Leiomioma do esôfago removido por videolaparoscopia

This report describes a leiomyoma of the inferior third section of the esophagus removed during laparoscopic cholecystectomy. The patient is a woman 55-years-age, carrying esophageal myoma of 40 mm in diameter wide, situated in the posterior wall of the lower esophagus. Indications for surgery were based mainly on the growth of the mass (6 mm when discovered 7 years previously, increased to 40 mm). Recently the patient returned suffering from pain, which could be attributed to his litiasic cholecystopaty. A small degree of low disphagia could also be observed. Radiologic imaging, direct endoscopic examination and endoscopic ultrasound showed that the mioma protruded on to the oesophagic lumen, discreetly diminishing there. A laparoscopic esophageal myomectomy was indicated at the same session of the laparoscopic cholecystectomy. Once the pneunoperitoneum was installed, five ports were placed as if for a hiatus hernia surgery. The cholecystectomy was uneventful. Next, an esophagoscopy was performed so as to determine the precise area covering the base of the tumour; at the right-lateral site. Longitudinal and circular fibres of the esophagus was severed over the lesion and the enucleation of the tumour was performed alternating the monopolar dissection, bipolar and hidrodisection. Control-endoscopy was carried out to verify mucosa integrity. Four suture points with poliglactine 3-0 string so as to close the musculature followed this. One suture was placed in for diminution of the size of the esophagean hiatus. Total time of intervention: two hours (30m for the cholecystectomy and one hour and thirty minutes for the myomectomy). Postoperative period: uneventful. Disappearance of the disphagia was observed. Radiologic transit control with water-soluble contrast at 4th post-operative day: good passage. Diagnosis from laboratory of pathology: conjunctive tumour formed by muscle non-striated cells: leiomyoma. The patient was re-examined on the two-month postoperative follow-up. General conditions were good and there were no complain of dysphagia. Neither there were any symptoms of gastro-esophageal reflux.

Pseudotumor inflamatório do fígado: diagnóstico diferencial de carcinoma hepatocelular

The authors present a rare case of inflammatory pseudotumor of the liver whose differential diagnosis with hepatocellular carcinoma - in some cases - is only possible with the histological examination. In this case, a female patient, 38 years-old was suffering from abdominal pain, enlarged liver, thinning, tiredness and fever; alpha-fetoprotein, the liver function tests, amylase and lipase were normal. Abdominal ultrasound and computed tomography showed a node in the right liver lobe. The patient was submitted to a right hepatectomy for hepatocellular carcinoma. Histological examination showed an inflammatory pseudotumor of the liver. The patient was discharged from the hospital on the seventh postoperative day; she is asymptomatic for three years.

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.

Video assisted resections. Increasing access to minimally invasive liver surgery?

Objective: To evaluate perioperative outcomes, safety and feasibility of video-assisted resection for primary and secondary liver lesions. Methods : From a prospective database, we analyzed the perioperative results (up to 90 days) of 25 consecutive patients undergoing video-assisted resections in the period between June 2007 and June 2013. Results : The mean age was 53.4 years (23-73) and 16 (64%) patients were female. Of the total, 84% were suffering from malignant diseases. We performed 33 resections (1 to 4 nodules per patient). The procedures performed were non-anatomical resections (n = 26), segmentectomy (n = 1), 2/3 bisegmentectomy (n = 1), 6/7 bisegmentectomy (n = 1), left hepatectomy (n = 2) and right hepatectomy (n = 2). The procedures contemplated postero-superior segments in 66.7%, requiring multiple or larger resections. The average operating time was 226 minutes (80-420), and anesthesia time, 360 minutes (200-630). The average size of resected nodes was 3.2 cm (0.8 to 10) and the surgical margins were free in all the analyzed specimens. Eight percent of patients needed blood transfusion and no case was converted to open surgery. The length of stay was 6.5 days (3-16). Postoperative complications occurred in 20% of patients, with no perioperative mortality. Conclusion : The video-assisted liver resection is feasible and safe and should be part of the liver surgeon armamentarium for resection of primary and secondary liver lesions.

Plastic surgery in chest wall reconstruction: relevant aspects - case series

Objective: to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. Methods: we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. Results: among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. Conclusion: the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.

Epidemiological evaluation of hepatic trauma victims undergoing surgery

Objective : to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. Methods : we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. Results : We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p <0.01). The most commonly used operative technique was hepatorrhaphy and damage control surgery was applied in 6.5% of patients. The average amounts of blood products used were 6.07 units of packed red blood cells and 3.01 units of fresh frozen plasma. The incidence of postoperative complications was 29.9%, the most frequent being infectious, including pneumonia, peritonitis and intra-abdominal abscess. The survival rate of patients suffering from blunt trauma was 60%, and penetrating trauma, 87.5% (p <0.05). Conclusion : despite technological advances in diagnosis and treatment, mortality rates in liver trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.

