Primary Retroperitoneal Paraganglioma Simulating a Pancreatic Mass: A Case Report and Review of the Literature

Paragangliomas are extra-adrenal tumors of the autonomic nervous system and may be found within the skull base, neck, chest, and abdomen. When presenting within the abdominal cavity, they may arise as a primary retroperitoneal neoplasm and can mimic vascular malformations or other conditions related to specific retroperitoneal organs such as the pancreas, kidneys, or adrenals. Retroperitoneal paragangliomas are mostly benign with good prognosis; however, they can present with abdominal pain, palpable mass, or hypertensive episodes. Patients should be initially evaluated with catecholamine levels, followed by computed tomography or magnetic resonance imaging to locate the primary lesion. Surgical excision remains the mainstay of treatment, although advanced disease and proximity to vital organs can make excision difficult or impossible. This case report describes a patient who initially underwent work up for a suspected pancreatic head mass which was discovered to be a retroperitoneal paraganglioma by frozen section

Taxonomy based on science is necessary for global conservation

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Planificación del sistema eléctrico de la ciudad de Guayaquil

El desarrollo de esta tesis plantea la situacion actual del sistema eléctrico de la ciudad de Guayaquil y los factores que deben ser considerados para su expansión entre los años 1977 y 1982. El contenido de la tesis está dividido en tres partes: - análisis del sistema actual; - análisis del futuro sistema; - conclusiones y recomendaciones.GuayaquilIngeniero Eléctric

Pulmonary Metastases from an Undifferentiated Embryonal Sarcoma of the Liver: A Case Report and Review

Undifferentiated embryonal sarcoma of the liver (UESL) is a rare malignant hepatic tumor that occurs primarily in children. Only a limited number of cases have been reported in the literature due to low incidence of one per million, and reports of metastatic lesion of UESL are even rarer. We hereby describe the case of a 13-year-old male who presented with a palpable mass with imaging findings suggestive of a large complex tumor in the right lobe of the liver. He underwent extended right hepatectomy followed by adjuvant chemotherapy. The tumor was confirmed to be UESL by postoperative pathology and immunohistochemical staining analysis. Four years later, surveillance imaging revealed a small lung nodule in the left lower lobe. Complete removal of the lung tumor by wedge resection was performed, and a histological diagnosis of metastatic UESL was made. The patient also received postoperative adjuvant chemotherapy and is currently in a good general condition and tumor-free in the present eight-month period. This case is presented with emphasis on clinicopathological and immunohistochemical findings of the primary UESL and lung metastases with the aim of collecting more data and expanding our understanding of this rare malignancy

Reporte de consultoría – Smart Brands

Smart Brands es una empresa con más de cinco años en el mercado, especializada en el desarrollo y gestión de marcas en el rubro de retail de moda, brindando la mejor experiencia a todos sus clientes a través de sus ocho reconocidas marcas. La cultura de Smart Brands se basa en poner al cliente al medio de toda la operación, y en brindar el mejor servicio y una experiencia sobresaliente en todos sus canales de venta. En los últimos años, ha tenido un crecimiento muy importante; sin embargo, el 2019 tuvo un crecimiento más moderado, porque el periodo de inversión terminó y se cerraron tiendas con baja rentabilidad, además de las dificultades para cumplir con el presupuesto de venta. Debido a esta situación, se sostuvo una reunión con el gerente general, en la que dio a conocer los tres principales problemas de la empresa: (a) alta competencia, (b) poca gestión de la base de clientes, y (c) sobreinventario de mercadería. Se identificó que la poca gestión de los clientes era el problema más relevante, ya que impacta directamente en las ventas de todos los canales y, a su vez, en los otros problemas mencionados. Es por ello que esta consultoría se enfocará en gestionar la base de clientes a través del diseño de una segmentación, utilizando como metodología el RFM, para luego definir y desplegar una variedad de estrategias, según los segmentos identificados, que permitan captar, retener y/o fidelizar a los clientes. Finalmente, con los segmentos y estrategias establecidas, se plantea la implementación de un CRM que permita gestionarlos y, de ser necesario, ampliar su implementación a los demás módulos para mejorar la gestión comercial y de marketing de Smart Brands.Smart Brands is a company operating in the market for more than five years, specialized in the development and the management of brands in the fashion retail industry, providing its customers with the best experience through its eight renowned brands. The culture of Smart Brands is based on putting the customer in the center of the whole operation, in offering the best service and an outstanding experience in all of its sales channels. It has had a very important growth in the last few years; however, it had a moderate growth in 2019 because the investment period ended, the less profitable stores were closed down, and also due to the challenges to meet the sales budget. Due to this situation, the general manager called for a meeting, where he revealed the three main issues of the company: (a) high competition, (b) poor management of the customer base, and (c) an overstock of the merchandise. It was observed that the most relevant issue was the poor management of the customers, since it impacts the sales in all of the channels directly, and, consequently, the other issues aforementioned. This is why this consulting work will focus on managing the customer base through the design of a segmentation, using RFM as a methodology, with the purpose of defining and displaying a range of schemes, according to the segments identified, which will allow engaging, retaining and/or enhancing customer loyalty. Finally, with the segments and schemes established, it is suggested to implement an RCM that may allow managing them and, if required, to extend its implementation to the other modules in order to improve the commercial operation and the marketing of Smart Brands.Tesi

Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings

This pictorial review discusses multi-detector computed tomography (MDCT) cases of non-vascular traumatic chest injuries, with a brief clinical and epidemiological background of each of the pathology. The purpose of this review is to familiarize the reader with common and rare imaging patterns of chest trauma and substantiate the advantages of MDCT as a screening and comprehensive technique for the evaluation of these patients. Images from a level 1 trauma center were reviewed to illustrate these pathologies. Pulmonary laceration, pulmonary hernia, and their different degrees of severity are illustrated as examples of parenchymal traumatic lesions. Pleural space abnormalities (pneumothorax and hemothorax) and associated complications are shown. Diaphragmatic rupture, fracture of the sternum, sternoclavicular dislocation, fracture of the scapula, rib fracture, and flail chest are shown as manifestations of blunt trauma to the chest wall. Finally, direct and indirect imaging findings of intrathoracic airway rupture and post-traumatic foreign bodies are depicted. The advantage of high quality reconstructions, volume rendered images, and maximal intensity projection for the detection of severe complex traumatic injuries is stressed. The limitations of the initial chest radiography and the benefits of MDCT authenticate this imaging technique as the best modality in the diagnosis of chest trauma

Accuracy of Multi-Detector Computed Tomography, Fluorodeoxyglucose Positron Emission Tomography-CT, and CA 19-9 Levels in Detecting Recurrent Pancreatic Adenocarcinoma

Context We compared the accuracy of fluorodeoxyglucose positron emission tomography-CT (FDG-PET-CT), multi-detector computed tomography (MDCT) and CA 19-9 levels in detecting pancreatic cancer recurrence in patients with resected CA 19-9 positive pancreatic adenocarcinomas. Methods We retrospectively evaluated 122 patients with pancreatic adenocarcinomas who underwent surgical resection of the tumor between January 2002 and December 2011. Twenty-five patients had MDCT, FDG-PET-CT and CA 19-9 levels performed no less than six weeks post-operation and within 8 weeks of each other for detection of tumor recurrence. Of these, 20 patients had high pre-operative CA 19-9 levels that dropped to a normal level postoperatively which will be the focus of this study. The sensitivity, specificity, positive and negative predictive value (PPV, NPV), and accuracy of MDCT, FDG-PET-CT, and CA 19-9 in detecting recurrence were compared. Results Operations performed included pyloric sparing pancreaticoduodenectomy (n=9), pancreaticoduodenectomy (n=7), distal pancreatectomy (n=3) and total pancreatectomy (n=1). Three patients had no recurrence, but local recurrence and distant metastasis were seen in 8 (40%) and 12 (60%) patients, respectively. In our study, sensitivity, specificity, PPV, NPV and diagnostic effectiveness  (accuracy) were: 82%, 100%, 100%, 50%, 85% for MDCT; 82%, 100%, 100%, 50%, 85% for FDG-PET-CT and 94%, 100%, 100%, 75%, 95% for CA 19-9. The difference in recurrence detection accuracy of the tests was not statistically significant. A combination of CA 19-9 with MDCT or FDG-PET-CT was 100% accurate in detecting cancer recurrence in our patients. Conclusion Our data suggests that CA 19-9 levels can be used reliably to detect recurrent pancreatic adenocarcinomas in patients with CA 19-9-positive primary tumors. Combination of CA 19-9 with MDCT or FDG-PET-CT is potentially the most accurate approach in detecting pancreatic cancer recurrence.Image: Surgeons from the patient's wiev (The Willis Knighton Health System "John C. McDonald Regional Transplant Center". Shreveport, LA, USA)