Historical Perspective and Innovations in Penile Urethroplasty

Penile urethral strictures are common and impact on quality of life and health-care costs. Management of penile urethral strictures is complex and depends on the physical characteristics of the stricture. Contemporary studies show no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes. Overall, long-term success rates range from 20 to 30%. However, their recurrence rate is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures, which make them less cost-effective. Surgical urethroplasty is associated with higher long-term success rates, averaging from 85 to 90%, mostly in virgin or noncomplex cases. Historically, modern urethral reconstruction has evolved from 1950s with the revolutionary introduction of Johanson’s technique for staged urethral reconstruction. Since then, many techniques have been developed and employed for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques

Organ-Preserving Surgery for Penile Carcinoma

Introduction. Penile carcinoma has traditionally been treated by either surgical amputation or radical radiotherapy, both associated with devastating anatomical, functional, and psychological impact on the patient's life. Innovative surgical techniques have focused on penile preservation in well-selected patients to minimize physical disfigurement and consequently maximize quality of life. The objective of this article is to define the current status of these organ-preserving surgical options for penile carcinoma. Materials and Methods. An extensive review of the Pubmed literature was performed to find articles discussing only reconstructive surgery which have contributed significantly to change traditional, frequently mutilating treatments, to develop less disfiguring surgery, and to improve patients' quality of life over the last two decades. Results. Several articles were included in this analysis in which a major contribution to the change in therapy was thought to have occurred and was documented as beneficial. Some articles reported novel techniques of less-mutilating surgery involving different forms of glans reconstruction with the use of flaps or grafts. The issue of safe surgical margins was also addressed. Conclusion. The development of less-disfiguring techniques allowing phallus preservation has reduced the negative impact on functional and cosmetic outcomes of amputation without sacrificing oncological objectives in appropriately selected patients based on stage, grade, and location of the tumour. Until more prospective studies are available and solid evidence is documented, organ preservation should be offered with caution

Tunnel 4 (Porto) : three-dimensional finite element analysis

Neste trabalho apresenta-se os principais resultados da aplicação de modelos de elementos finitos a um túnel superficial escavado em solos residuais graníticos, no Porto. Os cálculos foram efectuados através de análises tridimensionais, nas quais se tentou reproduzir a sequência completa da construção (fase de escavação e aplicação do suporte). O comportamento mecânico dos solos foi reproduzido usando um modelo elástico perfeitamente plástico, tendo os respectivos parâmetros definidores sido estimados com base em resultados de ensaios de campo realizados durante a prospecção e de ensaios laboratoriais. O comportamento observado é comparado com os resultados decorrentes dos cálculos numéricos, tendo-se obtido uma boa concordância.Fundação para a Ciência e a Tecnologia - Programa POCTI/ECM/2521/95 - Concepção, Projecto e Reabilitação de Túneis em Obras Viárias

Análise tridimensional de um túnel aberto num maciço de solo residual do granito

Neste trabalho são apresentados, e confrontados com os fornecidos pela instrumentação, alguns resultados de uma análise tridimensional, através de modelos de elementos finitos, de um túnel superficial escavado em solos residuais graníticos na cidade do Porto, Portugal. Nessa análise tentou-se reproduzir a sequência completa da construção (fase de escavação e aplicação do suporte), tendo sido o comportamento mecânico dos solos reproduzido através de um modelo elástico perfeitamente plástico.Fundação para a Ciência e a Tecnologia – Programa POCTI/ECM/2521/95 – Concepção, Projecto e Reabilitação de Túneis em Obras Viárias

Genótipos do vírus da hepatite C em pacientes em hemodiálise no Distrito Federal, Brasil

Hepatitis C virus (HCV) genotypes and subtypes were determined in hemodialysis patients in the Federal District, Brazil, by sequencing of the 5' noncoding (NC) and nonstructural 5B (NS5B) regions. From 761 patients, 66 anti-HCV-positive samples were tested for HCV RNA. All 51 HCV RNA-positive samples by PCR of the 5' NC region were genotyped as genotypes 1 (90.2%) and 3 (9.8%). Subtype 1a (82.3%) was the most prevalent, followed by subtypes 3a (9.8%), 1b (5.9%) and 1a/1b (2.0%). Forty-two samples could be amplified and genotyped in the NS5B region: 38 (90.5%) as genotype 1, subtypes 1a, and 8 (9.5%) as genotype 3, subtype 3a. For the 42 samples sequenced in both regions, the genotypes and subtypes determined were concordant in 100% and 95.2% of cases, respectively. Two samples presented discrepant results, with the 5' NC region not distinguishing correctly the subtypes 1a and 1b. These findings indicate that the HCV genotype 1, subtype 1a, is the most prevalent among hemodialysis patients in the Federal District, Brazil.Os genótipos e subtipos do vírus da hepatite C (HCV) foram determinados em pacientes em hemodiálise no Distrito Federal, Brasil, pelo sequenciamento das regiões 5' não codificante (NC) e não estrutural 5B (NS5B). De 761 pacientes, 66 amostras anti-HCV positivas foram testadas para RNA-HCV. Todas as 51 amostras RNA-HCV positivas por PCR para a região 5' NC foram genotipadas como dos genótipos 1 (90,2%) e 3 (9,8%). O subtipo 1a (82,3%) foi o mais prevalente, seguido pelos subtipos 3a (9,8%), 1b (5,9%) e 1a/1b (2,0%). Quarenta e duas amostras puderam ser amplificadas e genotipadas na região NS5B: 38 (90,5%) como genótipo 1, subtipo 1a, e 8 (9,5%) como genótipo 3, subtipo 3a. Para as 42 amostras sequenciadas nas duas regiões, os genótipos e subtipos determinados foram concordantes em 100% e 95,2% dos casos, respectivamente. Duas amostras apresentaram resultados discrepantes, sendo que a região 5' NC não diferenciou corretamente os subtipos 1a e 1b. Estes achados indicam que o genótipo 1, subtipo 1a, do HCV é o mais prevalente em pacientes em hemodiálise no Distrito Federal, Brasil

