979 resultados para Lymph-node Dissection


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Meshless methods are used for their capability of producing excellent solutions without requiring a mesh, avoiding mesh related problems encountered in other numerical methods, such as finite elements. However, node placement is still an open question, specially in strong form collocation meshless methods. The number of used nodes can have a big influence on matrix size and therefore produce ill-conditioned matrices. In order to optimize node position and number, a direct multisearch technique for multiobjective optimization is used to optimize node distribution in the global collocation method using radial basis functions. The optimization method is applied to the bending of isotropic simply supported plates. Using as a starting condition a uniformly distributed grid, results show that the method is capable of reducing the number of nodes in the grid without compromising the accuracy of the solution. (C) 2013 Elsevier Ltd. All rights reserved.

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The study of transient dynamical phenomena near bifurcation thresholds has attracted the interest of many researchers due to the relevance of bifurcations in different physical or biological systems. In the context of saddle-node bifurcations, where two or more fixed points collide annihilating each other, it is known that the dynamics can suffer the so-called delayed transition. This phenomenon emerges when the system spends a lot of time before reaching the remaining stable equilibrium, found after the bifurcation, because of the presence of a saddle-remnant in phase space. Some works have analytically tackled this phenomenon, especially in time-continuous dynamical systems, showing that the time delay, tau, scales according to an inverse square-root power law, tau similar to (mu-mu (c) )(-1/2), as the bifurcation parameter mu, is driven further away from its critical value, mu (c) . In this work, we first characterize analytically this scaling law using complex variable techniques for a family of one-dimensional maps, called the normal form for the saddle-node bifurcation. We then apply our general analytic results to a single-species ecological model with harvesting given by a unimodal map, characterizing the delayed transition and the scaling law arising due to the constant of harvesting. For both analyzed systems, we show that the numerical results are in perfect agreement with the analytical solutions we are providing. The procedure presented in this work can be used to characterize the scaling laws of one-dimensional discrete dynamical systems with saddle-node bifurcations.

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The bending of simply supported composite plates is analyzed using a direct collocation meshless numerical method. In order to optimize node distribution the Direct MultiSearch (DMS) for multi-objective optimization method is applied. In addition, the method optimizes the shape parameter in radial basis functions. The optimization algorithm was able to find good solutions for a large variety of nodes distribution.

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Multi-standard mobile devices are allowing users to enjoy higher data rates with ubiquitous connectivity. However, the benefits gained from multiple interfaces come at an expense—that being higher energy consumption in an era where mobile devices need to be energy compliant. One promising solution is the usage of short-range cooperative communication as an overlay for infrastructure-based networks taking advantage of its context information. However, the node discovery mechanism, which is pivotal to the bearer establishment process, still represents a major burden in terms of the total energy budget. In this paper, we propose a technology agnostic approach towards enhancing the MAC energy ratings by presenting a context-aware node discovery (CANDi) algorithm, which provides a priori knowledge towards the node discovery mechanism by allowing it to search nodes in the near vicinity at the ‘right time and at the right place’. We describe the different beacons required for establishing the cooperation, as well as the context information required, including battery level, modes, location and so on. CANDi uses the long-range network (WiMAX and WiFi) to distribute the context information about cooperative clusters (Ultra-wideband-based) in the vicinity. The searching nodes can use this context in locating the cooperative clusters/nodes, which facilitates the establishing of short-range connections. Analytical and simulation results are obtained, and the energy saving gains are further demonstrated in the laboratory using a customised testbed. CANDi saves up to 50% energy during the node discovery process, while the demonstrative testbed shows up to 75% savings in the total energy budget, thus validating the algorithm, as well as providing viable evidence to support the usage of short-range cooperative communications for energy savings.

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Lymphatic filariasis (LF) causes a wide range of clinical signs and symptoms, including urogenital manifestations. Transmission control and disability/morbidity management/control are the two pillars of the overall elimination strategy for LF. Lymph scrotum is an unusual urological clinical presentation of LF with important medical, psychological, social and economic repercussions. A retrospective case series study was conducted on outpatients attended at the National Reference Service for Filariasis, in an endemic area for filariasis (Recife, Brazil), between 2000 and 2007. Over this period, 6,361 patients were attended and seven cases with lymph scrotum were identified. Mean patient age was 45 years (range, 26 to 64 years). Mean disease duration was 8.5 years (range, two to 15 years). All patients had evidence of filarial infection from at least one laboratory test (parasitological, antigen investigation or "filarial dance sign" on ultrasound). Six patients presented histories of urological surgery. The authors highlight the importance of the association between filarial infection and the inadequate surgical and clinical management of hydrocele in an endemic area, as risk factors for lymph scrotum. Thus, filarial infection should be routinely investigated in all individuals presenting urological morbidity within endemic areas, in order to identify likely links in the transmission chain.

