We report a case of ectopic tubaric bilateral pregnancy. Given the low frequency of the disease w... more We report a case of ectopic tubaric bilateral pregnancy. Given the low frequency of the disease whose incidence ranges between 1 in 725 to 1 in 1,580 of all ectopic pregnancies. The factor that most often has been associated with bilateral ectopic pregnancy is the reproductive assisted therapy as a treatment for infertility, and its spontaneous appearance is almost exceptional. The case is of a 31 year old patient without any ectopic pregnancy risk factors who begins suffering from abdominal pain accompanied by nausea, vomiting, poor transvaginal bleeding, tachycardia and hypotension. Endovaginal ecocardiogram is done which suggests right broken tubaric ectopic pregnancy, it is scheduled for laparoscopy founding right ruptured tubarian ectopic pregnancy and left non ruptured ectopic pregnancy. Bilateral salpingostomy is done and the patient is discharged form hospital 48 hours later without complications.
The presence of malignant tumors during pregnancy complicates the management of both tumor and pr... more The presence of malignant tumors during pregnancy complicates the management of both tumor and pregnancy, since any diagnostic or therapeutic intervention could imply risks that may bring on detrimental effects to fetus or mother. The risks involved in exposing a fetus to cytotoxic therapy are associated to gestational age and the time of in utero exposure to that therapy. Cancer treatment has two different objectives: local control by surgery and radiotherapy, and one that seeks to eradicate systemic disease through chemotherapy, immunotherapy, hormone therapy, or targeted therapies.
Introduction: Hidradenoma papilliferum is a benign tumor of the apocrine glands that occurs in th... more Introduction: Hidradenoma papilliferum is a benign tumor of the apocrine glands that occurs in the female anogenital region, most often in women between 25-40 years of age; it measures 1-40 mm and is located in the labia majora (36%). In patients with recurrent bartholinitis, this pathology should be considered as a diagnosis since it is often underdiagnosed when it is not suspected. The treatment is complete excision of the tumor, which in most cases is curative. It is important to describe it because there are only a few cases reported in the literature. The objective of this article is to report a case of hidradenoma papilliferum and to review the literature, emphasizing the underdiagnosis of this condition. Case report: A 34-year-old female patient with a history of bilateral bartholinectomy in 2011 presented a vulvar mass in the left lower labia, which was punctured; the histopathological analysis showed hidradenoma papilliferum, followed by excision of the lesion, resulting in favorable outcome. Conclusion: Since it is a rare pathology with a difficult diagnosis, we recommend a high degree of suspicion to avoid misdiagnosis and reoperations.
Labial fusion is rarely presented in the postmenopausal age group, its predisposing factors are h... more Labial fusion is rarely presented in the postmenopausal age group, its predisposing factors are hipoestrogenism and a inflamation/repair process in the vaginal epithelium. Our case report involves a 73 years old woman that presents with urinary incontinence. On physical exploration, complete labial fusion was noted, a surgical approach was undertaken with liberation of the labia and fixation, postoperatory local estrogen ointment was indicated with complete recovery. The literature review confirmed that this was the ideal treatment and also confirms the role of local estrogen ointment as profilactic and therapeutic.
Anales Médicos de la Asociación Médica del Centro Médico ABC, May 15, 2015
The incidence rate of true umbilical knots is rare, occurring between 0.3-1.3% of all pregnancies... more The incidence rate of true umbilical knots is rare, occurring between 0.3-1.3% of all pregnancies. The rate of fetal death before delivery can be 4-10 times higher relative to the obstetric population with normal umbilical cord. This condition has been associated with several different risk factors and perinatal outcomes. The objective of this article is to describe four cases of true knots with favorable results are described, without perinatal outcomes.
Hemofilia adquirida. Una causa rara de hemorragia obstétrica reSUMen La hemofilia adquirida es un... more Hemofilia adquirida. Una causa rara de hemorragia obstétrica reSUMen La hemofilia adquirida es una enfermedad autoinmunitaria rara; cerca de 7 a 14% de todos los casos ocurre en el periodo posparto en el que se desarrolla un autoanticuerpo dirigido contra el factor VIII, que se manifiesta con hemorragia clínicamente significativa. Se debe sospechar si hay un recuento plaquetario normal, tiempo de protrombina normal con prolongación del tiempo de tromboplastina parcial activado que no se corrige con plasma. El tratamiento de la hemofilia posparto tiene como objetivo disminuir la hemorragia para disminuir la morbilidad y mortalidad.
