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Sample records for endonasal directo transesfenoidal

  1. Meningoencefalocele transesfenoidal transpalatina Transspheinoidal transpalatal meningoencephalocele

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    Marcílio Monteiro

    2006-09-01

    Full Text Available A meningoencefalocele transesfenoidal é rara apresentação dos disrafismos do tubo neural. Caracteriza-se pela herniação do tecido neural através de uma falha óssea no osso esfenóide. A apresentação clínica é variável, podendo ser desde assintomática até obstrução das vias aéreas, rinorréia, meningite, disfunção hipotalâmica e anomalias ópticas. Seu tratamento cirúrgico é controverso. Descrevemos o caso de um menino de 7 anos que apresentava uma estrutura pulsátil preenchendo o teto da cavidade oral, disgenesia palatina e hipertelorismo. O diagnóstico de meningoencefalocele transesfenoidal transpalatina foi confirmado pela tomografia computadorizada e ressonância magnética. A criança foi operada com sucesso pela via transpalatal/transesfenoidal.Transspheinoidal meningoencephalocele is a rare presentation of dysraphism of the neural tube. It is characterized by the herniation of the neural tissue through a bony defect in the sphenoid bone. The clinical presentation is variable. It may be assymptomatic or it may include an upper airway obstruction, rhinorrhea, meningitis, hypothalamic dysfunction and optic anomalies. The surgical treatment is controversial. We describe the case of a 7-year-old boy who presented a pulsate structure filling the palate, palate digenesis and hypertelorism. The diagnosis of transsphenoidal transpalatal meningoencephalocele was confirmed by a computerized tomography and a magnetic resonance imaging. The child was operated on by the transpalatal/transspheinoidal approach with a good result.

  2. Oronasal complications in patients after transsphenoidal hypophyseal surgery Complicações oronasais em pacientes pós-abordagem hipofisária via transesfenoidal

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    Carolina Petry

    2009-06-01

    Full Text Available Transsphenoidal surgery is the most commonly used surgical procedure to handle the hypophyseal region, sometimes associated with oronasal complications. MATERIAL AND METHODS/AIM: To evaluate prospectively (specific questionnaire, clinical evaluation undiagnosed chronic oronasal complications in patients submitted to conventional transsphenoidal adenomectomy surgery, operated at different neurosurgery services more than 6 months ago. RESULTS: 49 patients were evaluated, 37/45 presented macroadenoma. 28,5% were submitted to more than one intervention, 2/5 transsphenoidally. Transsphenoidal approach 92.8% through sublabial route. No patient had spontaneous complaint. With the specific questionnaire 63.2% presented complaints. One patient presented an oronasal fistula, 1 stenosis of the nasal valve area with external nasal deformity. Rhinoscopy detected alterations in 77.5%, nasal endoscopy in 87.7%. Septal perforation was present in 10/12 patients with scabs and 2 with purulent secretion. All 4 patients submitted to 2 transsphenoidal approaches presented septal perforation and nasal synechiae. In the endonasal, synechiae (2, alteration in medium meatus (1 and stenosis of the nasal valve area (1 were observed. Only two patients presented normal evaluation. CONCLUSION: A high incidence of nasal complications after conventional transsphenoidal surgery observed through examination and not reported spontaneously point to the need of otorhinolaryngological investigation complemented by nasal endoscopy in patients submitted to procedures through this route.A cirurgia transesfenoidal é o procedimento cirúrgico mais utilizado para abordagem da região hipofisária, sendo por vezes associada a complicações oronasais. MATERIAL E MÉTODOS/OBJETIVO: Estudo prospectivo, através de questionário específico e avaliação clínica complicações oronasais crônicas não-diagnosticadas, em pacientes submetidos à cirurgia transesfenoidal convencional em

  3. Endoscopic Endonasal Management of Craniopharyngioma.

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    Zacharia, Brad E; Amine, Muhamad; Anand, Vijay; Schwartz, Theodore H

    2016-02-01

    Craniopharyngioma is a rare clinical entity that poses a significant management challenge given their location and propensity to recur. As part of a minimally disruptive treatment paradigm, the expanded endonasal approach has the potential to improve rates of resection, improve postoperative visual recovery, and minimize surgical morbidity. This article updates the otolaryngologic community on the basic principles and techniques regarding the incorporation of the endoscopic, endonasal approach in the management paradigm of craniopharyngioma. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Endoscopic endonasal transsphenoidal approach for pituitary adenomas: technical aspects and report of casuistic Abordagem endoscópica endonasal para adenomas de hipófise: aspectos técnicos e relato de casuística

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    Américo Rubens Leite dos Santos

    2010-08-01

    Full Text Available OBJECTIVE: Analyse technical aspects, effectiveness and morbidity of the endoscopic endonasal transphenoidal approach for pituitary adenomas. METHOD: From January 2005 to September 2008, 30 consecutive patients underwent endoscopic endonasal resection of pituitary adenomas with a follow up from 3 to 36 months. Their medical charts were retrospectively analysed. RESULTS: There were 18 women and 12 men, mean age 44 years (range 17-65 yr. Among the 30 patients, 23 had macroadenomas and 7 microadenomas. Twelve patients had non-functioning tumors, 9 had ACTH-secreting tumors, 8 had GH-secreting tumors and 1 prolactinoma. Complete resection and hormonal control was achieved in all microadenomas. Macroadenomas were completely removed in 6 patients, subtotal resection in 6 and partial resection in 11. Three patients had diabetes insipidus and 5 had CSF leaks treated with lumbar drainage. CONCLUSION: The endonasal endoscopic approach for pituitary tumors is effective and has low morbidity.OBJETIVO: Analisar aspectos técnicos, eficácia e morbidade do acesso transesfenoidal endonasal endoscópico para adenomas hipofisários. MÉTODO: Estudo retrospectivo de trinta pacientes consecutivos submetidos à ressecção endoscópica endonasal de adenomas hipofisários, entre janeiro de 2005 e setembro de 2008, com seguimento pós-operatório entre três e 36 meses. RESULTADOS: Foram operados 18 mulheres e 12 homens com idades variando entre 17 e 65 anos (média 44 anos. Entre os 30 casos operados, 23 eram macroadenomas e sete microadenomas. Doze pacientes apresentavam adenomas não-funcionantes, nove tumores secretores de ACTH, oito tumores secretores de GH e um prolactinoma. Ressecção macroscópica completa e controle endócrino foram conseguidos em todos microadenomas. Ressecção dos macroadenomas foi completa em seis pacientes, subtotal em seis e parcial em seis casos. Três pacientes desenvolveram diabetes insipidus e cinco tiveram fístula liqüórica p

  5. Edema pulmonar por pressão negativa após hipofisectomia transesfenoidal: relato de caso

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    Viviane Ferreira Albergaria

    2008-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O edema pulmonar por pressão negativa (EPPN é uma complicação incomum que evolui rapidamente após quadro agudo ou crônico de obstrução de vias aéreas. O objetivo deste relato foi apresentar um caso de EPPN após obstrução de vias aéreas superiores em paciente com acromegalia que foi submetido à hipofisectomia transesfenoidal. RELATO DO CASO: Paciente do sexo masculino, 48 anos, 80 kg, estado físico ASA III, portador de tumor de hipófise, hipertensão arterial e acromegalia, foi submetido à hipofisectomia transesfenoidal sob anestesia geral balanceada. O procedimento cirúrgico evoluiu sem intercorrências. A extubação traqueal foi realizada com o paciente em plano anestésico superficial. Evoluiu com esforço ventilatório, retração da parede abdominal, hipoxemia grave (SpO2 30%, inconsciência e disritmia cardíaca (extra-sístole ventricular e bradicardia. A ventilação com pressão positiva sob máscara facial e cânula orofaríngea foi ineficaz. O paciente foi intubado e, nesse momento, havia estertores pulmonares bilaterais com a presença de secreção rósea aerada dentro da cânula traqueal compatível com quadro de EPPN. O paciente foi encaminhado ao CTI, onde permaneceu sob ventilação mecânica por 96 horas. Recebeu alta para a enfermaria no quinto dia pós-operatório sem seqüela neurológica. CONCLUSÃO: O EPPN pode ocorrer no período pós-anestésico imediato de hipofisectomia transesfenoidal. O diagnóstico e tratamento rápidos são essenciais para uma resolução precoce e diminuição da morbidade.

  6. Comprehensive review on endonasal endoscopic sinus surgery

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    Weber, Rainer K.; Hosemann, Werner

    2015-01-01

    Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3–4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment. PMID:26770282

  7. Expanded Endoscopic Endonasal Resection of Retrochiasmatic Craniopharyngioma.

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    Davanzo, Justin R; Goyal, Neerav; Zacharia, Brad E

    2018-02-01

    This video abstract demonstrates the use of the expanded endoscopic endonasal approach for the resection of a retrochiasmatic craniopharyngioma. These tumors are notoriously difficult to treat, and many approaches have been tried to facilitate safe and effective resection. The endoscopic endonasal approach has been increasingly utilized for selected sellar/suprasellar pathology. We present the case of a 39-year-old man who was found to have a cystic, partially calcified suprasellar mass consistent with a craniopharyngioma. To facilitate robust skull base repair, a vascularized nasoseptal flap was harvested. A wide sphenoidotomy was performed and the sella and tuberculum were exposed. After the dural opening and arachnoid dissection, the stalk was identified, merging seamlessly with the tumor capsule. The lesion was then internally debulked with the use of an ultrasonic aspirator. The capsule was then dissected off of the optic chiasm, thalamus, and hypothalamus. The cavity was inspected with an angled endoscope to ensure complete resection. A multilayered reconstruction was performed using autologous fascia lata, the previously harvested nasoseptal flap, and dural sealant. Postoperatively, the patient did have expected panhypopituitarism but remained neurologically intact and had improvement in his vision. In conclusion, this video demonstrates how an expanded endonasal approach can be used to safely resect a craniopharyngioma, even when in close proximity to delicate structures such as the optic chiasm. The link to the video can be found at: https://youtu.be/tahjHmrXhc4 .

  8. Variations of endonasal anatomy: relevance for the endoscopic endonasal transsphenoidal approach.

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    Lindert, E.J. van; Ingels, K.J.A.O.; Mylanus, E.A.M.; Grotenhuis, J.A.

    2010-01-01

    BACKGROUND: The endoscopic endonasal transsphenoidal approach (EETA) to the pituitary is performed by ear, nose, and throat (ENT) surgeons in collaboration with neurosurgeons but also by neurosurgeons alone even though neurosurgeons have not been trained in rhinological surgery. PURPOSE: To register

  9. Endoscopic Endonasal Approach for a Suprasellar Craniopharyngioma.

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    Zenonos, Georgios A; Snyderman, Carl H; Gardner, Paul A

    2018-04-01

    Objectives  The current video presents the nuances of an endoscopic endonasal approach to a suprasellar craniopharyngioma. Design  The video analyzes the presentation, preoperative workup and imaging, surgical steps and technical nuances of the surgery, the clinical outcome, and follow-up imaging. Setting  The patient was treated by a skull base team consisting of a neurosurgeon and an ENT surgeon, at a teaching academic institution. Participants  The case refers to a 67-year-old man who presented with vision loss and headaches, and was found to have a suprasellar mass, with imaging characteristics consistent with a craniopharyngioma. Main Outcome Measures  The main outcome measures consistent of the reversal of the patient symptoms (vision loss and headaches), the recurrence-free survival based on imaging, as well as the absence of any complications. Results  The patient's vision improved after the surgery; at his last follow-up there was no evidence of recurrence on imaging. Conclusions  The endoscopic endonasal approach is safe and effective in treating suprasellar craniopharyngiomas. The link to the video can be found at: https://youtu.be/p1VXbwnAWCo .

  10. [Transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess].

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    Yu, Huanxin; Liu, Gang

    2014-01-01

    To evaluate the effectiveness of transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess. Eighteen pathologically diagnosed pituitary abscess were resected through transsphenoidal endoscopic endonasal approach at Tianjing Huanhu hospital between January 2000 and December 2011.Retrospective analysis was done upon clinical presentations and imaging features. There were 6 males and 12 females. The average age was 48.5 years old and the average disease course was 5.8 years. The typical clinical manifestations included headache (13 cases), pituitary dysfunction (10 cases), Diabetes Insipidus (4 cases) visual interference (8 cases) and fever (4 cases). All cases were resected by transsphenoidal endoscopic endonasal approach with general anesthesia. The postoperative symptoms and follow-up results were recorded. All patients were followed up from 6 months to 6 years. Postoperatively, headache was recovered in 13 cases, visual was improved in 6 cases, hypopituitarism was relieved in 8 cases and polyuria was disappeared in 3 cases. One case was recurrent and cured by transsphenoidal endoscopic endonasal approach. Transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess is effective.

  11. Endoscopic endonasal approach for mass resection of the pterygopalatine fossa

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    Jan Plzák

    Full Text Available OBJECTIVES: Access to the pterygopalatine fossa is very difficult due to its complex anatomy. Therefore, an open approach is traditionally used, but morbidity is unavoidable. To overcome this problem, an endoscopic endonasal approach was developed as a minimally invasive procedure. The surgical aim of the present study was to evaluate the utility of the endoscopic endonasal approach for the management of both benign and malignant tumors of the pterygopalatine fossa. METHOD: We report our experience with the endoscopic endonasal approach for the management of both benign and malignant tumors and summarize recent recommendations. A total of 13 patients underwent surgery via the endoscopic endonasal approach for pterygopalatine fossa masses from 2014 to 2016. This case group consisted of 12 benign tumors (10 juvenile nasopharyngeal angiofibromas and two schwannomas and one malignant tumor. RESULTS: No recurrent tumor developed during the follow-up period. One residual tumor (juvenile nasopharyngeal angiofibroma that remained in the cavernous sinus was stable. There were no significant complications. Typical sequelae included hypesthesia of the maxillary nerve, trismus, and dry eye syndrome. CONCLUSION: The low frequency of complications together with the high efficacy of resection support the use of the endoscopic endonasal approach as a feasible, safe, and beneficial technique for the management of masses in the pterygopalatine fossa.

  12. Endoscopic endonasal approach for mass resection of the pterygopalatine fossa

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    Plzák, Jan; Kratochvil, Vít; Kešner, Adam; Šurda, Pavol; Vlasák, Aleš; Zvěřina, Eduard

    2017-01-01

    OBJECTIVES: Access to the pterygopalatine fossa is very difficult due to its complex anatomy. Therefore, an open approach is traditionally used, but morbidity is unavoidable. To overcome this problem, an endoscopic endonasal approach was developed as a minimally invasive procedure. The surgical aim of the present study was to evaluate the utility of the endoscopic endonasal approach for the management of both benign and malignant tumors of the pterygopalatine fossa. METHOD: We report our experience with the endoscopic endonasal approach for the management of both benign and malignant tumors and summarize recent recommendations. A total of 13 patients underwent surgery via the endoscopic endonasal approach for pterygopalatine fossa masses from 2014 to 2016. This case group consisted of 12 benign tumors (10 juvenile nasopharyngeal angiofibromas and two schwannomas) and one malignant tumor. RESULTS: No recurrent tumor developed during the follow-up period. One residual tumor (juvenile nasopharyngeal angiofibroma) that remained in the cavernous sinus was stable. There were no significant complications. Typical sequelae included hypesthesia of the maxillary nerve, trismus, and dry eye syndrome. CONCLUSION: The low frequency of complications together with the high efficacy of resection support the use of the endoscopic endonasal approach as a feasible, safe, and beneficial technique for the management of masses in the pterygopalatine fossa. PMID:29069259

  13. Respuesta Pulpar ante el recubrimiento Pulpar Directo: Revisión de la literatura

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    Camejo Suarez, Maria Valentina

    1999-01-01

    El recubrimiento pulpar directo es considerado un procedimiento controversial, debido a que la información concerniente al uso de esta técnica es escasa y ha sido desarrollada sobre la base de razonamientos empíricos y como consecuencia hay desconfianza por parte de los clínicos hacia estos procedimientos conservadores, a pesar de los avances en la práctica del recubrimiento directo. Se han empleado muchos materiales para el recubimiento pulpar directo y se ha aceptado el hidróxido de calcio ...

  14. [Endoscopic endonasal detection of cerebrospinal fluid leakage with topical fluorescein].

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    Sato, Taku; Kishida, Yugo; Watanabe, Tadashi; Tani, Akiko; Tada, Yasuhiro; Tamura, Takamitsu; Ichikawa, Masahiro; Sakuma, Jun; Omori, Koichi; Saito, Kiyoshi

    2013-08-01

    We evaluated the effectiveness of intraoperative topical application of fluorescein to detect the leakage point of cerebrospinal fluid(CSF)rhinorrhea. Three patients with CSF rhinorrhea were treated with an endoscopic endonasal technique. Ten percent fluorescein was topically used for intraoperative localization of the leak site. A change of the fluorescein color from brown to green due to dilation of CSF were recognized as evidence of CSF rhinorrhea. We repeated the procedure to detect any small defects. All CSF rhinorrheas were successfully repaired by this endoscopic endonasal approach. Topical application of fluorescein is simple and sensitive for identifying intraoperative CSF rhinorrhea.

  15. Non-endoscopic Mechanical Endonasal Dacryocystorhinostomy

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    Mohammad Etezad Razavi

    2011-01-01

    Full Text Available To circumvent the disadvantages of endoscopic dacryocystorhinostomy such as small rhinostomy size, high failure rate and expensive equipment, we hereby introduce a modified technique of non-endoscopic mechanical endonasal dacryocystorhinostomy (NE-MEDCR. Surgery is performed under general anesthesia with local decongestion of the nasal mucosa. A 20-gauge vitrectomy light probe is introduced through the upper canaliculus until it touches the bony medial wall of the lacrimal sac. While directly viewing the transilluminated target area, a nasal speculum with a fiber optic light carrier is inserted. An incision is made vertically or in a curvilinear fashion on the nasal mucosa in the lacrimal sac down to the bone using a Freer periosteum elevator. Approximately 1 to 1.5 cm of nasal mucosa is removed with Blakesley forceps. Using a lacrimal punch, the thick bone of the frontal process of the maxilla is removed and the inferior half of the sac is uncovered. The lacrimal sac is tented into the surgical site with the light probe and its medial wall is incised using a 3.2 mm keratome and then excised using the Blakesley forceps. The procedure is completed by silicone intubation. The NE-MEDCR technique does not require expensive instrumentation and is feasible in any standard ophthalmic surgical setting.

  16. Extended Endoscopic Endonasal Approach for Suprasellar Craniopharyngioma.

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    Locatelli, D; Pozzi, F; Agresta, G; Padovan, S; Karligkiotis, A; Castelnuovo, P

    2018-02-01

    Objectives  We illustrate a suprasellar craniopharyngiomas treated with an extended endoscopic endonasal approach (EEEA). Design  Case report of a 43-year-old male affected by cerebral lesion located in suprasellar region involving the third ventricle and compressing the neurovascular structures, causing an anterosuperior dislocation of the chiasma. There is a complete disruption of the pituitary stalk that can explain the clinical finding of partial anterior hypopituitarism and hyperprolactinemia. The lesion is characterized by a solid and cystic component. Considering the absence of lateral extension and the suprasellar location of the lesion, an EEEA is preferred. Setting  University Hospital "Ospedale di Circolo," Department of Neurosurgery, Varese, Italy. Participants  Neurosurgical and ENT Skull Base Team. Main Outcome Measures  A bilateral parasagittal approach is performed using a four-hand technique. The first step of the surgery is the preparation of the Hadad's flap. The approach is extended to the planum sphenoidalis to expose the suprasellar region. The lesion is completely removed employing also an ultrasound aspirator. Skull base reconstruction is performed with three-layer technique: graft of fat tissue, fascia lata, and nasoseptal flap. Results  No postoperative complications occurred. In the post-op, the patient presents a panhypopituitarism and an improvement in neurological status. The visual deficit remains stable. Post-op magnetic resonance imaging at 1 year documents the complete absence of pathological contrast enhancement. Conclusions  EEEA is a feasible approach in treating craniopharyngioma with suprasellar extension. The advantages include optimal visualization, good resection rate, and absence of brain retraction. The link to the video can be found at: https://youtu.be/IYm-8P1jbBo .

  17. Endoscopic Endonasal Approach to a Suprasellar Craniopharyngioma.

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    Todeschini, Alexandre B; Montaser, Alaa S; Shahein, Mostafa; Revuelta, Juan Manuel; Otto, Bradley A; Carrau, Ricardo L; Prevedello, Daniel M

    2018-04-01

    We present the case of a 57-year-old male who presented with progressive right side vision loss whose workup revealed a large suprasellar lesion with invasion of the third ventricle. The pituitary stalk was not visible. Hormonal panel showed no hormonal deficits. The initial diagnosis was of a type II transinfundibular craniopharyngioma (as classified by Kassam et al). An endoscopic endonasal transplanum transtuberculum approach was done using a standard binostril four-hand technique, with the patient positioned supine with the head turned to the right side and tilted to the left, fixed in a three-pin head clamp, under imaging guidance. The tumor was carefully dissected away from the optic apparatus while preserving the vessels, mainly the superior hypophyseal artery. The stalk was identified around the tumor and preserved. The third ventricle was entered and inspected at the end of the procedure and a near-total resection (a small residual in the right hypothalamus) with decompression of the optic apparatus was achieved. Reconstruction was done in a multilayered fashion, using collagen matrix and a nasoseptal flap. Patient had an uneventful postoperative stay and was discharged on POD 4, neurologically stable with no hormonal deficits. Pathology confirmed an adamantinomatous craniopharyngioma. Due to a small growth of the residual, patient underwent fractionated stereotactic radiation (50.4Gy in 28 sessions). He presented with panhypopituitarism 2 years after radiation therapy. At 3-month follow-up, his vision was back to normal and 6-year postoperative magnetic resonance imaging showed no signs of recurrence. The link to the video can be found at: https://youtu.be/chG7XIz7a_A .

  18. Expanded Endonasal Endoscopic Approach for Resection of an Infrasellar Craniopharyngioma.

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    Abou-Al-Shaar, Hussam; Blitz, Ari M; Rodriguez, Fausto J; Ishii, Masaru; Gallia, Gary L

    2016-11-01

    Craniopharyngiomas are uncommon benign locally aggressive epithelial tumors mostly located in the sellar and suprasellar regions. An infrasellar origin of these tumors is rare. The authors report a 22-year-old male patient with a purely infrasellar adamantinomatous craniopharyngioma centered in the nasopharynx with extension into the posterior nasal septum, sphenoid sinus, and clivus. Gross total resection was achieved using an expanded endonasal endoscopic transethmoidal, transsphenoidal, transpterygoid, and transclival approach. Follow-up at one year demonstrated no evidence of disease recurrence. Infrasellar craniopharyngioma should be included in the differential diagnosis of sinonasal masses even in the absence of sellar extension. Expanded endonasal endoscopic approaches provide excellent access to and visualization of such lesions and may obviate the need for postoperative radiotherapy when gross total resection is achieved. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Effectiveness of caudal septal extension graft application in endonasal septoplasty

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    Yunus Karadavut

    Full Text Available Abstract Introduction Septal deviation is a common disease seen in daily otorhinolaryngology practice and septoplasty is a commonly performed surgical procedure. Caudal septum deviation is also a challenging pathology for ear, nose, and throat specialists. Many techniques are defined for caudal septal deviation. Objective To evaluate the effectiveness of caudal septal extension graft (CSEG application in patients who underwent endonasal septoplasty for a short and deviated nasal septum. Methods Forty patients with nasal septal deviation, short nasal septum, and weak nasal tip support who underwent endonasal septoplasty with or without CSEG placement between August 2012 and June 2013 were enrolled in this study. Twenty patients underwent endonasal septoplasty with CSEG placement. The rest of the group, who rejected auricular or costal cartilage harvest for CSEG placement, underwent only endonasal septoplasty without any additional intervention. Using the Nasal Obstruction Symptom Evaluation (NOSE and Rhinoplasty Outcome Evaluation (ROE questionnaires, pre- and post-operative acoustic rhinometer measurements were evaluated to assess the effect of CESG placement on nasal obstruction. Results In the control group, preoperative and postoperative minimal cross-sectional areas (MCA1 were 0.44 ± 0.10 cm2 and 0.60 ± 0.11 cm2, respectively (p < 0.001. In the study group, pre- and postoperative MCA1 values were 0.45 ± 0.16 cm2 and 0.67 ± 0.16 cm2, respectively (p < 0.01. In the control group, the nasal cavity volume (VOL1 value was 1.71 ± 0.21 mL preoperatively and 1.94 ± 0.17 mL postoperatively (p < 0.001. In the study group, pre- and postoperative VOL1s were 1.72 ± 0.15 mL and 1.97 ± 0.12 mL, respectively (p < 0.001. Statistical analysis of postoperative MCA1 and VOL1 values in the study and the control groups could not detect any significant intergroup difference (p = 0.093 and 0.432, respectively. In the study group, mean nasolabial angles were

  20. Endoscopic endonasal repair of spontaneous sphenoid sinus lateral wall meningocele presenting with cerebrospinal fluid leak

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    Ali Erdem Yildirim

    2014-01-01

    Full Text Available Spontaneous sphenoid sinus lateral wall meningoceles are rare lesions with an unknown etiology. Endoscopic endonasal technique is a considerable route in the treatment of this condition. The aim of this paper is to report the etiology, surgical technique, and outcome in a patient repaired via endoscopic endonasal approach. A 51-year-old male patient applied with rhinorrhea started three months ago after an upper respiratory infection. There were no history of trauma or sinus operation. Biochemical analysis of the fluid was positive for beta-2-transferrin. This asypthomatic patient had undergone for repairment of lateral sphenoid sinus meningocele with endoscopic endonasal transsphenoidal approach. After endoscopic endonasal meningocele closure procedure no complications occured and a quick recovery was observed. Endoscopic endonasal approach is an effective and safe treatment modality of spontaneous lateral sphenoid sinus meningoceles and efficient in anterior skull base reconstruction.

  1. Two- versus four-handed techniques for endonasal resection of orbital apex tumors.

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    Craig, John R; Lee, John Y K; Petrov, Dmitriy; Mehta, Sonul; Palmer, James N; Adappa, Nithin D

    2015-01-01

    Open versus endonasal resection of orbital apex (OA) tumors is generally based on tumor size, location, and pathology. For endonasal resection, two- and four-handed techniques have been reported, but whether one technique is more optimal based on these tumor features has not been evaluated. To determine whether two- versus four-handed techniques result in better outcomes after endoscopic resection of OA tumors, and whether either technique is better suited for intra- versus extraconal location and for benign versus malignant pathology. A retrospective review of all expanded endonasal approaches for OA tumors was performed at a single institution from 2009 to 2013. A PubMed database search was also performed to review series published on endonasal OA tumor resection. Across all the cases reviewed, the following data were recorded: two- versus four-handed techniques, intra- versus extraconal tumor location, and benign versus malignant pathology. The relationship between these variables and resection extent was analyzed by the Fisher exact test. Postoperative visual status and complications were also reviewed. Ten cases from the institution and 94 cases from 17 publications were reviewed. Both two- and four-handed techniques were used to resect extra- and intraconal OA tumors, for both benign and malignant pathology. Four-handed techniques included a purely endonasal approach and a combined endonasal-orbital approach. On univariate analysis, the strongest predictor of complete resection was benign pathology (p = 0.005). No significant difference was found between the extent of resection and a two- versus a four-handed technique. Visual status was improved or unchanged in 94% of cases, and other complications were rare. Benign tumors that involve the medial extraconal and posterior inferomedial intraconal OA can be treated by either two- or four-handed endonasal techniques. Selecting two- versus four-handed techniques and endonasal versus endonasal-orbital four

  2. Meckel's cave access: anatomic study comparing the endoscopic transantral and endonasal approaches.

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    Van Rompaey, Jason; Suruliraj, Anand; Carrau, Ricardo; Panizza, Benedict; Solares, C Arturo

    2014-04-01

    Recent advances in endonasal endoscopy have facilitated the surgical access to the lateral skull base including areas such as Meckel's cave. This approach has been well documented, however, few studies have outlined transantral specific access to Meckel's. A transantral approach provides a direct pathway to this region obviating the need for extensive endonasal and transsphenoidal resection. Our aim in this study is to compare the anatomical perspectives obtained in endonasal and transantral approaches. We prepared 14 cadaveric specimens with intravascular injections of colored latex. Eight cadavers underwent endoscopic endonasal transpterygoid approaches to Meckel's cave. Six additional specimens underwent an endoscopic transantral approach to the same region. Photographic evidence was obtained for review. 30 CT scans were analyzed to measure comparative distances to Meckel's cave for both approaches. The endoscopic approaches provided a direct access to the anterior and inferior portions of Meckel's cave. However, the transantral approach required shorter instrumentation, and did not require clearing of the endonasal corridor. This approach gave an anterior view of Meckel's cave making posterior dissection more difficult. A transantral approach to Meckel's cave provides access similar to the endonasal approach with minimal invasiveness. Some of the morbidity associated with extensive endonasal resection could possibly be avoided. Better understanding of the complex skull base anatomy, from different perspectives, helps to improve current endoscopic skull base surgery and to develop new alternatives, consequently, leading to improvements in safety and efficacy.

  3. Cirugía transnasal transesfenoidal endoscópica en afecciones de región selar Endoscopic transsphenoidal transnasal surgery in affections of the sellar region

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    Justo Luis González González

    2005-08-01

    Full Text Available Para un gran número de tumores pituitarios la cirugía es e l tratamiento de primera línea y el abordaje transesfenoidal microquirúrgico el más utilizado. En estos momentos este procedimiento se ejecuta tanto por la vía microscópica como endoscópica. Recientemente el abordaje transnasal endoscópico ha irrumpido como una opción en desarrollo, que pudiera llegar a predominar en un futuro próximo. El objetivo del presente trabajo fue evaluar, mediante el análisis de los resultados, y - si es posible - realizar en nuestro medio el abordaje transnasal transesfenoidal endoscópico par a las lesiones de la región selar con resultados quirúrgicos al menos similares a los obtenidos con el método microquirúrgico tradicional . Se realizó una investigación limitada tipo cohorte, estrictamente controlada y prospectiva, de 10 pacientes seleccionados según criterios de inclusión, a quienes se les practicó el abordaje transnasal endoscópico como método de tratamiento quirúrgico, entre agosto del año 2002 y el mismo mes de 2003, en el servicio de Neurocirugía del Hospital "Hermanos Ameijeiras". Se operaron 6 casos que tenían macroadenomas hipofisarios: 3 productores de hormona del crecimiento (GH, 1 secretor de prolactina (PRL y otros 2 no productores. A los 4 restantes se les había diagnosticado fístula de líquido cefalorraquídeo (LCR a través del piso selar. De los 6 macroadenomas, en 5 se logró exéresis total del tumor, mientras que en el otro se obtuvo exéresis subtotal. La rinorrea desapareció en 2 pacientes con fístula de LCR y se mantuvo en los otros 2. De las complicaciones observadas en el 30 % de los casos, solo en 1 (10 % trascendieron más allá del transoperatorio. Se concluye que los resultados obtenidos con la utilización del método transnasal endoscópico hacen el procedimiento en nuestro medio lo suficientemente seguro como para justificar su realización, y a su vez efectuar estudios posteriores

  4. Outcomes following Purely Endoscopic Endonasal Resection of Pituitary adenomas

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    Rezaul Amin

    2013-01-01

    Full Text Available Background: The use of endoscope for the management of pituitary adenoma is not new. The better magnification and illumination provided by the endoscope gives better outcome than microscopic pituitary surgery. Objective: To find out the benefits of endoscope in relation to microscopic surgery. Materials and Methods: We performed 45 cases of pituitary adenoma surgery by endoscopic endonasal approach from July 2008 to July 2010. Results: Forty five cases underwent endoscopic transsphenoidal approach. Gross total removal was done in 35 cases and subtotal removal was done in 10 cases. Residual tumours were seen in 10 cases (22% in postoperative follow-up MRI scan. Visual improvement was satisfactory, and hormonal improvement of functional adenoma was nice. Postoperative visual acuity and visual field were improved in 75% cases. There were 37% cases of temporary diabetes insipidus and about 4.5% cases of permanent diabetes insipidus. The average duration of follow-up was 20 months. One patient required reexploration to correct visual deterioration in the immediate postoperative period. There were 4.5% cases of CSF leak and 6.6% mortality. Mortality was due to electrolyte imbalance and improper management of infection and hydrocephalus. Conclusion: Endoscopic endonasal pituitary surgery now has become a gold standard surgery for most of the pituitary adenomas because of its better advantages in relation to microscopic surgery and less complications and less hospital stay.

  5. Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center Fístula liquórica após cirurgia transesfenoidal endoscópica: experiência de um centro espanhol

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    Alicia Del Carmen Becerra Romero

    2010-06-01

    Full Text Available BACKGROUND: Postoperative cerebrospinal fluid (CSF fistula is the most serious complication after transsphenoidal surgery. OBJECTIVE: To analyze the incidence of CSF fistula after endoscopic transsphenoidal surgery for tumor removal in sellar region; to discuss associated factors and methods used for sellar closure. METHOD: Retrospective study of 67 patients (73 surgeries operated via transsphenoidal endoscopy at Hospital Vall D'Hebron and Hospital Clinic of the Universidad de Barcelona, Spain. The data collected included: age, sex, hospitalization stay, suprasellar extension of the lesion, type of tumor, evidence of intraoperative CSF fistula, complications of postoperative CSF fistula, previous surgery and radiotherapy. RESULTS: Six patients (8.2% had postoperative CSF fistula, and their average hospitalization was 5 days longer with resulting complications: two of whom had pneumoencephalus and two with meningitis. No association was found between the data collected and postoperative CSF fistula. CONCLUSION: The rate of CSF fistula after endoscopic transsphenoidal surgery from the present study is contained within the literature. Unlike other reports, no association between the variables and postoperative CSF fistula was found in this report.A fístula liquórica pós-operatória é a complicação mais séria após cirurgia transesfenoidal. OBJETIVO: Analisar a incidência de fístula liquórica após cirurgia endoscópica transesfenoidal para remoção de tumores selares, discutir fatores associados e método utilizado para fechamento selar. MÉTODO: Estudo retrospectivo de 67 pacientes (73 cirurgias operados via endoscopia transesfenoidal no Hospital Vall D'Hebron e Hospital Clínic da Universidad de Barcelona, Espanha. Os dados coletados foram: idade, sexo, dias de internação, extensão supra-selar da lesão, tipo de tumor, evidência de fístula liquórica intra-operatória, complicações da fístula liquórica p

  6. Intraoperative Neurophysiological Monitoring for Endoscopic Endonasal Approaches to the Skull Base: A Technical Guide

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    Harminder Singh

    2016-01-01

    Full Text Available Intraoperative neurophysiological monitoring during endoscopic, endonasal approaches to the skull base is both feasible and safe. Numerous reports have recently emerged from the literature evaluating the efficacy of different neuromonitoring tests during endonasal procedures, making them relatively well-studied. The authors report on a comprehensive, multimodality approach to monitoring the functional integrity of at risk nervous system structures, including the cerebral cortex, brainstem, cranial nerves, corticospinal tract, corticobulbar tract, and the thalamocortical somatosensory system during endonasal surgery of the skull base. The modalities employed include electroencephalography, somatosensory evoked potentials, free-running and electrically triggered electromyography, transcranial electric motor evoked potentials, and auditory evoked potentials. Methodological considerations as well as benefits and limitations are discussed. The authors argue that, while individual modalities have their limitations, multimodality neuromonitoring provides a real-time, comprehensive assessment of nervous system function and allows for safer, more aggressive management of skull base tumors via the endonasal route.

  7. [Endonasal Dacryocystorhinostomy (DCR) with Transcanalicular Endoillumination (TCE) of the Saccus Lacrimalis].

    Science.gov (United States)

    Hefner, J; Klask, J; Gerding, H

    2016-04-01

    Endonasal dacryocystorhinostomy (DCR) has been established as a standard procedure of lacrimal surgery, since it causes much less tissue damage than ab externo procedures. Diffiulties in visualization of the target area has been a limitation to the transnasal approach. An improvement of the classical endonasal DCR was achieved by the introduction of a transcanalicular endoillumination (TCE) of the lacrimal sac using a 23-Gauge vitreoretinal light probe, which can easily be intubated into the cannaliculi and advanced into the the lacrimal sac. Illumination of the lacrimal sac guides the endonasal approach and facilitates the creation of a lacrimal bypass. In our standard procedure a bicanalicular silicone intubation through the osteotomy is finally placed. Due to the introduction of TCE of the lacrimal sac, the surgical procedure of endonasal DCR became less traumatic and needed a significantly reduced operating time. Georg Thieme Verlag KG Stuttgart · New York.

  8. A checklist for endonasal transsphenoidal anterior skull base surgery.

    Science.gov (United States)

    Laws, Edward R; Wong, Judith M; Smith, Timothy R; de Los Reyes, Kenneth; Aglio, Linda S; Thorne, Alison J; Cote, David J; Esposito, Felice; Cappabianca, Paolo; Gawande, Atul

    2016-06-01

    OBJECT Approximately 250 million surgical procedures are performed annually worldwide, and data suggest that major complications occur in 3%-17% of them. Many of these complications can be classified as avoidable, and previous studies have demonstrated that preoperative checklists improve operating room teamwork and decrease complication rates. Although the authors' institution has instituted a general preoperative "time-out" designed to streamline communication, flatten vertical authority gradients, and decrease procedural errors, there is no specific checklist for transnasal transsphenoidal anterior skull base surgery, with or without endoscopy. Such minimally invasive cranial surgery uses a completely different conceptual approach, set-up, instrumentation, and operative procedure. Therefore, it can be associated with different types of complications as compared with open cranial surgery. The authors hypothesized that a detailed, procedure-specific, preoperative checklist would be useful to reduce errors, improve outcomes, decrease delays, and maximize both teambuilding and operational efficiency. Thus, the object of this study was to develop such a checklist for endonasal transsphenoidal anterior skull base surgery. METHODS An expert panel was convened that consisted of all members of the typical surgical team for transsphenoidal endoscopic cases: neurosurgeons, anesthesiologists, circulating nurses, scrub technicians, surgical operations managers, and technical assistants. Beginning with a general checklist, procedure-specific items were added and categorized into 4 pauses: Anesthesia Pause, Surgical Pause, Equipment Pause, and Closure Pause. RESULTS The final endonasal transsphenoidal anterior skull base surgery checklist is composed of the following 4 pauses. The Anesthesia Pause consists of patient identification, diagnosis, pertinent laboratory studies, medications, surgical preparation, patient positioning, intravenous/arterial access, fluid management

  9. Evaluation of a direct contact heat exchanger; Evaluacion de un intercambiador de calor de contacto directo

    Energy Technology Data Exchange (ETDEWEB)

    Siqueiros, J.; Bonilla, O. [Instituto de Investigaciones Electricas, Cuernavaca (Mexico)

    1997-12-31

    In this paper the application areas of the direct contact heat exchangers is discussed, as well as its main characteristics. A description is made of the experimental equipment designed and built at pilot scale including the instrumentation employed. The methodology employed as well as the analysis and the discussion of the results are also presented. [Espanol] Se mencionan las areas de aplicacion de los intercambiadores de calor de contacto directo, asi como sus caracteristicas principales. Se describe el equipo experimental a nivel piloto disenado y construido incluyendo la instrumentacion utilizada. Se presenta la metodologia empleada asi como el analisis y discusion de los resultados.

  10. Histopatología de los procesos reparativos pulpo-dentarios en el recubrimiento pulpar directo

    OpenAIRE

    Brau Aguadé, Esteban

    1986-01-01

    Se expone el mecanismo del cierre biológico a nivel de la periferia pulpar, después del recubrimiento directo con hidróxido cálcico. En primer lugar se describen, en los casos de caries profunda, las altera­ciones pulpo-odontoblásticas preexistentes, caracterizadas por degeneración progresiva del estrato odontoblástico, junto con manifestaciones reaccionales pulpares localizadas (alteraciones circulatorias, edema, microhemorragias, áci­dez, etc.). Asimismo se consideran las lesiones por dilac...

  11. Evaluation of a direct contact heat exchanger; Evaluacion de un intercambiador de calor de contacto directo

    Energy Technology Data Exchange (ETDEWEB)

    Siqueiros, J; Bonilla, O [Instituto de Investigaciones Electricas, Cuernavaca (Mexico)

    1998-12-31

    In this paper the application areas of the direct contact heat exchangers is discussed, as well as its main characteristics. A description is made of the experimental equipment designed and built at pilot scale including the instrumentation employed. The methodology employed as well as the analysis and the discussion of the results are also presented. [Espanol] Se mencionan las areas de aplicacion de los intercambiadores de calor de contacto directo, asi como sus caracteristicas principales. Se describe el equipo experimental a nivel piloto disenado y construido incluyendo la instrumentacion utilizada. Se presenta la metodologia empleada asi como el analisis y discusion de los resultados.

  12. Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations.

