Risk factors in reoperative thyroid surgery for recurrent goitre. Our experience

Aim. Reoperative thyroid surgery is an uncommon operation associated with a higher complication rate; we reviewed our series of patients on whom reoperative thyroid surgery was performed.Method. 106 patients had a thyroid reoperation for recurrent multinodular goiter (93 patients), recurrent thyrotoxicosis (3) or suspected malignancy (10); bilateral completion thyroidectomy was performed in 68 cases, lobectomy in 36, removal of a mediastinal recurrence and of a pyramidal remnant in 1 patient respectively. Results. Temporary hypoparathyroidism occurred in 41 patients (38.67%), definitive in 7 (6.6%), transient recurrent laryngeal nerve palsy in 5 (4.71%), permanent nerve palsy in 1 (0.94%); in 3 cases (2.83%) surgical revision of haemostasis was necessary for postoperative haemorrhage. After monolateral surgery we had 13 cases of transient hypoparathyroidism (34.21%), 2 of definitive (5.26%) and 1 transient recurrent laryngeal nerve palsy (2.63%); after bilateral surgery we had 29 cases of transient hypoparathyroidism (42.64%), 5 of definitive (7.35%), 4 of transient recurrent laryngeal nerve palsy (5.88%), 1 of definitive (1.47%) and 3 of postoperative bleeding (4.41%). Conclusions. Reoperative thyroid surgery is a technical challenge with a high incidence of complications. Scarring, edema and friability of the tissues together with distortion of the landmarks make reoperative surgery azardous. A higher risk of complications is described when previous surgery has been performed on both sides. Total thyroidectomy should be considered the procedure of choice for benign multinodular goiter eliminating the potential of a reoperation. Whenever necessary, reoperative hyroidectomy may be performed safely with little morbidity in experienced hands.

Volatile Blood Pressure Due To Baroreflex and Autonomic Failure

An 85-year-old male was hospitalized because of deterioration of his general condition and infection of the tracheostoma. He had had laryngectomy, bilateral neck dissection and radiation therapy for a laryngeal carcinoma 5 years earlier. Despite a good recovery, he could not get up because of a new onset of postural symptoms (dizziness, lightheadedness, collapse). Late onset of baroreflex failure and autonomic nervous system failure were diagnosed. Volatility of blood pressure (supine hypertension, upright hypotension) was treated with NaCl supplement during the day and a short-acting antihypertensive (clonidine) at night. With this regimen, the patient could walk without support.

El climatismo

En la actualidad, el lenguaje dominante en que se expresa la conciencia ecológica o ambiental gira alrededor del cambio climático antropogénico. La política de la ecología hoy día es la política del climatismo. El climatismo refleja, en primer lugar, la evolución de los discursos ambientales desde su aparición hasta el cambio de siglo y la nueva constelación política. En segundo lugar, encarna una configuración específica de actores y discursos en forma de un sentido común dominante a la hora de pensar la relación sociedad-medio natural, que generan un efecto de maquillaje verde, de pánico, de homogeneización métrica carbónica, y de sujeción estatal bajo el régimen Kioto. Todos estos efectos ayudan a crear o enmascarar inequidades. Tomar en cuenta ciertas visiones alternativas del régimen climático global puede ayudar a corregir estos efectos.

The romances of Alexandre Dumas.