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.

Pain symptoms and sleep problems among school-aged children. Long-term prevalence changes, and pain symptoms as predictors of later mental health

Children’s pain symptoms and sleep problems are among the most common health complaints. They distract children from activities, decrease the quality of life, contribute to a significant economic burden, and have shown continuity into adulthood. The main aims of this thesis were to investigate long-term changes in the prevalence of pain symptoms and sleep problems among Finnish school-aged children, and the later mental health of those who in childhood experience pain. Prevalence, co-occurrence, and associated psychosocial factors of pain symptoms and sleep problems were also assessed. In study I, prevalence changes in eight-year-old children’s pain symptoms and sleep problems were investigated in three cross-sectional population-based samples (years 1989: n=1038, 1999: n=1035, and 2005: n=1030). In study II, cross-sectional associations between pain symptoms, sleep problems, and psychosocial factors were assessed among 13-18-year-old adolescents (n=2476). In studies III and IV, associations between pain symptoms at age eight (n=6017), and register-based data on antidepressant use and severe suicidality by age 24, were examined in a nationwide birth cohort. Pain symptoms and sleep problems were common and often co-occurred. A considerable number of children’s pain symptoms remained unrecognized by the parents. The prevalence of pain symptoms, sleep problems, and multiple concurrent symptoms approximately doubled from 1989 to 2005. Psychiatric difficulties or demographic factors did not explain the increase. Psychosocial factors that were associated with pain, sleep problems, and a higher number of symptoms, were female sex, psychological difficulties, emotional symptoms, smoking, victimization, and feeling not cared about by teachers. In longitudinal analyses, the child’s own report of headache, and to a smaller degree the parental report of the child’s abdominal pain predicted later antidepressant use. Parental report of the child’s abdominal pain predicted severe suicidality among males. If one of the symptoms is present, health care professionals should inquire about other symptoms as well. Questions should be directed to the children, not only to their parents. Inquiring about psychiatric difficulties, substance use, victimization, and relations with teachers should be included as a part of the assessment. Further studies are needed to clarify the reasons that underlie the increased prevalence rates, and the factors that may increase or decrease the risk for later mental health problems among pain-suffering children.

Tekniset vaatimukset huonekohtaisen ilmanpuhdistimen valitsemiseksi sisäilmaongelmaisessa kohteessa

Tässä työssä tarkastellaan rakennusten sisäilman laatua heikentäviä epäpuhtauksia sekä niiden suodattamiseen huonekohtaisissa ilmanpuhdistimissa käytettäviä suodatustekniikoita. Tavoitteena oli selvittää ilmanpuhdistimien soveltuvuus sisäilmaongelmista kärsiviin kohteisiin. Ilmanpuhdistimia testattiin laboratoriossa ja testitulosten perusteella arvioitiin niiden teknisiä ominaisuuksia. Lisäksi laadittiin valintakriteerit huonekohtaisen ilmanpuhdistimen valitsemiseksi sisäilmaongelmaisessa kohteessa. Diplomityö tehtiin Helsingin kaupungin kiinteistöviraston Tilakeskuksessa vastaamaan tarpeeseen selvittää ilmanpuhdistimien teknisiä ominaisuuksia. Laboratoriotesteissä laitteista löydettiin eroavaisuuksia, ja tulosten perusteella laitteet asetettiin paremmuusjärjestykseen. Työssä suoritetun tutkimuksen perusteella voidaan todeta, että nykyisin markkinoilla olevat huonekohtaiset ilmanpuhdistimet soveltuvat pääosin melko heikosti sisäilmaongelmien ratkaisemiseen. Tähän syynä on erityisesti laitteiden aiheuttama suuri melupäästö.