    Science.gov (United States)

    Koutourousiou, Maria; Gardner, Paul A; Fernandez-Miranda, Juan C; Paluzzi, Alessandro; Wang, Eric W; Snyderman, Carl H

    2013-03-01

    Giant pituitary adenomas (> 4 cm in maximum diameter) represent a significant surgical challenge. Endoscopic endonasal surgery (EES) has recently been introduced as a treatment option for these tumors. The authors present the results of EES for giant adenomas and analyze the advantages and limitations of this technique. The authors retrospectively reviewed the medical files and imaging studies of 54 patients with giant pituitary adenomas who underwent EES and studied the factors affecting surgical outcome. Preoperative visual impairment was present in 45 patients (83%) and partial or complete pituitary deficiency in 28 cases (52%), and 7 patients (13%) presented with apoplexy. Near-total resection (> 90%) was achieved in 36 patients (66.7%). Vision was improved or normalized in 36 cases (80%) and worsened in 2 cases due to apoplexy of residual tumor. Significant factors that limited the degree of resection were a multilobular configuration of the adenoma (p = 0.002) and extension to the middle fossa (p = 0.045). Cavernous sinus invasion, tumor size, and intraventricular or posterior fossa extension did not influence the surgical outcome. Complications included apoplexy of residual adenoma (3.7%), permanent diabetes insipidus (9.6%), new pituitary insufficiency (16.7%), and CSF leak (16.7%, which was reduced to 7.4% in recent years). Fourteen patients underwent radiation therapy after EES for residual mass or, in a later stage, for recurrence, and 10 with functional pituitary adenomas received medical treatment. During a mean follow-up of 37.9 months (range 1-114 months), 7 patients were reoperated on for tumor recurrence. Three patients were lost to follow-up. Endoscopic endonasal surgery provides effective initial management of giant pituitary adenomas with favorable results compared with traditional microscopic transsphenoidal and transcranial approaches.

  13. Is endoscopic endonasal transsphenoidal surgery increases the susceptibility to rhinosinusitis.

    Science.gov (United States)

    Topuz, Muhammet Fatih; Sarı, Murat; Binnetoglu, Adem; Dogrul, Ramazan; Bugdaycı, Onur; Şeker, Aşkın

    2017-08-01

    The aim of the study was to analyze whether the measurement of changes in the anatomical position and volume of middle concha, the volume changes in the area between the middle concha and lamina papyracea, the evaluation of opacification in major paranasal sinuses, and osteomeatal complex occlusion in cases with middle concha by out-fracture technique during endoscopic endonasal transsphenoidal approach is a minimally invasive surgery, and also to find out whether these changes lead to the development of tendency to rhinosinusitis. It was a retrospective clinical study. Forty-five cases, between 2013 and 2015, planned for endoscopic endonasal transsphenoidal surgery due to hypophyseal pathology at the Neurosurgery Departments of Marmara University Hospital were evaluated retrospectively. The patients were evaluated for the changes in the anatomy of the middle concha and the effects of these changes to paranasal sinuses by paranasal computed tomographies were studied at the preoperative second week and postoperative 12 month. The Lund-Mackay scoring system was used for the evaluation of opacification in the five major paranasal sinuses and occlusion of the osteomeatal complex in the pre- and postoperative period. The Lund-Mackay scoring system was used to analyze the paranasal computed tomography of the patients at the preoperative 2 weeks and postoperative first year. According to the Lund-Mackay scoring system, no significant difference was detected between the preoperative and postoperative opacification of paranasal sinuses (p > 0.05). Besides, there was also no significant difference between the preoperative and postoperative osteomeatal complex occlusion (p > 0.05). Considering the distance between middle concha and lamina papyracea following the out-fracture of the middle concha, a significant lateralization of 0.5 mm between the preoperative and postoperative period was observed (p transsphenoidal surgery causes some variations in the structures of

  14. Uso de los anticoagulantes orales directos en la práctica clínica

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    Rubén Guillermo Jaramillo Salamanca

    2016-04-01

    Full Text Available Los anticoagulantes orales directos surgieron en respuesta a la búsqueda de un anticoagulante ideal después de que la warfarina fuera por mucho tiempo el único disponible. Los inhibidores del factor X activado —rivaroxabán y apixabán— y el inhibidor de trombina —dabigatrán etexilato— ya están aprobados en Colombia. Estos grupos farmacológicos están indicados en la tromboprofilaxis luego de artroplastia de rodilla y cadera, en la prevención del accidente cerebrovascular y el embolismo sistémico en pacientes con fibrilación auricular no valvular y en el tratamiento del tromboembolismo venoso. La aprobación de los inhibidores se dio luego de mostrar eficacia y seguridad al compararse con warfarina y enoxaparina. Entre las ventajas que estos presentan figuran las siguientes: inicio rápido de acción, efecto predecible, poca variabilidad interindividual que elimina la necesidad de la monitorización frecuente y menos interacciones medicamentosas; pero, al igual que en la warfarina, el sangrado es el principal evento adverso.   El objetivo de esta revisión es conocer la farmacología de los anticoagulantes orales directos aprobados en Colombia, los resultados de los ensayos clínicos que respaldan su uso, la dosificación, el uso perioperatorio y el cambio entre anticoagulantes; situaciones que plantean particularidades para cada uno.

  15. Outcomes of endonasal endoscopic dacryocystorhinostomy after maxillectomy in patients with paranasal sinus and skull base tumors.

    Science.gov (United States)

    Abu-Ghanem, Sara; Ben-Cnaan, Ran; Leibovitch, Igal; Horowitz, Gilad; Fishman, Gadi; Fliss, Dan M; Abergel, Avraham

    2014-06-01

    Maxillectomy followed by radiotherapy and/or chemotherapy can result in lacrimal blockage and the need for subsequent dacryocystorhinostomy (DCR). Endonasal endoscopic DCR, as opposed to external DCR, allows better accuracy and leaves no scar. To date no report was published regarding the results of endoscopic DCR in these patients. The current study presents a retrospective review of all patients with paranasal and skull base tumors who developed nasolacrimal duct blockage after ablative maxillectomy with or without radiotherapy and/or chemotherapy and underwent endonasal endoscopic DCR between January 2006 and October 2012 in a tertiary reference medical center. According to our results, ten patients underwent 11 subsequent endonasal endoscopic DCR. There were 6 men and 4 women with a median age of 55 years (range, 19-81 years); four suffered from benign tumors and six had malignant tumors. All underwent maxillectomy. Six received high-dose radiotherapy. Time interval between primary ablative surgery and endonasal endoscopic DCR was 18 months (range, 7-118 months). Silicone stents were removed after median period of 11 weeks (range, 1-57 weeks). Nine out of ten patients experienced symptomatic improvement following one endonasal endoscopic DCR. One patient had recurrent epiphora and underwent a successful endonasal endoscopic revision DCR. In conclusion, endonasal endoscopic DCR in patients with paranasal and skull base tumors, who previously underwent maxillectomy, is generally successful and not associated with a high rate of complications or failure. Moreover, our findings may suggest that silicone stents can be removed shortly after the operation with high success rate.

  16. Determinantes del intercambio directo de drogas ilegales a pequeña escala en Cali

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    Bustamante Amaya Christian David

    2012-09-01

    Full Text Available Este documento centra su análisis en el estudio de los determinantes que explican el intercambio directo de drogas ilegales a pequeña escala en la ciudad de Cali, a partir de la estimación de modelos de datos de conteo. Se verifica el cumplimiento de los supuestos teóricos de la elección racional de los individuos que son esbozados en la economía del crimen. Los resultados del modelo sugieren que si un expendedor considera su actividad como riesgosa, reduce en una significativa cantidad el número de horas dedicadas al expendio. Por otra parte, el precio de un cigarrillo de marihuana afecta negativamente el número de veces que un individuo consume al día; no obstante, la magnitud del efecto para esta variable denota el alto grado de inelasticidad al precio que tiene el consumo de esta droga.

  17. Clinical outcome of endonasal KTP laser assisted dacryocystorhinostomy

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    Carrie Sean

    2005-03-01

    Full Text Available Abstract Background To evaluate the clinical outcome of primary endonasal laser assisted dacryocystorhinostomy (ENL-DCR using the potassium-titanyl-phosphate laser. Methods We retrospectively reviewed all primary ENL-DCRs performed within a period of twelve months by the same combined Ophthalmology and Otorhinolaringology team in Freeman Hospital, Newcastle upon Tyne, UK. The main outcome measure for success was resolution or significant improvement of epiphora. Details of surgery, intraoperative and postoperative complications, as well as pathology associated with failure were also studied. Patients were followed up for at least 12 months. Results A total of 41 consecutive ENL-DCRs on 29 patients (22 females, 7 males, mean age 75 years were analysed. All patients had bicanalicular silicone intubation for at least 4 months. The success rate at 12 months postoperatively was 78.1%. Pathology associated with failure included: intranasal pathology (12.2%, mucocele (7.3%, and systemic sarcoidosis (2.4%. No significant intra-operative complications were recorded. Conclusion The ENL-DCR with potassium-titanyl-phosphate laser can be considered as a safe and efficient primary procedure for the treatment of nasolacrimal duct obstruction.

  18. Endoscopic endonasal transsphenoidal surgery: implementation of an operative and perioperative checklist.

    Science.gov (United States)

    Christian, Eisha; Harris, Brianna; Wrobel, Bozena; Zada, Gabriel

    2014-01-01

    Endoscopic endonasal surgery relies heavily on specialized operative instrumentation and optimization of endocrinological and other critical adjunctive intraoperative factors. Several studies and worldwide initiatives have previously established that intraoperative and perioperative surgical checklists can minimize the incidence of and prevent adverse events. The aim of this article was to outline some of the most common considerations in the perioperative and intraoperative preparation for endoscopic endonasal transsphenoidal surgery. The authors implemented and prospectively evaluated a customized checklist at their institution in 25 endoscopic endonasal operations for a variety of sellar and skull base pathological entities. Although no major errors were detected, near misses pertaining primarily to missing components of surgical equipment or instruments were identified in 9 cases (36%). The considerations in the checklist provided in this article can serve as a basic template for further customization by centers performing endoscopic endonasal surgery, where their application may reduce the incidence of adverse or preventable errors associated with surgical treatment of sellar and skull base lesions.

  19. Analyses and treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms

    Science.gov (United States)

    Cheng, You; Xue, Fei; Wang, Tian-You; Ji, Jun-Feng; Chen, Wei; Wang, Zhi-Yi; Xu, Li; Hang, Chun-Hua; Liu, Xin-Feng

    2017-01-01

    Abstract In this study, we analyze and discuss the treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms (PNs). We performed 129 endonasal transsphenoidal resections of PNs and analyzed and treated cases with nasal complications. After endonasal transsphenoidal resection of PNs, there were 26 cases of postoperative nasal complications (20.1%), including nasal hemorrhage (4.8%), cerebrospinal fluid rhinorrhea (6.9%), sphenoid sinusitis (2.3%), atrophic rhinitis (1.6%), olfactory disorder (1.6%), perforation of nasal septum (0.8%), and nasal adhesion (2.3%). All patients clinically recovered after therapy, which included treatment of the cavity through nasal endoscopy, intranasal corticosteroids, and nasal irrigation. We propose that regular nasal endoscopic review, specific nasal medications, and regular nasal irrigation can effectively clear nasal mucosal hyperemia-induced edema and nasal/nasoantral secretions, as well as promote regeneration of nasal mucosa, prevent nasal adhesion, maintain the sinus cavity drainage, and accelerate the recovery of the physiological function of the paranasal sinus. Timely treatment of patients with nasal complications after endonasal transsphenoidal resections of PNs could greatly relieve the clinical symptoms. Nasal cleaning is very beneficial to patients after surgery recovery. PMID:28403108

  20. Outcomes of revision external dacryocystorhinostomy and nasal intubation by bicanalicular silicone tubing under endonasal endoscopic guidance.

    Science.gov (United States)

    Ari, Seyhmus; Kürşat Cingü, Abdullah; Sahin, Alparslan; Gün, Ramazan; Kiniş, Vefa; Caça, Ihsan

    2012-01-01

    To evaluate the long-term treatment outcomes in patients who underwent revision of external dacryocystorhinostomy (DCR) and nasal intubation by bicanalicular silicone tubing (BSTI) under endonasal endoscopic guidance. Data from 28 patients with recurrent dacryocystitis were retrospectively reviewed. Revision external DCR and bicanalicular nasal intubation by silicone tubing under endonasal endoscopic guidance was performed in 28 eyes of 28 patients. The patients were evaluated with respect to the reason of recurrence, time to recurrence, time to revision, duration of follow-up and surgical success. Endoscopic endonasal examination detected an osteotomy-side obstruction by the excessive granulation tissue in 24 patients (86%), nasal septal deviation in three patients (10%) and nasal polyp in one patient (4%). Recurrence occurred after a mean duration of 5.3±3.7 months following the first operation. The mean time between the first DCR operation and the revision DCR was 11.5 ± 9.3 months. After a mean follow-up of 14.9±7.8 months, the rate of anatomic success alone was 85% (24/28); the rate of subjective success was 78% (22/28). Revision external DCR and bicanalicular nasal intubation by silicone tubing under endonasal endoscopic guidance can be recommended in patients with recurrent dacryocystitis as a surgical approach that achieves satisfactory objective and subjective success rates.

  1. Extended Transsphenoidal Endoscopic Endonasal Surgery of Suprasellar Craniopharyngiomas.

    Science.gov (United States)

    Fomichev, Dmitry; Kalinin, Pavel; Kutin, Maxim; Sharipov, Oleg

    2016-10-01

    The endoscopic extended transsphenoidal approach for suprasellar craniopharyngiomas may be a really alternative to the transcranial approach in many cases. The authors present their experience with this technique in 136 patients with craniopharyngiomas. From the past 7 years 204 patients with different purely supradiaphragmatic tumors underwent removal by extended endoscopic transsphenoidal transtuberculum transplanum approach. Most of the patients (136) had craniopharyngiomas (suprasellar, intra-extraventricular). The patients were analyzed according to age, sex, tumor size, growth and tumor structure, and clinical symptoms. Twenty-five patients had undergone a previous surgery. The mean follow-up was 42 months (range, 4-120 months). The operation is always performed with the bilateral endoscopic endonasal anterior extended transsphenoidal approach. A gross-total removal was completed in 72%. Improvement of vision or absence of visual deterioration after operation was observed in 89% of patients; 11% had worsening vision after surgery. Endocrine dysfunction did not improve after surgery, new hypotalamopituitary dysfunction (anterior pituitary dysfunction or diabetes insipidus) or worsening of it was observed in 42.6%. Other main complications included transient new mental disorder in 11%, temporary neurological postoperative deficits in 3.7%, bacterial meningitis in 16%, cerebrospinal fluid leaks in 8.8%. The recurrence rate was 20% and the lethality was 5.8%. Resection of suprasellar craniopharyngiomas using the extended endoscopic approach is a more effective and less traumatic technology, able to provide resection of the tumor along with high quality of life after surgery, and relatively rare postoperative complications and mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Endoscopic endonasal trans-sphenoid surgery of pituitary adenoma

    Directory of Open Access Journals (Sweden)

    Y R Yadav

    2012-01-01

    Full Text Available Endoscopic endonasal trans-sphenoid surgery (EETS is increasingly used for pituitary lesions. Pre-operative CT and MRI scans and peroperative endoscopic visualization can provide useful anatomical information. EETS is indicated in sellar, suprasellar, intraventricular, retro-infundibular, and invasive tumors. Recurrent and residual lesions, pituitary apoplexy and empty sella syndrome can be managed by EETS. Modern neuronavigation techniques, ultrasonic aspirators, ultrasonic bone curette can add to the safety. The binostril approach provides a wider working area. High definition camera is much superior to three-chip camera. Most of the recent reports favor EETS in terms of safety, quality of life and tumor resection, hospital stay, better endocrinological, and visual outcome as compared to the microscopic technique. Nasal symptoms, blood loss, operating time are less in EETS. Various naso-septal flaps and other techniques of CSF leak repair could help reduce complications. Complications can be further reduced after achieving the learning curve, good understanding of limitations with proper patient selection. Use of neuronavigation, proper post-operative care of endocrine function, establishing pituitary center of excellence and more focused residency and endoscopic fellowship training could improve results. The faster and safe transition from microscopic to EETS can be done by the team concept of neurosurgeon/otolaryngologist, attending hands on cadaveric dissection, practice on models, and observation of live surgeries. Conversion to a microscopic or endoscopic-assisted approach may be required in selected patients. Multi-modality treatment could be required in giant and invasive tumors. EETS appears to be a better surgical option in most pituitary adenoma.

  3. Como un cierre. Igualdad, honor y amistad entre contendientes directos, después de Malvinas

    Directory of Open Access Journals (Sweden)

    Rosana Guber

    2013-01-01

    Full Text Available Diez años después de concluido el conflicto anglo-argentino de 1982 conocido como la Guerra de Malvinas (Falklands en el mundo anglo-parlante comenzaron a salir a la luz pública los encuentros entre militares que habían sido contendientes directos. Estos encuentros, que fueron deseados, buscados y premeditados, y que se prolongaron luego en relaciones de amistad, incluyeron a tres pilotos argentinos del sistema de armas A-4B Skyhawk del Grupo 5 de Caza de la Fuerza Aérea, y personal aeronáutico o embarcado de Gran Bretaña. Este artículo busca comprender cómo significaron estos ex combatientes argentinos y británicos a sus encuentros, cómo se posicionaron recíprocamente y con respecto a sus roles en el combate y sus reflexiones en la postguerra. El artículo sostiene que en esos (reencuentros sus protagonistas actualizaron en la amistad una relación honorífica de igualdad que habían actuado en la contienda y que finalizó con la derrota argentina.

  4. Influencia del bloqueo directo y el uno contra uno en el éxito del lanzamiento en baloncesto

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    Verónica Muñoz Arroyave

    2015-03-01

    Full Text Available El presente estudio tiene como objetivo analizar el impacto del uno contra uno y el bloqueo directo sobre la eficacia en los lanzamientos. Se desarrolló un instrumento ad hoc denominado sistema de observación de conceptos fundamentales en baloncesto (SOCFB para estudiar las acciones ofensivas del Fútbol Club Barcelona Regal en la Copa del Rey en la temporada 2013-2014. Se analizaron un total de 643 acciones ofensivas donde se destacan los siguientes hallazgos: a el 34 % de las acciones del jugador con balón finalizaron en lanzamiento mientras que el 66 % terminaron en pases; b la principal consecuencia del uno contra uno interior fueron los lanzamientos (z = 6,2, p < 0,001; c en el uno contra uno exterior se encontraron relaciones estadísticamente significativas con el espacio exterior de la zona (z = 3,3, p < 0,001 y la lateralidad del espacio lateral izquierdo (z = 2, p <0,05; d en el bloqueo directo se observaron relaciones estadísticamente significativas con las acciones que no finalizaron. De estos resultados podemos extraer las siguientes conclusiones: a el bloqueo directo es el concepto más utilizado y fue utilizado como medio para la generación de ventajas; b el uno contra uno interior genera más lanzamientos y de mayor efectividad.

  5. Clival chordomas: considerations after 16 years of endoscopic endonasal surgery.

    Science.gov (United States)

    Zoli, Matteo; Milanese, Laura; Bonfatti, Rocco; Faustini-Fustini, Marco; Marucci, Gianluca; Tallini, Giovanni; Zenesini, Corrado; Sturiale, Carmelo; Frank, Giorgio; Pasquini, Ernesto; Mazzatenta, Diego

    2018-02-01

    OBJECTIVE In the past decade, the role of the endoscopic endonasal approach (EEA) has relevantly evolved for skull base tumors. In this study, the authors review their surgical experience with using an EEA in the treatment of clival chordomas, which are deep and infiltrative skull base lesions, and they highlight the advantages and limitations of this ventral approach. METHODS All consecutive cases of chordoma treated with an EEA between 1998 and 2015 at a single institution are included in this study. Preoperative assessment consisted of neuroimaging (MRI and CT with angiography sequences) and endocrinological, neurological, and ophthalmological evaluations, which were repeated 3 months after surgery and annually thereafter. Postoperative adjuvant therapies were considered. RESULTS Sixty-five patients (male/female ratio 1:0.9) were included in this study. The median age was 48 years (range 9-80 years). Gross-total resection (GTR) was achieved in 47 cases (58.7%). On univariate analysis, primary procedures (p = 0.001), location in the superior or middle third of the clivus (p = 0.043), extradural location (p = 0.035), and histology of conventional chordomas (p = 0.013) were associated with a higher rate of GTR. The complication rate was 15.1%, and there were no perioperative deaths. Most complications did not result in permanent sequelae and included 2 CSF leaks (2.5%), 5 transient cranial nerve VI palsies (6.2%), and 2 internal carotid artery injuries (2.5%), which were treated with coil occlusion of the internal carotid artery without neurological deficits. Three patients (3.8%) presented with complications resulting in permanent neurological deficits due to a postoperative hematoma (1.2%) causing a hemiparesis, and 2 permanent ophthalmoplegias (2.5%). Seventeen patients (26.2%) have died of tumor progression over the course of follow-up (median 52 months, range 7-159 months). Based on Kaplan-Meier analysis, the survival rate was 77% at 5 years and 57% at 10

  6. Endoscopic Endonasal Approach in the Management of Rathke's Cleft Cysts.

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    Domenico Solari

    Full Text Available Rathke's cleft cysts (RCCs are quite uncommon sellar lesions that can extend or even arise in the suprasellar area. The purpose of this study is to evaluate the effectiveness of both standard and extended endoscopic endonasal approaches in the management of different located RCCs.We retrospectively analyzed a series of 29 patients (9 males, 20 females complaining of a RCC, who underwent a standard or an extended endoscopic transsphenoidal approach at the Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, of the Università degli Studi di Napoli "Federico II". Data regarding patients' demographics, clinical evaluation, cyst characteristics, surgical treatments, complications and outcomes were extracted from our electronic database (Filemaker Pro 11, File Maker Inc., Santa Clara, California, USA.A standard transsphenoidal approach was used in 19 cases, while the extended variation of the approach in 10 cases (5 purely suprasellar and 5 intra-suprasellar RCC. Cysts contents was fully drained in all the 29 cases, whilst a gross total removal, that accounts on the complete cyst wall removal, was achieved in an overall 55,1% of patients (16/29, specifically 36,8% (7/19 that received standard approach and 90% (9/10 of those that underwent to extended approach. We reported a 56.2% of recovery from headache, 38.5% of complete recovery and 53.8% of improvement from visual field defect and an overall 46.7% of improvement of the endocrine functions. Postoperative permanent DI rate was 10.3%, overall post-operative CSF leak rate 6.9%; recurrence/regrowth occurred in 4 patients (4/29, 13.8%, but only one required a second surgery.The endoscopic transsphenoidal approach for the removal of a symptomatic RCC offers several advantages in terms of visualization of the surgical field during both the exposure and removal of the lesion. The "extended" variation of the endoscopic approach provides a direct access

  7. Diseño de un ASIC Sintetizador Digital Directo de alta velocidad

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    Abdel Martínez Alonso

    2012-12-01

    Full Text Available El trabajo describe el proceso general de diseño y optimización de un Módulo IP para un Circuito Integrado de Aplicación Específica, destinado a la obtención de ondas cuasi-sinusoidales, empleando la técnica de Síntesis Digital Directa. El trabajo se realizó en tres etapas fundamentales: Diseño de un Sintetizador Digital Directo empleando Lenguaje de Descripción de Hardware VHDL, realizado sobre la plataforma ISE del fabricante de Dispositivos Lógicos Programables Xilinx. La plataforma ISE permite el control de todos los aspectos del flujo de diseño para la transformación de la descripción abstracta en lenguaje VHDL al nivel de bloques lógicos de un FPGA. De un total de cinco módulos diseñados, con diferentes funcionalidades y prestaciones, se registraron cuatro versiones en el Centro Nacional de Derecho de Autor (CENDA. Implementación y modelado del diseño en VHDL sobre plataforma FPGA, para la validación funcional del Módulo IP, empleando como soporte las Tarjetas de Desarrollo Spartan3E Starter Kit y ML507 del fabricante Xilinx. Adaptación del diseño a una tecnología de fabricación CMOS 0.35?m. Se presenta un grupo de soluciones no documentadas en la literatura, basadas en principios de optimización de circuitos digitales, que posibilitan la adaptación del diseño a una tecnología específica de un fabricante dado. Dos de las versiones del Módulo IP y cinco Reportes Técnicos han sido presentados a un fabricante de Circuitos Integrados a la Medida.

  8. Sintaxis digital en el ciberperiodismo universitario: ACN, Directo Bogotá, Escenario y Papiro, un caso

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    Mireya Barón Pulido

    2013-06-01

    Full Text Available El actual artículo expone los resultados de la investigación cualitativa que pretende evidenciar el comportamiento y las relaciones de tres características sustanciales en la sintaxis del periodismo uni- versitario en línea: niveles de hipertextualidad, de multimedialidad y de interactividad, tomando como punto de referencia la macronavegación y/o micronavegación de los documentos digitales. Esta primera exploración acude a la lectura detalla- da en el monitor y de sus textos digitales. Se utilizó el software Qualrus con el propósito de sustentar las categorías del AC –análisis de contenido– en las  respectivas redes que visualizan la tendencia de macronavegación o micronavegación en los  cuatro periódicos universitarios; etapa que se cotejó con los datos de la sesión de grupos focales emisores: ACN (Universidad Central, Directo Bogotá (Universidad Javeriana, Escenario (Universidad Santo Tomás y Papiro (Politécnico Grancolombiano Institución Universitaria. Los datos arrojados se convierten en evidencia del comportamiento e incursión de la praxis ciberperiodística en el ámbito universitario, toda vez que son el escenario potenciador de la formación en competencias profesionales del periodista del siglo XXI en la región. Agradecemos la receptividad de los webmasters, diagramadores, docentes y estudiantes de las respectivas facultades que con su tiempo e información aportaron a  la consecución de la investigación.

  9. [Usefulness of endovascular treatment for delayed massive epistaxis following endoscopic endonasal transsphenoidal surgery: a case report].

    Science.gov (United States)

    Oka, Tetsuo; Sugiu, Kenji; Ishida, Joji; Hishikawa, Tomohito; Ono, Shigeki; Tokunaga, Koji; Date, Isao

    2012-01-01

    We report here a case of massive nasal bleeding from the sphenopalatine artery three weeks after endonasal transsphenoidal surgery. This 66-year-old male suffered from massive nasal bleeding with the status of hypovolemic shock. Under general anesthesia, an emergent angiography revealed an extravasation from the sphenopalatine artery. Trans-arterial embolization using coil and n-butyl-cyanoacrylate (NBCA) was performed following the diagnostic angiography. Complete occlusion of the injured artery was achieved. The patient showed good recovery from general anesthesia. Delayed nasal bleeding after endonasal transsphenoidal surgery is a rare but important complication. The sphenopalatine artery and its branch are located in the hidden inferior lateral corner of the sphenoid sinus and may be injured during enlargement of the sphenoid opening. When massive delayed nasal bleeding follows transsphenoidal surgery and damage of the internal carotid artery has been ruled out, endovascular treatment of the external carotid artery should be considered.

  10. Endoscopic Endonasal Approach in Skull Base Chondrosarcoma Associated with Maffucci Syndrome: Case Series and Literature Review.

    Science.gov (United States)

    Beer-Furlan, André; Balsalobre, Leonardo; Vellutini, Eduardo A S; Stamm, Aldo C

    2016-01-01

    Maffucci syndrome is a nonhereditary disorder in which patients develop multiple enchondromas and cutaneous, visceral, or soft tissue hemangiomas. The potential malignant progression of enchondroma into a secondary chondrosarcoma is a well-known fact. Nevertheless, chondrosarcoma located at the skull base in patients with Maffuci syndrome is a very rare condition, with only 18 cases reported in the literature. We report 2 other cases successfully treated through an expanded endoscopic endonasal approach and discuss the condition based on the literature review. Skull base chondrosarcoma associated with Maffucci syndrome is a rare condition. The disease cannot be cured, therefore surgical treatment should be performed in symptomatic patients aiming for maximal tumor resection with function preservation. The endoscopic endonasal approach is a safe and reliable alternative for the management of these tumors. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. [Endonasal versus trans-canalicular endoscopic dacriocystorhinostomy using diode laser. Surgical techniques and outcomes].

    Science.gov (United States)

    Piédrola Maroto, David; Franco Sánchez, Javier; Reyes Eldblom, Robin; Monje Vega, Elena; Conde Jiménez, Manuel; Ortiz Rueda, Manuel

    2008-01-01

    To evaluate the benefits and disadvantages of the endoscopic endonasal versus transcanalicular approaches using diode laser, and to compare their clinical outcomes. A total of 127 patients were operated on, 80 of them with the endonasal approach (Group I) and 47 with the transcanalicular technique (Group II). Epiphora improved completely in 67 patients in Group I (83.7 %) while the other 13 (16.2 %) continued to present the same symptoms. In Group II, a successful result was achieved in 39 patients (82.9 %) and 8 (17 %) of them had to be re-operated because of the persistence of epiphora. The surgical outcomes are similar with both laser techniques. The main advantages of using diode laser are that it does not require general anaesthesia, the lower intra- and peri-operative morbidity, the lack of nasal packing and the greater ease of performing additional interventions if it fails. The only real disadvantage of laser procedures is the high cost.

  12. Clinical Pearls in Anaesthesia for Endoscopic Endonasal Transsphenoid Pituitary Macroadenoma Surgery

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    Shah Shagun B

    2015-11-01

    Full Text Available Endoscopic Endonasal Trans-sphenoid Surgery (EETS aided by avant-garde neuro-navigation techniques, ultrasonic aspirators and bone curettes has come of age. Endoscopic surgery supersedes conventional microscopic approach due to better visualization, avoidance of craniotomy, brain retraction and undue neurovascular manipulation with less morbidity, blood loss and improved safety. Anaesthetic techniques must be tailored to cater for such advances in surgery.

  13. Utility and safety of the flexible-fiber CO2 laser in endoscopic endonasal transsphenoidal surgery.

    Science.gov (United States)

    Jayarao, Mayur; Devaiah, Anand K; Chin, Lawrence S

    2011-01-01

    This study sought to report on the utility and safety of the flexible-fiber CO2 laser in endoscopic endonasal transsphenoidal surgery. A retrospective chart review identified 16 patients who underwent laser-assisted transsphenoidal surgery. All tumor pathology types were considered. Results were assessed based on hormone status, tumor size, pathology, complications, and resection rates. Sixteen pituitary lesions (pituitary adenomas, 12; Rathke cleft cyst, 2; pituitary cyst and craniopharyngioma, 1 each) with an average size of 22.7 mm were identified by radiographic and pathologic criteria. All patients underwent flexible-fiber CO2 laser-assisted endoscopic endonasal transsphenoidal surgery. Of the adenomas, 8 were nonsecreting and 4 were secreting (3 prolactinomas and 1 ACTH secreting). Gross total resection was achieved in 7 of 16 patients (43.75%) with hormone remission in all patients (100%) after a mean follow-up of 19.3 months. Postoperative complications occurred in 3 patients (18.75%): 2 patients developed transient diabetes insipidus (DI) and 1 developed a CSF leak requiring surgical repair. Five patients (31.25%) underwent postoperative radiation to the residual lesions. We found that CO2-laser-assisted endoscopic endonasal transsphenoidal surgery for sellar tumors is a minimally invasive approach using a tool that is quick and effective at cutting and coagulation. The surgery has a low rate of complication, and no laser-related complications were encountered. The laser fiber allows the surgeon to safely cut and coagulate without the line-of-sight problems encountered with conventional CO2 lasers. Further studies are recommended to further define its role in endoscopic endonasal sellar surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Investigation of effectiveness of surgical treatment of chronic dacryocystitis - endonasal dacryocystorhinostomy

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    Borodulya V.L.

    2017-10-01

    Full Text Available Prolonged and conti­nuous lacrimation (symptom of epiphora causes discomfort, inclination to conjunctiva infect, reduces visual acuity and ultimately the quality of life of the patient. Despite the fact that there is a large number of various surgical interventions to restore tearing in patients with chronic dacryocystitis, the problem of lacrimation remains relevant. We have studied the operation of endonasal dacryocystorhinostomy and its long-term consequences. Surgical intervention in endonasal dacryocystorhinostomy is aimed at eliminating lacrimation by eliminating stenosis and forming a new combination of the cavity of the laryngeal canal with the nasal cavity, as well as the sanation of purulent foci of infection in the throat. There were 8 surgical interventions. Period of observation of patients in the postoperative period by ophthalmologist and ENT-doctor is from 1.5 to 2 years. The evaluation of the result was carried out in 6 months or more after the operation. A complete recovery with the recovery of the tear excretion in the nasal cavity has been achieved in all patients. The formed rhinostoma was wide, well functioning. Thus, endonasal dacryocystorhinostomy is a highly effective and should be a method of choice for inflammation of the lacrimal sac at any stage of development.

  15. [Neurophysiological identification of the cranial nerves in endoscopic endonasal surgery of skull base tumors].

    Science.gov (United States)

    Shkarubo, A N; Ogurtsova, A A; Moshchev, D A; Lubnin, A Yu; Andreev, D N; Koval', K V; Chernov, I V

    2016-01-01

    Intraoperative identification of the cranial nerves is a useful technique in removal of skull base tumors through the endoscopic endonasal approach. Searching through the scientific literature found one pilot study on the use of triggered electromyography (t-EMG) for identification of the VIth nerve in endonasal endoscopic surgery of skull base tumors (D. San-Juan, et al, 2014). The study objective was to prevent iatrogenic injuries to the cranial nerves without reducing the completeness of tumor tissue resection. In 2014, 5 patients were operated on using the endoscopic endonasal approach. Surgeries were performed for large skull base chordomas (2 cases) and trigeminal nerve neurinomas located in the cavernous sinus (3). Intraoperatively, identification of the cranial nerves was performed by triggered electromyography using a bipolar electrode (except 1 case of chordoma where a monopolar electrode was used). Evaluation of the functional activity of the cranial nerves was carried out both preoperatively and postoperatively. Tumor resection was total in 4 out of 5 cases and subtotal (chordoma) in 1 case. Intraoperatively, the IIIrd (2 patients), Vth (2), and VIth (4) cranial nerves were identified. No deterioration in the function of the intraoperatively identified nerves was observed in the postoperative period. In one case, no responses from the VIth nerve on the right (in the cavernous sinus region) were intraoperatively obtained, and deep paresis (up to plegia) of the nerve-innervated muscles developed in the postoperative period. The nerve function was not impaired before surgery. The t-EMG technique is promising and requires further research.

  16. Endoscopic endonasal double flap technique for reconstruction of large anterior skull base defects: technical note.

    Science.gov (United States)

    Dolci, Ricardo Landini Lutaif; Todeschini, Alexandre Bossi; Santos, Américo Rubens Leite Dos; Lazarini, Paulo Roberto

    2018-04-19

    One of the main concerns in endoscopic endonasal approaches to the skull base has been the high incidence and morbidity associated with cerebrospinal fluid leaks. The introduction and routine use of vascularized flaps allowed a marked decrease in this complication followed by a great expansion in the indications and techniques used in endoscopic endonasal approaches, extending to defects from huge tumours and previously inaccessible areas of the skull base. Describe the technique of performing endoscopic double flap multi-layered reconstruction of the anterior skull base without craniotomy. Step by step description of the endoscopic double flap technique (nasoseptal and pericranial vascularized flaps and fascia lata free graft) as used and illustrated in two patients with an olfactory groove meningioma who underwent an endoscopic approach. Both patients achieved a gross total resection: subsequent reconstruction of the anterior skull base was performed with the nasoseptal and pericranial flaps onlay and a fascia lata free graft inlay. Both patients showed an excellent recovery, no signs of cerebrospinal fluid leak, meningitis, flap necrosis, chronic meningeal or sinonasal inflammation or cerebral herniation having developed. This endoscopic double flap technique we have described is a viable, versatile and safe option for anterior skull base reconstructions, decreasing the incidence of complications in endoscopic endonasal approaches. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  17. Anatomic comparison of the endonasal and transpetrosal approaches for interpeduncular fossa access.

    Science.gov (United States)

    Oyama, Kenichi; Prevedello, Daniel M; Ditzel Filho, Leo F S; Muto, Jun; Gun, Ramazan; Kerr, Edward E; Otto, Bradley A; Carrau, Ricardo L

    2014-01-01

    The interpeduncular cistern, including the retrochiasmatic area, is one of the most challenging regions to approach surgically. Various conventional approaches to this region have been described; however, only the endoscopic endonasal approach via the dorsum sellae and the transpetrosal approach provide ideal exposure with a caudal-cranial view. The authors compared these 2 approaches to clarify their limitations and intrinsic advantages for access to the interpeduncular cistern. Four fresh cadaver heads were studied. An endoscopic endonasal approach via the dorsum sellae with pituitary transposition was performed to expose the interpeduncular cistern. A transpetrosal approach was performed bilaterally, combining a retrolabyrinthine presigmoid and a subtemporal transtentorium approach. Water balloons were used to simulate space-occupying lesions. "Water balloon tumors" (WBTs), inflated to 2 different volumes (0.5 and 1.0 ml), were placed in the interpeduncular cistern to compare visualization using the 2 approaches. The distances between cranial nerve (CN) III and the posterior communicating artery (PCoA) and between CN III and the edge of the tentorium were measured through a transpetrosal approach to determine the width of surgical corridors using 0- to 6-ml WBTs in the interpeduncular cistern (n = 8). Both approaches provided adequate exposure of the interpeduncular cistern. The endoscopic endonasal approach yielded a good visualization of both CN III and the PCoA when a WBT was in the interpeduncular cistern. Visualization of the contralateral anatomical structures was impaired in the transpetrosal approach. The surgical corridor to the interpeduncular cistern via the transpetrosal approach was narrow when the WBT volume was small, but its width increased as the WBT volume increased. There was a statistically significant increase in the maximum distance between CN III and the PCoA (p = 0.047) and between CN III and the tentorium (p = 0.029) when the WBT volume

  18. Endoscopic Endonasal Transplanum Transtuberculum Approach for the Resection of a Large Suprasellar Craniopharyngioma.

    Science.gov (United States)

    Mangussi-Gomes, João; Vellutini, Eduardo A; Truong, Huy Q; Pahl, Felix H; Stamm, Aldo C

    2018-04-01

    Objectives  To demonstrate an endoscopic endonasal transplanum transtuberculum approach for the resection of a large suprasellar craniopharyngioma. Design  Single-case-based operative video. Setting  Tertiary center with dedicated skull base team. Participants  A 72-year-old male patient diagnosed with a suprasellar craniopharyngioma. Main Outcomes Measured  Surgical resection of the tumor and preservation of the normal surrounding neurovascular structures. Results  A 72-year-old male patient presented with a 1-year history of progressive bitemporal visual loss. He also referred symptoms suggestive of hypogonadism. Neurological examination was unremarkable and endocrine workup demonstrated mildly elevated prolactin levels. Magnetic resonance images demonstrated a large solid-cystic suprasellar lesion, consistent with the diagnosis of craniopharyngioma. The lesion was retrochiasmatic, compressed the optic chiasm, and extended into the interpeduncular cistern ( Fig. 1 ). Because of that, the patient underwent an endoscopic endonasal transplanum transtuberculum approach. 1 2 3 The nasal stage consisted of a transnasal transseptal approach, with complete preservation of the patient's left nasal cavity. 4 The cystic component of the tumor was decompressed and its solid part was resected. It was possible to preserve the surrounding normal neurovascular structures ( Fig. 2 ). Skull base reconstruction was performed with a dural substitute, a fascia lata graft, and a right nasoseptal flap ( Video 1 ). The patient did well after surgery and referred complete visual improvement. However, he also presented pan-hypopituitarism on long-term follow-up. Conclusions  The endoscopic endonasal route is a good alternative for the resection of suprasellar lesions. It permits tumor resection and preservation of the surrounding neurovascular structures while avoiding external incisions and brain retraction. The link to the video can be found at: https://youtu.be/zmgxQe8w-JQ .

