Aneurisma roto de artéria esplênica: flagrante tomográfico de sangramento

The splenic artery aneurysm is a rare entity and its rupture is the most feared complication. The tomographic computed scan is a potential tool in the diagnosis, and can be used to patients with a suspicion of intra-abdominal bleeding, after adequate resuscitation. A case of a 68-year old male, hypertense patient, with a ruptured splenic artery aneurysm is reported. The diagnosis and treatment were given successfully by the abdominal computed tomographic scan and conventional surgery. The tomographic computed scan can be useful to the diagnosis of ruptured splenic artery aneurism, after the hemodynamic stabilization.

Hematoma espontâneo do músculo reto abdominal

Spontaneous hematoma of the rectus sheath is a rare entity, which may be confused with the surgical causes of acute abdomen. We present a well succeeded conservative therapy in a woman in the 7th decade of life.

Torção do grande omento

We present two cases of greater omental torsion, a rare condition of acute abdominal pain, emphasizing the clinical manifestations and imaging findings, which can lead us to the difficult preoperative diagnosis of this entity.

Atualização em GIST

Gastrointestinal stromal tumor (GIST) has been recently the subject of considerable clinical and experimental interest. This focus is based on insights gained during the past years concerning its identification as a distinct clinical entity and the advances in knowledge about the diagnosis and management. Historically, surgery has been considered the most effective treatment in spite of its limitations. Others therapeutic approaches have been tryng without success, until the introduction of imatinib. This drug provided hopeful results in the treatment of this neoplasia. The idea that imatinib could improve surgical outcome have led to some clinical trials with the hope that this association (imatinib & surgery) could achieve good results.

Duplicação uretral em homem adulto

Urethral duplication is a rare congenital anomaly. The clinical presentation and treatment varies because of the different anatomical patterns of this abnormality. We report a case of this entity in the adult male patient. The clinical, radiological and endoscopic findings, as well as the treatment are discussed.

Pseudotumor pancreático

The decrease in morbidity and mortality of pancreaticoduodenectomy in reference centers has increased the incidence of benign histopathologic diagnosis in cases where a pre-operative diagnosis of pancreatic ductal carcinoma was expected (9,2%). Recent reports have shown that autoimune pancreatitis, an entity that can lead to a pathologic diagnosis of sclerosing lymphoplasmatic pancreatitis has been the cause of about 2,5% of wrong preoperative diagnosis. Clinical and image definitive diagnosis is still uncertain on those borderline cases. An increase in IgG4 has been reported as frequent in patients with autoimune pancreatitis which can respond to steroid treatment. In doubtful cases, four diagnosis can be expected: 1. Pancreatic ductal carcinoma; 2. Chronic alcoholic pancreatitis; 3. "Chronic pancreatitis secondary to choledocal lithiasis"; 4. Sclerosing lymphoplasmatic pancreatitis. Modern medical literature sugests that evaluation of IgG4 in doubtful cases of pancreatic tumor (pseudotumor of the pancreas) could avoid unnecessary pancreaticoduodenectomies in the future.

Câncer colo-retal hereditário

The colorectal cancer has become a world public health problem as a consequence of the great number of new cases which have been diagnosed each year and the existence of some conditions related to the disease's natural history that can be identified and the cancer prevented. Knowing the fact that 20% out of all colorectal cancers develops as part of a hereditary cancer syndrome, it is crucial that the physician (not only the surgeon) be updated with this entity, being able to recognize, and mainly, implement screening programs to identify family members at risk of developing cancer and to allow the intervention to prevent the occurrence of the adenoma-carcinoma sequence.

Rabdomioma da cabeça e pescoço

Rhabdomyoma is a rare soft tissue tumor and account for 1 to 2 % of skeletal muscle tumors. Rhabdomyomas are uncommon with less than one hundred cases reported. Head and neck rhabdomyomas have their origin in the third and fourth branchial clefts skeletal muscle. Describe the clinical, histopathological and radiological aspects of a recurrent adult mouth floor rhabdomyoma and the differential diagnosis for this uncommon entity. Two years after surgical resection, of a fifty-four years old male patient, with mouth floor rhabdomyoma, he started to complain of submucosal lesion at the oropharynx right lateral wall. The CT scan has shown extension to the parapharyngeal space and recurrent rhabdomyoma hypothesis has been done. The patient underwent a new surgical resection and the histopathological examination confirmed a recurrent adult rhabdomyoma.