Det hjemløse menneske : en studie av sykdom og lidelse

The overall aim of this study was to achieve a deeper understanding of the relationship between human suffering, disease and illness. The study is rooted in the health-care scientific research tradition as developed by Eriksson and her co-researchers at Åbo Akademi. The over-riding methodological initiative was Gadamer's hermeneutic philosophy. The main research question is: What is suffering of illness and disease? Sub-questions: Which characteristics occur when people experience being acutely ill (Article I)? What do the concepts acute, critical and chronic mean semantically (Article II)? In which way does the relation between the human being's experience of disease, illness and suffering, be manifested and understood? How does one characterize the relationship between the experience of contracting disease, illness and suffering (Article III)? How can the hermeneutical conversation contribute to the understanding of suffering caused by disease and illness (Article IV)? The results of sub-study 1 showed that patients with acute myocardial infarction saw themselves as coping, competent, and autonomous individuals. They were used to exercising control, and it was difficult for them to relinquish control. The semantic analysis of acute in sub-study 2 revealed that the concept acute has had an unclear content in the Norwegian language over the past 65 years. Acute, as a concept, says something about the way a situation arises, but not much about what it is that arises. In sub-study, 3 the relation between disease, illness and suffering is discussed. The expression of illness and suffering as verbs can convey more clearly what it is that occurs with persons who experience disease, illness and suffering. The discussion in sub-study 4 focuses on trustworthiness in hermeneutical studies.

How glyphosate may affect transgenic soybean in different soil and phosphorus levels

The technology that employs genetic modifications brought a significant increase in the utilization of glyphosate. Transgenic soybean has been suffering injury, even though it possesses a resistance mechanism to glyphosate. Currently, there are only a few studies on the dynamics of glyphosate in transgenic soybean planted in soils with different textures interacting with phosphorus concentrations. This study focused on assessing the effects of glyphosate in transgenic soybean plants on different types of soil and at different phosphorus levels. The experimental design was completely randomized, in factorial design: 2 x 6 x 3, that being 2 soil types, 6 doses of glyphosate and 3 levels of phosphorus, and four replications. Plants were cultivated for thirty days in pots with two types of soil, one being clayey (Red-Yellow Latosol) and the other sandy (Quartzarenic Neosol). They received one, two, and three times the maintenance dose of fertilization of phosphorus, corresponding to: 170, 250 and 330 kg of P2O5 ha-1 to QN, and 380, 460 and 540 kg P2O5 ha-1 to RYL, respectively. Glyphosate was applied at six different doses: 0, 1,200, 2,400, 12,000, 60,000 and 120,000 g ha-1 of active ingredient. Plant height, a and b chlorophyll, and shoot were lower for the plants that received lower doses of glyphosate, regardless of the type of soil. Greater availability of phosphorus and lower amount of glyphosate used in Quartzarenic Neosol soil provided for less phytointoxication symptoms in transgenic soybean.

Glädje i vårdandets värld

The present study is made in the context of basic research within the field of caring science. The overall aim is to uncover and make joy visible as an idea in the world of caring. The core of caring has historically always been to alleviate suffering and to serve life and health in a spirit of love and mercy. This study has a comprehensive direction focusing on history of ideas and culminates in a pattern of ideas contenting joy in the world of caring. Knowledge formation is based on creating understanding, wholeness and meaning with regard to the knowledge related to a context. For that a hermeneutical approach is used throughout the study. In order to understand joy more deeply, the original idea, the essence and expression, the concept of 'joy' and the related concepts of 'glad' and 'light' are examined in etymological dictionaries and in Swedish, English and Latin dictionaries. To support the interpretation classical texts containing philosophers’ thoughts about joy are used. Joy as an idea glimpses forth and is presented in the form of seven-fold pattern of ideas. Through the meaning-nuances of synonyms a realization of joy could be discerned and anchored in the heart. The seven-fold pattern form the background and represent a guide for the hermeneutic reading of joy, as it appears in the stories about caring for the years 1900–1933. The historical sources consist of the trade magazine Svensk sjukskötersketidning, books containing stories about caring, archival materials and textbooks on nursing. The result culminates in the seven-fold pattern of ideas contenting what makes joy active as caring. The true heart's pure joy - love, joy is a proof of love. The ardent heart's deep joy - joy of living, joy inspires and generates strength. The bearing heart's radiant joy - generosity, joy is a gift to the other with the promise of help. The inviting heart's sparkling joy – communion, joy invites communion. The elated heart's exhilarated joy - integration, joy enables the human to forget his or her suffering and approach to what he or she wants to be. The atmospheric heart's solemn joy - dignifying, joy creates a mood and an atmosphere where people perceive themselves dignified. The peaceful heart's great joy - rescuing, a joy turns out when the human has received what may be requested of what is good, is eluded from what is evil and is contented with his or her living lot. It is hoped that this basic research will open up for a vision that can contribute to joys further attention in the world of caring and be articulated there.

