A cirurgia reconstrutiva em patologia oncológica do nariz : paralisia do nervo facial anatomia cirurgia do nariz

RESUMO: Os carcinomas localizados no nariz são muito frequentes em todas as séries conhecidas. São de diagnóstico clínico fácil e a sua confirmação por biópsia é muito segura. As terapêuticas mais indicadas são a cirurgia e a radioterapia, genericamente eficazes. Verifica-se, no entanto, que os pacientes continuam a solicitar tratamento em estádios muito avançados, mesmo conhecendo o diagnóstico e tendo acesso aos serviços sem custos. Esta situação poderá explicar-se face ao curso relativamente lento de muitos destes tumores e à idade geralmente avançada dos doentes que, de acordo com alguns inquéritos, receiam mais a terapeûtica do que a doença. Para obtenção de informação útil para condução deste problema, foram ainda analisados outros parâmetros. A maioria dos pacientes continua a solicitar tratamento quando as lesões envolvem duas subunidades nasais. Esta circunstância permite planear o tratamento cirúrgico com relativa facilidade, isto é, com exérese e reconstrução cujo resultado estético final é bastante aceitável. Os tumores de grandes dimensões, envolvendo várias subunidades, sendo frequentes, raramente implicam rinectomia total. Pelo contrário, são mais frequentes os tumores que envolvem metade do nariz e as estruturas vizinhas tais como o maxilar, a órbita e o lábio superior, atingindo mesmo a base do crânio. O controlo da doença nestes estádios é muito difícil. Não raramente, quando se crê que a doença está controlada, a cirurgia reconstrutiva bem como outras formas de reabilitação conjugadas, deixam ainda muita insatisfação. A nossa actividade tem-se desenvolvido seguindo os critérios adoptados nos melhores centros, isto é, as técnicas clássicas, complementadas com refinamentos recentes. Porém reflectindo sobre os resultados obtidos no tratamento de tumores do nariz, surge-nos um conjunto de questões para as quais ainda não encontrámos respostas cabais. Actuando de acordo com os princípios que definem o estado da arte, não obtivemos ainda resultados que satisfaçam tanto os doentes quanto os cirurgiões. Incessantemente procuramos novos dados técnicos e científicos que nos permitam sair deste ciclo vicioso em que o doente retarda a procura de assistência, receoso de que a terapêutica o deixe desfigurado. Tendo sempre em vista a obtenção dos melhores resultados com o mínimo de tempos cirúrgicos, valorizamos alguns detalhes praticados nos retalhos com padrão vascular bem definido. Dado que as sequelas na zona dadora de tecidos são uma incontornável preocupação, procuramos refinar a sua aplicação no sentido de as atenuarmos. A fronte, excelente zona dadora para reconstrucção nasal major, era sede de sequelas actualmente inaceitáveis. Estudado o comportamento dos tecidos na fronte, depois de levantado o retalho e efectuado o seu encerramento com uso da técnica de expansão intra-operatória, determinámos a presença do Factor de Crescimento Vascular Endotelial no próprio retalho e na zona dadora, tendo em vista que a sua presença poderá explicar o comportamento dos tecidos que foram submetidos a esta técnica. Procurou-se estudar a qualidade da reconstrução em 45 pacientes submetidos a cirurgia de exérese e reconstrução nasal major, assim como a qualidade de vida, relacionada com a doença e a terapêutica. Embora se possa admitir a existência de dados sugestivos de estratégias mais adequadas, não foi possível relacionar a qualidade da reconstrução com qualidade de vida dos pacientes. Poderá eventualmente concluir-se que a observação permanente da reconstrução, com qualidade estética e funcional, será o melhor método de alterar a ideia clássica, ainda muito divulgada, mas já ultrapassada, de que a cirurgia reconstrutiva do nariz não é mais que transformar um defeito horroroso num defeito ridículo.---------------ABSTRACT: Malignant tumours found in the nose are very frequent in all known series. Clinical diagnosis is simple and confirmation of biopsy diagnosis is accessible and safe. The most advisable therapies are surgery and radiotherapy. Despite everything patients continue to wait until the tumour is in an advanced stage before asking for therapy, although they know the diagnosis and have free access to specialised services. This situation could probably be explained by the slow development rate of the tumours which is associated with the age of the patient. Upon inquiry, it was found that a significant number of patients are more afraid of therapy than of the disease itself. Other parameters have been analysed in order to obtain useful information about the management of this problem. The majority of patients seek adequate treatment when the lesions involve two nasal subunits. This allows the programming of surgical therapy with relative ease as they may be removed and reconstructed with interesting final aesthetical results. Large tumours involving several subunits are frequent, but they rarely call for total rhinectomy. On the contrary, tumours more frequently involve half of the nose and their neighbouring structures: for example, maxillary, orbital and upper lip, even reaching as far as the base of the skull. The control of the disease is very difficult in these stages.In cases in which it is believed that the disease is under control, reconstructive surgery in conjunction with other forms of rehabilitation still result in a lot of dissatisfaction. In our activity we try to follow the criteria adopted by the best centres following classic techniques, complemented with recent refinements. Reflecting on the treatment of tumours of the nose has led us to a series of questions to which we haven’t yet found the answers. In accordance with the defined principles of ‘the state of the art’ it still doesn’t