The Finnish Paper Workers' Union at a crossroads: Labor union representativeness in a changing environment, 1980-2008

This thesis consists of four articles and an introductory section. The main research questions in all the articles refer to the changes in the representativeness of the Finnish Paper Workers' Union. Representativeness stands for the entire entity of external, internal, legal and reputational factors that enable the labor union to represent its members and achieve its goals. This concept is based on an extensive reading of quantitative and qualitative industrial relations literature, which includes works based on Marxist labor-capital relations (such as Hyman's industrial relations studies), and more recent union density studies as well as gender- and ethnic diversity-based 'union revitalization' studies. Müller-Jentsch's German studies of industrial relations have been of particular importance as well as Streeck's industrial unionism and technology studies. The concept of representativeness is an attempt to combine the insights of these diverse strands of literature and bring the scientific discussion of labor unions back to the core of a union's function: representing its members. As such, it can be seen as a theoretical innovation. The concept helps to acknowledge both the heterogeneity of the membership and the totality of a labor union organization. The concept of representativeness aims to move beyond notions of 'power'. External representativeness can be expressed through the position of the labor union in the industrial relations system and the economy. Internal representativeness focuses on the aspects of labor unions that relate to the function of the union as an association with members, such as internal democracy. Legal representativeness lies in the formal legal position of the union – its rights and instruments. This includes collective bargaining legislation, co-decision rules and industrial conflict legislation. Reputational representativeness is related to how the union is seen by other actors and the general public, and can be approximated using data on strike activity. All these aspects of representativeness are path-dependent, and show the results of previous struggles over issues. The concept of representativeness goes beyond notions of labor union power and symbolizes an attempt to bring back the focus of industrial relations studies to the union's basic function of representing its members. The first article shows in detail the industrial conflict of the Finnish paper industry in 2005. The intended focus was the issue of gender in the negotiations over a new collective agreement, but the focal point of the industrial conflict was the issue of outsourcing and how this should be organized. Also, the issue of continuous shifts as an issue of working time was very important. The drawn-out conflict can be seen as a struggle over principles, and under pressure the labor union had to concede ground on the aforementioned issues. The article concludes that in this specific conflict, the union represented its' female members to a lesser extent, because the other issues took such priority. Furthermore, because of the substantive concessions. the union lost some of its internal representativeness, and the stubbornness of the union may have even harmed the reputation of the union. This article also includes an early version of the representativeness framework, through which this conflict is analyzed. The second article discusses wage developments, union density and collective bargaining within the context of representativeness. It is shown that the union has been able to secure substantial benefits for its members, regardless of declining employment. Collective agreements have often been based on centralized incomes policies, but the paper sector has not always joined these. Attention is furthermore paid to the changing competition of the General Assembly, with a surprisingly strong position of the Left Alliance still. In an attempt to replicate analysis of union density measures, an analysis of sectoral union density shows that similar factors as in aggregate data influence this measure, though – due to methodological issues – the results may not be robust. On this issue, it can be said that the method of analysis for aggregate union density is not suitable for sectoral union density analysis. The increasingly conflict-ridden industrial relations predicted have not actually materialized. The article concludes by asking whether the aim of ever-increasing wages is a sustainable one in the light of the pressures of globalization, though wage costs are a relatively small part of total costs. The third article discusses the history and use of outsourcing in the Finnish paper industry. It is shown using Hyman's framework of constituencies that over time, the perspective of the union changed from 'members of the Paper Workers' Union' to a more specific view of who is a core member of the union. Within the context of the industrial unionism that the union claims to practice, this is an important change. The article shows that the union more and more caters for a core group, while auxiliary personnel is less important to the union's identity and constituencies, which means that the union's internal representativeness has decreased. Maintenance workers are an exception; the union and employers have developed a rotating system that increases the efficient allocation of these employees. The core reason of the exceptional status of maintenance personnel is their high level of non-transferable skills. In the end it is debatable whether the compromise on outsourcing solves the challenges facing the industry. The fourth article shows diverging discourses within the union with regard to union-employer partnership for competitiveness improvements and instruments of local union representatives. In the collective agreement of 2008, the provision regulating wage effects of significant changes in the organization or content of work was thoroughly changed, though this mainly reflected decisions by the Labor Court on the pre-2008 version of the provision. This change laid bare the deep rift between the Social Democratic and Left Alliance (ex-Communist) factions of the union. The article argues that through the changed legal meaning of the provision, the union was able to transform concession bargaining into a basis for partnership. The internal discontent about this issue is nonetheless substantial and a threat to the unity of the union, both locally and at the union level. On the basis of the results of the articles, other factors influencing representativeness, such as technology and EU law and an overview of the main changes in the Finnish paper industry, it is concluded that, especially in recent years, the Finnish Paper Workers' Union has lost some of its representativeness. In particular, the loss of the efficiency of strikes is noted, the compromise on outsourcing which may have alienated a substantial part of the union's membership, and the change in the collective agreement of 2008 have caused this decline. In the latter case, the internal disunion on that issue shows the constraints of the union's internal democracy. Furthermore, the failure of the union to join the TEAM industrial union (by democratic means), the internal conflicts and a narrow focus on its own sector may also hurt the union in the future, as the paper industry in Finland is going through a structural change. None of these changes in representativeness would have been so drastic without the considerable pressure of globalization - in particular changing markets, changing technology and a loss of domestic investments to foreign investments, which in the end have benefited the corporations more than the Finnish employees of these corporations. Taken together, the union risks becoming socially irrelevant in time, though it will remain formally very strong on the basis of its institutional setting and financial situation.