  19. First Application of 7T Magnetic Resonance Imaging in Endoscopic Endonasal Surgery of Skull Base Tumors

    Science.gov (United States)

    Barrett, Thomas F; Dyvorne, Hadrien A; Padormo, Francesco; Pawha, Puneet S; Delman, Bradley N; Shrivastava, Raj K; Balchandani, Priti

    2018-01-01

    Background Successful endoscopic endonasal surgery for the resection of skull base tumors is reliant on preoperative imaging to delineate pathology from the surrounding anatomy. The increased signal-to-noise ratio afforded by 7T MRI can be used to increase spatial and contrast resolution, which may lend itself to improved imaging of skull base. In this study, we apply a 7T imaging protocol to patients with skull base tumors and compare the images to clinical standard of care. Methods Images were acquired at 7T on 11 patients with skull base lesions. Two neuroradiologists evaluated clinical 1.5T, 3T, and 7T scans for detection of intracavernous cranial nerves and ICA branches. Detection rates were compared. Images were utilized for surgical planning and uploaded to a neuronavigation platform and used to guide surgery. Results Image analysis yielded improved detection rates of cranial nerves and ICA branches at 7T. 7T images were successfully incorporated into preoperative planning and intraoperative neuronavigation. Conclusion Our study represents the first application of 7T MRI to the full neurosurgical workflow for endoscopic endonasal surgery. We detected higher rates of cranial nerves and ICA branches at 7T MRI compared to 3T and 1.5 T, and found that integration of 7T into surgical planning and guidance was feasible. These results suggest a potential for 7T MRI to reduce surgical complications. Future studies comparing standardized 7T, 3T, and 1.5 T MRI protocols in a larger number of patients are warranted to determine the relative benefit of 7T MRI for endonasal endoscopic surgical efficacy. PMID:28359922

  20. First Application of 7-T Magnetic Resonance Imaging in Endoscopic Endonasal Surgery of Skull Base Tumors.

    Science.gov (United States)

    Barrett, Thomas F; Dyvorne, Hadrien A; Padormo, Francesco; Pawha, Puneet S; Delman, Bradley N; Shrivastava, Raj K; Balchandani, Priti

    2017-07-01

    Successful endoscopic endonasal surgery for the resection of skull base tumors is reliant on preoperative imaging to delineate pathology from the surrounding anatomy. The increased signal-to-noise ratio afforded by 7-T MRI can be used to increase spatial and contrast resolution, which may lend itself to improved imaging of the skull base. In this study, we apply a 7-T imaging protocol to patients with skull base tumors and compare the images with clinical standard of care. Images were acquired at 7 T on 11 patients with skull base lesions. Two neuroradiologists evaluated clinical 1.5-, 3-, and 7-T scans for detection of intracavernous cranial nerves and internal carotid artery (ICA) branches. Detection rates were compared. Images were used for surgical planning and uploaded to a neuronavigation platform and used to guide surgery. Image analysis yielded improved detection rates of cranial nerves and ICA branches at 7 T. The 7-T images were successfully incorporated into preoperative planning and intraoperative neuronavigation. Our study represents the first application of 7-T MRI to the full neurosurgical workflow for endoscopic endonasal surgery. We detected higher rates of cranial nerves and ICA branches at 7-T MRI compared with 3- and 1.5-T MRI, and found that integration of 7 T into surgical planning and guidance was feasible. These results suggest a potential for 7-T MRI to reduce surgical complications. Future studies comparing standardized 7-, 3-, and 1.5-T MRI protocols in a larger number of patients are warranted to determine the relative benefit of 7-T MRI for endonasal endoscopic surgical efficacy. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Ligadura endoscópica endonasal da artéria esfenopalatina para epistaxe severa

    Directory of Open Access Journals (Sweden)

    Santos Rodrigo P.

    2002-01-01

    Full Text Available Introdução: A epistaxe severa, geralmente associada a fatores predisponentes como hipertensão arterial sistêmica e coagulopatia, é uma doença desafiadora, e pode necessitar de uma abordagem cirúrgica nos casos que não respondem ao tratamento conservador, como cauterização e tamponamento nasal. Objetivo: avaliar os resultados da ligadura endoscópica endonasal da artéria esfenopalatina no tratamento da epistaxe severa refratária à abordagem terapêutica conservadora. Forma de estudo: Clínico prospectivo. Material e Método: foram avaliados doze casos de pacientes submetidos à ligadura endoscópica endonasal da artéria esfenopalatina no tratamento da epistaxe severa não responsiva ao tratamento conservador, observando-se a história clínica, os fatores predisponentes, a evolução e as complicações deste procedimento. Resultados: a idade média foi de 50,9 anos, e a distribuição por sexo foi de 33% do sexo feminino e 67% do sexo masculino; 33% apresentaram HAS e 16,6% coagulopatia (hepatopatia como fatores predisponentes. Um paciente (8,3% apresentou ressangramento após o procedimento cirúrgico. Discussão: a ligadura endoscópica endonasal da artéria esfenopalatina representa uma abordagem segura e garante um controle satisfatório do sangramento, com índice de ressangramento de 8,3% entre os nossos casos. Conclusão: a ligadura endoscópica endonasal da artéria esfenopalatina representa uma opção cirúrgica adequada, pois não apresenta as complicações das técnicas anteriores, atinge um controle satisfatório do sangramento e pode ser realizada por otorrinolaringologistas habituados à cirurgia endoscópica nasal.

  2. Endoscopic Endonasal Infrapetrous Transpterygoid Approach to the Petroclival Junction for Petrous Apex Chondrosarcoma: Technical Report.

    Science.gov (United States)

    Maurer, Adrian J; Bonney, Phillip A; Iser, Courtney R; Ali, Rohaid; Sanclement, Jose A; Sughrue, Michael E

    2015-07-01

    Chondrosarcomas of the skull base are rare tumors that present difficult management considerations due to the pathoanatomical relationships of the tumor to adjacent structures. We present the case of a 25-year-old female patient presenting with a chondrosarcoma of the right petrous apex extending inferiorly, medial to the cranial nerves. The tumor was resected via an endoscopic endonasal infrapetrous transpterygoid approach that achieved complete resection and an excellent long-term outcome with no complications. Technical nuances and potential pitfalls of the case are discussed in depth including measures to protect the carotid artery while performing the required drilling of the skull base to access the lesion.

  3. Gigant Transethmoidal Meningoencephalocele Operated by Full Endonasal Endoscopic Approach: Case Report

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    Omar Lopez Arbolay

    2012-01-01

    Full Text Available Intranasal meningoencephaloceles have historically been managed by neurosurgeons, although their main clinical manifestations are rhinological. Recent advances in endoscopic skull base surgery has significantly improved the treatment of these lesions and consequently diminished appreciable surgical morbidity. We report an ethmoidal meningoencephalocele case operated on by endonasal endoscopic approach for removal of the lesion and reconstructing the associated skull base. From this experience, we conclude that removal of the lesion and watertight closure of the skull base irrespective of the size of the mass and anterior skull base defect are the operation’s most important aspects.

  4. Plan de muestreo directo para Trialeurodes vaporariorum (Westwood (Hemiptera: Aleyrodidae en cultivos comerciales de tomate

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    Bernal Liliana

    2008-08-01

    Full Text Available

    Los daños ocasionados por Trialeurodes vaporariorum generan pérdidas económicas que disminuyen la producción y pueden contribuir en el alza de los precios del tomate. Para su control se acude a aplicaciones continuas de insecticidas, sin obtener resultados satisfactorios. Como alternativa de control se realizan liberaciones del parasitoide E. formosa. Sin embargo, el éxito de este sistema implica estimar la densidad de la plaga a través de un método de muestreo adecuado. Por ello, se estandarizó un plan de muestreo directo, económicamente viable, para ninfas de mosca blanca en un cultivo comercial de tomate bajo invernadero. Se determinó la incidencia de prácticas de manejo y de la fenología en la distribución espacial de ninfas. En términos generales, el muestreo se dividió en tres etapas: 1 muestreo totalmente aleatorio, entre las 5 y 7 semanas después de la siembra (sds, para plantas no divididas en tercios; 2 muestreo aleatorio, entre las 8 y 16 sds, los conteos se realizaron en hojas del tercio inferior; 3 muestreo bietápico: planta y hoja, entre las 17 y 24 sds, los conteos se efectuaron sobre hojas de los tercios medio y superior. Se encontró que prácticas culturales como el despunte influyeron en la distribución espacial de las ninfas. La implementación del muestreo directo generó un incremento en la producción del 0,06% y permitió estimar la densidad de ninfas de Trialeurodes vaporariorum en el cultivo (con precisiones de 5%, 10% y 25% como criterio para liberar E. formosa.

  5. Meningitis caused by Enterococcus casseliflavus with refractory cerebrospinai fluid leakage following endoscopic endonasal removal of skull base chondrosarcoma

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    To the Editor:Meningitis caused by Enterococcus casseliflavus (E.casseliflavus) is extremely rare.Here we report an unusual case of meningitis caused by E.casseliflavus coexisting with refractory cerebrospinal fluid (CSF) leakage following endoscopic endonasal resection of skull base chondrosarcoma.

  6. A prospective qualitative study on patients' perceptions of endoscopic endonasal transsphenoidal surgery.

    Science.gov (United States)

    Edem, Idara J; Banton, Beverly; Bernstein, Mark; Lwu, Shelly; Vescan, Allan; Gentilli, Fred; Zadeh, Gelareh

    2013-02-01

    Endoscopic transsphenoidal surgery has been shown to be a safe and effective treatment option for patients with pituitary tumours, but no study has explored patients' perceptions before and after this surgery. The authors in this study aim to explore patients' perceptions on endoscopic transsphenoidal surgery. Using qualitative research methodology, two semi-structured interviews were conducted with 30 participants who were adults aged > 18 undergoing endoscopic transsphenoidal surgery for the resection of a pituitary tumour between December 2008 and June 2011. The interviews were audiotaped and transcribed. The resulting data was analyzed using a modified thematic analysis. Seven overarching themes were identified: (1) Patients had a positive surgical experience; (2) patients were satisfied with the results of the procedure; (3) patients were initially surprised that neurosurgery could be performed endonasally; (4) patients expected a cure and to feel better after the surgery; (5) many patients feared that something might go wrong during the surgery; (6) patients were psychologically prepared for the surgery; (7) most patients reported receiving adequate pre-op and post-op information. This is the first qualitative study reporting on patients' perceptions before and after an endoscopic endonasal transsphenoidal pituitary surgery, which is increasingly used as a standard surgical approach for patients with pituitary tumours. Patients report a positive perception and general satisfaction with the endoscopic transsphenoidal surgical experience. However, there is still room for improvement in post-surgical care. Overall, patients' perceptions can help improve the delivery of comprehensive care to future patients undergoing pituitary tumour surgery.

  7. [The extended endoscopic endonasal transsphenoidal approach in surgery for epidermoid cysts of the chiasmatic region].

    Science.gov (United States)

    Fomichev, D V; Kalinin, P L; Kutin, M A; Sharipov, O I; Chernov, I V

    Surgical treatment for epidermoid cysts of the chiasmatic region is a challenge because of the tendency to a massive spread of epidermoid masses through the cerebrospinal fluid pathways and a significant lesion deviation from the midline. To analyze capabilities of the extended endoscopic endonasal transsphenoidal approach in surgery for epidermoid cysts. The study included 6 patients with epidermoid cysts of the chiasmatic region who were operated on using the extended anterior endoscopic endonasal transsphenoidal approach at the Burdenko Neurosurgical Institute in the past 5 years. Epidermoid masses were completely removed in 5 patients; in none of the cases, complete removal of the epidermoid cyst capsule was achieved. There were no cases of vision deterioration and the development of new focal neurological symptoms. One female patient developed hypopituitary disorders in the postoperative period. There was no recurrence of epidermoid cysts during follow-up. Removal of epidermoid cysts of the chiasmatic region using the extended anterior endoscopic transsphenoidal approach may be an alternative to transcranial microsurgery.

  8. Olfactory function and quality of life following microscopic endonasal transsphenoidal pituitary surgery.

    Science.gov (United States)

    Wang, Shousen; Chen, Yehuang; Li, Jianzhong; Wei, Liangfeng; Wang, Rumi

    2015-01-01

    Olfactory outcomes as well as oronasal postoperative complications of transsphenoidal pituitary surgery have not been well studied. The objective of this study was to investigate nasal symptoms including olfactory function as well as quality of life following transsphenoidal pituitary surgery. The study is designed as a prospective cohort study set in a single tertiary hospital. A total of 53 patients with pituitary adenomas were included. All patients underwent pituitary surgery with the right-sided endonasal transsphenoidal approach. Outcomes were assessed with the Chinese version of the Medical Outcomes Study Short Form-36 (SF-36) to survey patient health, the Chinese version of the 22-item Sinonasal Outcome Test (SNOT-22), and a Toyota and Takagi (T&T) olfactometer. Assessments were carried out before surgery and at 1 week, and 1 and 4 months after surgery. The overall SF-36 scores were significantly lower, but the SNOT-22 scores were higher at 1 week and 1 month postoperatively compared with baseline (all P surgery were independent risk factors for a higher SNOT-22 score at 1 week after surgery. The findings show that microscopic endonasal transsphenoidal pituitary surgery impairs olfactory function in most patients for at least 4 months after surgery.

  9. Successful endonasal dacryocystorhinostomy in a patient with Wegener’s granulomatosis

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    P Eloy

    2009-11-01

    Full Text Available P Eloy, E Leruth, B Bertrand, Ph RombauxENT and HNS department, Cliniques Universitaires de Mont-Godinne, Université Catholique de Louvain, 5530, Yvoir, BelgiumAbstract: Wegener’s granulomatosis (WG is one form of idiopathic autoimmune vasculitis. The disease has a predilection for the upper and lower respiratory tracts (lungs, nose, sinus, and kidneys. WG may be systemic, severe, and potentially lethal, but it may also be limited to the otolaryngological area or to the eyes and the orbits. Obstruction of the lacrimal pathway is a possible complication of the disease that affects approximately 7% of patients with WG. It usually occurs as a direct extension of sinonasal disease and typically is a late manifestation. Management of such a condition is generally viewed as difficult. We report the case of a patient with a quiescent WG limited to the otolaryngological area. This patient presented a bilateral obstruction of the nasolacrimal ducts caused by bilateral extensive adhesions in the nasal cavity. Because she had several episodes of left-side acute dacryocystitis which necessitated several courses of broad-spectrum antibiotics, she successfully underwent an endonasal endoscopic dacryocystorhinostomy using a diode laser and powered instrumentation. The authors describe the clinical case, the surgical technique, and review the literature.Keywords: Wegener’s granulomatosis, recurrent dacryocystitis, endonasal DCR, diode, laser, powered instrumentation

  10. Extended Endoscopic Endonasal Approaches for Cerebral Aneurysms: Anatomical, Virtual Reality and Morphometric Study

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    Alberto Di Somma

    2014-01-01

    Full Text Available Introduction. The purpose of the present contribution is to perform a detailed anatomic and virtual reality three-dimensional stereoscopic study in order to test the effectiveness of the extended endoscopic endonasal approaches for selected anterior and posterior circulation aneurysms. Methods. The study was divided in two main steps: (1 simulation step, using a dedicated Virtual Reality System (Dextroscope, Volume Interactions; (2 dissection step, in which the feasibility to reach specific vascular territory via the nose was verified in the anatomical laboratory. Results. Good visualization and proximal and distal vascular control of the main midline anterior and posterior circulation territory were achieved during the simulation step as well as in the dissection step (anterior communicating complex, internal carotid, ophthalmic, superior hypophyseal, posterior cerebral and posterior communicating, basilar, superior cerebellar, anterior inferior cerebellar, vertebral, and posterior inferior cerebellar arteries. Conclusion. The present contribution is intended as strictly anatomic study in which we highlighted some specific anterior and posterior circulation aneurysms that can be reached via the nose. For clinical applications of these approaches, some relevant complications, mainly related to the endonasal route, such as proximal and distal vascular control, major arterial bleeding, postoperative cerebrospinal fluid leak, and olfactory disturbances must be considered.

  11. Resident simulation training in endoscopic endonasal surgery utilizing haptic feedback technology.

    Science.gov (United States)

    Thawani, Jayesh P; Ramayya, Ashwin G; Abdullah, Kalil G; Hudgins, Eric; Vaughan, Kerry; Piazza, Matthew; Madsen, Peter J; Buch, Vivek; Sean Grady, M

    2016-12-01

    Simulated practice may improve resident performance in endoscopic endonasal surgery. Using the NeuroTouch haptic simulation platform, we evaluated resident performance and assessed the effect of simulation training on performance in the operating room. First- (N=3) and second- (N=3) year residents were assessed using six measures of proficiency. Using a visual analog scale, the senior author scored subjects. After the first session, subjects with lower scores were provided with simulation training. A second simulation served as a task-learning control. Residents were evaluated in the operating room over six months by the senior author-who was blinded to the trained/untrained identities-using the same parameters. A nonparametric bootstrap testing method was used for the analysis (Matlab v. 2014a). Simulation training was associated with an increase in performance scores in the operating room averaged over all measures (p=0.0045). This is the first study to evaluate the training utility of an endoscopic endonasal surgical task using a virtual reality haptic simulator. The data suggest that haptic simulation training in endoscopic neurosurgery may contribute to improvements in operative performance. Limitations include a small number of subjects and adjudication bias-although the trained/untrained identity of subjects was blinded. Further study using the proposed methods may better describe the relationship between simulated training and operative performance in endoscopic Neurosurgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center.

    Science.gov (United States)

    Gondim, Jackson A; Schops, Michele; de Almeida, João Paulo C; de Albuquerque, Lucas Alverne F; Gomes, Erika; Ferraz, Tânia; Barroso, Francisca Andréa C

    2010-01-01

    Pituitary tumors are challenging tumors in the sellar region. Surgical approaches to the pituitary have undergone numerous refinements over the last 100 years. The introduction of the endoscope have revolutionized pituitary surgery. The aim of this study is to report the results of a consecutive series of patients undergoing pituitary surgery using a pure endoscopic endonasal approach and to evaluate the efficacy and safety of this procedure. We reviewed the data of 228 consecutive patients who underwent endonasal transsphenoidal adenoma removal over an 10-year period. Pre- and post-operative hormonal status (at least 3 months after surgery) were analyzed and compared with clinical parameters presented by the patients. Tumor removal rate, endocrinological outcomes, and complications were retrospectively assessed in 228 patients with pituitary adenomas who underwent 251 procedures between December 1998 and December 2007. There were 93 nonfunctioning adenomas, 58 growth hormone-secreting, 41 prolactin-secreting, 28 adrenocorticotropin hormone secreting, 7 FSH-LH secreting and 1 thyroid-stimulating hormone-secreting adenomas. Gross total removal was achieved in 79.3% of the cases after a median follow-up of 61.5 months. The remission results for patients with nonfunctioning adenomas was 83% and for functioning adenomas were 76.3% (70.6% for GH hormone-secreting, 85.3% for prolactin hormone-secreting, 71.4% for ACTH hormone-secreting, 85.7% for FSH-LH hormone-secreting and 100% for TSH hormone-secreting), with no recurrence at the time of the last follow-up. Post-operative complications were present in 35 (13.9%) cases. The most frequent complications were temporary and permanent diabetes insipidus (six and two cases, respectively), syndrome of inappropriate antidiuretic hormone secretion (two cases) and CSF leaks (eight cases). There was no death related to the procedure in this series. The endoscopic endonasal approach for resection of pituitary adenomas, provides

  13. Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

    Science.gov (United States)

    NISHIOKA, Hiroshi

    2017-01-01

    For the treatment of pituitary tumors, microscopic transsphenoidal surgery has been considered the “gold standard” since the late 1960s. Over the last two decades, however, a worldwide shift towards endoscopic endonasal surgery is in progress for many reasons. These include a wide panoramic view, improved illumination, an ability to look around anatomical corners using angled tip and, in addition, application to the extended approaches for parasellar tumors. Both endoscopic and microscopic approaches appear equally effective for nonfunctioning adenomas without significant suprasellar or lateral extensions, whereas the endoscopic approach may improve outcomes associated with the extent of resection and postoperative complications for larger tumors. Despite many theoretical benefits in the endoscopic surgery, remission rates of functioning adenomas do not substantially differ between the approaches in experienced hands. The endoscopic approach is a valid alternative to the microscopic approach for adenomas. The benefits will be more appreciated in the extended surgery for parasellar tumors. PMID:28239067

  14. Surgical treatment of non-functioning pituitary macroadenomas by the endoscopic endonasal approach in the elderly

    Directory of Open Access Journals (Sweden)

    Horacio Armando Marenco

    2015-09-01

    Full Text Available Over the past three decades, surgical series of elderly patients treated for pituitary adenomas have been published, all of which used the microscopic transsphenoidal or transcranial approach. The objective of this study was to retrospectively analyze the surgical results of our first 25 elderly patients with non-functioning pituitary macroadenoma (NFPM operated by the endoscopic endonasal approach (EEA. Preoperative visual loss was found in 92.8% of the cases, and 70.8% experienced visual improvement following surgery. Preoperative pituitary dysfunction was found in 69.2% of the cases and postoperative pituitary recovery occurred in 22.2% of them. Mean hospital stay was 6.7 days. The results of this study suggest that surgery remains the first line of treatment for NFPM in the elderly. Because age alone is not a barrier for surgery, patients should be selected for surgical treatment based on their symptoms and clinical condition, as defined by comorbidities.

  15. Initial Experiments with the Leap Motion as a User Interface in Robotic Endonasal Surgery.

    Science.gov (United States)

    Travaglini, T A; Swaney, P J; Weaver, Kyle D; Webster, R J

    The Leap Motion controller is a low-cost, optically-based hand tracking system that has recently been introduced on the consumer market. Prior studies have investigated its precision and accuracy, toward evaluating its usefulness as a surgical robot master interface. Yet due to the diversity of potential slave robots and surgical procedures, as well as the dynamic nature of surgery, it is challenging to make general conclusions from published accuracy and precision data. Thus, our goal in this paper is to explore the use of the Leap in the specific scenario of endonasal pituitary surgery. We use it to control a concentric tube continuum robot in a phantom study, and compare user performance using the Leap to previously published results using the Phantom Omni. We find that the users were able to achieve nearly identical average resection percentage and overall surgical duration with the Leap.

  16. Limitations of the endonasal endoscopic approach in treating olfactory groove meningiomas. A systematic review.

    Science.gov (United States)

    Shetty, Sathwik Raviraj; Ruiz-Treviño, Armando S; Omay, Sacit Bulent; Almeida, Joao Paulo; Liang, Buqing; Chen, Yu-Ning; Singh, Harminder; Schwartz, Theodore H

    2017-10-01

    To review current management strategies for olfactory groove meningioma (OGM)s and the recent literature comparing endoscopic endonasal (EEA) with traditional transcranial (TCA) approaches. A PubMed search of the recent literature (2011-2016) was performed to examine outcomes following EEA and TCA for OGM. The extent of resection, visual outcome, postoperative complications and recurrence rates were analyzed using percentages and proportions, the Fischer exact test and the Student's t-test using Graphpad PRISM 7.0Aa (San Diego, CA) software. There were 444 patients in the TCA group with a mean diameter of 4.61 (±1.17) cm and 101 patients in the EEA group with a mean diameter of 3.55 (± 0.58) cm (p = 0.0589). GTR was achieved in 90.9% (404/444) in the TCA group and 70.2% (71/101) in the EEA group (p OGMs.

  17. Initial Experiments with the Leap Motion as a User Interface in Robotic Endonasal Surgery

    Science.gov (United States)

    Travaglini, T. A.; Swaney, P. J.; Weaver, Kyle D.; Webster, R. J.

    2016-01-01

    The Leap Motion controller is a low-cost, optically-based hand tracking system that has recently been introduced on the consumer market. Prior studies have investigated its precision and accuracy, toward evaluating its usefulness as a surgical robot master interface. Yet due to the diversity of potential slave robots and surgical procedures, as well as the dynamic nature of surgery, it is challenging to make general conclusions from published accuracy and precision data. Thus, our goal in this paper is to explore the use of the Leap in the specific scenario of endonasal pituitary surgery. We use it to control a concentric tube continuum robot in a phantom study, and compare user performance using the Leap to previously published results using the Phantom Omni. We find that the users were able to achieve nearly identical average resection percentage and overall surgical duration with the Leap. PMID:26752501

  18. Outcome of functional endonasal sinus surgery with and without CT-navigation.

    Science.gov (United States)

    Tschopp, Kurt P; Thomaser, Esther G

    2008-06-01

    Computer-assisted surgery (CAS) has found widespread use in functional endonasal sinus surgery (FESS) over the past few years. The present study investigates if CAS leads to a better outcome in FESS. All patients who underwent endonasal sphenoethmoidectomy were enrolled in a prospective, non-randomized case-control study. The procedures were done without CAS (group A) in 2003 and with CAS (group B) in 2004, using a Stryker navigation unit. Sixty-two patients (113 sphenoidectomies) were included in group A and 61 patients (109 sphenoidectomies) in group B. The underlying disease was recurrent chronic sinusitis or polyposis nasi in all patients except for inverted papilloma in one patient from group A and in two patients from group B. The follow-up period was 12 months. Symptom scores were assessed preoperatively and at 12 months postoperatively, using a questionnaire. A CT-scan was obtained in all patients preoperatively and at 6 months postoperatively. No significant difference was found between group A and B, neither with respect to symptom scores at 12 months postoperatively, nor in postoperative CT-scans. The operation strategy did not change by the introduction of CAS. The frontal sinuses were entered in group A and B in 59% and 64% of the patients, respectively. All parameters improved significantly postoperatively, compared to the preoperative values. As far as complications are concerned, two anterior orbital injuries and one retrobulbar haematoma occurred in group A and one postoperative lacrimal stenosis in group B. CAS does not lead to a better clinical outcome in FESS. Our data suggest that the rate of complications may be reduced using CAS. However, studies with a much larger number of patients would be necessary in order to definitely answer the question of whether CAS reduce complications in FESS.

  19. [Does CT-navigation improve the outcome of functional endonasal sinus surgery?].

    Science.gov (United States)

    Thomaser, E G; Tschopp, K

    2007-08-01

    Computer-assisted surgery (CAS) has found widespread use in functional endonasal sinus surgery (FESS) over the past few years. The present study investigates if CAS leads to a better outcome in FESS. All patients who underwent endonasal sphenoethmoidectomy were enrolled in a prospective, non-randomized study. The procedures were done without CAS (group A) in 2003 and in 2004 with CAS (group B), using a Stryker navigation unit. 62 patients (113 sphenoidectomies) were included in group A and 61 patients (109 sphenoidectomies) in group B. The underlying disease was recurrent chronic sinusitis or polyposis nasi in all patients except for inverted papilloma in one patient of group A and in two patients of group B. The follow-up period was 6 months. Preoperatively and at 6 months postoperatively, a CT-scan was obtained and symptom scores were assessed using a questionnaire. No significant difference was found between group A and B with respect to symptom scores, and CT-scans preoperatively and at 6 months postoperatively. The operation strategy did not change by the introduction of CAS. The frontal sinus was entered in group A and B in 59% and 64%, respectively. All parameters significantly improved postoperatively, compared to the preoperative values. As far as complications are concerned, two anterior orbital injuries and one retrobulbar haematoma occurred in group A and one postoperative lacrimal stenosis in group B. CAS does not lead to a better clinical outcome in FESS. Our data suggest that the rate of complications may be reduced using CAS. However, studies with a much larger number of patients would be necessary for a definite answer to this issue.

  20. Changes in cytokines in tears after endoscopic endonasal dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction.

    Science.gov (United States)

    Lee, J K; Kim, T H

    2014-05-01

    We attempted to compare the cytokine composition of tears between primary acquired nasolacrimal duct (NLD) obstruction and normal controls. We investigated the changes in cytokines in tears after endoscopic endonasal dacryocystorhinostomy (DCR). Eighteen patients underwent endonasal DCR, with seven patients undergoing bilateral DCR, resulting in twenty-five DCRs in total. Eleven contralateral un-operated eyes were used as normal controls. Silicone stents were removed 3 months after surgery. Tear samples were collected from all eyes before surgery, and at 1 month, 2 months, 3 months, and 4 months after surgery. The level of interleukin (IL)-1β, IL-2, IL-6, IL-10, transforming growth factor (TGF)-β2, fibroblast growth factor (FGF)-2, and vascular endothelial growth factor (VEGF) in the tears was measured. The concentrations of IL-2, IL-6, IL-10, VEGF, and FGF-2 were significantly higher in eyes with NLD obstruction than controls before surgery (P=0.006, 0.018, 0.002, 0.048, and 0.039, respectively). Most inflammatory cytokines (IL-1β, IL-2, IL-6, VEGF, and FGF-2) were higher in the tears of the DCR group compared with the controls during the postoperative follow-up, but then rapidly decreased to the level of the controls after removal of the silicone stent. The recurred eyes showed a higher level of TGF-β2 and FGF-2 in tears compared with the eyes that showed good surgical results (Ptear levels of inflammatory cytokines were higher in eyes with NLD obstruction than controls. The changes in cytokine level during the postoperative period showed the importance of cytokine analysis in understanding wound healing after DCR.

  1. Management of odontogenic cysts by endonasal endoscopic techniques: A systematic review and case series.

    Science.gov (United States)

    Marino, Michael J; Luong, Amber; Yao, William C; Citardi, Martin J

    2018-01-01

    Odontogenic cysts and tumors of the maxilla may be amendable to management by endonasal endoscopic techniques, which may reduce the morbidity associated with open procedures and avoid difficult reconstruction. To perform a systematic review that evaluates the feasibility and outcomes of endoscopic techniques in the management of different odontogenic cysts. A case series of our experience with these minimally invasive techniques was assembled for insight into the technical aspects of these procedures. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to identify English-language studies that reported the use of endoscopic techniques in the management of odontogenic cysts. Several medical literature data bases were searched for all occurrences in the title or abstract of the terms "odontogenic" and "endoscopic" between January 1, 1950, and October 1, 2016. Publications were evaluated for the technique used, histopathology, complications, recurrences, and the follow-up period. A case series of patients who presented to a tertiary rhinology clinic and who underwent treatment of odontogenic cysts by an endoscopic technique was included. A systematic review identified 16 case reports or series that described the use of endoscopic techniques for the treatment of odontogenic cysts, including 45 total patients. Histopathologies encountered were radicular (n = 16) and dentigerous cysts (n = 10), and keratocystic odontogenic tumor (n = 12). There were no reported recurrences or major complications for a mean follow-up of 29 months. A case series of patients in our institution identified seven patients without recurrence for a mean follow-up of 10 months. Endonasal endoscopic treatment of various odontogenic cysts are described in the literature and are associated with effective treatment of these lesions for an average follow-up period of >2 years. These techniques have the potential to reduce morbidity associated with the resection of these

  2. Transcanalicular Laser-Assisted Dacryocystorhinostomy With Endonasal Augmentation in Primary Nasolacrimal Duct Obstruction: Our Experience.

    Science.gov (United States)

    Goel, Ruchi; Nagpal, Smriti; Kumar, Sushil; Meher, Ravi; Kamal, Saurabh; Garg, Sonam

    To evaluate and compare the success rate of transcanalicular laser-assisted dacryocystorhinostomy with endonasal augmentation, with and without intubation, in patients suffering from primary acquired nasolacrimal duct obstruction, at 1 year of follow up. A prospective, randomized interventional pilot study was conducted at a tertiary care center, in accordance with the guidelines of Declaration of Helsinki. Sixty eyes of 60 adult patients with primary acquired nasolacrimal duct obstruction were included. The participants were divided randomly into 2 equal groups (A and B-without and with bicanalicular intubation, respectively). An osteotomy was first created using 980 nm diode laser (set at 8W continuous mode) transcanalicularly and then enlarged intranasally using Blakesley's nasal forceps, followed by bicanalicular silicon intubation in group B patients. The tubes were removed at the end of 8 weeks. The ostium size was assessed endoscopically at 8 weeks and again at the end of follow up, at 1 year. A successful outcome was defined in terms of ostium patency at the end of 1 year. The results were analyzed at the end of a follow up of 1 year, using various statistical tests (p < 0.05). The mean age of the patients was 35.3 ± 15.89 years, with 23 male and 37 female patients, the 2 groups having a similar male:female ratio. An overall success rate of 90% was achieved at the end of 1 year with no statistically significant difference between the groups. Postoperative complications like tube displacement and punctal, canalicular injury were more in the intubated group. The average osteotomy size was 8.06 ± 5.4 mm at the end of 1 year. Transcanalicular laser-assisted dacryocysto rhinostomy, with endonasal augmentation, is a scarless, effective, daycare procedure, for treatment of primary acquired nasolacrimal duct obstruction with no additional advantage offered by silicone intubation.

  3. The Usefulness of the Endonasal Incisional Approach for the Treatment of Nasal Bone Fracture

    Directory of Open Access Journals (Sweden)

    Hyo Seong Kim

    2012-05-01

    Full Text Available BackgroundAmong all facial fractures, nasal bone fractures are the most common, and they have been reduced by closed reduction (CR for a long time. But several authors have reported suboptimal results when using CR, and the best method of nasal bone reduction is still being debated. We have found that indirect open reduction (IOR through an endonasal incisional approach is a useful method for more accurate reduction of the nasal bone.MethodsA retrospective chart review was performed of 356 patients who underwent reduction of a nasal bone fracture in our department from January, 2006, to July, 2011. We treated 263 patients with IOR. We assessed patients' and doctors' satisfaction with surgical outcomes after IOR or CR. We evaluated the frequency of nasal bleeding owing to mucosal injury, and followed the surgical outcomes of patients who had simultaneous dorsal augmentation rhinoplasty.ResultsAccording to the analysis of the satisfaction scores, both patients and doctors were significantly more satisfied in the IOR group than the CR group (P<0.05. Mucosal injury with nasal bleeding occurred much less in the IOR group (5.3% than the CR group (12.9%. Dorsal augmentation rhinoplasty with IOR was performed simultaneously in 34 cases. Most of them (31/34 showed satisfaction with the outcomes.ConclusionsIOR enables surgeons to manipulate the bony fragment directly through the endonasal incisional approach. However, we propose that CR is the proper technique for patients under 16 and for those with comminuted nasal bone fractures because submucosal dissection in IOR can damage the growth or circulation of nasal bone.

  4. Cirurgia da hipófise por via trans-esfenoidal sob controle radiofluoroscópico e microdissecção novo tratamento da retinopatia diabética, tumores selares e neoplasias endocrinodependentes The surgery of the pituitary gland using a transphenoidal approach under radiofluoroscopic control and microdisection: a new treatment for diabetic retinopathy, pituitary tumors and endocrinodependent growths

    Directory of Open Access Journals (Sweden)

    Jules Hardy

    1968-03-01

    Full Text Available É apresentada nova técnica para a ablação total ou seletiva da hipófise utilizando via de acesso trans-esfenoidal, controle radiofluoroscópico e microdissecção, com traumatismo desprezível às estruturas circunvizinhas. Os autores comentam as aplicações do método à prática neurocirúrgica, relatando parte de uma série de mais 140 casos já operados. São discutidos os resultados obtidos no tratamento de 17 casos de retinopatia diabética, em 11 dos quais apenas o lobo anterior da hipófise foi removido, assim como aqueles obtidos na exérese de 20 casos de tumores selares. As indicações da hipofisectomia por via trans-esfenoidal no controle da sintomatologia das neoplasias endòcrinodependentes é estudada à luz dos resultados obtidos em 17 casos, sendo os resultados comparados com casos nos quais foi feita a implantação selar de ítrio90. As complicações operatorias em relação às três entidades nosológicas acima estudadas são também analisadas. Os autores salientam que a técnica descrita constitui, no presente estado das técnicas neurocirúrgicas utilizadas para a produção de uma insuficiência hipofisária duradoura, a intervenção de escolha.A new neurosurgical technique for the partial or total exéresis of the pituitary gland, using a transphenoidal approach under radiofluoroscopic control and microdisection is described. Part of a series of more than 140 cases operated upon by this method is reported. Results obtained in the treatment of diabetic retinopathy in 17 cases, 11 of which had only the pars anterior removed, are discussed. The applications of the transphenoidal route in 20 cases of pituitary fossa tumors are analysed. The indications of this type of operation in the management of endocrinodependent cancer is studied in 17 cases and compared with the results of 36 cases submitted to implant of Yttrium90 in the sella turcica. The operative complications following transphenoidal exéresis of the

  5. [Bath Plug Closure Method for Cerebrospinal Fluid Leakage by Endoscopic Endonasal Approach:Cooperative Treatment by Neurosurgeons and Otolaryngologists].

    Science.gov (United States)

    Kawaguchi, Tomohiro; Arakawa, Kazuya; Nomura, Kazuhiro; Ogawa, Yoshikazu; Katori, Yukio; Tominaga, Teiji

    2017-12-01

    Endoscopic endonasal surgery, an innovative surgical technique, is used to approach sinus lesions, lesions of the skull base, and intradural tumors. The cooperation of experienced otolaryngologists and neurosurgeons is important to achieve safe and reliable surgical results. The bath plug closure method is a treatment option for patients with cerebrospinal fluid(CSF)leakage. Although it includes dural and/or intradural procedures, surgery tends to be performed by otolaryngologists because its indications, detailed maneuvers, and pitfalls are not well recognized by neurosurgeons. We reviewed the cases of patients with CSF leakage treated by using the bath plug closure method with an endoscopic endonasal approach at our institution. Three patients were treated using the bath plug closure method. CSF leakage was caused by a meningocele in two cases and trauma in one case. No postoperative intracranial complications or recurrence of CSF leakage were observed. The bath plug closure method is an effective treatment strategy and allows neurosurgeons to gain in-depth knowledge of the treatment options for CSF leakage by using an endoscopic endonasal approach.

  6. Endoscopic endonasal pituitary adenomas surgery: the surgical experience of 178 consecutive patients and learning curve of two neurosurgeons.

    Science.gov (United States)

    Shou, Xuefei; Shen, Ming; Zhang, Qilin; Zhang, Yichao; He, Wenqiang; Ma, Zengyi; Zhao, Yao; Li, Shiqi; Wang, Yongfei

    2016-11-30

    We aim to study surgical technique and analyze the related factors affecting tumor total removal and postoperative endocrinological remission for endoscopic endonasal pituitary adenomas surgery. We retrospectively analyzed 178 endoscopic endonasal pituitary adenomas surgery from March 2011 to May 2014. Endonasal approach included the routine transnasal-sphenoidal approach, transnasal- maxillary sinus approach in four cases and transnasal-clivus approach in one case. According to postoperative imaging data and endocrine examination results, total removal was achieved in 129 patients (72.5%), and endocrinological remission was achieved in 38 patients with functional adenomas (44.1%). Statistical analysis of the clinical data showed that total removal rate was much closely related to tumor volume (P = 0.006), and tumor invasiveness (P < 0.001). In this study, we found tumor sizes and invasion of cavernous sinus were related to total removal rate and endocrinological remission rate; the direction and degree of tumor invasion, and the surgeon's experience were the key influence factors of the endocrinological remission rate for invasive functional pituitary adenomas.

  7. Partial maxillectomy for ameloblastoma of the maxilla with infratemporal fossa involvement: A combined endoscopic endonasal and transoral approach.

    Science.gov (United States)

    Guha, A; Hart, L; Polachova, H; Chovanec, M; Schalek, P

    2018-02-21

    Ameloblastoma represents the most common epithelial odontogenic tumor. Because of the proximity of the maxillary tumors to the orbit and skull base, it should be managed as radically as possible. Maxillectomy, mainly via the transfacial or transoral approach, represents the most common type of surgical procedure. Drawback of these approaches is limited control of the superiomedial extent of the tumour in the paranasal area. We report the use of a combined endoscopic endonasal and transoral approach to manage maxillary plexiform ameloblastoma in a 48-year-old male patient. A combined endoscopic endonasal and transoral approach enabled the radical removal of tumour with a 1.5cm margin of radiographically intact bone with good control from both intrasinusal and intraoral aspects. Adequate visualization of the extent of the lesion (e.g. orbit, infratemporal fossa, anterior cranial base) had been achieved. Non-complicated healing was achieved. This technique of partial maxillectomy led to very good aesthetic and functional results. No recurrence had been noted during review appointments. The combination of endoscopic endonasal and transoral approach for a partial maxillectomy allows sufficient reduction of the defect, thus eliminating the necessity for reconstruction and reducing the morbidity associated with it. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  8. СOMPARATIVE EFFICIENCY OF USE OF METHYLETHYLPYRIDINOL BY THE ENDONASAL ELECTROPHORESIS AND PARABULBAR INJECTIONS AT THE CHORIORETINAL DYSTROPHY

    Directory of Open Access Journals (Sweden)

    A. M. Razumovskaya

    2017-01-01

    Full Text Available Research objective: comparative assessment of efficiency of use of Emoxypin® by an endonasal electrophoresis and parabulbar injections at a chorioretinal dystrophy. Methods: 71 patients (average age of 55±3 years suffering from a chorioretinal dystrophy of various genesis were in the study. The ophthalmologic examination included: evaluation of visual acuity, a field of vision, a visual fatigue, a condition of bulbar microcirculation (the general conjunctiva index. Besides, electrophysiological examination was conducted, including critical frequency of merge of flickers and electric sensitivity of an eye. The patients were divided into 2 groups. The main group (28 patients received Emoxypin® with endonasal electrophoresis and group B (43 patients received Emoxypin® by parabulbar injections. Results: Results of the statistical analysis in both groups showed visual acuity increasment, expansion of borders of a field of vision, depression of visual fatigability, indicators of electrophysiological examination and bulbar microcirculation improved. Conclusion: The comparative assessment of efficiency of use of Emoxypin® by an endonasal electrophoresis and parabulbar injections at a chorioretinal dystrophic various a genesis showed appreciable medical effect in the course of restoration of visual functions which in some cases (18% even better effect observed at parabulbar injections.

  9. Neurophysiological Identification of Cranial Nerves During Endoscopic Endonasal Surgery of Skull Base Tumors: Pilot Study Technical Report.

