Frontal sinus pneumocele: case report and literature review

The authors report a rare case of frontal sinus pneumocele in a 26-year-old female patient assessed by computed tomography.

Ten years of R&D and full automation in molecular diagnosis.

A 10-year experience of our automated molecular diagnostic platform that carries out 91 different real-time PCR is described. Progresses and future perspectives in molecular diagnostic microbiology are reviewed: why automation is important; how our platform was implemented; how homemade PCRs were developed; the advantages/disadvantages of homemade PCRs, including the critical aspects of troubleshooting and the need to further reduce the turnaround time for specific samples, at least for defined clinical settings such as emergencies. The future of molecular diagnosis depends on automation, and in a novel perspective, it is time now to fully acknowledge the true contribution of molecular diagnostic and to reconsider the indication for PCR, by also using these tests as first-line assays.

Hemosuccus pancreaticus: causa rara de hemorragia digestiva maciça

Hemosuccus pancreaticus is a unusual syndrome manifested by hemorrhage into the pancreatic duct and by blood loss through the ampulla of Vater: It may be caused by tumors, arteriovenous malformation, pancreatic lithiasis, aneurism rupture from adjacent vessels, or erosion of pancreatic and peripancreatic vessels due to chronic pancreatitis. The authors describe a case of massive and recurrent gastrointestinal upper hemorrhage in a 26-year-old man without known risk factors for pancreatitis. This man underwent urgent surgery due to gastrointestinal bleeding during the ínvestigation. During the procedure, blood was found in the intestinal lumen and a tumor in the head of pancreas with two centimeters of diameter: A gastroduodenopancreatectomy was performed. Histological study showed chronic pancreatitis with a fistula from the pancreatic vessels to the Wirsung duct. The patient was discharged without postoperative complications and after months, remains assymptomatic.

Pseudoaneurisma gigante de artéria esplênica

Splenic artery pseudoaneurysm larger than 10 cm is a rare condition. The risk of rupture is probably high and surgical treatment is necessary. The objective of this article is to report a case of a patient with giant pseudoaneurysm of the splenic artery submitted to surgical resection. A 26-year-old man complaining of gastrointestinal hemorrhage and abdominal pain The patient’s medical history revealed that one year before he had an abdominal blunt trauma. The angiography showed a giant pseudoaneurysm of the splenic artery with compression of the stomach. The patient was operated on by abdominal access and the spleen and pseudoaneurysm were resected. The postoperative course was uneventful and the patient was discharged 13 days after surgery without problems.

Manejo terapêutico do hepatocarcinoma fibrolamelar

Fibrolamellar carcinoma of the liver is a distinct variant of hepatocellular carcinoma characterized by the lack of association with cirrhosis or other underlying liver diseases, as hepatitis B virus. The serum alpha-fetoprotein level is often not elevated, occuring typically in young patients. Distinction from conventional hepatocellular carcinoma is of clinical significance, because prognosis is far better due to higher ressecability and more indolent growth. We describe a case of a 26-year-old woman free of other liver diseases presenting with a large abdominal palpable mass. After ressection by vascular exclusion technique, the pathologic examination revealed fibrolamellar carcinoma. The former should not be confused with the hepatocellular carcinoma, since it is related with a more favorable prognosis.

