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Colelitíase e cirrose hepática
Fontes, Paulo Roberto Ott;Nectoux, Mauro;Eilers, Rene Jacobsen;
Revista do Colégio Brasileiro de Cirurgi?es , 1998, DOI: 10.1590/S0100-69911998000200011
Abstract: the cholelithiasis and hepatic cirrhosis are frequent in the population. this association is often observed. it’s important to known this situation because the evolution of cirrhosis may be complicated by cholelithiasis and, on the other hand, the treatment of symptomatic cholelithiasis may be difficult in cirrhotic patients. in the compensated disease (child a and b), cholecystectomy is the treatment of choice. in patients child c, the biliary surgery has a high morbi-mortality rate and the initial management must be clinical observation. in these cases, the biliary symptoms must be relieved and the surgery delayed, if possible, until the improvement of hepatic function. jaundiced patients must be carefully evaluated in the preoperative period, specially because choledocholithiasis is frequently absent and the jaundice is caused by hepatic failure. in child c patients, if surgery is really necessary, cholecystostomy or partial cholecystectomy by pribram technique can be considerated. the authors reviewed the clinical and therapeutic aspects of this association.
Colangiografia transoperatória em colecistectomia laparoscópica
Fontes, Paulo Roberto Ott;Nectoux, Mauro;Eilers, Rene Jacobsen;Chem, Eduardo Mainieri;Reidner, Charles Edison;
Revista do Colégio Brasileiro de Cirurgi?es , 1998, DOI: 10.1590/S0100-69911998000600005
Abstract: with laparoscopic cholecystectomy, the intraoperative cholangiography has been motive of intense controversy. some authors perform it routinely. they consider laparoscopic cholecystectomy only an alternative to open access and, in that case, must be the same as conventional procedure. on the other hand, many authors believe that few patients have a true indication to evaluate the biliary tree. these authors do selectively intraoperative cholangiography. we performed 309 laparoscopic cholecystectomies between may 1993 and june 1997. the records of these patients were reviewed. our results and experience with intraoperative cholangiography are evaluated. we usually perform intraoperative cholangiography by cystic duct catheterization, whenever feasible and without risk of injury to the biliary tree. it was possible in 244 (78.9%) cases. the main cause of unsuccessful was the presence of narrow cystic duct and occurred in 21 (6.8%) patients. the exam was normal in 229 (93.8%). unsuspected choledocholithiasis was detected in six (2.4%), cystic duct draining into right hepatic duct was present in three (j.2%)and one (0.4%) had a choledocal cyst. the intraoperative cholangiography was a safe procedure in our patients who underwent laparoscopic cholecystectomy and, with our results, we recommend your routinely employment.
Colecistectomia laparoscópica em cirróticos
Fontes Paulo Roberto Ott,Mattos ?ngelo Alves de,Eilers Rene Jacobsen,Nectoux Mauro
Arquivos de Gastroenterologia , 2002,
Colecistectomia laparoscópica em cirróticos
Fontes, Paulo Roberto Ott;Mattos, ?ngelo Alves de;Eilers, Rene Jacobsen;Nectoux, Mauro;Pinheiro, Jorge Olavo Pitta;
Arquivos de Gastroenterologia , 2002, DOI: 10.1590/S0004-28032002000400002
Abstract: background: initially considered a contraindication to the surgical laparoscopy, cirrhosis have been an occasional discovery during this procedure. until now many series reported in the literature suggest that the majority of the surgeons still consider cirrhosis as contraindication to the laparoscopic cholecystectomy. aim: to evaluate our experience in laparoscopic treatment of the cholelithiasis in cirrhotic patient. pacients and methods: six hundred and four patients with symptomatic cholelithiasis were operated on clinical and surgical gastroenterology unit, "santa casa de misericórdia de porto alegre", porto alegre, rs, brazil, during the period from may 1993 to may 2000. of these, 10 (1,6%) presented hepatic cirrhosis. the patients' age was between 22 and 69 years (average of 50,4 ± 18,1). eight patients (80%) were female. the alcohol was the etiological factor in four, chronic hepatitis b and c, primary biliary cirrhosis and of alfa-1 antitripsin deficiency in one patient each. in two patient the causal agent was not identified. results: cholecystectomy was accomplished in all patients and in seven also diagnostic hepatic biopsy. in two (20%) the surgery was converted. the result of the intraoperative cholangiography was normal in all cases. in seven patients the postoperative was uneventfull. clinically controlled ascite was observed in two (20%). both were child a at the moment of the surgery. the last patient, child c, died. he presented irreversible hepatic failure. conclusions: despite larger experience still should be acquired, it seems that laparoscopic is a safe approach in well compensated cirrhotic patients with symptomatic cholelithiasis. in child c patients we believed that all of the efforts should be driven to the improvement of the hepatic function or a less invasive method such as cholecystostomy.
