Sleeve Gastrectomy Associated with Antral Lesion Resection and Roux-en-Y Antrojejunal Reconstruction

Obesity has been growing worldwide, reaching epidemic proportions. Bariatric surgery is the most effective and durable treatment for severe obesity and related diseases. Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) are the most frequently performed bariatric operations, with long-term good results, in terms of weight loss and comorbidities control. Gastroesophageal Reflux Disease (GERD) is commonly associated with obesity. In general, it precludes the indication of sleeve gastrectomy, since this technique has a refluxogenic potential, as shown in many studies. In such cases, RYGB is considered the best surgery, reaching good weight loss and gastroesophageal reflux disease control. The drawback of this technique is that it leaves the remnant stomach, the duodenum, and the proximal part of the jejunum inaccessible. Besides, RYGB makes transoral endoscopic access to the biliary tree impossible. For all these reasons, this bariatric technique is not indicated in cases of gastric polyposis, gastric dysplasia, or strong family history of cancer, among others. We report a case of a morbidly obese patient with intense GERD, for whom a RYGB was precluded due to her strong family history of cancer, even knowing that it would be the best choice for reflux disease control. Instead, SG was chosen, even knowing it could worsen the gastroesophageal reflux disease. The patient signed an informed consent, after being fully enlightened about the risks. During the surgery, a small subserosal whitish lesion was detected, near the pylorus, on the anterior wall of the antrum. Thinking in a Gastrointestinal Stromal Tumor (GIST), it was resected, with a 2 cm safety margin, leaving a 4 to 5 cm hole on the gastric wall. The decision to maintain the proposed sleeve gastrectomy was made, to avoid leaving a remnant stomach, in a patient with such a strong family history of cancer. In the area of the resected lesion, an intraoperative decision was made not to just close the big gastric hole, being afraid of causing some anatomic or functional disturbance in gastric emptying. Instead, we decided to use the gastric opening to construct a Roux-en-Y antrotrojejunal anastomosis, with a 50 cm alimentary limb and a 200 cm biliopancreatic limb. Accordingly, it was performed a sleeve gastrectomy, associated with an antrojejunostomy in a Roux-en-Y fashion. The patient had an uneventful postoperative course. In the second year, she achieved normal weight and good nutritional status, without gastroesophageal reflux symptoms complaints. Seriography study shows that most of the contrast material passes through the antrojejunal anastomosis, instead of the pylorus, while the duodenum is endoscopically patent. This case report shows an unexpected surgical finding that led to a tactic of adding a Roux-en-Y gastric bypass in the antrum, associated with a sleeve gastrectomy, a strategy that may be adopted in cases of morbidly obese patients with important GERD, for whom gastrointestinal exclusions are contraindicated. To confirm this hypothesis, controlled studies are needed.info:eu-repo/semantics/publishedVersio

Технологическая подготовка производства деталей комбайна зерноуборочного самоходного КЗС-1218 «ПАЛЕССЕ GS12» с разработкой технологического процесса механической обработки детали рычаг КЗК 0109611-02 и анализом технологического обеспечения параметров точности и шероховатости поверхностей детали

Avancerad fastighetsautomation intog marknaden under 2000-talets första år. Visionen var att skapa smarta byggnader där fastighetsövervakning, klimatstyrning och belysning sammankopplades mot en central huvuddator för att eliminera manuell styrning. Syftet med examensarbetet är att undersöka funktionalitet och reell brukbarhet hos ett av de första installationsobjekten, PostNords huvudkontor. Rapporten presenterar fastighetens övergripande funktioner samt analyserar hur systemstyrningen kan optimeras för bättre lönsamhet respektive komfort. Exemplifieringen påvisar generella risker och potential med avancerade styrsystem i förvaltningsskedet. Arbetet har begränsat sig till fastighetens kontorsytor som stället högst krav på inomhusklimat och användarvänlighet. För att nå uppsatt mål har litteraturstudier, intervjuer, egna observationer samt en genomgång av fastighetsdokumentation genomförts. Resultatet visar att den höga teknikgraden gjort förvaltarna beroende av inhyrd spetskompetens. Det avancerade språket har försvårat kommunikationen mellan parterna vilket begränsat möjligheten att optimera systemet. Förbättring av inomhusklimat och energiprestanda kan först ske när man förstår en helhet. Förvaltarna borde tillsätta en samlad kartläggning av hela systemet istället för att experimentera med ytterligare ny teknik.Advanced building automation reached the market in the early 2000s. The vision was to create smart buildings where property surveillance, climate control and lightning where to be linked through a main computer to eliminate manual control. The purpose with this thesis is to investigate the functionality and real serviceability of one of the first objects of installation, the PostNord headquarters. This thesis presents the overall features of the real estate and also analyses how the control system can be optimized for higher profitability and comfort. The exemplification shows general risks and potential with advanced control systems in real estate management. This work is limited to the real estates office spaces that demand the highest standards of indoor environment and convenience. To reach set goal, studies of literature, interviews, observations and reviews of property documentation have been executed. The result shows that a high level of technical complexity has made the property managers dependent on hiring expert consultants. The advanced use of language has made the communication between the parts difficult, which has limited the opportunity to optimize the system. Improvement of indoor climate and energy efficiency can only be reached when the entire case is grasped. The real estate managers should start a complete mapping of the system instead of experimenting with additional technology

Localizando as condições pretéritas e as relações correntes na complexa fronteira Brasil-Bolívia

