bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative computed tomography registration and electromagnetic neuronavigation for transsphenoidal pituitary surgery: accuracy and time effectiveness
Authors: Eboli Paula , Shafa Bob , Mayberg Marc 
Published: June 2010

Object
The authors assessed the feasibility, anatomical accuracy, and cost effectiveness of frameless electromagnetic (EM) neuronavigation in conjunction with portable intraoperative CT (iCT) registration for transsphenoidal adenomectomy (TSA).

Methods
A prospective database was established for data obtained in 208 consecutive patients who underwent TSA in which the iCT/EM navigation technique was used. Data were compared with those acquired in a retrospective cohort of 65 consecutive patients in whom fluoroscope-assisted TSA had been performed by the same surgeon. All patients in both groups underwent transnasal removal of pituitary adenomas or neuroepithelial cysts, using identical surgical techniques with an operating microscope. In the iCT/EM technique–treated cases, a portable iCT scan was obtained immediately prior to surgery for registration to the EM navigation system, which did not require rigid head fixation. Preexisting (nonnavigation protocol) MR imaging studies were fused with the iCT scans to enable 3D navigation based on MR imaging data. The accuracy of the navigation system was determined in the first 50 iCT/EM cases by visual concordance of the navigation probe location to 5 preselected bony landmarks. For all patients in both cohorts, total operating room time, incision-to-closure time, and relative costs of imaging and surgical procedures were determined from hospital records.

Results
In every case, iCT registration was successful and preoperative MR images were fused to iCT scans without affecting navigation accuracy. There was 100% concordance between probe tip location and predetermined bony loci in the first 50 cases involving the iCT/EM technique. Total operating room time was significantly less in the iCT/EM cases (mean 108.9 ± 24.3 minutes [208 patients]) compared with the fluoroscopy group (mean 121.1 ± 30.7 minutes [65 patients]; p < 0.001). Similarly, incision-to-closure time was significantly less for the iCT/EM cases (mean 61.3 ± 18.2 minutes) than for the fluoroscopy cases (mean 71.75 ± 19.0 minutes; p < 0.001). Relative overall costs for iCT/EM technique and intraoperative C-arm fluoroscopy were comparable; increased costs for navigation equipment were offset by savings in operating room costs for shorter procedures.

Conclusions
The use of iCT/MR imaging–guided neuronavigation for transsphenoidal surgery is a time-effective, cost-efficient, safe, and technically beneficial technique.
Neurosurgical rotations or clerkships in US medical schools
Authors: Fox Benjamin D. , Amhaz Hassan H. , Patel Akash J. , Fulkerson Daniel H. , Suki Dima , Jea Andrew , Sawaya Raymond E. 
Published: June 2010

Object
Medical student exposure to neurosurgery is limited. To improve the educational interactions between neurosurgeons and medical students as well as neurosurgical medical student rotations or clerkships (NSCs) we must first understand the current status.

Methods
Two questionnaires were sent, one to every neurosurgery course coordinator or director at each US neurosurgery residency program (99 questionnaires) and one to the associated parent medical school dean's office (91 questionnaires), to assess the current status of NSCs and the involvement of neurosurgeons at their respective institutions.

Results
We received responses from 86 (87%) of 99 neurosurgery course coordinators or directors and 64 (70%) of 91 medical school deans' offices. Most NSCs do not have didactic lectures (53 [62%] of 86 NSCs), provide their medical students with a syllabus or educational handouts (53 [62%] of 86), or have a recommended/required textbook (77 [90%] of 86). The most common method of evaluating students in NSCs is a subjective performance evaluation. Of 64 medical school deans, 38 (59%) felt that neurosurgery should not be a required rotation. Neurosurgical rotations or clerkships are primarily offered to students in their 4th year of medical school, which may be too late for appropriate timing of residency applications. Only 21 (33%) of 64 NSCs offer neurosurgery rotations to 3rd-year students.

