bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acromegaly: a review of current medical therapy and new drugs on the horizon
Authors: Fleseriu Maria , Delashaw Johnny B. , Cook David M. 
Published: October 2010

Acromegaly is a disease that results from a growth hormone (GH)–secreting pituitary tumor. Clinically, the disease is characterized by excessive skeletal growth, soft tissue enlargement with disfigurement, and increased risk of cardiovascular death. The goals of treatment are the removal or reduction of the tumor mass via surgery and normalization of GH secretion. Another treatment goal is the preservation of normal pituitary function if possible.
Transsphenoidal surgery by an experienced neurosurgeon is usually the first line of therapy, especially for small tumors. Surgeon expertise is crucial for outcome, with dedicated pituitary surgeons having better results. However, overall cure rates remain low because patients with these tumors usually present at an incurable stage. Therefore, medical therapy to control excess GH secretion plays a significant role in a large proportion of patients with acromegaly who are not cured by surgery or other forms of therapy, such as radiotherapy, and/or are awaiting the effects of radiotherapy. If surgery is not curative, lifelong monitoring and the control of excess GH is usually necessary by a care team experienced in handling this chronic disease.
In the past decade major progress has occurred in the development of highly specific and selective pharmacological agents that have greatly facilitated more aggressive management of active acromegaly. Treatment approach should be individualized and take into consideration a patient's tumor size and location, symptoms, comorbid conditions, and preferences. Because a surgical cure can be difficult to achieve, all patients, even those with what seems to be a clinically and biochemically inactive disease, should undergo long-term biochemical testing and pituitary MR imaging.
Patterns of extrasellar extension in growth hormone–secreting and nonfunctional pituitary macroadenomas
Authors: Zada Gabriel , Lin Ning , Laws Edward R. 
Published: October 2010

Object
Growth patterns of pituitary adenomas have been observed to vary by histopathological subtype. The authors aimed to analyze variations in the patterns of extrasellar extension of nonfunctional macroadenomas (NFMAs) and growth hormone (GH)–secreting macroadenomas.

Methods
A retrospective review was conducted of data obtained in 75 patients who underwent transsphenoidal operations for histologically confirmed NFMAs (50 patients) and GH-secreting macroadenomas (25 patients) at the Brigham and Women's Hospital over an 18-month period. Patients with microadenomas and prior operations were excluded from the analysis. Preoperative MR images were reviewed to assess patterns of extrasellar extension in the varying tumor subtypes.

Results
The mean maximal tumor diameter in NFMAs and GH-secreting macroadenomas was 26 and 16 mm, respectively (p < 0.0001). Extension of the NFMAs occurred into the following regions: infrasellar, 23 patients (46%); suprasellar, 41 patients (82%); and cavernous sinus, 20 patients (40%). Extension of GH-macroadenomas occurred into the following regions: infrasellar, 18 patients (72%); suprasellar, 4 patients (16%); and cavernous sinus, 4 patients (16%). Compared with GH-adenomas, NFMAs were more likely to develop suprasellar extension (82% vs 16%, p < 0.0001), cavernous sinus extension (40% vs 16%, p = 0.04), and isolated suprasellar extension (30% vs 4%, p = 0.0145). GH-macroadenomas had higher overall rates of infrasellar extension (72% vs 46%, p < 0.05), and isolated infrasellar extension (52% vs 6%, p < 0.0001). Of the 13 GH-macroadenomas with isolated infrasellar extension, 5 (42%) met WHO criteria for atypical adenomas.

Conclusions
Substantial differences in extrasellar growth patterns were observed among varying histological subtypes of pituitary macroadenomas. Despite smaller tumor diameters, GH-macroadenomas demonstrated a proclivity for infrasellar extension, whereas NFMAs exhibited preferential extension into the suprasellar region.
Olfactory improvement in acromegaly after transnasal transsphenoidal surgery
Authors: Actor Bertrand , Sarnthein Johannes , Prömmel Peter , Holzmann David , Bernays René L. 
Published: October 2010

Object
The direct transnasal transsphenoidal approach to the sellar region has become a widely adopted surgical procedure among neurosurgeons and ear, nose, and throat specialists. Nasal complications and their incidence have been investigated, but a systematic testing of olfactory disturbance has not previously been performed. Considering that the sense of smell is deeply anchored and interwoven within the CNS, and that its impairment implies a considerable loss in quality of life, surgical practice should aim at its preservation.

