Assessing the environmental management and operational efficiency of Brazilian public ports that export soybeans / Evaluación de la eficiencia de la gestión ambiental y eficiencia operacional de puertos públicos brasileños que exportan soja / Avaliação da eficiência da gestão ambiental e eficiência operacional de portos públicos brasileiros que exportam soja

Abstract Using Data Envelopment Analysis (DEA), seven public ports in Brazil that trade soybeans had their environmental management assessed. Data regarding the management of sewage, solid waste, and of the presence of synanthropic fauna in public ports was used along with the port environmental index created by ANTAQ in the analysis. The results show that the quality of the environmental management needs to be addressed, so the efficiency of the system can be reached, and that DEA can be a useful tool.

Resumen Se evaluaron siete puertos públicos brasileños de embarque de soja en cuanto a su gestión ambiental usando el análisis por envoltura de datos (DEA). Para el análisis, los datos referentes a la gestión de efluentes líquidos, residuos sólidos, y presencia de fauna sinantrópica en esos puertos se utilizaron en conjunto con el Índice de Desempeño Ambiental de la ANTAQ (Agencia Nacional de Transportes Acuáticos). Los resultados muestran que la calidad de la gestión ambiental debe abordarse para que el sistema sea eficiente en su totalidad, y para ello, el DEA puede ser una herramienta útil.

Resumo Sete portos públicos brasileiros que movimentam soja foram avaliados quanto a sua gestão ambiental usando-se Análise por Envelopamento de Dados (DEA). Para a análise, os dados referentes ao gerenciamento de efluentes líquidos, resíduos sólidos, e presença de fauna sinantrópica nesses portos foram utilizados em conjunto com o Índice de Desempenho Ambiental da ANTAQ. Os resultados mostram que a qualidade da gestão ambiental precisa ser abordada para que o sistema seja eficiente como um todo, e para isso, DEA pode ser uma ferramenta útil.

Targetoid hemosiderotic hemangioma - Case report

Targetoid Hemosiderotic Hemangioma, also known as Hobnail Hemangioma, is a lesion of vascular origin, probably lymphatic. The most common clinical feature is a solitary violaceous papule surrounded by a pale, thin area and a peripheral ecchymotic ring, simulating a target. Histopathologically, there is a biphasic pattern, with dilated vessels in the superficial dermis and pseudoangiosarcomatous pattern in the deep dermis, and endothelial cells with hobnail morphology. A simple excision is curative. We report a rare case of Targetoid Hemosiderotic Hemangioma.

Targetoid hemosiderotic hemangioma - Case report.

Targetoid Hemosiderotic Hemangioma, also known as Hobnail Hemangioma, is a lesion of vascular origin, probably lymphatic. The most common clinical feature is a solitary violaceous papule surrounded by a pale, thin area and a peripheral ecchymotic ring, simulating a target. Histopathologically, there is a biphasic pattern, with dilated vessels in the superficial dermis and pseudoangiosarcomatous pattern in the deep dermis, and endothelial cells with hobnail morphology. A simple excision is curative. We report a rare case of Targetoid Hemosiderotic Hemangioma.

Corymbiform nodular amyloidosis.

Amyloidosis is part of a group of deposition diseases. Nodular amyloidosis is a rare form of primary cutaneous amyloidosis. It affects men and women, usually over the age of 60 years. Presenting manifestation of the disease are yellowish-erythematous or brownish nodules or plaques in single or multiple infiltrates. Systemic evaluation should be performed to rule out involvement of other organs. Follow-up of the patient is important because the condition may progress to systemic amyloidosis. We report a case of nodular amyloidosis in which the lesion had a corymbiform aspect without systemic involvement and no recurrence after two years of follow-up.

Corymbiform nodular amyloidosis / Amiloidose nodular com lesão corimbiforme

Amyloidosis is part of a group of deposition diseases. Nodular amyloidosis is a rare form of primary cutaneous amyloidosis. It affects men and women, usually over the age of 60 years. Presenting manifestation of the disease are yellowish-erythematous or brownish nodules or plaques in single or multiple infiltrates. Systemic evaluation should be performed to rule out involvement of other organs. Follow-up of the patient is important because the condition may progress to systemic amyloidosis. We report a case of nodular amyloidosis in which the lesion had a corymbiform aspect without systemic involvement and no recurrence after two years of follow-up.

As amiloidoses constituem um grupo de doenças de depósito. A amiloidose nodular é uma forma rara de amiloidose cutânea primária. Acomete homens e mulheres, geralmente acima de 60 anos. Apresenta-se com nódulos ou placas eritemato-amareladas ou acastanhadas infiltradas isoladas ou múltiplas. A avaliação sistêmica deve ser feita para descartar comprometimento de outros órgãos. É importante o seguimento devido a possibilidade de evolução para amiloidose sistêmica. Relatamos um caso de amiloidose nodular com lesão de aspecto corimbiforme sem sistematização e sem recidiva após dois anos de seguimento.

Case for diagnosis.

Porokeratosis is a primary keratinizing disorder of unknown etiology. This disorder is characterized by the presence of centrifugally enlarging hyperkeratotic plaques, associated with the histopathological hallmark of cornoid lamellae. Genital porokeratosis is extremely rare. No more than thirty cases have been reported in the literature, including only one case of linear porokeratosis confined to the genital area. This case report describes a patient with genital linear porokeratosis, who was successfully treated with cryotherapy. Over two years of follow-up, the lesion improved and there was no evidence of recurrence or signs of malignant transformation. Nevertheless, there is a need for long-term follow-up data on recurrence and malignant transformation.