satisfy either the patients or the surgeons. We are looking for new technical and scientific data which allows us to leave this vicious cycle, in that the deferred patient avoids looking for assistance, based on the fear that therapy could leave them disfigured. We attach importance to some practiced details on the well-defined vascular pattern of the flaps, with the principle aim of obtaining a good result, from the minimum number of operations. It is known that sequels in donor sites are a concern, so applied refinements are used in order to reduce the defect. The forehead has been considered an excellent donor site for major nasal reconstruction but the area of sequel is nowadays unacceptable. We tried to study the behaviour of the tissues of the forehead after taking the flap and closing the wound, using the intraoperative expansion technique. We determined the presence of Vascular Endothelial Growth Factor in the flaps and in the donor site, in which its presence could explain the behaviour of the tissues of the forehead that are submitted to this technique. The quality of the reconstruction was studied in 45 patients who were submitted to surgical exeresisand major nasal reconstruction, as was the relationship between the disease and the therapy regarding quality of life. It was not possible to directely relate the quality of the reconstruction to the quality of patients life, although some suggestive data of more adequate manegement may be interesting. One might eventually conclude that, permanent exposure of the reconstruction with aesthetic and funcional quality would be the best method in order to modify the classic idea which is still known although overridden today, that nasal reconstruction could transform a horrible defect into a ridiculous one.-------RÉSUMÉ: Les carcinomes situés sur le nez sont très fréquents dans toutes les séries connues. Ils sont de diagnostic facile et la confirmation de ce dernier par une biopsie, est accessible et très fiable. La chirurgie et la radiothérapie sont les thérapeutiques les mieux indiquées. Toutefois les patients continuent de solliciter un traitement, seulement dans des états très avancés bien qu’ils aient eu connaissance du diagnostic et ayant accès aux services. Cette situation pourra probablement s’expliquer par l’évolution relativement indolente de beaucoup de tumeurs, associée à l’âge des malades; bien que selon quelques enquêtes réalisées un nombre élevé de malades craint davantage la thérapeutique que la maladie. D’autres paramètres sont analysés en vue d’obtenir des informations utiles pour l’accompagnement de ce problème. La majorité de nos patients sollicite le traitement adéquat quand les lésions entourent deux sous-unités nasales, ce qui permet de planifier le traitement chirurgique avec une certaine facilité, c’est à dire l’exérèse et la reconstruction ayant un résultat final esthétique généralement très acceptable. Les tumeurs de grandes dimensions entourant différentes sous-unités sont fréquentes mais elles impliquent rarement une amputation nasal total. Au contraire, les tumeurs les plus fréquentes sont celles qui entourent la moitié du nez et les structures voisines comme le maxillaire, l’orbite et la lèvre supérieure, parfois, elles peuvent même atteindre la base du crâne. Le contrôle de la maladie dans ces états est très difficile et quand nous pensons que la maladie est contrôlée, la chirurgie reconstructrice associée à d’autres formes de réhabilitation provoquent encore une grande insatisfaction. Nous exerçons notre activité en essayant de suivre les critères adoptés dans les meilleurs centres. Nous appliquons les techniques classiques complétées de retouches pour obtenir un meilleur resultat. Le fait de traiter les tumeurs nasales nous fait réfléchir et poser un ensemble de questions auxquelles nous n’avons pas pu trouver de réponses. En actuant en accord avec les principes qui définissent l’état de l’art, nous n’avons pas obtenu de résultats qui satisfassent les malades et les chirurgiens. Nous recherchons de nouvelles données techniques et scientifiques qui nous permettent de sortir de ce cercle vicieux dans lequel le patient retarde la recherche d’aide craignant que la thérapeutique le défigure. Nous valorisons certains détails pratiqués sur les lambeaux de patron vasculaire bien défini et ayant comme principaux objectifs l’obtention d’un bon résultat en moins de temps de chirurgie. Nous savons que les séquelles de la zone donneuse de tissus sont préoccupantes, ainsi, que les retouches qui ont été appliqués dans l’objectif de les atténuer. Le front, excellente zone donneuse pour la reconstruction nasale majeure, était une source de séquelle actuellement inacceptable. Nous avons étudié le comportement des tissus du front après avoir relevé le lambeau et effectué la fermeture avec la technique de l’expansion intraoperative. Nous avons déterminé la présence du Facteur de Croissance Vasculaire Endothéliale dans le propre lambeau et dans la zone donneuse, celle-ci pourra expliquer le comportement des tissus du front qui ont été soumis à cette technique. On a essayé d´etudier la qualité de la reconstruction sur 45 patients soumis à la chirurgie d´exérèse et la reconstruction nasal majeure, ainsi comme la qualité de vie en relation avec la maladie et la thérapie. Quoique l´on puisse conclure par l´existence des données subjectives des stratégies plus justes, il est impossible de faire un rapport sur la qualité de la reconstruction avec la qualité de vie des patients. Eventuellement l´on purrait conclure que l´observation permanente de la reconstruction avec qualité esthétique et fonctionnelle, se serait la meilleure méthod de changer l´idée classique, mais depassée, de que la rhinopoièse n´est pas que transformer un affreux défaut par un défaut ridicule.