Methods
In this retrospective study, pre- and postoperative olfactory performance, nasal airway passage, septal perforation, and epistaxis were assessed in 96 patients who underwent direct transnasal transsphenoidal microsurgery at the authors' department between January 2007 and August 2009. Olfactory performance was assessed using the Sniffin' Sticks test and/or the Zürcher Geruchstest.

Results
After surgery, 47 (49%) of 96 patients improved, 34 (35%) of 96 deteriorated, and 15 (16%) of 96 presented with unchanged olfactory performance. With respect to the underlying pathological entity, the authors noticed a remarkable difference between patients with acromegaly (23 cases) and all other patients (73 cases). Fifteen (65%) of 23 patients with acromegaly improved (others 44%), only 3 (13%) of 23 deteriorated (others 42%), and 5 (22%) of 23 remained unchanged (others 14%) in their ability to distinguish odors. This illustrates a significant shift toward improved postoperative olfactory performance (cross-tabulation, Fisher exact test; p = 0.028) in patients with acromegaly.
In nasal breathing, 77 (80%) of 96 patients noticed no change, 11 (12%) of 96 improved, and 8 (8%) of 96 worsened postoperatively. Of the 11 patients with improved breathing, 6 (55%) had acromegaly. Improved nasal airway patency was more frequent in patients with acromegaly (cross-tabulation, Fisher exact test; p = 0.002).

Conclusions
The data provide the first significant evidence for improvement in olfactory performance in patients with acromegaly after transsphenoidal surgery (TSS) of growth hormone–producing adenomas. Furthermore, postoperative olfactory disturbance in patients treated with transnasal TSS is more frequent than previously reported. Nevertheless, recurrent transnasal TSS can be performed successfully, even multiple times, and does not involve a higher risk of nasal complications.
Intraoperative magnetic resonance imaging–assisted transsphenoidal pituitary surgery in patients with acromegaly
Authors: Bellut David , Hlavica Martin , Schmid Christoph , Bernays René L. 
Published: October 2010

Object
Acromegaly is a rare disease, usually caused by a growth hormone (GH)–producing pituitary adenoma. If untreated, severe cardiovascular, metabolic, cosmetic, and orthopedic disturbances will result. Surgery is generally recommended as the first-line treatment. Transsphenoidal surgical techniques were recently extended by the introduction of intraoperative MR (iMR) imaging. In the present study, the contribution of ultra-low-field (0.15-T) iMR imaging to tumor resection, complication avoidance, and endocrinological and neurological outcome was analyzed.

Methods
A series of 39 consecutive transsphenoidal iMR imaging–guided (using the PoleStar N20 device) surgical procedures performed between September 2005 and August 2009 for GH-producing pituitary adenomas was retrospectively analyzed. In addition to the patients' clinical data, the following criteria were evaluated independently: duration of surgery; length of hospital stay; endocrinological parameters; results of neurological examinations; and pre-, post-, and intraoperative MR imaging results.

Results
Thirty-seven patients with acromegaly underwent 39 transsphenoidal surgeries for pituitary adenomas. During a median follow-up period of 30 months (range 9–56 months), the remission rate was 73.5% in 34 patients with primary surgery and 20% in 5 cases with previous surgery; overall the remission rate was 66.7%. There were no serious postoperative complications. Detection of tumor remnant on iMR imaging led to a 5.1% increase in remission rate.

