Intestinal duplication cyst in the esophagogastric junction as a cause of gastroesophageal reflux disease: a case report

This report presents a rare case of a 42-year-old woman with refractory gastroesophageal reflux disease (GERD) attributable to a 5×4 cm enteric duplication cyst at the esophagogastric junction. Despite a year of proton pump inhibitor therapy, the patient experienced persistent symptoms, including nausea and nocturnal vomiting. Surgical intervention involved hiatal plasty, partial Dor fundoplication, and the unexpected discovery of the cystic tumor during the procedure. The cyst, firmly adhered and delimited, ruptured during dissection, leading to successful de-roofing, cauterization, and drainage. The patient's immediate postoperative course was satisfactory, demonstrating the effectiveness of this approach in managing an enteric duplication cyst. This case underscores the importance of considering congenital anomalies in the context of refractory GERD, with the enteric duplication cyst located at the esophagogastric junction representing a unique manifestation. The study contributes valuable insights into the atypical presentation, diagnostic challenges, and successful surgical management of such anomalies

Bowel obstruction secondary to type IV hiatal hernia: a case report

Hiatal hernias are classified into four types. Type 4 hernias are not limited to the stomach alone, but involve herniation of the omentum, colon, small intestine, peritoneum, pancreas, or spleen into the chest cavity. Account for less than 5% of all cases. The probability that a patient with a paraesophageal hernia will develop acute symptoms and require emergency surgery is 1.16% per year. We present a case of acute paraesophageal hiatal hernia repair in a patient who developed large bowel obstruction. An 82-year-old female was admitted to emergency room referring abdominal distension, intolerance to the oral intake, vomiting of fecal content, as well as impossibility to pass gas or evacuate. On physical evaluation with tachycardia and acute abdomen, laboratory studies showed leukocytosis, radiographic data of intestinal obstruction, and at the level of the left hemithorax, space occupation by the colon was evident. An emergency surgery was performed finding paraesophageal hernia with involvement of the stomach and transverse colon, and retrograde dilatation of the ascending and transverse colon with ischemic changes. The patient presented hemodynamic instability, so an extended right hemicolectomy was decided, with distal closure, ileostomy, and hiatal plasty performed. She was discharged on postoperative day four without complications. Type 4 hiatal hernia complicated with intestinal obstruction is a condition that carries high rates of morbidity and mortality, so early surgery is mandatory to avoid a fatal outcome for the patient. There are currently no clear guidelines regarding the management of acute complicated paraesophageal hernias

Bochdalek hernia associated with intestinal malrotation as an incidental finding in an adult patient: case report

Bochdalek hernia (BH) is the most common congenital diaphragmatic hernia, however in adults the clinical presentation and diagnosis is rare. Intestinal malrotation (IM) is a congenital anomaly that results in an alteration in intestinal anatomy secondary to inadequate intestinal rotation, which occurs at the end of the first trimester of embryonic development, some digestive anomalies may be related, such as diaphragmatic hernia, its Diagnosis is made in the neonatal period although it can be diagnosed in older children and adults, debuting with symptoms of intestinal obstruction or being an incidental finding. Below we present a case report of an adult patient with a diagnosis of Bochdalek congenital diaphragmatic hernia (CDH) in whom an incidental diagnosis of IM was made, who underwent elective surgery, performing laparoscopic diaphragmatic plasty with favorable results

Implementation overview of organizational routines in Lean Product Development (LPD)

Most organizations cannot sustain one of the principles of the Lean approach, such as the pursuit of perfection / continuous improvement. So they fail over time. The proposal for the use of the same as the facts and functional functions to the practical practice, the functional function and the approach to work with other aspect as tangible (thought gerential, routines). Some authors advocate an idea that journeys are a way of maintaining a journey for continuous improvement. Based on this, this article aimed to analyze how the organizational routines are worked with the objective of maintaining the search for continuous improvement in Lean Product Development. The method awoke the research for the theoretical-conceptual process, based on the systematic bibliographical review for the accomplishment of bibliometric analysis and scientific content. The research resulted in a portfolio of 12 articles, which were analyzed according to the purpose of a research. This surveys aims to contribute to the verification of a gap in the knowledge of how routines are performed and treated within the Lean Product Development in order to assist as organizations in the quest for the sustainability of continuous improvement

