Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2008. / Titre provenant de l'écran-titre. Bibliogr. f. 55-59.

INTRODUCTION Benign prostatic hyperplasia (BPH) is the most common pathological condition of aged men which significantly impairs the quality of life status. Though pharmacotherapy with adrenoblockers and 5-alpha reductase inhibitors markedly decreased the rate of surgical interventions, BPH surgery still constitutes the main workload (around ¼ of total) of urologists in the department. The results of the observational study performed by Barry et al. show that the probability of surgical treatment of BPH during the period of 4 years for subjects with mild symptoms equals to 10%, and in case of moderate and severe symptoms - 24% and 39%, respectively. According to the data of large multicenter study performed with 7,588 men in Asia and Australia, moderate and severe symptoms are present in 29%, 40%, and 56% of men in their fifth, sixth, and seventh decade of life, respectively. Symptoms are the main driving force of BPH treatment, but their correlation with residual urine, objective findings of uroflowmetry and invasive urodynamics is only poor. The association of various parameters with the outcomes of surgical treatment is complicated and still not completely investigated. Therefore finding parameters that predict the outcome of surgical BPH treatment is important. According to the literature, unfavorable outcomes of transurethral resection are present in around 15-30% of men with symptomatic BPH. This is mostly associated with inadequate preoperative evaluation, not fully... [to full text]

Inguinoscrotal herniation of the ureter is a rare finding with the potential for serious surgical complications. Two anatomic forms are defined. In the more common paraperitoneal variant, the herniating peritoneal sac drags the ureter and sometimes other abdominal structures with it. The uncommon variant – extraperitoneal inguinal hernia – is without a peritoneal sac and consists of the ureter and fat tissue. We report a case of extraperitoneal inguinoscrotal hernia possibly due to a prior inguinal hernia repair. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The decisions and actions of management in organisations have an increasing impact on individuals, other organisations and the community. The importance of the exercise of corporate social responsibility can no longer be based on the assumption that the self–interest of the owner of the property will lead to the public good, or that self–interest and public good can be kept apart and have nothing to do with each other. On the contrary, it requires of managers that they assume responsibility for the public good, that they subordinate their actions to an ethical code of conduct, that they restrain their authority wherever their exercise would infringe upon the common will and upon the freedom of the individual. South Africa is one of the countries with the highest illiteracy rate in the world. There are more children dropping out of school in South Africa than any other country in the world. The social and economic impact of the lack of education is difficult to comprehend. Lack of education affects company productivity and competitiveness adversely. A lack of education increases the training costs of organisations immensely. Hence, companies cannot sit on the sideline, but should rather be involved in education through corporate social responsibility programs. The primary objective of the study is to investigate the relationship between corporate social responsibility spending by companies, especially on education, and improvement in standards of education, thereby increasing the overall annual Grade 12 pass rate. In order to address the primary objectives of the study, the following secondary objectives were formulated: * To understand and obtain insight into the dynamics of social responsibility programs of companies that are involved in education; * To analyse and identify the main reason for companies to be involved in education; * To analyse and assess corporate and school partnerships in and around the designated area; * To measure output for different township high schools by using the grade 12 pass rate as a measuring tool; * To establish the level of satisfaction within companies that have embarked on corporate social responsibility programs; and * To establish the importance of mathematics and science as part of the school education. The most important conclusions that could be drawn from the study are: * Companies had endorsed corporate social responsibility as part of their strategy; * It had been extremely difficult to obtain information about companies' corporate social responsibility programs due to information being classified as confidential by companies. This could be a serious impediment for advancement of literature and research in the country; and * Companies had contributed massive resources to the advancement of education through their educational programs, but this had not yielded the consistently desired results through improvement of the Grade 12 pass rate. / Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2011.

The decisions and actions of management in organisations have an increasing impact on individuals, other organisations and the community. The importance of the exercise of corporate social responsibility can no longer be based on the assumption that the self–interest of the owner of the property will lead to the public good, or that self–interest and public good can be kept apart and have nothing to do with each other. On the contrary, it requires of managers that they assume responsibility for the public good, that they subordinate their actions to an ethical code of conduct, that they restrain their authority wherever their exercise would infringe upon the common will and upon the freedom of the individual. South Africa is one of the countries with the highest illiteracy rate in the world. There are more children dropping out of school in South Africa than any other country in the world. The social and economic impact of the lack of education is difficult to comprehend. Lack of education affects company productivity and competitiveness adversely. A lack of education increases the training costs of organisations immensely. Hence, companies cannot sit on the sideline, but should rather be involved in education through corporate social responsibility programs. The primary objective of the study is to investigate the relationship between corporate social responsibility spending by companies, especially on education, and improvement in standards of education, thereby increasing the overall annual Grade 12 pass rate. In order to address the primary objectives of the study, the following secondary objectives were formulated: * To understand and obtain insight into the dynamics of social responsibility programs of companies that are involved in education; * To analyse and identify the main reason for companies to be involved in education; * To analyse and assess corporate and school partnerships in and around the designated area; * To measure output for different township high schools by using the grade 12 pass rate as a measuring tool; * To establish the level of satisfaction within companies that have embarked on corporate social responsibility programs; and * To establish the importance of mathematics and science as part of the school education. The most important conclusions that could be drawn from the study are: * Companies had endorsed corporate social responsibility as part of their strategy; * It had been extremely difficult to obtain information about companies' corporate social responsibility programs due to information being classified as confidential by companies. This could be a serious impediment for advancement of literature and research in the country; and * Companies had contributed massive resources to the advancement of education through their educational programs, but this had not yielded the consistently desired results through improvement of the Grade 12 pass rate. / Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2011.

