Malacoplaquia intestinal

Malacoplakia is a chronic granulomatous disease of unknown origin. However immunodeficiency states (immunossuppressive medication, old people, renal transplantation, leukaemia, diabetes mellitus, malnutrition and others) have been associated with patients with malacoplakia. An infectious cause of malakoplakia is suggested by the finding of coliform bacteria in the phagolysosomes of macrophages. The histologic study is characterized by a infiltrate of large macrophages (Hansenmann cells) with pathognomonic inclusions containing siderocalcific structures (Michaelis-Gutmann bodies). Most of the cases reported in literature, involve the genitourinary tract, but other structures can be affected (brain, bone, adrenal glands, lymph nodes, intestine, and others). A 66-year-old man whith a abdominal mass, went to our hospital with a colonic tumour diagnosis. The patient was submitted to a surgery, with resection of the rigth colon. The disease was invading a portion of the retroperitoneal tissue that was removed. The histopatologic study showed the pathognomonic sign of malakoplakia (Hansenmann cells and Michaelis-Gutmann bodies). Norfloxacin have been used to the complementar treatment with total cure of the patient.

Pseudotumor de pâncreas por corpo estranho

The diagnosis of pancreatic masses represents a great challenger for imaging studies. However the occurrence of pancreatic masses have been reported more frequently in the last years due to advances in imaging diagnostic methods. During the last decade, the surgical approach of pancreatic masses was limited to an attempt of establishing histological diagnosis, staging and evaluation of resection of these masses. Recently, the approach and staging of pancreatic masses was facilitated by sophisticated methods of diagnosis, especially, ultrasound, dynamic computerized tomography, magnetic resonance imaging (/RM), angiography, endoscopic retrograde cholangiopancreatography (CPRE), endoscopic ultrasound, laparoscopy and biochemical tumors markers. The present paper reports a case of a pancreatic mass due to foreign body in which the imaging study helped to determine out this rare etiological agent that has not been previouly described in literature.

Biopolttoaineiden leijutusominaisuuksien karakterisointi

Tässä diplomityössä selvitettiin biopolttoaineiden ominaisuuksia leijutuksen kannalta. Ensiksi tutkittavat biopolttoaineet, hake ja turve, seulottiin ja seulotut näytteet analysoitiin. Seuraavaksi turvetta ja haketta leijutettiin eri nopeuksilla ja eri leijutusnopeuksilla saadut näytteet analysoitiin kuva-analysilla. Partikkeleista selvitettiin runsaasti mittoja, kuten keskihalkaisija, pinta-ala ja muotokerroin. Kirjallisuudesta löytyvien korrelaatioiden avulla laskettiin leijutettujen partikkelien vastuskertoimet ja terminaalinopeudet. Korrelaatioiden tuloksia verrattiin mittaustuloksiin. Tässä työssä myös laskettiin kyseisiin biopolttoaineisiin vaikuttavat ominaisvoimat leijutuksessa sekä laskettiin korjauskerroin, jota käytettiin ominaisvoimien korjaamiseen. Referenssiaineina käytettiin hiekkaa ja lasikuulia.

Condroma de laringe: apresentação atípica

The authors report a case of laryngeal chondroma , a rare benign larynx tumor in the cricoid and arytenoid cartilages. There are aproximately 250 cases previously described in literature. A male, 41 year-old patient, presented a severe and progressive dyspnea leading to tracheostomy. Direct microlaryngoscopy revealed arytenoid enlargement and subglottic stenosis and the endoscopical biopsy was inconclusive, since the tumor present a hard gnistency. We performed surgical excision by laringofissura and total resection of the tumor, with good result. The histopathological examination showed a chondroma with no malignance.

Reconstrução da parede torácica nos defeitos adquiridos

Acquired chest wall defects present a challenging problem for thoracic surgeons. Many of such defects can be repaired with the use of local and regional musculocutaneous flaps, but larger defects compromising skeletal structure require increasingly sophisticated reconstructive techniques. The following discussion will review the options for repair acquired chest wall defects based in literature. The authors searched the Pubmed (www.pubmed.com) and found citations from January 1996 to February 2008. By reading the titles and the abstracts most of the citations were discharged because they focused in congenital chest wall defects or were cases report. However, many papers were found describing the outcome of large series of patients with acquired chest wall deformities. A review of recent literature shows that the repair of chest wall defects with soft tissues, if possible, remains the treatment of choice. Large chest wall defects require skeletal reconstruction to prevent paradoxical respiration. The selection of the most appropriate flap is primary dictated by the location and the size of the defect. It is important to transfer tissue with good vitality, so understanding the vascular supply is imperative. Autogenous grafts have been used in the past for skeletal reconstruction but a combination of synthetic materials with musculocutaneous flaps has been used lately. Based in the literature, the use of prosthetic material in chest wall reconstruction does not significantly increases the risk of wound infection.

