of business organization and industrial relations. The state continues strong and played active role in the process of economic reforms. There are, nevertheless, doubts about the impacts of the reforms and the new configuration of Korean capitalism. They will depend on the current transformations in world economy and in the East Asian countries.

Suomen laskusuhdanteiden vertailu: 1990-luvun laman ja 2000-luvun globaalin finanssikriisin vaikutukset kuluttajille

Suomessa merkittävimpiä talouden laskusuhdanteita ja talouskriisejä ovat sotien jälkeen olleet 1990-luvun alun lama sekä vuonna 2008 alkanut finanssikriisin jälkeinen taantuma. Näillä kahdella ilmiöllä on ollut laajalti vaikutuksia koko kansantalouteemme, ja luonnollisesti suomalaisten kuluttajien taloudellinen hyvinvointi on muuttunut ilmiöiden myötä. Yksilöiden aiempaa huonompi taloudellinen hyvinvointi laskusuhdanteissa aiheutuu laskeneista tuloista, työttömyydestä ja varallisuushintojen laskusta sekä edellä mainittujen seurauksista. Tämän tutkielman tavoitteena on analysoida ja vertailla 1990-luvun laman ja 2000-luvun globaalin finanssikriisin aiheuttamia taloudellisia vaikutuksia suomalaisille kuluttajille. Lisäksi tarkoituksena on selvittää, minkä eri tekijöiden kautta laskusuhdanteet vaikuttavat kuluttajiin ja miksi. Tutkielman empiirisessä osiossa käytetään pääasiassa Tilastokeskuksen tuottamaa kvantitatiivista materiaalia sekä analyysin rikastamiseksi erilaisia kvalitatiivisia tutkimustuloksia aiheesta. Tutkielman lopputuloksena voidaan todeta 1990-luvun laman vaikuttaneen suomalaisiin kuluttajiin voimakkaammin ja pitkäkestoisemmin kuin finanssikriisin aiheuttaman taantuman. Laman vaikutukset kestivät useita vuosia, ja palautuminen oli hidasta. Erityisen suureksi ongelmaksi nousi työttömyyden voimakas kasvu. Finanssikriisin myötä työttömyys reagoi bruttokansantuotteen laskuun nähden sen sijaan maltillisesti, eivätkä esimerkiksi kotitalouksien tulot laskeneet samalla tavalla kuin laman aikana. Lisäksi merkittävässä osassa 1990-luvun lamaa oli asuntomarkkinoiden hintakupla ja sen puhkeaminen, jolla oli voimakas vaikutus reaalitalouteen. Laskukausien toisistaan poikkeavat vaikutukset johtuvat pitkälti niiden syntyyn johtaneiden syiden eroista sekä valtion talouspoliittisista toimista laskukausien helpottamiseksi. Siinä missä 1990-luvun lama johtui pääasiassa Suomen sisäisistä poliittisista päätöksistä ja pankkisektorista, oli finanssikriisi Suomen ulkopuolinen globaalin rahoitusmarkkinoiden häiriö.