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The use of minimally invasive surgery for the treatment of lung cancer has been growing worldwide. Between May 2008 and November 2012, we performed 24 videothoracoscopic anatomical lung resections in our department. This includes 22 lobectomies and 2 anatomic segmentectomies, which is known to be a more complex surgery, since it demands a finer dissection of sub-lobar structures. We report the clinical cases of two patients who underwent anatomic segmentectomies. The first one was a 63 year old woman, smoker and with a history of breast cancer 20 years earlier. An incidental 9 mm node was found in the lingula. The patient underwent an anatomic lingulectomy and the frozen section was suggestive of a primary lung cancer. Therefore, we proceeded to a full lymphadenectomy. The final pathology evaluation showed a typical carcinoid tumour (pT1aN0). The second patient was a 50 year old woman, a smoker and with a heavy family history of lung cancer. In a screening CT scan a 8 mm ground glass opacity was identified in the left lower lobe (segment VI). After a VATS wedge resection of the node the frozen section evaluation was compatible with adenocarcinoma. We then proceeded to an anatomic segmentectomy with lymphadenectomy. The definitive pathology evaluation confirmed that it was a pT1a N0 bronchioloalveolar adenocarcinoma. The patients now have 5 and 2 months of follow up respectivelly and neither of them has signs of recurrence and the surgical incision showed a good aesthetic result. Anatomic segmentectomy is the indicated surgery especially in patients with low grade tumours, in early stage lung cancers or in patients without pulmonary function for a lobar resection, and it can be done safely using VATS.

