BackgroundPrecise knowledge of axillary lymph node status is essential in the treatment of operable carcinoma of the breast. For many years, axillary nodal clearance (ANC) has been an integral part of the conventional management of early-stage breast cancer. During the last few decades the trend of these surgical procedures has been one of decreasing invasiveness in order to try and achieve a much lower level of morbidity. To help reach this improved level of treatment the concept of the sentinel lymph node (SLN) was utilized. Recent studies have shown that SNB can provide an accurate assessment of the axillary nodal status in clinically node negative patients, negating the need to remove the majority of the axillary contents and thus reducing morbidity. A recent meta-analysis of all the literature to date appears to reveal that the dual technique (blue dye and technetium-labelled sulfur) is the gold-standard for successful identification of the SLN in the context of early-stage breast cancer. We aim to highlight the on-going wide range of differing methods employed, and compare this to the gold-standard recommended guidelines.MethodsA questionnaire was devised to provide a snapshot overview of the current management of the axilla in patients with clinically node-negative T1 invasive breast cancer amongst UK beast surgeons in August 2006.ResultsOf the 271 UK surgeons, 74 (27.3%) performed ANC as the initial management of the axilla in patients with clinically node negative T1 invasive breast cancer, 56 (20.7%) used axillary node sampling (not directed by sentinel node mapping) and a total of 141 (52.0%) used the technique of SNB, of which 50 (18.5%) used blue dye alone and 91 (33.6%) used a combination of blue dye and radioisotope.ConclusionDespite the obvious advantages, our survey has revealed that the procedure is only used by 52% of British breast surgeons in this subgroup of patients (clinically node negative, tumour equal of smaller than 2 cm) most of whom have no disease within the axilla. The reasons for this include limited hospital resources and lack of surgeons training and accreditation and ARSAC license (nuclear medicine license).
The AMPLATZER Vascular Plug (AVP; AGA Medical, USA) is designed to provide optimal embolization of peripheral veins and arteries through single-device occlusion. There are no reported cases of the AVP's being used to prevent bile leak. We report the successful use of the AVP within the liver to prevent intraperitoneal bile leak following inadvertent subcapsular stent deployment.
Image-guided procedures have made a significant impact in medical management in many specialties. These techniques continue to evolve rapidly and afford opportunities to reduce patient morbidity and in-patient length of stay.
Em meio ao atual cenário da economia brasileira o incentivo ao empreendedorismo e à educação empreendedora tem sido uma prática constante principalmente porque são os pequenos empreendimentos que movimentam a economia. O objetivo do presente estudo foi fazer uma reflexão a respeito do desenvolvimento de competências empreendedoras por meio da utilização dos conceitos da teoria da aprendizagem significativa e aprendizagem empreendedora e os impactos da utilização destas competências para o amadurecimento do ecossistema de Startups no Brasil. dos grandes desafios para as organizações que buscam aumentar seus lucros, reduzir os custos decorrentes do processo produtivo e manter-se competitivas no mercado está relacionado com a tomada de decisões. A Pesquisa Operacional (PO) lida com diversos problemas e é aplicada em diversas áreas como: indústria, transporte, serviços públicos etc., de maneira que obtenha a melhor solução ou solução ótima e auxiliando os gestores e executivos a tomar as melhores decisões. Dentre os métodos analíticos da PO, está a Programação Linear (PL) que está relacionada ao planejamento de recursos escassos, atendendo as condições operacionais e os objetivos estabelecidos. Desta O método utilizado para a elaboração do estudo foi qualitativo e consistiu em revisão da literatura por meio de pesquisa bibliográfica, aplicação e análise dos resultados de um questionário aplicado a partir da plataforma online Google forms. As análises identificaram a preocupação crescente do setor com o desenvolvimento das competências empreendedoras, a inter-relação entre as aprendizagens empreendedora e significativa com o aprimoramento das competências empreendedoras e por fim a necessidade de aprofundar estas reflexões para embasar o crescimento estruturado do setor.
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