Conclusions
In this largest study to date of GH-producing pituitary adenomas in which iMR imaging–guided transsphenoidal surgery was analyzed, the results suggest that this method is a highly effective and safe treatment modality, even compared with previously published surgical series in which high-field iMR imaging was used. Limitations of iMR imaging are the detection of small residual tumor in the cavernous sinus and persisting disease that could not be observed, even on diagnostic high-field follow-up MR images. This points to a general limitation regarding remission rates that can be achieved using iMR imaging. Nevertheless, iMR imaging led to an increase of the remission rate in this study.
Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center
Authors: Gondim Jackson A. , Almeida João Paulo , de Albuquerque Lucas Alverne F. , Gomes Erika , Schops Michele , Ferraz Tania 
Published: October 2010

Object
Acromegaly is a chronic disease related to the excess of growth hormone (GH) and insulin-like growth factor–I secretion, usually by pituitary adenomas. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The introduction of endoscopy as an additional tool for surgical treatment of pituitary adenomas and, therefore, acromegaly represents an important advance of pituitary surgery in the recent years. The aim of this retrospective study is to evaluate the results of pure transsphenoidal endoscopic surgery in a series of patients with acromegaly who were operated on by a pituitary specialist surgeon. The authors discuss the advantages, outcome, complications, and factors related to the success of the endoscopic approach in cases of GHsecreting adenomas.

Methods
The authors retrospectively analyzed data from cases involving patients with GH-secreting adenomas who underwent pure transsphenoidal endoscopic surgery at the Department of Neurosurgery of the General Hospital in Fortaleza, Brazil, between 2000 and 2009. Tumors were classified according to size as micro- or macroadenomas, and tumor extension was analyzed based on suprasellar/parasellar extension and sella floor destruction. All patients were followed up for at least 1 year. The criteria of disease control were GH levels < 1 ng/L after oral glucose tolerance test and normal insulin-like growth factor–I levels for age and sex.

Results
During the study period, 67 patients underwent pure endoscopic transsphenoidal surgery for treatment of acromegaly. Disease control was obtained in 50 cases (74.6%). The rate of treatment success was higher in patients with microadenomas (disease control achieved in 12 [85.7%] of 14 cases) than in those with larger lesions. Suprasellar/parasellar extension and high levels of sella floor erosion were associated with lower rates of disease control (p = 0.01 and p = 0.02, respectively). Complications related to the endoscopic surgery included epistaxis (6.0%), transitory diabetes insipidus (4.5%), and 1 case of seizure (1.5%).

Conclusions
Endoscopic transsphenoidal surgery represents an effective option for treatment of patients with acromegaly. High disease control rates and a small number of complications are some of the most important points related to the technique. Factors related to the success of the endoscopic surgery are lesion size, suprasellar/parasellar extension, and the degree of sella floor erosion. Although presenting important advantages, there is no conclusive evidence that endoscopy is superior to microsurgery in treatment of GH-secreting adenomas.
Endoscopic endonasal transsphenoidal surgery for growth hormone–secreting pituitary adenomas
Authors: Hofstetter Christoph P. , Mannaa Raaid H. , Mubita Lynn , Anand Vijay K. , Kennedy John W. , Dehdashti Amir R. , Schwartz Theodore H. 
Published: October 2010

Object
The aim of this study was to determine the preoperative predictors of the extent of resection and endocrinological remission following endonasal endoscopic removal of growth hormone (GH)-secreting pituitary adenomas.

Methods
The authors analyzed a prospectively collected database of 24 consecutive acromegalic patients who underwent endoscopic endonasal transsphenoidal surgery. The extent of resection was evaluated on postoperative contrast-enhanced MR imaging. Endocrinological remission was defined as normal insulin-like growth factor I (IGFI) serum levels and either a nadir GH level of < 0.4 ng/ml after an oral glucose load or a basal GH serum level < 1 ng/ml.

Results
The majority of acromegalic patients (83%) had macroadenomas > 1 cm in maximum diameter. Gross-total resection was achieved in 17 (71%) of 24 patients. Notably, endoscopic transsphenoidal surgery allowed complete resection of all lesions without cavernous sinus invasion, regardless of the suprasellar extent. Biochemical remission was achieved in 11 (46%) of 24 patients. A smaller tumor volume and a postoperative reduction in GH serum levels were associated with a higher rate of biochemical cure (p < 0.05). During a 23-month follow-up period 5 patients (21%) underwent Gamma Knife treatment of any residual disease to further reduce excess GH production. Twenty patients (83%) reported significant relief of their symptoms, while 3 (13%) considered their symptoms stable. Two patients (8%) with large macroadenomas experienced postoperative panhypopituitarism, and 2 patients (8%) suffered from CSF leaks, which were treated with lumbar CSF diversion.