Conclusions
There is significant room for improvement in the neurosurgeon-to–medical student interactions in both the NSCs and during the didactic years of medical school.
Predictors of Gastrostomy Placement and Dependence in Oropharyngeal Cancer Patients Treated with Chemoradiotherapy
Authors: Har-El Gady , McCoul Edward D , Sundaram Krishnamurthi 
Published: June 2010

AbstractIntroductionTreatment of oropharyngeal cancer (OPC) with primary chemoradiotherapy (CRT) may necessitate placement of a gastrostomy tube (GT). We sought to identify factors that may predict GT placement and dependence.Materials and methodsA retrospective review of 61 consecutive patients receiving primary CRT for OPC over a 10-year period at a tertiary referral center. Patients with prior head and neck malignancy, distant metastasis, incomplete treatment course, or inadequate follow-up were excluded. Forty-four patients were included for analysis.ResultsSixty-one percent of tumors were located in the tonsil and 62% were stage IV disease at presentation. Complete response to CRT occurred in 36 patients, among whom GT placement was more likely when weight loss occurred before the start of CRT than after CRT (p= 0.028). Continued GT dependence was more likely in patients with GT placement after the start of CRT (p= 0.019). Multivariate analysis showed significant associations of GT placement with post-treatment dysphagia and mucositis. Advanced tumor stage was a significant predictor of GT dependence.ConclusionsProphylactic GT placement may be advisable in patients receiving CRT for OPC who have pretreatment weight loss. Conversely, GT may be withheld from asymptomatic patients.
B-mode and Power Doppler Ultrasound in Adnexal Masses
Authors: Ajossa Silvia , Paoletti Anna Maria , Garau Nicoletta , Mais Valerio , Piras Bruno , Silvetti Enrico , Melis Gian Benedetto , Angioni Stefano , Angiolucci Marco , Pilloni Monica 
Published: June 2010

Abstract
Adnexal masses can be classified in ovarian, paraovarian or tubal. In the present review we analyzed the diagnostic performance of transvaginal ultrasonography in identifying simple ultrasonographic findings of benign adnexal pathology but also the role of color Doppler in the differential diagnoses between benign and malignant masses and in the preoperative triage. Because of many kinds of adnexal masses have usually a typical ultrasound appearance, the results of the studies present in literature showed a good and sufficient diagnostic accuracy. Unfortunately some cases with uncertain findings are present and in these cases the addition of color Doppler can be useful as demonstrated by several authors. Using the location of flow evaluated using color Doppler as main parameter a mass should be graded as malignant if flow is shown centrally within the excrescences or solid areas. The same approach should be used to triage the patients with adnexal masses to the most appropriate surgical approach with an increase of less invasive surgery.
Cervical Length, Volume and Flow Indices During Pregnancy by Transvaginal 2D and 3D Ultrasonography
Authors: Yig¢iter Alin Basşgül , Kavak Zehra Nesşe 
Published: June 2010

Abstract
Recently, many researches suggested that 2D US is insufficient for defining the true sagittal plane of uterine cervix. When the cervix is bent or curved, it is difficult to get a perfect sagittal section but rather mid oblique image by 2D US. Only 3D US allows us to evaluate the cervix in the coronal section and reproduce images in many cut. Coronal section of the cervix is especially useful in evaluating cervical funneling. Diagnosing internal orifice dilatation, asymmetrical, flattened or fissure-like cervices is possible. 3D US favors a more detailed study of cervical anatomy and biometry than 2D US. Cervical evaluation by 3D multiplanar sections can be added in the screening for preterm labor.
Three-dimensional (3D) imaging combined with power Doppler, theoretically provides the possibility to assess the volume and quantify the power Doppler signal in the whole target organ, whereas, information from 2D US on vascularization and blood flow is restricted to a single subjectively chosen 2D plane. The measurement of cervical indices is reproducible and may be used in clinical practice and research to determine the changes of the cervical morphology and vascularization in pregnancy. Consequently, further studies of 3D ultrasound imaging of the cervix in pregnancy and clinical correlations to obstetrical events are required for better understanding the physiology and functional pathophysiology of the cervix during pregnancy.
Study of Fetal Neurodevelopment in Multiple Pregnancies
Authors: Azumendi Guillermo , Perva Sejfulah , Marton Ingrid , Al-Noobi Madeeha 
Published: June 2010