4. The count of Monte Cristo / illustrated by Edmund H. Garrett -- 5. Agénor de Mauléon : a romance of the reign of Charles V. of France / illustrated by J. Wagrez -- 6. Agénor de Mauléon : a romance of the reign of Charles V. of France / illustrated by J. Wagrez -- 7. The Brigand : a romance of the reign of Don Carlos and Black the story of a dog / illustrated by Eugéne Grivaz -- 8. Ascanio : a romance of the reign of Francis First / illustrated by Evert Van Muyden -- 9. The two Dianas : a romance of the reign of Henry ll. / illustrated by Evert Van Muyden -- 10. The two Dianas : a romance of the reign of Henry ll. / illustrated by Evert Van Muyden -- 11. The page of the Duke of Savoy : a romance of the reign of Henry ll. / illustrated by Frank T. Merrill -- 12. The horoscope : a romance of the reign of Francois ll. and tales of the caucasus / illustrated by Eugéne Grivaz -- 13. Marguerite de Valois : a romance of the reign of Charles lX. / illustrated by Félix Oudart -- 14. La Dame de Monsoreau : a romance of the reign of Henry lll. / illustrated by Eugéne Courboin -- 15. The fourty-five : a romance of the reign of Henri lll. / illustrated by Eugéne Courboin -- 16. The Three Musketeers : a romance of the reign of Louis Xlll. / illustrated by E. Abot, Gustave Doré, Félix Oudart and Edmund H. Garrett -- 17. The Three Musketeers : a romance of the reign of Louis Xlll. / illustrated by E. Abot, Gustave Doré, Félix Oudart and Edmund H. Garrett -- 20. The Vicomte de Bragelonne or, Ten years later : a romance of the reign of Louis XlV. in which are included the stories of "Louise de La Valliére" and "The Iron Mask" / illustrated by Evert Van Muyden, Félix Oudart and Edmund H. Garrett -- 21. The Vicomte de Bragelonne or, Ten years later : a romance of the reign of Louis XlV. in which are included the stories of "Louise de La Valliére" and "The Iron Mask" / illustrated by Evert Van Muyden, Félix Oudart and Edmund H. Garrett -- 22. The Vicomte de Bragelonne or, Ten years later : a romance of the reign of Louis XlV. in which are included the stories of "Louise de La Valliére" and "The Iron Mask" / illustrated by Félix Oudart and Edmund H. Garrett --23. The Vicomte de Bragelonne or, Ten years later : a romance of the reign of Louis XlV. in which are included the stories of "Louise de La Valliére" and "The Iron Mask" / illustrated by Evert Van Muyden, Félix Oudart and Edmund H. Garrett -- 24. Sylvandire : a romance of the time of Louis XlV. and The Woman with the Velvet Necklace : a romance of the Revolution / illustrated by J. Wagrez -- 25. The war of women : a romance of the Fronde / illustrated by Eugéne Grivaz -- 26. Le Chevalier D'Harmental : a romance of the regency of Philippe, Duc D'Orléans / illustrated by Evert Van Muyden -- 27. The Regents daughter and the black tulip / illustrated by Evert Van Muyden, Félix Oudart and Edmund H. Garrett -- 28. Olympe de Cléves and Chauvelin's will : romances of the reign of Louis XV. / illustrated by Evert Van Muyden -- 29. Olympe de Cléves and Chauvelin's will : romances of the reign of Louis XV. illustrated by Evert Van Muyden -- 30. Memoirs of a physician : a romance of the reign of Louis XV. / illustrated by Félix Oudart, Evert Van Muyden and Eugéne Courbion -- 31. Memoirs of a physician : a romance of the reign of Louis XV. / illustrated by Félix Oudart, Evert Van Muyden and Eugéne Courbion -- 32. Memoirs of a physician : a romance of the reign of Louis XV. / illustrated by Félix Oudart, Evert Van Muyden and Eugéne Courbion -- 33. The Queens necklace : a romance of the reign of Louis XVl. / illustrated by Eugéne Courbion, Félix Oudart and Evert Van Muyden -- 34. The Queens necklace : a romance of the reign of Louis XVl. / illustrated by Eugéne Courbion, Félix Oudart and Evert Van Muyden -- 35. Ange Pitou and Blanche de Beaulieu : romances of the French Revolution / illustrated by Eugéne Courbion and Evert Van Muyden -- 36. Ange Pitou and Blanche de Beaulieu : romances of the French Revolution / illustrated by Eugéne Courbion and Evert Van Muyden -- 37. La Comtesse de Charny : a romance of the French Revolution / illustrated by Félix Oudart, Eugéne Courbion and Evert Van Muyden -- 38. La Comtesse de Charny : a romance of the French Revolution / illustrated by Félix Oudart, Eugéne Courbion and Evert Van Muyden -- 39. La Comtesse de Charny : a romance of the French Revolution / illustrated by Félix Oudart, Eugéne Courbion and Evert Van Muyden -- 40. The Chevalier de Maison-Rouge : a romance of the French Revolution / illustrated by E. Abot -- 41. The companions of Jehu : a romance of the consulate under Napoleon / illustrated by Evert Van Muyden and F. T. Merrill -- 42. The whites and the blues : a romance of the directory / illustrated by Félix Oudart, Eugéne Courbion and Evert Van Muyden -- 43.The whites and the blues : a romance of the directory / illustrated by Félix Oudart, Eugéne Courbion and Evert Van Muyden -- 44. The She-Wolves of Machecoul : a romance of the Last Vendée to which are added The Corsican Brothers / illustrated by Evert Van Muyden, Félix Oudart and Edmund H. Garrett -- 45. The She-Wolves of Machecoul : a romance of the Last Vendée to which are added The Corsican Brothers / illustrated by Evert Van Muyden, Félix Oudart and Edmund H. Garrett.