Lecture notes in business information processing, 2018
Process modeling is a complex and important task in any business process management project. Gath... more Process modeling is a complex and important task in any business process management project. Gathering information to build a process model needs effort by analysts in different ways, such as interviews and document review. However, this documentation is not always well structured and can be difficult to be understood. Thus, techniques that allow the structuring and recognition of process elements in the documentation can help in the understanding of the process and, consequently, in the modeling activity. In this context, this paper proposes an approach to recognize business process elements in natural language texts. We defined a set of 32 mapping rules to recognize business process elements in texts using natural language processing techniques and which were identified through an empirical study in texts containing descriptions of a process. Furthermore, a prototype was developed and it showed promising results. The analyses of 70 texts revealed 73.61% precision, 70.15% recall and 71.82% F-measure. Moreover, two surveys showed that 93.33% of participants agree with the mapping rules and that the approach helps the analysts in both the time spent and the effort made in the process modeling task. This paper is a reiteration and an evolution of the work presented in Ferreira et al. [1].
Lecture notes in business information processing, 2018
The design of comprehensible process models is a very complex task. In order to obtain them, proc... more The design of comprehensible process models is a very complex task. In order to obtain them, process analysts usually rely on process modeling guidelines. This is specially true when dealing with collections counting up to hundreds of process models, since querying or organizing such a collection is not easy. In this paper we report a method presented in an earlier work to verify if a process model is following process modeling guidelines. In addition we propose an interface prototype to display which process models are not following which guidelines. A collection of 31 process models were used to validate the identification method and the results shows that 23 of these process models contains at least one guideline violation.
Process modeling guidelines are an essential tool to help process modelers to create models that ... more Process modeling guidelines are an essential tool to help process modelers to create models that are correct and easy to understand. Many guidelines have been proposed in the literature, but there is little empirical evidence to which extent guidelines are effectively used. This paper addresses this research gap by presenting the results of a semi-controlled experiment conducted on two occasions with 21 students from a Business Process Management course. Two successive process modeling tasks were compared, one before and one after the subjects were presented to a set of 20 guidelines, which were collected through a systematic literature review. From the results obtained with the experiment, it was observed that the subjects would be more receptive to the guidelines if they were easier to understand and use.
Process modeling plays a significant role in the business process lifecycle, as it must stress th... more Process modeling plays a significant role in the business process lifecycle, as it must stress the quality of process models for supporting all the next steps. However, this phase is time consuming and expensive, a consequence of the huge amount of unstructured input information. In a previous research, we presented an approach for identifying business process elements in natural language texts which facilitate the modeler’s work. Such approach relies on a set of mapping rules associated with natural language processing techniques. The identification itself was already validated, but how to apply this information to minimize the modelers’ effort remains unclear. Highlighting the identified rules in the text can enhance its comprehensibility. This paper explores the applicability of such mapping rules on supporting the modeler by marked up texts. The validation shows promising results, as the time spent and effort perceived by the modeler were both minimized.
Purpose-Process modeling guidelines are a valuable instrument for increasing the quality of proce... more Purpose-Process modeling guidelines are a valuable instrument for increasing the quality of process models. Since finding and selecting suitable guidelines are challenging, this paper aims to find and select suitable guidelines because they are scattered across the many studies of the literature. Also, not all of them are supported by empirical studies. Design/methodology/approach-The authors conducted a systematic literature review to collect and analyze process modeling guidelines present in the literature and the empirical evidence that supports them. Findings-The authors investigated a total of 793 articles and identified a total of 45 process modeling guidelines in five different categories. For each of these guidelines, the authors report empirical evidence together with corresponding measures, such as comprehension accuracy and error probability. Originality/value-Compared to the prior literature reviews on process model quality and process modeling guidelines, this article extends current knowledge by analyzing the empirical evidence and variables associated with each guideline. This analysis provides guidance for practitioners and scholars on which guidelines to use while modeling a process and perform further research on.
Pectus excavatum e assimetrias mamárias: correção com mamoplastia de aumento Introduction: Pectus... more Pectus excavatum e assimetrias mamárias: correção com mamoplastia de aumento Introduction: Pectus excavatum is defined as a depression approaching the sternum and costal cartilages to the spine. Several theories explain its etiology, the most accepted of which is the exaggerated growth of the costal cartilages, which causes a posterior displacement of the sternum and consequent depression. The treatment includes correction of breast asymmetries by using silicone breast implants in patients without cardiopulmonary symptoms, only with esthetic complaints. Methods: We reviewed the medical and photographic records of eight female patients diagnosed as having pectus excavatum, who underwent operation at a private hospital in the southern region of Brazil. These women sought consultation for local esthetic complaints and had no cardiorespiratory complaints. Results: Six patients submitted only for breast prosthesis placement. One patient had a prosthesis implanted 15 years before, which was replaced by a new implant in the same plane. Another patient had undergone pectus repair with Nuss surgery 10 years before, and the patient came to the hospital with a complaint of hypomasty and asymmetry. The preferred anesthesia was general anesthesia in five of the cases. The prosthesis inclusion plane in almost all the cases was subglandular. Only one patient had a complication (seroma). Conclusions: In our sample, the placement of breast prostheses in the patients with pectus excavatum brought harmonic esthetic results, attenuating and/or masking the chest defect, with satisfactory esthetic results for the patients.