    Science.gov (United States)

    Shkarubo, Alexey Nikolaevich; Chernov, Ilia Valerievich; Ogurtsova, Anna Anatolievna; Moshchev, Dmitry Aleksandrovich; Lubnin, Andrew Jurievich; Andreev, Dmitry Nicolaevich; Koval, Konstantin Vladimirovich

    2017-02-01

    Intraoperative identification of cranial nerves is crucial for safe surgery of skull base tumors. Currently, only a small number of published papers describe the technique of trigger electromyography (t-EMG) in endoscopic endonasal removal of such tumors. To assess the effectiveness of t-EMG in preventing intraoperative cranial nerve damage in endoscopic endonasal surgery of skull base tumors. Nine patients were operated on using the endoscopic endonasal approach within a 1-year period. The tumors included large skull base chordomas and trigeminal neurinomas localized in the cavernous sinus. During the surgical process, cranial nerve identification was carried out using monopolar and bipolar t-EMG methods. Assessment of cranial nerve functional activity was conducted both before and after tumor removal. We mapped 17 nerves in 9 patients. Third, fifth, and sixth cranial nerves were identified intraoperatively. There were no cases of postoperative functional impairment of the mapped cranial nerves. In one case we were unable to get an intraoperative response from the fourth cranial nerve and observed its postoperative transient plegia (the function was normal before surgery). t-EMG allows surgeons to control the safety of cranial nerves both during and after skull base tumor removal. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Radiation therapy rather than prior surgery reduces extent of resection during endonasal endoscopic reoperation for craniopharyngioma.

    Science.gov (United States)

    Younus, Iyan; Forbes, Jonathan A; Ordóñez-Rubiano, Edgar G; Avendano-Pradel, Rafael; La Corte, Emanuele; Anand, Vijay K; Schwartz, Theodore H

    2018-07-01

    Radiation therapy is often advocated for residual or recurrent craniopharyngioma following surgical resection to prevent local recurrence. However, radiation therapy is not always effective and may render tumors more difficult to remove. If this is the case, patients may benefit more from reoperation if gross total resection can be achieved. Nevertheless, there is little data on the impact of radiation on reoperations for craniopharyngioma. In this study, we sought to analyze whether a history of previous radiation therapy (RT) affected extent of resection in patients with recurrent craniopharyngiomas subsequently treated with reoperation via endoscopic endonasal approach (EEA). The authors reviewed a prospectively acquired database of EEA reoperations of craniopharyngiomas over 13 years at Weill Cornell, NewYork-Presbyterian Hospital. All procedures were performed by the senior author. The operations were separated into two groups based on whether the patient had surgery alone (group A) or surgery and RT (group B) prior to recurrence. A total of 24 patients (16 male, 8 female) who underwent surgery for recurrent craniopharyngioma were identified. The average time to recurrence was 7.64 ± 4.34 months (range 3-16 months) for group A and 16.62 ± 12.1 months (range 6-45 months) for group B (p < 0.05). The average tumor size at recurrence was smaller in group A (1.85 ± 0.72 cm; range 0.5-3.2) than group B (2.59 ± 0.91 cm; range 1.5-4.6; p = 0.00017). Gross total resection (GTR) was achieved in 91% (10/11) of patients in group A and 54% (7/13) of patients in group B (p = 0.047). There was a near significant trend for higher average Karnofsky performance status (KPS) score at last follow-up for group A (83 ± 10.6) compared with group B (70 ± 16.3, p = 0.056). While RT for residual or recurrent craniopharyngioma may delay time to recurrence, ability to achieve GTR with additional surgery is reduced. In the case of

  11. Alexitimia como predictor directo y mediado por la depresión en la violencia de pareja

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    José Moral de la Rubia

    2015-07-01

    Full Text Available La investigación de la violencia de pareja se ha centrado tradicionalmente en la mujer como víctima y el hombre como agresor; no obstante, la violencia frecuentemente es recíproca. La alexitimia constituye un potencial factor de riesgo de violencia de pareja por sus características de un vínculo inseguro, un estilo pasivo de afrontamiento, un déficit de empatía y dificultades de control emocional. Además, la alexitimia se encuentra relacionada con la depresión. El artículo estudia la relación de la alexitimia con la violencia sufrida y la violencia ejercida (frecuencia y daño en hombres y mujeres con una pareja heterosexual controlada por la variable depresión. Se aplicaron el Cuestionario de Violencia Sufrida y Ejercida de Pareja (CVSE, Moral de la Rubia & Ramos Basurto, 2015, la Escala de Alexitimia de Toronto de 20 ítems (EAT-20, Bagby, Parker & Taylor, 1994, en su versión mexicana de Moral de la Rubia, 2008a y el Inventario de Depresión de Beck (2ª ed., IDB-2, Beck, Steer & Brown, 1996, en su Formato Simplificado de Aplicación, IDB-2-FSA; Moral de la Rubia, 2013 a una muestra no probabilística de 240 participantes (120 mujeres y 120 hombres en Monterrey, México. La alexitimia correlacionó más con la violencia sufrida que con la violencia ejercida, más con el daño que con la frecuencia dentro de la violencia sufrida y más con la frecuencia que con el daño dentro de la violencia ejercida. La mayoría de estas correlaciones permanecieron significativas al parcializar la depresión. En un modelo con buen ajuste en la muestra conjunta (hombres y mujeres, la alexitimia mostró un efecto significativo tanto sobre la violencia sufrida como la ejercida y este efecto fue tanto directo como indirecto con la mediación de la depresión. Concluye que la alexitimia es principalmente un factor de riesgo para sufrir violencia y en menor medida para ejercerla.

  12. Costo directo de cesáreas y reembolso del Seguro Integral de Salud: El caso del Hospital de Apoyo Pomabamba, Ancash, Perú

    Directory of Open Access Journals (Sweden)

    Gladys Moncada Vega

    2009-01-01

    Full Text Available Objetivo: Determinar el costo directo de la cesárea y el porcentaje de reembolso realizado por el Seguro Integral de Salud (SIS, en el Hospital de Apoyo Pomabamba (HAP, en Ancash. Material y métodos: Estudio de costos, transversal descriptivo de corte retrospectivo. Se consideraron todos los partos por cesárea en el periodo enero a diciembre 2003, 39 de ellas fueron sin complicaciones y 12 complicadas. Se revisaron las historias clínicas y los reportes operatorios de cada paciente. Se realizó análisis univariado considerando frecuencias, porcentajes y medidas de tendencia central y dispersión. Resultados: La edad media fue 25,57 años (rango: 16-43 años, el índice de cesárea en el periodo fue 5,9%. El costo directo por cesárea no complicada fue 307,64 nuevos soles y de la cesárea complicada 469,61 nuevos soles. La diferencia de 52,65% mayor a la cesárea complicada está relacionada al uso de medicamentos y mayor estancia hospitalaria. El monto por cesárea facturado al SIS en HAP fue 17 633,30 nuevos soles (media: 345,75 nuevos soles. Conclusiones: El porcentaje asumido por el HAP para las cesáreas financiadas por el SIS fue 36,5% (6 435,30 nuevos soles. Los costos directos calculados son propios del HAP y no se puede generalizar a otros hospitales, porque varían según las características y prácticas propias de cada hospital. Es necesario considerar estudios de costos que permitan observar posibles brechas en el financiamiento del SIS.(Rev Med Hered 2009;20:4-10.

  13. El ingreso en el hogar y su costo directo en Cuba The direct costs of home care in Cuba

    Directory of Open Access Journals (Sweden)

    Isabel M. Barroso Utra

    2007-03-01

    Full Text Available OBJETIVOS: Analizar el tiempo de estadía en ingreso en el hogar (IH y su costo diario y por paciente en Cuba, según el diagnóstico al ingreso y la zona donde se brinda el servicio. MÉTODOS: Se analizó la información de los 837 pacientes en IH entre julio de 2001 y junio de 2002 en un área del municipio Playa, en Ciudad de La Habana (zona urbana metropolitana, una del municipio Cruces, en Cienfuegos (zona urbana no metropolitana, otra del Municipio Unión de Reyes, en Matanzas (zona rural y una de Fomento, en Sancti Spiritus (zona rural montañosa. Se analizó la mediana del tiempo del IH mediante curvas de supervivencia Kaplan Meier y se evaluó el efecto del diagnóstico al ingreso (afecciones respiratorias, gastrointestinales, ginecobstétricas, egreso hospitalario precoz y otras causas, la zona del IH, el sexo y la edad, sobre la posibilidad de egresar del IH. Para cada municipio se calculó el costo directo del servicio, el costo por paciente y el costo por día de estadía. Se ajustaron modelos de regresión lineal múltiple para identificar el efecto que sobre el costo por paciente tienen el tiempo de estadía, el diagnóstico al ingreso y el área donde se presta el servicio de IH. RESULTADOS: La causa más frecuente de IH en los municipios estudiados fueron las afecciones respiratorias (31,4%, seguidas del egreso hospitalario precoz (15,5%, las afecciones ginecobstétricas (10,8% y los trastornos gastrointestinales (8,1%. La mediana del tiempo de estadía fue de 6 días (IC95%: 5,75 a 6,25. En Fomento los pacientes tuvieron 66% menos probabilidad de egresar que en Cruces y 30% menos que en Playa y Unión de Reyes. El costo directo del IH en los municipios estudiados medido en pesos cubanos ($ varió entre $3 983,54 y $9 624,87. El costo por día de estadía fue de $2,57 a $6,88, mientras el costo por paciente fue de $23,04 a $42,78. El tiempo de estadía tuvo un efecto intrínseco sobre el costo por paciente (P OBJECTIVE: To

  14. Correlaciones de parámetros medios de proceso para el secado de productos agropecuarios en cama fina en secadores solares directos

    OpenAIRE

    Bergues-Ricardo, Ciro César; Díaz-López, José Raúl; Torres-Ten, Alonso

    2013-01-01

    Se da un grupo de correlaciones entre la velocidad media de secado, las pérdidas de energía, la energía útil y la eficiencia térmica media del proceso, válidas para condiciones de secado en cama fina en secadores solares directos, y contribuyen a un enfoque integral del secado solar en estas condiciones. Ellas son válidas para procesos de secado de diversos productos agropecuarios tales como viandas, vegetales, frutas, granos y madera con convección natural o forzada. Las correlaciones fueron...

  15. Análisis de las nuevas tendencias en Ortopodología: Técnica de Adaptación en Directo

    OpenAIRE

    Cortés-Jerónimo, María Encarnación

    2014-01-01

    Esta tesis está compuesta de tres capítulos, el objetivo principal del estudio fue definir con un rigor científico, el uso de la técnica de adaptación en directo en pacientes con dolor en el pie, la confección de soportes plantares a medida ha sufrido una constante evolución, aunque no siempre acompañada de criterios científicos, sino de experiencias clínicas basadas en el ensayo-error. Un primer estudio analizo un total de 209 tratamientos de soportes plantares realizados con Técnica de ...

  16. Análisis de las nuevas tendencias en Ortopodología: Técnica de Adaptación en Directo

    OpenAIRE

    Cortés Jerónimo, María Encarnación

    2014-01-01

    Esta tesis está compuesta de tres capítulos, el objetivo principal del estudio fue definir con un rigor científico, el uso de la técnica de adaptación en directo en pacientes con dolor en el pie, la confección de soportes plantares a medida ha sufrido una constante evolución, aunque no siempre acompañada de criterios científicos, sino de experiencias clínicas basadas en el ensayo-error.Un primer estudio analizo un total de 209 tratamientos de soportes plantares realizados con Técnica de adap...

  17. Evaluación del desempeño de un secador solar directo sobre semillas de cacao (Theobroma cacao L.

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    Enrique Romero Frasca

    2016-01-01

    Full Text Available Se desarrolló un secador solar directo con un diseño basado en dispositivos deshidratadores rudimentarios de uso regular, en granjas cacaoteras de Tabasco; con el objetivo de evaluar su desempeño en la obtención de cacao seco con- forme a la NMX-F-352-S-1980, mediante una exposición a luz solar durante cuatro días. Re- sultados: disminución paulatina del contenido de humedad hasta en un 7.50%, en promedio, en un producto con valor comercial a insertarse en el mercado.

  18. Endoscopic Endonasal Dacryocystorhinostomy Combined with Canaliculus Repair for the Management of Dacryocystitis with Canalicular Obstruction

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    Yunhai Tu

    2015-01-01

    Full Text Available Purpose. The aim of this study is to propose a simple and efficient combination surgery for the management of dacryocystitis with canalicular obstruction. Methods. A retrospective noncomparative case series of dacryocystitis with canalicular obstruction has been studied. Twelve patients with dacryocystitis and canalicular obstruction underwent a conventional endoscopic endonasal dacryocystorhinostomy (EE-DCR combined with a modified canalicular repair. Postoperative observations included slit lamp, fluorescein dye disappearance test, lacrimal syringing, lacrimal endoscopy, and nasal endoscopy. Results. After 6–18 months of postoperative follow-up, the symptoms of epiphora and mucopurulent discharge disappeared completely in 10 patients, and occasional or intermittent epiphora remained in 2 patients. All of the twelve patients showed an opened intranasal ostium and normal fluorescein dye disappearance test. Patent bicanalicular irrigation was achieved in 9 patients. One patient had a partial and the other two had a complete reobstruction by lacrimal irrigation to their repaired lower canaliculus; however, all of them had a patent lacrimal irrigation to upper canaliculus. The functional success rate for the combination surgery is 83% (10/12, and anatomical success rate is 75% (9/12. Conclusion. EE-DCR combined with modified canalicular repair is a simple and efficient method for the management of dacryocystitis with canalicular obstruction.

  19. [Endonasal endoscopic surgery in the treatment of spontaneous or post-traumatic cerebrospinal fluid (csf) leaks].

    Science.gov (United States)

    Nallet, E; Decq, P; Bezzo, A; Le Lievre, G; Peynegre, R; Coste, A

    1998-10-01

    The incidence and the risk of meningitidis justify treatment in all cases of cerebrospinal fluid rhinorrhea with spontaneous etiology or after traumatic injury. Endonasal surgery with endoscopic instruments provides many advantages compared with transcranial or transfacial approach used by neurosurgeons. We report our experience and our surgical technique in the treatment of CSF leaks in 5 patients. Intrathecal injection of fluoresceine was very useful in all cases for detecting the CSF leak. Total or selected ethmoidectomy depended on the localization of the leakage. Wide sphenoidotomy enables detection and repair of CSF leaks from the sphenoid cavity. A free graft of inferior turbinal mucosal was used to repair the breache. This rapid low morbidity surgery offered secure closure of rhinorrhea in 4 cases after one procedure and in 1 case after two procedures with an average follow up of 22 months. Cerebrospinal fluid rhinorrhea can be managed in first line therapy with endoscopic intranasal surgical techniques when they are localized in the anterior ethmoid or in the sphenoid cavity.

  20. Nasal and skull base anatomy of endoscopic endonasal transsphenoidal surgery with multi-detector computed tomography

    International Nuclear Information System (INIS)

    Hasegawa, Yuzo; Saeki, Naokatsu; Murai, Hisayuki; Horiguchi, Kentaro; Hanazawa, Toyoyuki; Okamoto, Miyoshi; Yanagawa, Noriyuki

    2008-01-01

    The endoscope is a new and highly useful instrument for transphenoidal surgery (TSS), and is generally used because of its minimally invasiveness. In addition, endoscopic transsphenoidal surgey (eTSS) has a potential for more radical tumor removal at the pituitary and the parasellar regions by wider visualization and more powerful illumination. To operate these regions safely, we need to know nasal and skull base anatomy under the endoscope which looks different from images under a microscope. In this paper, we demonstrated nasal and skull base anatomy with multi-detector computed tomography, which was performed in 23 recent patients with pituitary and parasellar legions. In the nasal legion, deviation of nasal septum and deviation of sphenoid ostium are important for endonasal approach of eTSS, and often determine the difficulty of surgery in the nasal cavity. Our study showed that deviation of nasal septum was seen in 26% of patients. Deviation of sphenoid ostium was 5.5±1.5 mm from the midline. The anatomy of sphenoid sinus plays a key role in our determination of the safety of a bony opening of the sella. In addition to sellar, presellar, and concha types, carotid prominence and optic prominence are important to determine the midline orientation. Development of carotid prominence was significantly related to the extent of lateral pneumatization of sphenoid sinus (P=0.0016). Reconstructed 3D-image of sphenoid sinus was very useful in visual understanding skull base anatomy. (author)

  1. Endoscopic Endonasal Transsphenoidal Drainage of a Spontaneous Candida glabrata Pituitary Abscess.

    Science.gov (United States)

    Strickland, Ben A; Pham, Martin; Bakhsheshian, Joshua; Carmichael, John; Weiss, Martin; Zada, Gabriel

    2018-01-01

    Noniatrogenic pituitary abscess remains a rare clinical entity, and is the indication for surgery in abscess caused by Candida species, and also provide an intraoperative video showing the endoscopic management of this pathology. A 33-year-old woman presented with headache, hypopituitarism, and vision loss in the setting of diabetic ketoacidosis, and was found to have multiple abscesses in the liver, lung, kidney, and uterus. Brain magnetic resonance imaging revealed a 15-mm cystic sellar mass with restricted diffusion. The patient underwent urgent evacuation of the abscess via an endoscopic endonasal transsphenoidal route, with obvious purulent material filling the sella, later identified as Candida glabrata. Antimicrobial therapy was refined appropriately, and she exhibited significant improvement in neurologic function, although endocrinopathy has persisted. With timely management, including a combination of surgical drainage and appropriate antimicrobial therapy, neurologic outcomes are good in most cases of pituitary abscess; however, endocrinopathy often does not improve. Although most reported cases with identified causative organisms speciate bacteria, some cases are of fungal etiology and require different antimicrobial agents. This further underscores the importance of identifying the causative agent. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Endoscopic Endonasal Approach for Resection of a Pediatric Craniopharyngioma: Operative Video and Technical Nuances.

    Science.gov (United States)

    Liu, James K; Eloy, Jean Anderson

    2018-04-01

    We present a pediatric case of a retrochiasmatic craniopharyngioma in the suprasellar region with third ventricular extension that was resected through a purely endoscopic endonasal approach (EEA) via the transplanum transtuberculum corridor. The patient is a 12-year-old boy who presented with progressive visual loss and panhypopituitarism. The EEA allows direct visualization of the undersurface of the optic chiasm and hypothalamus so that safe and meticulous tumor dissection can be performed to preserve these critical neurovascular structures. This video atlas demonstrates the operative technique and surgical nuances of the endoscopic skull base approach, microdissection of the tumor from the critical neurovascular structures, and multilayered reconstruction of the skull base defect with a nasoseptal flap. A gross total resection was achieved, and the patient was neurologically intact with improved visual acuity and visual fields. In summary, the EEA via the transplanum transtuberculum corridor is an important strategy in the armamentarium for surgical management of pediatric craniopharyngiomas. The link to the video can be found at: https://youtu.be/bmgO_PMRHPk .

  3. Endoscopic endonasal dacryocystorhinostomy combined with stent implantation as treatment for acute dacryocystitis

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    Si-Si Pu

    2017-02-01

    Full Text Available AIM: To discuss the feasibility and clinical efficacy of endoscopic endonasal dacryocystorhinostomy(EN-DCRcombined with stent implantation for treatment of acute dacryocystitis. METHODS: A total of 31 patients(32 eyespresenting with acute dacryocystitis were treated with EN-DCR combined with stent implantation under antibiotic cover from April 2014 to December 2015. These patients were followed up for 3 to 12mo. RESULTS: The medial canthal edema and erythema was gradually reducing within 48h in all patients. The hospitalization time took 2 to 8d(average 3.8±1.6d. Patients underwent removal of stent about 3mo after surgery. Thirty-one eyes showed no symptoms such as lacrimation or pus discharging, and irrigation of lacrimal duct was unobstructed. Irrigation of lacrimal duct was passable in 1 of 32 patients who has a relative narrow ostial. Results in this series, 31 cases were cured,1case improved, the total cure rate was 97%. CONCLUSION: There is no evidence shown that EN-DCR combined with stent implantation can increase the risk of spreading infection through tissue planes, causing septicemia, and exacerbating inflammation. Instead, it has advantages like gradual reduction in inflammatory symptoms, economic benefits of reduced patient stay, maintenance of the orbicularis muscle lacrimal pump and absence of external scar. It is indicated that EN-DCR combined with stent implantation is a safe and feasible surgical procedure for patients with acute dacryocystitis.

  4. Endoscopic Endonasal Transturbinate Approach to the Pterygopalatine Fossa in the Management of Juvenile Nasopharyngeal Angiofibromas

    Directory of Open Access Journals (Sweden)

    Satoru Kodama

    2012-01-01

    Full Text Available Pterygopalatine fossa (PPF is a difficult-to-access anatomic area located behind the posterior wall of the maxillary sinus. Juvenile nasopharyngeal angiofibroma (JNA often affects this area, and the management of feeding artery to the tumor is important in the surgery. Endoscopic endonasal approach to the PPF without endangering all other nasal structures is useful in the management of JNA. We describe a new approach to the PPF, endoscopic transturbinate approach, which is effective in the management of JNA. Submucous inferior turbinoplasty was performed, and sphenopalatine artery, the feeder to the tumor, was identified at the sphenopalatine foramen. The posterior wall of maxillary sinus was removed. Internal maxillary artery was identified in the PPF and was ligated with a hemoclip. The tumor in the PPF was pushed into the nasal cavity. These procedures were all performed via submucous turbinate tunnel. Then, the tumor was successfully removed in en bloc from the nasal cavity by transnasal approach without ethmoidectomy. This approach improves accessibility and visualization in the PPF and potential to reduce intraoperative bleeding due to ligation of the feeder safely without touching the tumor. Endoscopic transturbinate approach is effective in the management of early stage of JNA.

  5. Endoscopic Endonasal Transsphenoidal Approach for Apoplectic Pituitary Tumor: Surgical Outcomes and Complications in 45 Patients.

    Science.gov (United States)

    Zhan, Rucai; Li, Xueen; Li, Xingang

    2016-02-01

    Objective To assess the safety and effectiveness of the endoscopic endonasal transsphenoidal approach (EETA) for apoplectic pituitary adenoma. Design A retrospective study. Setting Qilu Hospital of Shandong University; Brain Science Research Institute, Shandong University. Participants Patients admitted to Qilu Hospital of Shandong University who were diagnosed with an apoplectic pituitary tumor and underwent EETA for resection of the tumor. Main Outcome Measures In total 45 patients were included in a retrospective chart review. Data regarding patient age, sex, presentation, lesion size, surgical procedure, extent of resection, clinical outcome, and surgical complications were obtained from the chart review. Results In total, 38 (92.7%) of 41 patients with loss of vision obtained visual remission postoperatively. In addition, 16 patients reported a secreting adenoma, and postsurgical hormonal levels were normal or decreased in 14 patients. All other symptoms, such as headache and alteration of mental status, recovered rapidly after surgery. Two patients (4.4%) incurred cerebrospinal fluid leakage. Six patients (13.3%) experienced transient diabetes insipidus (DI) postoperatively, but none of these patients developed permanent DI. Five patients (11.1%) developed hypopituitarism and were treated with replacement of hormonal medicine. No cases of meningitis, carotid artery injury, or death related to surgery were reported. Conclusion EETA offers a safe and effective surgical option for apoplectic pituitary tumors and is associated with low morbidity and mortality.

  6. Two-Dimensional High Definition Versus Three-Dimensional Endoscopy in Endonasal Skull Base Surgery: A Comparative Preclinical Study.

    Science.gov (United States)

    Rampinelli, Vittorio; Doglietto, Francesco; Mattavelli, Davide; Qiu, Jimmy; Raffetti, Elena; Schreiber, Alberto; Villaret, Andrea Bolzoni; Kucharczyk, Walter; Donato, Francesco; Fontanella, Marco Maria; Nicolai, Piero

    2017-09-01

    Three-dimensional (3D) endoscopy has been recently introduced in endonasal skull base surgery. Only a relatively limited number of studies have compared it to 2-dimensional, high definition technology. The objective was to compare, in a preclinical setting for endonasal endoscopic surgery, the surgical maneuverability of 2-dimensional, high definition and 3D endoscopy. A group of 68 volunteers, novice and experienced surgeons, were asked to perform 2 tasks, namely simulating grasping and dissection surgical maneuvers, in a model of the nasal cavities. Time to complete the tasks was recorded. A questionnaire to investigate subjective feelings during tasks was filled by each participant. In 25 subjects, the surgeons' movements were continuously tracked by a magnetic-based neuronavigator coupled with dedicated software (ApproachViewer, part of GTx-UHN) and the recorded trajectories were analyzed by comparing jitter, sum of square differences, and funnel index. Total execution time was significantly lower with 3D technology (P < 0.05) in beginners and experts. Questionnaires showed that beginners preferred 3D endoscopy more frequently than experts. A minority (14%) of beginners experienced discomfort with 3D endoscopy. Analysis of jitter showed a trend toward increased effectiveness of surgical maneuvers with 3D endoscopy. Sum of square differences and funnel index analyses documented better values with 3D endoscopy in experts. In a preclinical setting for endonasal skull base surgery, 3D technology appears to confer an advantage in terms of time of execution and precision of surgical maneuvers. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. A panoramic view of the skull base: systematic review of open and endoscopic endonasal approaches to four tumors.

    Science.gov (United States)

    Graffeo, Christopher S; Dietrich, August R; Grobelny, Bartosz; Zhang, Meng; Goldberg, Judith D; Golfinos, John G; Lebowitz, Richard; Kleinberg, David; Placantonakis, Dimitris G

    2014-08-01

    Endoscopic endonasal surgery has been established as the safest approach to pituitary tumors, yet its role in other common skull base lesions has not been established. To answer this question, we carried out a systematic review of reported series of open and endoscopic endonasal approaches to four major skull base tumors: olfactory groove meningiomas (OGM), tuberculum sellae meningiomas (TSM), craniopharyngiomas (CRA), and clival chordomas (CHO). Data from 162 studies containing 5,701 patients were combined and compared for differences in perioperative mortality, gross total resection (GTR), cerebrospinal fluid (CSF) leak, neurological morbidity, post-operative visual function, post-operative anosmia, post-operative diabetes insipidus (DI), and post-operative obesity/hyperphagia. Weighted average rates for each outcome were calculated using relative study size. Our findings indicate similar rates of GTR and perioperative mortality between open and endoscopic approaches for all tumor types. CSF leak was increased after endoscopic surgery. Visual function symptoms were more likely to improve after endoscopic surgery for TSM, CRA, and CHO. Post-operative DI and obesity/hyperphagia were significantly increased after open resection in CRA. Recurrence rates per 1,000 patient-years of follow-up were higher in endoscopy for OGM, TSM, and CHO. Trends for open and endoscopic surgery suggested modest improvement in all outcomes over time. Our observations suggest that endonasal endoscopy is a safe alternative to craniotomy and may be preferred for certain tumor types. However, endoscopic surgery is associated with higher rates of CSF leak, and possibly increased recurrence rates. Prospective study with long-term follow-up is required to verify these preliminary observations.

  8. COMPLICATIONS OF ENDONASAL ENDOSCOPIC TRANSSPHENOIDAL APPROACH FOR PITUITARY ADENOMAS: OUR EXPERIENCE IN 50 PATIENTS TREATED AT OUR TERTIARY CENTRE

    Directory of Open Access Journals (Sweden)

    Mani Ram

    2015-12-01

    Full Text Available INTRODUCTION Between September 2013 and October 2014, we conducted a retrospective analysis to assess the complications related to endoscopic pituitary surgery in a series of 50 patients. We analysed the complications in preoperative, postoperative and endocrinological categories. We had a follow up of 1-2 years. Endonasal endoscopic transsphenoidal surgery (ETSS is an effective option for pituitary tumors. Complications do occur, but they can be reduced with experience & expertise and there is a steep learning curve. It demands a multidisciplinary approach.

  9. Extended endoscopic endonasal surgery using three-dimensional endoscopy in the intra-operative MRI suite for supra-diaphragmatic ectopic pituitary adenoma.

    Science.gov (United States)

    Fuminari, Komatsu; Hideki, Atsumi; Manabu, Osakabe; Mitsunori, Matsumae

    2015-01-01

    We describe a supra-diaphragmatic ectopic pituitary adenoma that was safely removed using the extended endoscopic endonasal approach, and discuss the value of three-dimensional (3D) endoscopy and intra-operative magnetic resonance imaging (MRI) to this type of procedure. A 61-year-old-man with bitemporal hemianopsia was referred to our hospital, where MRI revealed an enhanced suprasellar tumor compressing the optic chiasma. The tumor extended on the planum sphenoidale and partially encased the right internal carotid artery. An endocrinological assessment indicated normal pituitary function. The extended endoscopic endonasal approach was taken using a 3D endoscope in the intraoperative MRI suite. The tumor was located above the diaphragma sellae and separated from the normal pituitary gland. The pathological findings indicated non-functioning pituitary adenoma and thus the tumor was diagnosed as a supra-diaphragmatic ectopic pituitary adenoma. Intra-operative MRI provided useful information to minimize dural opening and the supra-diaphragmatic ectopic pituitary adenoma was removed from the complex neurovascular structure via the extended endoscopic endonasal approach under 3D endoscopic guidance in the intra-operative suite. Safe and effective removal of a supra-diaphragmatic ectopic pituitary adenoma was accomplished via the extended endoscopic endonasal approach with visual information provided by 3D endoscopy and intra-operative MRI.

  10. Endonasal endoscopic transsphenoidal pituitary surgery: early experience and outcome in paediatric Cushing's disease.

    Science.gov (United States)

    Storr, Helen L; Drake, William M; Evanson, Jane; Matson, Matthew; Berney, Dan M; Grossman, Ashley B; Akker, Scott A; Monson, John P; Alusi, Ghassan; Savage, Martin O; Sabin, Ian

    2014-02-01

    Selective adenomectomy remains the first-line treatment for Cushing's disease (CD), until recently by microscopic transsphenoidal pituitary surgery. Endonasal transsphenoidal endoscopic surgery (ETES) is emerging as a novel, less invasive treatment for pituitary adenomas and has become the optimal surgical approach. There are no published series for the treatment of paediatric CD by ETES, and we report our centre's preliminary results. Retrospective analysis. Six paediatric patients (median age 15·8 years; range 11·7-17·0 years) fulfilled standard diagnostic criteria for CD. Preoperatively, no abnormality was identified on pituitary MR scanning in 3 (50%) patients, one had a macroadenoma. Bilateral petrosal sinus sampling demonstrated central ACTH secretion (IPS/P ACTH ratio ≥3·0, post-CRH) in 3/6 (50%) patients. The same neurosurgeon and endoscopic nasal surgeon undertook all the operations. Therapeutic outcome and rate of complications. Clinical recovery and biochemical 'cure' were achieved in 5 (83%) patients, and a corticotroph adenoma was confirmed histologically in all cured cases. One case developed post-operative CSF leak requiring lumbar drain insertion and patching. At a mean interval of 4·7 years (0·1-10·8 years) post-operatively, cured patients have shown no recurrence. One patient, with a large diffuse adenoma requiring more extensive surgery, has panhypopituitarism, and another patient has GH and gonadotrophin deficiencies. Our experience shows that ETES for removing corticotroph adenomas in children, in most cases not visualized on MRI, is minimally invasive and gave excellent post-operative recovery/results. In skilled hands, this technique provides an alternative to conventional transsphenoidal microscopic surgery in managing paediatric CD. © 2013 John Wiley & Sons Ltd.

  11. A practical 3D printed simulator for endoscopic endonasal transsphenoidal surgery to improve basic operational skills.

    Science.gov (United States)

    Wen, Guodao; Cong, ZiXiang; Liu, KaiDong; Tang, Chao; Zhong, Chunyu; Li, Liwen; Dai, XuJie; Ma, Chiyuan

    2016-06-01

    We aimed to present a practical three-dimensional (3D) printed simulator to comprehensively and effectively accelerate the learning curve of endoscopic endonasal transsphenoidal surgery (EETS). The 3D printed simulator consists of three parts: (1) skull frame, (2) the nasal passage and the nasal alar of the face, and (3) a modified sella turcica. We aimed to improve three basic operational skills of surgeons: drilling, curetting, and aspirating. Eighteen neurosurgeons and five post-graduates were recruited and consented for the training. For trainees, (1) as the training progressed, the scores increased gradually, (2) a significant increase in the average scores was observed in the tenth training compared to the first training, and (3) there is a significant decrease in trainee variability in the shortening of the gap. The 18 neurosurgeons were divided into three groups: experts, assistants, and observers. For all three basic operations, (1) the average score of experts was obviously higher than that of the assistants, observers, and trainees' tenth training and (2) the average scores of assistants and observers were obviously higher than that of trainees' first training. A significant high in the average score between the assistants and the observers was seen for aspirating, but not for drilling or curetting. For curetting and aspirating, the tenth training average score of trainees was obviously higher than that of assistants and observers. This 3D printed simulator allows different endoscopic basic operations to be simulated and improves the EETS techniques of surgeons. We believed it to be a practical, simple, and low-cost simulator.

  12. Modified Graded Repair of Cerebrospinal Fluid Leaks in Endoscopic Endonasal Transsphenoidal Surgery

    Science.gov (United States)

    Park, Jae-Hyun; Choi, Jai Ho; Kim, Young-Il; Kim, Sung Won

    2015-01-01

    Objective Complete sellar floor reconstruction is critical to avoid postoperative cerebrospinal fluid (CSF) leakage during transsphenoidal surgery. Recently, the pedicled nasoseptal flap has undergone many modifications and eventually proved to be valuable and efficient. However, using these nasoseptal flaps in all patients who undergo transsphenoidal surgery, including those who had none or only minor CSF leakage, appears to be overly invasive and time-consuming. Methods Patients undergoing endoscopic endonasal transsphenoidal tumor surgery within a 5 year-period were reviewed. Since 2009, we classified the intraoperative CSF leakage into grades from 0 to 3. Sellar floor reconstruction was tailored to each leak grade. We did not use any tissue grafts such as abdominal fat and did not include any procedures of CSF diversions such as lumbar drainage. Results Among 200 cases in 188 patients (147 pituitary adenoma and 41 other pathologies), intraoperative CSF leakage was observed in 27.4% of 197 cases : 14.7% Grade 1, 4.6% Grade 2a, 3.0% Grade 2b, and 5.1% Grade 3. Postoperative CSF leakage was observed in none of the cases. Septal bone buttress was used for Grade 1 to 3 leakages instead of any other foreign materials. Pedicled nasoseptal flap was used for Grades 2b and 3 leakages. Unused septal bones and nasoseptal flaps were repositioned. Conclusion Modified classification of intraoperative CSF leaks and tailored repair technique in a multilayered fashion using an en-bloc harvested septal bone and vascularized nasoseptal flaps is an effective and reliable method for the prevention of postoperative CSF leaks. PMID:26279811

  13. Endoscopic Endonasal Versus Microscopic Transsphenoidal Surgery for Recurrent and/or Residual Pituitary Adenomas.

    Science.gov (United States)

    Esquenazi, Yoshua; Essayed, Walid I; Singh, Harminder; Mauer, Elizabeth; Ahmed, Mudassir; Christos, Paul J; Schwartz, Theodore H

    2017-05-01

    Surgery for recurrent/residual pituitary adenomas is increasingly being performed through endoscopic surgery. Whether this new technology has altered the indications and outcomes of surgery is unknown. We conducted a systematic review and meta-analysis of published studies to compare the indications and outcomes between microscopic and endoscopic approaches. A PubMed search was conducted (1985-2015) to identify surgical series of endoscopic endonasal and microscopic transsphenoidal resection of residual or recurrent pituitary adenomas. Data were extracted regarding tumor characteristics, surgical treatment, extent of resection, endocrine remission, visual outcome, and complications. Twenty-one studies met inclusion criteria. A total of 292 patients were in the endoscopic group, and 648 patients were in the microscopic group. Endoscopic cases were more likely nonfunctional (P < 0.001) macroadenomas (P < 0.001) with higher rates of cavernous sinus invasion (P = 0.012). The pooled rate of gross total tumor resection was 53.5% for the endoscopic group and 46.6% for the microscopic group. Endocrine remission was achieved in 53.0% and 46.7% of patients, and visual improvement occurred in 73.2% and 49.6% for the endoscopic and microscopic groups. Cerebrospinal fluid leak and pituitary insufficiency were higher in the endoscopic group. This meta-analysis indicates that the use of the endoscope to reoperate on residual or recurrent adenomas has only led to modest increases in resection rates. However, larger more complex cases are being tackled, so direct comparisons are misleading. The most dramatic change has been in visual improvement along with modest increases in risk. Reoperation for recurrent or residual adenomas is a safe and effective treatment option. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Three-Hand Endoscopic Endonasal Transsphenoidal Surgery: Experience With an Anatomy-Preserving Mononostril Approach Technique.

    Science.gov (United States)

    Eseonu, Chikezie I; ReFaey, Karim; Pamias-Portalatin, Eva; Asensio, Javier; Garcia, Oscar; Boahene, Kofi D; Quiñones-Hinojosa, Alfredo

    2018-02-01

    Variations on the endoscopic transsphenoidal approach present unique surgical techniques that have unique effects on surgical outcomes, extent of resection (EOR), and anatomical complications. To analyze the learning curve and perioperative outcomes of the 3-hand endoscopic endonasal mononostril transsphenoidal technique. Prospective case series and retrospective data analysis of patients who were treated with the 3-hand transsphenoidal technique between January 2007 and May 2015 by a single neurosurgeon. Patient characteristics, preoperative presentation, tumor characteristics, operative times, learning curve, and postoperative outcomes were analyzed. Volumetric EOR was evaluated, and a logistic regression analysis was used to assess predictors of EOR. Two hundred seventy-five patients underwent an endoscopic transsphenoidal surgery using the 3-hand technique. One hundred eighteen patients in the early group had surgery between 2007 and 2010, while 157 patients in the late group had surgery between 2011 and 2015. Operative time was significantly shorter in the late group (161.6 min) compared to the early group (211.3 min, P = .001). Both cohorts had similar EOR (early group 84.6% vs late group 85.5%, P = .846) and postoperative outcomes. The learning curve showed that it took 54 cases to achieve operative proficiency with the 3-handed technique. Multivariate modeling suggested that prior resections and preoperative tumor size are important predictors for EOR. We describe a 3-hand, mononostril endoscopic transsphenoidal technique performed by a single neurosurgeon that has minimal anatomic distortion and postoperative complications. During the learning curve of this technique, operative time can significantly decrease, while EOR, postoperative outcomes, and complications are not jeopardized. Copyright © 2017 by the Congress of Neurological Surgeons

  15. Experimental assessment of energy requirements and tool tip visibility for photoacoustic-guided endonasal surgery

    Science.gov (United States)

    Lediju Bell, Muyinatu A.; Dagle, Alicia B.; Kazanzides, Peter; Boctor, Emad M.

    2016-03-01

    Endonasal transsphenoidal surgery is an effective approach for pituitary adenoma resection, yet it poses the serious risk of internal carotid artery injury. We propose to visualize these carotid arteries, which are hidden by bone, with an optical fiber attached to a surgical tool and a transcranial ultrasound probe placed on the patient's temple (i.e. intraoperative photoacoustic imaging). To investigate energy requirements for vessel visualization, experiments were conducted with a phantom containing ex vivo sheep brain, ex vivo bovine blood, and 0.5-2.5 mm thick human cadaveric skull specimens. Photoacoustic images were acquired with 1.2-9.3 mJ laser energy, and the resulting vessel contrast was measured at each energy level. The distal vessel boundary was difficult to distinguish at the chosen contrast threshold for visibility (4.5 dB), which was used to determine the minimum energies for vessel visualization. The blood vessel was successfully visualized in the presence of the 0-2.0 mm thick sphenoid and temporal bones with up to 19.2 dB contrast. The minimum energy required ranged from 1.2-5.0 mJ, 4.2-5.9 mJ, and 4.6-5.2 mJ for the 1.0 temporal and 0-1.5 mm sphenoid bones, 1.5 mm temporal and 0-0.5 mm sphenoid bones, and 2.0 mm temporal and 0-0.5 mm sphenoid bones, respectively, which corresponds to a fluence range of 4-21 mJ/cm2. These results hold promise for vessel visualization within safety limits. In a separate experiment, a mock tool tip was placed, providing satisfactory preliminary evidence that surgical tool tips can be visualized simultaneously with blood vessels.

  16. Low complication rate of sellar reconstruction by artificial dura mater during endoscopic endonasal transsphenoidal surgery.

    Science.gov (United States)

    Ye, Yuanliang; Wang, Fuyu; Zhou, Tao; Luo, Yi

    2017-12-01

    To evaluate effect of sellar reconstruction during pituitary adenoma resection surgery by the endoscopic endonasal transsphenoidal approach using artificial cerebral dura mater patch.This was a retrospective study of 1281 patients who underwent endoscopic transsphenoidal resection for the treatment of pituitary adenomas between December 2006 and May 2014 at the Neurosurgery Department of the People's Liberation Army General Hospital. The patients were classified into 4 grades according to intraoperative cerebrospinal fluid (CSF) leakage site. All patients were followed up for 3 months by telephone and outpatient visits.One thousand seventy three (83.7%) patients underwent sellar reconstruction using artificial dura matter patched outside the sellar region (method A), 106 (8.3%) using artificial dura matter patched inside the sellar region (method B), and 102 (8.0%) using artificial dura matter and a mucosal flap (method C). Method A was used for grade 0-1 leakage, method B for grade 1 to 2 leakage, and method C for grade 2 to 3 leakage. During the 3-month follow-up, postoperative CSF leakage was observed in 7 patients (0.6%): 2 among patients who underwent method B (1.9%) and 5 among those who underwent method C (4.9%). Meningitis was diagnosed in 13 patients (1.0%): 2 among patients who underwent method A (0.2%), 4 among those who underwent method B (3.8%), and 7 among those who underwent method C (6.7%).Compared with other reconstruction methods, sellar reconstruction surgery that only use artificial dura mater as repair material had a low rate of complications. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  17. Pure endoscopic expanded endonasal approach for olfactory groove and tuberculum sellae meningiomas.