A fronteira Brasil-Bolívia, na parte mais ao sul, teve papel importante no abastecimento do oeste brasileiro através dos rios da Bacia do Prata no início do sec. XX, nos anos cinquenta ensaiou um processo de industrialização, até se transformar em uma rica fronteira vibrante no final do século. Repleta de ambiguidades, porosidades e deslizamentos a fronteira conurbada de Corumbá-Ladário-Puerto Qijarro-Puerto Suarez tem demonstrado um rico processo de integração socioeconômica e uma complexa rede de relações sociais e institucionais. Este texto tem a intensão de localizar as condições pretéritas da fronteira Brasil-Bolívia e contextualizar as relações cotidianas daquela conurbação fronteiriça, sob a tutela metodológica da historiografia e da categoria território da ciência geografia. É parta do projeto de pesquisa “Polos geográficos de ligação” com financiamento da Fundect e do CNPq até 2016

Índio, gado e blindagens na construção da fronteira no sul de Mato Grosso

Este texto objetiva entender e interrogar o processo de ocupação territorialda fronteira oeste do antigo Mato Grosso, região conhecida como pantanal doMato Grosso do Sul nos dias de hoje. Esclarece que o processo de ocupaçãonão foi pacífico, senão o contrário; a apropriação indébita e a utilização damão-de-obra indígena foi ponto nevrálgico de todo o processo dafuncionalização definitiva daquele território, para os intentos do modeloocidental de pensar, ser e agir. Ainda que a questão geopolítica, paraassegurar a fixação das fronteiras territoriais, não possa ser desprezada, ocentro das questões movidas para a conquista do lugar teve como cerne: ocriatório de gado, a blindagem dos colonos e a utilização do índio, em trabalho quase compulsório

Evaluation of skin absorption of drugs from topical and transdermal formulations

The skin barrier function has been attributed to the stratum corneum and represents a major challenge in clinical practice pertaining to cutaneous administration of drugs. Despite this, a large number of bioactive compounds have been successfully administered via cutaneous administration because of advances in the design of topical and transdermal formulations. In vitro and in vivo evaluations of these novel drug delivery systems are necessary to characterize their quality and efficacy. This review covers the most well-known methods for assessing the cutaneous absorption of drugs as an auxiliary tool for pharmaceutical formulation scientists in the design of drug delivery systems. In vitro methods as skin permeation assays using Franz-type diffusion cells, cutaneous retention and tape-stripping methods to study the cutaneous penetration of drugs, and in vivo evaluations as pre-clinical pharmacokinetic studies in animal models are discussed. Alternative approaches to cutaneous microdialysis are also covered. Recent advances in research on skin absorption of drugs and the effect of skin absorption enhancers, as investigated using confocal laser scanning microscopy, Raman confocal microscopy, and attenuated total reflectance Fourier-transform infrared spectroscopy, are reviewed

SADI-S with Extended Duodeno-Bulb Preservation: Case Report

Obesity has been growing in Brazil and in the world. It is reaching epidemic proportions, and bariatric surgery is the most effective treatment for patients with this disease. Among the procedures described in the literature, ileal surgeries such as biliopancreatic diversion with duodenal switch (BPD-DS) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) present better long-term results in terms of weight loss and comorbidities control. However, there are concerns regarding long term nutritional problems with these procedures. In this case report the aim is to demonstrate the technical feasibility of preserving an extended duodenal bulb segment, in the SADIS-S procedure, when there are difficulties in dissecting the retrobulbar region, as occurred here, due to fibrosis in this area. This assures the maintenance of the proposed surgical technique, in such a situation. The dissection and transection of the duodenum was done 7 cm distally to the pylorus, under endoscopic view, proximally to the papillae, where the tissue was normal. Additionally, due the importance of the duodenal mucosa on minerals and trace elements absorption and the release of important hormones in this region, this case report elicits the evaluation of the impact of this technical modification, which occurred casually, in the nutritional, hormonal and metabolic results, long term. In this case report, the extended duodenal length has demonstrated reasonable weight loss, adequate comorbidities control and good nutritional status, so far. These aspects must be evaluated in the long term, by clinical trials.info:eu-repo/semantics/publishedVersio

Polymorphism: an evaluation of the potential risk to the quality of drug products from the Farmácia Popular Rede Própria

O polimorfismo em sólidos é um fenômeno frequente em fármacos e pode levar a problemas na qualidade dos medicamentos por alterar suas propriedades físico-químicas, em especial a solubilidade e, consequentemente, a biodisponibilidade. Nesse trabalho realizou-se levantamento bibliográfico sobre os principais estudos e problemas relacionados ao polimorfismo em fármacos presentes nos medicamentos disponibilizados pela Farmácia Popular do Brasil. O polimorfismo deve ser controlado a fim de evitar possível ineficácia terapêutica e/ou dosagem inapropriada dos medicamentos. Destacamos que são poucos os ensaios obrigatórios para identificação e controle desse fenômeno em medicamentos, o que pode acarretar grande problema de saúde pública.Polymorphism in solids is a common phenomenon in drugs, which can lead to compromised quality due to changes in their physicochemical properties, particularly solubility, and, therefore, reduce bioavailability. Herein, a bibliographic survey was performed based on key issues and studies related to polymorphism in active pharmaceutical ingredient (APIs) present in medications from the Farmácia Popular Rede Própria. Polymorphism must be controlled to prevent possible ineffective therapy and/or improper dosage. Few mandatory tests for the identification and control of polymorphism in medications are currently available, which can result in serious public health concerns