Extra-articular knee resection for a secondary chondrosarcoma evolving from an isolated enchondroma of the distal femur: A case report.

Introduction: Enchondromas are among the most current benign bone tumours. Malignant degeneration is extremely rare (<1%) and generally presents as a low grade chondrosarcoma. For localized grade 1 lesions, the treatment of choice is curettage. Wide excision and reconstruction is generally not necessary, unless locally advanced or more aggressive behaviour is suspected at presentation. Case report: A healthy 72 yo male presented with pain and recurrent knee joint effusion. X-rays show a classical central distal metaphyseal enchondroma of the femur associated with subtle osteolysis of the lateral condyle. MRI confirms the presence of a locally aggressive chondromatous lesion based in a classical enchondroma. Core needle biopsy revealed a grade 1 chondrosarcoma, which was in contrast to the radiological aggressiveness of the lesion. Total body CT-scan did not reveal metastatic disease. A wide resection was planned, as a high-grade lesion and joint contamination was suspected. We performed an extra-articular knee resection and reconstruction with a hinged modular total knee megaprosthesis. The definitive histology was grade 1 chondrosarcoma, the surgical margins were wide. The evolution was favourable and the patient was able to perform all his activities of daily living independently without pain at 6 weeks postop. Knee flexion reached 90°. The oncologic screening at 18 months did not show local or distant recurrence. Conclusion: Joints near a benign tumour that suddenly become symptomatic or present an effusion might indicate a malignant transformation. Wide resection and prosthetic reconstruction remains an effective treatment option even in low grade cartilaginous lesions if (1) the adjacent joint is contaminated, or (2) joint-sparing surgery would result in a severe functional impairment of the limb.

Efeitos da infertilidade no relacionamento dos cônjuges

Trata-se de um estudo sobre os efeitos da infertilidade no relacionamento dos cônjuges, com os objetivos de descrever o perfil da população de estudo e analisar os efeitos da infertilidade na vida emocional, sexual e conjugal. Para tal, foi realizado um estudo transversal e prospectivo em instituição especializada. A amostra foi constituída por 50 casais inférteis com seis anos de infertilidade em média. As mulheres manifestaram sentimentos negativos perante a infertilidade, enquanto os homens assumiram uma postura de suporte e apoio. Os efeitos na vida sexual foram mais expressivos nas mulheres, e o tratamento da infertilidade levou a mudanças positivas para ambos os cônjuges. Ao comparar os efeitos da infertilidade sobre os indivíduos que haviam realizado mais de um tratamento com aqueles no primeiro tratamento, observamos que não houve diferenças entre as mulheres; entre os homens houve diferenças no aspecto emocional (frustração e alívio) e no relacionamento conjugal (fortalecimento e amadurecimento).

Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): results of a multidisciplinary international expert panel-EPACT II

Introduction: High-grade evidence is lacking for most therapeutic decisions in Crohn's disease. Appropriateness criteria were developed for upper gastro-intestinal, extra-intestinal manifestations and drug safety during conception, pregnancy and breastfeeding in patients with Crohn's disease, to assist the physician in clinical decision making. Methods: The European Panel on the Appropriateness of Crohn's Disease Therapy (EPACT II), a multidisciplinary international European expert panel, rated clinical scenarios based on evidence from the published literature and panelists' own clinical expertise. Median ratings (on a 9-point scale) were stratified into three categories: appropriate (7-9), uncertain (4-6 with or without disagreement) and inappropriate (1-3). Experts were also asked to rank appropriate medications by priority. Results: Proton pump inhibitors, steroids, azathioprine/6-mercaptopurine and infliximab are appropriate for upper gastro-duodenal Crohn's disease; for stenosis, endoscopic balloon dilation is the first-tine therapy, although surgery is also appropriate. Ursodeoxycholic acid is the only appropriate treatment for primary sclerosing cholangitis. Infliximab is appropriate for Pyoderma gangrenosum, ankylosing spondylitis and uveitis, steroids for Pyoderma gangrenosum and ankylosing spondylitis, adalimumab for Pyoderma gangrenosum and ankylosing spondylitis, cyclosporine-A/tacrolimus for Pyoderma gangrenosum. Mesalamine, sulfasalazine, prednisone, azathioprine/6-mercaptopurine, ciprofloxacin, and probiotics, may be administered safety during pregnancy or for patients wishing to conceive, with the exception that mate patients considering conception should avoid sulfasalazine. Metronidazol is considered safe in the 2nd and 3rd trimesters whereas infliximab is rated safe in the 1st trimester but uncertain in the 2nd and 3rd trimesters. Methotrexate is always contraindicated at conception, during pregnancy or during breastfeeding, due to its known teratogenicity. Mesalamine, prednisone, probiotics and infliximab are considered safe during breastfeeding. Conclusion: EPACT II recommendations are freely available online (www.epact.ch). The validity of these criteria should now be tested by prospective evaluation. (C) 2009 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Colecções etnográficas extra-ocidentais em Portugal:

O estudo sistemático da cultura material extra-ocidental existente em museus portugueses, bem como, a caracterização e avaliação dos contextos de recolha que originaram esses acervos, enquadram duas componentes fundamentais da história da antropologia no nosso país. Tais estudos permitem reformular algumas teorias sobre as nossas alteridades espaço-temporais, a cultura material acumulada, os objectos aculturados e as mudanças culturais. Num momento em que se pretende reavaliar qual o papel dos museus com acervos coloniais, chama-se à atenção para a importância deste património na reflexão que os cidadãos podem e devem fazer sobre o seu passado, a sua contemporaneidade e as mudanças em curso.

Extra microchromosome mosaicism in amniotic cells confirmed in fetal tissues.

Mosaicism for an extra microchromosome was discovered in amniotic cell cultures of a 39-year-old woman. Using G, Q, C bands and silver staining, it was concluded that the extra chromosome was bisatellited. Parents' karyotype was normal. Parents elected for termination of the pregnancy. The presence of the extra microchromosome was confirmed in various tissues of the aborted fetus. The literature on the subject is briefly reviewed.

Gestão de Relacionamento e Satisfação do Cliente: Estudo de Caso Correios de Cabo Verde (CCV) na Cidade da Praia

Hoje a empresa que pensa em sustentabilidade tem que ser melhor que os seus concorrentes, com acções que se diferencie e que traga benefícios reais para os seus clientes. E é isso que a gestão de relacionamentos nos proporciona, através das actividades e acções que cativam os clientes. Para construir e manter um bom relacionamento com os clientes é preciso criar estruturas adequadas, criar estratégias de relacionamentos, inovar, ter funcionários capacitados e motivados e oferecer valor através da qualidade dos produtos/serviços prestados pela empresa. E os CCV na cidade da praia têm vindo a demostrar interesse em melhorar a satisfação dos seus clientes através de um relacionamento forte e saudável. E para que isso seja possível a empresa terá que criar estratégias de relacionamentos baseados em factores que influencia um bom relacionamentos e factores que ajudam na gerência destes mesmos relacionamentos.

Modelo de Relacionamento Banca-Pme

Embora as PME sejam consideradas o motor do crescimento europeu, devido a sua capacidade de inovação e criação de emprego, a sua dificuldade em conseguir financiamento faz-se sentir agudamente. Daí, para uma economia que deseja prosperar, torna-se crucial garantir-lhes melhor acesso aos créditos, principalmente através de empréstimos bancários. Este trabalho revisa o debate sobre as relações existente entre a banca e as PME no mercado português. A amostra baseia-se num inquérito dirigido aos gestores de empresas da zona centro de Lisboa das cinco maiores instituições bancárias a operar em Portugal, a fim de avaliar as suas percepções sobre o relacionamento com as PME. Constatou-se que a relação banca-PME não tem ainda uma base teórica sólida, apesar de inúmeros estudos sobre a importância de manter uma clara e total confiança entre as partes. Todavia, a literatura destaca, crescentemente, a ideia de que o mercado das PME pode ser um segmento rentável para os bancos. Este inquérito apoia esta percepção, embora de uma forma menos acentuada, comparativamente à evidenciada nas várias observações teóricas e empíricas. A alta centralização dos bancos inqueridos em informações de carácter financeiro aquando da avaliação inicial de um crédito, na avaliação de um empréstimo adicional e na análise de um relacionamento contínuo, demonstram esta falta de confiança entre as partes. De igual modo, constatou-se pouca atenção à rotatividade dos gestores de empresas, o que pode prejudicar o aprofundamento de uma relação com as PME. Ainda assim, os bancos têm reconfigurados as suas organizações e têm criados departamentos descentralizados e/ou separados nas suas operações para melhor servir as PME. As próprias características das PME e as percepções de maiores riscos são apontadas como os principais factores que limitam o envolvimento dos bancos com as PME.