Mucocele de apêndice

Appendiceal mucocele is a rare entity characterized by a gross enlargement of the appendix from accumulation of mucoid substance within the lumen. It is encountered in only 0.1 - 0.4% of all appendicectomies with a female predominance (M/F: 1/4) and a mean age of more than 50 years at the time of presentation . Because of that, appendiceal mucocele is often incidentally discovered either during surgery or on radiologic examination. A case of benign appendiceal mucocele is reported here, in a 49 years old male. The pathogenesis and the different surgical strategies are discussed.

Mondor's disease in puerperium: case report

Mondor's disease is a rare entity characterized by sclerosing thrombophlebitis classically involving one or more of the subcutaneous veins of the breast and anterior chest wall. It is usually a self-limited, benign condition, despite of rare cases of association to cancer. We present the case of a 32 year-old female, breast-feeding, who went to emergency due to left mastalgia for the past week. She was taking antibiotics and non-steroidal anti-inflammatory drugs, previously prescribed for suspicious of mastitis, for three days, with no clinical improvement. Physical examination showed an enlarged left breast, an axillary lump and a painful cord-like structure in the upper outer quadrant of the same breast. Ultrasound scan showed a markedly dilated superficial vein in the upper outer quadrant of left breast. The patient was given a ventropic therapy and was kept in anti-inflammatory, with progressive pain improvement. Ultrasound control was performed after four weeks, showing reperfusion.

Innostuneena ikään katsomatta - Ikäjohtamisen vaikutus työmotivaatioon

Tämän tutkimuksen tarkoituksena oli tutkia, voidaanko ikäjohtamisella vaikuttaa henkilöstön työmotivaatioon. Tutkimus toteutettiin laadullisena tapaustutkimuksena haastattelemalla pankissa toimivia eri-ikäisiä palveluneuvojia lokakuussa 2012. Tutkimuksen tuloksena havaittiin että ikäjohtamisella on vaikutusta henkilöstön työmotivaatioon sekä suoraan että välillisesti. Suorat vaikutukset syntyvät pääasiassa yksilöllisen johtamisen kautta, jossa esimies ottaa huomioon alaisensa persoonan, taustan sekä osaamisen ja muokkaa työtehtäviä sekä omaa esimiestyötään niiden mukaisesti. Työmotivaation kannalta on oleellista että työntekijän yksilölliset ominaisuudet yhdistyvät työn sisältöön häntä motivoivalla tavalla. Motivoivassa työssä korostuvat työn merkityksellisyys, vastuullisuus ja tuloksellisuus. Välilliset vaikutukset syntyvät ennen kaikkea työn organisoinnin ja työyhteisössä vallitsevan ilmapiirin myötä ja vaikuttavat sitä kautta sekä fyysiseen että sosiaaliseen työympäristöön, joilla kummallakin on merkitystä työmotivaation rakentumisessa. 