Designing comprehensible process models is a complex task. Process analysts must rely on the expe... more Designing comprehensible process models is a complex task. Process analysts must rely on the experience of expert systems managers to achieve process models with high comprehensibility, also known as pragmatic quality. In the literature, this is portrayed as process modeling guidelines that help modelers to avoid common issues which hinder the comprehension of the process model. In this paper, we propose a method for the semiautomatic verification of business process models according to process modeling guidelines. This method uses the BPMN Ontology and the ontology editor Protégé to assist the modeler with validation of the process model's syntax before certifying its pragmatic quality. The validation of the developed method was applied to a collection of 31 process models and the results show that 23 process models of the collection contain at least one guideline violation.
Business process descriptions are useful documents that are becoming increasingly important for i... more Business process descriptions are useful documents that are becoming increasingly important for identifying and documenting business processes. They are particularly beneficial during discovery when information about the process is gathered in interviews or by observation. Such business process descriptions are written as natural language text, which makes them intrinsically ambiguous. For this reason, it is the major challenge to formulate them in a precise and correct way right from the start. Therefore, this paper presents a service oriented architecture that analyzes a process description written in natural language to generate a sound process description. Being sound means that a description is structured, unambiguous, reveals possible quality and soundness problems related to BPMN 2.0, and contains clear identifiers for all known process elements in the original text. More specifically, we develop specific analysis and transformation techniques that are integrated by our proposed architecture. For validation purposes, we have implemented a prototype of this architecture. Our evaluation demonstrates that our techniques to generate sound process descriptions cover an average of 95% of the information extracted from its original process description while maintaining quality properties. Finally, our architecture can be enhanced with additional services that contribute to the creation and management of processes descriptions in organizations.
We report a case of ectopic tubaric bilateral pregnancy. Given the low frequency of the disease w... more We report a case of ectopic tubaric bilateral pregnancy. Given the low frequency of the disease whose incidence ranges between 1 in 725 to 1 in 1,580 of all ectopic pregnancies. The factor that most often has been associated with bilateral ectopic pregnancy is the reproductive assisted therapy as a treatment for infertility, and its spontaneous appearance is almost exceptional. The case is of a 31 year old patient without any ectopic pregnancy risk factors who begins suffering from abdominal pain accompanied by nausea, vomiting, poor transvaginal bleeding, tachycardia and hypotension. Endovaginal ecocardiogram is done which suggests right broken tubaric ectopic pregnancy, it is scheduled for laparoscopy founding right ruptured tubarian ectopic pregnancy and left non ruptured ectopic pregnancy. Bilateral salpingostomy is done and the patient is discharged form hospital 48 hours later without complications.
The presence of malignant tumors during pregnancy complicates the management of both tumor and pr... more The presence of malignant tumors during pregnancy complicates the management of both tumor and pregnancy, since any diagnostic or therapeutic intervention could imply risks that may bring on detrimental effects to fetus or mother. The risks involved in exposing a fetus to cytotoxic therapy are associated to gestational age and the time of in utero exposure to that therapy. Cancer treatment has two different objectives: local control by surgery and radiotherapy, and one that seeks to eradicate systemic disease through chemotherapy, immunotherapy, hormone therapy, or targeted therapies.
Introduction: Hidradenoma papilliferum is a benign tumor of the apocrine glands that occurs in th... more Introduction: Hidradenoma papilliferum is a benign tumor of the apocrine glands that occurs in the female anogenital region, most often in women between 25-40 years of age; it measures 1-40 mm and is located in the labia majora (36%). In patients with recurrent bartholinitis, this pathology should be considered as a diagnosis since it is often underdiagnosed when it is not suspected. The treatment is complete excision of the tumor, which in most cases is curative. It is important to describe it because there are only a few cases reported in the literature. The objective of this article is to report a case of hidradenoma papilliferum and to review the literature, emphasizing the underdiagnosis of this condition. Case report: A 34-year-old female patient with a history of bilateral bartholinectomy in 2011 presented a vulvar mass in the left lower labia, which was punctured; the histopathological analysis showed hidradenoma papilliferum, followed by excision of the lesion, resulting in favorable outcome. Conclusion: Since it is a rare pathology with a difficult diagnosis, we recommend a high degree of suspicion to avoid misdiagnosis and reoperations.