Aplicação ambiental do teorema de Coase: o caso do mercado de créditos de carbono

The article evaluates the influence from Coase´s writings on the development from the carbon credit market. It begins debating the origin of Coase theory, explaining its basic principles, the propriety rights and transaction costs. Then, it shows the relations between Coase theorem and it environmental applications. After explaining how the carbon credit market was developed and the main criticisms towards its functioning, the article concludes that the Coase theorem is the theoretical base from this market and it´s an important tool to make advances on environmental policy.Este artigo tem como objetivo avaliar a influência do trabalho de Coase na construção do Mercado de Crédito de Carbono. Inicialmente debate-se a origem da formulação teórica de Coase, elencando seus principais pressupostos, como os direitos de propriedade e custos de transação. Posteriormente é visto de qual maneira o Teorema de Coase pode ser aplicado à abordagem ambiental e de qual forma se encaixa na formulação do Mercado de Crédito de Carbono. Conclui-se, através de estudos de caso, que o Teorema de Coase é o principal alicerce para o funcionamento deste tipo de mercado

Hepatic undifferentiated embryonal sarcoma as a cause of acute abdomen

Primary liver sarcoma represents less than 1% of all primary liver tumors. Hepatic undifferentiated embryonal sarcoma (HUES) is included in the histologic group of primary liver sarcomas. HUES is a rare malignant liver tumor with a low incidence in the adult population. At moment there is no tumor marker that increases suspicion or diagnosis Early diagnosis is key to rise the possibilities of long-term survival. It has currently improved its prognosis through multidisciplinary management with surgical resection and chemotherapy. This case report presents a 20-year-old female patient with acute abdomen and anemic syndrome secondary to spontaneous rupture of a HUES requiring medical management initially based on resuscitation and arterial embolization with subsequent surgical resection

Horta no tabuleiro

O presente trabalho relata um projeto de participação ativa e colaborativa entre entidades - o Colégio D. Pedro V (DPV) e o STOL-Science Through Our Lives/Dep. Biologia-UMinho (STOL) - no âmbito da Educação Ambiental e tendo subjacente os quatro pilares da Educação Delors (UNESCO) – “Aprender a Ser”, “Aprender a Fazer”, “Aprender a Conhecer” e “Aprender a Viver Juntos”. O projeto “Horta no Tabuleiro” desenvolveu-se em duas fases. Primeiro, com a visita de duas turmas do 1º Ciclo (36 crianças) à Horta-STOL no campus de Gualtar da Universidade do Minho, foi explorada a abordagem prática e presencial do que é uma horta e a sua biodiversidade; do tipo de plantas cultivadas, técnicas de cultivo e valorização de resíduos; das relações entre plantas e delas com o meio envolvente. Numa segunda fase, seguiu-se uma sessão em sala no DPV com especial atenção à exploração do conceito “bioversidade". Para isso recorreu-se a um conjunto de jogos de tabuleiro originais produzidos pelo STOL com imagens recolhidas na própria horta (um jogo da memória sobre a biodiversidade vegetal, um jogo do loto sobre biodiversidade animal e alguns puzzles focando a polinização, as inflorescências e a frutificação) e ainda a três X-banner sobre a Horta-STOL. Como forma de inferir o alcance das ações desenvolvidas e aferir os instrumentos de avaliação dessas aprendizagens, as crianças foram desafiadas, individualmente, de diversas formas, quer antes da visita (construção de mapas mentais à volta do conceito biodiversidade e desenhos sobre o que esperariam ver na horta), quer posteriormente. Nesta segunda fase: (i) completaram-se os mapas mentais anteriores com uma segunda ronda de novas palavras, (ii) registou-se em desenho a ida à horta, (iii) escreveram-se textos narrativos sobre a visita e (iv) uma semana depois, após a repetição dos jogos de tabuleiro no DPV, preencheu-se um questionário sobre os conceitos abordados. Contamos apresentar a análise de todos estes instrumentos