Inguinal hernias in patients of 50 years and above. Pattern and outcome

OBJECTIVE: to evaluate a one year experience with inguinal hernia repair, in patients of > 50years, with respect to the type of inguinal hernia, type of surgery, postoperative complications and recurrence. METHODS: a prospective descriptive study of patients (n=57) > 50 years operated for inguinal hernia during a one year period. Tension-free meshplasty and herniorrhaphy, using 3"x6" polypropylene mesh and 2-0 polypropylene suture, were performed in elective and emergency surgery respectively. Follow-up visits were scheduled at six weeks, three and six months postoperatively. RESULTS: the most representative age group was 61-70 years, and all patients were male. 52 (91.22%) patients had unilateral inguinal hernias, while five (8.77%) had bilateral hernias. In 50 (87.71%) patients, the hernia was uncomplicated, while seven (12.28%) patients presented with some complication such as obstruction or strangulation. Elective surgery was performed in 50 (87.71%) patients while seven (12.28%) patients were operated in emergency. Postoperatively, 50 (87.7%) patients had uneventful recovery, while seven (12.28%) patients developed some complications which were treated conservatively. Mean hospital stay was six days. One recurrence was observed and there was no peri/postoperative death. CONCLUSION: tension-free meshplasty and herniorrhaphy are safe, simple and applicable even in elderly patients after adequate pre-operative assessment and optimization. Although associated with longer hospital stay, the mortality rate is nil and complication as well as recurrence rate is low. Hence, timely repair is necessary in elderly patients even in those with comorbid conditions.

Glutamic acid decarboxylase antibodies are indicators of the course, but not of the onset, of diabetes in middle-aged adults: the Atherosclerosis Risk in Communities Study

To efficiently examine the association of glutamic acid decarboxylase antibody (GADA) positivity with the onset and progression of diabetes in middle-aged adults, we performed a case-cohort study representing the ~9-year experience of 10,275 Atherosclerosis Risk in Communities Study participants, initially aged 45-64 years. Antibodies to glutamic acid decarboxylase (GAD65) were measured by radioimmunoassay in 580 incident diabetes cases and 544 non-cases. The overall weighted prevalence of GADA positivity (³1 U/mL) was 7.3%. Baseline risk factors, with the exception of smoking and interleukin-6 (P £ 0.02), were generally similar between GADA-positive and -negative individuals. GADA positivity did not predict incident diabetes in multiply adjusted (HR = 1.04; 95%CI = 0.55, 1.96) proportional hazard analyses. However, a small non-significant adjusted risk (HR = 1.29; 95%CI = 0.58, 2.88) was seen for those in the highest tertile (³2.38 U/mL) of positivity. GADA-positive and GADA-negative non-diabetic individuals had similar risk profiles for diabetes, with central obesity and elevated inflammation markers, aside from glucose, being the main predictors. Among diabetes cases at study's end, progression to insulin treatment increased monotonically as a function of baseline GADA level. Overall, being GADA positive increased risk of progression to insulin use almost 10 times (HR = 9.9; 95%CI = 3.4, 28.5). In conclusion, in initially non-diabetic middle-aged adults, GADA positivity did not increase diabetes risk, and the overall baseline profile of risk factors was similar for positive and negative individuals. Among middle-aged adults, with the possible exception of those with the highest GADA levels, autoimmune pathophysiology reflected by GADA may become clinically relevant only after diabetes onset.

Plan de empresa "Dorcé"

Dorcé es una idea de negocio que responde de manera directa a la necesidad de vestir de las mujeres a través de su innovador sistema operativo “Diseño y confección a tu manera” el cual tiene como objetivo revolucionar la tradicional forma de adquirir prendas de vestir femeninas en la ciudad de Villavicencio. Desde su creación y ejecución, se ha observado una gran aceptación de dicho sistema operativo por parte de los clientes antiguos generando muy buenos resultados económicos partiendo de sus actividades principales, el diseño, la confección y venta de prendas de vestir femeninas. Es por esto que el desarrollo de este trabajo de grado va dirigido a organizar de una manera más administrativa los diferentes procesos que se llevan a cabo dentro de la organización a fin de conseguir incrementar la producción y llegar así a un grupo más amplio de clientes con base en sus necesidades y a las actuales tendencias de la moda. Esta labor tiene como fin, responder y satisfacer a la mujer villavicense en términos de moda, servicio y confección, agregándole un valor adicional en cuanto a menores tiempos de entrega, altos estándares de calidad y exclusividad. Todo lo anterior, en un solo lugar. El sistema operativo (factor diferenciador) de esta idea de negocio consiste en ofrecer a los clientes, diferentes modelos de las partes (cuello, manga, contorno, falda y panty) que componen las prendas que fabrica Dorcé (Blusa, vestido y traje de baño). Con el fin de que el cliente pueda armar la prenda a su gusto teniendo el plus de ir “a la medida”. Dicha prenda de carácter exclusivo, es confeccionada y entregada al cabo de un máximo de 3 días dependiendo de la complejidad que tenga para ser elaborada, garantizándole al cliente no solo la originalidad del diseño de su prenda sino también fabricarla en menor tiempo que la competencia. Es un producto y un servicio innovador que va dirigido a mujeres de quince a setenta años de edad de la ciudad de Villavicencio, mujeres de media y alta sociedad que se caracterizan por su gusto por la moda y la calidad. Una vez se satisfacen las necesidades de nuestros clientes se da lugar a nuevas ventas dentro del grupo social de cada una de ellas, una vez nos refieran de manera positiva con sus amigas y conocidas. Este tipo de publicidad (voz a voz) es la que ha llevado a Dorcé a crecer a través de los años sin perder la exclusividad de su mercado; sin embargo, en la actualidad, la idea de negocio carece de estructura empresarial adecuada, de estrategias que garanticen su crecimiento y sostenibilidad, también carece de recursos financieros inmediatos que faciliten la ampliación y adecuación de la planta de producción y del almacén. Es por ello que las actuales empresarias de esta idea de negocio tienen como objetivo, mediante la elaboración de este plan de empresa, desarrollar, organizar y mejorar las estrategias, acciones, objetivos, alianzas, cambios, inversiones, que se tienen y necesitan para el mejoramiento interno y externo de la compañía. Para el desarrollo de dicho plan, Dorcé cuenta con Doris Blanco, una diseñadora de modas de 25 años de experiencia en el sector textil y confección en la ciudad de Villavicencio, quien está a cargo del área de producción de la empresa, dos estudiantes de Administración de Negocios Internacionales, Fernanda Montes y Juliana Villamizar, quienes están a cargo de la parte administrativa, comercial y estratégica de la empresa. De igual forma cuenta con el conocimiento del mercado textil y de confección, así mismo amplias relaciones que se han venido fortaleciendo a través del tiempo con los diferentes proveedores de materia prima en la ciudad, maquinaria y materia prima inicial, cerca de sesenta mujeres que se han vinculado a la empresa como clientes fieles a la idea de negocio promocionándolo de manera positiva día a día, así como también el interés, empuje y compromiso por parte de las involucradas en desarrollar, ejecutar y sostener esta idea de negocio como proyecto de vida.

Tamizaje neonatal para fibrosis quística en una muestra de la ciudad de Bogotá

La Fibrosis Quística es la enfermedad autosómica recesiva mas frecuente en caucásicos. En Colombia no se conoce la incidencia de la enfermedad, pero investigaciones del grupo de la Universidad del Rosario indican que podría ser relativamente alta. Objetivo: Determinar la incidencia de afectados por Fibrosis Quística en una muestra de recién nacidos de la ciudad de Bogotá. Metodología: Se analizan 8.297 muestras de sangre de cordón umbilical y se comparan tres protocolos de tamizaje neonatal: TIR/TIR, TIR/DNA y TIR/DNA/TIR. Resultados: El presente trabajo muestra una incidencia de 1 en 8.297 afectados en la muestra analizada. Conclusiones: Dada la relativamente alta incidencia demostrada en Bogotá, se justifica la implementación de Tamizaje Neonatal para Fibrosis Quística en Colombia.