Labial fusion is rarely presented in the postmenopausal age group, its predisposing factors are h... more Labial fusion is rarely presented in the postmenopausal age group, its predisposing factors are hipoestrogenism and a inflamation/repair process in the vaginal epithelium. Our case report involves a 73 years old woman that presents with urinary incontinence. On physical exploration, complete labial fusion was noted, a surgical approach was undertaken with liberation of the labia and fixation, postoperatory local estrogen ointment was indicated with complete recovery. The literature review confirmed that this was the ideal treatment and also confirms the role of local estrogen ointment as profilactic and therapeutic.
Anales Médicos de la Asociación Médica del Centro Médico ABC, May 15, 2015
The incidence rate of true umbilical knots is rare, occurring between 0.3-1.3% of all pregnancies... more The incidence rate of true umbilical knots is rare, occurring between 0.3-1.3% of all pregnancies. The rate of fetal death before delivery can be 4-10 times higher relative to the obstetric population with normal umbilical cord. This condition has been associated with several different risk factors and perinatal outcomes. The objective of this article is to describe four cases of true knots with favorable results are described, without perinatal outcomes.
Hemofilia adquirida. Una causa rara de hemorragia obstétrica reSUMen La hemofilia adquirida es un... more Hemofilia adquirida. Una causa rara de hemorragia obstétrica reSUMen La hemofilia adquirida es una enfermedad autoinmunitaria rara; cerca de 7 a 14% de todos los casos ocurre en el periodo posparto en el que se desarrolla un autoanticuerpo dirigido contra el factor VIII, que se manifiesta con hemorragia clínicamente significativa. Se debe sospechar si hay un recuento plaquetario normal, tiempo de protrombina normal con prolongación del tiempo de tromboplastina parcial activado que no se corrige con plasma. El tratamiento de la hemofilia posparto tiene como objetivo disminuir la hemorragia para disminuir la morbilidad y mortalidad.
Lecture notes in business information processing, 2018
Process modeling is a complex and important task in any business process management project. Gath... more Process modeling is a complex and important task in any business process management project. Gathering information to build a process model needs effort by analysts in different ways, such as interviews and document review. However, this documentation is not always well structured and can be difficult to be understood. Thus, techniques that allow the structuring and recognition of process elements in the documentation can help in the understanding of the process and, consequently, in the modeling activity. In this context, this paper proposes an approach to recognize business process elements in natural language texts. We defined a set of 32 mapping rules to recognize business process elements in texts using natural language processing techniques and which were identified through an empirical study in texts containing descriptions of a process. Furthermore, a prototype was developed and it showed promising results. The analyses of 70 texts revealed 73.61% precision, 70.15% recall and 71.82% F-measure. Moreover, two surveys showed that 93.33% of participants agree with the mapping rules and that the approach helps the analysts in both the time spent and the effort made in the process modeling task. This paper is a reiteration and an evolution of the work presented in Ferreira et al. [1].
Lecture notes in business information processing, 2018
The design of comprehensible process models is a very complex task. In order to obtain them, proc... more The design of comprehensible process models is a very complex task. In order to obtain them, process analysts usually rely on process modeling guidelines. This is specially true when dealing with collections counting up to hundreds of process models, since querying or organizing such a collection is not easy. In this paper we report a method presented in an earlier work to verify if a process model is following process modeling guidelines. In addition we propose an interface prototype to display which process models are not following which guidelines. A collection of 31 process models were used to validate the identification method and the results shows that 23 of these process models contains at least one guideline violation.
Process modeling guidelines are an essential tool to help process modelers to create models that ... more Process modeling guidelines are an essential tool to help process modelers to create models that are correct and easy to understand. Many guidelines have been proposed in the literature, but there is little empirical evidence to which extent guidelines are effectively used. This paper addresses this research gap by presenting the results of a semi-controlled experiment conducted on two occasions with 21 students from a Business Process Management course. Two successive process modeling tasks were compared, one before and one after the subjects were presented to a set of 20 guidelines, which were collected through a systematic literature review. From the results obtained with the experiment, it was observed that the subjects would be more receptive to the guidelines if they were easier to understand and use.