    Science.gov (United States)

    Khan, Osaama H; Krischek, Boris; Holliman, Damian; Klironomos, George; Kucharczyk, Walter; Vescan, Allan; Gentili, Fred; Zadeh, Gelareh

    2014-06-01

    The expanded endoscopic endonasal (EEE) approach for the removal of olfactory groove (OGM) and tuberculum sellae (TSM) meningiomas is currently becoming an acceptable surgical approach in neurosurgical practice, although it is still controversial with respect to its outcomes, indications and limitations. Here we provide a review of the available literature reporting results with use of the EEE approach for these lesions together with our experience with the use of the endoscope as the sole means of visualization in a series of patients with no prior surgical biopsy or resection. Surgical cases between May 2006 and January 2013 were retrospectively reviewed. Twenty-three patients (OGM n=6; TSM n=17) were identified. In our series gross total resection (GTR) was achieved in 4/6 OGM (66.7%) and 11/17 (64.7%) TSM patients. Vision improved in the OGM group (2/2) and 8/11 improved in the TSM group with no change in visual status in the remaining three patients. Post-operative cerebrospinal fluid (CSF) leak occurred in 2/6 (33%) OGM and 2/17 (11.8%) TSM patients. The literature review revealed a total of 19 OGM and 174 TSM cases which were reviewed. GTR rate was 73% for OGM and 56.3% for TSM. Post-operative CSF leak was 30% for OGM and 14% for TSM. With careful patient selection and a clear understanding of its limitations, the EEE technique is both feasible and safe. However, longer follow-ups are necessary to better define the appropriate indications and ideal patient population that will benefit from the use of these newer techniques. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  18. Transbasal versus endoscopic endonasal versus combined approaches for olfactory groove meningiomas: importance of approach selection.

    Science.gov (United States)

    Liu, James K; Silva, Nicole A; Sevak, Ilesha A; Eloy, Jean Anderson

    2018-04-01

    OBJECTIVE There has been much debate regarding the optimal surgical approach for resecting olfactory groove meningiomas (OGMs). In this paper, the authors analyzed the factors involved in approach selection and reviewed the surgical outcomes in a series of OGMs. METHODS A retrospective review of 28 consecutive OGMs from a prospective database was conducted. Each tumor was treated via one of 3 approaches: transbasal approach (n = 15), pure endoscopic endonasal approach (EEA; n = 5), and combined (endoscope-assisted) transbasal-EEA (n = 8). RESULTS The mean tumor volume was greatest in the transbasal (92.02 cm 3 ) and combined (101.15 cm 3 ) groups. Both groups had significant lateral dural extension over the orbits (transbasal 73.3%, p 95%) was achieved in 20% of transbasal and 37.5% of combined cases, all due to tumor adherence to the critical neurovascular structures. The rate of CSF leakage was 0% in the transbasal and combined groups, and there was 1 leak in the EEA group (20%), resulting in an overall CSF leakage rate of 3.6%. Olfaction was preserved in 66.7% in the transbasal group. There was no significant difference in length of stay or 30-day readmission rate between the 3 groups. The mean modified Rankin Scale score was 0.79 after the transbasal approach, 2.0 after EEA, and 2.4 after the combined approach (p = 0.0604). The mean follow-up was 14.5 months (range 1-76 months). CONCLUSIONS The transbasal approach provided the best clinical outcomes with the lowest rate of complications for large tumors (> 40 mm) and for smaller tumors (OGMs invading the sinonasal cavity. Careful patient selection using an individualized, tailored strategy is important to optimize surgical outcomes.

  19. Supraorbital Versus Endoscopic Endonasal Approaches for Olfactory Groove Meningiomas: A Cost-Minimization Study.

    Science.gov (United States)

    Gandhoke, Gurpreet S; Pease, Matthew; Smith, Kenneth J; Sekula, Raymond F

    2017-09-01

    To perform a cost-minimization study comparing the supraorbital and endoscopic endonasal (EEA) approach with or without craniotomy for the resection of olfactory groove meningiomas (OGMs). We built a decision tree using probabilities of gross total resection (GTR) and cerebrospinal fluid (CSF) leak rates with the supraorbital approach versus EEA with and without additional craniotomy. The cost (not charge or reimbursement) at each "stem" of this decision tree for both surgical options was obtained from our hospital's finance department. After a base case calculation, we applied plausible ranges to all parameters and carried out multiple 1-way sensitivity analyses. Probabilistic sensitivity analyses confirmed our results. The probabilities of GTR (0.8) and CSF leak (0.2) for the supraorbital craniotomy were obtained from our series of 5 patients who underwent a supraorbital approach for the resection of an OGM. The mean tumor volume was 54.6 cm 3 (range, 17-94.2 cm 3 ). Literature-reported rates of GTR (0.6) and CSF leak (0.3) with EEA were applied to our economic analysis. Supraorbital craniotomy was the preferred strategy, with an expected value of $29,423, compared with an EEA cost of $83,838. On multiple 1-way sensitivity analyses, supraorbital craniotomy remained the preferred strategy, with a minimum cost savings of $46,000 and a maximum savings of $64,000. Probabilistic sensitivity analysis found the lowest cost difference between the 2 surgical options to be $37,431. Compared with EEA, supraorbital craniotomy provides substantial cost savings in the treatment of OGMs. Given the potential differences in effectiveness between approaches, a cost-effectiveness analysis should be undertaken. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Endoscopic Endonasal Resection of Retrochiasmatic Craniopharyngioma with Fascia Lata Button and Nasoseptal Flap Reconstruction.

    Science.gov (United States)

    Kshettry, Varun R; Nyquist, Gurston; Evans, James J

    2018-02-01

    Surgery for craniopharyngiomas can be challenging due to the involvement of multiple critical neurovascular structures. The expanded endoscopic endonasal approach can provide superior access to suprasellar craniopharyngiomas, particularly with retrochiasmatic extension and significant hypothalamic involvement. We describe the surgical technique used to treat a 30-year-old patient who presented with 4 weeks of worsening vision, fatigue, and memory loss. His vision was counting fingers at 1 feet on the right and 20/800 on the left with a temporal hemianopsia. Laboratory evaluation demonstrated central hypoadrenalism, hypothyroidism, and hypogonadism. Imaging showed a large solid and cystic suprasellar mass. The transtubercular approach with removal of the lateral tubercular strut can provide wide bilateral access to the opticocarotid region. The superior intercavernous sinus must be coagulated and ligated. Initial arachnoid dissection is centered at the midline, mobilizing the superior hypophyseal branches to the optic apparatus laterally. The cyst capsule is opened and care is taken to minimize spillage of cyst fluid into the subarachnoid space. Central debulking and then extracapsular dissection is performed under direct visualization using sharp dissection. Reconstruction of the dura is performed with an inlay/onlay fascia lata button that is held together with four sutures that hold the graft edges against the native dural edges. This is followed by vascularized nasoseptal flap reconstruction. No lumbar drain or nonabsorbable packing is required. The patient's vision had dramatic improvement and by 1 week postoperatively was 20/20 with full visual fields. Postoperative diabetes insipidus was managed with nasal desmopressin. Postoperative MRI demonstrated complete removal. The link to the video can be found at: https://youtu.be/QQxCNUcq1qg .

  1. Transsphenoidal Approach in Endoscopic Endonasal Surgery for Skull Base Lesions: What Radiologists and Surgeons Need to Know.

    Science.gov (United States)

    García-Garrigós, Elena; Arenas-Jiménez, Juan José; Monjas-Cánovas, Irene; Abarca-Olivas, Javier; Cortés-Vela, Jesús Julián; De La Hoz-Rosa, Javier; Guirau-Rubio, Maria Dolores

    2015-01-01

    In the last 2 decades, endoscopic endonasal transsphenoidal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal invasiveness, lower incidence of complications, and lower morbidity and mortality rates compared with traditional approaches. The transsphenoidal route is the surgical approach of choice for most sellar tumors because of the relationship of the sphenoid bone to the nasal cavity below and the pituitary gland above. More recently, extended approaches have expanded the indications for transsphenoidal surgery by using different corridors leading to specific target areas, from the crista galli to the spinomedullary junction. Computer-assisted surgery is an evolving technology that allows real-time anatomic navigation during endoscopic surgery by linking preoperative triplanar radiologic images and intraoperative endoscopic views, thus helping the surgeon avoid damage to vital structures. Preoperative computed tomography is the preferred modality to show bone landmarks and vascular structures. Radiologists play an important role in surgical planning by reporting extension of sphenoid pneumatization, recesses and septations of the sinus, and other relevant anatomic variants. Radiologists should understand the relationships of the sphenoid bone and skull base structures, anatomic variants, and image-guided neuronavigation techniques to prevent surgical complications and allow effective treatment of skull base lesions with the endoscopic endonasal transsphenoidal approach. ©RSNA, 2015.

  2. Time to Revive the Value of the Pseudocapsule in Endoscopic Endonasal Transsphenoidal Surgery for Growth Hormone Adenomas.

    Science.gov (United States)

    Xie, Tao; Liu, Tengfei; Zhang, Xiaobiao; Chen, Lingli; Luo, Rongkui; Sun, Wei; Hu, Fan; Yu, Yong; Gu, Ye; Lu, Zhiqiang

    2016-05-01

    To investigate the role of endoscopic endonasal transsphenoidal surgery and the pseudocapsule in the treatment of growth hormone adenomas. The study included 43 patients (age range, 21-64 years) with growth hormone adenomas treated with an endoscopic endonasal approach. We compared the tumor characteristics and surgical outcomes of cases with (group A, 21 cases, from November 2013 to January 2015) and without (group B, 22 cases, from October 2011 to October 2013) extra-pseudocapsule resection. The preoperative demographics, tumor characteristics, and surgical complications were not significantly different between groups A and B. Postoperative remission without adjuvant therapy was achieved in 18 of 21 cases (85.7%) in group A, which was significantly greater than that observed in group B (12 of 22 cases [54.4%]). In group A, the pseudocapsules were verified by endoscopy and histopathology. The pseudocapsule was removed en bloc with the whole adenoma in only 5 cases (23.8%). For the remaining 16 patients (76.2%), following extra-pseudocapsule dissection, incomplete pseudocapsule removals with intracapsule procedures were achieved. The combination of extra-pseudocapsule resection and endoscopy led to a high rate of gross total tumor resection and endocrinologicl remission in acromegalic patients compared with the group with intracapsular resection. Extra-pseudocapsule resection resulted in no additional postoperative complications. Copyright © 2016. Published by Elsevier Inc.

  3. A road map to the internal carotid artery in expanded endoscopic endonasal approaches to the ventral cranial base.

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    Labib, Mohamed A; Prevedello, Daniel M; Carrau, Ricardo; Kerr, Edward E; Naudy, Cristian; Abou Al-Shaar, Hussam; Corsten, Martin; Kassam, Amin

    2014-09-01

    Injuring the internal carotid artery (ICA) is a feared complication of endoscopic endonasal approaches. To introduce a comprehensive ICA classification scheme pertinent to safe endoscopic endonasal cranial base surgery. Anatomic dissections were performed in 33 cadaveric specimens (bilateral). Anatomic correlations were analyzed. Based on anatomic correlations, the ICA may be described as 6 distinct segments: (1) parapharyngeal (common carotid bifurcation to ICA foramen); (2) petrous (carotid canal to posterolateral aspect of foramen lacerum); (3) paraclival (posterolateral foramen lacerum to the superomedial aspect of the petrous apex); (4) parasellar (superomedial petrous apex to the proximal dural ring); (5) paraclinoid (from the proximal to the distal dural rings); and (6) intradural (distal ring to ICA bifurcation). Corresponding surgical landmarks included the Eustachian tube, the fossa of Rosenmüller, and levator veli palatini for the parapharyngeal segment; the vidian canal and V3 for the petrous segment; the fibrocartilage of foramen lacerum, foramen rotundum, maxillary strut, lingular process of the sphenoid bone, and paraclival protuberance for the paraclival segment; the sellar floor and petrous apex for the parasellar segment; and the medial and lateral opticocarotid and lateral tubercular recesses, as well as the distal osseous arch of the carotid sulcus for the paraclinoid segment. The proposed endoscopic classification outlines key anatomic reference points independent of the vessel's geometry or the sinonasal pneumatization, thus serving as (1) a practical guide to navigate the ventral cranial base while avoiding injury to the ICA and (2) further foundation for a modular access system.

  4. Interpretación auditiva de enunciados declarativos, enfáticos e interrogativos directos por hablantes nativos de coreano en clases de nivel intermedio

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    Barajas de Santiago, Daniel

    2017-06-01

    Full Text Available Este artículo investiga la interpretación auditiva de enunciados declarativos, enfáticos e interrogativos directos (pronominales y de valor absoluto por 60 estudiantes universitarios de ELE hablantes nativos de coreano en clases de nivel intermedio (B1. En él se analizan los errores cometidos en una prueba auditiva cuyo estímulo grabaron dos informantes hispanohablantes nativos de norma estándar y diferente sexo, con objeto de jerarquizar dichos tipos de enunciados en función del grado de dificultad interpretativa, y se compara dicha jerarquía con la obtenida por el mismo autor en un estudio anterior con oyentes matriculados en cursos de nivel básico, a fin de secuenciar la enseñanza de la entonación en el currículo conforme al orden de adquisición.

  5. Sobre condiciones suficientes de estabilidad para sistemas mecánicos sometidos a fuerzas dependientes de la velocidad por el método directo de Liapunov

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    Rodríguez Rebollo, Rafael

    1979-05-01

    Full Text Available Consideramos la estabilidad de un estado de un sistema mecánico, discreto o continuo, sometido a fuerzas generalizadas dependientes o no de la velocidad y cuyas ecuaciones variacionales de movimiento, para pequeñas perturbaciones, son ecuaciones diferenciales de segundo orden respecto del tiempo y de una estructura formal frecuente en diversos problemas de estabilidad de medios continuos y de sistemas de partículas y de sólidos rígidos. Se obtienen criterios de estabilidad y de estabilidad asintótica según Liapunov por el método directo, generalizando resultados conocidos. Son condiciones de estabilidad condicional para soluciones de tipo exponencial respecto del tiempo.

  6. Patient satisfaction following endoscopic endonasal dacryocystorhinostomy: a quality of life study.

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    Jutley, G; Karim, R; Joharatnam, N; Latif, S; Lynch, T; Olver, J M

    2013-09-01

    To assess the subjective success and quality of life of adult patients post endoscopic endonasal dacryocystorhinostomy (EE-DCR) for acquired nasolacrimal duct obstruction. Retrospective, questionnaire study performed at least 6 months post EE-DCR. Hundred and ten of the 282 consecutive patients who underwent EE-DCR. A standardised questionnaire (Glasgow Benefit Inventory, GBI) was used to analyse the quality of life. The questionnaire examines four parameters, providing total, subscale, social, and physical scores. We aimed to assess patient experience following EE-DCR surgery. Total GBI scores range from -100 to +100, the former reflecting maximal negative benefit and corresponding to subjective worsening of tearing and impact on quality of life. Any positive score reflects a satisfactory surgical outcome and +100 represents maximal positive benefit. A score of zero is no perceived benefit. The average age was 62 years, 63% were female. In three of the parameters measured, there was a subjective improvement post surgery: subscale score 22.16 (95% CI: 15.23-29.09), total score 15.04 (95% CI: 9.74-20.35), and social support score 4.67 (95% CI: 0.93-8.42). Physical health scored -4.47 (95% CI: -10.25 to 1.32). Secondary analyses demonstrate no statistical significance with respect to outcome whether a trainee or consultant performed the procedure. Younger patients (under split median of 63.5) had a better total score 19.04 (95% CI: 11.35-27.74) than those older than 63.5 years (11.04, 95% CI: 3.61-18.47). This study shows that EE-DCR gave patients improvement in quality of life, proven by a validated questionnaire. The mean total score of 15.04 found in our study compares with the 18.7 recorded by Feretis et al in 2009. Results were irrespective of the grade of surgeon, similar to the findings of Fayers et al for functional successes. This study supports the use of EE-DCR for the improvement of quality of life in adult patients.

  7. Comparison of external dacryocystorhinostomy and 5-fluorouracil augmented endonasal laser dacryocystorhinostomy. A Retrospective review

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    Watts Patrick

    2001-01-01

    Full Text Available Purpose: To compare the success rates of external dacryocystorhinostomy (EXT-DCR with 5-fluorouracil (5-FU augmented endonasal laser dacryocystorhinostomy (ENL-DCR and to record the complications associated with 5-FU augmented ENL-DCR Materials and Methods: This was a retrospective non-randomised study. Forty-one patients with primary acquired nasolacrimal duct obstruction underwent an EXT-DCR (19 patients or an ENL-DCR (22 patients over a 3-year period. A Holmium YAG laser (Ho:YAG was used in the latter group of patients. Silicone tubes intubated in all patients were removed at three months. 5-FU was applied intraoperatively at the site of the ostium in the ENL-DCR patients. The median follow-up was 12 months (range 3-24 months for the ENL-DCR group and 22 months (range 6-28 months for the EXT-DCR group. The patency of the lacrimal system and the severity of epiphora were assessed at a final-review. Results: The median age of the EXT-DCR group was 77 years (range 53-87 and that of the ENL-DCR group was 71 years (range 23 to 84. There were 12 female patients in the former group and 19 in the latter. The percentage of success in the EXT-DCR group was 94.7% (95% confidence interval (CI = 75.4-99.1 = , and 63.6% in the ENL-DCR group (95% CI= 43.0-80.3. The confidence interval for the difference of 31.1% was 5.6-52.2. There was a statistically significant difference between the two groups, p=0.024 (Fisher exact test. Conclusions: These data suggest that EXT-DCR provides better results than 5-FU augmented ENL-DCR. However, ENL-DCR is the procedure of choice in certain circumstances such as in elderly, frail or medically unfit patients. Our results of 5-FU augmented ENL-DCR compare favourably with other published series.

  8. Pontine encephalocele and abnormalities of the posterior fossa following transclival endoscopic endonasal surgery.

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    Koutourousiou, Maria; Filho, Francisco Vaz Guimaraes; Costacou, Tina; Fernandez-Miranda, Juan C; Wang, Eric W; Snyderman, Carl H; Rothfus, William E; Gardner, Paul A

    2014-08-01

    Transclival endoscopic endonasal surgery (EES) has recently been used for the treatment of posterior fossa tumors. The optimal method of reconstruction of large clival defects following EES has not been established. A morphometric analysis of the posterior fossa was performed in patients who underwent transclival EES to compare those with observed postoperative anatomical changes (study group) to 50 normal individuals (anatomical control group) and 41 matched transclival cases with preserved posterior fossa anatomy (case-control group) using the same parameters. Given the absence of clival bone following transclival EES, the authors used the line between the anterior commissure and the basion as an equivalent to the clival plane to evaluate the location of the pons. Four parameters were studied and compared in the two populations: the pontine location/displacement, the maximum anteroposterior (AP) diameter of the pons, the maximum AP diameter of the fourth ventricle, and the cervicomedullary angle (CMA). All measurements were performed on midsagittal 3-month postoperative MR images in the study group. Among 103 posterior fossa tumors treated with transclival EES, 14 cases (13.6%) with postoperative posterior fossa anatomy changes were identified. The most significant change was anterior displacement of the pons (transclival pontine encephalocele) compared with the normal location in the anatomical control group (p 50% of the clivus) and dura. Nine (64.3%) of the 14 patients were overweight (body mass index [BMI] > 25 kg/m(2)). An association between BMI and the degree of pontine encephalocele was observed, but did not reach statistical significance. The use of a fat graft as part of the reconstruction technique following transclival EES with dural opening was the single significant factor that prevented pontine displacement (p = 0.02), associated with 91% lower odds of pontine encephalocele (OR = 0.09, 95% CI 0.01-0.77). The effect of fat graft reconstruction was

  9. Training to acquire psychomotor skills for endoscopic endonasal surgery using a personal webcam trainer.

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    Hirayama, Ryuichi; Fujimoto, Yasunori; Umegaki, Masao; Kagawa, Naoki; Kinoshita, Manabu; Hashimoto, Naoya; Yoshimine, Toshiki

    2013-05-01

    Existing training methods for neuroendoscopic surgery have mainly emphasized the acquisition of anatomical knowledge and procedures for operating an endoscope and instruments. For laparoscopic surgery, various training systems have been developed to teach handling of an endoscope as well as the manipulation of instruments for speedy and precise endoscopic performance using both hands. In endoscopic endonasal surgery (EES), especially using a binostril approach to the skull base and intradural lesions, the learning of more meticulous manipulation of instruments is mandatory, and it may be necessary to develop another type of training method for acquiring psychomotor skills for EES. Authors of the present study developed an inexpensive, portable personal trainer using a webcam and objectively evaluated its utility. Twenty-five neurosurgeons volunteered for this study and were divided into 2 groups, a novice group (19 neurosurgeons) and an experienced group (6 neurosurgeons). Before and after the exercises of set tasks with a webcam box trainer, the basic endoscopic skills of each participant were objectively assessed using the virtual reality simulator (LapSim) while executing 2 virtual tasks: grasping and instrument navigation. Scores for the following 11 performance variables were recorded: instrument time, instrument misses, instrument path length, and instrument angular path (all of which were measured in both hands), as well as tissue damage, max damage, and finally overall score. Instrument time was indicated as movement speed; instrument path length and instrument angular path as movement efficiency; and instrument misses, tissue damage, and max damage as movement precision. In the novice group, movement speed and efficiency were significantly improved after the training. In the experienced group, significant improvement was not shown in the majority of virtual tasks. Before the training, significantly greater movement speed and efficiency were demonstrated in

  10. [Clinical observation on controlling antihypertension with the general anesthesia of TEAS and anesthetics in endoscopic endonasal surgery].

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    Zhao, Wensheng; Zhao Xian; Li, Jinjin; Fang, Jianqiao

    2015-12-01

    To study whether the dose of controlling antihypertensive drug is reduced by transcutaneous electrical acupoint stimulation (TEAS) and the anesthetics, as well as the control of blood pressure (BP) and heart rate (HR) in endoscopic endonasal surgery with general anesthesia. Sixty patients for selective endoscopic endonasal surgery with general anesthetics and controlling antihypertension involved were selected and randomized into a TEAS group, a sham-TEAS group, 30 cases in each one. The electric pads were attached to bilateral Hegu (LI 4), Zusanli (ST 36), Sanyinjiao (SP 6) and Quchi (LI 11), stimulated with Hans-200 apparatus, 3 to 5 mA, 2 Hz/100 Hz in the TEAS group based on the patients' response to comfort. No electric stimulation was applied to the sham-TEAS group. The general anesthesia started after 30 min intervention and lasted till the end of surgery. The BP and HR were observed and recorded at the end of monitoring in operation room, 10 min after tranquilization (T0), 30 min after intervention (Tj, after induction~of general anestiesa (T2), 30 min after surgery start (T3), 60 min after surgery start (T4) and 30 min after extubation (T5). The doses of vecuronium bromide, propofol and nitroglycerin were recorded statistically in surgery, as well as the operative bleeding volume, the operative time, the resuscitation time and the visual analogue scale (VAS) score after resuscitation. Compared with that at T0, the mean arterial pressure (MAP) at T2, T3, T4 and T5 in the TEAS group and at T3 and T4 in the sham-TEAS group was all reduced, indicating the significant difference (all P 0.05). HR was different at T2 to Ts in the sham-TEAS group statistically (all P 0.05). The general anesthesia with TEAS and anesthetics involved for controlling antihypertension contributes to the control of BP and HR in the patients in endoscopic endonasal surgery. The impacts are not obvious on the doses of antihypertensive drug, the general anesthetics, the operative bleeding

  11. Evaluación de los métodos directo, precipitado y Friedewald para la cuantificación de colesterol LDL y HDL en pollos de engorde

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    José Henry Osorio

    2012-12-01

    Full Text Available El objetivo fue evaluar los métodos directo y precipitado para el colesterol de las lipoproteínas de alta densidad y los métodos directo, precipitado y Friedewald para el colesterol de las lipoproteínas de baja densidad en pollos de engorde. Se obtuvo suero de 30 pollos de engorde de 36 días de edad, en ayunas, de la línea Cobb 500, se determinaron los niveles de triglicéridos y colesterol total usando un kit enzimático-colorimétrico. El colesterol, tanto de las lipoproteínas de alta densidad como de las de baja densidad, se midió por el método de precipitación y el método directo, y la estimación del colesterol de la lipoproteína de baja densidad se determinó usando la fórmula de Friedewald. Las medias ± desviación estándar para los niveles de colesterol de las lipoproteínas de alta densidad, por los métodos directo y precipitado, en mg/dl, fueron de: 92,8 ± 16,7; 92,2 ± 16,3, respectivamente. El valor P del test F es mayor a 0,05, por lo cual no hay diferencia estadísticamente significativa, con un índice de confianza de 95 % entre métodos, y para los niveles de colesterol de la lipoproteínas de baja densidad por los métodos directo, precipitado y Friedewald, en mg/dl, fueron: 51,8 ± 9,4; 21,9 ± 12,6 y 26,1 ± 12,9, respectivamente. El valor P del test F es inferior a 0,05 evidenciando diferencia estadísticamente significativa, con un índice de confianza de 95 % entre métodos. Se concluye que en los pollos de engorde se puede cuantificar el colesterol de la lipoproteína de alta densidad con los dos métodos evaluados (directo y precipitado, sin embargo, para calcular el colesterol de la lipoproteína de baja densidad solo se recomienda utilizar el método directo ya que los métodos de precipitado y de Friedewald dieron resultados mucho menores en dicha especie.

  12. Endoscopic endonasal transsphenoidal surgery using the iArmS operation support robot: initial experience in 43 patients.

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    Ogiwara, Toshihiro; Goto, Tetsuya; Nagm, Alhusain; Hongo, Kazuhiro

    2017-05-01

    Objective The intelligent arm-support system, iArmS, which follows the surgeon's arm and automatically fixes it at an adequate position, was developed as an operation support robot. iArmS was designed to support the surgeon's forearm to prevent hand trembling and to alleviate fatigue during surgery with a microscope. In this study, the authors report on application of this robotic device to endoscopic endonasal transsphenoidal surgery (ETSS) and evaluate their initial experiences. Methods The study population consisted of 43 patients: 29 with pituitary adenoma, 3 with meningioma, 3 with Rathke's cleft cyst, 2 with craniopharyngioma, 2 with chordoma, and 4 with other conditions. All patients underwent surgery via the endonasal transsphenoidal approach using a rigid endoscope. During the nasal and sphenoid phases, iArmS was used to support the surgeon's nondominant arm, which held the endoscope. The details of the iArmS and clinical results were collected. Results iArmS followed the surgeon's arm movement automatically. It reduced the surgeon's fatigue and stabilized the surgeon's hand during ETSS. Shaking of the video image decreased due to the steadying of the surgeon's scope-holding hand with iArmS. There were no complications related to use of the device. Conclusions The intelligent armrest, iArmS, seems to be safe and effective during ETSS. iArmS is helpful for improving the precision and safety not only for microscopic neurosurgery, but also for ETSS. Ongoing advances in robotics ensure the continued evolution of neurosurgery.

  13. Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update.

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    Dlouhy, Brian J; Dahdaleh, Nader S; Menezes, Arnold H

    2015-04-01

    The craniovertebral junction (CVJ), or the craniocervical junction (CCJ) as it is otherwise known, houses the crossroads of the CNS and is composed of the occipital bone that surrounds the foramen magnum, the atlas vertebrae, the axis vertebrae, and their associated ligaments and musculature. The musculoskeletal organization of the CVJ is unique and complex, resulting in a wide range of congenital, developmental, and acquired pathology. The refinements of the transoral approach to the CVJ by the senior author (A.H.M.) in the late 1970s revolutionized the treatment of CVJ pathology. At the same time, a physiological approach to CVJ management was adopted at the University of Iowa Hospitals and Clinics in 1977 based on the stability and motion dynamics of the CVJ and the site of encroachment, incorporating the transoral approach for irreducible ventral CVJ pathology. Since then, approaches and techniques to treat ventral CVJ lesions have evolved. In the last 40 years at University of Iowa Hospitals and Clinics, multiple approaches to the CVJ have evolved and a better understanding of CVJ pathology has been established. In addition, new reduction strategies that have diminished the need to perform ventral decompressive approaches have been developed and implemented. In this era of surgical subspecialization, to properly treat complex CVJ pathology, the CVJ specialist must be trained in skull base transoral and endoscopic endonasal approaches, pediatric and adult CVJ spine surgery, and must understand and be able to treat the complex CSF dynamics present in CVJ pathology to provide the appropriate, optimal, and tailored treatment strategy for each individual patient, both child and adult. This is a comprehensive review of the history and evolution of the transoral approaches, extended transoral approaches, endoscopie assisted transoral approaches, endoscopie endonasal approaches, and CVJ reduction strategies. Incorporating these advancements, the authors update the

  14. Extended Endoscopic Endonasal Resection of a Suprasellar and Third Ventricular Retrochiasmatic Craniopharyngioma with a Narrow Pituitary Gland-Optic Chiasm Interval: Techniques to Optimize Resection.

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    Kenning, Tyler J; Pinheiro-Neto, Carlos D

    2018-04-01

    The extended endoscopic endonasal approach can be utilized to surgically treat pathology within the suprasellar space. This relies on a sufficient corridor and interval between the superior aspect of the pituitary gland and the optic chiasm. Tumors located in the retrochiasmatic space and within the third ventricle, however, may not have a widened interval through which to work. With mass effect on the superior and posterior aspect of the optic chiasm, the corridor between the chiasm and the pituitary gland might even be further narrowed. This may negate the possibility of utilizing the endoscopic endonasal approach for the management of pathology in this location. We present a case of a retrochiasmatic craniopharyngioma with a narrow resection corridor that was treated with the extended endoscopic approach and we review techniques to potentially overcome this limitation. The link to the video can be found at: https://youtu.be/ogRZj-aBqeQ .

  15. A Case of Pseudoaneurysm of the Internal Carotid Artery Following Endoscopic Endonasal Pituitary Surgery: Endovascular Treatment with Flow-Diverting Stent Implantation

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    Ali Karadag

    2017-10-01

    Full Text Available Internal carotid artery (ICA pseudoaneurysm is a rare complication of endoscopic endonasal surgery occurring in 0.4–1.1% of cases. Pseudoaneurysms can subsequently result in other complications, such as subarachnoid hemorrhage, epistaxis, and caroticocavernous fistula with resultant death or permanent neurologic deficit. In this case, we illustrate endovascular treatment with a flow-diverting stent for an ICA pseudoaneurysm after endoscopic endonasal surgery for a pituitary adenoma in a 56-year-old male. Surgery was complicated by excessive intraoperative bleeding and emergent CT angiography confirmed an iatrogenic pseudoaneurysm on the anteromedial surface of the ICA. The pseudoaneurysm was treated endovascularly with flow-diverting stent implantation only. Follow-up CT angiography after three months demonstrated occlusion of the pseudoaneurysm.

  16. Lumbar Drains Decrease the Risk of Postoperative Cerebrospinal Fluid Leak Following Endonasal Endoscopic Surgery for Suprasellar Meningiomas in Patients With High Body Mass Index.

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    Cohen, Salomon; Jones, Samuel H; Dhandapani, Sivashanmugam; Negm, Hazem M; Anand, Vijay K; Schwartz, Theodore H

    2018-01-01

    Postoperative cerebrospinal fluid (CSF) leak is a persistent, albeit much less prominent, complication following endonasal endoscopic surgery. The pathology with highest risk is suprasellar meningiomas. A postoperative lumbar drain (LD) is used to decrease the risk of CSF leak but is not universally accepted. To compare the rates of postoperative CSF leak between patients with and without LD who underwent endonasal endoscopic surgical resection of suprasellar meningiomas. A consecutive series of newly diagnosed suprasellar meningiomas was drawn from a prospectively acquired database of endonasal endoscopic surgeries at our institution. An intraoperative, preresection LD was placed and left open at 5 cc/h for ∼48 h. In a subset of patients, the LD could not be placed. Rates of postoperative CSF leak were compared between patients with and without an LD. Twenty-five patients underwent endonasal endoscopic surgical resection of suprasellar meningiomas. An LD could not be placed in 2 patients. There were 2 postoperative CSF leaks (8%), both of which occurred in the patients who did not have an LD (P = .0033). The average body mass index (BMI) of the patients in whom the LD could not be placed was 39.1 kg/m2, compared with 27.6 kg/m2 for those in whom the LD could be placed (P = .009). In the subgroup of obese patients (BMI > 30 kg/m2), LD placement was protective against postoperative CSF leak (P = .022). The inability to place an LD in patients with obesity is a risk factor for postoperative CSF leak. An LD may be useful to prevent postoperative CSF leak, particularly in patients with elevated BMI. Copyright © 2017 by the Congress of Neurological Surgeons

  17. Endoscopic endonasal approach for craniopharyngioma: the importance of the relationship between pituitary stalk and tumor.

    Science.gov (United States)

    Dho, Yun-Sik; Kim, Yong Hwy; Se, Young-Bem; Han, Doo Hee; Kim, Jung Hee; Park, Chul-Kee; Wang, Kyu-Chang; Kim, Dong Gyu

    2017-09-29

    OBJECTIVE The endoscopic endonasal approach (EEA) is commonly used for the treatment of craniopharyngioma; therefore, it is essential to analyze outcomes in order to understand the benefits and drawbacks. The goal of this paper was to evaluate the clinical features and outcomes associated with this treatment approach. METHODS From July 2010 to March 2016, 82 adult craniopharyngioma patients underwent an EEA at the authors' institution. Of these cases, intraoperative records and immediate postoperative MR images were available for 68 patients. The patients underwent systemized endocrinological evaluation. Eighteen of 68 patients who underwent EEA for recurrence or regrowth of residual lesions after previous surgical management were excluded in the analysis of the anatomical tumor classification. The authors retrospectively analyzed preoperative clinical features and previous anatomical classifications, focusing on the relationship of the pituitary stalk and tumor, to determine predictive factors for the clinical outcome, such as the extent of resection, visual function, endocrinological function, recurrence rate, and complications. RESULTS The mean tumor size was 2.5 cm (3.1 cm for primary tumors and 1.9 cm for recurrent lesions). Gross-total resection (GTR) was achieved in 62 (91.1%) patients (48 [96.0%] patients with primary tumors and 14 [77.8%] patients with recurrent tumors). The rate of GTR was higher in the primary group than in the group with recurrence (p = 0.038). The overall pre- and postoperative visual impairment scale (VIS) scores were 40.8 and 22.1, respectively (50.9 and 14.3 in the primary group and 30.7 and 29.9 in patients with recurrence, respectively). The improvement rate in VIS score was higher in the primary group than in the recurrent group (p = 0.001). Endocrinological function was improved in 4 patients (5.9%) and deteriorated in 32 of 68 patients (47.1%). Tumor invasion into the center of the pituitary stalk affected the postoperative

  18. Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications

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    Edson Rocha Constantino

    2016-05-01

    Full Text Available ABSTRACT Objective In this study, we investigate our institutional experience of patients who underwent endoscopic endonasal transsphenoidal approach for treatment of large and giant pituitary adenomas emphasizing the surgical results and approach-related complications. Method The authors reviewed 28 consecutive patients who underwent surgery between March, 2010 and March, 2014. Results The mean preoperative tumor diameter was 4.6 cm. Gross-total resection was achieved in 14.3%, near-total in 10.7%, subtotal in 39.3%, and partial in 35.7%. Nine patients experienced improvement in visual acuity, while one patient worsened. The most common complications were transient diabetes insipidus (53%, new pituitary deficit (35.7%, endonasal adhesions (21.4%, and cerebrospinal fluid leak (17.8%. Surgical mortality was 7.1%. Conclusions Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for large or giant pituitary adenomas, which results in high rates of surgical decompression of cerebrovascular structures.

  19. Urgent Optic Nerve Decompression via an Endoscopic Endonasal Transsphenoidal Approach for Craniopharyngioma in a 12-Month-Old Infant: A Case Report.

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    Shibata, Teishiki; Tanikawa, Motoki; Sakata, Tomohiro; Mase, Mitsuhito

    2018-01-01

    Craniopharyngiomas are benign tumors and account for approximately 5.6-13% of all intracranial tumors in children. Diagnosis of pediatric craniopharyngioma is often delayed until the tumor becomes relatively large and manifests severe visual and/or endocrine disturbance. Endoscopic endonasal approaches have recently been introduced to surgery for craniopharyngioma. These techniques, however, have rarely been utilized in patients affected with craniopharyngioma as young as 1 year old. This report documents a 12-month-old male infant with sellar craniopharyngioma who presented with acute total vision loss. To increase the chances of visual recovery, an endoscopic endonasal optic nerve decompression was performed as an urgent procedure. After decompression, which resulted in improvement of his visual disturbance, gross total resection of the tumor was undertaken through an anterior interhemispheric approach at a later date. Tumor mass reduction through an endoscopic endonasal transsphenoidal approach followed by secondary radical total resection under craniotomy was considered to be useful in cases such as this when urgent optic nerve decompression is required. © 2018 S. Karger AG, Basel.

  20. Endoscopic endonasal approach for the treatment of a large clival giant cell tumor complicated by an intraoperative internal carotid artery rupture

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    Iacoangeli M

    2013-01-01

    Full Text Available Maurizio Iacoangeli,1 Alessandro Di Rienzo,1 Massimo Re,2 Lorenzo Alvaro,1 Niccolò Nocchi,1 Maurizio Gladi,1 Maurizio De Nicola,3 Massimo Scerrati11Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy; 2Department of Ear, Nose, and Throat Surgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy; 3Department of Radiology, Interventional Radiology Section, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, ItalyAbstract: Giant cell tumors (GCTs are primary bone neoplasms that rarely involve the skull base. These lesions are usually locally aggressive and require complete removal, including the surrounding apparently healthy bone, to provide the best chance of cure. GCTs, as well as other lesions located in the clivus, can nowadays be treated by a minimally invasive fully endoscopic extended endonasal approach. This approach ensures a more direct route to the craniovertebral junction than other possible approaches (transfacial, extended lateral, and posterolateral approaches. The case reported is a clival GCT operated on by an extended endonasal approach that provides another contribution on how to address one of the most feared complications attributed to this approach: a massive bleed due to an internal carotid artery injury.Keywords: clival giant cell tumor, endoscopic endonasal approach, internal carotid artery injury, minimally invasive surgery

  1. Metodología para la estimación de costos directos de la atención integral para enfermedades no trasmisibles

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    Nancy Castillo

    Full Text Available Enfermedades como la diabetes mellitus (DM y la hipertensión arterial (HTA generan altos costos y son la causa más frecuente de mortalidad en la región de las Américas. En el caso del Perú, dados los cambios demográficos y epidemiológicos, y particularmente el aumento alarmante del sobrepeso y la obesidad, la carga de estas enfermedades tiene un crecimiento constante que implica la necesidad de asignar cada vez más recursos financieros a los servicios de salud. Los costos de la atención integral de estas enfermedades y sus complicaciones representan una carga económica que debe ser considerada por las instituciones de salud al elaborar su presupuesto. Con ese propósito, la Organización Panamericana de la Salud (OPS ha apoyado al Ministerio de Salud (MINSA con la realización de un estudio para la estimación de estos costos. En el presente artículo se describe esquemáticamente la metodología desarrollada para la estimación de los costos directos en la atención integral de la DM e HTA en los servicios de salud del MINSA y gobiernos regionales.

  2. Interpretación auditiva de enunciados declarativos, enfáticos e interrogativos directos por estudiantes coreanos en clases de nivel avanzado

    Directory of Open Access Journals (Sweden)

    Barajas de Santiago, Daniel

    2018-06-01

    Full Text Available Este trabajo investiga la interpretación auditiva, por parte de 61 estudiantes universitarios de ELE hablantes nativos de coreano, de enunciados declarativos, enfáticos e interrogativos directos (pronominales dotados de la entonación propia de las preguntas pronominales con matiz de cortesía e interrogativos de valor absoluto en clases de nivel avanzado (B2. Así, se analizan los errores cometidos en una prueba auditiva cuyo estímulo grabaron dos informantes hispanohablantes nativos de norma estándar y diferente sexo, a fin de jerarquizar dichas clases de enunciados en función del grado de dificultad interpretativa, y se compara dicha jerarquía con la obtenida previamente por el mismo autor en sus experimentos con oyentes matriculados en cursos de nivel básico e intermedio. El objetivo final de tal comparación es conocer el orden diacrónico de adquisición de la competencia interpretativa de las diferentes clases de enunciados, el cual permitirá secuenciar la enseñanza de la entonación en el currículo conforme a él en futuros trabajos.