Conclusions
A purely endoscopic endonasal transsphenoidal adenoma resection leads to a high rate of gross-total tumor resection and endocrinological remission in acromegalic patients, even those harboring macroadenomas with wide suprasellar extension. Extended approaches and angled endoscopes are useful tools for increasing the extent of resection.
Selective dorsal rhizotomy in children with spastic hemiparesis
Authors: Oki Allison , Oberg Wende , Siebert Beth , Plante Dutch , Walker Marion L. , Gooch Judith L. 
Published: October 2010

Object
Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe spasticity, which can lead to significant deformity and interfere with function. Treatments for spasticity include oral medications, intramuscular botulinum toxin type A injections, orthopedic surgeries, intrathecal baclofen pump implantation, and selective dorsal rhizotomy (SDR). Selective dorsal rhizotomy, which has been well studied in children with spastic diplegia, results in significant reduction in spasticity and improved function in children. To the authors' knowledge, there are no published outcome data for SDR in patients with spastic hemiparesis. The object of this study was to examine the effects of SDR on spastic hemiparesis.

Methods
A 2-year study was undertaken including all children with spastic hemiparesis who underwent SDR at the authors' institution. The degree of spasticity, as measured by the Modified Ashworth Scale or quality of gait rated using the visual gait assessment scale, the gait parameters, and velocity were compared in patients before and after undergoing SDR.

Results
Thirteen children (mean age 6 years 7 months) with spastic hemiparesis underwent SDR performed by the same surgeon during a 2-year period. All of the patients had a decrease in tone in the affected lower extremity after the procedure. The mean reduction in tone in 4 muscle groups (hip adductors, knee flexors, knee extensors, and ankle plantar flexors) according to the modified Ashworth scale score was 2.6 ± 1.26 (p < 0.0001). The quality of gait was assessed in 7 patients by using the visual gait assessment scale. This score improved in 6 patients and remained the same in 1. Stride length and gait velocity were measured in 4 children. Velocity increased in 3 patients and decreased in a 3-year-old child. Parents and clinicians reported an improvement in quality of gait after the procedure. Stride length increased bilaterally in 3 patients and increased on one side and decreased on the other in the other patient.

Conclusions
Selective dorsal rhizotomy showed efficacy in the treatment of spastic hemiparesis in children. All of the patients had decreased tone after SDR as measured by the modified Ashworth scale. The majority of patients had qualitative and quantitative improvements in gait.
Posterior reversible encephalopathy syndrome during posterior fossa tumor resection in a child
Authors: Patel Akash J. , Fox Benjamin D. , Fulkerson Daniel H. , Yallampalli Sasidhar , Illner Anna , Whitehead William E. , Curry Daniel J. , Luerssen Thomas G. , Jea Andrew 
Published: October 2010

Posterior reversible encephalopathy syndrome (PRES) has been described in the setting of malignant hypertension, renal disease, eclampsia, and immunosuppression. In addition, a single case of intraoperative (posterior fossa craniotomy) PRES has been reported; however, this case occurred in an adult.
The authors present a clinically and radiographically documented case of intraoperative PRES complicating the resection of a posterior fossa tumor in a 6-year-old child. During tumor resection, untoward force was used to circumferentially dissect the tumor, and excessive manipulation of the brainstem led to severe hypertension for a 10-minute period. An immediate postoperative MR image was obtained to rule out residual tumor, but instead the image showed findings consistent with PRES. Moreover, the patient's postoperative clinical findings were consistent with PRES.
Aggressive postoperative management of blood pressure and the institution of anticonvulsant therapy were undertaken. The patient made a good recovery; however, he required a temporary tracheostomy and tube feedings for prolonged lower cranial nerve dysfunction.
Posterior reversible encephalopathy syndrome can occur as a result of severe hypertension during surgery, even among young children. With prompt treatment, the patient in the featured case experienced significant clinical and radiographic recovery.
The art of chatting on the Internet
Authors: Verville Danielle , Lafrance Jean-Paul 
Published: October 2010