Although theoretically practical algorithms for torus embedding exist, they have not yet been successfully implemented and their complexity may be prohibitive to their practicality. We describe a simple exponential algorithm for embedding graphs on the torus (a surface shaped like a doughnut) and discuss how it was inspired by the quadratic time planar embedding algorithm of Demoucron, Malgrange and Pertuiset. We show that it is faster in practice than the only fully implemented alternative (also exponential) and explain how both the algorithm itself and the knowledge gained during its development might be used to solve the well-studied problem of finding the complete set of torus obstructions.

Although theoretically practical algorithms for torus embedding exist, they have not yet been successfully implemented and their complexity may be prohibitive to their practicality. We describe a simple exponential algorithm for embedding graphs on the torus (a surface shaped like a doughnut) and discuss how it was inspired by the quadratic time planar embedding algorithm of Demoucron, Malgrange and Pertuiset. We show that it is faster in practice than the only fully implemented alternative (also exponential) and explain how both the algorithm itself and the knowledge gained during its development might be used to solve the well-studied problem of finding the complete set of torus obstructions.

Made available in DSpace on 2014-06-11T19:23:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-04-07Bitstream added on 2014-06-13T19:09:51Z : No. of bitstreams: 1 laskoski_lm_me_jabo.pdf: 647030 bytes, checksum: 950b1f5d5358b98ef4e5d3a67333637b (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A laminite está associada a ativação inflamatória sistêmica, a qual ocorre em diversas afecções, principalmente as gastrointestinais. Sua patogenia este relacionada a ativação de metaloproteinases e degradação do colágeno e/ou hemidesmossomos. 0 objetivo deste estudo foi analisar alterações morfológicas, apoptose, metaloproteinases (MMP) 2 e 9 e infiltração leucocitária, pela pesquisa da lipocalina liberada por neutrófilos (NGAL), no tecido laminar de equinos submetidos a obstrução intestinal experimental. Os animais foram distribuídos nos grupos: controle (Gc), instrumentado (Gi), com procedimento de enterotomia sem obstrução; obstruído tratado com hidrocortisona (Gt) e obstruído não tratado (Gnt). 0 tecido laminar foi analisado pelas técnicas de microscopia em luz, imunohistoquímica e zimografia. Os animals dos grupos experimentais (Gi, Gt e Gnt) demonstraram alterações morfológicas, MMPs e substância formada pela M M P-9 e NGAL superiores aos resultados do Cc. A presença de apoptose não foi evidenciada pelo procedimento cirúrgico. 0 Gc não foi diferente quanto as alterações morfológicas quando comparado ao Gi, e também não diferiu do Gt em relação e MMP-9, principalmente associada a neutrófilos. Com estes resultados, conclui-se que: o modelo experimental pode causar alterações morfológicas associadas a laminite; a apoptose não participa da fase inicial de alterações laminares no córium laminar; a hidrocortisona pode ser utilizada para coibir os efeitos deletérios da ativação inflamatória associada a diversas doenças, sem comprometer o córium laminar. / The laminitis is associated to systemic inflammatory activation that occur in several diseases, mainly gastrointestinal. The pathogeny of the laminitis is related to matrix metalloproteinases (MMPs) activation with collagen or hemidesmossomos degradation. The aim of this study is evaluated of the morphologic alterations, apoptosis, MMPs 2 and 9 and leukocyte infiltration, for research of MMP-9 related to neutrophil gelatinase associated to lipocalin (NGAL) in laminar corium of horses subjected to intestinal obstruction experimental. The animals were divided in groups: control (Cc), instrumented (Gi), with enterotomy without obstruction; obstruction treated by hydrocortisone (Gt) and without treatment (Gnt). The laminar tissue was analyzed by optical microscopy, immunohistochemistry and zymography. The animals showed morphologic alterations, MM Ps expression and MMP-9 associated to NGAL greater the Gc. The presence of apoptosis was not evidend by cirurgical procedure. However, the Gc was not different to Gi about morphologic alterations, and too Gt, about MMP-9, mainly the form conjugated to NGAL. The results indicate that the experimental model can cause morphologic alterations associated with laminitis. The apoptosis is not prerequisite for laminar lesion. The hydrocortisone can be administrated to reduce the deleterious effects of inflammatory activation in several diseases, without to affect the laminar corium.