Hérnia intercostal transdiafragmática após fratura espontânea de costelas secundária à crise de tosse

One case of transdiafragmatic intercostal hernia after intense coughing fit followed by rib fractures in patient with history of pneumonia is presented. He had a severe coughing fit, developed a right toracoabdominal hematoma and then a tumor that was gradually enlarging. Image exams confirmed the diagnosis. Treatment consisted of surgical repair with the use of a polypropylene prosthetic mesh. It is a rare type of hernia. Only four cases were found in literature. The sooner the disease is diagnosed and treated the better the prognoses will be since it will prevent hernia from strangulation and incarceration.

Lipoma gástrico: relato de caso

We report a case of gastric lipoma, a rare benign stomach tumor. There are approximately 200 cases previously described in literature. A male, 62-year-old patient with no clinical complaint presented a tumor lesion in the stomach antrum found in a routine upper endoscopy. A surgical resection (subtotal gastrectomy) was done and the histological examination showed submucosal lipoma without signs of malignancy. This report points to the growth of routine examination in the current clinical practice and the dilemma brought by overdiagnosis.

Ultrafiltration of pulp mill bleaching effluents

Main objective of this research was to find suitable polymeric ultrafiltration membranes with high retentions, good capacities and low fouling tendencies for the E2- and EP-effluent ultrafiltration. Purpose was to treat alkaline bleaching effluents with ultrafiltration in a way that permeates of the filtrations could be recycled back to process and the consumption of fresh water in the pulp mill could be reduced significantly. In the theoretical part of this work the challenges set by the pulp and paper indus-try processes for membranes were examined. An overview of the membrane tech-nology in the pulp industry was also provided. In addition process conditions in the chemical pulp bleaching and properties of bleaching effluents were discussed in literature study. In experimental part the E2- and EP-stage bleaching effluents from Stora Enso Imatra kraft pulp mill were ultrafiltered with CR250- and CR200-filters. Suitable membranes for ultrafiltration were chosen after screening experiments. Concentra-tion experiment was made for the E2-effluent in order to estimate water saving potential. The E2-effluent was finally ultrafiltered in the pulp mill in order to test the feasibility of ultrafiltration in a real industrial environment. Good membrane for the EP-effluent ultrafiltration based on the EP-screening ex-periments was polyethersulfone membrane UP020 with cut-off value of 20 000 Da. Polysulfone membrane UFX05 with cut-off value of 5 000 Da was promising membrane for the ultrafiltration of the E2-effluent. Based on the concentration filtration of the E2-effluent with UFX05 membrane the water saving potential could be 2.2 m3/Adt for the industrial scale ultrafiltration process. Retention re-sults, such as average COD retention of 60 %, from the trial filtration at the pulp mill with UFX05 membrane were modest compared to the screening experiments, where average COD retention was 75 %. Therefore tighter ultrafiltration mem-branes should be tested for the ultrafiltration of the E2-effluent. The UP020 mem-brane seemed to be suitable for the ultrafiltration of the EP-effluent however con-centration and pilot scale ultrafiltration experiments are needed to verify this.

Effects of laparoscopy on the cardiorespiratory system of brown brocket deer (Mazama gouazoubira) anesthetized with ketamine/ xylazine/ midazolam combination and isoflurane