Abstract
According to many reports multiple pregnancies compared to singelton have a 5-10 fold increased risk for CP and some of increased risk is due to the risk of preterm delivery, no mater whether, it mono or dizygotic conception. In those cases CP is most probably complication of peripartal periventricular hemorrhage or leukomalacia. Known fact about twins is that the lower is the gestational age at the time of delivery, the probability that they are monozygotic is greater. Monochorionic multiple pregnancies and feto-fetal hemodynamic transfusion instability are leading to cerebral ischemia. For all of mentionable reasons monozygotic multiple pregnancies have a greater risk of cerebral impairment.
CP in an apparently singleton pregnancy could be associated with a “vanishing” twin phenomenon. There are reports that some of the congenital anomalies in apparently singleton pregnancies may be associated with the unrecognized or unrecorded loss of a co-twin.
It has been established that ART conceptions are at a greater risk of CP because of the greater risk of preterm delivery. There have been many attempts to minimize CP prevalence by reduction of number of fetuses in a multifetal ART pregnancy but without affect, most probably because the majority of ART conceptions are dizygotic.
Pre- and Postnatal Features of Hydrometrocolpos in One Fetus of a Dizygotic Twin Pregnancy
Authors: Troyano-Luque Juan Mario , de la Rosa Margarita Álvarez , Padilla Ana Isabel , Ces Laura , Martínez José María , Puerto Bienvenido , Gratacós Eduardo , Mercé Luis Tadeo 
Published: June 2010

Abstract
A female fetus of a dizygotic pregnancy presented with a retrovesical cystic mass at 16 weeks. Severe and recurrent fetal ascitis developed at 25 weeks. Pre-eclampsia, probably due to mirror syndrome, precipitated fetal extraction, which led to severe prematurity complications and neonatal death. Necropsy showed: cloacal anomaly, anal atresia, ambiguous genitalia and bicornuate uterus.
Clinical Simulation in Modern Teaching and Training of Sonography in Obstetrics and Gynecology
Authors: Akins Ralitsa , Ho Hoi 
Published: June 2010

Abstract
Advances in computer technology, hardware and software have made ultrasound a diagnostic imaging technique of choice in certain areas of medicine or specialties such as obstetrics and gynecology. In teaching and training of obs/gyne ultrasonography, medical educators can utilize different forms of clinical simulators: traditional standardized patients and standard ultrasound diagnostic equipment, computer-based simulators, ultrasound simulators or ultrasound simulators with manikins. The popularity of a simulator is determined not only by its features, ease of use and cost, but also by its available learning modules and applications.
Technology in ultrasound and computers are rapidly advancing in enhancing the quality and miniaturizing ultrasound machines. Portable and handheld ultrasound equipments are quickly becoming indispensable diagnostic instruments in different health care settings especially the emergency rooms and physician offices. Concerns, however, remain related to the lack of competence of health care providers in using and interpreting results of ultrasound studies, and the needs to standardize the training in ultrasonography. It is important to have access to one or more ultrasound simulators; however, it is even more important to establish and integrate fundamental structure of training ultrasonography into the main training curriculum of undergraduate, graduate, and postgraduate medical education.
The Physiology of Pregnancy Illustrated with Ultrasound Images
Authors: Janssen Herbert F , Osborne David L 
Published: June 2010

Abstract
Pregnancy is the culmination of many unexplained anatomical, physiological, and biochemical processes. While many aspects of pregnancy remain vague, ultrasound imaging techniques have provided a clearer understanding of many aspects of the process. This has included a more complete description of the ovulation process and implantation of the blastocyst into the endometrium. Ultrasound imaging using 3-D and 4-D capabilities has also provided a dynamic view of fetal development. A clearer and more complete description of fetal circulation is now available. In the hands of trained individuals, ultrasound techniques have captured fetal heart images revealing both normal and abnormal development. As the techniques improve, this progression of knowledge will also increase our ability to understand the entire reproductive process.
Embryology of the Human Brain
Authors: Shiota Kohei 
Published: June 2010

AbstractIn this paper, the process of CNS development in human embryos and fetuses is described. The primordium of the nervous system appears as early as during the third week after fertilization, but its differentiation and maturation require a considerably long period of time until after birth. Therefore, the developing brain is vulnerable to various kinds of deleterious environmental effects during the preand perinatal life. This paper aims at giving an overview of the major organogenesis of the brain in human embryos and fetuses.
From Neonatal to Fetal Neurology: Some Clues for Interpreting Fetal Findings
Authors: Gosselin Julie , Amiel-Tison Claudine 
Published: June 2010