Breve consideração sobre a crítica de Hegel à teoria moral de Kant nos Princípios da Filosofia do Direito

No presente trabalho buscar-se-á apresentar, primeiramente, em linhas gerais a compreensão kantiana de lei moral e imperativo categórico. Posteriormente, far-se-á um exame da crítica de Hegel à teoria moral kantiana, entendida como um formalismo vazio e baseada no princípio de não-contradição. Por fim, tentaremos oferecer uma resposta para as críticas de Hegel ao imperativo categórico, demonstrando que Kant não baseou, e nem poderia basear, sua ética em um simples princípio formal de contradição, o que faria com que todo o trabalho kantiano de edificar a moralidade sobre um fundamento sólido viesse a ruir e desabar

The hybrid identity of micro enterprises: Contrasting the perspectives of community pharmacies’ owners-managers and employees

Purpose: The purpose of this paper is to examine the effect of ownership of community pharmacies on the perception of organizational identity and its relationships with organizational performance. Design/methodology/approach: A survey was carried out on a sample of pharmacists working in community pharmacies in Portugal. The sample comprised 1,369 pharmacists, of whom 51 percent were owner-managers. Measures of pharmacies’ normative (community health oriented) and utilitarian (business oriented) identities, identity strength (clear and unifying), substantive (stockholder focused) and symbolic (society focused) performance were included. Findings: Both owners and employed pharmacists rated the normative identity of pharmacies higher than the utilitarian identity. Compared with employed pharmacists, owners perceive a lower level of utilitarian identity, the same level of normative identity, and higher levels of identity strength. Normative identity and identity strength predicted symbolic performance. Normative and utilitarian identities and identity strength predicted substantive performance. The relationship between utilitarian identity and substantive performance was significant among owner pharmacists but not among employed pharmacists. Research limitations/implications: The limitations include the use of perceptive measures and the focus on the individual level of analysis. Practical implications: In order to improve pharmacies’ performance, pharmacists who manage community pharmacies are challenged to reconcile tensions arising from the co-existence of business and community health identities and from their own agency (self-serving) and stewardship (altruistic) motives. Originality/value: This study draws on institutional, identity and stewardship theories to understand how pharmacists, owners and employees, view the identity of community pharmacies and how identity relates to organizational performance

Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular vertigo. It is caused by free-floating otoconia moving freely in one of the semicircular canals (canalolithiasis) or by otoliths adhered to the cupula (cupulolithiasis). The posterior canal is the most common canal affected, followed by the lateral canal. Diagnosis of the side affected is critical for successful treatment;therefore, suppressing visual fixation is essential to examination of these patients' eye movement. On the basis of our experience, we have adopted the Zuma maneuver and the modified Zuma maneuver for both apogeotropic and geotropic variants of lateral canal BPPV. Knowledge of the anatomy and pathophysiologic mechanisms of the semicircular canals is essential for correct management of these patients. Hence, using a single maneuver and its modification may facilitate daily neurotological practice

Effectiveness of gallium and aluminum Arsenide laser in bone repair/Efetividade do laser de Arseneto de gálio e alumínio no reparo ósseo

Introdução - O conhecimento de métodos que estimulem a consolidação óssea vem adquirindo considerável importância atualmente. Dentre eles, estudos experimentais com laserterapia mostraram-se promissores. Objetivo -  avaliar o efeito de diferentes doses de Laser de baixa potência (LBP) sobre o processo de consolidação óssea em Rattus norvegicus. Métodos - Utilizaram-se 45 ratos da espécie rattus norvegicus, divididos em quatro grupos, um controle e três terapêuticos (4J, 6J, 10J) com aplicação de LBP em lesões nas tíbias esquerdas. Após o sacrifício, analisaram-se as dosagens bioquímicas de cálcio, fósforo, fosfatase alcalina e a densidade mineral óssea média. Quanto aos níveis séricos de fósforo, observou-se maior concentração nos grupos terapêuticos. Resultados - Verificaram-se resultados distintos entre os grupos de animais irradiados, sendo encontrada maior concentração de fosfatase alcalina no de 6J, e conforme a medição da densidade mineral óssea, o de 4J apresentou maior valor, e o de 10J, o menor. Conclusão - o laser favorece a remodelação óssea, porém conforme a análise radiográfica, os melhores resultados foram obtidos com dosagem de 4J, apesar da análise bioquímica, evidenciar altos níveis de fosfatase alcalina sérica no grupo de 6J