Introdução: a maioria dos pacientes com neoplasia maligna da via biliar são diagnosticados em fase avançada. A drenagem biliar ecoguiada é uma alternativa às técnicas de drenagem percutânea trans-hepática e cirúrgicas na ocasião de falha do acesso convencional por colangiografia retrógrada endoscópica (CPRE). Objetivo: avaliar a eficácia e segurança da drenagem biliar ecoguiada em pacientes com obstrução biliar maligna e falha da CPRE. Analisar as complicações e qualidade de vida. Métodos: no período de abril de 2010 a setembro de 2011, 32 pacientes portadores de neoplasia maligna avançada da via biliar foram tratados no Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Todos os pacientes apresentavam quadro clínico de icterícia obstrutiva e falha na drenagem da via biliar pela CPRE. O tratamento preconizado foi a drenagem da via biliar pela técnica ecoguiada, sob controle radiológico. Dos 32 pacientes, três foram excluídos devido à falha do procedimento ecoguiado. Vinte e nove (90,62%) pacientes foram submetidos a drenagem biliar ecoguiada, avaliações clínica, laboratorial e de qualidade de vida. Na avaliação clínica foram observados a evolução dos sinais e sintomas, e complicações relacionadas ao procedimento. Na avaliação laboratorial, foram analisados os níveis de bilirrubina total, gama-glutamil-transferase, fosfatase alcalina e número de leucócitos. A qualidade de vida foi avaliada pelo questionário SF-36. Resultados: dos 32 pacientes,3 (9,4%) foram excluídos devido a falha técnica. O sucesso técnico foi de 90.6% (29/32) e o clínico de 100% (29/29). Em relação aos dados gerais endossonográficos, verificou-se metástase à distância em 6 (18,75%) e invasão do eixo mesentero-portal em 26 (81,25%) pacientes. O diâmetro da via biliar extra-hepática apresentou mediana de 23,45 mm (20 - 30 mm) e da intra-hepática foi de 17,54 mm (10 - 24 mm). A invasão duodenal ocorreu em 10 (31,25%) pacientes e prótese metálica foi posicionada em 7 (21,85%) casos. A coledocoduodenostomia ecoguiada foi o procedimento mais frequente (58,62%). Complicações ocorreram em 6 (18,75%) casos. Verificou-se uma queda significativa dos níveis de bilirubina (p <0,001) e os pacientes obtiveram melhora significativa da qualidade de vida após o procedimento (p<0,05). A sobrevida média foi de 90 dias. Conclusão: a drenagem biliar ecoguiada foi um procedimento eficaz e seguro, com taxa de complicações aceitável, proporcionando melhora significativa na qualidade de vida dos pacientes / Introduction: most of patients with malignant neoplasia of the biliary tract are diagnosed at an advanced stage. Echoguided biliary drainage is an alternative to percutaneous transhepatic and surgical drainage techniques at the time of failure of conventional access by endoscopic retrograde cholangiography (ERCP). Objective: to evaluate the efficacy and safety of echoguided biliary drainage in patients with malignant biliary obstruction and failure of ERCP. To evaluate the complications and quality of life. Methods: from April 2010 to September 2011, 32 patients with advanced malignant biliary tract disease were treated at the Gastrointestinal Endoscopy Service, Clinics Hospital, Faculty of Medicine, University of Sao Paulo. All patients had a clinical picture of obstructive jaundice and failure in the drainage of the biliary tract by ERCP. Treatment was based on echoguided biliary drainage technique under radiological control. Of the 32 patients, three were excluded due to failure of the echoguided procedure. Twenty-nine (90.62%) patients underwent echoguided biliary drainage, clinical, laboratory and quality of life evaluation. In the clinical evaluation were assessed the evolution of signs and symptoms, and procedure-related complications. In laboratory tests, we assessed the levels of total bilirubin, gamma glutamyl transferase, alkaline phosphatase and number of leukocytes. The quality of life was assessed by SF-36 questionary. Results: of 32 patients, three (9.4%) were excluded due to technical failure. Technical success was 90.6% (29/32) and clinical 100% (29/29). In relation to the general endosonographic data, there was distant metastasis in 6 (18.75%) and invasion of the mesenteric-portal axis in 26 (81.25%) patients. The diameter of extrahepatic biliary tree was 23.45 mm (20 - 30mm) and intrahepatic was 17.54mm(10 - 24mm). The duodenal invasion occurred in 10 (31.25%) and metallic prosthesis was positioned in 7 (21.85) cases. Echoguided choledochoduodenostomy was the most common procedure (58.62%). Complications occurred in 6 (18.75%) cases. There was a significant decrease in bilirubin levels (p <0.001) and patients had significant improvement in quality of life after the procedure (p < 0.05). The median survival was 90 days. Conclusion: echoguided biliary drainage was effective and safe procedure with acceptable complication rates, providing significant improvement in quality of life of patients