Case for diagnosis / Caso para diagnóstico

Porokeratosis is a primary keratinizing disorder of unknown etiology. This disorder is characterized by the presence of centrifugally enlarging hyperkeratotic plaques, associated with the histopathological hallmark of cornoid lamellae. Genital porokeratosis is extremely rare. No more than thirty cases have been reported in the literature, including only one case of linear porokeratosis confined to the genital area. This case report describes a patient with genital linear porokeratosis, who was successfully treated with cryotherapy. Over two years of follow-up, the lesion improved and there was no evidence of recurrence or signs of malignant transformation. Nevertheless, there is a need for long-term follow-up data on recurrence and malignant transformation.

A poroceratose é uma desordem primária de queratinização, de etiologia desconhecida. Apresenta-se com lesões eritemato-acastanhadas com crista periférica e centro normal ou atrófico, e está associada ao achado anatomopatológico de lamela cornoide. O envolvimento genital nessa doença é extremamente raro. Não mais que trinta casos têm sido descritos na literatura, sendo um desses casos de poroceratose linear localizado na área genital. Descrevemos um caso de poroceratose linear genital tratado com crioterapia. Durante dois anos de seguimento, houve melhora do aspecto das lesões, sem recorrência ou sinais de transformação maligna. Entretanto, um acompanhamento a longo prazo se faz necessário.

A meta-analysis to compare speech recognition in noise with bilateral cochlear implants and bimodal stimulation.

OBJECTIVE: This investigation quantified the relative benefits of binaural CI arrangements (i.e., bilateral, bimodal) for three binaural phenomena (i.e., binaural squelch, binaural summation, head-shadow effect) and sensitivity of two speech-recognition test paradigms (i.e., adaptive and fixed). DESIGN: A repeated-measures meta-analytical approach was used to compare effect sizes between binaural CI arrangements for each of the three binaural-listening phenomena and between the two test paradigms. STUDY SAMPLE: A total of 95 effect sizes were calculated and analyzed from 42 peer-reviewed studies published between January 2000 and April 2011. RESULTS: Findings revealed significant effect sizes for both CI arrangements for the binaural phenomena of summation and head-shadow effect. A significant effect size for binaural squelch was determined only for bilateral CI users. Further, the two paradigms resulted in similar effect sizes for bilateral and bimodal users, with the exception of binaural squelch. Here, significant effect sizes were significant only in the fixed-testing paradigm. CONCLUSIONS: The average user of binaural CI arrangements realizes the binaural phenomena of summation and the head-shadow effect, but only the bilateral CI arrangement is afforded the advantage of binaural squelch. Statistically, listeners fit with bilateral CIs have a slight advantage in binaural performance over those using bimodal stimulation.

Porfiria cutânea tardia: relato de dois casos / Porphyria cutanea tarda: case two reports

JUSTIFICATIVA E OBJETIVOS: A infrequência da porfiria cutânea tardia (PCT) e as suas várias formas de apresentação clínica justificam tal exposição. O objetivo deste estudo foi relatar dois casos de PCT: uma secundária a fármacos e outra de origem familiar. RELATO DO CASO: Caso 1: Paciente do sexo feminino, 70 anos com lesões bolhosas e vesiculosas no dorso das mãos, face e couro cabeludo havia dois anos, além de cicatrizes com milium. Fazia uso de fenitoína para epilepsia, sendo a PCT desencadeada por este fármaco. Caso 2: Trata-se de uma paciente de 35 anos com lesões vesiculosas e bolhosas no dorso das mãos, úlceras de difícil cicatrização, hipercromia e hipertricose facial. História familiar positiva de um irmão com hemocromatose em tratamento.CONCLUSÃO: A PCT resulta de um defeito enzimático caracterizado por diminuição da atividade da uroporfirinogênio-decarboxilase. Hemocromatose hereditária, hepatite C, estrógenos e história familiar constituem os principais fatores de risco para porfiria cutânea tardia. Clinicamente, observam-se vesículas, bolhas e ulcerações em áreas fotoexpostas, cicatrizes, pequenos cistos (milium), hipertricose e hiperpigmentação cutânea. O diagnóstico é clínico associado à dosagem de porfirinas na urina, sangue e fezes, podendo ser complementado com o exame histopatológico. A terapêutica inclui a eliminação do fator causal, flebotomias repetidas e/ou administração de cloroquina ou cimetidina por via oral.

BACKGROUND AND OBJECTIVES: The porphyria cutanea tarda (PCT) is an infrequent dermatosis and has several presentations that justify this paper. This objective of study was relating two PCT cases: one of them is a secondary drugs form and the other is a familiar one. CASE REPORT: Case 1: A woman patient, 70 old year with bullous and vesicles on the hand, face and scalp along two years beside milium scars. This patient was being treated with phenytoin for brain?s cysticercosis and this drug probably desencaded the PCT. The urinary?s porphyrinas dosage elevated associated with histopalogic confirmed the diagnostic. Case 2: Woman patient, 35 old year with bullous and vesicles on the hand, ulcers that not scars. There was facial hypercromia and hypertrichosis. Hers brothers has hemocromatosis. CONCLUSION: The PCT is an enzymatic defect characterized for reduced uroporphyrinogen decarboxilasi?s activity. Hereditary hemocromatosis, C hepatitis, estrogens and family history are the main risk factors for porphyria cutanea tarda. Clinically, we can observe vesicles, bullae and ulcers in areas exposed to light, atrophic scars, small cysts (milia), hypertrichosis and cutaneous hyper pigmentation. Clinical aspects associated to porphyrina's detection urinary, blood and stools makes the diagnosis. It can be complemented by skin's histopathology. The treatment can be done by eliminating the risk factors, repeated phlebotomies and/or introducing oral chloroquine or cimetidine.