  3. La toma de decisiones en baloncesto. Una propuesta de árboles decisionales para la enseñanza del bloqueo directo

    Directory of Open Access Journals (Sweden)

    Ernesto Suárez-Cadenas

    Full Text Available Resumen El presente artículo tiene por objetivo clarificar conceptos relacionados con la toma de decisiones en el deporte y proponer su aplicación para la enseñanza-aprendizaje del bloqueo directo (BD en baloncesto. Se realiza un repaso histórico hasta llegar a las teorías modernas de mayor vigencia en el ámbito deportivo. De la misma forma, se analiza el estado del arte actual de la enseñanza y aprendizaje de la toma de decisiones, mostrando las distintas ventajas e inconvenientes del uso de las estrategias de enseñanza intencional e incidental. Posteriormente, a partir de los conceptos revisados (reglas si-entonces y las distintas estrategias de enseñanza incidental e intencional, se establece una propuesta de entrenamiento del BD en baloncesto. A través de distintos árboles decisionales y de propuestas de tareas específicas se ha intentado resolver el problema de cómo potenciar la toma de decisiones de los jugadores durante el BD atendiendo a la lógica interna y a los principios del juego, pero intentando, a la vez, que los jugadores desarrollen una toma de decisiones propia, única e individual.

  4. The "suprasellar notch," or the tuberculum sellae as seen from below: definition, features, and clinical implications from an endoscopic endonasal perspective.

    Science.gov (United States)

    de Notaris, Matteo; Solari, Domenico; Cavallo, Luigi M; D'Enza, Alfonso Iodice; Enseñat, Joaquim; Berenguer, Joan; Ferrer, Enrique; Prats-Galino, Alberto; Cappabianca, Paolo

    2012-03-01

    The tuberculum sellae is a bony elevation ridge that lines up the anterior aspect of the sella, dividing it from the chiasmatic groove. The recent use of the endoscopic endonasal transtuberculum approach has provided surgeons with a method to reach the suprasellar area, offering a new surgical point of view somehow "opposite" of this area. The authors of this study aimed to define the tuberculum sellae as seen from the endoscopic endonasal view while also providing CT-based systematic measurements to objectively detail the anatomical features of such a structure, which was renamed the "suprasellar notch." The authors analyzed routine skull CT scans from 24 patients with no brain pathology or fractures and measured the interoptic distance at the level of the limbus sphenoidale, the chiasmatic groove sulcal length and width, and the angle of the suprasellar notch. Indeed, the suprasellar notch was defined as the angle between 2 lines, the first passing through the tuberculum sellae midpoint and perpendicular to the cribriform plate, and a second line passing between 2 points, the midpoints of the limbus sphenoidale and the tuberculum sellae. Moreover, the authors performed on 15 cadaveric heads an endoscopic endonasal transplanum transtuberculum approach with the aid of a neuronavigator to achieve a step-by-step comparison with the radiological data. The whole CT scanning set was statistically analyzed to determine the statistical interdependency of the suprasellar notch angle with the other 3 measurements, that is, the sulcal length at the midline, the interoptic distance at the optic canal entrance, and the interoptic distance at the limbus. Based on the endoscopic endonasal view and CT imaging analysis, the authors identified a certain anatomical variability and thus introduced a new classification of the suprasellar notch: Type I, angle 138°. They then analyzed the surgical implications of the endoscopic endonasal approach to the suprasellar area, which could be

  5. Solución analítica del problema directo de la tomografía de capacitancia eléctrica para un fluido bifásico con una inclusión circular

    Directory of Open Access Journals (Sweden)

    Silvia Reyes

    2012-01-01

    Full Text Available En este artículo se expone un modelo matemático al problema de la Tomografía de Capacitancia Eléctrica (TCE, para el caso de un fluido bifásico dieléctrico con una inclusión circular. Se resuelve el problema directo, que consiste en obtener una expresión analítica para las capacitancias mutuas. La solución del problema directo servirá para validar cualquier método de solución al problema inverso, para calibrar los equipos de medición actualmente existentes y además para construir un método de discretización adaptiva para resolver el problema inverso de la TCE.

  6. Costos directos de la artritis reumatoide temprana en el primer año de atención: simulación de tres situaciones clínicas en un hospital universitario de tercer nivel en Colombia

    Directory of Open Access Journals (Sweden)

    Gerardo Quintana

    2009-03-01

    Conclusión. El principal elemento de los costos médicos directos en la artritis reumatoide temprana son los costos por medicamentos y se incrementa 40 veces con el uso de la terapia biológica. Deben realizarse estudios de evaluación económica completos para determinar la viabilidad y pertinencia clínica y económica del uso de la terapia biológica en estos pacientes.

  7. MINIMIZACIÓN DE RESIDUOS DE CROMO MEDIANTE LA APLICACIÓN DE UNA TÉCNICA DE RECICLADO DIRECTO DE LICORES DE PIQUELADO - CURTIDO EN EL PROCESAMIENTO DE PIELES

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    Ramiro Escalera Vásquez

    2013-07-01

    Full Text Available Uno de los problemas ambientales confrontados por las curtiembres bolivianas es la emisión de residuos líquidos contaminados con cromo, del cual se desechan significativas cantidades en los procesos convencionales. Aunque este versátil metal pesado juega un rol importante en el metabolismo de plantas y animales, en bajas concentraciones, sus derivados oxidados, Cr (VI, son extremadamente tóxicos. Como alternativa de prevención de la contaminación, se ha realizado una investigación en torno a la aplicación del método de Reciclado Directo  de Licores Residuales en la etapa de piquelado - curtido de pieles. Se ha demostrado mediante numerosas corridas experimentales realizadas en laboratorio y en planta, que el reciclaje directo de licores residuales de curtido es técnicamente viable para su implantación en las etapas de piquelado y curtido del proceso de fabricación de cueros al cromo en una curtiembre común. La calidad del cuero terminado no se deteriora con el re-uso directo de los licores de cromo hasta en 10 reciclos. El control del proceso puede realizarse con la medición de parámetros muy simples: La densidad de los licores, la fuerza iónica relacionada con la densidad, el grado de acidez (pH y la concentración de cromo en los licores residuales. Se generan ahorros importantes en el consumo de reactivos químicos, entre el 9% y el 44%, y sobre todo, en consumo de agua, 77%. La mitigación del impacto ambiental producido por el contenido de Cr(III en los licores de curtido, se traduce en una disminución de más de 70% de la masa desechada de Cr(III, cuando se usa el reciclado directo, respecto de la masa que se desecha en curtidos normales sin reciclo. La implementación del reciclado directo de licores de cromo es replicable a otras industrias similares, que existen en gran número en Bolivia.

  8. ¿Qué es un competidor directo? Estudio para corroborar la percepción de competencia directa con base en tres factores

    Directory of Open Access Journals (Sweden)

    Jorge Vera Martínez

    2012-01-01

    Full Text Available En el presente trabajo se ofrece la hipótesis de que la percepción de competencia directa por parte de un líder de unidad estratégica de negocio (UEN depende de tres variables: similitud del producto ofrecido, similitud del mercado atacado y similitud de capacidades estratégicas de las empresas competidoras. Se propone que la competencia directa depende más de la percepción de los gerentes que de una decisión basada en una regla objetiva. Estas tres variables son detectadas inicialmente en una revisión de literatura y son corroboradas mediante un estudio cualitativo donde se entrevistó a líderes de UEN. La relación entre estas tres variables y la percepción de competencia directa se corrobora mediante una prueba empírica donde se aplican cuestionarios -también a líderes de UEN- que sirvieron para medir la relación entre tales variables. El presente trabajo se enmarca en la noción de grupos estratégicos; se parte de que los integrantes de uno tenderían a percibirse como competidores directos y que esta percepción de competencia directa podría ser un factor para conformar tales grupos. Los resultados arrojan que la percepción de competencia directa sí es dependiente de cada una de las tres variables de similitud. Se hace un análisis estadístico de dos tipos: uno basado en correlaciones tomando la percepción de competencia directa como una variable ordinal y otro en chi-cuadrada y tablas de contingencia tomando la dependiente como una variable dicotómica: la de competencia más directa versus la de competencia menos directa.

  9. Endoscopic endonasal skull base surgery: advantages, limitations, and our techniques to overcome cerebrospinal fluid leakage: technical note.

    Science.gov (United States)

    Ishii, Yudo; Tahara, Shigeyuki; Teramoto, Akira; Morita, Akio

    2014-01-01

    In recent years, resections of midline skull base tumors have been conducted using endoscopic endonasal skull base (EESB) approaches. Nevertheless, many surgeons reported that cerebrospinal fluid (CSF) leakage is still a major complication of these approaches. Here, we report the results of our 42 EESB surgeries and discuss the advantages and limits of this approach for resecting various types of tumors, and also report our technique to overcome CSF leakage. All 42 cases involved midline skull base tumors resected using the EESB technique. Dural incisions were closed using nasoseptal flaps and fascia patch inlay sutures. Total removal of the tumor was accomplished in seven pituitary adenomas (33.3%), five craniopharyngiomas (62.5%), five tuberculum sellae meningiomas (83.3%), three clival chordomas (100%), and one suprasellar ependymoma. Residual regions included the cavernous sinus, the outside of the intracranial part of the internal carotid artery, the lower lateral part of the posterior clivus, and the posterior pituitary stalk. Overall incidence of CSF leakage was 7.1%. Even though the versatility of the approach is limited, EESB surgery has many advantages compared to the transcranial approach for managing mid-line skull base lesions. To avoid CSF leakage, surgeons should have skills and techniques for complete closure, including use of the nasoseptal flap and fascia patch inlay techniques.

  10. Value of free-run electromyographic monitoring of lower cranial nerves in endoscopic endonasal approach to skull base surgeries.

    Science.gov (United States)

    Thirumala, Parthasarathy D; Mohanraj, Santhosh Kumar; Habeych, Miguel; Wichman, Kelley; Chang, Yue-Fang; Gardner, Paul; Snyderman, Carl; Crammond, Donald J; Balzer, Jeffrey

    2012-08-01

    Objective The main objective of this study was to evaluate the value of free-run electromyography (f-EMG) monitoring of cranial nerves (CNs) VII, IX, X, XI, and XII in skull base surgeries performed using endoscopic endonasal approach (EEA) to reduce iatrogenic CN deficits. Design We retrospectively identified 73 patients out of 990 patients who had EEA in our institution who had at least one CN monitored. In each CN group, we classified patients who had significant (SG) f-EMG activity as group I and those who did not as group II. Results We monitored a total of 342 CNs. A total of 62 nerves had SG f-EMG activity including CN VII = 18, CN IX = 16, CN X = 13, CN XI = 5, and CN XII = 10. No nerve deficit was found in the nerves that had significant activity during procedure. A total of five nerve deficits including (CN IX = 1, CN X = 2, CN XII = 2) were observed in the group that did not display SG f-EMG activity during surgery. Conclusions f-EMG seems highly sensitive to surgical manipulations and in locating CNs. It seems to have limited value in predicting postoperative neurological deficits. Future studies to evaluate the EMG of lower CNs during EEA procedures need to be done with both f-EMG and triggered EMG.

  11. Value of Free-Run Electromyographic Monitoring of Extraocular Cranial Nerves during Expanded Endonasal Surgery (EES) of the Skull Base.

    Science.gov (United States)

    Thirumala, Parthasarathy D; Mohanraj, Santhosh Kumar; Habeych, Miguel; Wichman, Kelley; Chang, Yue-Fang; Gardner, Paul; Snyderman, Carl; Crammond, Donald J; Balzer, Jeffrey

    2013-06-01

    Objective To evaluate the value of free-run electromyography (f-EMG) monitoring of extraocular cranial nerves (EOCN) III, IV, and VI during expanded endonasal surgery (EES) of the skull base in reducing iatrogenic cranial nerve (CN) deficits. Design We retrospectively identified 200 patients out of 990 who had at least one EOCN monitored during EES. We further separated patients into groups according to the specific CN monitored. In each CN group, we classified patients who had significant (SG) f-EMG activity as Group I and those who did not as Group II. Results A total of 696 EOCNs were monitored. The number of muscles supplied by EOCNs that had SG f-EMG activity was 88, including CN III = 46, CN IV = 21, and CN VI = 21. There were two deficits involving CN VI in patients who had SG f-EMG activity during surgery. There were 14 deficits observed, including CN III = 3, CN IV = 2, and CN VI = 9 in patients who did not have SG f-EMG activity during surgery. Conclusions f-EMG monitoring of EOCN during EES can be useful in identifying the location of the nerve. It seems to have limited value in predicting postoperative neurological deficits. Future studies to evaluate the EMG of EOCN during EES need to be done with both f-EMG and triggered EMG.

  12. Panorama of Reconstruction of Skull Base Defects: From Traditional Open to Endonasal Endoscopic Approaches, from Free Grafts to Microvascular Flaps

    Science.gov (United States)

    Reyes, Camilo; Mason, Eric; Solares, C. Arturo

    2014-01-01

    Introduction A substantial body of literature has been devoted to the distinct characteristics and surgical options to repair the skull base. However, the skull base is an anatomically challenging location that requires a three-dimensional reconstruction approach. Furthermore, advances in endoscopic skull base surgery encompass a wide range of surgical pathology, from benign tumors to sinonasal cancer. This has resulted in the creation of wide defects that yield a new challenge in skull base reconstruction. Progress in technology and imaging has made this approach an internationally accepted method to repair these defects. Objectives Discuss historical developments and flaps available for skull base reconstruction. Data Synthesis Free grafts in skull base reconstruction are a viable option in small defects and low-flow leaks. Vascularized flaps pose a distinct advantage in large defects and high-flow leaks. When open techniques are used, free flap reconstruction techniques are often necessary to repair large entry wound defects. Conclusions Reconstruction of skull base defects requires a thorough knowledge of surgical anatomy, disease, and patient risk factors associated with high-flow cerebrospinal fluid leaks. Various reconstruction techniques are available, from free tissue grafting to vascularized flaps. Possible complications that can befall after these procedures need to be considered. Although endonasal techniques are being used with increasing frequency, open techniques are still necessary in selected cases. PMID:25992142

  13. Costos directos de la hemodiálisis en unidades públicas y privadas Direct cost analysis of hemodialysis units

    Directory of Open Access Journals (Sweden)

    Luis Durán-Arenas

    2011-01-01

    Full Text Available OBJETIVO. Estimar y comparar el costo por sesión de hemodiálisis dentro del sector público y privado en la Ciudad de México. MATERIAL Y MÉTODOS. Se calcularon los costos de los insumos utilizados en las hemodiálisis de cuatro hospitales públicos y dos privados de la Ciudad de México, mediante la estrategia de micro-costeo denominada PAATI. Para la obtención de los datos se utilizó el método de sombra; además, se empleó Excel para elaborar cédulas en las que se determina el PAATI para cada sesión. RESULTADOS. El costo anual promedio directo en el sector público por el tratamiento de un individuo en hemodiálisis es de $158 964.00 M. N., y el costo de atender a la población que podría demandar terapia de reemplazo renal se estima en $10 921 788 072.00 M. N. CONCLUSIÓN. La disponibilidad de recursos humanos e infraestructura en el país es muy limitada para el campo de la nefrología en general y, en particular, para ofrecer servicios de hemodiálisis, por lo que sería necesario inyectar más recursos para poder responder ante la demanda por insuficiencia renal terminal.OBJECTIVE. To estimate and compare direct costs per hemodialysis session in public and private units in Mexico City. MATERIAL AND METHODS. PAATI, a microcosting strategy, was used to determine total costs of four public and two private health hospitals in Mexico City. A "shadow study" approach was employed to collect the needed data. Charts containing the "PAATI" information for each session were developed in Microsoft Excel. RESULTS. The average annual cost per patient undergoing hemodialysis in public units is $158 964.00 MX. The estimated cost for the care of all population estimated in need of renal replacement therapy (via hemodialysis was estimated to be $10 921 788 072.00 MX. CONCLUSION. Human resources and infrastructure availability in México are very limited for nephrology, and in consequence for offering hemodialysis services.

  14. Comparación de los métodos Directo y de Friedewald para la determinación de los niveles de colesterol LDL en el equino

    Directory of Open Access Journals (Sweden)

    José Osório O.

    2011-05-01

    Full Text Available Objetivo. Comparar el método Directo con el método de precipitación de Friedewald para la determinación de colesterol LDL en una especie con patrón metabólico HDL. Materiales y métodos. Fueron tomadas en estado de ayuno, muestras de sangre de 200 equinos de diferente edad, raza y sexo. Luego de extraer el suero, fueron determinados los niveles de colesterol LDL mediante el método directo, posteriormente fueron determinados los niveles de colesterol LDL utilizando el método de Friedewald. Los resultados fueron analizados estadísticamente mediante ANOVA de una vía. Resultados. El método directo reportó valores (mg/dl de promedio, mínimo, máximo, rango y desviación estándar de 27.9; 14; 51; 37; 6.4 respectivamente, mediante el método de Friedewald se obtuvieron valores (mg/dl de promedio, mínimo, máximo, rango y desviación estándar de 29; 11.2; 54.2; 43; 7.0 respectivamente. El valor de P en el test F fue mayor o igual a 0.05, por lo cual no se evidenció diferencia significativa a un nivel de confidencia del 95% entre los valores obtenidos por los dos métodos. Conclusiones. Pueden ser utilizados cualquiera de los dos métodos analizados para la determinación del colesterol LDL en especies con patrón HDL.

  15. Imaging Evaluation of the Location and Fenestration of Sellar Floor during Endonasal Transsphenoidal Surgery in Patients with Pituitary Adenomas.

    Science.gov (United States)

    Wang, Shousen; Qin, Yong; Xiao, Deyong; Wu, Zhifeng; Wei, Liangfeng

    2018-05-03

    To evaluate the clinical value of three-dimensional (3D) CT reconstruction of the sphenoidal sinus separation in localizing sellar floor during endonasal transsphenoidal surgery, and determine the size and location of sellar floor fenestration. After exclusion,51 patients were eligible for study inclusion. A pre-operative CT scan of the paranasal sinus and CT scan and MRI of the pituitary gland were obtained. Sphenoidal sinus separation was reconstructed using Mimics 15.0 software and the quantity, shape, and orientation were observed and compared with intra-operative data, the purpose of which was to guide the localization of sellar floor. Anatomic variation of the sphenoidal sinus and adjacent structures, tumor and sella turcica morphology, minimal distance between the cavernous segment of the internal carotid artery(CSICA) bilaterally, and the shortest distance from the midline were measured. Based upon the shape of the sphenoidal sinus separation, sellar floor was accurately localized in all cases. Intra-operative sphenoidal sinus separation was consistent with pre-operative 3D CT reconstruction images. The sellar floor was extremely small in two patients, and insufficient fenestration of the sellar floor negatively affected tumor resection. Pre-operative 3D CT reconstruction is helpful for accurate and rapid localization of the saddle floor. The anatomic variation of sphenoidal sinus and adjacent structures, the characteristics of tumor and Sella, the minimum distance between bilateral CSICA and the shortest distance from the midline are helpful for the establishment of individualized Sellar bottom fenestration. Copyright © 2018. Published by Elsevier Inc.

  16. Endoscopic endonasal transsphenoidal surgery for patients aged over 80 years with pituitary adenomas: Surgical and follow-up results.

    Science.gov (United States)

    Fujimoto, Kenji; Yano, Shigetoshi; Shinojima, Naoki; Hide, Takuichiro; Kuratsu, Jun-Ichi

    2017-01-01

    With the rapid aging of the general population, the number of pituitary adenoma (PA) diagnosed in elderly patients is increasing. The aim of this study was to evaluate the efficacy of endoscopic endonasal transsphenoidal surgery (ETSS) for PA in patients aged ≥80 years. We retrospectively reviewed the medical records of all patients aged ≥80 years who underwent ETSS for PA at our hospital from January 2001 through December 2014. Treatment results were assessed by the extent of surgical removal, symptom improvement, postoperative complications, and Karnofsky performance status (KPS). The results were also compared with the surgical result of PA patients aged <80 years. Twelve patients aged ≥80 years underwent ETSS for PA. Recovery of visual function was observed in 11 patients (91.7%). Postoperative cerebrospinal fluid (CSF) leakage was observed in 3 patients. New hormonal replacement therapy was required in 2 patients. These complications had not affected patient prognosis. During the follow-up periods, deterioration of KPS was observed in 2 patients due to pneumonia or cerebral infarction. In total, 150 PA patients aged <80 years were compared with the patients aged ≥80 years. The percentage of total removal was significantly higher in the younger patient group than that in the older one (54.0% vs 16.6%, respectively; P = 0.016). Visual improvement was observed in 93.2% of the younger patient group, which was almost equal to that in the older one. ETSS is a safe and effective surgical technique in PA patients aged ≥80 years.

  17. Endoscopic Endonasal Transsphenoidal Surgery, A Reliable Method for Treating Primary and Recurrent/Residual Craniopharyngiomas: Nine Years of Experience.

    Science.gov (United States)

    Bal, Ercan; Öge, Kamil; Berker, Mustafa

    2016-10-01

    Craniopharyngioma resection is one of the most challenging surgical procedures. Herein, we describe our extended endoscopic endonasal transsphenoidal surgery (EETS) technique, and the results of 9 years of use on primary and recurrent/residual craniopharyngiomas. This study reviewed 28 EETSs in 25 patients with craniopharyngiomas between January 2006 and September 2015. The patients were divided into 2 groups, newly diagnosed patients (group A, n = 15), and patients having residual or recurrent tumors (group B, n = 10). There was no significant difference between the groups in terms of the largest tumor diameter (P = 0.495), and all patients underwent EETS. The clinical and ophthalmologic examinations, imaging studies, endocrinologic studies, and operative findings for these cases were reviewed retrospectively. The number of gross total resections in group A was 13/15, and 7/10 in group B. Three of the patients developed postoperative cerebrospinal fluid leakage (all in group A). There were no neurovascular or ophthalmologic complications, and no meningitis or mortality was observed. There has been a notable increase in the use of EETS in the treatment of craniopharyngiomas during the last decade. Despite its increased use in the treatment of primary craniopharyngiomas, its implementation for recurrent or residual craniopharyngiomas has been viewed with suspicion. In this study, the results have been presented separately for primary and recurrent/residual craniopharyngiomas, so that the results can be compared. Overall, EETS is a reliable and successful surgical treatment method for primary and recurrent/residual craniopharyngiomas. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Endoscopic Endonasal Surgery for Remission of Cushing Disease Caused by Ectopic Intracavernous Macroadenoma: Case Report and Literature Review.

    Science.gov (United States)

    Koutourousiou, Maria; Winstead, Welby I

    2017-02-01

    Complete surgical resection of an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma is the gold standard of treatment of Cushing disease. Ectopic location of these adenomas is an extremely rare condition that may compromise the diagnosis and surgical success. We present the first case of an ectopic intracavernous ACTH-secreting macroadenoma totally resected with endoscopic endonasal surgery (EES). A 36-year-old woman presented with Cushing syndrome. Increased ACTH, serum cortisol, and free urine cortisol levels were identified; however, pituitary magnetic resonance imaging failed to show a pituitary tumor; instead, a parasellar lesion in the left cavernous sinus (CS) was noticed. Inferior petrosal sinus sampling showed a significant central to peripheral and lateralized left-sided ACTH gradient. The patient underwent EES. No tumor was found in the sella; however, the left CS was widely explored and a tumor was found lateral to the paraclival segment of the carotid artery. There were no complications after EES. Pathology confirmed the diagnosis of an ACTH-secreting adenoma. During the immediate postoperative course, serum cortisol levels decreased lower than 5 μg/dL. Postoperative magnetic resonance imaging showed complete tumor resection. At 20 months follow-up, the patient remained in clinical and biochemical remission of Cushing disease. Only 12 cases of ectopic intracavernous ACTH-secreting adenomas have been reported and all were microadenomas. The presence of an ectopic ACTH-secreting macroadenoma in the CS represents a surgical challenge. EES is the ideal approach for complete resection of ectopic intracavernous adenomas, allowing for a wide exploration of the CS with no surgical complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Propuesta de desarrollo de un sistema para la distribución de recursos financieros basado en el método de costeo directo en una entidad deportiva.

    OpenAIRE

    Veloz Vanegas, Gerardo Andrés

    2017-01-01

    El presente estudio contempla la propuesta de desarrollar un sistema de gestión financiera para el adecuado control del presupuesto a las actividades deportivas de una institución deportiva provincial priorizando la estrategia de la misma. A través de la metodología de costeo directo, o costeo variable, se plantea la implementación de un nuevo sistema con enfoque de relación directa para la definición de los costos que requiere un deporte. En la actualidad las instituciones deportivas...

  20. Metodología del cálculo directo de la estructura principal de un petrolero de doble casco mediante la aplicación de un programa de elementos finitos

    OpenAIRE

    Bustos Pérez, Alfonso

    2011-01-01

    Analizar el procedimiento de cálculo de la estructura de un buque petrolero de doble casco realizado empleando un programa de cálculo de estructuras de acuerdo con: Las reglas de construcción de la Asociación Internacional de Sociedades de Clasificación (IACS). Los procedimientos de cálculo directo, en concreto el método de elementos finitos. Escuela Técnica Superior de Ingeniería Naval y Oceánica

  1. COMENTARIO A LA SENTENCIA RECAÍDA AL AMPARO DIRECTO EN REVISIÓN 992/2014 DE LA SUPREMA CORTE DE MÉXICO. No discriminación en las convocatorias de empleo

    OpenAIRE

    Mario Santiago Juárez

    2016-01-01

    Se estudia la sentencia Amparo Directo en Revisión 992/2014, dictada por la Primera Sala de la Suprema Corte de Justicia de la Nación (Primera Sala o Corte) el 12 de noviembre de 2014, relacionada con el derecho de acceso al empleo y la no discriminación por razones de edad. En ella se establece la inconstitucionalidad de tres convocatorias de empleo que una empresa de restaurantes publicó en un diario de circulación nacional. En éstas se establecía como requisito para solicitar el empleo, en...

  2. Costos directos de la artritis reumatoide temprana en el primer año de atención: simulación de tres situaciones clínicas en un hospital universitario de tercer nivel en Colombia

    OpenAIRE

    Gerardo Quintana; Claudia Mora; Andrés González; Jorge Díaz Díaz

    2009-01-01

    Introducción. En Colombia se desconoce cuál es la carga derivada de las enfermedades reumatológicas crónicas de forma global y en las diferentes esferas del sistema de salud. La artritis reumatoide es una de las enfermedades más frecuentes en su clase y, actualmente, representa un alto costo para el sistema de salud derivado de la atención de los pacientes. Objetivo. Determinar los costos médicos directos en pacientes con artritis reumatoide temprana en el primer año de diagnóstico en un h...

  3. Surgical Outcome of Endoscopic Endonasal Surgery for Non-Functional Pituitary Adenoma by a Team of Neurosurgeons and Otolaryngologists Adenoma by a Team of Neurosurgeons and Otolaryngologists.

    Science.gov (United States)

    Kikuchi, Ryogo; Toda, Masahiro; Tomita, Toshiki; Ogawa, Kaoru; Yoshida, Kazunari

    2017-01-01

    This study aimed to assess the efficacy of endoscopic endonasal surgery, conducted by a team of neurosurgeons and otolaryngologists. We studied 40 patients who were undergoing surgery for primary non-functional pituitary adenomas with Knosp grades 1 to 3, at Keio University Hospital between 2005 and 2012. We compared the endoscopic endonasal transsphenoidal approach (team-eTSS; T-eTSS), with a microscopic transsphenoidal approach (mTSS). Analyses were conducted for differences between the two groups in tumor resection rates, operating durations, and complications from the non-functional pituitary adenomas. We also compared the heminostril and binostril approaches for T-eTSS. Tumor resection rates were higher when the surgeries were conducted by T-eTSS than mTSS. In particular, when the maximum tumor diameter was more than 25 mm, resection rates were significantly higher for T-eTSS than for mTSS. There were no unexpected complications in either group. There was no significant difference in resection rates between the heminostril and binostril approaches when T-eTSS was performed. T-eTSS is an efficacious surgical option for non-functional pituitary adenomas, particularly when the adenoma is of large size. Benefits of the heminostril approach are evident.

  4. Evaluación de los efectos del Programa de Apoyos Directos al Campo (Procampo en el mercado de maíz en México, 2005-2007

    Directory of Open Access Journals (Sweden)

    José Alberto García-Salazar

    2011-01-01

    Full Text Available El Programa de Apoyos Directos al Campo (Procampo es un pago directo al ingreso de los productores de México que inició en 1993. El maíz es el cultivo que más recursos ha obtenido de Procampo. Los resultados de un modelo de equilibrio espacial e intertemporal indican que en ausencia de Procampo, la producción y el consumo anual de maíz hubieran sido 18.7 y 28.8 millones de toneladas en el periodo 2005-2007. Los beneficios fueron más altos que los costos del programa, y un aumento de 50% en el subsidio aumentaría la producción de maíz en 1.6 millones de toneladas y disminuiría las importaciones en 20.7%. Debido a los efectos positivos del Programa, se recomienda la continuación y el aumento del apoyo.

  5. Design and Validation of an Open-Source, Partial Task Trainer for Endonasal Neuro-Endoscopic Skills Development: Indian Experience.

    Science.gov (United States)

    Singh, Ramandeep; Baby, Britty; Damodaran, Natesan; Srivastav, Vinkle; Suri, Ashish; Banerjee, Subhashis; Kumar, Subodh; Kalra, Prem; Prasad, Sanjiva; Paul, Kolin; Anand, Sneh; Kumar, Sanjeev; Dhiman, Varun; Ben-Israel, David; Kapoor, Kulwant Singh

    2016-02-01

    Box trainers are ideal simulators, given they are inexpensive, accessible, and use appropriate fidelity. The development and validation of an open-source, partial task simulator that teaches the fundamental skills necessary for endonasal skull-base neuro-endoscopic surgery. We defined the Neuro-Endo-Trainer (NET) SkullBase-Task-GraspPickPlace with an activity area by analyzing the computed tomography scans of 15 adult patients with sellar suprasellar parasellar tumors. Four groups of participants (Group E, n = 4: expert neuroendoscopists; Group N, n =19: novice neurosurgeons; Group R, n = 11: neurosurgery residents with multiple iterations; and Group T, n = 27: neurosurgery residents with single iteration) performed grasp, pick, and place tasks using NET and were graded on task completion time and skills assessment scale score. Group E had lower task completion times and greater skills assessment scale scores than both Group N and R (P ≤ 0.03, 0.001). The performance of Groups N and R was found to be equivalent; in self-assessing neuro-endoscopic skill, the participants in these groups were found to have equally low pretraining scores (4/10) with significant improvement shown after NET simulation (6, 7 respectively). Angled scopes resulted in decreased scores with tilted plates compared with straight plates (30° P ≤ 0.04, 45° P ≤ 0.001). With tilted plates, decreased scores were observed when we compared the 0° with 45° endoscope (right, P ≤ 0.008; left, P ≤ 0.002). The NET, a face and construct valid open-source partial task neuroendoscopic trainer, was designed. Presimulation novice neurosurgeons and neurosurgical residents were described as having insufficient skills and preparation to practice neuro-endoscopy. Plate tilt and endoscope angle were shown to be important factors in participant performance. The NET was found to be a useful partial-task trainer for skill building in neuro-endoscopy. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Combined Endoscopic Transorbital and Endonasal Repair of High Flow Orbital Apex/Middle Fossa Cerebrospinal Fluid Leak with a Nasoseptal Flap.

    Science.gov (United States)

    Lucke-Wold, Brandon; Mendez, Gustavo; Cua, David; Akins, Paul; Gillham, Haley; Ciporen, Jeremy

    2018-01-01

    High flow orbital apex or middle fossa cerebrospinal fluid (CSF) leaks can be life threatening and complex to repair. These leaks associated with large dural defects are most commonly repaired with an open temporalis muscle patch or free flaps, but these flaps do not always stop the leak. A 65-year-old patient presented two years after orbital exenteration and radiation for squamous cell carcinoma. He developed multi-organism meningitis and pneumocephalus secondary to a large high-flow orbital apex/middle fossa CSF leak. To repair the leak, a combined endoscopic transorbital/endonasal approach with pedicled nasospetal flap and dermis fat graft was used. We describe the unique endoscopic technique that was used to treat the life threatening high flow orbital apex/middle fossa CSF leak. The technique allowed the use of the transposed pedicled flap, which is an alternative to the free flap in controlling CSF leak. Cisternogram post-operatively and clinical exam confirmed resolution of CSF leak. Although a critically ill patient at admission with a modified Rankin scale (MRS) of 5, he was discharged home on continued IV antibiotic therapy with a MRS of 3. Endoscopic evaluation at three months after treatment showed the effectiveness of the flap and he continued to improve clinically. This is the first case to describe a combined endoscopic transorbital and endonasal repair of high flow orbital apex/middle fossa CSF leak with a pedicled nasoseptal flap. These techniques can be utilized during initial reconstruction after orbital exenteration or as a salvage flap.

  7. Como a corrupção influencia os influxos de investimento directo estrangeiro: efeito da corrupção no país receptor e investidor

    OpenAIRE

    Carreira, Hélder

    2012-01-01

    Dissertação de Mestrado em Negócios Internacionais apresentada à ESTG - Escola Superior de Tecnologia e Gestão do Instituto Politécnico de Leiria. Ao longo dos últimos anos têm surgido vários estudos destinados a mostrar a relação existente entre a corrupção e a capacidade de atracção de investimento directo estrangeiro (IDE). A maioria dos estudos existentes tem revelado uma relação negativa entre a corrupção e os influxos de IDE. Contudo, um número reduzido de estudos tem posto ...

  8. Biodiversidad de cefalópodos del Golfo de Tehuantepec, México, determinada a partir de muestreos directos y del análisis de la dieta de peces pelágicos grandes

    OpenAIRE

    Alejo-Plata, María del Carmen; Salgado-Ugarte, Isaías; Herrera-Galindo, Jorge; Meraz-Hernando, Juan

    2014-01-01

    Se examinó la información relativa a la fauna de cefalópodos en el Golfo de Tehuantepec, México, obtenida a partir de varias fuentes: 1) análisis del contenido estomacal de grandes peces depredadores como el pez vela, dorado, tiburones y túnidos, 2) revisión de las capturas de la pesca artesanal, 3) la exploración de la fauna de acompañamiento en la pesca del camarón y 4) muestreos directos por buceo autónomo. Un total de 1,661 especímenes pertenecientes a 8 familias y 15 especies fueron iden...

  9. Gigantism treated by pure endoscopic endonasal approach in a case of McCune-Albright syndrome with sphenoid fibrous dysplasia: a case report.

    Science.gov (United States)

    Sharifi, Guive; Jalessi, Maryam; Sarvghadi, Farzaneh; Farhadi, Mohammad

    2013-12-01

    McCune-Albright syndrome (MAS) is an uncommon polyostotic manifestation of fibrous dysplasia in association with at least one endocrinopathy that is mostly associated with precocious puberty and hyperpigmented skin macules named café-au-lait spots. We present an atypical manifestation of McCune-Albright syndrome in a 19-year-old man with the uncommon association of polyostotic fibrous dysplasia and gigantism in the absence of café-au-lait spots and precocious puberty. He presented with a height increase to 202 cm in the previous 3 years, which had become more progressive in the few months prior. Physical examination revealed only a mild facial asymmetry; however, a computed tomography (CT) scan discovered vast areas of voluminous bones with ground-glass density and thickening involving the craniofacial bones and skull base. Magnetic resonance imaging (MRI) found a right stalk shift of the pituitary with a 20 mm pituitary adenoma. We describe the diagnostic and endoscopic endonasal transsphenoidal approach for excision of the tumor. Georg Thieme Verlag KG Stuttgart · New York.

  10. ¿Cómo lee mi paciente?: Contribución a la metodología del examen directo en psiquiatría de niños

    Directory of Open Access Journals (Sweden)

    José Pérez Villar

    Full Text Available El autor propone la inclusión de un breve ejercicio de lectura e interpretación como parte integrante del examen directo en psiquiatría infantil. Esta actividad arroja luz sobre la esfera cognitiva y la afectiva del niño y de la interacción con sus progenitores. En los lectores muy buenos o término medio puede casi siempre descartarse cualquier tipo de déficit cognitivo sin necesidad de realizar pruebas complementarias (psicométricas, pedagógicas, etcétera. En los malos lectores y/o interpretadores puede descubrirse el origen de síntomas que han sido achacados erróneamente a otras causas, así como observar directamente las reacciones disfuncionales que se producen ante la frustración del fracaso escolar, en el niño y sus familiares. Todo ello será parte de la plataforma para diseñar nuestras intervenciones terapéuticas.

  11. La doble dimensión informativa-espectacular de las retransmisiones radiofónicas en directo en España: análisis comparativo de los eventos deportivos y las procesiones de Semana Santa

    Directory of Open Access Journals (Sweden)

    Hilario José Romero Bejarano

    2014-06-01

    Full Text Available Las retransmisiones deportivas en directo se han consolidado como uno de los formatos radiofónicos de mayor seguimiento en España. Estos espacios reúnen las tendencias y aspectos narrativos que mejor definen el actual panorama de radio. Por un lado, el objetivo de la presente investigación es llevar a cabo un análisis exploratorio de los principales rasgos que identifican a estos programas. Por otro, estudiar las diferencias y similitudes existentes con respecto a las retransmisiones de procesiones en Semana Santa, valorando así el nivel de homogeneidad del formato más allá de la temática en cuestión. La metodología seleccionada se ha basado en la combinación de técnicas cuantitativas y cualitativas, y la muestra se ha elaborado a partir de la selección de diez programas diferentes de Canal Sur Radio. Las retransmisiones en radio se definen por su carácter dialógico y la hibridación de géneros, si bien las principales diferencias se encuentran en el estilo de locución empleado para cada tipo de acontecimiento. Los resultados obtenidos permitirán seguir trabajando sobre la creación de un modelo narrativo que facilite el estudio de los programas radiofónicos.

  12. Tuberculosis patients in the Dominican Republic face severe direct and indirect costs and need social protection Los pacientes con tuberculosis en la República Dominicana afrontan altos costos directos e indirectos, y necesitan protección social

    Directory of Open Access Journals (Sweden)

    Verena Mauch

    2013-05-01

    Full Text Available OBJECTIVE: To examine direct and indirect costs incurred by new, retreatment, and multidrug-resistant (MDR tuberculosis (TB patients in the Dominican Republic before and during diagnosis, and during treatment, to generate an evidence base and formulate recommendations. METHODS: The "Tool to Estimate Patients' Costs" was adapted to the local setting, translated into Spanish, and pretested. Patients attending 32 randomly selected health facilities in six chosen study areas on the study days were interviewed. Responses from patients 18-65 years old who had received treatment for at least one month and provided signed informed consent were collected, entered into a database, and analyzed. RESULTS: A total of 200 patients were interviewed. For most respondents, direct and indirect costs increased while income decreased. Total costs amounted to a median of US$ 908 for new patients, US$ 432 for retreatment patients, and US$ 3 557 for MDR-TB patients. The proportion of patients without a regular income increased from 1% to 54% because of falling ill with TB. Following its review of the study results the Ministry of Health has made efforts to allocate public funds for food supplements and to include in- and outpatient TB services in the national health insurance schemes. CONCLUSIONS: Free TB diagnosis and treatment are not enough to alleviate the financial constraints experienced by vulnerable groups as a result of the illness. Health insurance covering TB in- and outpatient costs is critical to prevent TB-related financial hardship.OBJETIVO: Examinar los costos directos e indirectos afrontados por los pacientes con tuberculosis en la República Dominicana, ya sea por un tratamiento nuevo, por retratamiento, o por una tuberculosis multirresistente (MR, antes y a lo largo del proceso diagnóstico y durante el tratamiento, con objeto de generar una base de datos probatorios y formular recomendaciones. MÉTODOS: El "Instrumento de cálculo de los costos

  13. No direct effects of resistant soybean cultiva IAC-24 on Podisus nigrispinus (Heteroptera: Pentatomidae Efectos no directos de resistencia del cultivar de soya IAC-24 sobre Podisus nigrispinus (Heteroptera: Pentatomidae

    Directory of Open Access Journals (Sweden)

    José Cola Zanuncio

    2012-12-01

    Full Text Available The parameters of survival, development and reproduction of Podisus nigrispinus Dallas, 1851 (Heteroptera: Pentatomidae may be affected by feeding on soybean (Glycine max L. Merr.; Fabaceae cultivars. The direct effect was evaluated of the insect-resistant soybean 'IAC-24' (insect-susceptible soybean 'UFVS-2006' + pupae of Tenebrio molitor L., 1758 Coleoptera: Tenebrionidae versus 'IAC-24' plants + pupae of T. molitor in the nymph and adult stages of the predator P. nigrispinus. The duration of the nymph stage was similar between treatments, but 'IAC-24' reduced the duration of the IV instar of this predator. The survival of P. nigrispinus was similar between treatments in the instars I, II, IV and V and in the nymph stage, but the survival of the III instar was longer with 'IAC-24' plants. The body mass of nymphs in the first day of the III, IV, and V instars after ecdysis and newly emerged adults; reproductive characteristics (periods of pre-oviposition, oviposition, post-oviposition and egg incubation; egg laying interval, number of egg masses per female, nymphs per female, nymphs per egg mass and percentage of nymphs hatching and life span of males and females of P. nigrispinus were similar between treatments. The resistant soybean 'IAC-24' showed no direct deleterious effects on P. nigrispinus, which implies its innocuity and compatibility with this predator.Los par ámetros de supervivencia, desarrollo y reproducción de Podìsus nìgrìspìnus Dallas, 1851 (Heteroptera: Pentatomidae pueden verse afectados por la alimentación en cultivos de soya (Glycìne max L. Merr.; Fabaceae. Se evaluó el efecto directo de la soya 'IAC-24' resistente a insectos (soya 'UFVS-2006' susceptible a insectos + pupas de Tenebrìo molìtor L., 1758 Coleoptera: Tenebrionidae vs. plantas 'IAC-24' + pupas de T. molìtor sobre los estados de ninfa y adulto del depredador P. nìgrìspìnus. La duración del estado ninfal fue similar entre tratamientos, no obstante

  14. ¿Cómo lee mi paciente?: Contribución a la metodología del examen directo en psiquiatría de niños

    Directory of Open Access Journals (Sweden)

    José Pérez Villar

    1996-12-01

    Full Text Available El autor propone la inclusión de un breve ejercicio de lectura e interpretación como parte integrante del examen directo en psiquiatría infantil. Esta actividad arroja luz sobre la esfera cognitiva y la afectiva del niño y de la interacción con sus progenitores. En los lectores muy buenos o término medio puede casi siempre descartarse cualquier tipo de déficit cognitivo sin necesidad de realizar pruebas complementarias (psicométricas, pedagógicas, etcétera. En los malos lectores y/o interpretadores puede descubrirse el origen de síntomas que han sido achacados erróneamente a otras causas, así como observar directamente las reacciones disfuncionales que se producen ante la frustración del fracaso escolar, en el niño y sus familiares. Todo ello será parte de la plataforma para diseñar nuestras intervenciones terapéuticas.The author porposes the inclusion of a brief reading and interpretation exercise as a component part of the direct test in children's psychiactrics. This activity throws light on the cognitive and affective sphere of children and on their interaction with parents. In the very good or fairly good readers, any type of cognitive deficit may be almost always discarded and it is not necessary to do complementary tests (psychometric, pedagogic, etc.. Among those who read or interpretate badly it may be found the origin of some symptoms which are weongly imputed to other causes, and there may be observed the dysfunctional reactions resulting from school failure dissapointment in children and their relatives. All this will part of the platform to design our therapeutic procedures.