Productividad del sector textil propuesta de creación de un cluster para el sector

El sector textil y de Confecciones tiene más de 100 años de experiencia en Colombia y cuenta con una cadena productiva consolidada, tiene un potencial exportador importante dentro de la economía colombiana, por lo cual hace parte del Programa de transformación Productiva PTP. El Ministerio de Comercio Industria y Turismo, presentó el PTP el cual consiste en una alianza público-privada, que busca fomentar la productividad y competitividad de aquellos sectores que presentan un elevado potencial exportador, aprovechando los acuerdos comerciales que existen. El sector tiene varias características que lo hacen llamativo para la inversión lo cual hace que sea parte de la transformación productiva del país: El sector representó alrededor del 5% del total de las exportaciones de Colombia, lo cual lo hace ser el sector más representativo en exportaciones no tradicionales; En 2011 el Sector textil y de confecciones representó alrededor del 10% del PIB de la industria manufacturera y el 1.2% del PIB nacional; La creciente tendencia a importar textiles y fibras de algodón por parte de los confeccionistas colombianos, resalta la oportunidad que existe de inversión en la producción de fibras textiles para cubrir la demanda interna; Existe un acceso preferencial a más de 48 países y a alrededor de 1500 millones de consumidores gracias a los acuerdos comerciales vigentes; Colombia se ha destacado a nivel mundial por la alta calidad de sus productos de confección, además de ser eficientes en la producción de dichos productos.

Análisis de la relación entre la accidentalidad y el incremento de trabajo en un proyecto de la construcción en Colombia durante los años 2012 y 2013

La construcción es una de las industrias que mayores accidentes laborales genera, en esta investigación se realizó un análisis retrospectivo para determinar si existe alguna relación entre la ocurrencia de accidentes y la fecha de entrega de una meta, debido al incremento en la cantidad de trabajo expresado por la cantidad de días y horas extras trabajados, se cuenta con información de la accidentalidad de cinco empresas constructoras de un gran proyecto vial en Colombia en los años de 2012 y 2013. Se analizó la información correspondiente a la nómina de las mismas empresas, con el valor de la nómina mensual, el valor de las incapacidades mensuales y la cantidad de trabajadores por cada empresa en cada periodo. El manejo de los datos se hizo con EXCEL y el análisis estadístico con STATA 11.1, se usó la correlación de Spearman para encontrar la relación entre la cantidad de accidentes acumulados y: la cantidad acumulada de días trabajados en cada mes, la cantidad acumulada de horas extras trabajadas mensualmente y el costo acumulado en porcentaje de la nómina mensual, encontrándose en todos los casos una relación lineal. Por otra parte, se realizó una prueba binomial para establecer la relación de la fecha de entrega de la meta con la accidentalidad 30 días antes y después, encontrando que la accidentalidad aumenta en la proximidad previa a la entrega de la meta

Reforesting degraded agricultural landscapes with Eucalypts: effects on carbon storage and soil fertility after 26years

In the Western Australian wheatbelt, the restoration of native eucalypt forests for managing degraded agricultural landscapes is a critical part of managing dryland salinity and rebuilding biodiversity. Such reforestation will also sequester carbon. Whereas most investigative emphasis has been on carbon stored in biomass, the effects of reforestation on soil organic carbon (SOC) stores and fertility are not known. Two 26 year old reforestation experiments with four Eucalyptus species (E. cladocalyx var nana, E. occidentalis, E. sargentii and E. wandoo) were compared with agricultural sites (Field). SOC stores (to 0.3 m depth) ranged between 33 and 55 Mg ha−1, with no statistically significant differences between tree species and adjacent farmland. Farming comprised crop and pasture rotations. In contrast, the reforested plots contained additional carbon in the tree biomass (23–60 Mg ha−1) and litter (19–34 Mg ha−1), with the greatest litter accumulation associated with E. sargentii. Litter represented between 29 and 56% of the biomass carbon and the protection or utilization of this litter in fire-prone, semi-arid farmland will be an important component of carbon management. Exch-Na and Exch-Mg accumulated under E. sargentii and E. occidentalis at one site. The results raise questions about the conclusions of SOC sequestration studies following reforestation based on limited sampling and reiterate the importance of considering litter in reforestation carbon accounts.