Hankintalain mukaisen tarjouspyynnön laatiminen ja sen merkitys kunnallisissa rakennusurakkahankinnoissa

Suomalaiset kunnat ovat julkisissa hankinnoissaan suurien haasteiden edessä heikentyvän taloustilanteen, muuttoliikkeen ja osaamisen puutteen takia. Rakennusinvestoinnit muodostavat valtaosan kunnallisista investoinneista. Epäonnistuessaan rakennusurakan hankintamenettely voi aiheuttaa kunnalle merkittäviä viivästyksiä sekä tappioita, joten menettelyn onnistuminen on kunnalle erittäin tärkeää. Hankintaprosessin sujuvuus riippuu tarjouspyyntöasiakirjojen oikeaoppisesta laatimisesta ja niiden sisällön soveltamisesta. Tämän tutkimuksen tavoitteena on löytää yleisimmät hankintamenettelyyn liittyvät virheet sekä määritellä hankintayksikölle toimintatavat, joita noudattamalla hankintayksikkö voi virheet välttää. Tutkimusmenetelmä on lainopillinen ja tutkimus perustuu oikeuskäytäntöön, pääasiassa markkinaoikeustapauksiin nojaavaan empiiriseen analyysiin. Tutkielman perusteella hankintayksiköiden osaamista tarjouspyyntöasiakirjojen laadinnassa ja sisällön soveltamisessa on kehitettävä seuraavasti: Tarjoajien ja tarjousten vertailuvaiheet on eroteltava selkeästi toisistaan. Tarjoajiin kohdistuvia vaatimuksia sekä kokonaistaloudellisen edullisuuden laadullisia vertailuperusteita on yksityiskohtaistettava. Kullekin menettelyvaiheelle on varattava riittävästi aikaa ja hankintamenettely on valmisteltava niin, että täsmennys- ja täydennyspyynnöiltä voidaan välttyä. Julkisen talouden elvyttämiseksi suunniteltuun rakennusurakkahankintojen keskittymiseen on reagoitava jakamalla urakka mahdollisuuksien mukaan pienempiin osiin urakoitsijamarkkinoiden monipuolisuuden ylläpitämiseksi.

Kiinteistönvälittäjän tiedonantovelvollisuus käytetyn asunnon kaupassa

Tutkielman tarkoituksena on selvittää kiinteistövälittäjän tiedonantovelvollisuuden laajuus käytetyn asunnon kaupassa. Tutkielma noudattaa lainopillista tutkimusmenetelmää ja sen perustan muodostaa kiinteistönvälitystä ja asuntokauppaa sääntelevä lainsäädäntö ja sen tulkinta. Tarkemmat rajaukset kiinteistönvälittäjän tiedonantovelvollisuudelle sekä tukea lain tulkinnalle haetaan aihetta käsittelevistä korkeimman oikeuden ennakkopäätöksistä ja oikeuskirjallisuudesta. Ennakkopäätösten sekä kuluttajariitalautakunnan ratkaisujen läpikäynti ja tulkinta muodostavat tutkimuksen ytimen. Tutkimus osoittaa, että kiinteistönvälittäjän tiedonantovelvollisuuteen vaikuttaa monta tekijää kussakin yksittäisessä asuntokaupassa, jolloin tiedonantovelvollisuuden täyttäminen on monisyinen ja tulkinnanvarainen seikka. Laki ei siis anna tyhjentävää vastausta kiinteistönvälittäjän tiedonantovelvollisuudesta, vaan se on kokonaisuus, joka täytyy arvioida voimassa olevan lain sekä ennakkopäätösten linjausten valossa.