  15. Comparison of endoscopic endonasal and bifrontal craniotomy approaches for olfactory groove meningiomas: A matched pair analysis of outcomes and frontal lobe changes on MRI.

    Science.gov (United States)

    de Almeida, John R; Carvalho, Felipe; Vaz Guimaraes Filho, Francisco; Kiehl, Tim-Rasmus; Koutourousiou, Maria; Su, Shirley; Vescan, Allan D; Witterick, Ian J; Zadeh, Gelareh; Wang, Eric W; Fernandez-Miranda, Juan C; Gardner, Paul A; Gentili, Fred; Snyderman, Carl H

    2015-11-01

    We compare the outcomes and postoperative MRI changes of endoscopic endonasal (EEA) and bifrontal craniotomy (BFC) approaches for olfactory groove meningiomas (OGM). All patients who underwent either BFC or EEA for OGM were eligible. Matched pairs were created by matching tumor volumes of an EEA patient with a BFC patient, and matching the timing of the postoperative scans. The tumor dimensions, peritumoral edema, resectability issues, and frontal lobe changes were recorded based on preoperative and postoperative MRI. Postoperative fluid-attenuated inversion recovery (FLAIR) hyperintensity and residual cystic cavity (porencephalic cave) volume were compared using univariable and multivariable analyses. From a total of 70 patients (46 EEA, 24 BFC), 10 matched pairs (20 patients) were created. Three patients (30%) in the EEA group and two (20%) in the BFC had postoperative cerebrospinal fluid leaks (p=0.61). Gross total resections were achieved in seven (70%) of the EEA group and nine (90%) of the BFC group (p=0.26), and one patient from each group developed a recurrence. On postoperative MRI, there was no significant difference in FLAIR signal volumes between EEA and BFC approaches (6.9 versus 13.3 cm(3); p=0.17) or in porencephalic cave volumes (1.7 versus 5.0 cm(3); p=0.11) in univariable analysis. However, in a multivariable analysis, EEA was associated with less postoperative FLAIR change (p=0.02) after adjusting for the volume of preoperative edema. This study provides preliminary evidence that EEA is associated with quantifiable improvements in postoperative frontal lobe imaging. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas-a meta-analysis.

    Science.gov (United States)

    Muskens, Ivo S; Briceno, Vanessa; Ouwehand, Tom L; Castlen, Joseph P; Gormley, William B; Aglio, Linda S; Zamanipoor Najafabadi, Amir H; van Furth, Wouter R; Smith, Timothy R; Mekary, Rania A; Broekman, Marike L D

    2018-01-01

    In the past decade, the endonasal transsphenoidal approach (eTSA) has become an alternative to the microsurgical transcranial approach (mTCA) for tuberculum sellae meningiomas (TSMs) and olfactory groove meningiomas (OGMs). The aim of this meta-analysis was to evaluate which approach offered the best surgical outcomes. A systematic review of the literature from 2004 and meta-analysis were conducted in accordance with the PRISMA guidelines. Pooled incidence was calculated for gross total resection (GTR), visual improvement, cerebrospinal fluid (CSF) leak, intraoperative arterial injury, and mortality, comparing eTSA and mTCA, with p-interaction values. Of 1684 studies, 64 case series were included in the meta-analysis. Using the fixed-effects model, the GTR rate was significantly higher among mTCA patients for OGM (eTSA: 70.9% vs. mTCA: 88.5%, p-interaction OGM (p-interaction = 0.33). CSF leak was significantly higher among eTSA patients for both OGM (eTSA: 25.1% vs. mTCA: 10.5%, p-interaction OGM resection (p-interaction = 0.10). Mortality was not significantly different between eTSA and mTCA patients for both TSM (p-interaction = 0.14) and OGM resection (p-interaction = 0.88). Random-effect models yielded similar results. In this meta-analysis, eTSA was not shown to be superior to mTCA for resection of both OGMs and TSMs.

  17. Direct costs of osteoporosis and hip fracture: an analysis for the Mexican Social Insurance Health Care System Costos directos de la osteoporosis y fracturas de cadera: un análisis para el sistema de salud mexicano

    Directory of Open Access Journals (Sweden)

    Fernando Carlos

    2009-01-01

    Full Text Available OBJECTIVE: To compare costs of diagnosis and annual treatment of osteoporosis and hip fracture between the Instituto Nacional de Rehabilitación (INR and the protocol used by the Seguro Popular de Salud (SPSS. METHODS: Direct costs gathered in a prospective study with real cases at the INR are presented, and then this data is re-analyzed with the methodology and protocol for the SPSS to estimate the costs of those cases if treated with the SPSS protocol. RESULTS: Important differences were found in the cost of hip fracture: the SPSS estimates ($37 363.73 MXN almost double the INR cost ($20 286.86 MXN . This discrepancy was caused by the different types of surgeries the INR and SPSS protocols call for (the SPSS assumes that all hip fractures will necessitate a hip replacement and the cost of subsequent hospitalization. A prospective study at the SPSS is needed to validate these results. CONCLUSIONS: Important differences were found between treatment of the same osteoporosis related problems at the INR and SPSS. We recommend revising the SPSS protocol to include less costly surgical treatments.OBJETIVO: Realizar una comparación de costos de diagnóstico y tratamiento anual de la osteoporosis y la fractura de cadera entre el Instituto Nacional de Rehabilitación (INR y el protocolo utilizado por el Seguro Popular de Salud (SPSS. MATERIAL Y MÉTODOS: Los costos directos obtenidos en un estudio prospectivo con casos reales en el INR fueron utilizados para realizar un escenario considerando la metodología y protocolo del SPSS para estimar los costos de este último. RESULTADOS: Existen diferencias importantes en el costo de la fractura de cadera utilizando el escenario de SPSS; los costos estimados en SPSS fueron casi del doble respecto al INR ($37 363.73 vs. $20 286.86 pesos. Las diferencias están dadas por el tipo y costo de la cirugía (el SPSS asume que todas las fracturas de cadera tengan un remplazo total de cadera y el costo de la

  18. Relación entre el aporte fiscal directo, la calidad del cuerpo docente y la producción científica de las instituciones pertenecientes al Consejo de Rectores de las universidades chilenas

    Directory of Open Access Journals (Sweden)

    Paulina Manríquez Maulén

    2015-03-01

    Full Text Available La búsqueda del conocimiento como uno de los principales focos que tienen las universidades se encuentra estrechamente relacionada con la calidad docente. Materializar este concepto implica establecer una relación entre la producción científica en Chile, la calidad docente y el Aporte Fiscal Directo (AFD que es destinado a las universidades pertenecientes al CRUCH, éste es el objetivo de esta investigación. Para el análisis, primero se busca determinar si existe correlación entre las variables de estudio. Posteriormente, se obtiene el índice de correlación simple entre las mismas. Los resultados muestran una correlación muy alta entre cada una de las variables. Además, se realiza este mismo procedimiento segmentando a las universidades según su ubicación, en la Región Metropolitana o en regiones y si son estatales o no, obteniendo resultados similares. De forma complementaria, se realiza un análisis con la técnica de regresión lineal simple en donde se obtiene que sólo un pequeño porcentaje de las publicaciones científicas provenientes de las instituciones pertenecientes el CRUCH estarían siendo publicadas por otro tipo de investigadores. The pursuit of knowledge as one of the main focuses of universities is closely related to quality. To materialize this concept in establishing the relationship of scienti­fic production in Chile, quality of faculty and Direct Fiscal Funding (AFD destinated to universities belonging to the CRUCH, is the aim of this research. For analysis, a scatter plot is created to intuitively determine if there is a correlation between the study variables. Subsequently, the rate of simple correlation is obtained between the same variables, which results in a very high correlation between each one of the variables. In addition, this same procedure is performed after segmenting universities by location, in the metropolitan area or other regions, and by being state-owned or not, obtaining similar results

  19. Costos directos y aspectos clínicos de las reacciones adversas a medicamentos en pacientes hospitalizados en el servicio de medicina interna de una institución de tercer nivel de Bogotá.

    Directory of Open Access Journals (Sweden)

    Gabriel Tribiño

    2006-03-01

    Full Text Available Introducción. Las reacciones adversas a medicamentos constituyen un problema clínico frecuente en el ámbito hospitalario y aumentan los costos de la atención en salud. En Colombia son pocos los estudios realizados para evaluarlas desde el punto de vista clínico y económico. Objetivo. Determinar los costos generados por las reacciones adversas a medicamentos en pacientes hospitalizados en el servicio de medicina interna de una institución de tercer nivel e identificar sus principales características clínicas. Materiales y métodos. Se hizo seguimiento intensivo de los pacientes del servicio de medicina interna durante un período de cinco meses para detectar reacciones adversas. La información se recolectó mediante un formulario basado en el formato de reporte del INVIMA. La probabilidad de causalidad se generó mediante el algoritmo de Naranjo. Se calcularon los costos directos desde la perspectiva del pagador teniendo en cuenta la estancia adicional, los medicamentos, los exámenes paraclínicos, los procedimientos, los traslados a la unidad de cuidado intermedio o intensivo y los insumos. Resultados. Se detectaron 268 reacciones adversas en 208 de los 836 pacientes que ingresaron en el servicio (proporción de incidencia, 25,1%; razón de presencia, 0,32. El 74,3% se clasificó como probable; el 92,5% fue tipo A; el 81,3% correspondió a reacciones moderadas. El sistema más frecuentemente afectado fue el hematológico (33,9%. Los medicamentos que actúan en sangre fueron los más frecuentemente relacionados (37,6%. El costo generado por la atención de las reacciones adversas fluctuó entre $93'633.422 y $122'155.406. Conclusiones. Dado el impacto negativo de las reacciones adversas en el bienestar de los pacientes, los recursos que se emplean en su atención y la proporción importante de reacciones adversas prevenibles, se requieren programas operativos de farmacovigilancia institucional.

  20. Desarrollo y evaluación de técnicas espectrocópicas basadas en plasmas inducidos por láser y en descargas luminiscentes estimuladas con campos magnéticos para el análisis directo de sólidos

    OpenAIRE

    Vega Reguilón, Paola

    2016-01-01

    El gran desarrollo de nuevos materiales impulsa la investigación en las técnicas de análisis directo de sólidos, en particular de aquellas que permiten obtener información sobre la distribución espacial de la composición elemental de un material (tanto en superficie como en profundidad), información que quedaría destruida si la muestra fuese disuelta. Una de estas técnicas es la descarga luminiscente generada mediante radiofrecuencia (rf-GD) que consiste en un plasma a baja presión que acopl...

  1. Costos directos del glaucoma primario de ángulo abierto

    OpenAIRE

    Fernández García, Ariana; Triana Casado, Idalia; Villar Valdés, Rosendo

    2012-01-01

    Introducción: la magnitud del costo asociado al glaucoma primario de ángulo abierto deriva de la atención sanitaria y de la disminución de la calidad de vida del paciente. Objetivos: estimar los costos del glaucoma primario de ángulo abierto en los pacientes atendidos durante el 2010 en el servicio de glaucoma del hospital "Dr. Salvador Allende." Métodos: se realizó un estudio retrospectivo, en el campo de la Evaluación Económica en Salud es un estudio del tipo de descripción de costos, que a...

  2. 2014 Fermilab Laboratory Directoed Research & Development Annual Report

    Energy Technology Data Exchange (ETDEWEB)

    Wester, W. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States)

    2016-05-26

    After initiation by the Fermilab Laboratory Director, a team from the senior Laboratory leadership and a Laboratory Directed Research and Development (LDRD) Advisory Committee developed an implementation plan for LDRD at Fermilab for the first time. This implementation was captured in the approved Fermilab 2014 LDRD Program Plan and followed directions and guidance from the Department of Energy (DOE) order, DOE O 413.2B, a “Roles, Responsibilities, and Guidelines, …” document, and examples of best practices at other DOE Office of Science Laboratories. At Fermilab, a FY14 midyear Call for Proposals was issued. A LDRD Selection Committee evaluated those proposals that were received and provided a recommendation to the Laboratory Director who approved seven LDRD projects. This Annual Report focuses on the status of those seven projects and provides an overview of the current status of LDRD at Fermilab. The seven FY14 LDRD approved projects had a date of initiation late in FY14 such that this report reflects approximately six months of effort approximately through January 2015. The progress of these seven projects, the subsequent award of six additional new projects beginning in FY15, and preparations for the issuance of the FY16 Call for Proposals indicates that LDRD is now integrated into the overall annual program at Fermilab. All indications are that LDRD is improving the scientific and technical vitality of the Laboratory and providing new, novel, or cutting edge projects carried out at the forefront of science and technology and aligned with the mission and strategic visions of Fermilab and the Department of Energy.

  3. Efeito direto e interativo do período de avaliação sobre a orientação temporal dos gestores Efecto directo e interactivo del periodo de evaluación en la orientación de tiempo de gestión Direct and interactive effect of evaluation period on managerial time orientation

    Directory of Open Access Journals (Sweden)

    Andson Braga de Aguiar

    2013-03-01

    Full Text Available O objetivo neste estudo é investigar o efeito direto e interativo do período de avaliação sobre a orientação temporal dos gestores (OTG, isto é, o horizonte de tempo entre o momento de alocação de recursos e o momento do impacto financeiro dessa alocação. Tendo por base a literatura contábil e econômica, são examinadas as seguintes hipóteses: um período de avaliação mais de longo prazo afeta positivamente a OTG e o efeito positivo de um período de avaliação mais de longo prazo sobre a OTG é maior no caso de maior importância atribuída a medidas não financeiras do que a medidas financeiras de desempenho. Aplica-se a técnica estatística de mínimos quadrados parciais (PLS para testar as hipóteses deste estudo, sendo os dados coletados por meio de um levantamento realizado junto a 66 gestores de nível intermediário que atuam em 11 empresas. Os resultados sugerem que o período de avaliação não possui efeitos diretos sobre a OTG; no entanto, quando considerada sua interação com a medida de desempenho, os resultados indicam que o efeito do período de avaliação sobre a OTG depende da importância relativa de medidas financeiras versus não financeiras. A principal implicação desses resultados é que o uso de um período de avaliação de longo prazo em combinação com um peso maior atribuído a medidas não financeiras de desempenho não afeta positivamente a OTG; ao contrário, esse efeito positivo sobre a OTG está presente quando um período de avaliação de curto prazo está associado a menor importância de medidas não financeiras de desempenho.El objetivo en este estudio es investigar el efecto directo e interactivo del periodo de evaluación en la orientación de tiempo de gestión (OTG, es decir, el horizonte temporal entre el momento de la asignación de recursos y el tiempo de sus efectos financieros. Con base en la literatura contable y sobre economía, se examinan las siguientes hipótesis: i un

  4. Extended Endoscopic Endonasal Approach for Craniopharyngioma Removal.

    Science.gov (United States)

    Messerer, Mahmoud; Maduri, Rodolfo; Daniel, Roy Thomas

    2018-02-01

    Objective  Endoscopic transsphenoidal extended endoscopic approach (EEA) represents a valid alternative to microsurgery for craniopharyngiomas removal, especially for retrochiasmatic lesions without large parasellar extension. The present video illustrates the salient surgical steps of the EEA for craniopahryngioma removal. Patient  A 52-year-old man presented with a bitemporal hemianopia and a bilateral decreased visual acuity. MRI showed a Kassam type III cystic craniopharyngioma with a solid component ( Fig. 1 , panels A and B). Surgical Procedure  The head is rotated 10 degrees toward the surgeons. The nasal step is started through the left nostril with a middle turbinectomy. A nasoseptal flap is harvested and positioned in the left choana. The binostril approach allows a large sphenoidotomy to expose the key anatomic landmarks. The craniotomy boundaries are the planum sphenoidale superiorly, the median opticocarotid recesses, the internal carotid artery laterally and the clival recess inferiorly. After dural opening and superior intercavernous sinus coagulation, the tumor is entirely removed ( Fig. 2 , panels A and B). Skull base reconstruction is ensured by fascia lata grafting and nasoseptal flap positioning. Results  Postoperative MRI showed the complete tumor resection ( Fig. 1 , panels C and D). At 3 months postoperatively, the bitemporal hemianopia regressed and the visual acuity improved. A novel left homonymous hemianopia developed secondary to optic tract manipulation. Conclusions  The extended EEA is a valid surgical approach for craniopharyngioma resection. A comprehensive knowledge of the sellar and parasellar anatomy is mandatory for safe tumor removal with decreased morbidity and satisfactory oncologic results. The link to the video can be found at: https://youtu.be/NrCPPnVK2qA .

  5. Costos directos de atención médica en pacientes con diabetes mellitus tipo 2 en México: análisis de microcosteo Direct costs of medical care for patients with type 2 diabetes mellitus in Mexico micro-costing analysis

    Directory of Open Access Journals (Sweden)

    Rosibel de los Ángeles Rodríguez Bolaños

    2010-12-01

    Full Text Available OBJETIVO: Estimar los costos directos de la atención médica a pacientes con diabetes mellitus tipo 2 (DM2 en el Instituto Mexicano del Seguro Social (IMSS. MÉTODOS: Se revisaron expedientes clínicos de 497 pacientes que ingresaron a unidades de segundo y tercer nivel de atención durante el período 2002-2004. Los costos se cuantificaron utilizando el enfoque de costeo de enfermedad (CDE desde la perspectiva del proveedor, la técnica del microcosteo y la metodología de abajo-arriba (bottom-up. Se estimaron costos promedio anuales de diagnóstico, por complicación y total de la enfermedad. RESULTADOS: El costo total anual de los pacientes con DM2 para el IMSS fue de US$452 064 988, correspondiente a 3,1% del gasto de operación. El costo promedio anual por paciente fue de US$3 193,75, correspondiendo US$2 740,34 para el paciente sin complicaciones y US$3 550,17 para el paciente con complicaciones. Los días/cama en hospitalización y en unidad de cuidados intensivos fueron los servicios con mayor costo. CONCLUSIONES: Los elevados costos en la atención médica a pacientes con DM2 y complicaciones representan una carga económica que las instituciones de salud deben considerar en su presupuesto, a fin de poder brindar un servicio de calidad, adecuado y oportuno. El empleo de la metodología de microcosteo permite un acercamiento a datos reales de utilización y manejo de la enfermedadOBJECTIVE: Estimate the direct cost of medical care incurred by the Mexican Social Security Institute (IMSS, Instituto Mexicano del Seguro Social for patients with type 2 diabetes mellitus (DM2. METHODS: The clinical files of 497 patients who were treated in secondary and tertiary medical care units in 2002-2004 were reviewed. Costs were quantified using a disease costing approach (DCA from the provider's perspective, a micro-costing technique, and a bottom-up methodology. Average annual costs by diagnosis, complication, and total cost were estimated. RESULTS

  6. Direct medical costs associated with schizophrenia relapses in health care services in the city of São Paulo Costo directo médico-hospitalario de recaída en esquizofrenia en servicios de salud en la ciudad de Sao Paulo, sureste de Brasil Custo direto médico-hospitalar de recaída em esquizofrenia em serviços de saúde na cidade de São Paulo

    Directory of Open Access Journals (Sweden)

    Claudiane Salles Daltio

    2011-02-01

    Full Text Available OBJECTIVE: To assess direct medical costs associated with schizophrenia relapses in mental health services. METHODS: The study was conducted in three health facilities in the city of São Paulo: a public state hospital; a Brazilian National Health System (SUS-contracted hospital; and a community mental health center. Medical records of 90 patients with schizophrenia who received care in 2006 were reviewed. Information on inpatient expenditures was collected and used for cost estimates. RESULTS: Mean direct medical cost of schizophrenia relapses per patient was US$ 4,083.50 (R$ 8,167.58 in the public state hospital; US$ 2,302.76 (R$ 4,605.46 in the community mental health center; and US$ 1,198.50 (R$ 2,397.74 in the SUS-affiliated hospital. The main component was daily inpatient room rates (87% - 98%. Medication costs varied depending on the use of typical or atypical antipsychotic drugs. Atypical antipsychotic drugs were more often used in the community mental health center. CONCLUSIONS: Costs associated with schizophrenia relapses support investments in antipsychotic drugs and strategies to reduce disease relapse and the need for mental health inpatient services. Treating patients in a community mental health center was associated with medium costs and added the benefit of not depriving these patients from family life.OBJETIVO: Evaluar el costo directo médico-hospitalario de la recaída en esquizofrenia, en servicios en salud mental. MÉTODOS: Estudio conducido en tres servicios de salud de la ciudad de Sao Paulo (Sureste de Brasil: un hospital público estatal, un hospital contratado en convenio con el Sistema Único de Salud, y un centro de atención psicosocial. Se analizaron 90 prontuarios de pacientes portadores de esquizofrenia atendidos durante el año de 2006. Los recursos utilizados durante la permanencia de los pacientes en los servicios fueron obtenidos y valorados para cálculos de las estimaciones. RESULTADOS: El costo directo m

  7. Cirugía transesfenoidal: primera opción de tratamiento para adenomas hipofisarios secretores de GH Transsphenoidal surgery: first treatment option for GH secreting hypophyseal adenomas

    OpenAIRE

    Omar López Arbolay; Justo Luis González González; Osmany Morales Sabina; Lorenzo Nedel Valdés

    2004-01-01

    La elevación de los niveles de hormona del crecimiento (GH) promueve el crecimiento grotesco de partes acras (acromegalia) o incremento de la talla (gigantismo) según la edad, así como trastornos metabólicos de relevancia biológica. La adenomectomía selectiva clasifica entre las modalidades de tratamiento. El objetivo del presente trabajo fue evaluar los resultados del tratamiento microquirúrgico por vía transeptoesfenoidal de los adenomas productores de GH en nuestro medio. Presentamos un es...

  8. Cirugía transesfenoidal: primera opción de tratamiento para adenomas hipofisarios secretores de GH Transsphenoidal surgery: first treatment option for GH secreting hypophyseal adenomas

    Directory of Open Access Journals (Sweden)

    Omar López Arbolay

    2004-12-01

    Full Text Available La elevación de los niveles de hormona del crecimiento (GH promueve el crecimiento grotesco de partes acras (acromegalia o incremento de la talla (gigantismo según la edad, así como trastornos metabólicos de relevancia biológica. La adenomectomía selectiva clasifica entre las modalidades de tratamiento. El objetivo del presente trabajo fue evaluar los resultados del tratamiento microquirúrgico por vía transeptoesfenoidal de los adenomas productores de GH en nuestro medio. Presentamos un estudio retrospectivo de pacientes intervenidos por vía transeptoesfenoidal, por esta variedad de adenomas, en el servicio de neurocirugía del Hospital "Hermanos Ameijeiras" desde 1996 al 2003. Se analizaron edad, sexo, síntomas cardinales, imaginología, niveles hormonales, complicaciones y evolución posoperatoria. Resultó que las complicaciones relacionadas con el proceder quirúrgico no fueron relevantes y ninguna persistió más allá del mes. La diabetes insípida fue la más frecuente. Los síntomas mejoraron y los títulos de GH descendieron por debajo de los niveles de curación en el 58,06 % de los operados. Se concluye que la adenomectomía transeptoesfenoidal es un proceder seguro y recomendable como tratamiento de elección en estos pacientes.The elevation of the growth hormone (GH levels enhances the grotesque growth of acral parts (acromegaly or the increase of height (gigantism according to age, as well as metabolic disorders of biological relevance. The selective adenotomy is among the treatment modalities. The objective of the present paper was to evaluate the results of the microsurgical transseptosphenoidal treatment of the GH producing adenomas in our setting. A retrospective study of patients that underwent transseptosphenoidal surgery for presenting this variety of adenomas at the neurosurgery service of "Hermanos Ameijeiras" Hospital from 1996 to 2003, was conducted. Age, cardinal symptoms, imaging, hormonal levels, complications and evolution, were analyzed. Complications related to the surgical procedure were not significant and none of them persisted more than a month. Diabetes insipidus was the most frequent. The symptoms improved and the GH titers were under the cure levels in 58.06 % of the operated on. It was concluded that transseptosphenoidal adenotomy is a safe and recommendable procedure as an elective treatment in these patients

  9. Endoscopic Endonasal Surgery for Purely Intrathird Ventricle Craniopharyngioma.

    Science.gov (United States)

    Nishioka, Hiroshi; Fukuhara, Noriaki; Yamaguchi-Okada, Mitsuo; Yamada, Shozo

    2016-07-01

    Extended endoscopic transsphenoidal surgery (EETS) is a safe and effective treatment for many suprasellar craniopharyngiomas, including those with third-ventricle involvement. Craniopharyngioma entirely within the third ventricle (purely intraventricular type), however, is generally regarded unsuitable for treatment with EETS. Three patients underwent total removal of a purely intraventricular craniopharyngioma with inferior extension via EETS by direct incision of the bulging, stretched ventricular floor and fine dissection from the ventricular wall. In 2 patients with an anteriorly displaced chiasm, the space between the chiasm and pituitary stalk created a wide corridor to the ventricle, whereas in the third case, in which the infrachiasmal space was somewhat narrowed, partial sacrifice of the pituitary gland was necessary to obtain sufficient space. Despite preservation of the stalk in 2 patients, hypopituitarism and diabetes insipidus developed after surgery. There was no other complication including obesity. Selected patients with purely intraventricular craniopharyngioma can be treated effectively and safely with EETS. Those with inferior extension in the interpeduncular fossa and anterior displacement of the chiasm may be suitable candidates. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas.

    Science.gov (United States)

    Gondim, Jackson A; Almeida, João Paulo; de Albuquerque, Lucas Alverne F; Gomes, Erika; Schops, Michele; Mota, Jose Italo

    2015-07-01

    With the increase in the average life expectancy, medical care of elderly patients with symptomatic pituitary adenoma (PA) will continue to grow. Little information exists in the literature about the surgical treatment of these patients. The aim of this study was to present the results of a single pituitary center in the surgical treatment of PAs in patients > 70 years of age. In this retrospective study, 55 consecutive elderly patients (age ≥ 70 years) with nonfunctioning PAs underwent endoscopic transsphenoidal surgery at the General Hospital of Fortaleza, Brazil, between May 2000 and December 2012. The clinical and radiological results in this group were compared with 2 groups of younger patients: surgery for treatment of PAs. The mean follow-up period was 50 months (range 12-144 months). The most common symptoms were visual impairment in 38 (69%) patients, headache in 16 (29%) patients, and complete ophthalmoplegia in 6 (10.9%). Elderly patients presented a higher incidence of ophthalmoplegia (p = 0.032) and a lower frequency of pituitary apoplexy before surgery (p transsphenoidal surgery for elderly patients with PAs may be associated with higher complication rates, especially secondary to early transitory complications, when compared with surgery performed in younger patients. Although the worst preoperative clinical status might be observed in this group, age alone is not associated with a worst final prognosis after endoscopic removal of nonfunctioning PAs.

  11. Behandling af invert papillom med endonasal endoskopisk sinuskirurgi

    DEFF Research Database (Denmark)

    Andersen, Pia Juul; Kjeldsen, Anette Drøhse; Pedersen, Arne Toft

    2002-01-01

    INTRODUCTION: Inverted papilloma is a benign sinonasal tumour and has a marked tendency to recur after surgical excision. The tumour may be associated with malignancy and during growth it may destroy surrounding tissue. The treatment is either lateral rhinotomy or endoscopic sinus surgery. The aim...... of the study was to describe the course of all patients treated with endoscopic sinus surgery at the ENT Department at Vejle County Hospital during the period 1 January to 31 December 1999. MATERIAL AND METHODS: Twenty-eight journals of patients diagnosed with inverted nasal papillomas were reviewed...... with carcinoma. We did not see any serious side effects to the treatment. DISCUSSION: Endoscopic sinus surgery in combination with Caldwell-Luc can be recommended as an alternative treatment to lateral rhinotomy in patients with inverted papillomas. Preoperative staging with CT or MR-scanning, experienced...

  12. Coblation-assisted endonasal endoscopic resection of juvenile nasopharyngeal angiofibroma.

    Science.gov (United States)

    Ye, L; Zhou, X; Li, J; Jin, J

    2011-09-01

    Juvenile nasopharyngeal angiofibroma may be successfully resected using endoscopic techniques. However, the use of coblation technology for such resection has not been described. This study aimed to document cases of Fisch class I juvenile nasopharyngeal angiofibroma with limited nasopharyngeal and nasal cavity extension, which were completely resected using an endoscopic coblation technique. We retrospectively studied 23 patients with juvenile nasopharyngeal angiofibroma who underwent resection with either traditional endoscopic instruments (n = 12) or coblation (n = 11). Intra-operative blood loss and overall operative time were recorded. The mean tumour resection time for coblation and traditional endoscopic instruments was 87 and 136 minutes, respectively (t = 9.962, p angiofibroma (Fisch class I), with good surgical margins and minimal blood loss.

  13. Bilateral endoscopic endonasal marsupialization of nasopalatine duct cyst

    Directory of Open Access Journals (Sweden)

    Yohei Honkura

    2015-02-01

    Full Text Available Nasopalatine duct cysts are the most common non-odontogenic cysts in the maxilla, and are conventionally treated through a sublabial or palatine approach. Recently, the endoscopic approach has been used, but experience is extremely limited. We treated a 29-year-old male with nasopalatine duct cyst by endoscopic marsupialization, but paresthesia of the incisor region occurred after surgery. This paresthesia gradually remitted within 6 months. The nasopalatine nerve, which innervates the upper incisor region, enters two lateral canals separately at the nasal floor and exits the central main canal at the palate. Damage to the bilateral nasopalatine nerves might lead to paresthesia, so we recommend careful examination for nerve fibers during endoscopic surgery, especially if fenestration is performed on both sides.

  14. No linealidad del efecto piezoelectrico directo d33 en cerámicas PZT

    Directory of Open Access Journals (Sweden)

    Gorri, J. A.

    2006-06-01

    Full Text Available A new measurement method has been developed in order to analyse the non-linear behaviour of piezoelectric ceramics. Based on Berlincourt–type method, the applied stress is so high that non linear effects can be produced. Its response is analysed not only in terms of the stress amplitude but also in terms of the instantaneous value. The treatment is similar to that we have applied to the dielectric response. Previously, the dependence on the pre-stress strength has been determined, and also the influence of the time elapsed since its application. A decrease in d33 is observed when pre-stress TB rises. Piezoelectric coefficient d33 increases linearly with the amplitude, not only in soft but also in hard PZT ceramics, opposite to the dielectric behaviour. The rate between real and imaginary part of the coefficient d33 is equal to the expected value in soft PZT, but it is not so in hard one. Since in the dielectric case hard PZT shows a strong and positive dependence with the applied instantaneous field, in that case the dependence is very light. This study is complemented by the dependence of the dielectric constant non-linearities with the applied pre-stress.Se ha implementado una nueva técnica de medida para la determinación del comportamiento no lineal de las cerámicas piezoeléctricas. Es una medida tipo Berlincourt, en la que se aplica un esfuerzo suficientemente intenso para producir efectos no lineales, y se analiza la respuesta no sólo en función de la amplitud del esfuerzo sino de su valor instantáneo. Con ello se realiza un tratamiento similar al realizado anteriormente en la medida de la constante dieléctrica. Previamente, se ha determinado la dependencia con el pre-esfuerzo aplicado y con el tiempo transcurrido desde su aplicación. Se observa el decrecimiento de d33 al aumentar el pre-esfuerzo TB. Se ha observado que el coeficiente d33 aumenta siempre linealmente con la amplitud, tanto en las cerámicas PZT comerciales blandas como en las duras, a diferencia de lo que ocurre con su comportamiento dieléctrico. La relación entre los coeficientes d33 imaginario y real en los materiales blandos es la esperada según el modelo de Rayleigh, pero no así en los duros. Mientras que en el caso dieléctrico los materiales duros presentan una dependencia fuerte y positiva con el campo instantáneo aplicado, en este caso la dependencia con el esfuerzo instantáneo es muy pequeña. El estudio se complementa con la dependencia de la constante dieléctrica no lineal con el pre-esfuerzo aplicado.

  15. Costeo directo, mundo del valor y programación lineal

    OpenAIRE

    Souza, Alceus; Clemente, Ademir; Perfeito, Juarez

    2006-01-01

    Este artículo presenta una comparación entre el Abordaje del Mundo del Valor propuesto por Eliyahu M. Goldratt (1992) en el libro titulado A síndrome del palheiro: garimpando informação num océano de dados (El síndrome del pajar: cómo extraer información del océano de datos) y la Programación Lineal. Se utiliza para la comparación el caso de la optimización de un mix de producción con restricciones en el proceso y en el mercado. Se muestra que el Abordaje de las Ganancias, conceptualmente, no...

  16. El discurso directo en la Crónica Real Ccstellana del siglo XV

    Directory of Open Access Journals (Sweden)

    Luis Fernández Gallardo

    2014-10-01

    Full Text Available In the fifteenth Century, the Castilian royal chronicle reached a literary maturity that is evident in the use of direct speech. There is no linear evolution, but swings from the rich plurality of voices in García de Santa María´s chronicle, to the extreme selection of Barrientos, conditioned by various propaganda strategies. Enriquez del Castillo expresses the aspiration to eloquence of humanistic historiography. Nevertheless, it is only thanks to Fernando de Pulgar that full awareness of humanistic writing of history is taken, by means of the imitatio of its model, Livy. Humanistic eloquence became a means of exalting the monarchy of the Catholic Monarchs.

  17. Los orígenes del impuesto directo y progresivo en América Latina

    Directory of Open Access Journals (Sweden)

    José Joaquín Pinto Bernal

    2013-01-01

    Full Text Available This article studies the establishment of direct and progressive taxes in Latin Ame- rican, as part of the process of consolidation of the republican fiscal system in Argentina, Mexico, Panama, Venezuela, Colombia and Ecuador after their independence of Spain. Initially the establishment process of direct taxes is described and then the dynamic of the contribution is studied in quantitative terms. Fina- lly, the reasons of the mentioned dynamics are exposed, base upon the reports of the managers of the Treasury in each country context. This exercise was develo- ped from a compared perspective, allowing to find similar patterns between each of the national contexts, which were the cause of the small productivity mar- gin of the establishment of the direct and progressive taxation in the continent.

  18. Caracterización experimental de una pila de combustible de etanol directo

    OpenAIRE

    Medina Ramiro, Álvaro

    2015-01-01

    El uso creciente de los combustibles fósiles por las sociedades industrializadas está conduciendo al agotamiento de estos recursos no renovables y al incremento descontrolado de las emisiones contaminantes y gases de efecto invernadero (CO2, CH4, etc.). Esto hace necesario recurrir a nuevas formas de producción de energía basadas en tecnologías limpias. En este escenario entran en juego las Pilas de Combustible, dispositivos electroquímicos que convierten directamente la energía química de lo...

  19. Ajuste de un modelo directo de amortiguador MR mediante algoritmos genéticos

    OpenAIRE

    Pacheco Martín, Manuel

    2015-01-01

    This Bachelor Degree Project seeks to model a direct magneto-rheological damper aided by genetic algorithms. The main function of the suspension system of a vehicle is to ensure that all tires are in contact with the pavement, that all vibrations created by the contact of the tires are absorbed and that the suspensions assures safety and comfort to the vehicle’s passengers. There are three different set ups for the suspension system of a vehicle, based in its control system. Passive sus...

  20. Costos medicos directos en pacientes con enfermedad pulmonar obstructiva Crónica en Mexico.

    Science.gov (United States)

    Nevárez-Sida, Armando; Castro-Bucio, Augusto Javier; García-Contreras, Fernando; Cisneros-González, Nelly

    2017-12-01

    chronic obstructive pulmonary disease (COPD) is a progressive, incurable and potentially mortal. COPD generates a high burden of illness and decreased quality of life in patients. The aim of this study was to determine the direct medical cost of COPD and the primary variables associated. We conducted a multicenter clinical study, based in a retrospective cohort as base of a partial economic evaluation in patients diagnosed with moderate to severe COPD. It was considered an institutional point of view to determine medical costs, with an annual time horizon. For analysis of associations between explanatory and end point variables, a generalized lineal regression model was developed. We analyzed data from 283 patients, Fifty-nine percent were women, the average age was 72 years ± 11, Sixty-five percent of patients had a history of smoking and 57.6 % were exposed to wood smoke. The annual direct medical costs (MXN 2016) was 20,754 and 41,887 for patients with moderate and severe COPD, respectively, this difference is mainly due to the use of oxygen as well as longer hospital stay (12.9 vs. 24.7 days) of patients with severe COPD. Although the severity level is associated with greater health care costs, the quality of life of the patients should be considered carefully because it is inversely associated with the cost of care for patients with COPD. Copyright © 2017. Published by Elsevier Inc.

  1. Cálculo directo del coeficiente de mayoración

    Directory of Open Access Journals (Sweden)

    Hernández, Pimpo

    1969-10-01

    Full Text Available In this paper explicit formulae are obtained for the calculation of the factor of safety in reinforced concrete structures. These formula are based on the principle of minimum generalised cost, in agreement with the method proposed in the «Instrucción H.A. 61 para el Cálculo de Estructuras de Hormigón Armado» (2nd and 3rd parts, published by the Institute Eduardo Torroja, Madrid, 1961. Consequently they provide results similar to those of this H.A.61 Instruction, avoiding the need to undertake trial and error methods. To obtain the formula, approximate analytical expressions of the cost of the structure, and of its probability of failure, are first worked out, as fimctions of the factor of safety. In the paper, numerical examples are also worked out. This paper is a revised summary of the article «The Factor of Safety in Reinforced Concrete Structures», by J. H. Hernández, «Revista de Ingeniería Civil», Havana, 1965.Se obtienen fórmulas explícitas para el cálculo del coeficiente de mayoración en estructuras de hormigón armado. Dichas fórmulas se basan en el principio del coste generalizado mínimo, al igual que el método propuesto en la «Instrucción H.A. 61 para el Cálculo de Estructuras de Hormigón Armado» (2.ª y 3.ª partes, del Instituto Eduardo Torroja, Madrid (1961, y permiten, por tanto, llegar a resultados similares a los de este último, sin necesidad de tanteos. Para deducir las fórmulas, se obtienen previamente expresiones analíticas aproximadas del coste de la estructura resistente y de su probabilidad de hundimiento, como funciones del coeficiente de seguridad. Se resuelven ejemplos numéricos ilustrativos. Este trabajo es un resumen revisado del artículo «El Coeficiente de Seguridad en Estructuras de Hormigón Armado», por J. E. Hernández, Revista Ingeniería Civil, La Habana (1965.

  2. Potencial para el uso directo de los aceites vegetales en los motores de combustión

    OpenAIRE

    Ortiz Laurel, Hipólito; Rössel Kipping, Dietmar; Schümann, Ulrike

    2012-01-01

    Los combustibles fósiles son aquellos que provienen de restos orgánicos vegetales y animales y se extraen de la naturaleza. Estos combustibles son contaminantes del medio ambiente a través de los gases que salen de los motores de combustión. El biodiesel es un combustible de origen vegetal obtenido a partir de los aceites vegetales de semillas, plantas y algas oleaginosas. El biodiesel es menos contaminante que los combustibles fósiles. Este trabajo presenta una revisión de las propiedades en...