En vårdvetenskaplig teori om interkulturellt vårdande : att föda barn i en annan kultur

The aim of this dissertation is to develop a theory on intercultural caring to deepen the understanding of caring between nurses and patients who have different cultural backgrounds. The research questions are: 1) What is intercultural caring? 2) How is intercultural caring described and understood? 3) How is intercultural caring described and understood in a maternity care context from the patients’ perspective? 4) What is the substance in a theory on intercultural caring? 5) What is the substance in a theory on intercultural caring in maternity care from the patients’ perspective? The theoretical perspective is based on caritative theory and the caring science-tradition (Eriksson, 2001, 2002) and has a hermeneutic approach. In the first study, 19 texts of Campinha-Bacote, Kim-Godwin, Leininger and Ray are analysed through content analysis. A model for intercultural caring is then created abductively. The second study is a metasynthesis of 40 studies on intercultural caring in maternity care research. The third study is a focused ethnography, in which 17 immigrant mothers are interviewed and observed. The theory on intercultural caring is created through a hermeneutic synthesis of the three studies. A synthesis of the studies with a maternity context results in five patterns of interpretation: the experience of caring is related to power; the family is always present; childbearing and change of culture can give women multiple vulnerabilities; both the mother and the nurse change when they meet; conflicts can cause change. The theory and patterns of interpretation consolidate into a contextual theory on intercultural caring for clinical maternity praxis. In this theory, caring consists of four dimensions: universal, cultural, contextual, and unique caring, which permeate each other. Universal caring is nondependent of time and space. Cultural caring considers the cultural background, the acculturation and the equality of each mother. In the maternity care culture, cultural competence, cultural safety, and acculturation of the nurse are emphasised. Contextual caring considers the specific cultural features of the childbearing mother. In this respect, the nurse is expected to be an expert and to clarify cultural assumptions in maternity care. In unique caring, the mother expects good communication, respect for the family, goodwill and somebody who cares for her and meets her needs, in order for trust to be built. In this respect, the nurse listens to the woman’s narrative, is flexible, open, courageous, and non-judgemental. The nurse shows an understanding for the life situation of the woman, and strives for continuity to preserve the care relationship. It was found that external circumstances affect intercultural caring. Moreover, intercultural caring is expected to decrease misunderstandings and conflicts, alleviate suffering and promote health and life. The theory adds knowledge to the phenomenon of intercultural caring for the nursing and caring sciences, and for the nursing care of patients with other cultural backgrounds than the nurses. The theory can be used in nursing, education, research and administration.

A laboratory cage for foster nursing newborn mice

We describe a cage to be used for foster nursing in order to guarantee that original mother's colostrum is not ingested by the newborn mice. A common (30.5 cm x 19.5 cm x 12.0 cm) mouse cage was fitted with a wire net tray with a mesh (1 cm x 1 cm), which divides the cage into an upper and a lower compartment. Mice born to females placed in the upper compartment pass through the mesh and fall into the lower compartment, where another lactating female with one or two of its own pups are. Of a total of 28 newborn mice of C3H/He and Swiss strains, 23 were successfully fostered. Important observations are presented to show that this is a valuable alternative for foster studies without great suffering on the part of the female.

Ischemic preconditioning reduces peripheral oxidative damage associated with brain ischemia in rats

Brain ischemia followed by reperfusion causes neuronal death related to oxidative damage. Furthermore, it has been reported that subjects suffering from ischemic cerebrovascular disorders exhibit changes in circulating platelet aggregation, a characteristic that might be important for their clinical outcome. In the present investigation we studied tert-butyl hydroperoxide-initiated plasma chemiluminescence and thiol content as measures of peripheral oxidative damage in naive and preconditioned rats submitted to forebrain ischemia produced by the 4-vessel occlusion method. Rats were submitted to 2 or 10 min of global transient forebrain ischemia followed by 60 min or 1, 2, 5, 10 or 30 days of reperfusion. Preconditioned rats were submitted to a 10-min ischemic episode 1 day after a 2-min ischemic event (2 + 10 min), followed by 60 min or 1 or 2 days of reperfusion. It has been demonstrated that such preconditioning protects against neuronal death in rats and gerbils submitted to a lethal (10 min) ischemic episode. The results show that both 2 and 10 min of ischemia cause an increase of plasma chemiluminescence when compared to control and sham rats. In the 2-min ischemic group, the effect was not present after reperfusion. In the 10-min ischemic group, the increase was present up to 1 day after recirculation and values returned to control levels after 2 days. However, rats preconditioned to ischemia (2 + 10 min) and reperfusion showed no differences in plasma chemiluminescence when compared to controls. We also analyzed plasma thiol content since it has been described that sulfhydryl (SH) groups significantly contribute to the antioxidant capacity of plasma. There was a significant decrease of plasma thiol content after 2, 10 and 2 + 10 min of ischemia followed by reperfusion when compared to controls. We conclude that ischemia may cause, along with brain oxidative damage and cell death, a peripheral oxidative damage that is reduced by the preconditioning phenomenon.