Den uppnådda medborgarfredens betydelse och förpliktelse (Tal, hållet i november 1939 under tiden för den extra reservövningen vid en fest I Mässhallen)

Puhe

Extra burden of psychosomatic complaints among adolescents suffering from chronic conditions.

OBJECTIVE:: To determine whether there are differences in health perception and health care use among adolescents with psychosomatic symptoms (PS), with chronic conditions (CCs), and with both conditions compared with healthy controls. METHODS:: By using the SMASH02 database, 4 groups were created: youths with PS but no CCs (N = 1010); youths with CCs but no PS (N = 497); youths with both psychosomatic symptoms and chronic conditions (PSCC, N = 213); and youths with neither PS nor CC (control, N = 5709). We used χ tests and analysis of variance to compare each variable between the 4 groups. In a second step, all health and health care use variables were included in a multinomial regression analysis controlling for significant (p < .05) background variables and using the control group as the reference. RESULTS:: Overall, PS and PSCC youths were significantly more likely to rate their health as poor, to be depressed, and to have consulted several times their primary health care provider or a mental health professional than their healthy peers. With the exception of being depressed, PSCC adolescents reported worse health perception and higher health care use than CC and PS. CONCLUSIONS:: Although PS youths do not define PS as a CC, it should be considered as one. Moreover, having PS represents an additional burden to chronically ill adolescents. Health professionals dealing with adolescents must be aware of the deleterious health effects that PS can have on adolescents and have this diagnosis in mind to better target the treatment and improve their management.

La dyspnée laryngée paroxystique: une manifestation extra-oesophagienne peu connue du reflux gastro-oesophagien [Gastroesophageal reflux: a possible cause of paroxysmal laryngeal dyspnea]

An important number of patients are referred to the ENT specialist because of extraoesophageal manifestations of gastroesophageal reflux. The most alarming symptom is a paroxysmal dyspnea secondary to a laryngospasm. The patients report a laryngeal choking sensation associated to an aphonia. We report three cases of laryngospasm secondary to acid gastric reflux. The diagnosis was made with the clinical history, a laryngeal examination and a 24-hour pH-monitoring enabled us to demonstrate a clear temporal relation between the reflux episodes and the choking episodes. In conclusion, the pharyngo-laryngeal reflux is a possible cause of laryngospasm. In our three patients, a high dose antiacid treatment was efficient to bring a lasting relief of the symptoms.

Neuropsychological outcome after extra-temporal epilepsy surgery.

BACKGROUND: The neuropsychological results of temporal lobe epilepsy surgery are well reported in the literature. The aim of this study was to analyse the neuropsychological outcome in a consecutive series of patients with extra-temporal epilepsy. METHODS: We retrospectively analysed the data of patients operated between 1996 and 2008 for extra-temporal epilepsy. Standard neuropsychological tests were applied. We assessed the neuropsychological outcome after surgery and the correlation of the neuropsychological outcome with (1) side and localisation of surgery, (2) Engel scale for seizure outcome and (3) timing of surgery. FINDINGS: Patients had a better neuropsychological outcome when undergoing non-frontal resection [χ2 (2) =6.66, p = 0.036]. Subjects who had undergone left or right resection showed no difference in outcome [χ2 (2) =0.533, p = 0.766]. The correlation between the Engel scale for seizure re-occurence and the neuropsychological scores showed only a tendency for better outcome (Spearman ρ = -0.437; p = 0.069). The global measure of change did not correlate significantly with delay of surgery (Spearman ρ = -0.163; p = 0.518). CONCLUSIONS: Resective epilepsy surgery improves neuropsychological status outcome in patients with extra-temporal epilepsy even if the patient did not become seizure free. The outcome is better for non-frontal localisation.

Monsieur Badin : scène de la vie de bureau, saynète en 1 acte (Paris, Grand-Guignol, 13 avril 1897) ; et l'Extra-Lucide : saynète en 1 acte (Paris, Carillon, 17 mai 1897) / Georges Courteline

Collection : Les pièces à succès ; N° 18