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The dynamics of the stress neuromatrix
Get PDFStressful stimuli in healthy subjects trigger activation of a consistent and reproducible set of brain regions; yet, the notion that there is a single and constant stress neuromatrix is not sustainable. Indeed, after chronic stress exposure there is activation of many brain regions outside that network. This suggests that there is a distinction between the acute and the chronic stress neuromatrix. Herein, a new working model is proposed to understand the shift between these networks. The understanding of the factors that modulate these networks and their interplay will allow for a more comprehensive and holistic perspective of how the brain shifts 'back and forth' from a healthy to a stressed pattern and, ultimately, how the latter can be a trigger for several neurological and psychiatric conditions
Treatment of Metastasized Prostate Carcinoma: Emergence of New Therapeutic Horizons
Get PDFThe evolution in the treatment of metastatic prostate cancer currently provides to the urologist a wide range of therapeutic possibilities that have shown an improvement on overall survival and quality of life of patients. It is presented a clinical case in this article which reflects not only the effectiveness of these therapies but also their rapid evolution
Temporal Bone Meningoencephalic Herniation
Get PDFBackground: Temporal bone meningoencephalic herniations correspond to the presence of brain parenchyma and/or prolapsed meninges through a bone defect. It is a rare condition with potentially catastrophic consequences for the patient.
Case Description: Sixty-nine year-old female patient with past medical history of chronic otitis media submitted to otologic surgery, arterial hypertension and breast cancer. Admitted to emergency department with tonic-clonic seizures secondary to meningoencephalitis triggered by otologic infection. The imaging investigation revealed the presence of a meningoencephalic herniation that was surgically treated by a multidisciplinary ENT and neurosurgery team.
Discussion/Conclusions: Surgical treatment aims to remove meningoencephalic herniated tissue, bone defect repair and hearing recovery. Size and location of bone defect and meningoencephalic herniation are decisive factors in surgical approaches choice
Visual Impairment with Minimal Macular Damage in Femtosecond Laser Injury
Get PDFThe authors describe the case of a 26-year-old female patient with a history of bilateral central scotomas which has lasted 24 hours, which appeared after an injury caused by a plasma laser for the production of nanoparticles. The ophthalmologic assessment including observing the ocular fundis in mydriasis, fluorescein angiography and optical coherence tomography (OCT).
In a first assessment, the visual acuity of the right eye was 20/20 and the left eye was 20/25. Foveal pigmentary alterations were observed in the macula of both eyes. Bilaterally, the OCT revealed a central interruption of the photoreceptor layer; the fluorescein angiography was normal. In subsequent assessments, the visual acuity was always 20/20 bilaterally. The abnormal findings observed in the OCT disappeared in less than five months, despite continued subjective complaints of scotomas in the left eye
Combined tools for Surgical Case Packages contents and cost optimization: a preliminary study
Get PDFThis paper presents a solution proposal based on mathematical and statistical tools to optimize Surgical Case Packages of an Operating Room (OR) in a Portuguese public hospital that it is the most complex environment in a hospital. In this particular hospital, more than 27000 surgeries/year are performed, employing, sometimes, misadjusted composition of standard surgical packages and non-optimized grouping of surgical instruments. Problem consequences are, among others, high transport of
various surgical cases packages; high number of open cases and delays in surgical times following surgery. These type of problems are waste that do not add value to the service in the context of Lean Healthcare and must be eliminated using the most suitable tools. After the analysis, different tools were used: combinatorial analysis to optimize surgical cases composition and statistical analysis to identify the instruments usage and surgical basic case patterns. An optimization model was developed which produced a sterilizing initial solution of 135.24€. By identifying the most commonly employed instruments, it was concluded that some instruments have never been used and others rarely and some patterns were identified. The results achieved
were based on minor sample and in a form of data collection that needs some adjustment