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INTRODUÇÃO: O carcinoma oculto é uma entidade pouco frequente, que se define como a presença de metástases com tumor primário indetetável na altura da apresentação. O prognóstico da maioria dos casos de tumor oculto é reservado, no entanto, o desenvolvimento de técnicas imunohistoquímicas que permitem a caracterização do tumor, tornaram alguns subgrupos de tumor oculto potencialmente curáveis. A presença de adenopatias axilares é a forma de apresentação do cancro da mama em 0,3-1% das mulheres, sendo a origem mais provável a mama ipsilateral. CASO CLÍNICO: Os autores relatam dois casos clínicos de tumor oculto da mama: Caso 1: Doente de 57 anos, com antecedentes familiares de primeiro e segundo grau de cancro da mama, com estudo genético negativo. Recorreu à consulta por adenopatia axilar direita.Exame objetivo (EO), mamografia + ecografia mamária normais. Microbiópsia (MB) ganglionar:metástase de carcinoma compatível com origem na mama, recetores de estrogénios (RE) +, HER2 +, CK7 +, Ca125 +, CK20 (-). RMN mamária e PET não identificaram tumor primário. Procedeu-se a dissecção axilar: 10 gânglios sem metástases. Realizou terapêutica adjuvante com quimioterapia (QT) e imunoterapia (IT). Manteve follow-up regular com EO, RMN e mamografia alternadas até aos 4 anos sem alterações. Aos 4,5 anos detetou-se ao E.O. nódulo palpável na mama direita e nódulo axilar. Mamografia + ecografia: lesão sólida suspeita (R5) cuja caracterização histológicademonstrouCDIG3, recetores hormonais (-) (RH), HER2 3+, Ki67 >30%. A TC TAP e a cintigrafia óssea não revelaram alterações. Em reunião multidisciplinar de decisão terapêutica (RMDT) decidiu-serealizar mastectomia total direita + mastectomia profilática contralateral com reconstrução. Exame histológico:CDI G3 com 22mm,confirmando-se a caracterização imunohistoquímica, com invasão vascular e presença de 3 gânglios com metástase e extensão extracapsular (T2 N2). Realizou terapêutica adjuvante com QT + IT+ Radioterapia (RT) da parede torácica e ganglionar. Um ano após a mastectomia, a doente mantém-se em follow-up sem sinais de recidiva. Caso 2: Doente de 50 anos, com antecedentes familiares de primeiro grau de cancro da mama. Recorreu à consulta por nódulo da axila esquerda e nódulo da mama direita com 2 meses de evolução. EO: nódulo palpável da mama direita e duas adenopatias axilares à esquerda. Mamografia + eco: microcalcificações atípicas da mama esquerda (R5) ealterações benignas da mama direita (R2). Realizaram-se microbiópsia por estereotaxia e biópsia assistida por vácuo da mama esquerda e citologia aspirativa de agulha fina (CAAF) de nódulo da mama direita:sem alterações neoplásicas. A biópsia de adenopatia axilar revelou metástase ganglionar de carcinoma compatível com origem na mama, RH (-), GCDFP15 (-),HER2 3+ e CK7 +.A RM mamária revelou apenas lesões benignas. TC TAP, ecografia abdominal e cintigrafia óssea normais. PET: lesão localizada na axila esquerda, nos três níveis axilares. Por recusa da doente em realizar microbiópsias adicionais ou mastectomia radical modificada, optou-se por realizar dissecção axilar esquerda. Exame histológico: 7 em 14 gânglios com metástases, morfologia e estudo imunohistoquímico concordantes com o anterior. Em RMDT foi decidida terapêuticaadjuvante com RT, QT e IT que a doente se encontra no momento a realizar. DIAGNÓSTICOS DIFERENCIAIS/ DISCUSSÃO A presença de adenopatias axilares relaciona-se na maioria dos casos com processos benignos, mas naqueles em que se diagnostica uma neoplasia maligna, mais de 50% correspondem a carcinoma da mama. Outras neoplasias que se podem apresentar com metástases axilares são: linfoma, melanoma, sarcoma, tiróide, pulmão, estômago, ovário, útero. A avaliação diagnóstica deve incluir além do exame físico, a biópsia ganglionar (para exame histológico e caracterização imunohistoquímica), mamografia, ecografia mamária e ressonância magnética mamária, eventual TC toraco-abdominal, cintigrafia óssea nas mulheres sintomáticas, existindo controvérsia sobre autilidade da PET. CONCLUSÕES O tumor oculto representa um problema diagnóstico e um desafio terapêutico. O carcinoma da mama apresentando-se sob a forma de metástase axilar sem tumor primário identificável e sem doença à distância, considera-se um dos casos potencialmente curáveis, se for tratado de acordo com as guidelines para o estadio II do cancro da mama. A abordagem recomendada inclui dissecção axilar, de importância crucial pela informação prognóstica que guiará o restante tratamento e por ajudar no controlo local da doença. A terapêutica adequada da mama ipsilateral é controversa, e pode passar pela mastectomia radical modificada ou RT. Não existem até à data estudos randomizados comparando a mastectomia versus RT mamária e os estudos retrospetivos disponíveis não apresentam resultados consensuais. A decisão de RT da parede torácica pós-mastectomia e de terapêutica adjuvante deverá ser tomada tendo em conta as guidelines publicadas. BIBLIOGRAFIA 1- www.uptodate.com; Kaklamani, V., et al; “Axillary node metastases with occult primary breast cancer”; Mar 2012 2- Wang, J., et al; “Occult breast cancer presenting as metastatic adenocarcinoma of unknown primary: clinical presentation, immunohistochemistry, and molecular analysis”; Case Rep Oncol 2012;5:9-16 3- Takabatake, D.; “Two cases of occult breast cancer in which PET-CT was helpful in identifying primary tumors”; Breast Cancer (2008) 15:181-184 4- Kinoshita, S., et al.; “Metachronous secondary primary occult breast cancer initially presenting with metastases to the contralateral axillary lymph nodes: report of a case”; Breast Cancer (2010) 17:71-74 5- Bresser, J., et al; “Breast MRI in clinically and mammographically occult breast cancer presenting with an axillary metastasis: a systematic review”; EJSO 36 (2010) 114-119 6- Sharon, W., et al.; “Benefit of ultrasonography in the detection of clinically and mammographically occult breast cancer”; World J Surg (2008) 32:2593-2598 7- Masinghe, S.P., et al.; “Breast radiotherapy for occult breast cancer with axillary nodal metastases – does it reduce the local recurrence rate and increase overall survival?”; Clinical Oncology 23 (2011) 95-100 8- Altan, E., et al.; “Clinical and pathological characteristics of occult breast cancer and review of the literature”; J Buon 2011 Jul-Sep;16(3):434-6