Sivistyksestä sivilisaatioon. Kulttuurikäsitys J. V. Snellmanin historiallisessa ajattelussa

From Bildung to Civilisation. Conception of Culture in J. V. Snellman’s Historical Thinking The research explores Johan Vilhelm Snellman’s (1806–1881) conception of culture in the context of his historical thinking. Snellman was a Finnish, Swedish-speaking journalist, teacher and thinker, who held a central position in the Finnish national discourse during the nineteenth century. He has been considered as one of the leading theorists of a Finnish nation, writing widely about the themes such as the advancement of the national education, Finnish language and culture. Snellman is already a widely studied person in Finnish intellectual history, often characterised as a follower of G. W. F. Hegel’s philosophical system. My own research introduces a new kind of approach on Snellman’s texts, emphasising the conceptual level of his thought. With this approach, my aim is to broaden the Finnish research tradition on conceptual history. I consider my study as a cultural history of concepts, belonging also to the field of intellectual history. My focus is on one hand on the close reading of Snellman’s texts and on the other hand on contextualising his texts to the European intellectual tradition of the time. A key concept of Snellman’s theoretical thinking is his concept of bildning, which can be considered as a Swedish counterpart of the German concept of Bildung. The Swedish word incorporated all the main elements of the German concept. It could mean education or the so-called high culture, but most fundamentally it was about the self-formation of the individual. This is also the context in which Snellman’s concept of bildning has often been interpreted. In the study, I use the concept of bildning as a starting point of my research but I broaden my focus on the cognate concepts such as culture (kultur), spirit (anda) and civilisation. The purpose of my study is thus to illustrate how Snellman used and modified these concepts and from these observations to draw a conclusion about the nature of his conception of culture. Snellman was an early Finnish philosopher of history but also interested in the practice of the writing of history. He did not write any historical presentations himself but followed the publications in the field of history and introduced European historical writing to the Finnish, Swedish-speaking reading audience in his newspapers. The primary source material consists of different types of Snellman’s texts, including philosophical writings, lecture material, newspaper articles and private letters. I’m reading Snellman’s texts in the context of other texts produced both by his Finnish predecessors and contemporaries and by Swedish, German and French writers. Snellman’s principal philosophical works, Versuch einer spekulativen Entwicklung der Idee der Persönlichkeit (1841) and Läran om staten (1842), were both written abroad. Both of the works were contributions to contemporary debates on the international level, especially in Germany and Sweden. During the 1840s and 1850s Snellman had two newspapers of his own, Saima and Litteraturblad, which were directed towards the Swedish-speaking educated class. Both of the newspapers were very popular and their circulations were among the largest of their day in Finland. The topics of his articles and reviews covered literature, poetry, philosophy and education as well as issues concerning the economic, industrial and technical development in Finland. In his newspapers Snellman not only brought forth his own ideas but also spread the knowledge of European events and ideas to his readers. He followed very carefully the cultural and political situation in Western Europe. He also followed European magazines and newspapers and was well acquainted with German, French and also English literature – and of course Swedish literature to with which he had the closest ties. In his newspapers Snellman wrote countless number of literary reviews and critics, introducing his readers to European literature. The study consists of three main chapters in which I explore my research question in three different, yet overlapping contexts. In the first of these chapters, I analyse Snellman’n theoretical thinking and his concepts of bildning, kultur, anda and civilisation in the context of earlier cultural discourse in Finland as well as the tradition of German idealistic philosophy and neo-humanism. With the Finnish cultural discourse I refer to the early cultural discussion in Finland, which emerged after the year 1809, when Finland became an autonomous entity of its own as a Grand Duchy of Russia. Scholars of the Academy of Turku opened a discussion on the themes such as the state of national consciousness, the need for national education and the development of the Finnish language as a national language of Finland. Many of these academics were also Snellman’s teachers in the early years of his academic career and Snellman clearly formulated his own ideas in the footsteps of these Finnish predecessors. In his theoretical thinking Snellman was a collectivist; according to him an individual should always be understood in connection with the society, its values and manners, as well as to the traditions of a culture where an individual belongs to. In his philosophy of the human spirit Snellman was in many ways a Hegelian but his notion of education or ‘bildning’ includes also elements that connect him with the wider tradition of German intellectual history, namely the neo-humanist tradition and, at least to some extent, to the terminology of J. G. Herder or J. G. Fichte, for example. In this chapter, I also explore Snellman’s theory of history. In his historical thinking Snellman was an idealist, believing in the historical development of the human spirit (Geist in German language). One can