Abstract
As early as possible, neonatologists try to identify neonates at risk of unfavorable neurodevelopmental outcomes. They are fairly reliable in predicting very poor outcomes as well as optimal outcomes. However, within these two extremes, the prediction still remains a challenge. Immaturity of the neonatal brain constitutes a limit in itself. During decades with the growing knowledge of brain development, many methods have been developed for neurological assessment of the neonate. Neither of them applied alone was perfect in terms of clinical applicability, sensitivity, reproducibility and specificity.
The motor function is the first to provide the clinician with clues. Higher functions, in particular language and other cognitive functions, will develop later. However, recent researchers give credit to the brainstem for controlling exceedingly rudimentary learning-related cognitive-like activity. At present, the anticipation of late emerging developmental disabilities remains difficult even though early motor dysfunction has repeatedly been associated with a higher risk of intellectual or other learning disabilities. Despite our modest recent contribution to the domain of prediction, further studies on welldefined high risk populations with rigorous methodology that aim to demonstrate these links are still needed. Besides neurological observations, research is in process of including behavioral and stress/ reactivity measures; feasibility and benefits have to be demonstrated.
At present, fetal neurology is supported by neonatal neurology. Obstetricians are wise enough to take from both methods described above the elements they are able to transpose to fetal life. A comparative table of neonatal and fetal assessment is to be found elsewhere. As for neonatal neurology, the future of fetal neurology will have to rely on short- and long-term follow-up studies to define the predictive value of the chosen items. Obstetricians will have to be as patient as pediatricians, to work, step by step, towards defining optimality and impairment. They will have to be very careful when deciding to interrupt pregnancies; at the time being, such decisions are restricted to cases of very severe impairment. In line with the spectrum described above, they can expect to find more cases with moderate to mild abnormalities than cases with severe ones. However the most pleasant aspect for the echographer is to check fetal optimality. Just as a newborn infant categorized as at risk of brain damage is competent enough to demonstrate CNS integrity from birth, a high risk fetus will soon be competent enough to demonstrate CNS integrity before birth.
Maturation of Cerebral Connections and Fetal Behavior
Authors: Judas Milos , Kostovic Ivica 
Published: June 2010

AbstractModern imaging methods enabled systematic studies of fetal behaviour as well as a continuation of that behaviour in prematurely born infants (for a review, see 1-4). The following question represents a great challenge for human developmental neurobiologist: what is the neurobiological basis of various behavioural patterns observed in human fetuses and preterm infants?2 First of all, it is essential to determine whether there is an early spontaneous (nonsensory- driven) activity and to what extent the cerebrum and the cerebral cortex may be involved. In addition, it is necessary to describe for each successive phase, the developmental status of neuronal circuitry and synaptic organization.In this review, we present evidence on the development of cortical connections during different phases of fetal development and evaluate a possible functional significance of cerebral involvement.
Ultrasound Imaging in Animal Models of Human Disease—Is it a Step Toward Early Diagnosis in Humans?
Authors: Abramowicz Jacques S , Barua Animesh , Bitterman Pincas , Bahr Janice M , Sheiner Eyal , Luborsky Judith L 
Published: June 2010

AbstractDespite extensive research, cancer of the ovaries remains a major medical problem. The main reason is delay in diagnosis and hence, poor prognosis. This is due to issues in screening and a lack of specific symptoms in early disease. Yearly ultrasound examination and measurement of serum CA125 remain the recommended method despite less than ideal results. Animal research plays a major role in medical research, especially in cancer. Many publications describe the use of ultrasound in cancer research in a large variety of animals. Bmode, spectral and color Doppler have been employed and, more recently, ultrasound contrast agents, both for diagnostic and therapeutic purposes. We have demonstrated that ultrasound can be used to detect early ovarian cancer in the egg-laying chicken. The major advantage is that chickens develop spontaneous ovarian cancer, with a tumor histology that is identical to humans. Furthermore, chickens with ovarian tumors have serum anti-tumor antibodies similar to humans. In addition, the first sign that the egg-laying chicken is going to develop cancer is that it stops laying eggs prematurely.* Thus, a strong biological sign exists to categorize the chicken in a very high risk group, allowing sequential examinations at very close intervals. We have also shown that ultrasound contrast agents may be used for visualization of ovarian vascularity, a step, we hope, in the development of better methods for screening and early diagnosis.
Lower Urinary Tract Obstruction
Authors: Hajdu Julia , Harmath Ágnes , Pete Barbara , Zoltan Papp 
Published: June 2010