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Breast cancer is the most common type of cancer among women all over the world. An important issue that is not commonly addressed in breast cancer imaging literature is the importance of imaging the underarm region—where up to 80% of breast cancer cells can metastasise to. The first axillary lymph nodes to receive drainage from the primary tumour in the breast are called Sentinel Node. If cancer cells are found in the Sentinel Node, there is an increased risk of metastatic breast cancer which makes this evaluation crucial to decide what follow-up exams and therapy to follow. However, non-invasive detection of cancer cells in the lymph nodes is often inconclusive, leading to the surgical removal of too many nodes which causes adverse side-effects for patients. Microwave Imaging is one of the most promising non-invasive imaging modalities for breast cancer early screening and monitoring. This novel study tests the feasibility of imaging the axilla region by means of the simulation of an Ultra-Wideband Microwave Imaging system. Simulations of such system are completed in several 2D underarm models that mimic the axilla. Initial imaging results are obtained by means of processing the simulated backscattered signals by eliminating artefacts caused by the skin and beamforming the processed signals in order to time-align all the signals recorded at each antenna. In this dissertation several image formation algorithms are implemented and compared by visual inspection of the resulting images and through a range of performance metrics, such as Signal-to-Clutter Ratio and FullWidth Half Maximum calculations. The results in this study showed that Microwave Imaging is a promising technique that might allow to identify the presence and location of metastasised cancer cells in axillary lymph nodes, enabling the non-invasive evaluation of breast cancer staging.

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All coelomate animals possess a population of cells that do not make part of an organ and instead freely flow inside the body cavity. These cells, termed hemocytes (in invertebrates) or blood cells (in vertebrates), are involved in varied functions including immune response, clearance of apoptotic cells and distribution of nutrient and gases (Grigorian & Hartenstein 2013).(...)

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In this thesis a CMOS low-power and low-voltage RF receiver front-end is presented. The main objective is to design this RF receiver so that it can be powered by a piezoelectric energy harvesting power source, included in a Wireless Sensor Node application. For this type of applications the major requirements are: the low-power and low-voltage operation, the reduced area and cost and the simplicity of the architecture. The system key blocks are the LNA and the mixer, which are studied and optimized with greater detail, achieving a good linearity, a wideband operation and a reduced introduction of noise. A wideband balun LNA with noise and distortion cancelling is designed to work at a 0.6 V supply voltage, in conjunction with a double-balanced passive mixer and subsequent TIA block. The passive mixer operates in current mode, allowing a minimal introduction of voltage noise and a good linearity. The receiver analog front-end has a total voltage conversion gain of 31.5 dB, a 0.1 - 4.3 GHz bandwidth, an IIP3 value of -1.35 dBm, and a noise figure lower than 9 dB. The total power consumption is 1.9 mW and the die area is 305x134.5 m2, using a standard 130 nm CMOS technology.

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Data traces, consisting of logs about the use of mobile and wireless networks, have been used to study the statistics of encounters between mobile nodes, in an attempt to predict the performance of opportunistic networks. Understanding the role and potential of mobile devices as relaying nodes in message dissemination and delivery depends on the knowledge about patterns and number of encounters among nodes. Data traces about the use of WiFi networks are widely available and can be used to extract large datasets of encounters between nodes. However, these logs only capture indirect encounters between nodes, and the resulting encounters datasets might not realistically represent the spatial and temporal behaviour of nodes. This paper addresses the impact of overlapping between the coverage areas of different Access Points of WiFi networks in extracting encounters datasets from the usage logs. Simulation and real-world experimental results show that indirect encounter traces extracted directly from these logs strongly underestimate the opportunities for direct node-to- node message exchange in opportunistic networks.

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Coronary dissection occurs frequently and in several degrees during coronary angioplasty, which is one of the mechanisms for increasing the lumen diameter of a vessel. However the length of the dissection may affect the procedure, becoming the most frequent cause of total occlusion after coronary angioplasty. We report here a case of extensive dissection that occurred during the coronary angioplasty of a focused lesion, which we treated with two long stents.