GIANT FUSIFORM ANEURYSM ARISING FROM FENESTRATED POSTERIOR CEREBRAL ARTERY and BASILAR TIP VARIATION: CASE REPORT

OBJECTIVE: A giant fusiform aneurysm in the posterior cerebral artery (PCA) is rare, as is fenestration of the PCA and basilar apex variation. We describe the angiographic and surgical findings of a giant fusiform aneurysm in the P1-P2 PCA segment associated with PCA bilateral fenestration and superior cerebellar artery double origin.CLINICAL PRESENTATION: A 26-year-old woman presented with a 2-month history of visual blurring. Digital subtraction angiography showed a giant (2.5 cm) fusiform PCA aneurysm in the right P1-P2 segment. The 3-dimensional view showed a caudal fusion pattern from the upper portion of the basilar artery associated with a bilateral long fenestration of the P1 and P2 segments and superior cerebellar artery double origin.INTERVENTION: Surgical trapping of the right P1 -P2 segment, including the posterior communicating artery, was performed by a pretemporal approach. Angiograms performed 3 and 13 months after surgery showed complete aneurysm exclusion, and the PCA was permeated and filled the PCA territory. Clinical follow-up at 14 months showed the patient with no deficits and a return to normal life.CONCLUSION: To our knowledge, this is the first report of a giant fusiform aneurysm of the PCA associated with P1-P2 segment fenestration and other variations of the basilar apex (bilateral superior cerebellar artery duplication and caudal fusion). Comprehension of the embryology and anatomy of the PCA and its related vessels and branches is fundamental to the decision-making process for a PCA aneurysm, especially when parent vessel occlusion is planned.

Mandibular Movement Restoration Through Bilateral Coronoidectomy by Intraoral Approach

The present study aimed at reporting a clinical and surgical case of bilateral coronoidectomy, using an intraoral approach. The patient is a 26-year-old man, who sought attendance complaining of a gradual reduction of his oral opening in the past 3 years; however, he had an aggravation in the last 2 months. After clinical examination and imaging evaluation, the diagnosis of coronoid process hyperplasia was confirmed, and the surgical treatment was proposed. Under general anesthesia, with nasotracheal intubation guided by a nasofiberendoscope, using an intraoral approach, the bilateral coronoidectomy was performed. In the immediate postoperative period, an increase of the buccal opening measured 29 mm, representing an enhancement of 11 mm, and in the 30th postoperative day, it measured 31.12 mm. During the clinical follow-up period, a reestablishment of the mandibular movements was observed. Therefore, coronoidectomy by an intraoral approach and the physiotherapy performed in the postoperative period were efficient procedures.

Escuta analítica no hospital geral: : implicações com o desejo do analista

Partindo da experiência na enfermaria de um hospital-escola1, do confronto com o status-quo do trabalho dos psicólogos em hospitais e da avaliação da literatura sobre a clínica psicanalítica em hospital, esta pesquisa se propôs a buscar avanços frente a uma questão específica: a escuta psicanalítica no trabalho em enfermarias de hospital geral e as implicações dessa prática com o desejo do psicanalista. Foram entrevistados quinze psicólogos declaradamente de orientação psicanalítica, vinculados a unidades de internação e com experiência mínima de dois anos de trabalho em hospital geral. As entrevistas foram abertas e semi-estruturadas, com o intuito de contemplar de maneira uniforme a coleta de informações de cunho mais objetivo, assim como de facilitar a pertinência ao tema de estudo. A interpretação dos dados foi realizada à luz do referencial clínico psicanalítico (freud-lacaniano), sendo que tal interpretação nos permitiu identificar uma importante interação entre os impasses, presentes na instituição hospitalar, da prática clínica psicanalítica com questões pessoais e de formação do profissional, interação que se vincula à postura de trabalho adotada no hospital. Reafirmamos, através desta pesquisa, a possibilidade de fazer uso de uma escuta analítica no trabalho com pacientes internados, a qual está sempre voltada para as manifestações do inconsciente ao longo da fala, e na qual a direção do tratamento é a emergência do sujeito do inconsciente.