Increase of the Delivered Power Probability in Distribution Networks using Pareto DC Programming

A methodology to increase the probability of delivering power to any load point through the identification of new investments in distribution network components is proposed in this paper. The method minimizes the investment cost as well as the cost of energy not supplied in the network. A DC optimization model based on mixed integer non-linear programming is developed considering the Pareto front technique in order to identify the adequate investments in distribution networks components which allow increasing the probability of delivering power for any customer in the distribution system at the minimum possible cost for the system operator, while minimizing the energy not supplied cost. Thus, a multi-objective problem is formulated. To illustrate the application of the proposed methodology, the paper includes a case study which considers a 180 bus distribution network

Estudo comparativo da utilização do biodiesel produzido a partir de óleos alimentares usados e do gasóleo numa frota industrial

A definição de teores mínimos de incorporação de biocombustíveis, constitui objeto de discussão entre grupos pro-desenvolvimento e ambientalistas. Esses últimos argumentam que as consequências da utilização desta fonte energética ainda são desconhecidas. Além disso, alegam que a produção de biocombustíveis é, em parte, responsável pelo aumento no preço dos alimentos, encoraja a conversão de florestas em monoculturas e conduz à exploração de trabalhadores em países em desenvolvimento (PEDs). Para responder à dependência energética dos combustíveis de origem fóssil, e ajudar a reduzir as emissões de gases com efeito de estufa, sobretudo no sector dos transportes, o biodiesel produzido a partir de óleos alimentares usados têm sido apontado como uma “solução verde” capaz de minimizar o problema das alterações climáticas e valorizar um resíduo, e simultaneamente conferir ao setor energético um pouco mais de independência. De forma a desmistificar e clarificar um pouco estas premissas, a presente dissertação pretende fazer um estudo de avaliação do impacto da utilização do biodiesel, nomeadamente no que diz respeito às emissões gasosas. Posteriormente realizou-se, tomando como referência uma pequena frota industrial existente, uma análise comparativa dos consumos e emissões dos principais poluentes decorrentes da utilização do biodiesel em diferentes percentagens de incorporação no gasóleo, comparativamente ao gasóleo puro. O trabalho culmina com uma abordagem técnica sobre o comportamento de um veículo equipado com um motor de ignição por compressão, utilizando como biocombustível o biodiesel.

Invited review: Models for the optimization of regional wastewater treatment systems

European Journal of Operational Research, nº 73 (1994)

