Diagnosis, staging and treatment of hepatocellular carcinoma

Hepatocellular carcinomas are aggressive tumors with a high dissemination power. An early diagnosis of these tumors is of great importance in order to offer the possibility of curative treatment. For an early diagnosis, abdominal ultrasound and serum alpha-fetoprotein determinations at 6-month intervals are suggested for all patients with cirrhosis of the liver, since this disease is considered to be the main risk factor for the development of the neoplasia. Helicoidal computed tomography, magnetic resonance and/or hepatic arteriography are suggested for diagnostic confirmation and tumor staging. The need to obtain a fragment of the focal lesion for cytology and/or histology for a diagnosis of hepatocellular carcinoma depends on the inability of imaging methods to diagnose the lesion. Several classifications are currently available for tumor staging in order to determine patient prognosis. All take into consideration not only the stage of the tumor but also the degree of hepatocellular dysfunction, which is known to be the main factor related to patient survival. Classifications, however, fail to correlate treatment with prognosis and cannot suggest the ideal treatment for each tumor stage. The Barcelona Classification (BCLC) attempts to correlate tumor stage with treatment but requires prospective studies for validation. For single tumors smaller than 5 cm or up to three nodules smaller than 3 cm, surgical resection, liver transplantation and percutaneous treatment may offer good anti-tumoral results, as well as improved patient survival. Embolization or chemoembolization are therapeutic alternatives for patients who do not benefit from curative therapies

Cutaneous lesions of the nose

Skin diseases on the nose are seen in a variety of medical disciplines. Dermatologists, otorhinolaryngologists, general practitioners and general plastic and dermatologic surgeons are regularly consulted regarding cutaneous lesions on the nose. This article is the second part of a review series dealing with cutaneous lesions on the head and face, which are frequently seen in daily practice by a dermatologic surgeon. In this review, we focus on those skin diseases on the nose where surgery or laser therapy is considered a possible treatment option or that can be surgically evaluated

Influence of cultural mechanisms on horizontal inter-firm collaborations

Abstract: The evolution of organizations that work in multinational environments has considerably altered their production strategies. One of the consequences has been the appearance of Horizontal Inter-firm Collaborations (HICs), which include all kinds of enterprises and production centres and establish a new type of horizontal collaborations and relations between independent companies or even competitors who establish occasional collaborations on projects they could not take on individually. HICs are dynamically changing organizations formed by Original Equipment Manufacturers (OEMs), Contract Manufacturers (CMs), turn-key and component suppliers, R+D centres and distributors. The dynamic relations that exist within the HICs allow them a very permeable organization easy to connect and disconnect from one to each other as well as to choose a set of partners with specific attributes. The result is a highly flexible system characterized by low barriers to entry and exit, geographic flexibility, low costs, rapid technological diffusion, high diversification through contract manufacturers and exceptional economies of scale. This study of organizational culture at the network level includes aspects such as cultural similarity among its actors, social embeddedness, tacit knowledge transfer or the importance of trust atinter-firm collaborations. The presence, under a systemic perspective, of homogeneous cultural values and practices in which collaboration actors can be identified may strengthen the group membership or establish a social network that underlies the own HIC and facilitates interactions among its members. The feasibility of this approach would facilitate the formation of new HICsby establishing, ex ante, a cultural prescriptive model at the network level. Finally, to validate the proposed Influence of cultural mechanisms on horizontal inter-firm collaborations 13