characterise his theory of history by stating that it is a mixture of a Hegelian triumph of the spirit and Herderian emphasis on humanity (Humanität) and the relative nature of ‘Bildung’. For Snellman, the process of ‘bildning’ or ‘Bildung’ is being realised in historical development through the actions of human beings. Snellman believed in the historical development of the human civilization. Still Snellman himself considered that he had abandoned Hegel’s idea about the process of world history. Snellman – rightly or wrongly – criticised Hegel of emphasising the universal end of history (the realisation of the freedom of spirit) at the expense of the historical plurality and the freedom of each historical era. Snellman accused Hegel of neglecting the value and independency of different historical cultures and periods by imposing the abstract norm, the fulfilment of the freedom of spirit, as the ultimate goal of history. The historicist in Snellman believed in the individuality of each historical period; each historical era or culture had values, traditions and modes of thought of its own. This historicist in Snellman could not accept the talk about one measure or the end of history. On the other hand Snellman was also a universalist. He believed that mankind had a common task and that task was the development of ‘Bildung’, freedom or humanity. The second main chapter consists of two parts. In the first part, I explore the Finnish nationalistic discourse from the cultural point of view by analysing the notions such as a nation, national spirit or national language and showing how Snellman formulated his own ideas in a dialogic situation, participating in the Finnish discourse but also reacting to international discussions on the themes of the nation and nationality. For Snellman nationality was to a great extent the collective knowledge and customs or practices of the nation. Snellman stated that nationality is to be considered as a form of ‘bildning’. This could be seen not simply as affection for the fatherland but also for the mental identity of the nation, its ways of thinking, its practices, national language, customs and laws, the history of the nation. The simplest definition of nationality that Snellman gives is that nationality is the social life of the people. In the second part of the chapter I exam Snellman’s historical thinking and his understanding about historical development, interaction between different nations and cultures in the course of history, as well as the question of historical change; how do cultures or civilisations develop and who are the creators of culture? Snellman did not believe in one dominating culture but understood the course of history as a dialogue between different cultures. On the other hand, his views are very Eurocentric – here he follows the ideas of Hegel or for example the French historian François Guizot – for Snellman Europe represented the virtue of pluralism; in Europe one could see the diversity of cultures which, on the other hand, were fundamentally based on a common Christian tradition. In the third main chapter, my focus is on the writing of history, more precisely on Snellman’s ideas on the nature of history as a science and on the proper way of writing historical presentations. Snellman wrote critics on the works of history and introduced his readers to the writing of history especially in France, Sweden and German-speaking area – in some extend also in Britain. Snellman’s collectivistic view becomes evident also in his reviews on historical writing. For Snellman history was not about the actions of the states and their heads, nor about the records of ruling families and battles fought. He repeatedly stressed that history is a discipline that seeks to provide a total view of a phenomenon. A historian should not only collect information on historical events, since this information touches only the surface of a certain epoch or civilisation; he has to understand an epoch as totality. This required an understanding about the major contours in history, connections between civilisations and an awareness of significant turning points in historical development. In addition, it required a holistic understanding about a certain culture or historical era, including also the so-called inner life of a specific nation, a common people and their ways of life. Snellman wrote explicitly about ‘cultural history’ in his texts, referring to this kind of broad understanding of a society. In historical writing Snellman found this kind of broader view from the works of the French historians such as François Guizot and Jules Michelet. In all of these chapters, I elaborate the conceptual dimension of Snellman’s historical thinking. In my study I argue that Snellman not only adopted the German concepts of Bildung or Kultur in his own thinking but also developed the Swedish concepts in a way that include personal and innovative aspects. Snellman’s concept of bildning is not only a translation from ‘Bildung’ but he uses the Swedish concept in a versatile way that includes both the moral aspect of human development and social dimension of a human life. Along with ‘bildning’ Snellman used also the terms ‘kultur’ and ‘civilisation’ when referring to the totality of a certain nation or historical era, including both the so-called high culture (arts, science, religion) and the modes of thought as well as ways of life of the people as a whole. Unlike many of his Finnish contemporaries, Snellman did not use civilisation as a negative concept, lacking the moral essence of German term ‘Bildung’ or ‘Kultur’. Instead, for Snellman civilisation was a neutral term and here he comes close to the French tradition of using the term. In the study I argue that Snellman’s conception of culture in fact includes a synthesis of the German tradition of ‘Bildung’ and the French tradition of ‘civilisation’.