RESUMO
The Andean tree genus Polylepis (Rosaceae) is notorious for the high morphological plasticity of its species and the difficulty in their circumscription. The evolutionary mechanisms that have driven diversification of the genus are still poorly understood, with factors as diverse as ecological specialisation, reticulate evolution, polyploidisation and apomixis being proposed to contribute. In the present study, chromosome counts, flow cytometry and stomata guard cell size measurements were employed to document for the first time the presence of polyploidy in the genus and to infer ploidy levels for most species. Inferred ploidy levels show a clear progression from diploidy in cloud forest species to polyploidy (tetra- to octoploidy) in the morphologically and ecologically specialised incana group, indicating that polyploidisation may have played a major role in speciation processes and the colonisation of novel habitats during the Andean uplift. At least two species of Polylepis comprise populations with varying degrees of ploidy. More extensive studies are needed to obtain a better understanding of the prevalence and effects of intraspecific polyploidy in the genus.
Assuntos
Poliploidia , Rosaceae/genética , Árvores/genética , Cromossomos de Plantas , DNA de Plantas/genética , Cariotipagem , Estômatos de Plantas/anatomia & histologia , América do SulRESUMO
The present paper shows the way a mental health organization works and, at the same time, examines some results upon the post-therapy follow-up for outpatient treatments, the therapists' qualities perceived by the patients and the readmission rate. The results are twofold: for internal purposes, they allow a feedback for continuous quality improvement. For the outside, they generate information for future comparisons among other similar organizations. This paper also address the debate between two major stands in the field of psychotherapy research (one for the Evidence Based Psychotherapy and the other for the Psychotherapy Based on Common Features).
Assuntos
Satisfação do Paciente , Psicoterapia , Adolescente , Adulto , Idoso , Criança , Seguimentos , Humanos , Pessoa de Meia-IdadeRESUMO
The present paper shows the way a mental health organization works and, at the same time, examines some results upon the post-therapy follow-up for outpatient treatments, the therapists qualities perceived by the patients and the readmission rate. The results are twofold: for internal purposes, they allow a feedback for continuous quality improvement. For the outside, they generate information for future comparisons among other similar organizations. This paper also address the debate between two major stands in the field of psychotherapy research (one for the Evidence Based Psychotherapy and the other for the Psychotherapy Based on Common Features).
RESUMO
The present paper shows the way a mental health organization works and, at the same time, examines some results upon the post-therapy follow-up for outpatient treatments, the therapists qualities perceived by the patients and the readmission rate. The results are twofold: for internal purposes, they allow a feedback for continuous quality improvement. For the outside, they generate information for future comparisons among other similar organizations. This paper also address the debate between two major stands in the field of psychotherapy research (one for the Evidence Based Psychotherapy and the other for the Psychotherapy Based on Common Features).
Assuntos
Feminino , Humanos , Cirurgia Geral , Ginecologia , Procedimentos Cirúrgicos em GinecologiaRESUMO
We describe an 8-year-old boy who had asymptomatic hypercalcemia 4 years after radiotherapy involving the left orbit and lungs. A right parathyroid adenoma was diagnosed, and normocalcemia was achieved after its removal. Routine monitoring of serum calcium and phosphate levels is recommended for children after head and neck irradiation.
Assuntos
Adenoma/etiologia , Neoplasias Induzidas por Radiação , Neoplasias das Paratireoides/etiologia , Rabdomiossarcoma/radioterapia , Criança , Terapia Combinada , Humanos , Hipercalcemia/etiologia , Hiperparatireoidismo/etiologia , Masculino , Rabdomiossarcoma/tratamento farmacológico , Hormônios Tireóideos/sangueRESUMO
Eight patients with persistent hyperinsulinemic hypoglycemia of infancy who were treated with octreotide without pancreatectomy are described. All had severe, early-onset disease that would have required partial pancreatectomy had octreotide not been available. Along with octreotide, frequent feedings and raw cornstarch at night were required by all. Octreotide was given in three or four daily subcutaneous injections in four patients and in a continuous subcutaneous infusion with an insulin infusion pump in four. All had mild, transient gastrointestinal symptoms (vomiting, abdominal distention, steatorrhea) after the start of therapy. Asymptomatic gallstones were found in 1 patient after 1 year of treatment. No other long-term untoward effects were noted, including no detrimental effect on psychomotor development. Growth was not affected in five of six patients treated for more than 6 months. In five patients, octreotide was discontinued after 9 months to 5 1/2 years; patients were given diazoxide instead, two required percutaneous gastrostomy, and one 5 1/2-year-old child required no further treatment. The remaining three patients (aged 5 to 9 months) are still being treated with octreotide. We conclude that, with the use of octreotide, pancreatectomy can be avoided in some patients. Particularly in light of our findings of a high incidence of diabetes years after partial pancreatectomy, and clinical improvement after months to years of octreotide treatment, we believe that aggressive medical therapy, when effective, is preferable to partial pancreatectomy.