Splenectomy for splenomegaly and secondary hypersplenism

Splenomegaly and secondary hypersplenism may be associated with acute and chronic infections, autoimmune states, portal hypertension or splenic vein thrombosis, and a number of infiltrative and neoplastic conditions involving the spleen. Our experience and that of others with these various conditions demonstrates that the decision to perform splenectomy should be based on well-defined and often strictly limited indications. Except for idiopathic splenomegaly, the presence and severity of secondary hypersplenism or severely symptomatic splenomegaly should be well documented. In each case, the potential for palliation and known mean duration of expected response must be weighed against the increased morbidity and mortality of splenectomy (as compared to operation for “primary” hypersplenism) . La splénomégalie avec hypersplénisme secondaire relève de multiples causes: infection aigue ou chronique, états autoimmunologiques, hypertension portale, thrombose de la veine splénique, lésions tumorales spléniques. L'expérience de l'auteur qui rejoint celle de nombreux collègues lui permet d'affirmer que les indications de la splénectomie doivent être bien définies et sont strictement limitées. A l'exception de la splénomégalie idiopathique, l'existence et l'intensité de l'hypersplénisme, l'importance des symptomes provoqués par la splénomégalie doivent être aprréciées avec précision. Dans chaque cas le potentiel de la rémission de l'affection et la durée de la rémission doivent être pris en considération en fonction de l'éventuelle morbidité et de l'éventuelle mortalité de la splénectomie (par comparaison avec la splénectomie pour hypersplénisme primaire). Eplenomegalia e hiperesplenismo secundario pueden estar asociados con infecciones agudas y crónicas, estados autoinmunes (síndrome de Felty, lupus eritematoso sistémico), “esplenomegalia congestiva” por hipertensión portal o trombosis de la vena esplénica y con una variedad de entidades de tipo infiltrativo y neoplásico que afectan al bazo (sarcoidosis, enfermedad de Gaucher, varios desórdenes mieloproliferativos y linfomas). Nuestra experiencia, y aquella de otros autores, con tales condiciones demuestra que la decisión de realizar esplenectomía debe estar fundamentada en indicaciones bien definidas y estrictamente limitadas. Excepto en casos de esplenomegalia idiopática, la presencia y severidad del hiperesplenismo secundario o de esplenomegalia severamente sintomática debe ser bien documentada. En cada caso debe determinarse el potencial de paliación y la duración de la respuesta que se espera obtener frente a la incrementada morbilidad y mortalidad de la esplenectomía (en comparación con la operación que se realiza por hiperesplenismo “primario”).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41318/1/268_2005_Article_BF01655279.pd

Untangling the effects of overexploration and overexploitation on organizational performance: The moderating role of environmental dynamism

Because a firm's optimal knowledge search behavior is determined by unique firm and industry conditions, organizational performance should be contingent oil the degree to which a firm's actual level of knowledge search deviates from the optimal level. It is thus hypothesized that deviation from the optimal search, in the form of either overexploitation or overexploration, is detrimental to organizational performance. Furthermore, the negative effect of search deviation oil organizational performance varies with environmental dynamism: that is, overexploitation is expected to become more harmful. whereas overexploration becomes less so with all increase in environmental dynamism. The empirical analyses yield results consistent with these arguments. Implications for research and practice are correspondingly discussed

Search for Neutrinoless Double- β Decay in Ge 76 with the Majorana Demonstrator

The Majorana Collaboration is operating an array of high purity Ge detectors to search for neutrinoless double-β decay in Ge76. The Majorana Demonstrator comprises 44.1 kg of Ge detectors (29.7 kg enriched in Ge76) split between two modules contained in a low background shield at the Sanford Underground Research Facility in Lead, South Dakota. Here we present results from data taken during construction, commissioning, and the start of full operations. We achieve unprecedented energy resolution of 2.5 keV FWHM at Qββ and a very low background with no observed candidate events in 9.95 kg yr of enriched Ge exposure, resulting in a lower limit on the half-life of 1.9×1025 yr (90% C.L.). This result constrains the effective Majorana neutrino mass to below 240-520 meV, depending on the matrix elements used. In our experimental configuration with the lowest background, the background is 4.0-2.5+3.1 counts/(FWHM t yr)

Fontes e Níveis de Energia Digestível em Rações para Suínos Machos Inteiros dos 60 aos 100 kg Lipidic Sources and Digestible Energy Levels in Rations for 60 to 100 kg Boars

Visando avaliar o efeito de duas fontes lipídicas (óleo de soja e gordura de coco) e de quatro níveis de energia digestível (3350, 3450, 3550 e 3650 kcal/kg de ração) sobre o desempenho de suínos machos inteiros, dos 60 aos 100 kg, foram utilizados oitenta animais, distribuídos num arranjo fatorial 2 x 4 (fontes x níveis de energia), em delineamento de blocos ao acaso, com cinco repetições de dois animais por baia. As rações experimentais, formuladas à base de milho, farelo de soja e suplemento mineral-vitamínico; foram fornecidas à vontade até o fim do período experimental, quando os animais atingiram o peso médio de 100,40 &plusmn; 5,67 kg. Não houve efeito do nível de energia digestível (ED) sobre o consumo de ração diário e ganho de peso diário; no entanto, estes parâmetros foram influenciados pela fonte de energia, sendo os melhores resultados obtidos com a utilização da gordura de coco. A conversão alimentar foi influenciada de forma quadrática pelos níveis de ED, quando se utilizou a gordura de coco. Não se observou efeito do óleo de soja sobre a conversão alimentar. A eficiência de utilização da energia para ganho melhorou de forma quadrática, com a utilização da gordura de coco e piorou linearmente com o uso do óleo de soja nas rações. O consumo de energia digestível não foi influenciado pela variação dos níveis de ED e o consumo de lisina diário também não foi influenciado pelos níveis de ED, embora tenha sido maior quando a gordura de coco foi utilizada como fonte lipídica. Rações contendo gordura de coco como fonte lipídica proporcionaram melhor resultado de ganho de peso. A melhor resposta de conversão alimentar dos animais que receberam as rações contendo gordura de coco foi estimada no nível de 3583 kcal.<br>To evaluate the effects from two lipid sources (soybean oil and coconut oil) and of four energy levels (3350, 3450, 3550 and 3650 kcal/kg ration) on performance from 60 to 100 kg boars, eighty animals were used. The experimental design of randomized blocks with a factorial arrangement of 2 x 4 (sources x energy levels), with five replications of two animals per box, was used. Experimental diets formulated on the basis of maize, soybean meal and vitaminic and mineral supplement were feed ad libitum until the end of the experimental period when animals reached 100.40 &plusmn; 5.67 kg average weight . There was no effect of the digestible energy (DE) level on the daily feed intake neither on the daily weight gain; however, these parameters were influenced by the energy source and the best results obtained with the use of the coconut oil. The feed:gain ratio was influenced in a quadratic way by the DE levels, when using the coconut oil. No effects of the soybean oil were observed on feed:gain ratio. The efficiency of the energy use for weight gain was improved in a quadratic way when using the coconut oil and linearly worsened when using the soybean oil in the diets. The digestible energy intake was not influenced by changing in the DE levels. The daily intake of lysine was not influenced by the DE levels, although it was higher when the coconut oil was used as lipidic source. Diets with coconut oil as lipidic source showed the best results of weight gain. The best value of feed:gain ratio of the animals that received diets with coconut oil was estimated in level of 3583 kcal