784 resultados para Management of museum goods
Resumo:
The objective of the study is to describe our experience in the surgical management of foramen magnum meningiomas with regard to the clinical-radiological findings, the surgical approach and the outcomes after mid-term follow up. Over a 5-year period, 15 patients presenting with meningiomas of the foramen magnum underwent surgical treatment. The medical records were reviewed in order to analyze the clinical-radiological aspects, as well as the surgical approach and the outcomes. Based on the preoperative magnetic resonance imaging exams, the tumors were classified as anterior or anterolateral in the axial slices and clivospinal or spinoclival in the sagittal slices. The lateral approach was used in all cases. However, the extent of bone removal and the management of the vertebral artery were tailored to each patient. Fourteen patients were females, and one was male, ranging in age from 42 to 74 years (mean 55,9 years). The occipital condyle was partially removed in eight patients, and in seven patients, removal was not necessary. Total removal of the tumor was achieved in 12 patients, subtotal in two, and partial resection in one patient. Postoperative complications occurred in two patients. Follow-up ranged from 6 to 56 months (mean 23.6 months).There was no surgical mortality in this series. The extent of the surgical approach to foramen magnum meningiomas must be based on the main point of dural attachment and tailored individually case-by-case. The differentiation between the clivospinal and spinoclival types, as well as anterior and anterolateral types, is crucial for the neurosurgical planning of foramen magnum meningiomas.
Resumo:
Psychostimulants produce a broad range of effects. Adverse effects can exist on a spectrum of severity from minor symptoms to life threatening toxicity. Although regular use or use of high doses increases risk of adverse events, many adverse events requiring emergency intervention may occur even in the naïve user.
Resumo:
Purpose: To describe a patient with Tessier cleft number 5 and 9 and review the literature on the ocular impairment and management of this extremely rare anomaly. Methods: Interventional case report and literature review. Results: The literature review showed that the present patient is the second case with clefts 5/9. The ophthalmic consequences of this rare association are virtually unreported. Our case demonstrates that the presence of cleft number 9 adds a cicatricial component on the upper eyelid that severely impairs the dynamics of this lid. The corneal status of the patient was successfully managed with simultaneous upper eyelid lengthening and facial reconstruction. Conclusion: In order to avoid corneal perforation, simultaneous upper and lower eyelid reconstruction is mandatory in cases of cleft 5/9. The affected patients should be continuously followed in order to prevent amblyopia.
Resumo:
Coastal wetlands are dynamic and include the freshwater-intertidal interface. In many parts of the world such wetlands are under pressure from increasing human populations and from predicted sea-level rise. Their complexity and the limited knowledge of processes operating in these systems combine to make them a management challenge.Adaptive management is advocated for complex ecosystem management (Hackney 2000; Meretsky et al. 2000; Thom 2000;National Research Council 2003).Adaptive management identifies management aims,makes an inventory/environmental assessment,plans management actions, implements these, assesses outcomes, and provides feedback to iterate the process (Holling 1978;Walters and Holling 1990). This allows for a dynamic management system that is responsive to change. In the area of wetland management recent adaptive approaches are exemplified by Natuhara et al. (2004) for wild bird management, Bunch and Dudycha (2004) for a river system, Thom (2000) for restoration, and Quinn and Hanna (2003) for seasonal wetlands in California. There are many wetland habitats for which we currently have only rudimentary knowledge (Hackney 2000), emphasizing the need for good information as a prerequisite for effective management. The management framework must also provide a way to incorporate the best available science into management decisions and to use management outcomes as opportunities to improve scientific understanding and provide feedback to the decision system. Figure 9.1 shows a model developed by Anorov (2004) based on the process-response model of Maltby et al. (1994) that forms a framework for the science that underlies an adaptive management system in the wetland context.