The other of myself: representations of portuguese teachers about intercultural education related concepts

Having into consideration that we live in a multicultural society, it is important to analyse how far people view and accept each other. Therefore, one should reflect upon concepts such as: representations and stereotypes, because they are interpersonal constructs which are (re)built during the interaction of different sociocultural groups. In this study, we focus our attention on the representations a sociocultural group – Portuguese teachers - has of intercultural education and the role of teachers and educators in the promotion of an intercultural approach at school. We believe that teachers have the responsibility to: find out the representations students have of the Other; reconfigure stereotyped representations; and create representations which favor dialogue and relationship with the Other flourish. Following a sociolinguistic approach (Müller, 1998; Vasseur, 2001; Vasseur & Hudelot, 1998), which is related to the construction and diffusion of representations in discourse, we analyse the discourse of teachers during a workshop called ‘The Other and Myself’, in which they build and discuss about a didactic mask that portrays their own vision of both themselves and their ideas of intercultural education.

Should eye protection be worn during dermatological surgery: prospective observational study

Background There is a potential risk of infection with blood-borne viruses if a doctor receives a blood splash to a mucous membrane. The quantification of facial contamination with blood has never been documented in the context of dermatological surgery. Objectives (i) To identify the number of facial blood splashes that occur during skin surgery and to identify the procedures that present higher risks for the operator and assistant. (ii) To assess the provision of eye protection and attitudes to its use in dermatological surgery in the U.K. Methods (i) Prospective, observational study in the skin surgery suite of a U.K. teaching hospital assessing 100 consecutive dermatological surgery procedures, plus 100 consecutive operations in which an assistant was present. Primary outcome: number of face-mask visors with at least one blood splash. Secondary outcomes: to identify if any of the following variables influenced the occurrence of a blood splash: grade of operator, site and type of procedure, and the use of electrocautery. (ii) A postal survey of all U.K.-based members of the British Society of Dermatological Surgery (BSDS) was conducted assessing facilities available and the attitudes of U.K.-based clinicians to the use of face masks during surgery. Results (i) In 33% of all surgical procedures there was at least one facial splash to the operator (range 1–75) and in 15% of procedures the assistant received at least one splash (range 1–11). Use of monopolar electrocautery was significantly less likely to result in splashes to the mask compared with bipolar electrocautery [odds ratio (OR) 0Æ04; 95% confidence interval (CI) 0Æ01–0Æ19]. Compared with the head/neck, operations on the body were significantly more likely to result in splashes to the mask (OR 6Æ52) (95% CI 1Æ7–25Æ07). The type of procedure and the status of the operator did not have a bearing on the likelihood of receiving a splash to the mask. (ii) From the survey, 33 of 159 (20Æ8%) of BSDS members had no face masks available and 54 of 159 (34Æ0%) did not wear any facial protection while operating. The majority (53Æ5%) thought they received a splash in £ 1% of procedures. Conclusions There is a substantial risk of a splash of blood coming into contact with the face during dermatological surgery for both the operator and assistant, regardless of the procedure. The risk of receiving a blood splash to the face may be substantially underestimated by U.K.-based dermatologists. The use of protective eyewear is advisable at all times, but particularly when using bipolar electrocautery, or when operating on high-risk individuals.

