Добірка наукової літератури з теми "Corona Baratech"

A 14-year old female with Down syndrome presented with a 3-year history of recurrent purulent left otorrhea. The discharge had become more frequently blood-tinged. Otologic examination revealed a stenotic ear canal with polypoid granulation obstructing the view of the tympanic membrane. High resolution computerized tomographic (HRCT) imaging of the temporal bone was performed to assess the status of the middle ear and mastoid. Particular attention was given to assess for bony erosion associated with cholesteatoma formation. Comparison of the scutum on coronal view (Figure 1) did not show a marked visual difference in the sharpness of the scutum edge. As erosion of the scutum edge is the hallmark radiological finding in the diagnosis of a pars flaccida or attic retraction-based acquired cholesteatoma, a confident radiologic diagnosis of cholesteatoma via this pathophysiologic mechanism could not be given. Figure 1.Coronal HRCT images of the scutum. The left scutum (white arrow) does not appear to be blunted when compared to the right scutum, which is known to be intact. The left middle ear space is entirely filled with a soft tissue lesion, whilst there is only soft tissue in the right epitympanum lateral and superior to the ossicles. Meticulous examination of the ossicles on axial view (Figure 2) showed a subtle thinning of the short process of the incus by sharply marginated, seemingly expansile soft tissue medially located between the incus and the tympanic segment of the facial nerve. Exploratory surgery via an initial external end-aural approach revealed the presence of a posterior pars tensa retraction cholesteatoma underneath the granulation polyp. The cholesteatoma had extended medial to the ossicular chain, causing erosion of the long process and medial portion of the short process of the incus, as well as the entire stapes superstructure. Definitive surgery consisting of a canal-wall down mastoidectomy via a post-auricular approach, cartilage graft tympanoplasty without ossicular chain reconstruction, meatoplasty and partial mastoid obliteration was performed. This case is particularly instructive with regards to two issues: otologic disease in Down syndrome and radiological evidence of erosive middle ear disease. An increased incidence of otologic conditions in Down syndrome is well established in the medical literature. These include external auditory canal stenosis, ossicular chain abnormalities and otitis media with effusion (OME).1,2 Cholesteatoma as a sequelae of undiagnosed or untreated OME has to be suspected in children with Down syndrome, especially in those with recurrent otorrhea and persistent hearing loss. Unfortunately, the identification of a cholesteatoma may be difficult due to stenosis of the external auditory canal or a sub-optimal otologic examination due to behavioral problems in children with Down syndrome.2 These factors were both present in this particular case, as the cholesteatoma remained undiagnosed for several years despite regular consultations with an otolaryngologist. Radiologic evaluation with high-resolution computerized tomographic (HRCT) imaging is extremely important in these situations. As described by Barath et al., the “typical findings associated with cholesteatoma include a sharply marginated expansile soft-tissue lesion, retraction of the tympanic membrane, scutum blunting, and erosion of the tympanic tegmen and ossicles. Holotympanic absence of bony changes is suggestive of otitis media without cholesteatoma formation, whereas presence of bony erosions (along with clinical suspicion) indicates cholesteatoma.”3 In this particular case, the presence of soft tissue within the epitympanum and antrum accompanied by the subtle evidence of ossicular erosion were crucial in the decision to advise and perform surgery. Although it may be argued that a high clinical suspicion based on the suggestive otological history in a child with Down syndrome may be enough to warrant surgical exploration, it cannot be disputed that the radiological findings help in advising patients pre-operatively about the indications for and expected outcomes of surgical management. In this case, it also impacted on the surgical approach – a transmeatal procedure appropriate for a limited middle ear exploration was initially performed, with conversion to a standard post-auricular approach appropriate for more extensive mastoid surgery once the presence and extent of the cholesteatomatous disease was confirmed intra-operatively.

Cette thèse tente d'analyser la matrice disciplinaire de la science historique dans l'Espagne d'après-guerre. Pour ce faire, elle s'appuie sur la figure de Carlos E. Corona et sur l'évolution de l'historiographie consacrée à l'âge moderne
This thesis attempts to analyse the disciplinary matrix of historical science in post-war Spain. To do so, it takes the figure of Carlos E. Corona and the evolution of historiography dedicated to the Modern Age

Although percutaneous coronary intervention has revolutionized the treatment of coronary artery disease, it has been limited by acute ischaemic complications and restenosis. It is well recognized that elastic recoil, negative remodelling, and neointimal hyperplasia are the underlying mechanisms of restenosis, with a clear association between the extent of vascular injury sustained and subsequent intimal hyperplasia. The search for a method to dilate an obstructive coronary lesion without invoking this proportional injury response led to the development of a variety of devices designed to excise or modify plaque in order to limit intimal injury. In 1991, Barath and colleagues developed a noncompliant cutting balloon with three or four microblades fixed radially to it. It was hypothesized that the discrete longitudinal incisions created during balloon inflation might improve the success of conventional balloon angioplasty by reducing elastic recoil and minimizing intimal injury, thereby minimizing the subsequent neointimal proliferative response. Theoretically, this effect would allow cutting balloon angioplasty to achieve and maintain a larger lumen diameter using lower balloon inflation pressures and durations than conventional balloon angioplasty. Technology has since progressed rapidly through several stages, with the introduction of intracoronary stents, advances in adjunctive antiplatelet therapies, and the advent of drug-eluting stents. However, the Cutting Balloon®, and the recently approved AngioSculpt® scoring balloon, remain in the armamentarium of the interventional cardiologist today. This chapter summarizes the clinical experience with these devices to date and their place in the current era.

Esta pesquisa propõe-se a estudar a produção do espaço urbano no Brasil a partir da retomada das políticas sociais ligadas à habitação, debruçando-se sobre o caso da Região Metropolitana do Rio de Janeiro. Serão analisadas a expansão dos programas habitacionais em direção as periferias e as possíveis consequências socioespaciais deste movimento. O Estado, a fim de baratear o custo das moradias contribui para o isolamento das camadas desfavorecidas nas áreas distantes, precárias e com infraestrutura limitada. O referido processo já ocorreu anteriormente com as políticas do Banco Nacional de Habitação, porém, no momento atual, os limites físicos da metrópole têm sido ultrapassados. Espera-se constatar a importância das cidades médias e periferias metropolitanas para a produção de moradia e analisar a mobilidade intra/interurbana em função da intensificação destas relações. O aporte teórico teve como base autores que examinam a produção do espaço urbano e crescimento das cidades, tais como Corrêa (1999), Limonad (2007), Randolph & Gomes (2007) e Lopes de Souza (2001). A conjugação deste amparo teórico, aliado às averiguações provenientes da interpretação de dados atuais, servirá como alicerce para o desenvolvimento do trabalho.