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O artigo apresenta a economia circular, seus conceitos, princípios, benefícios e as mudanças na produção e pós-produção, além de abordar aspectos sobre economia linear, sustentabilidade, logística e logística reversa. A produção tradicional de bens e serviços usa, em grande maioria, recursos extraídos da natureza de forma intensa e em uma velocidade que não permite tempo para sua regeneração. No final da produção e no pós-consumo dos produtos, ocorre um acúmulo de resíduos nem sempre adequadamente descartados ou tratados, com outro impacto na natureza - o lixo, que muitas vezes tem valor, se processado adequadamente, podendo ser aproveitado como insumo de outros processos e, no limite, nem existir. A economia circular traz mudanças significativas na produção e na cadeia de suprimentos, alterando formas de consumo, de relacionamento na cadeia de suprimentos, na produção e do próprio negócio. Aborda o desenvolvimento sustentável e como a economia circular contribui para a melhoria do meio ambiente, dos negócios e das pessoas, a importância da logística e logística reversa na economia circular e na sustentabilidade sob o ponto de vista econômico, ambiental e social, gerando benefícios e valor para as partes envolvidas. Também são comentados aspectos de empresas no Brasil que praticam a economia circular.

Chronic lymphocytic leukemia (CLL) is an indolent lymphoproliferative disorder and is manifested by progressive accumulation of B cells in the blood, bone marrow and lymphatic tissues. Chronic Myeloid Leukemia (CML) is a clonal myeloproliferative disorder characterized by the presence of all the stages of myeloid development in the peripheral blood, and it is believed to be driven by the aberrant protein tyrosine kinase, a product of the mutant BCR-ABL1 gene.Multiple Myeloma (MM) is characterized by the accumulation of clonal plasmcells in the bone marrow with skeletal lesions, anemia, hypercalcemia and renal failure. Our patient is a 78 year-old man. In 2014 diagnosis of CLL and monoclonal gammopathy of undetermined significance (MGUS).At diagnosis: HB 13.5 g/dl; normal renal function;calcium 8.7 mg/dl;IgG 1678 mg/dl,serum immunoelectrophoresis: IgG kappa, Bence Jones kappa; total protein 7.5 g/dl, beta1 6,5%, beta2 24,1%;peripheral blood immunophenotyping showed CLL, FISH:negative;Cariotype: 46, XY; RX skeleton: positive for osteolytic lesions, total body TC scan: adenopathies of 18 mm and 15 mm at bilateral axillary level, norma spleen, adenopathy of 22 cm in the left obturator iliac region; presence of left hip prosthesis; bone marrow biopsy: localization by low-grade plasmacytoma.No CLL.The patient was only observed until April 2015, when there was a presence of myelocytes and metamyelocytes in peripheral blood and an increased spleen (18 cm). So he performed : bone marrow aspirate: diagnosis of CML (Sokal Score: 1,34 H; Eutos Score: 60 L, Hasford Score 1488,5);bone marrow biopsy: suggestive for a myeloproliferative disease (CML), MGUS with a modest lymphoid B component,BCR-ABL: 60;FISH: pathological presence of double fusion signal of the ABL1 and BCR loci in 209 of 271 interphase nuclei examined (77%).The patient started therapy with Imatinib, 400mg/die until July 2015, on the basis of the good response to treatment and the progressive increase of the M component that confirmed the progression to MM: Hb 9.1 g/dL, creatinine 1,1 mg/dl;calcium 10,5 mg/dl;total protein: 8,6 g/dl, gamma 48.02% (CM 4 gr); IgG 3536 mg/dl, cariotype: male with t (9; 22) and Philadelphia chromosome (25%);BCR-ABL: 14,32; bone marrow aspirate: plasmacells 15%;bone marrow biopsy: intermediate-interstitial plasmacytoma, CLL / lymphoma; RMN whole body: hyperintensity at the level of the seventh right rib; PET: osteolytic lesions of the side arch tenth right rib, right iliac bone, left iliac region, right tibia third diaphyseal.RX right hemithorax: osteolytic area at the level of the seventh right rib. So the patient started treatment with Bortezomib, Desamethasone, Alkeran (total 7 cycles).On March 2016, he performed a radiography that showed many osteolytic areas of 45 mm on third distal femur, third proximal and intermediate tibia, third proximal and third distal of fibula.A second PET documented a further MM progression due to new bone localizations and a left tibia biopsy showed localization disease. Radiotherapy colleagues have ruled out the usefulness of a radiation therapy program in consideration of the cerebral damage risk. On June 2016 the patient started a treatment with Lenalidomide for 15 days, interspersed by Glivec, maintaining the disease stable. In September 2017 he developed diplopia and with a nasal surgery, only inflammatory tissue was exported. A revision of the material confirmed plasmacytoma localization. In the same period appearance of a right gluteus sore treated initially with surgical dressing.As blood tests revealed increase of paraprotein levels, bone marrow biopsy resulted negative to myeloma and lymphoma diseases, instead a gluteal skin biopsy revealed plasmacytoma. It was decided to treat cerebral localization due to diplopia and peripherical paralysis. Radiotherapy was started on April 2018 (18 sessions). Bone marrow aspirate test showed plasmacells 15%, BCR-ABL dosage: 213,87, M component increase(5gr), IgG 4440 mg/dl, creatinine and serum calcium: normal. Due to disease progression, a rescue chemotherapy was started according to PAD protocol. After 4 cycles, a bone marrow aspirate documented the presence of plasmacells equal to 80%.The cytogenetic study confirmed the presence of a complex karyotype. So the patient started therapy with Daratumumab, Lenalidomide and Desamethasone which is currently ongoing with an excellent hematological and clinical response Disclosures Ciolli: Janssen: Honoraria; Abbvie: Research Funding.

ObjectiveThe purpose of this case-control study is to evaluate the prevalence of occult temporal encephalomeningocele (OTE) in patients with temporal lobe epilepsy (TLE) of unknown etiology presenting to an epilepsy center, independently from drug sensitivity.MethodsWe studied 95 patients with TLE (51 female, mean age 49.4 ± 17.1 years) and 151 controls (88 female, mean age 54.1 ± 21.0 years) using a 1.5T brain MRI, including balanced steady-state gradient echo sequences, targeted to the temporal lobes.ResultsOTE was found in 5.2% of the TLE population (9.5% of drug-resistant TLE) and in none of the controls (p = 0.008). Two patients with OTE and drug-resistant TLE became seizure-free after lesionectomy (follow-up 18–24 months).ConclusionOTE is not a rare finding in unselected patients with TLE of unknown origin, provided that it is carefully searched. The absence of OTE in a large group of nonepileptic controls adds evidence to its epileptogenic role.

Aortic injuries represent a rare but life-threatening complication of spinal surgery. Perforation of the aorta due to pedicle screw penetration or misplacement can lead to immediate bleeding with hemodynamic instability or to pseudoaneurysm development with delayed risk of rupture, which can occur weeks to months later. Recently, thoracic endovascular aortic repair (TEVAR) in aortic trauma has contributed to a reduction of both mortality and morbidity. The literature on this subject is reviewed. doi: 10.1111/jocs.12052 (J Card Surg 2013;28:163–167)

Giant sacral tumors present unique challenges to surgeons because there is no established consensus regarding the best treatment options. The authors report on the care of and outcome in a patient presenting with low-back pain only, who underwent preoperative biopsy sampling and subsequent embolization of the feeding vessels of a giant, sacral cellular schwannoma. The main procedure was performed via a combined posterior-anterior approach with complete microsurgical removal of the tumor, without the use of instrumentation, bracing, or adjuvant radio- and chemotherapy. At the 10-year follow-up, no evidence of residual tumor, recurrence, or instability was recognizable. Giant, sacral cellular schwannomas can be aggressively completely removed without any significant morbidity, achieving long-term control of the disease.

STUDY DESIGN A case report and clinical discussion. OBJECTIVE To describe the diagnosis, pathophysiology, and treatment of a papillary renal cell carcinoma that developed an intradural spinal mass with cauda equina infiltration. SUMMARY OF BACKGROUND DATA Cancers that metastasize intradurally to the spinal canal are uncommon, accounting for the 6% of all spinal metastases. Those from renal cell carcinoma are especially unusual. Only 3 reports that describe the spread of metastatic renal cell carcinoma to the cauda equina have been published to our knowledge. METHODS A female patient had undergone nephrectomy for the treatment of the papillary renal cell carcinoma 2 years before, and only 1 localization (at the genital tract) was previously diagnosed. The patient presented with lower back pain irradiated to both legs, vesical incontinence, and severe paraparesis. RESULTS Preoperative magnetic resonance images of the lumbar spine showed an intradural spinal mass from L3-L5 with infiltration of the cauda equina; the lesion measured 62 mm craniocaudally and 16 mm anteroposteriorly, and thus occupied the majority of the intrathecal space at that level. The magnetic resonance images, surgical treatment, and related pathophysiology are reviewed. CONCLUSIONS The majority of cauda equina tumors are primary tumors, and metastases are very rare. To our knowledge, this is the fourth case described of metastasis of renal cell carcinoma at the cauda equina and the first of papillary type.

IntroductionThere are several options to treat instable thoraco-lumbar spinal fractures without spinal cord involvement. A short percutaneous posterior instrumentation [SPPI] (i.e., involving only ...

An Erratum for this article can be found here: http://iospress.metapress.com/content/e16437020701m0u5/?p=df8dd6709cf44367a0c0e5d917aaeddf&pi=11We describe the cases of two adult sisters recently diagnosed with the attenuated form of mucopolysaccharidosis VI (MPS VI, Maroteaux-Lamy syndrome). MPS VI is a rare, clinically heterogeneous lysosomal storage disorder that is characterized by a deficiency in the glycosaminoglycan-degrading enzyme arylsulfatase B. Both cases had been misdiagnosed for over 30 years despite the presence of several characteristics of the disease, including short stature (mild), coarse facial features, skeletal dysmorphisms, carpal tunnel syndrome, heart valve disease, and spinal cord compression, which together are suggestive of a lysosomal storage disease. Awareness about the clinical features of MPS VI should be communicated amongst treating neurologists, rheumatologists and other specialists who are involved in the healthcare decisions of these patients with presenting symptoms, so they can refer them to specialized centers for proper diagnosis and treatment.

Giant sacral tumors present unique challenges to surgeons because there is no established consensus regarding the best treatment options. The authors report on the care of and outcome in a patient presenting with low-back pain only, who underwent preoperative biopsy sampling and subsequent embolization of the feeding vessels of a giant, sacral cellular schwannoma. The main procedure was performed via a combined posterior-anterior approach with complete microsurgical removal of the tumor, without the use of instrumentation, bracing, or adjuvant radio- and chemotherapy. At the 10-year follow-up, no evidence of residual tumor, recurrence, or instability was recognizable. Giant, sacral cellular schwannomas can be aggressively completely removed without any significant morbidity, achieving long-term control of the disease.

Meningiomas are meningothelial cell neoplasms that account for approximately 25% of all primary intracranial tumors. Most meningiomas are slow-growing benign lesions, and they are usually attached to the inner surface of the dura mater. Nevertheless, since the first description by of Cushing and Eisenhardt, many meningiomas without dural attachment have been reported. A subgroup located in the sylvian fissure (also called deep sylvian meningiomas) has been described, and these represent a radiological and neurosurgical challenge. We describe an atypical sylvian fissure meningioma in a 23-year-old male with a brief history of headache and mild hemiparesis. We also review the pertinent literature defining the major epidemiological, clinical, radiological and surgical characteristics of these rare tumors.

A case report and clinical discussion.To describe the diagnosis, pathophysiology, and treatment of a papillary renal cell carcinoma that developed an intradural spinal mass with cauda equina infiltration.Cancers that metastasize intradurally to the spinal canal are uncommon, accounting for the 6% of all spinal metastases. Those from renal cell carcinoma are especially unusual. Only 3 reports that describe the spread of metastatic renal cell carcinoma to the cauda equina have been published to our knowledge.A female patient had undergone nephrectomy for the treatment of the papillary renal cell carcinoma 2 years before, and only 1 localization (at the genital tract) was previously diagnosed. The patient presented with lower back pain irradiated to both legs, vesical incontinence, and severe paraparesis.Preoperative magnetic resonance images of the lumbar spine showed an intradural spinal mass from L3-L5 with infiltration of the cauda equina; the lesion measured 62 mm craniocaudally and 16 mm anteroposteriorly, and thus occupied the majority of the intrathecal space at that level. The magnetic resonance images, surgical treatment, and related pathophysiology are reviewed.The majority of cauda equina tumors are primary tumors, and metastases are very rare. To our knowledge, this is the fourth case described of metastasis of renal cell carcinoma at the cauda equina and the first of papillary type.