Review: Head and neck squamous cell carcinoma in sub-Saharan Africa

Aim Review the literature from 1990 to 2013 to determine known anatomic sites, risk factors, treatments, and outcomes of head and neck squamous cell carcinoma (HNSCC) in sub-Saharan Africa. Methods Using a systematic search strategy, literature pertaining to HNSCC in sub-Saharan Africa was reviewed and patient demographics, anatomic sites, histology, stage, treatment, and outcomes were abstracted. The contributions of human immunodeficiency virus (HIV), human papillomavirus (HPV) and behavioural risk factors to HNSCC in the region were assessed. Results Of the 342 papers identified, 46 were utilized for review, including 8611 patients. In sub-Saharan Africa, the oropharyngeal/oral cavity was found to be the most common site, with 7750 cases (90% of all cases). Few papers distinguished oropharyngeal from oral cavity, making identification of possible HPV-associated oropharyngeal squamous cell carcinoma (SCC) difficult. SCC of the nasopharynx, nasal cavity, or paranasal sinuses was identified in 410 patients (4.8% of all cases). Laryngeal SCC was found in 385 patients (4.5% of all cases), and only 66 patients (0.8% of all cases) with hypopharyngeal SCC were identified. In 862 patients with data available, 43% used tobacco and 42% used alcohol, and reported use varied widely and was more common in laryngeal SCC than that of the oropharyngeal/oral cavity. Toombak and kola nut use was reported to be higher in patients with HNSCC. Several papers reported HIV-positive patients with HNSCC, but it was not possible to determine HNSCC prevalence in HIV-positive compared to negative patients. Reports of treatment and outcomes were rare. Conclusions The oropharyngeal/oral cavity was by far the most commonly reported site of HNSCC reported in sub-Saharan Africa. The roles of risk factors in HNSCC incidence in sub-Saharan Africa were difficult to delineate from the available studies, but a majority of patients did not use tobacco and alcohol.

Characterization of patients undergoing noninvasive ventilation admitted in unit intermediate care

Non-invasive ventilation (NIV) is the application of a ventilatory support without resorting to invasive methods. Today it’s considered a credible therapeutic option, with enough scientiic evidence to support its application in various situations and clinical settings related to the treatment of acute respiratory disease, as well as chronic respiratory disease. Objectives: Characterize patients undergoing NIV admitted in Unit Intermediate Care (ICU) in the period from October 1st 2015 to June 30th 2016. Methods: Prospective study conducted in ICU between October 2015 and June 2016. In this study were included all patients hospitalized in this unit (ICU) and in that time period a sample of 57 participants was obtained. As data collection instruments we used a questionnaire for sociodemographic and clinical data and the Braden scale. Results: Participants were mostly male 38 (66.7%), the average age 69.5 ± 11.3 years, ranging between 43 and 92 years. They weighed on average 76.6 kg (52 and 150), with an average body mass index of 28.5 kg/m2 (20 to 58.5). With skin intact 28 (49.1%) with abnormal perfusion 12 (21.1%), with altered sensitivity 11 (19.3%) and a high risk of ulcer on the scale of Braden 37 (65%). The admission diagnosis was respiratory failure 33 (57.3%) and had different backgrounds. We used reused mask 53 (93.0%), the average time of NIV was 7.1 days (1-28), 4.8 days of hospitalization (1-18) and an average of 7.8 IPAP pressure. 11 (19.3%) of the participants developed face ulcer pressure.Conclusions: The NIV is used in patients with advanced age, obesity, respiratory failure and high risk of face ulcer development.

A construção do Ethos no discurso publicitário : sob a máscara da cientificidade

“A construção do ethos no discurso publicitário: sob a máscara da cientificidade” resulta de um trabalho de investigação de mestrado que tem por objeto de estudo o discurso publicitário impresso, que refere a autoridade científica como estratégia persuasiva, ganhando, assim, um caráter de seriedade e de verdade. A análise, tributária dos estudos do campo da Retórica, da Análise do Discurso, da Linguística Textual, da Pragmática e da Teoria da Argumentação, visa demonstrar os mecanismos envolvidos no processo de construção do ethos no discurso publicitário marcado pela cientificidade. Neste sentido, a partir da observação do corpus, constata-se a eficácia argumentativa da cientificidade na construção do ethos presente no discurso publicitário.

Environmental and grazing influence on spatial variability of intertidal biofilm on subtropical rocky shores

Epilithic biofilm on rocky shores is regulated by physico-chemical and biological factors and is important as a source of food for benthic organisms. The influences of environmental and grazing pressure on spatial variability of biomass of biofilm were evaluated on shores on the north coast of São Paulo State (SE Brazil). A general trend of greater abundance of microalgae was observed lower on the shore, but neither of the environmental factors evaluated (wave exposure and shore level) showed consistent effects, and differences were found among specific shores or times (September 2007 and March 2008). The abundance of slow-moving grazers (limpets and littorinids) showed a negative correlation with chlorophyll a concentration on shores. However, experimental exclusion of these grazers failed to show consistent results at small spatial scales. Observations of divergent abundances of the isopod Ligia exotica and biomass of biofilm on isolated boulders on shores led to a short exclusion experiment, where the grazing pressure by L. exotica significantly decreased microalgal biomass. The result suggests that grazing activities of this fast-moving consumer probably mask the influence of slow-moving grazers at small spatial scales, while both have an additive effect at larger scales that masks environmental influences. This is the first evaluation of the impact of the fast-moving herbivore L. exotica on microalgal biomass on rocky shores and opens an interesting discussion about the role of these organisms in subtropical coastal environments.