This examination of how people behave in a virtual environment shows that interactional conventions are transposed from real life, rather than modified.
After immersing themselves in the world of The Palace, a leading French- language chat room, the authors have identified a highly codified community. They describe the way this community functions in detail, from a Goffmanian viewpoint.
L’émergence d’un droit communautaire africain de la concurrence : “double variation sur une partition européenne”
Authors: Priso-Essawe Samuel-Jacques 
Published: October 2010

In order to be more attractive to foreign investments, the Western African Economic and Monetary Union (UEMOA) and the Central African Economic and Monetary Community(CEMAC) have recently issued regional regulations on economic competition. Largely inspired by the European Community competition law, these regulations tend to propose adapted rules in the specific African context.
The rising community competition law in Africa is surprising to some extent: where unlawful practices are defined on the European community law basis, a typical pattern is built to ensure fair competition practices, with the private economic forces contributing to this enforcement; but the model sometimes remains open to criticism as regarding the fundamental treaties or some local problems.
Perceptions of Level I and Level II Fieldwork in the Same Site
Authors: Evenson Mary , Barnes Mary Alicia , Cohn Ellen S. 
Published: October 2010

Abstract
Perceptions of the Same Site Model (SSM) of fieldwork, where students complete a Level I and Level II fieldwork requirement in the same setting, were examined by survey. The benefits, drawbacks, and implications of the SSM are discussed. Fieldwork educators and students identified gaining familiarity with the setting, increased comfort and decreased anxiety, and preparation for Level II fieldwork as benefits of this model. The SSM survey results suggest that this model may be helpful in decreasing stress associated with fieldwork as experienced by students and fieldwork educators.
Confluence: Moving Forward With Affective Strength
Authors: Peloquin Suzanne M. 
Published: October 2010

Abstract
The term confluent education describes a flowing together of the affective and cognitive elements of learning. Confluent education accords high value to affect because of its core principle that the realization of human potential includes attention to the affective elements of human nature. This article reviews the literature on confluent education, extends a previous introduction of the topic, and proposes an integration of affect into all realms of occupational therapy practice. The visual metaphors, philosophical principles, and practical strategies developed in the literature on confluent education are useful when applied to the functions of occupational therapy practitioners engaged in direct care, education, or research. Because the contexts within which occupational therapy practice occurs today often challenge its affective elements, the author proposes confluence as a timely approach. To advance into the future with the affective strength that has characterized occupational therapy since its inception is a matter of reclaiming the profession’s heart.
Occupational Therapy’s Dance With Diversity
Authors: Black Roxie M. 
Published: October 2010

Abstract
As the demographics of the United States continue to change and we become a more pluralistic society, the increased diversity of the occupational therapy workforce and our consumers calls for an examination of the profession’s stance on multiculturalism and diversity. Using the metaphor of dance, this article identifies the dance partners as the organization’s leaders and its members. A historical review of the profession from the 1940s to the present traces the partners’ steps to determine which led the dance of diversity during the profession’s development. In this review, I discovered that the period when the profession most effectively and productively explored issues of diversity was during the early- to mid-1990s—a time when the organization and its members worked in harmony. At that time, occupational therapy’s dance with diversity flowed with rhythm and synchronicity.
Ecological Synergies in Two Groups of Zoo Chimpanzees: Divergent Patterns of Time Use
Authors: Wood Wendy 
Published: October 2010

Abstract
This study investigated how two groups of zoo chimpanzees, one that lived in a small and mostly barren physical habitat yet had a successful social history and the other that lived in a larger and more enriched physical habitat yet had a turbulent social history, invested time occupationally. Different ecological synergies were found to emerge from these respective conditions and to influence time use in highly particularistic ways. As related to considerations of adaptedness, the limits of enriched physical environs when coupled with a dearth of social facilitation were revealed, as were the limits of social facilitation within impoverished physical spaces. Findings suggest that occupational therapists’ expertise in activity analysis could be enlarged to encompass analysis of naturally socially embedded ways of doing things across multiple contexts. To advance the ethic of occupational justice, functional assessments of individuals could also be expanded into functional assessments of the occupational aliveness of proximate life environments.