Process modeling plays a significant role in the business process lifecycle, as it must stress th... more Process modeling plays a significant role in the business process lifecycle, as it must stress the quality of process models for supporting all the next steps. However, this phase is time consuming and expensive, a consequence of the huge amount of unstructured input information. In a previous research, we presented an approach for identifying business process elements in natural language texts which facilitate the modeler’s work. Such approach relies on a set of mapping rules associated with natural language processing techniques. The identification itself was already validated, but how to apply this information to minimize the modelers’ effort remains unclear. Highlighting the identified rules in the text can enhance its comprehensibility. This paper explores the applicability of such mapping rules on supporting the modeler by marked up texts. The validation shows promising results, as the time spent and effort perceived by the modeler were both minimized.
Purpose-Process modeling guidelines are a valuable instrument for increasing the quality of proce... more Purpose-Process modeling guidelines are a valuable instrument for increasing the quality of process models. Since finding and selecting suitable guidelines are challenging, this paper aims to find and select suitable guidelines because they are scattered across the many studies of the literature. Also, not all of them are supported by empirical studies. Design/methodology/approach-The authors conducted a systematic literature review to collect and analyze process modeling guidelines present in the literature and the empirical evidence that supports them. Findings-The authors investigated a total of 793 articles and identified a total of 45 process modeling guidelines in five different categories. For each of these guidelines, the authors report empirical evidence together with corresponding measures, such as comprehension accuracy and error probability. Originality/value-Compared to the prior literature reviews on process model quality and process modeling guidelines, this article extends current knowledge by analyzing the empirical evidence and variables associated with each guideline. This analysis provides guidance for practitioners and scholars on which guidelines to use while modeling a process and perform further research on.
Pectus excavatum e assimetrias mamárias: correção com mamoplastia de aumento Introduction: Pectus... more Pectus excavatum e assimetrias mamárias: correção com mamoplastia de aumento Introduction: Pectus excavatum is defined as a depression approaching the sternum and costal cartilages to the spine. Several theories explain its etiology, the most accepted of which is the exaggerated growth of the costal cartilages, which causes a posterior displacement of the sternum and consequent depression. The treatment includes correction of breast asymmetries by using silicone breast implants in patients without cardiopulmonary symptoms, only with esthetic complaints. Methods: We reviewed the medical and photographic records of eight female patients diagnosed as having pectus excavatum, who underwent operation at a private hospital in the southern region of Brazil. These women sought consultation for local esthetic complaints and had no cardiorespiratory complaints. Results: Six patients submitted only for breast prosthesis placement. One patient had a prosthesis implanted 15 years before, which was replaced by a new implant in the same plane. Another patient had undergone pectus repair with Nuss surgery 10 years before, and the patient came to the hospital with a complaint of hypomasty and asymmetry. The preferred anesthesia was general anesthesia in five of the cases. The prosthesis inclusion plane in almost all the cases was subglandular. Only one patient had a complication (seroma). Conclusions: In our sample, the placement of breast prostheses in the patients with pectus excavatum brought harmonic esthetic results, attenuating and/or masking the chest defect, with satisfactory esthetic results for the patients.
Designing comprehensible process models is a complex task. Process analysts must rely on the expe... more Designing comprehensible process models is a complex task. Process analysts must rely on the experience of expert systems managers to achieve process models with high comprehensibility, also known as pragmatic quality. In the literature, this is portrayed as process modeling guidelines that help modelers to avoid common issues which hinder the comprehension of the process model. In this paper, we propose a method for the semiautomatic verification of business process models according to process modeling guidelines. This method uses the BPMN Ontology and the ontology editor Protégé to assist the modeler with validation of the process model's syntax before certifying its pragmatic quality. The validation of the developed method was applied to a collection of 31 process models and the results show that 23 process models of the collection contain at least one guideline violation.
Business process descriptions are useful documents that are becoming increasingly important for i... more Business process descriptions are useful documents that are becoming increasingly important for identifying and documenting business processes. They are particularly beneficial during discovery when information about the process is gathered in interviews or by observation. Such business process descriptions are written as natural language text, which makes them intrinsically ambiguous. For this reason, it is the major challenge to formulate them in a precise and correct way right from the start. Therefore, this paper presents a service oriented architecture that analyzes a process description written in natural language to generate a sound process description. Being sound means that a description is structured, unambiguous, reveals possible quality and soundness problems related to BPMN 2.0, and contains clear identifiers for all known process elements in the original text. More specifically, we develop specific analysis and transformation techniques that are integrated by our proposed architecture. For validation purposes, we have implemented a prototype of this architecture. Our evaluation demonstrates that our techniques to generate sound process descriptions cover an average of 95% of the information extracted from its original process description while maintaining quality properties. Finally, our architecture can be enhanced with additional services that contribute to the creation and management of processes descriptions in organizations.
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