This article presents the results of a study conducted in a Metallurgical industry located in the town of Santa Rosa--Rio Grande do Sul State, Brazil. Its central goal was to obtain a better understanding of the struc...This article presents the results of a study conducted in a Metallurgical industry located in the town of Santa Rosa--Rio Grande do Sul State, Brazil. Its central goal was to obtain a better understanding of the structural changes in the organization and identify its working practices through both case and bibliographic studies, taking into consideration the technological advances and the new management being implemented in the company, due to its acquisition by a multinational company. The proposal of a new organizational structure which has brought inevitable changes to the organizations but the structure needs to be well defined to lead to the company under study and its employees the best way, through continuous improvement and competitive entrepreneurship. The results obtained enable a better understanding of the history and nature of changes in the organization, considering it as a living and changing system.展开更多
Background:We utilized transcystic clearance and intra-operative papillotomy through a rendezvous technique for the treatment of cholecysto-choledocolithiasis.The goal of this study was to evaluate the reliability of ...Background:We utilized transcystic clearance and intra-operative papillotomy through a rendezvous technique for the treatment of cholecysto-choledocolithiasis.The goal of this study was to evaluate the reliability of pre-operative parameters to address the most suitable surgical procedure.Methods:A total of 180 patients affected by calculi of the gallbladder and bile duct underwent the single-stage treatment.According to several pre-operative parameters,141 patients had to supposedly undergo transcystic clearance of the bile duct,while 39 patients had to be treated with the rendezvous technique.All patients were treated with the sequential procedure:first,we tried the transcystic procedure and,if there was a failure,we used a rendezvous technique.We prospectively analysed each group based on a series of variables such as sex,age,operative time,success rate of proposed treatment,conversion rate,post-operative complications and hospital stay.Results:Transcystic clearance was successful in 134 out of 141 patients(95.0%),while 2 patients needed to undergo a laparo-endoscopy procedure(failure).Thirty-five out of 39 patients(89.7%)obtained common bile-duct(CBD)clearance through the rendezvous technique,while 1 patient obtained clean-up through the simple transcystic procedure(failure).Five out of 141 patients with transcystic clearance and 3 out of 39 patients with the rendezvous technique underwent laparotomy CBD clearance with conversion rates of 3.5%and 7.7%,respectively.Post-operative complications showed similar percentages for both procedures.However,the surgical time turned out to be longer for the rendezvous technique.Conclusions:The one-stage procedure for the treatment of cholecysto-choledocolithiasis was possible in 94%of the cases utilizing a surgical technique selected according to the patient’s case history.The pre-operative parameters,such as jaundice,CBD diameters and stone diameters,have certified their reliability as good predictors of the most suitable procedure to follow.展开更多
文摘This article presents the results of a study conducted in a Metallurgical industry located in the town of Santa Rosa--Rio Grande do Sul State, Brazil. Its central goal was to obtain a better understanding of the structural changes in the organization and identify its working practices through both case and bibliographic studies, taking into consideration the technological advances and the new management being implemented in the company, due to its acquisition by a multinational company. The proposal of a new organizational structure which has brought inevitable changes to the organizations but the structure needs to be well defined to lead to the company under study and its employees the best way, through continuous improvement and competitive entrepreneurship. The results obtained enable a better understanding of the history and nature of changes in the organization, considering it as a living and changing system.
文摘Background:We utilized transcystic clearance and intra-operative papillotomy through a rendezvous technique for the treatment of cholecysto-choledocolithiasis.The goal of this study was to evaluate the reliability of pre-operative parameters to address the most suitable surgical procedure.Methods:A total of 180 patients affected by calculi of the gallbladder and bile duct underwent the single-stage treatment.According to several pre-operative parameters,141 patients had to supposedly undergo transcystic clearance of the bile duct,while 39 patients had to be treated with the rendezvous technique.All patients were treated with the sequential procedure:first,we tried the transcystic procedure and,if there was a failure,we used a rendezvous technique.We prospectively analysed each group based on a series of variables such as sex,age,operative time,success rate of proposed treatment,conversion rate,post-operative complications and hospital stay.Results:Transcystic clearance was successful in 134 out of 141 patients(95.0%),while 2 patients needed to undergo a laparo-endoscopy procedure(failure).Thirty-five out of 39 patients(89.7%)obtained common bile-duct(CBD)clearance through the rendezvous technique,while 1 patient obtained clean-up through the simple transcystic procedure(failure).Five out of 141 patients with transcystic clearance and 3 out of 39 patients with the rendezvous technique underwent laparotomy CBD clearance with conversion rates of 3.5%and 7.7%,respectively.Post-operative complications showed similar percentages for both procedures.However,the surgical time turned out to be longer for the rendezvous technique.Conclusions:The one-stage procedure for the treatment of cholecysto-choledocolithiasis was possible in 94%of the cases utilizing a surgical technique selected according to the patient’s case history.The pre-operative parameters,such as jaundice,CBD diameters and stone diameters,have certified their reliability as good predictors of the most suitable procedure to follow.