Esofagomanometria e pHmetria esofágica de 24 h em uma ampla amostra de pacientes com manifesta??es respiratórias
Machado, Mirna da Mota;Cardoso, Paulo Francisco Guerreiro;Ribeiro, Iana Oliveira e Silva;Zamin Júnior, Idílio;Eilers, Rene Jacobsen;
Jornal Brasileiro de Pneumologia , 2008, DOI: 10.1590/S1806-37132008001200009
Abstract: objective: to determine the prevalence of gastroesophageal reflux disease (gerd) and to evaluate the esophageal motor profile of patients with respiratory symptoms referred to a digestive motility referral center for esophageal function testing. methods: the results of esophageal manometry and 24-h esophageal ph-metry were analyzed.the inclusion criterion was presenting respiratory symptoms, with or without accompanying digestive symptoms. results: of the 1,170 patients included in the study, 602 (51.5%) reported having digestive and respiratory symptoms (drs group), and 568 (48.5%) reported having only respiratory symptoms (rs group). asthma was diagnosed in 142 patients in the rs group (rs-a subgroup) and in 201 of those in the drs group (drs-a). of the 346 cases of esophageal dysmotility, hypomotility was found in 175 (14.3% and 15.6% in the drs and rs groups, respectively), and lower esophageal sphincter (les) hypotonia was found in 411 (40.3% and 30.2%, respectively). hypotonia correlated with gerd. exposure of the distal esophagus to acid was markedly abnormal in the supine position. the prevalence of gerd in the sample as a whole, the rs-a/drs-a subgroups and the rs-a subgroup alone was 39.8%, 44.0% and 35.2%, respectively conclusions: hypotonic les was the most common abnormality and correlated with gerd. although gerd was more evident in the drs group, approximately one third of the patients in the rs group also presented gerd (silent gerd). the findings suggest that gerd can be an extrapulmonary cause of chronic respiratory symptoms unresponsive to conventional therapy.
Construction and Operation of the Fehmarn Belt Immersed Tunnel Is a High-Risk Business Case  [PDF]
Hans Schj?r-Jacobsen
Journal of Financial Risk Management (JFRM) , 2017, DOI: 10.4236/jfrm.2017.61001
Abstract: The Fehmarn Belt immersed tunnel project conditionally approved by the Danish parliament on 28 April 2015 is supposed to be built and commercially operated by a Danish state owned company and financed by loans guaranteed by the Danish government. The loans are going to be amortized by incomes from the tunnel users. According to plans construction work was supposed to start by 2016 followed by tunnel inauguration in 2022, this has been put on hold awaiting clarification of major uncertainty issues. Since the official financial model is publicly unavailable, the uncertainty profiles presented in this paper are based on a financial model developed by the author covering 60 years of future tunnel operation and validated in terms of project payback period (PBP) compared to published results generated by the official model. Uncertainty is represented and calculated by probabilistic uncertainty representation and Monte Carlo simulation as well as interval analysis. The resulting project uncertainty profiles are presented in terms of a traffic light metaphor: Green light corresponds to a payback period less than 40 years, yellow to 40-50 years, and red to larger than 50 years. It turns out that the tunnel project constitutes a high-risk business case and the likelihood of financial project failure in terms of the payback period being outside of the green light zone is substantially larger than acknowledged by the project proponents and presented to the public. This is primarily due to apparently too optimistic base case assumptions of critical, but uncertain, project variables and methodologically insufficient partial sensitivity analyses.
External Quality Assurance of the Fehmarn Belt Fixed Link Business Case—Too Little, Too Late, and Too Unreliable  [PDF]
Hans Schj?r-Jacobsen
Journal of Financial Risk Management (JFRM) , 2017, DOI: 10.4236/jfrm.2017.62011
Abstract: The external quality assurance (EQA) of the Fehmarn Belt fixed link business case commissioned by the Danish Ministry of Transport is critically analyzed regarding the New Construction Budgeting requirements as well as common practical criteria. A time line of analyses, decisions and external quality assurance activities as well as external criticism is established as a basis for analyzing the completeness, timeliness and trustworthiness of the quality assurance. Information obtained per the Public Records Act is included. It is found that the external quality assurance was grossly incomplete with limited scopes and exclusion of major elements of the project. The overall financial performance and financial uncertainty analyses were not subject to external quality assurance at all. The bulk of external quality assurance was carried out only after the decision-to-build was made, preparatory construction activities initiated or major economic commitments made, thus jeopardizing the timeliness. The trustworthiness of the external quality assurance is limited for different reasons: bad timing of activities, lack of independence of consultancies, and controversial findings of opposing analyses. The external quality assurance is found to be too little, too late, and too unreliable. The status of the project as a high-risk business case is not improved by the external quality assurance.
'Liberalismo tropical': cómo explicar el auge de una doctrina económica europea en América Latina, 1780-1885
Historia Crítica , 2007,
Abstract: the article traces the processes through which the northwest european doctrine of economic liberalism achieved dominance in nineteenth century latin america. it focuses on transmission channels, domestic and foreign interest groups, institutions, civil society, economic structures and conjunctures, and political cultures to account for the spread on economic liberalism in various countries of the region between the 1770s and 1890. the doctrine was dominant in latin america for a shorter time than commonly thought, only between ca. 1850 and 1890, and underwent multiple changes and adjustments in each of the region's countries. after 1890, promotion of externally lead growth went hand in hand with a gradual turning away from economic liberalism.
Web Archiving: Issues and Problems in Collection Building and Access
Grethe Jacobsen
Liber Quarterly : The Journal of European Research Libraries , 2008,
Abstract: Denmark began web archiving in 2005 and the experiences are presented with a specific focus on collection-building and issues concerning access. In creating principles for what internet materials to collect for a national collection, one can in many ways build on existing practice and guidelines. The actual collection requires strategies for harvesting relevant segments of the internet in order to assure as complete a coverage as possible. Rethinking is also necessary when it comes to the issue of description, but cataloguing expertise can be utilised to find new ways for users to retrieve information. Technical problems in harvesting and archiving are identifiable and can be solved through international cooperation. Access to the archived materials, on the other hand, has become the major challenge to national libraries. Legal obstacles prevent national libraries from offering generel access to their archived internet materials. In Europe the principal obstacles are the EU Directive on Data Protection (Directive 95/46/EC) and local data protection legislation based on this directive. LIBER is urged to take political action on this issue in order that the general public may have the same access to the collection of internet materials as it has to other national collections.
Who’s Whose? The Balkan Literary Context
Per Jacobsen
Studi Slavistici , 2009,
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