Fístula vésico-apendicular em adenocarcinoma mucinoso do apêndice

BACKGOUND: A rare case of vesicoappendiceal fistula secondary to mucinous adenocarcinoma of the appendix is presented. CASE REPORT: A 62-year-old man with a one year history of recurrent urinary tract infections. After two months he developed pneumaturia and fecaluria. An abdominal and pelvic computed tomography demonstrated a trans-mural mass in the posterior wall of the bladder with a vesicoenteric fistula leading to the terminal ileum. Laparotomy revealed a tumor arising from the appendix contiguous with the bladder posterior wall. The bladder was opened and a large fistula and tumor on the posterior bladder wall near the trigone was identified. Frozen pathological analysis showed a mucinous adenocarcinoma. En-bloc right hemicolectomy and partial cystectomy, preserving bladder trigone was performed. After manipulating the tumor, grossly leakage of mucinous materials occurred into the pelvic cavity. A peritoneal washing with a mytomicin solution at 42º C was then performed, to prevent peritoneal seeding. The patient had a prolonged postoperative ileus and was discharged at the 15th day. Five months after the procedure the patient was recieving chemotherapy with 5-fluoracil and leucovorin and there was no signs of recurrent disease. CONCLUSION: The presentation with vesico-appendiceal fistula is extremely rare with only a few cases reported in the literature. Knowledge of different types of neoplasm and appropriate treatment allows the surgeon to provide patients optimal care referring to specialized centers whenever appropriate.INTRODUÇÃO: Apresenta-se raro caso de fístula vésico-apendicular secundária a adenocarcinoma mucinoso do apêndice. RELATO DE CASO: Paciente masculino de 62 anos com história de um ano de infecções urinárias de repetição. Após dois meses desenvolveu pneumatúria e fecalúria, sendo indicada tomografia computadorizada de abdômen que mostrou massa trans-mural na parede da bexiga, com fistula vésico-entérica para região do íleo terminal. A laparotomia revelou tumoração surgindo do apêndice cecal, em continuidade com a parede posterior da bexiga. A mesma foi aberta, sendo identificada grande fistula e material tumoral até próximo ao trígono vesical. A biópsia de congelação identificou adenocarcinoma mucinoso. Realizada hemicolectomia associada à cistectomia parcial em bloco, com preservação do trígono vesical. Houve extravasamento de mucina para a cavidade pélvica pela manipulação. Optado por lavagem peritoneal com solução de mitomicina a 42º C para prevenir disseminação peritoneal. O paciente evoluiu com íleo prolongado pós-operatório, tendo alta hospitalar no15º dia. Cinco meses após o procedimento encontrava-se em quimioterapia com 5-fluouracil e leucovorin, sem sinais de doença recidivante. CONCLUSÃO: A presença de fístula vésico-apendicecal é extremamente rara, tendo poucos casos relatados na literatura. O conhecimento dos diferentes tipos de neoplasias e seus tratamentos adequados permite ao cirurgião oferecer melhor cuidado ao paciente

Análise da sensibilidade do modelo geológico no sequenciamento de lavra

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Caracterização florística e estrutural da vegetação arbórea em um trecho de Floresta Estacional Decidual, RS, Brasil

 The objective of the study was to evaluate the floristic and structural composition of an area located in a section of secondary Forest, in the municipality of Dona Francisca, RS state. To do so, 50 permanent plots with a dimension of 10 x 20 m (200 m²) were installed in a systematic way, 10 m apart and 40 m between tracks, totaling 1 ha. All individuals with CAP ≥ 15.7 cm were identified and sampled and the phytosociological estimators were calculated. The species accumulation curve was used to verify the sample adequacy. For the calculation of diversity and dominance estimators, the Shannon Index (H ') and Pielou Equability (J') were used. Subsequently, the floristic and structural composition was evaluated through the Distributed Correspondence Analysis (DCA). It was also verified the diameter and histopic distribution of the tree community, and for the species, with importance value above 5%, the distribution in classes of DAP. Statistical analyzes were performed in the R program. 65 tree and shrub species were identified with 2,045 individuals distributed in 31 botanical families. The species with a value of importance above 5% were Casearia sylvestris (14, 04 %), Nectandra lanceolata (12, 86 %), Cupania vernalis (9, 57 %), Guarea macrophylla (7,29 %) and Ocotea puberula (5.07 %). The values for diversity and dominance were, respectively, 2.91 nats.ind-1 and 0.69, indicating that the area has low diversity and dominance of few species and that by DCA it is possible to verify that the plots are homogeneously distributed in the forest. The diameter distribution represented the expected behavior for the arboreal community with J-inverted tendency and the majority of the trees presented height concentrated in the middle stratum of the forest. Only Nectandra lanceolata and Ocotea puberula did not present negative exponential curve from the five species analyzed. It was possible to observe the mosaic of tree species distributed in the forest section. In addition, there is a predominance of individuals in the first classes of DBH and height, which characterizes the resilience of the area after the disturbance and its capacity for natural recovery. It also indicates the fluctuations and stability of species in ecological succession of a forest in an intermediate stage of regeneration.O objetivo do estudo foi avaliar a composição florística e estrutural em um trecho de floresta secundária, no município de Dona Francisca - RS. Foram instaladas 50 parcelas permanentes de dimensão 10 x 20 m, de modo sistemático, distanciadas 10 m entre si e 40 m entre faixas, totalizando 1 ha. Foram amostrados todos os indivíduos que apresentassem CAP ≥ 15,7 cm e calculado os estimadores fitossociológicos. Foi realizada a curva de acumulação de espécie para verificar a suficiência amostral. Para o cálculo de diversidade e dominância, utilizou-se o Índice de Shannon (H’) e Equabilidade de Pielou (J’). Para a riqueza potencial utilizaram-se os estimadores não paramétricos Jackknife. Avaliou-se a composição florística e estrutural por meio da Análise de Correspondência Distendida (DCA). Verificou-se, também, a distribuição diamétrica e hipsométrica da comunidade arbórea, e para as espécies, com valor de importância acima de 5 %, a distribuição em classes de DAP. As análises estatísticas foram realizadas no programa R. Foram identificadas 65 espécies arbóreas e arbustivas com 2.045 indivíduos distribuídas em 31 famílias botânicas. As espécies com valor de importância acima de 5% foram Casearia sylvestris (14,04%), Nectandra lanceolata (12,86 %), Cupania vernalis (9,57 %), Guarea macrophylla (7,29 %) e Ocotea puberula (5,07 %). Os valores para a diversidade e dominância foram, respectivamente, de 2,91 nats.ind-1 e 0,69, indicando que a área possui baixa diversidade e dominância de poucas espécies. Pela DCA é possível verificar que as parcelas estão distribuídas homogeneamente no trecho florestal. A distribuição diamétrica representou o esperado para a comunidade arbórea com tendência ao J-invertido e a maioria das árvores apresentou altura concentrada no estrato intermediário da floresta. Das cinco espécies analisadas, apenas Nectandra lanceolata e Ocotea puberula não apresentaram curva exponencial negativa. Foi possível observar que há um predomínio de indivíduos nas primeiras classes de DAP e altura, o que caracteriza a resiliência da área após distúrbio. Ainda, indica as flutuações e estabilidade das espécies, na sucessão ecológica, de uma floresta em estágio intermediário de regeneração

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Observation of the diphoton decay of the Higgs boson and measurement of its properties

Peer reviewe

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Mechanical stability of the CMS strip tracker measured with a laser alignment system

Peer reviewe

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass