bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic cyst fenestration in the treatment of uniloculated hydrocephalus in children
Authors: El-Ghandour Nasser M. F. 
Published: February 2013

Object
The treatment of uniloculated hydrocephalus is a difficult problem in pediatric neurosurgery. Definitive treatment is surgical, yet the approach remains controversial. This study evaluates the role of endoscopic cyst fenestration (ECF) in the management of this disease.

Methods
Thirty-one pediatric patients with uniloculated hydrocephalus who underwent endoscopic surgery, performed by the author, between May 1999 and December 2010 constitute the patient group for this study. The patients included 17 boys and 14 girls, with ages ranging from 5 months to 5 years (mean 22.9 months). Patients with multiloculated hydrocephalus were not included. The patients' charts were reviewed for demographic data, radiological findings, information regarding morbidity, improvement of hydrocephalus, incidence of recurrence, shunt dependency, and the need for shunt revision.

Results
Neuroepithelial cysts were the most common cause (17 cases), followed by postoperative gliosis due to previous shunt infection (9 cases), intraventricular hemorrhage (3 cases), and meningitis (2 cases). Multiplanar MRI was reliable in making the diagnosis and is indicated if CT shows disproportionate hydrocephalus. Surgical treatment included ECF (31 cases), endoscopic revision of malfunctioning preexisting shunts (9 cases), endoscopic third ventriculostomy (4 cases), and placement of a new shunt (3 cases). Endoscopic cyst fenestration was easily performed in all the cases, with devascularization of the cyst wall by coagulation to prevent recurrence. Improvement of hydrocephalus was observed in 26 cases (83.9%). Among the group of patients without prior shunts (22 cases), 3 patients (13.6%) required repeat ECF and 3 patients (13.6%) required placement of a shunt (new shunt placement). In the 9 patients with preexisting shunts, endoscopy reduced the mean rate of shunt revision from 2.7 revisions per year before fenestration to 0.25 per year after fenestration. Four of these 9 patients had multiple shunts, which could be converted to a single shunt; however, repeat ECF was necessary in all 9 patients. With a mean follow-up duration of 4.3 years, none of the patients with a prior shunt was able to become shunt-independent, whereas 86.4% of patients without a prior shunt were able to avoid shunt placement. Endoscopic complications were reversible (unilateral subdural effusion in 5 cases, minor arterial bleeding in 2 cases, CSF leakage in 1 case), and there was no death (0%).

Conclusions
Endoscopic cyst fenestration is recommended in the treatment of uniloculated hydrocephalus because it is effective, simple, minimally invasive, and associated with low morbidity and mortality rates. The fact that all previously shunt-treated patients needed repeat ECF and that none of these patients was able to become shunt-independent makes it clear that uniloculated hydrocephalus due to postoperative gliosis induced by previous shunt infection carries the worst prognosis.
Gamma Knife thalamotomy for tremor in the magnetic resonance imaging era
Authors: Kooshkabadi Ali , Lunsford L. Dade , Tonetti Daniel , Flickinger John C. , Kondziolka Douglas 
Published: February 2013

Object
The surgical management of disabling tremor has gained renewed vigor with the availability of deep brain stimulation. However, in the face of an aging population of patients with increasing surgical comorbidities, noninvasive approaches for tremor management are needed. The authors' purpose was to study the technique and results of stereotactic radiosurgery performed in the era of MRI targeting.

Methods
The authors evaluated outcomes in 86 patients (mean age 71 years; number of procedures 88) who underwent a unilateral Gamma Knife thalamotomy (GKT) for tremor during a 15-year period that spanned the era of MRI-based target selection (1996–2011). Symptoms were related to essential tremor in 48 patients (19 age ≥ 80 years and 3 age ≥ 90 years), Parkinson disease in 27 patients (11 age ≥ 80 years [1 patient underwent bilateral procedures]), and multiple sclerosis in 11 patients (1 patient underwent bilateral procedures). A single 4-mm isocenter was used to deliver a maximum dose of 140 Gy to the posterior-inferior region of the nucleus ventralis intermedius. The Fahn-Tolosa-Marin clinical tremor rating scale was used to grade tremor, handwriting, and ability to drink. The median follow-up was 23 months.

Results
The mean tremor score was 3.28 ± 0.79 before and 1.81 ± 1.15 after (p < 0.0001) GKT; the mean handwriting score was 2.78 ± 0.82 and 1.62 ± 1.04, respectively (p < 0.0001); and the mean drinking score was 3.14 ± 0.78 and 1.80 ± 1.15, respectively (p < 0.0001). After GKT, 57 patients (66%) showed improvement in all 3 scores, 11 patients (13%) in 2 scores, and 2 patients (2%) in just 1 score. In 16 patients (19%) there was a failure to improve in any score. Two patients developed a temporary contralateral hemiparesis, 1 patient noted dysphagia, and 1 sustained facial sensory loss.

Conclusions
Gamma Knife thalamotomy in the MRI era was a safe and effective noninvasive surgical strategy for medically refractory tremor in the elderly or those with contraindications to deep brain stimulation or stereotactic radiofrequency (thermal) thalamotomy.
Brainstem gangliogliomas: a retrospective series
Authors: Zhang Si , Wang Xiang , Liu Xuesong , Ju Yan , Hui Xuhui 
Published: February 2013

Object
The authors retrospectively analyzed data on brainstem gangliogliomas treated in their department and reviewed the pertinent literature to foster understanding of the preoperative characteristics, management, and clinical outcomes of this disease.

Methods
In 2006, the authors established a database of treated lesions of the posterior fossa. The epidemiology findings, clinical presentations, radiological investigations, pathological diagnoses, management, and prognosis for brainstem gangliogliomas were retrospectively analyzed.

Results
Between 2006 and 2012, 7 patients suffering from brainstem ganglioglioma were treated at the West China Hospital of Sichuan University. The mean age of the patients, mean duration of symptoms prior to diagnosis, and mean duration of follow-up were 28.6 years, 19.4 months, and 38.1 months, respectively. The main presentations were progressive cranial nerve deficits and cerebellar signs. Subtotal resection was achieved in 2 patients, and partial resection in 5. All tumors were pathologically diagnosed as WHO Grade I or II ganglioglioma. Radiotherapy and adjuvant chemotherapy were not administered. After 21–69 months of follow-up, patient symptoms were resolved or stable without aggravation, and MRI showed that the size of residual lesions was unchanged without progression or recurrence.

Conclusions
The diagnosis of brainstem ganglioglioma is of great importance given its favorable prognosis. The authors recommend the maximal safe resection followed by close observation without adjuvant therapy as the optimal treatment for this disease.
Quality measures for the management of hydrocephalus: concepts, simulations, and preliminary field-testing
Authors: Barton Spencer E. , Campbell Jeffrey W. , Piatt Joseph H. 
Published: February 2013

Object
The authors define and examine the properties of 2 new, practice-based quality measures for the management of hydrocephalus.

Methods
The Surgical Activity Rate (SAR) is defined as the number of definitive operations for the treatment of hydrocephalus performed in a neurosurgical practice over the course of a year, divided by the number of patients with hydrocephalus seen in follow-up during that year. The Revision Quotient (RQ) is defined as the number of definitive revision operations performed in a neurosurgical practice in the course of a year, divided by the number of definitive initial operations during that year for patients with newly diagnosed hydrocephalus. Using published actuarial shunt survival data, the authors conducted Monte Carlo simulations of a pediatric neurosurgical practice to illustrate the properties and interpretations of the SAR and RQ. They used data from the Kids' Inpatient Database (KID) for 2009 to calculate RQs for hospitals accounting for more than 10 admissions coded for initial CSF shunt insertions.

Results
During the initial growth phase of a simulated neurosurgical practice, the SAR approached its steady-state value much earlier than the RQ. Both measures were sensitive to doubling or halving of monthly failure rates. In the 2009 KID, 117 hospitals reported more than 10 initial shunt insertions. The weighted mean (± standard deviation) RQ for these hospitals was 1.79 ± 0.69. Among hospitals performing 50 or more initial shunt insertions, the RQ ranged between 0.71 and 3.65.

Conclusions
The SAR and RQ have attractive qualitative features as practice-based quality measures. The RQ, at least, exhibits clinically meaningful interhospital variation as applied to CSF shunt surgery. The SAR and RQ merit prospective field-testing as measures of quality in the management of childhood hydrocephalus.
Curve progression after decompression surgery in patients with mild degenerative scoliosis
Authors: Hosogane Naobumi , Watanabe Kota , Kono Hitoshi , Saito Masashi , Toyama Yoshiaki , Matsumoto Morio 
Published: February 2013

Object
The authors undertook this study to evaluate curve progression, risk factors for curve progression, and outcomes after decompression surgery in patients with degenerative lumbar scoliosis with minimal to moderate curvature.

Methods
Of 852 patients with lumbar canal stenosis treated by posterior decompression surgery, 50 patients had a lumbar curve greater than 10° at final follow-up. These patients were divided into 2 groups according to curve progression during the follow-up period: the P group (11 patients), with a curve progression of more than 5°, and the NP group (39 patients), with a curve progression of 5° or less. The authors compared preoperative parameters in these 2 groups to elucidate risk factors associated with curve progression and other surgical outcomes.

Results
The average lumbar curve progression in the total group of 50 patients was 3.4° ± 3.9° (range −2.0° to 22.0°). In the P group the average curve progression was 8.5°, and in the NP group it was 2.0°. Multivariate logistic regression analysis showed no significant association between curve progression and any of the potential risk factors evaluated (including curve magnitude, decompression method, and degenerative intervertebral disc changes). Spur formation, evaluated with the Nathan classification at the concave side of the curve, tended to be greater in the P group, although the difference was not statistically significant. There was no significant difference in revision surgery rate, and none of the patients required arthrodesis due to curve progression. Clinical outcomes, evaluated with the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and the Scoliosis Research Society 22-question questionnaire, were also similar in the 2 groups.

Conclusions
Surgical outcomes did not deteriorate in the P group. While curve progression after decompression surgery could not be predicted from the preoperative factors considered, spur formation at the concave side of the curve may be a candidate factor. The results of this study indicate that spinal fixation to halt deformity progression is not always necessary if the patient's pathological condition derives mainly from canal stenosis.
Accuracy and complications associated with the freehand C-1 lateral mass screw fixation technique: a radiographic and clinical assessment
Authors: Hu Yong , Kepler Christopher K. , Albert Todd J. , Yuan Zhen-shan , Ma Wei-hu , Gu Yong-jie , Xu Rong-ming 
Published: February 2013

Object
The aims of this study were to evaluate a large series of posterior C-1 lateral mass screws (LMSs) to determine accuracy based on CT scanning findings and to assess the perioperative complication rate related to errant screw placement.

Methods
Accuracy of screw placement was evaluated using postoperative CT scans obtained in 196 patients with atlantoaxial instability. Radiographic analysis included measurement of preoperative and postoperative CT scans to evaluate relevant anatomy and classify accuracy of instrumentation placement. Screws were graded using the following definitions: Type I, screw threads completely within the bone (ideal); Type II, less than half the diameter of the screw violates the surrounding cortex (safe); and Type III, clear violation of transverse foramen or spinal canal (unacceptable).

Results
A total of 390 C-1 LMSs were placed, but 32 screws (8.2%) were excluded from accuracy measurements because of a lack of postoperative CT scans; patients in these cases were still included in the assessment of potential clinical complications based on clinical records. Of the 358 evaluable screws with postoperative CT scanning, 85.5% of screws (Type I) were rated as being in the ideal position, 11.7% of screws (Type II) were rated as occupying a safe position, and 10 screws (2.8%) were unacceptable (Type III). Overall, 97.2% of screws were rated Type I or II. Of the 10 screws that were unacceptable on postoperative CT scans, there were no known associated neurological or vertebral artery (VA) injuries. Seven unacceptable screws erred medially into the spinal canal, and 2 patients underwent revision surgery for medial screws. In 2 patients, unilateral C-1 LMSs penetrated the C-1 anterior cortex by approximately 4 mm. Neither patient with anterior C-1 penetration had evidence of internal carotid artery or hypoglossal nerve injury. Computed tomography scanning showed partial entry of C-1 LMSs into the VA foramen of C-1 in 10 cases; no occlusion, associated aneurysm, or fistula of the VA was found. Two patients complained of postoperative occipital neuralgia. This was transient in one patient and resolved by 2 months after surgery. The second patient developed persistent neuralgia, which remained 2 years after surgery, necessitating referral to the pain service.

Conclusions
The technique for freehand C-1 LMS fixation appears to be safe and effective without intraoperative fluoroscopy guidance. Preoperative planning and determination of the ideal screw insertion point, the ideal trajectory, and screw length are the most important considerations. In addition, fewer malpositioned screws were inserted as the study progressed, suggesting a learning curve to the technique.
Ökosystemleistungen von Dauerwäldern – eine aktuelle Analyse des Waldbaus
Authors: Huth Franka , Wagner Sven 
Published: February 2013

Ecosystem services and continuous cover forests – a silvicultural analysis
Current concepts of “Dauerwald” or continuous cover forestry rely on complex silvicultural strategies, which are often modified according to site conditions and the management objectives of the forest owners. The preservation of continuity and the provision of an adequate structural diversity within forest ecosystems are the common underlying principles of the different concepts of continuous cover forestry. In light of the uncertainty of the predicted climatic changes, an increased risk of disturbances and changing demands regarding the services provided by forests, it is questionable whether the silvicultural strategies currently applied in the context of continuous cover forestry (e.g. “Plenterwald”) fully embrace these changes. In order to address this issue, forest structures favoured by concepts of continuous cover forestry are assessed with respect to their direct impact on different ecosystem services (utilization, conservation, recreation). The analysis illustrates that there are currently few studies dealing with the direct link between the silvicultural strategies applied in continuous cover forests, the forest structures resulting therefrom and, subsequently, the provided ecosystem services. Although continuous cover forests deliver a wide range of ecosystem services, their concept must nevertheless be developed further, because even in continuous cover forests the equitable maximization of diverse ecosystem services cannot be realized.
Cancer screening in the United States, 2013
Authors: Smith Robert A. , Brooks Durado , Cokkinides Vilma , Saslow Debbie , Brawley Otis W. 
Published: February 2013

AbstractAnswer questions and earn CME/CNEEach year the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection, a report on data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, current ACS cancer screening guidelines are summarized, as are updated guidelines on cervical cancer screening and lung cancer screening with low‐dose helical computed tomography. The latest data on the use of cancer screening from the National Health Interview Survey also are described, as are several issues related to screening coverage under the Patient Protection and Affordable Care Act of 2010. CA Cancer J Clin 2013;. © 2013 American Cancer Society.
Excess Female Siblings and Male Fetal Loss in Families with Systemic Lupus Erythematosus
Authors: Aggarwal Rachna , Sestak Andrea L. , Chakravarty Eliza F. , Harley John B. , Scofield R. Hal 
Published: February 2013

Objective.Systemic lupus erythematosus (SLE) occurs more frequently among women than men. We aimed to determine whether the male-female ratio in SLE families is different from what would be expected by chance, and whether excess male fetal loss is found.Methods.All patients with SLE met the revised American College of Rheumatology classification criteria, while unaffected subjects were shown not to satisfy these same criteria. Putative family relationships were confirmed by genetic testing. Pregnancy history was obtained from all subjects, including unrelated control women. Adjusted Wald binomial confidence intervals were calculated for ratio of boys to girls in families and compared to the expected ratio of 1.06.Results.There were 2579 subjects with SLE, with 6056 siblings. Considering all subjects, we found 3201 boys and 5434 girls (ratio 0.59, of 95% CI 0.576–0.602). Considering only the SLE-unaffected siblings, there were 2919 boys and 3137 girls (ratio 0.93, 95% CI 0.92–0.94). In both cases, the ratio of males to females was statistically different from the known birth rate. Among patients with SLE as well as among their sisters and mothers, there was an excess of male fetal loss compared to the controls.Conclusion.Siblings of patients with SLE are more likely than expected to be girls. This finding may be in part explained by excess male fetal loss, which is found among patients with SLE and their first-degree relatives.
Le sujet amoureux
Authors: Lauru Didier 
Published: February 2013

Résumé Sentiment méconnu et chanté par les poètes, l’expérience amoureuse est ineffable douloureuse et merveilleuse, unique et pourtant répétant l’ombre de nous-mêmes dans notre quête de l’autre toujours à jamais perdu. C’est au travers de cette recherche de l’autre à jamais perdu que le procès de la subjectivation avance. Nous le retrouvons dans le transfert sous un jour particulier. Les adultes renouent avec leur adolescence par le biais d’expériences amoureuses, qui peuvent saisir le sujet à tout âge !
Sur les traces d'un objet insaisissable
Authors: Journet-Diallo Odile 
Published: February 2013

Résumé Si l’ethnologue ne peut rien dire de l’affect éprouvé par l’« autre », il peut toutefois tenter d’en saisir les traces dans les matériaux (dispositifs institutionnels, littérature orale, témoignages, formes de jalousie) dont il dispose. C’est ce que tente cet article en examinant quelques cas de figure situés dans le contexte de deux types de sociétés africaines, les unes marquées par un fort taux de polygynie et la prévalence des tractations familiales sur les sentiments éprouvés par les intéressés, une autre par la prise en compte initiale de ces sentiments, mais leur dénigrement lorsqu’ils ne sont plus congruents avec les objectifs du mariage. Le détour par une autre catégorie de sentiment – ceux qu’une mère peut éprouver pour son enfant – et la façon dont il est traité, permet de mettre en relief le statut du sentiment amoureux là même où il semblerait pris en compte par les institutions. Dans tous les cas évoqués, « aimer dans son cœur » est l’ultime trésor qui résiste aux contraintes sociales.
Les enfants et les jeunes face à la pauvreté urbaine en Afrique
Authors: Djakaridja Koné 
Published: February 2013

Résumé Dans les rues des villes africaines, face à la pauvreté de nombreux enfants et jeunes, inventent quotidiennement, au détriment des activités éducatives fondamentales, des solutions originales pour survivre, dans l’indifférence générale et parfois l’exploitation organisée. Si la plupart de ces jeunes de la rue restent encore en lien avec leurs familles et continuent d’en être influencés, un nombre de plus en plus important, en rupture, échappent à tout contrôle adulte et vivent dans la rue. Ces situations confèrent à ces jeunes un rôle moteur dans les changements accélérés de l’espace urbain et la construction de nouvelles cultures urbaines « métissées » à la place des cultures « ethniques » villageoises en voie de disparition. Cela a rendu caduques les modes classiques d’encadrement et a invité les intervenants socio-éducatifs en milieu urbain à changer leurs regards et leurs approches.
A propos de L'Éducation sentimentale de Flaubert, écriture et réminiscence
Authors: Pynson Pascale 
Published: February 2013

Résumé L’éducation sentimentale, occupe une place centrale dans l’œuvre de Flaubert. Le texte est traversé par des réminiscences que Flaubert prête à son héros, Frédéric Moreau, et qui sont autant de retours du souvenir de sa première rencontre amoureuse. L’apparition-disparition dans leur évidence visuelle sont une des caractéristiques dans le roman d’un mode de progression dans l’apprentissage de Frédéric de sa vie d’adulte, tempéré par la certitude pour Flaubert que l’expérience originaire de l’amour ne pourrait que se répéter au travers de figures féminines dont on perçoit la dimension maternelle. Trois textes de jeunesse constituent la matrice du roman. A la lueur des études de Freud sur la vie sexuelle et les « constructions dans l’analyse », une relecture nous éclaire sur le travail du souvenir et d’une écriture qui se révèle comme une auto-analyse.
Voices of Family Members and Significant Others in the Tele–Intensive Care Unit
Authors: Jahrsdoerfer Mary , Goran Susan 
Published: February 2013

Background
Research suggests that tele–intensive care units (tele-ICUs) are associated with decreases in mortality rates, length of stay, and health care costs. However, little is known about the awareness and perceptions of the tele-ICU among patients’ significant others.

Objectives
To assess whether patients’ significant others were informed about the tele-ICU, what their preferences are regarding source and type of information about the tele-ICU, and what their perceptions are of the impact of the tele-ICU on patient care.

Methods
A survey was conducted with a nonprobability, convenience sample of patients’ significant others at 3 health systems.

Results
Two-thirds of patients’ significant others reported that they were uninformed about the tele-ICU and identified staff as the preferred source for this information. The 3 most important topics of information were patients’ physical privacy, impact on patient care, and the technology. Most expressed favorable perceptions of the tele-ICU.

Conclusions
This pilot study demonstrated significant gaps in communication about the tele-ICU between staff and patients’ significant others and revealed a preference to be informed about the tele-ICU by staff. Study findings will help define goals, objectives, and methods for further research to improve communication with patients’ significant others about the tele-ICU.