Submitted by (edna.saturno@ufrpe.br) on 2016-10-20T16:03:20Z No. of bitstreams: 1 Mucio Veloso de Moarais.pdf: 837045 bytes, checksum: 867f9892acaac56c2811fddaf38aaa4e (MD5) / Made available in DSpace on 2016-10-20T16:03:20Z (GMT). No. of bitstreams: 1 Mucio Veloso de Moarais.pdf: 837045 bytes, checksum: 867f9892acaac56c2811fddaf38aaa4e (MD5) Previous issue date: 2012-02-20 / The present work aimed to conduct a study of clinical, epidemiological and laboratory data of 62 sheep and goats from 2001 up to 2011. During this period, it was found that the disease was predominant in sheep with 83.7% of the animals, while for the caprine, it occurred in 16.3%. The most predominant races in sheep were the Santa Ines, in ovine with 71.7% and SRD, in caprine, with 33.33%. There was a predominance in animals less than three years old. In both species, the highest occurrence was found in the dry season with 67.9%. Most animals (75.8%) were kept under intensive farming, with a diet based on concentrate and forage (88.7%) and 85.5% received mineral supplementation. The predominant clinical signs were apathy, pain, dehydration, conjunctive hyperemic mucosa, tachycardia, tachypnea, anorexia, dysuria and anuria. The mortality rate was very high with 40.3% of the animals dying and 16.1% being sacrificed. In the haemogram, leukocytosis was observed with regenerative deviation to the left in goats, and hyperfibrinogenemia. In serum biochemistry, increased urea and creatinine was found which led the animals to a perspective of azotenia and increase of GGT and CK enzymes. The serum levels of calcium, phosphorus and magnesium, were beyond the normal patterns for the species with low Ca and high P and Mg levels. The findings of urinalysis revealed hematuria in 72.2% of animals with acid pH of urine (44.4%) as well as alkaline (55.56%). In the sedimentoscopy, erythrocytes predominated in 66.6% of the samples, epithelial cells in 66.6% of the samples and crystals of various compositions. Regarding the composition of urolites, it was found that 62.5% was oxalate, 8.32% phosphate and 8.33% penicillin. In the conclusion of this study, it was observed that the obstructive urolithiasis is a disease of poor prognosis and can lead to loss of valuable livestock animals, and therefore, serious losses in production. / Considerando-se a importância clínica e econômica da urolitíase obstrutiva para a produção de pequenos ruminantes, objetivou-se desenvolver um estudo dessa enfermidade em caprinos e ovinos. Para tanto, utilizou-se dados dos prontuários de 62 animais atendidos no período de 2001 a 2011, considerando-se variáveis epidemiológicas, clínicas, urinálise, hemograma, funções hepática, renal e muscular, glicose, perfil sérico de cálcio, fósforo e magnésio, além da análise da composição química dos urólitos, compondo o estudo descritivo. A urolitíase obstrutiva observada em 5,1% dos animais estudados. A espécie ovina foi a mais acometida, assim como as raças Santa Inês e Dorper. A maior ocorrência da doença se deu em animais com menos de três anos, no período seco, criados sob regime intensivo, cuja dieta era a base de concentrados (ad libitum) e forragem. Dos acometidos 43,6% receberam alta, 40,3% foram a óbito e 16,1% foram eutanaziados. Dentre os achados clínicos mais frequentes observou-se alterações da micção; desidratação; congestão das mucosas conjuntivas; sinais de dor; diminuição ou ausência de motilidade ruminal; taquicardia; alterações do comportamento e do apetite e; taquipnéia. Nos exames laboratoriais observou-se leucocitose com desvio à esquerda regenerativo nos caprinos, hiperfibrinogemia, valores da creatinina e da uréia elevados, enzimas GGT e CK também elevadas, hiperglicemia e, níveis de Ca, P e Mg desbalanceados. A urina apresentou-se turva, com hematúria, proteinúria, acidúria e alcalinúria, além de baixa densidade. No tocante a sedimentoscopia observou-se o aumento de hemácias e leucócitos, células do epitélio uretral e renal, além de bactérias. Houve predominância de oxalato na composição dos urólitos, porém 8,33% dos urólitos eram compostos de penicilina. A urolitíase obstrutiva acomete mais animais confinados, alimentados com dietas desbalanceadas a base de concentrado. Os exames laboratoriais mostraram ser importantes para o diagnóstico de urolitíase obstrutiva.