Analisador de qualidade de energia eléctrica embebido na instalação eléctrica

A monitorização da qualidade da energia eléctrica tem revelado importância crescente na gestão e caracterização da rede eléctrica. Estudos revelam que os custos directos relacionados com perda de qualidade da energia eléctrica podem representar cerca de 1,5 % do PIB nacional. Para além destes, tem-se adicionalmente os custos indirectos o que se traduz num problema que necessita de minimização. No contexto da minimização dos danos causados pela degradação de energia, são utilizados equipamentos com capacidade de caracterizar a energia eléctrica através da sua monitorização. A utilização destes equipamentos têm subjacente normas de qualidade de energia, que impõem requisitos mínimos de modo a enquadrar e classificar eventos ocorridos na rede eléctrica. Deste modo obtêm-se dados coerentes provenientes de diferentes equipamentos. A monitorização dos parâmetros associados à energia eléctrica é frequentemente realizada através da instalação temporária dos esquipamentos na rede eléctrica, o que resulta numa observação de distúrbios a posteriori da sua ocasião. Esta metodologia não permite detectar o evento eléctrico original mas, quando muito, outros que se espera que sejam semelhantes ao ocorrido. Repare-se, no entanto, que existe um conjunto alargado de eventos que não são repetitivos, constituindo assim uma limitação aquela metodologia. Este trabalho descreve uma alternativa à metodologia de utilização tradicional dos equipamentos. A solução consiste em realizar um analisador de energia que faça parte integrante da instalação e permita a monitorização contínua da rede eléctrica. Este equipamento deve ter um custo suficientemente baixo para que seja justificável nesta utilização alternativa. O analisador de qualidade de energia a desenvolver tem por base o circuito integrado ADE7880, que permite obter um conjunto de parâmetros da qualidade de energia eléctrica de acordo com as normas de energia IEC 61000-4-30 e IEC 61000-4-7. Este analisador permite a recolha contínua de dados específicos da rede eléctrica, e que posteriormente serão armazenados e colocados à disposição do utilizador. Deste modo os dados recolhidos serão apresentados ao utilizador para consulta, de maneira a verificar, de modo continuo a eventual ocorrência das anomalias na rede. Os valores adquiridos podem ainda ser reutilizados vantajosamente para muitas outras finalidades tais como efectuar estudos sobre a optimização energética. O trabalho presentemente desenvolvido decorre de uma utilização alternativa do dispositivo WeSense Energy1 desenvolvido pela equipa da Evoleo Technologies. A presente vertente permite obter parâmetros determinados pelo ADE7880 tais como por exemplo harmónicos, eventos transitórios de tensão e corrente e o desfasamento entre fases, realizando assim uma nova versão do dispositivo, o WeSense Energy2. Adicionalmente este trabalho inclui a visualização remota dos através de uma página web.

A Random Access Protocol incorporating Multi-Packet Reception, Retransmission Diversity and Successive Interference Cancellation

8th International Workshop on Multiple Access Communications (MACOM2015), Helsinki, Finland.

Distributed Linear Precoding and User Selection in Coordinated Multicell Systems

In this manuscript we tackle the problem of semidistributed user selection with distributed linear precoding for sum rate maximization in multiuser multicell systems. A set of adjacent base stations (BS) form a cluster in order to perform coordinated transmission to cell-edge users, and coordination is carried out through a central processing unit (CU). However, the message exchange between BSs and the CU is limited to scheduling control signaling and no user data or channel state information (CSI) exchange is allowed. In the considered multicell coordinated approach, each BS has its own set of cell-edge users and transmits only to one intended user while interference to non-intended users at other BSs is suppressed by signal steering (precoding). We use two distributed linear precoding schemes, Distributed Zero Forcing (DZF) and Distributed Virtual Signalto-Interference-plus-Noise Ratio (DVSINR). Considering multiple users per cell and the backhaul limitations, the BSs rely on local CSI to solve the user selection problem. First we investigate how the signal-to-noise-ratio (SNR) regime and the number of antennas at the BSs impact the effective channel gain (the magnitude of the channels after precoding) and its relationship with multiuser diversity. Considering that user selection must be based on the type of implemented precoding, we develop metrics of compatibility (estimations of the effective channel gains) that can be computed from local CSI at each BS and reported to the CU for scheduling decisions. Based on such metrics, we design user selection algorithms that can find a set of users that potentially maximizes the sum rate. Numerical results show the effectiveness of the proposed metrics and algorithms for different configurations of users and antennas at the base stations.