ORAMA project deliverable 1.2. Final analysis and recommendations for the improvement of statistical data collection methods in Europe for primary raw materials

This report brings together the outputs of Task 1.1 and 1.2 of Work Package 1 of the ORAMA project. Task 1.1 aims to produce an inventory of how minerals data are collected within Europe, via a survey of data providers, and Task 1.2 aims to review previous work from past projects, working groups and professional organisations in this subject area. Together this has built a comprehensive understanding of how minerals data are collected in Europe, what data gaps exist, what the issues are with regard to creating harmonised European datasets for minerals information and what good practice examples exist that lessons can be learnt from. The results of the survey show that countries that have a clear legal and regulatory procedure for collecting data often have the most robust systems in place. These countries often also have a strong motivation for collecting such data, such as receiving a significant income from mineral royalties as a result of state ownership of minerals, although resource management or land use planning also provide motivation for the collection of data. The results of the survey also showed there is a large variety in the way data is collected within Europe. This variety is not necessarily an issue with regard harmonisation as long as data providers ensure that they adhere to common data standards and classification systems, such as INSPIRE or UNFC when providing data for aggregation at a European level. The review of previous projects showed the breadth of work that had gone into the improvement of statistical datasets over the last few years. Especially from projects such as Minventory and Minerals4EU, which provide a clear roadmap for harmonising European minerals datasets, or the work of the EGS MREG (EuroGeoSurveys Mineral Resources Expert Group) towards the harmonisation of resource and reserve codes within Europe. A common theme of many of these recommendations is the need for common standards to be adhered to and that in some instances these specifications may need to be adapted to accommodate statistical data for mineral resources which are aggregated at a national scale

Análise de prescrições médicas de antimicrobianos dispensadas em uma rede privada de drogarias / Analysis of antimicrobial medical prescriptions dispensed in a private drugstore network

A prescrição médica é considerada um instrumento que contém as informações necessárias visando o uso correto de medicamentos, sendo ela um elo entre o prescritor, paciente e dispensador. Os antimicrobianos são compostos naturais ou sintéticos capazes de inibir o crescimento ou causar morte de fungos ou bactérias. A análise de prescrição pode contribuir para uma avaliação preliminar da qualidade da terapia, na medida em que evidencia falhas que comprometem a adesão ao tratamento e favorecem o aparecimento de reações adversas e falhas terapêuticas.O presente trabalho teve como objetivo analisar as prescrições médicas de antimicrobianos dispensadas em uma rede de farmácia no município de Montes Claros-MG, onde se averiguou a adequação das prescrições às normas da RDC n° 20/2011. Foram analisadas 715 receitas de antimicrobianos, onde se observou que 100% continham o nome completo do paciente, 22,4% a idade, 21,8% o gênero,99,3% o nome do prescritor, 92,6% a data da prescrição e 98% continham a inscrição no Conselho Regional de Medicina (CRM). Já em relação ao preenchimento dos dados da medicação, 20,8% das prescrições encontravam-se ilegíveis. Quanto a posologia, verificou-se que esse dado estava presente em 98,3% das prescrições, a dosagem presente em 97,5%, a forma farmacêutica presente em 93,7% e a data vigente presente em 92,6% das prescrições.Os resultados obtidos neste estudo demonstram que os médicos prescritores estão cumprindo alguns quesitos exigidos pela RDC nº 20?2011, tais como assinar, carimbar e datar suas prescrições, porém descumprem as exigências relacionadas ao fornecimento de informações sobre o paciente, principalmente os dados de idade e sexo.A conduta dos prescritores e dispensadores em relação ao não cumprimento dos critérios exigidos pela RDC nº20/2011 pode ser melhorada. É de grande relevância a orientação dos respectivos conselhos para os profissionais de saúde a fim de minimizar problemas cotidianos, dos pequenos aos mais graves, estabelecendo maior comunicação e familiarização nos requisitos prescrição e paciente