Laparoscopy is not widely used as a tool to perform assisted reproduction techniques in South American cervids; thus, scarce information in literature is available regarding its effects and appropriate anesthetic protocols to perform it. This study evaluated the effect of laparoscopy on heart rate (HR), respiration rate (RR), saturation of oxyhemoglobin (SpO2) and rectal temperature (RT) of six female brown brocket deer (Mazama gouazoubira) anesthetized with ketamine (5mg/kg), xylazine (0.3mg/kg), midazolam (0.5mg/kg) combination i.v. and isoflurane. Twelve laparoscopies were performed and each animal was used twice with a 40-day interval. After anesthetized, the animals were placed in dorsal recumbency to perform laparoscopy procedure using abdominal CO2 insufflations (14.2 ± 2.39mmHg; M ± SE). The main events of the laparoscopy procedure were divided into three periods: animal without (P1) and with abdominal insufflation (P2) and abdominal insufflation with the hips raised at 45º (P3). As a control, the animals were anesthetized again 40 days after the last laparoscopy, and were maintained in a dorsal recumbency for the same average duration of the previous anesthesia and no laparoscopy procedure was conducted. The period of anesthesia for the controls was also divided into P1, P2, and P3 considering the average duration of these periods in previous laparoscopies performed. Data were analyzed through the (ANOVA) variance analysis followed by Tukey test and values at P<0.05 were considered significant. No significant differences were observed in the parameters evaluated at P1, P2 and P3 between the animals submitted to laparoscopy and control. However, the RR mean between P1 (38.8 ± 4.42) and P3 (32.7 ± 4.81); and the RT mean between the P1 (38.2ºC ± 0.17), P2 (37.6ºC ± 0.19) and P3 (37.0ºC ± 0.21) varied significantly, independent of the laparoscopy. These data indicated that laparoscopy didn't cause any significant alterations in the cardiorespiratory parameters evaluated, even though the anesthetic protocol used can cause a reduction in the RT contributing to development of hypothermia during anesthesia.

Lengsel - en kraft til helse

The aim of this study is to explore longing and its implication for health. The overall purpose is to develop a theory model of longing. The research question is: What is the substance of longing in a caring science perspective? The model is developed based on theoretical and empirical studies, which contains three different research materials; hermeneutic reading of texts by Augustine and Kierkegaard, and interpretation of research interviews with nine women in a cancer context. The design of the study is explorative and the ontological hermeneutics of Gadamer is chosen as a guidance for understanding. The main standpoint of the study is performed within the systematic caring science, which through basic research, generates knowledge about the human desire as crucial for the deeper health processes. Through the contextual study there is a link to the clinical caring science. In the ontology of the systematic caring science, the character of longing is in touch with two different aspects. Longing is rooted in the inner source of love of the ethos of the human where the inscrutable depth exists and contains the reality beyond the visible. Further, longing is essential for human being becoming in health and suffering, through holiness as a unit of body, soul and spirit. The results of the study are presented in a theory model. The model has by abduction provided new and deeper understanding of dimensions of longing related to health. On a general level the forces in longing unfolds in two perspectives; suffering and the basis of love. There appears to be a relationship between human and the source of love in all three materials. When human opens up his life in a larger perspective, resting in love, he can manage to stand in the thrill, and acknowledge loss and emptiness. In the transparency of an inner dialogue unfolding dispair, deeper longing can be opened up so that lives are released from the source of love. The holiness of the human desire has such appeal because the holiness of the source of love is always more than the suffering and the particular. The holiness in longing seems to satisfy the hearts deepest searching. The directon of longing is performed in relation to human and the source of love. The study reveals how longing is associated with the source of love, where the holiness of longing seems to drag the human and by that gives the answer to the seeking of the heart. Dynamics forces have direction from the human suffering in the foundation and a release of the power is given back to transform, deepen and reconcile life and suffering. The movements of the power released by longing are keys to understand the suffering of human in relation to the source of love, becoming in health. By this study, results contribute to deepen the ontological core of caring science. Firstly, human in his longing is connected to the inner ethos and by that the most sacred and absolute in itself so that parts of the potential of love can be released to health. Secondly, longing is the road of reconciliation and can further expand to authentic reconciliation, where human is becoming towards unity and holiness. Thirdly, the spirituality is unfolding through longing and the transcendental is received. In longing, human is in touch with the mystery, the longing exceeds the present and moving towards eternity and infinity, and is in what is yet to come. Such deep experience of longing moments leave an impression and show the longing fulfilled.

Productizing professional consultancy services modularly through service blueprinting: Case QPR Software

Services are getting more complex and difficult to manage, but much less attention and resources are directed towards service development than product development both in literature and business life. The paper sheds light on how productization together with modularization and service blueprinting would help make consultancy services more manageable, scalable and efficient while retaining their customer focus. The research was qualitative and based on active research and participant observation. A theoretical framework was constructed on the basis of relevant literature and was then evaluated in two steps: first the overall framework was evaluated by mirroring it to a real life case at QPR Software. Then a service blueprint was created of a selected service, and its benefits and challenges were evaluated. The framework reflected the case company's situation well. Service blueprinting proved to be a valuable tool for facilitating discussion and knowledge sharing. The characteristics of consultancy services provide many challenges for productization. They are highly heterogeneous and people-centric whereas productization is based on standardizing the offering, the delivery processes and managing the service's tangible properties. The research indicated that by modularizing services, both customer focus and standardization can be achieved by creating variety.

Epidemiology of leptospirosis at Sorocaba Zoo, São Paulo state, Southeastern Brazil

Leptospirosis is considered a worldwide distributed zoonosis, caused by the bacteria Leptospira spp. Since several species of wildlife animals are reportedly reservoirs, the aim of the present study was to know the epidemiology of leptospirosis at the Sorocaba Zoo, Southern Brazil. Serum samples of wild mammals from Artiodactyla, Carnivora, Didelphimorphia, Diprotodontia, Perissodactyla, Pilosa, Primates, Proboscidea and Rodentia orders, kept in captivity as well as from zoological staff were assayed by microscopic agglutination test (MAT). Whole blood, urine and tissue samples from wild mammals and synanthropic animals were assayed by polymerase chain reaction (PCR). An epidemiological survey was applied to evaluate the risk factors for animal infection and staff level of knowledge on leptospirosis. A total of 13/229 (5.68%; CI95% 3.37-9.47%) serum samples from wild mammals were reagent on MAT. Serology from synanthropic animals, zoo staff and molecular analysis of animal samples were all negative. Leptospirosis knowledge of zoo park staff was considered medium. In conclusion, leptospiral infection occurs at the studied zoo but due to the low occurrence found, the lowest reported in literature, wild captive mammals do not act as source of infection of leptospirosis to other animals and human beings.

Acquisition target selection of a serial acquirer : case KONE Oyj

Acquisitions are a way for a company to grow, enter new geographical areas, buy out competition or diversify. Acquisitions have recently grown in both size and value. Despite of this, only approximately 25 percent of acquisitions reach their targets and goals. Companies making serial acquisitions seem to be exceptionally successful and succeed in the majority of their acquisitions. The main research question this study aims to answer is: “What issues impact the selection of acquired companies from the point of view of a serial acquirer? The main research question is answered through three sub questions: “What is a buying process for a serial acquirer like?”, “What are the motives for a serial acquirer to buy companies?” and “What is the connection between company strategy and serial acquisitions?”. The case company KONE is a globally operating company which mainly produces and maintains elevators and escalators. Its headquarter is located in Helsinki, Finland. The company has a long history of making acquisitions and does 20- 30 acquisitions a year. By a key person interview, the acquisition process of the case company is compared with the literature about successful serial acquirers. The acquisition motives in this case are reflected upon three of the acquisition motive theories by Trautwein: efficiency theory, monopoly theory and valuation theory. The linkage between serial acquisitions and company strategy is studied through the key person interview. The main research findings are that the acquisition process of KONE is compatible with a successful acquisition process recognized in literature (RAID). This study confirms the efficiency theory as an acquisition motive and more closely the operational synergies. The monopoly theory can only vaguely be supported by this study, but cannot be totally rejected because of the structure of the industry. The valuation theory does not get any support in this study and can therefore be rejected. The linkage between company strategy and serial acquisitions is obvious and making acquisitions can be seen as growth strategy and a part of other company strategies.

Palvelun kehittämisen prosessi: Uusien ratkaisuiden yhtäaikainen kehittäminen ja testikäyttö henkilöstöravintolassa

Palveluiden kehittämista on tutkittu suhteellisen vähän. Ensimmäiset palvelukehitysprosessit esitettiin kirjallisuudessa jo 80-luvulla mutta sen jälkeen kehitysprosessia ei ole radikaalisti päivitetty. Tämän työn tarkoituksena on koota kirjallisuudesta erilaisia lähestymistapoja palveluiden kehittämiseen ja näiden tutkimuksien löydöksien pohjalta rakentaa synteesi palveluiden kehittämisen prosessista sekä tutkia sen toteutumista IBM:n ja Fazer Amican yhteishankkeena toteutetun Tulevaisuuden henkilöstöravintola –projektin tapauksessa. Palveluiden kehittämisen prosessin synteesi perustuu kirjallisuudessa esitettyyn perinteiseen 12-vaiheiseen kehitysprosessiin, jota on muokattu päällekkäin suoritettujen vaiheiden kehitysprosessin, teknologian mahdollistaman palvelukehityksen, testikäytön ja interaktioiden kautta oppimisen näkökulmasta. Synteesissä on esitetty prosessin neljä päävaihetta, jotka ovat ideointi, palvelun kehittäminen ja testikäyttö, tuotteistus ja lanseeraus.

Litteratur och livskunskap : modersmålslärarens berättelse om undervisningen i årkurs 7-9

-