Brachycephalic obstructive airway syndrome : a review with six clinical cases

Dissertação de Mestrado Integrado em Medicina Veterinária

Competências extra-musicais solicitadas na obra para clarinete solo Der Kleine Harlekin de Karlheinz Stockausen

O objeto de estudo do presente trabalho é a obra Der kleine Harlekin para clarinete solo do compositor Karlheinz Stockhausen. Dada a falta de coesão sentida ao longo da obra aquando da visualização das seis gravações disponíveis, surgiu a necessidade de analisar o papel da consciência corporal do músico na performance, a aproximação da obra à commedia dell' arte e, consequentemente, a temática da utilização da máscara durante a mesma. Paralelamente, o trabalho apresenta ainda uma análise pormenorizada de todas as indicações disponíveis nas intruções da obra, bem como uma conexão entre a liberdade presente em cada uma dessas indicações e a compreensão de uma narrativa ao longo da performance por parte do público, dando especial atenção à ação como elemento base das escolhas interpretativas; Extra-musical skills in the works of musical theater for solo clarinet Abstract: This is an investigation into the piece Der kleine Harlekin for clarinet solo by Karlheinz Stockhausen. Six recordings were analysed and it was possible to understand that, at some moments, there is no cohesion throughout the all work. Thus, an analysis is made on the importance of body awareness, the approach to commedia dell' arte and, thereafter, the use of the mask on performance. Furthermore, the work also presents a detailed analysis of all the information available in the work instructions as well as a connection between their freedom and the understanding of a narrative throughout the performance by the public, giving special attention to the action as a base element of the interpretative choices.

Awake examination versus DISE for surgical decision making in patients with OSA: A systematic review

OBJECTIVE: Traditionally, upper airway examination is performed while the patient is awake. However, in the past two decades, drug-induced sleep endoscopy (DISE) has been used as a method of tridimensional evaluation of the upper airway during pharmacologically induced sleep. This study aimed to systematically review the evidence regarding the usefulness of DISE compared with that of traditional awake examination for surgical decision making in patients with obstructive sleep apnea (OSA). DATA SOURCES: Scopus, PubMed, and Cochrane Library databases were searched. REVIEW METHODS: Only studies with a primary objective of evaluating the usefulness of DISE for surgical decision making in patients with OSA were selected. The included studies directly compared awake examination data with DISE outcome data in terms of possible influences on surgical decision making and operation success. RESULTS: A total of eight studies with 535 patients were included in this review. Overall, the surgical treatment changed after DISE in 50.24% (standard deviation 8.4) cases. These changes were more frequently associated with structures contributing to hypopharyngeal or laryngeal obstruction. However, these differences do not automatically indicate a higher success rate. CONCLUSION: This review emphasized the direct impact of DISE compared with that of awake examination on surgical decision making in OSA patients. However, it is also clear that the available published studies lack evidence on the association between this impact and surgical outcomes

Estudo retrospetivo sobre traqueostomia permanente como tratamento cirúrgico em cães com síndrome braquicefálica obstrutiva

Dissertação de Mestrado Integrado em Medicina Veterinária

Supressão do ruído de rolamento superficial utilizando a transformada Curvelet

Among the many types of noise observed in seismic land acquisition there is one produced by surface waves called Ground Roll that is a particular type of Rayleigh wave which characteristics are high amplitude, low frequency and low velocity (generating a cone with high dip). Ground roll contaminates the relevant signals and can mask the relevant information, carried by waves scattered in deeper regions of the geological layers. In this thesis, we will present a method that attenuates the ground roll. The technique consists in to decompose the seismogram in a basis of curvelet functions that are localized in time, in frequency, and also, incorporate an angular orientation. These characteristics allow to construct a curvelet filter that takes in consideration the localization of denoise in scales, times and angles in the seismogram. The method was tested with real data and the results were very good