Adolescents and School Asthma Knowledge and Attitudes

Introduction: bronchial asthma is a chronic disease that affects a high percentage of adolescents, with a significant restriction of daily activities, and is a cause of school absenteeism. The relationships between adolescents and asthma disease in school were assessed, with a view to improving knowledge about the asthmatic adolescent. Methods: a survey was conducted in the Lisbon metropolitan area, covering urban (Lisbon) and rural (Lourinh˜a ) zones and including 1879 students and 81 teachers from the 7th to 9th high school years. The study groups were asthmatic students, their peers, and teachers. A self-administered questionnaire was applied to collect information. The results were compared with a reference group of 91 asthmatic students attending our Department of Immunoallergy-Hospital Dona Estefânia. Cotinine urinary measurements were made in a sample of asthmatics and a control group. Results: the prevalence of current asthma among students was 10%. Estimates of asthma annual burden among 7th to 9th year students from Lisbon and Lourinh˜a high schools included 4,307 days missed from school, 4,148 medical consultations and a minimum of 351 hospital emergency care and 80 hospital admissions. Exposure to passive smoking was not significantly different between asthmatic students and theirs peers. Cotinine urinary measurements did not discriminate between exposed and non-exposed individuals. Cigarette smoking was almost as common among adolescent asthmatics (5.4%) as it was in non-asthmatic subjects (6.7%). However, 55% of asthmatics mentioned active and passive smoking as an asthma exacerbating factor. Asthmatic students, theirs peers and teachers showed a deficient knowledge about asthma (mean group scores: 17.6; 14.2 and 17.7 of a possible 30), particularly in the areas related to asthma recognition and its management. Asthmatics attending our Allergy Department had the highest scores. All groups showed tolerance in the sense of a positive and understanding attitude toward a person with asthma. However, traditional beliefs about asthma disease (dependence, inferiority...) were confirmed. A positive correlation between knowledge levels and tolerance attitudes was found. Conclusion: in view of the dimension of the asthma problem in adolescence and its social and economic impact, it is justifiable to assess the need for the implementation of asthma education programs in schools in order to improve asthma management by the adolescents and their schools.

On the Scalability of Constructive Interference in Low-Power Wireless Networks

12th European Conference on Wireless Sensor Networks (EWSN 2015). 9 to 11, Feb, 2015. Porto, Portugal

Toward a Run-Time Verification Framework for Real-Time Safety-Critical Systems

Presented at SEMINAR "ACTION TEMPS RÉEL:INFRASTRUCTURES ET SERVICES SYSTÉMES". 10, Apr, 2015. Brussels, Belgium.

As crianças e a internet. Crianças e tweens, as redes sociais e as ferramentas interactivas em Portugal - uma análise do canal temático ‘DISNEY CHANNEL PORTUGAL’

Trabalho projecto de mestrado em Novos Media e Práticas Web

Dynamic stability metrics for the container loading problem

The Container Loading Problem (CLP) literature has traditionally evaluated the dynamic stability of cargo by applying two metrics to box arrangements: the mean number of boxes supporting the items excluding those placed directly on the floor (M1) and the percentage of boxes with insufficient lateral support (M2). However, these metrics, that aim to be proxies for cargo stability during transportation, fail to translate real-world cargo conditions of dynamic stability. In this paper two new performance indicators are proposed to evaluate the dynamic stability of cargo arrangements: the number of fallen boxes (NFB) and the number of boxes within the Damage Boundary Curve fragility test (NB_DBC). Using 1500 solutions for well-known problem instances found in the literature, these new performance indicators are evaluated using a physics simulation tool (StableCargo), replacing the real-world transportation by a truck with a simulation of the dynamic behaviour of container loading arrangements. Two new dynamic stability metrics that can be integrated within any container loading algorithm are also proposed. The metrics are analytical models of the proposed stability performance indicators, computed by multiple linear regression. Pearson’s r correlation coefficient was used as an evaluation parameter for the performance of the models. The extensive computational results show that the proposed metrics are better proxies for dynamic stability in the CLP than the previous widely used metrics.

Stochastic simulation of the morphology of fluvial sand channels reservoirs

Dissertação para obtenção do Grau de Mestre em Engenharia Geológica (Georrecursos)

A ten-year follow-up of human leptospirosis in Uruguay: an unresolved health problem

Leptospira spp. are delicate bacteria that cannot be studied by usual microbiological methods. They cause leptospirosis, a zoonotic disease transmitted to humans through infected urine of wild or domestic animals. We studied the incidence of this disease in the Uruguayan population, its epidemiologic and clinical features, and compared diagnostic techniques. After examining 6,778 suspect cases, we estimated that about 15 infections/100,000 inhabitants occurred yearly, affecting mainly young male rural workers. Awareness about leptospirosis has grown among health professionals, and its lethality has consequently decreased. Bovine infections were probably the principal source of human disease. Rainfall volumes and floods were major factors of varying incidence. Most patients had fever, asthenia, myalgias or cephalalgia, with at least one additional abnormal clinical feature. 30-40% of confirmed cases presented abdominal signs and symptoms, conjunctival suffusion and altered renal or urinary function. Jaundice was more frequent in patients aged > 40 years. Clinical infections followed an acute pattern and their usual outcome was complete recovery. Laboratory diagnosis was based on indirect micro-agglutination standard technique (MAT). Second serum samples were difficult to obtain, often impairing completion of diagnosis. Immunofluorescence was useful as a screening test and for early detection of probable infections.