Abstract
Lower urinary tract obstruction is defined as partial or complete obstruction of the urinary tract at the level of the urethra and the bladder. The posterior urethral valves are the most common cause, 9 percent of the fetal uropathies. The incidence range is wide, because of different databases show different populations. The most severe obstructive uropathy is in patients with kidney damage, oligohydramnios and pulmonary insufficiency. If no prenatal intervention is performed, 45 percent of these patients die in the first 3 weeks of life and 25 percent have renal failure. In utero therapy is indicated to prevent renal damage and pulmonary hypoplasia in cases associated with progressive development of oligohydramnios. The treatment is usually limited to male fetuses with bladder outlet obstruction. The selection criteria (contraindications of fetal intervention) are: normal amniotic fluid volume, suggestion of nonobstructive dilatation of the urinary tract, sonographic evidence of renal cystic dysplasia, abnormal fetal urinary parameters, abnormal karyotype, presence of associated major congenital anomalies, fetal urinary parameters are above threshold. At the follow up after a prenatal intervention showed an apparent statistically significant improvement in perinatal survival with prenatal intervention relative to no intervention. Furthermore, there was no significant difference between the proportions of survivors with normal renal function who underwent bladder drainage and those who did not. Improved perinatal survival was also suggested in those fetuses with a poor prognosis. A nonsignificant improvement in perinatal survival for those fetuses with a good prognosis was also seen.
Polyhydramnios: An Update
Authors: Lapaire Olav , Holzgreve Wolfgang , Zanetti-Daellenbach Rosanna , Refecca Moffat Ecker , Irene Hbsli , Sevgi Tercanli 
Published: June 2010

Abstract
Maternal, fetal or placental pathologies may result in an excessive amount of amniotic fluid (AF) volume. Therefore, the surveillance of the AF volume, predominantly by ultrasound, has become an important instrument for the assessment of fetal well-being. An excessive accumulation of amniotic fluid, as a consequence of a disturbed balance between production, fetal resorption and secretion, is defined as polyhydramnios. Its degree correlates significantly with fetal morbidity and mortality. Therefore, polyhydramnios is an important clinical pattern in perinatal medicine. Approximately 20 percent of the fetuses with severe polyhydramnios show a congenital anomaly, whereas 50 percent of all cases are considered to be idiopathic, mostly with mild patterns. Furthermore, the likelihood of aneuploidy varies from 0.4 to 10 percent. Early detection, provides a correct diagnosis and allows a individual therapy. A referral to a tertiary center is advised in case of severe polyhydramnios and unknown etiology.
In this review, current diagnostic as well as therapeutical aspects are discussed.
Residual Fertility in Childhood Cancer Survivors
Authors: Battaglia Cesare , Mancini Fulvia , Persico Nicola , Cianciosi Arianna , Busacchi Paolo , Aloysio Domenico de 
Published: June 2010

Abstract
During the past three decades, major improvements have been made in the treatment and cure of certain hematological malignancies, as well as solid tumors in young patients. As a result of improved survival, attention has been turned to the long-term physical and psychological sequelae of treatment. The loss of fertility in males and premature menopause in females are important and common long-term side effects of curative radio- and chemotherapy. The frequency of fertility failure varies with the type, dose, duration of radio- and chemotherapy, and age of patient. Currently, there are no good estimates of the magnitude of the risk involved in relation to these factors. However, the combination of hormonal values, pubertal staging and the ultrasonography and Doppler analyses of the gonads may noninvasively study the subtle modification following anticancer therapies. This could help to find new insights on potential preventive acts before initiation of the anticancer therapy, and hopefully, the restoration of fertility after treatment.