  3. Los estudios de fecundidad en poblaciones contemporáneas como referentes directos para los estudios paleodemográficos

    Directory of Open Access Journals (Sweden)

    Patricia Olga Hernández Espinoza

    2014-01-01

    Full Text Available Las limitantes del trabajo paleodemográfico, como la obtención de datos sobre la fecundidad de las sociedades antiguas, han impulsado el desarrollo de estrategias metodológicas para obtener esta información con algún grado de certeza. En este estudio contrastamos dos tipos de metodologías para obtener datos sobre fecundidad: la paleodemográfica basada en el análisis bioarqueológico de una serie esquelética maya prehispánica, utilizando el modelo de Weiss, y la metodología demográfica moderna aplicada a datos censales de Quintana Roo, con los que se calcularon varios indicadores de fecundidad. Los resultados muestran que el método estadístico que hemos aplicado en nuestras investigaciones permite tener un acercamiento confiable a los niveles de fecundidad y mortalidad que pudieron haber tenido estos grupos en el pasado, pues las estimaciones paleodemográficas presentan valores consistentes con la información obtenida de los censos, con un cálculo de cuatro a seis hijos para el grupo maya prehispánico de Chac Mool.

  4. Los liberalismos de José María Vigil y Antonio Caso y el realismo directo

    Directory of Open Access Journals (Sweden)

    José Hernández

    2013-11-01

    Full Text Available Jose Maria Vigil (1829-1909 and Antonio Caso (1883-1946 were two defenders of liberal democracy and of the possibility of a limited but effective conscious management of public and social affairs, within the adverse contexts of Mexico during the administration of Porfirio Diaz as well as the post-revolutionary period. Both authors based their positions on a critique concerning positivism and social-historical determinism, which would aim at a way of thinking quite distant from subjectivist thought, although very close to an epistemological "direct realism" that establishes that the world is not actually a subjective or inter-subjective construction, that may be interpreted in the same subjective or inter-subjective way. However, it is not either something that might be known through a mental or conceptual copy or representation of its entities and processes. Perhaps, the most evocative defender of direct realism in history has been the 18* Century Scottish philosopher, Thomas Reid (1710-1796, a great "common-sensist", explicitly recovered by Vigil and vindicated in a tacit manner by Antonio Caso.

  5. Técnica mejorada de control reactivo aplicada a centrales undimotrices con accionamiento directo mediante generadores lineales

    OpenAIRE

    García Santana, Agustín

    2014-01-01

    Tesis descargada desde portal de la Escuela de Ingenieros http://catedras-etsi.us.es/endesared/documentos/tesis_agustin_garcia.pdf La frecuencia a la cual las olas del mar excitan a los WECs (Wave Energy Converters) puede variar enormemente, pero el ancho de captura del dispositivo es limitado. Los absorbedores puntuales tienen un ancho de captura estrecho, por lo que se debe controlar el movimiento recÍproco del WEC, al objeto de que trabaje adecuadamente en un amplio rango de frecu...

  6. El ingreso en el hogar y su costo directo en Cuba The direct costs of home care in Cuba

    OpenAIRE

    Isabel M. Barroso Utra; Anai García Fariñas; Armando Rodríguez Salvá; Pol de Vos; Mariano Bonet Gorbea; Patrick Van Der Stuyft

    2007-01-01

    OBJETIVOS: Analizar el tiempo de estadía en ingreso en el hogar (IH) y su costo diario y por paciente en Cuba, según el diagnóstico al ingreso y la zona donde se brinda el servicio. MÉTODOS: Se analizó la información de los 837 pacientes en IH entre julio de 2001 y junio de 2002 en un área del municipio Playa, en Ciudad de La Habana (zona urbana metropolitana), una del municipio Cruces, en Cienfuegos (zona urbana no metropolitana), otra del Municipio Unión de Reyes, en Matanzas (zona rural) y...

  7. El directo: análisis de una situación informativa privilegiada (o "carpe diem"

    Directory of Open Access Journals (Sweden)

    Lic. Josep María Blanco

    1999-01-01

    Full Text Available el momento, ¡eso es! Cuando se oprime el interruptor de un televisor y se atrapa el mando a distancia se aspira a satisfacer alguna necesidad o a dar respuesta incluso a la propia ausencia de necesidades. ¿Y es eso malo? De ninguna manera; se trata de un intento de emplear, de aprovechar el tiempo, porqué no, para distraerse, para informarse, para aprender o simplemente para llenar el vacío sonoro que en el hogar, por ejemplo, acentúa la sensación de soledad.

  8. Gamma spectra pictures using a digital plotter. Program MONO; Representacion de Espectros directos mediante un trazado digital. Prograa MONO

    Energy Technology Data Exchange (ETDEWEB)

    Los Arcos, J M

    1978-07-01

    The program MONO has been written for a CALCOMP-936 digital plotter operating off- -line with a UMI VAC 1106 computer, to obtain graphic representations of single gamma spectra stored on magnetic tape. It allows to plot the whole spectrum or only a part, as well as to draw a given spectrum on the same or different picture than the previous one. Ten representation scales are available and at up nine comment lines can be written in a graphic. (Author) 4 refs.

  9. Successful endoscopic endonasal repair of nasal meningoencephalocele in a 21-day-old neonate

    OpenAIRE

    Mohindra, Satyawati; Mohindra, Sandeep; Patro, Sourabha Kumar

    2015-01-01

    Introduction: Indications of surgical intervention in congenital nasal meningoencephaloceles includes presence of cerebro spinal fluid rhinorrhea having a risk of causing meningitis, episodes of prior meningitis and bilateral nasal obstruction causing respiratory difficulty in these obligate nasal breathers. Many authors would like to wait till the patient attains the age of 2 to 3 years for repair of the defect due to surgical feasibility. However, early intervention prevents further episode...

  10. Endoscopic Endonasal Anterior Skull Base Surgery: A Systematic Review of Complications During the Past 65 Years.

    Science.gov (United States)

    Borg, Anouk; Kirkman, Matthew A; Choi, David

    2016-11-01

    Endoscopic skull base surgery is becoming more popular as an approach to the anterior skull base for tumors and cerebrospinal fluid (CSF) fistulae. It offers the advantages of better cosmesis and improved quality of life after surgery. We reviewed the complication rates reported in the literature. A literature search was performed in the electronic database Ovid MEDLINE (1950 to August 25, 2015) with the search item "([Anterior] AND Skull base surgery) AND endoscopic." We identified 82 relevant studies that included 7460 cases. An average overall complication rate of 17.1% (range 0%-68.0%) and a mortality rate of 0.4% (0%-10.0%) were demonstrated in a total of 82 studies that included 7460 cases. The average CSF leak rate for all studies was 8.9% (0%-40.0%) with meningiomas and clival lesions having the greatest CSF leak rates. The most frequent benign pathology encountered was pituitary adenomas (n = 3720, 49.8% of all cases) and the most frequent malignant tumor was esthesioneuroblastoma (n = 120, 1.6% of all cases). Studies that included only CSF fistula repairs had a lower average total complication rate (12.9%) but a greater rate of meningitis compared with studies that reported mixed pathology (2.4% vs. 1.3%). A trend towards a lower total complication rate with increasing study size was observed. The endoscopic approach is an increasingly accepted technique for anterior skull base tumor surgery and is associated with acceptable complication rates. Increasing experience with this technique can decrease rates of complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. EVALUATING THE EFFICACY OF PRESERVING THE MUCOSAL FLAP IN ENDONASAL DCR

    Directory of Open Access Journals (Sweden)

    Koteswar

    2015-11-01

    Full Text Available INTRODUCTION Endoscopic DCR is routinely performed by otolaryngologists for the treatment of chronic dacryocystitis. However, postoperative stenosis and failure rates are common. OBJECTIVE The objective of our study is to evaluate the role of preserving the mucosal flap in maintaining the patency of neo ostium. The surgical technique involved the creation of nasal mucosal and large posterior lacrimal flaps at the medial lacrimal sac wall and the two flaps were placed in close apposition. Success was defined as complete resolution of epiphora and a patent lacrimal system, evaluated by lacrimal irrigation and endoscopy followed upto 1 year postoperatively. MATERIALS AND METHODS A prosective study was conducted in 60 patients and followed for a duration of 1 year in ENT department,KMC,Guntur RESULTS In our study, Symptomatic and anatomic success was seen in 59 out of 60 operations that is 98% success in syringing patency was seen with this technique, which is comparable to external DCR and better than other endoscopic techniques. CONCLUSION Mucosal flap preservation appears to be the single most important innovation in endoscopic DCR surgery, which makes it comfortable for both the surgeon and patient, apart from providing a 98% success rate in our study.

  12. Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases.

    Science.gov (United States)

    Mamelak, Adam N; Carmichael, John; Bonert, Vivien H; Cooper, Odelia; Melmed, Shlomo

    2013-09-01

    The objective of this study was to evaluate outcomes of endoscopic transsphenoidal surgery using a single-surgeon technique as an alternative to the more commonly employed two-surgeon, three-hand method. Three hundred consecutive endoscopic transsphenoidal procedures performed over a 5 year period from 2006 to 2011 were reviewed. All procedures were performed via a binasal approach utilizing a single surgeon two handed technique with a pneumatic endoscope holder. Expanded enodnansal cases were excluded. Surgical technique, biochemical and surgical outcomes, and complications were analyzed. 276 patients underwent 300 consecutive surgeries with a mean follow-up period of 37 ± 22 months. Non-functioning pituitary adenoma (NFPA) was the most common pathology (n = 152), followed by growth hormone secreting tumors (n = 41) and Rathke's cleft cysts (n = 30). Initial gross total cyst drainage based on radiologic criteria was obtained in 28 cases of Rathke's cleft cyst, with 5 recurrences. For NFPA and other pathologies (n = 173) gross total resection was obtained in 137 cases, with a 92% concordance rate between observed and expected extent of resection. For functional adenoma, remission rates were 30/41 (73%) for GH-secreting, 12/12 (100%) for ACTH-secreting, and 8/17 (47%) for prolactin-secreting tumors. Post-operative complications included transient (11%) and permanent (1.4%) diabetes insipidus, hyponatremia (13%), and new anterior pituitary hormonal deficits (1.4%). CSF leak occurred in 42 cases (15%), and four patients required surgical repair. Two carotid artery injuries occurred, both early in the series. Epistaxis and other rhinological complications were noted in 10% of patients, most of which were minor and diminished as surgical experience increased. Fully endoscopic single surgeon transsphenoidal surgery utilizing a binasal approach and a pneumatic endoscope holder yields outcomes comparable to those reported with a two-surgeon method. Endoscopic outcomes appear to be better than those reported in microscope-based series, regardless of a one or two surgeon technique.

  13. National long-lasting effect of endonasal endoscopic sphenopalatine artery clipping for epistaxis

    DEFF Research Database (Denmark)

    Ludvigsen Gede, Lisbeth; Aanaes, Kasper; Collatz, Helle

    2013-01-01

    We consider sphenopalatine artery ligation to be a safe and effective treatment of posterior epistaxis as the long-term need for revision surgery and the complication rates are low. Surgery should be considered earlier in the treatment of posterior epistaxis....

  14. Robot-assisted endoscope guidance versus manual endoscope guidance in functional endonasal sinus surgery (FESS).

    Science.gov (United States)

    Eichhorn, Klaus Wolfgang; Westphal, Ralf; Rilk, Markus; Last, Carsten; Bootz, Friedrich; Wahl, Friedrich; Jakob, Mark; Send, Thorsten

    2017-10-01

    Having one hand occupied with the endoscope is the major disadvantage for the surgeon when it comes to functional endoscopic sinus surgery (FESS). Only the other hand is free to use the surgical instruments. Tiredness or frequent instrument changes can thus lead to shaky endoscopic images. We collected the pose data (position and orientation) of the rigid 0° endoscope and all the instruments used in 16 FESS procedures with manual endoscope guidance as well as robot-assisted endoscope guidance. In combination with the DICOM CT data, we tracked the endoscope poses and workspaces using self-developed tracking markers. All surgeries were performed once with the robot and once with the surgeon holding the endoscope. Looking at the durations required, we observed a decrease in the operating time because one surgeon doing all the procedures and so a learning curve occurred what we expected. The visual inspection of the specimens showed no damages to any of the structures outside the paranasal sinuses. Robot-assisted endoscope guidance in sinus surgery is possible. Further CT data, however, are desirable for the surgical analysis of a tracker-based navigation within the anatomic borders. Our marker-based tracking of the endoscope as well as the instruments makes an automated endoscope guidance feasible. On the subjective side, we see that RASS brings a relief for the surgeon.

  15. The Usefulness of the Endonasal Incisional Approach for the Treatment of Nasal Bone Fracture

    Directory of Open Access Journals (Sweden)

    Hyo Seong Kim

    2012-05-01

    Full Text Available Background Among all facial fractures, nasal bone fractures are the most common, andthey have been reduced by closed reduction (CR for a long time. But several authors havereported suboptimal results when using CR, and the best method of nasal bone reduction isstill being debated. We have found that indirect open reduction (IOR through an endonasalincisional approach is a useful method for more accurate reduction of the nasal bone.Methods A retrospective chart review was performed of 356 patients who underwentreduction of a nasal bone fracture in our department from January, 2006, to July, 2011.We treated 263 patients with IOR. We assessed patients’ and doctors’ satisfaction withsurgical outcomes after IOR or CR. We evaluated the frequency of nasal bleeding owing tomucosal injury, and followed the surgical outcomes of patients who had simultaneous dorsalaugmentation rhinoplasty.Results According to the analysis of the satisfaction scores, both patients and doctors weresignificantly more satisfied in the IOR group than the CR group (P<0.05. Mucosal injury withnasal bleeding occurred much less in the IOR group (5.3% than the CR group (12.9%. Dorsalaugmentation rhinoplasty with IOR was performed simultaneously in 34 cases. Most of them(31/34 showed satisfaction with the outcomes.Conclusions IOR enables surgeons to manipulate the bony fragment directly through theendonasal incisional approach. However, we propose that CR is the proper technique forpatients under 16 and for those with comminuted nasal bone fractures because submucosaldissection in IOR can damage the growth or circulation of nasal bone.

  16. Long-Term Endocrine Outcomes Following Endoscopic Endonasal Transsphenoidal Surgery for Acromegaly and Associated Prognostic Factors.

    Science.gov (United States)

    Babu, Harish; Ortega, Alicia; Nuno, Miriam; Dehghan, Aaron; Schweitzer, Aaron; Bonert, H Vivien; Carmichael, John D; Cooper, Odelia; Melmed, Shlomo; Mamelak, Adam N

    2017-08-01

    Long-term remission rates from endoscopic transsphenoidal surgery for acromegaly and their relationship to prognostic indicators of disease aggressiveness are not well documented. To investigate long-term remission rates in patients with acromegaly after endoscopic transsphenoidal surgery, and correlate this with molecular and radiographic markers of disease aggressiveness. We identified all patients undergoing endoscopic transsphenoidal surgery for acromegaly from 2005 to 2013 at Cedars-Sinai Pituitary Center. Hormonal remission was established by normal insulin-like growth factor (IGF)-1, basal serum growth hormone <2.5 ng/mL, and growth hormone suppression to <1 ng/mL following oral glucose tolerance test. Oral glucose tolerance test was performed at 3 months after surgery, and then as indicated. IGF-1 was measured at 3 months and then at least annually. We evaluated tumor granularity, nuclear expression of p21, Ki67 index, and extent of cavernous sinus invasion, and correlated these with remission status. Fifty-eight patients that underwent surgery had follow-up from 38 to 98 months (mean 64 ± 32.2 months). There were 21 microadenomas and 37 macroadenomas. Three months after surgery 40 of 58 patients (69%) were in biochemical remission. Four additional patients were in remission at 6 months after surgery, and 1 patient had recurrence within the first year after surgery. At last follow-up, 43 of 44 (74.1%) of patients remained in remission. Cavernous sinus invasion by tumor predicted failure to achieve remission. Prognostic markers of disease aggressiveness other than cavernous sinus invasion did not correlate with surgical outcome. Long-term remission after surgery alone was achieved in 74% of patients, indicating long-term efficacy of endoscopic surgery. Copyright © 2017 by the Congress of Neurological Surgeons

  17. Endoscopic endonasal anatomy of superior orbital fissure and orbital apex regions: critical considerations for clinical applications.

    Science.gov (United States)

    Dallan, Iacopo; Castelnuovo, Paolo; de Notaris, Matteo; Sellari-Franceschini, Stefano; Lenzi, Riccardo; Turri-Zanoni, Mario; Battaglia, Paolo; Prats-Galino, Alberto

    2013-05-01

    The superior orbital fissure is a critical three-dimensional space connecting the middle cranial fossa and the orbit. From an endoscopic viewpoint, only the medial aspect has a clinical significance. It presents a critical relationship with the lateral sellar compartment, the pterygopalatine fossa and the middle cranial fossa. The connective tissue layers and neural and vascular structures of this region are described. The role of Muller's muscle is confirmed, and the utility of the maxillary and optic strut is outlined. Muller's muscle extends for the whole length of the inferior orbital fissure, passes over the maxillary strut and enters the superior orbital fissure, representing a critical surgical landmark. Dividing the tendon between the medial and inferior rectus muscle allows the identification of the main trunk of the oculomotor nerve, and a little laterally, it is usually possible to visualize the first part of the ophthalmic artery. Based on a better knowledge of anatomy, we trust that this area could be readily addressed in clinical situations requiring an extended approach in proximity of the orbital apex.

  18. Un caso de variación no galego moderno: posibles realizacións do complemento directo dos verbos oír e escoitar

    Directory of Open Access Journals (Sweden)

    María Pereira Maceda

    2009-01-01

    Full Text Available In this article we describe a typology of arguments in the direct object slot for the Galician auditory perception verbs oír and escoitar. We begin with an overview of possible argument types, presenting relevant data concerning frequencies in a modern Galician text corpus consisting of documents written between 1800 and 2000. Following this empirical survey of actual usage, we posit structural criteria to explain the preferred or even mandatory use of one or another type of complement in various contexts. The corpus is subjected to three complementary analytical approaches. The fi rst of these is based on coreference between the verb of perception and the verb in a direct-object complement clause. The second approach takes into account the gramatical consequences of different conceptualizations of what is perceived. Finally, we look at the use of certain case markers performing a disambiguation function with regard to the implicit transitivity structure of arguments: subject plus direct object. This interpretative proposal is enriched with pertinent references to sociolinguistic features affecting the development of the Galician language up to the present.

  19. Estudio internacional de los efectos directos e indirectos del ciberacoso en la victimización por acoso sexual cibernético mediados por la autoestima

    OpenAIRE

    Wachs, Sebastian; Ksinan Jiskrova, Gabriela; Vazsonyi, Alexander T.; Wolf, Karsten D.; Junger, Marianne

    2016-01-01

    The present study reports frequency rates of cybergrooming, profiled characteristics of cybergrooming perpetrators, and examine direct and indirect associations between cyberbullying victimization, self-esteem, and cybergrooming victimization. The study sample included 2,162 adolescents between 11 and 19 years from three Western (Germany, the Netherlands, the United States) countries and one Southeast Asian country (Thailand). Across countries, 18.5% of participants reported having had contac...

  20. Remoción anaerobia del colorante azul directo brl en Reactor Anaerobio de Flujo Ascendente UASB (Upflow Anaerobic Sludge Blanket con carbón activado

    Directory of Open Access Journals (Sweden)

    Christian Zavala-Rivera

    2015-11-01

    Full Text Available In this research the brl direct blue dye was used for anaerobic removal with a bacterial consortium of industrial effluents from Industrial Park Río Seco (IPRS, Arequipa, Peru; in an anaerobic reactor of UASB Upflow with activated carbon. The reactor had a capacity of 14.4 L with sludge and activated carbon of 40% of volume, with an organic load of 6 Kg COD/m3•dia and a hydraulic retention time of 1 day with an upward flow. The objective was to measure the efficiency of the anaerobic removal of coloring in a time of 28 days. The results showed an increase of 41% of the solids suspended volatile (SSV 12894 mg•L-1 up to 21546 mg•L-1 under the conditions of the experiment, with a removal of 57% of the chemical demand of oxygen (COD from 484 mg•L-1 to 122 mg•L-1 and a removal of 87% of the dye Blue direct the 69.61 brl mg•L-1 to 9 mg•L-1. Results with activated charcoal granular only, they showed a removal of 61% of the dye Blue direct 70.67 brl mg•L-1 to 27.83 mg•L-1 at 28 days.

  1. El marketing directo alcances y logros económicos y financieros de las empresas comerciales en los cantones Quito, Cayambe y Pedro Moncayo

    OpenAIRE

    Delgado Betancourt, Jessica Tamara; Saá Pinta, John Patricio

    2013-01-01

    Today there are plenty of products that are offered equal differently by companies, but be competition to them are forced to resort to a very important tool in commerce, direct marketing, so get as many and customer loyalty. Marketing is a set of activities whose primary purpose is to inform consumers about the features and benefits of a product or service in order to conquer the market by meeting the needs of consumers. Several types of mar...

  2. El mercadeo directo aplicado al lanzamiento y posicionamiento de nuevos productos y servicios. Diseño de un modelo práctico para portar celular.

    OpenAIRE

    Espinosa Ayala, Edgar Ramiro

    2005-01-01

    Muchas empresas se han enfrentado a grandes dificultades al momento de lanzar un nuevo producto y/o servicio, dichas dificultades, generadas o no por errores de las mismas empresas, han llevado a la gran mayoría de los casos a que los productos y/o servicios tengan un ciclo de vida sumamente reducido, a que fracasen en el corto plazo o a que se posicionen de manera errónea en las mentes de los consumidores. Estos fracasos en los lanzamientos afectan no solo al producto, sino ta...

  3. El cumplimiento de los parámetros del debido proceso en el procedimiento directo del Código Orgánico Integral Penal

    OpenAIRE

    Grunauer Reinoso, Estefanía Cristina

    2016-01-01

    Con la evolución del derecho penal, han surgido dos grandes tendencias extremadamente opuestas entre sí y que se han arraigado en el pensamiento penal mundial, y que de acuerdo a la política criminal de cada Estado, para el ejercicio de su poder punitivo, han sido implementadas con el fin de alcanzar los objetivos en materia de delincuencia y seguridad. Estas grandes tendencias son: Eficientismo y Garantismo. El garantismo penal busca controlar el poder punitivo del estado frente a los ciudad...

  4. Automatic storing of single gamma spectra on magnetic tape. Programs LONGO, DIRE; Automatizacion del almacenamiento en cinta magnetica de espectros gamma directos. Programas LONGO, DIRE

    Energy Technology Data Exchange (ETDEWEB)

    Los Arcos Merino, J M

    1978-07-01

    The program LONGO provides the block size and the block number in a binary file on magnetic tape. It has been applied to analyse the structure of the nine-track magnetic tapes storing single or coincidence gamma spectra files, recorded in octet form by a MULTI-8 minicomputer in the Nuclear Spectrometry Laboratory of J.E.N. Then the program DIRE has been written to transform the single gamma spectra into a new FASTRAND disk file, storing the information in-36 bit words. A copy of this file is obtained on magnetic tape and the single gamma spectra are then available by standard FORTRAN V reading sentences. (Author) 3 refs.

  5. COSTES SANITARIOS DIRECTOS DE LAS NEOPLASIAS DE PULMÓN Y VEJIGA DE ORIGEN LABORAL EN ESPAÑA EN 2008

    OpenAIRE

    Montserrat García Gómez; Rosa Urbanos Garrido; Rosario Castañeda López; Patricia López Menduiña

    2012-01-01

    Fundamentos: La falta de reconocimiento del origen laboral de algunos tumores malignos conlleva que el coste de su asistencia sanitaria recaiga sobre el Sistema Nacional de Salud. El objetivo de nuestro estudio es conocer el número de procesos atendidos por cáncer de pulmón y vejiga atribuibles al trabajo en España en el Sistema Nacional de Salud (SNS) en 2008, así como los costes sanitarios derivados de su atención. Métodos: El número de procesos se estimó aplicando las fracciones atribuible...

  6. COSTES SANITARIOS DIRECTOS DE LAS NEOPLASIAS DE PULMÓN Y VEJIGA DE ORIGEN LABORAL EN ESPAÑA EN 2008

    Directory of Open Access Journals (Sweden)

    Montserrat García Gómez

    2012-01-01

    Full Text Available Fundamentos: La falta de reconocimiento del origen laboral de algunos tumores malignos conlleva que el coste de su asistencia sanitaria recaiga sobre el Sistema Nacional de Salud. El objetivo de nuestro estudio es conocer el número de procesos atendidos por cáncer de pulmón y vejiga atribuibles al trabajo en España en el Sistema Nacional de Salud (SNS en 2008, así como los costes sanitarios derivados de su atención. Métodos: El número de procesos se estimó aplicando las fracciones atribuibles al trabajo obtenidas en la literatura. Para el cálculo de los costes se utilizaron datos primarios relativos a la atención especializada del SNS (ambulatoria e ingresos hospitalarios, y fuentes secundarias para calcular el coste de la atención primaria de salud y la atención farmaceútica. Los cálculos se realizaron por enfermedad y sexo. Resultados: 10.652 altas hospitalarias durante 2008 fueron debidas a cánceres de pulmón y vejiga atribuibles al trabajo (se reconocieron 16 como profesionales el mismo año. El tratamiento de estos casos costó casi 88 millones de euros, de los cuales 61,2 corresponden al cáncer de pulmón y 26,5 al de vejiga. Destaca el enorme peso relativo de la atención especializada (64% y el escaso peso de la atención primaria (2,3%. Conclusiones: La magnitud del cáncer de pulmón y vejiga derivado del trabajo en España es muy superior a la que refleja el registro de enfermedades profesionales, siendo imprescindible su reconocimiento como profesional para activar su adecuada prevención. La atención sanitaria de estas enfermedades supone un elevado gasto para el sistema público de salud.

  7. El Salvador, acceso ciudadano directo a las Elecciones Legislativas y de Concejos Municipales, 11 marzo del 2012: una experiencia desde la observación electoral

    Directory of Open Access Journals (Sweden)

    Arturo Fournier Facio

    2014-07-01

    Full Text Available Perspectiva de la experiencia como observador electoral internacional en las elecciones de medio período de El Salvador, para los puestos de elección popular de la Asamblea Legislativa y de miembros de Concejos Municipales. Inicia con una comparación de los fundamentos normativos y constitucionales del sistema electoral de Costa Rica y el Salvador, para continuar con la descripción de las novedades implementadas en el proceso. Finaliza con un informe sobre el proceso de observación, los pro y contra detectados durante la jornada electoral.

  8. Costos directos de la hemodiálisis en unidades públicas y privadas Direct cost analysis of hemodialysis units

    OpenAIRE

    Luis Durán-Arenas; Paula D Ávila-Palomares; Rodrigo Zendejas-Villanueva; María Magaly Vargas-Ruiz; Laura L Tirado-Gómez; Malaquías López-Cervantes

    2011-01-01

    OBJETIVO. Estimar y comparar el costo por sesión de hemodiálisis dentro del sector público y privado en la Ciudad de México. MATERIAL Y MÉTODOS. Se calcularon los costos de los insumos utilizados en las hemodiálisis de cuatro hospitales públicos y dos privados de la Ciudad de México, mediante la estrategia de micro-costeo denominada PAATI. Para la obtención de los datos se utilizó el método de sombra; además, se empleó Excel para elaborar cédulas en las que se determina el PAATI para cada ses...

  9. ¿Qué es un competidor directo? Estudio para corroborar la percepción de competencia directa con base en tres factores

    OpenAIRE

    Vera Martínez Jorge; Díaz Ruíz Roberto

    2012-01-01

    En el presente trabajo se ofrece la hipótesis de que la percepción de competencia directa por parte de un líder de unidad estratégica de negocio (UEN) depende de tres variables: similitud del producto ofrecido, similitud del mercado atacado y similitud de capacidades estratégicas de las empresas competidoras. Se propone que la competencia directa depende más de la percepción de los gerentes que de una decisión basada en una regla objetiva. Estas tres variables son detectadas inicialmente en u...

  10. Diferencias del clima laboral entre empleados contratados por outsourcing y empleados directos: evidencia empírica de la zona norte de Colombia.

    Directory of Open Access Journals (Sweden)

    David Juliao Esparragoza

    2014-12-01

    Full Text Available Son pocos los estudios empíricos sobre clima laboral en Colombia que muestran las diferencias entre grupos de trabajadores que, teniendo las mismas funciones en la empresa, cuentan con diferentes tipos de contrato. Esta investigación, a partir de un estudio realizado con empleados de una importante empresa de bebidas ubicada en la costa norte de Colombia, trata de aportar a la resolución de esta carencia, verificando si existen diferencias significativas, en algunas variables del clima laboral, entre los grupos de trabajadores contratados directamente y aquellos vinculados por prestación de servicios. El trabajo es de tipo descriptivo y transversal, se apoya en el método hipotético inductivo y utiliza el instrumento imcoc (evaluando las diferencias inter-grupales en las seis variables que lo componen, a saber: objetivos, cooperación, liderazgo, toma de decisiones, relaciones interpersonales, motivación y control.

  11. Un método directo para imponer coacciones en cualquier dirección, en el análisis matricial de una estructura

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    Recuero, A.

    1972-04-01

    Full Text Available When analysing a structure by matrix methods, it is common to come up against the problem of imposing restrictions in various directions, so that it is impossible to choose a system of Cartesian axes that will make the directions of these axes coincide with those along which restrictions are to be imposed. This work presents a general method for imposing restrictions in any direction, in a mathematically exact and direct form, modifying the stiffness matrix in the area corresponding to the nodes in which such restrictions are imposed, being the new stiffness matrix, equally symmetrical, and having singular directions.Al analizar una estructura por métodos matriciales es frecuente encontrarse con el problema de imponer coacciones en varias direcciones, de forma que es imposible elegir un sistema de ejes cartesianos para que las direcciones de dichos ejes coincidan con las direcciones en las que hay que imponer las coacciones. El presente trabajo describe un método general para imponer de forma matemáticamente exacta y directa coacciones en cualquier dirección modificando la matriz de rigidez en la zona correspondiente a los nudos en que se imponen tales coacciones, siendo la nueva matriz de rigidez igualmente simétrica y no presentándose direcciones singulares.

  12. El Salvador, acceso ciudadano directo a las Elecciones Legislativas y de Concejos Municipales, 11 marzo del 2012: una experiencia desde la observación electoral

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    Arturo

    2014-07-01

    Full Text Available La figura del partido político en Costa Rica juega un rol fundamental dentro del sistema político y se considera el vehículo legítimo para acceder al poder público. El proceso electoral 2013-2014 aporta elementos significativos y brinda pistas que permiten fortalecer el Estado democrático de derecho costarricense, mediante el abordaje de dos ejes específicos. El primero, la dinámica interna seguida por los partidos políticos en dos de sus procesos que tuvieron directa vinculación al proceso electoral: la renovación periódica de sus autoridades internas y la escogencia de sus candidaturas a puestos de elección popular. El segundo abarca la interacción reproducida entre el sistema de partidos políticos y la ciudadanía, tanto en forma singular como asociativamente durante el proceso electoral, espacio de conexión entre ambos actores, donde la institución de la representación política se activa de manera más intensa y directa, a través del ejercicio del sufragio

  13. Costos directos e impacto sobre la morbimortalidad hospitalaria de eventos adversos prevenibles a medicamentos en una institución de tercer nivel de Bogotá

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    José Fernando Pinzón

    2011-03-01

    Conclusiones. Es importante tomar medidas tendientes a disminuir la presentación de eventos adversos prevenibles a medicamentos, ya que repercuten negativamente tanto sobre la salud de los pacientes, como en el consumo de recursos.

  14. ENFERMEDAD DE CUSHING: PRESENTACIÓN DE UN CASO EN PACIENTE JOVEN

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    Brenda Anahí López López

    2014-12-01

    Full Text Available Los adenomas de la hipófisis son la causa más frecuente de los síndromes de hipersecreción e hiposecreción de hormonas hipofisarias. La prevalencia es de 200 casos por millón de habitantes. Los adenomas funcionales, secretan un exceso de la hormona correspondiente a las células afectadas y de ahí se manifiesta su síndrome clínico característico. Se describe el caso de un adenoma hipofisiario  en una paciente de 17 años, quien acude a consulta por presentar acné resistente a tratamientos anteriores. No responde nuevamente al tratamiento indicado y presenta nuevas manifestaciones clínicas (aumento de peso sin causa aparente, estrías violáceas, giba cervical, dolor de cabeza y problemas visuales, se toman los niveles de cortisol plasmático y urinarios, encontrándolos elevados. Se le prescribe 1 mg de dexametasona oral seguido de la medición del nivel de cortisol al día siguiente, además se procede a realizar una resonancia magnética (RNM, que mostró dos imágenes sugestivas de adenomas en la adenohipófisis. Dichas masas fueron extraídas mediante un abordaje endonasal endoscópico transesfenoidal, el estudio patológico confirma que corresponden a adenomas hipofisarios productores de ACTH, confirmando el diagnóstico de Enfermedad de Cushing. La  mayoría de los casos reportados de adenomas hipofisiarios corresponden a pacientes adultos mayores. La  paciente forma parte de un raro número de jóvenes que llegan a presentar este tipo de tumor.  El diagnóstico temprano y la extracción oportuna de los adenomas propicia a que los efectos producidos por el exceso de producción hormonal de las células afectadas se reviertan completamente, sin dejar secuelas graves en el paciente. Palabras Clave: Adenoma hipofisario, Enfermedad de Cushing, ACTH (hormona adrenocorticotropa.

  15. Prospective comparison of sinonasal outcomes after microscopic sublabial or endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary adenomas.

    Science.gov (United States)

    Pledger, Carrie L; Elzoghby, Mohamed A; Oldfield, Edward H; Payne, Spencer C; Jane, John A

    2016-08-01

    OBJECT Both endoscopic and microscopic transsphenoidal approaches are accepted techniques for the resection of pituitary adenomas. Although studies have explored patient outcomes for each technique individually, none have prospectively compared sinonasal and quality of life outcomes in a concurrent series of patients at the same institution, as has been done in the present study. METHODS Patients with nonfunctioning adenomas undergoing transsphenoidal surgery were assessed for sinonasal function, quality of life, and pain using the Sino-Nasal Outcome Test-20 (SNOT-20), the short form of the Nasal Obstruction Symptom Evaluation (NOSE) instrument, the SF-36, and a headache scale. Eighty-two patients undergoing either endoscopic (47 patients) or microscopic (35 patients) surgery were surveyed preoperatively and at 24-48 hours, 2 weeks, 4 weeks, 8 weeks, and 1 year after surgery. RESULTS Patients who underwent endoscopic and microscopic transsphenoidal surgery experienced a similar recovery pattern, showing an initial increase in symptoms during the first 2 weeks, followed by a return to baseline by 4 weeks and improvement beyond baseline functioning by 8 weeks. Patients who underwent endoscopic surgery experienced better sinonasal outcomes at 24-48 hours (SNOT total p = 0.015, SNOT rhinologic subscale [ssRhino] p surgery, no significant differences in sinonasal outcomes were observed between the 2 groups. Headache scales at 1 year improved in all dimensions except duration for both groups (total result 73%, p = 0.004; severity 46%, p surgery, both groups experienced significant improvements in mental health (13%, p = 0.005) and vitality (15%, p = 0.037). By 1 year after surgery, patients improved significantly in mental health (14%, p = 0.03), role physical (14%, p = 0.036), social functioning (16%, p = 0.009), vitality (22%, p = 0.002), and SF-36 total (10%, p = 0.024) as compared with preoperative measures. There were no significant differences at any time point between the 2 groups for the total SF-36 or for any of the 8 subscales. CONCLUSIONS Patients who underwent either an endoscopic or a microscopic approach experienced the greatest nasal symptoms at 2 weeks postoperatively and exhibited similar time courses of recovery in nasal, headache, and quality of life assessments. Although patients who underwent endoscopic surgery experienced significantly fewer nasal symptoms during the first 8 weeks, by 1 year after surgery, there were no significant differences between the 2 groups.

  16. Somatotrophic and corticotrophic function outcome after transesphenoidal surgery in patients with sellar tumors and pre-operative endocrine deficits Evolução das funções somatotrófica e corticotrófica após cirurgia transesfenoidal em pacientes com tumores selares e deficits endócrinos pré-operatórios

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    Fernando R. Pimentel-Filho

    1997-09-01

    Full Text Available Sixteen patients with sellar tumors that were treated surgically and who had pre-operative somatotrophic and corticotrophic function deficits were submitted to pre- and early post-operative insulin tolerance tests (ITTs. Seven patients had non-functioning adenomas, 5 had prolactinomas, 3 had craniopharyngioma and 1 had cordoma of the clivus. All patients had macro-tumors and none received radiotherapy within the studied period. Seven patients had GH, 4 had Cortisol and 5 had both GH/cortisol function pre-operative deficit. Five patients with isolated GH, 4 with isolated Cortisol and 3 with both GH/cortisol deficiencies showed a postoperative functional recovery. New Cortisol secretion deficits were observed in 2 patients postoperatively and both required long-term steroid replacement. These data suggest that preoperative endocrine deficits may be reversible after surgical decompression of the sellar region and that new endocrine deficits are rarely seen after surgery. All such patients should be tested postoperatively from an endocrinological point of view to reevaluate the need for replacement therapies.Dezesseis pacientes com tumores da região selar que foram tratados cirurgicamente e que possuíam deficits funcionais dos eixos somatotrófico ou corticotrófico foram submetidos a teste de tolerância à insulina pré- e pós-operatoriamente. Sete pacientes possuíam adenomas não-funcionantes, 5 possuíam prolactinomas, 3 craniofaringiomas e 1 possuía cordoma de clivus. Todos os pacientes possuíam macrotumores e nenhum deles foi submetido a radioterapia durante o período do estudo. Sete pacientes possuíam deficiência isolada do setor somatotrófico, 4 isolada do setor corticotrófico e 5 possuíam deficiência de ambos os setores. Cinco pacientes com deficiência isolada do setor somatotrófico, 4 com deficit isolado do setor corticotrófico e 3 com deficiência nos dois setores obtiveram melhora funcional pós-operatoriamente. Novos deficits do setor corticotrófico ocorreram em 2 pacientes, que necessitaram reposição de esteróides por longo prazo. Estes dados sugerem que deficits endócrinos pré-operatórios podem ser revertidos pela descompressão cirúrgica da região selar e que novos deficits causados pela cirurgia são raros. Estes pacientes devem ser retestados pós-operatoriamente do ponto de vista endócrino para se determinar a necessidade de terapia de reposição hormonal.

  17. Análisis de redes sociales para catalizar la innovación agrícola: de los vínculos directos a la integración y radialidad

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    Norman Aguilar-Gallegos

    2016-07-01

    Full Text Available Se analizan los efectos de las interacciones, directas e indirectas, entre agricultores y otros actores relevantes en el intercambio de información y conocimiento para la innovación agrícola. Los datos se obtuvieron al preguntar a 120 agricultores «¿de quién aprende y/o a quién recurre para obtener información o conocimiento de cuestiones técnicas y productivas en torno a su unidad de producción?». Se emplean indicadores del análisis de redes sociales para proponer lineamientos que permitan catalizar la innovación agrícola. Los resultados confirman la importancia de los vínculos indirectos, pues estos permiten que los agricultores alcancen mejor información de fuentes externas. Se recomienda que los programas encaminados a promover la innovación agrícola consideren la interacción preexistente en las redes de los agricultores.

  18. Cambios en el rendimiento en la prueba de marcha en 6 minutos y en el consumo de oxigeno directo en un paciente amputado transtibial con diferentes pies protésicos

    OpenAIRE

    Sandoval Hernández, Oscar Andrés; Silva Caicedo, Octavio

    2016-01-01

    La prescripción de las prótesis para los diferentes niveles de amputación está relacionada con el nivel de actividad del paciente y debe estar además asociada a la capacidad funcional y cardiorrespiratoria. El consumo de oxígeno en los pacientes amputados, se debe ver afectado por el tipo de prótesis que se está usando y por los elementos asociado la misma. La cuantificación del consumo de oxígeno y su relación con el rendimiento den la prueba de marcha de 6 minutos permite individualizar la ...

  19. Alcances y logros económicos y financieros de las empresas de servicios turísticos, en los cantones Quito, Cayambe y Pedro Moncayo, como resultado del marketing directo

    OpenAIRE

    Caicedo Armas, Cristina Cinthya; Jara Córdova, Juan José

    2013-01-01

    In this project it is possible to observe a detailed investigation concerning the benefits about the usage of direct marketing as a tool for communicate with the customer, from part of the enterprises which provide touristic services in the cantons of Quito, Cayambe and Pedro Moncayo. The goal is to determine its economic and financial impact with respect to their daily procedure in these organizations of touristic services....

  20. Implementación de un control fuzzy para el control cinemático directo en un robot manipulador Implementation of a fuzzy control for the direct kinematic control of a robot manipulator

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    D.A Tibaduiza

    2011-12-01

    Full Text Available En este artículo se muestra el desarrollo e implementación de la lógica difusa como herramienta de control de posición para cada una de las articulaciones de un robot tipo PUMA. Se hace una descripción general del robot y se muestra el cálculo del volumen de trabajo, el cual es usado para la fuzzificación en el desarrollo del controlador. Finalmente es mostrado el desarrollo y la simulación del controlador usando la toolbox fuzzy de Matlab, así como la descripción de una implementación realizada en un PLC.In this article, the development and implementation of a fuzzy logic system as position control tool of each one of the joints in a PUMA robot is shown. A general description, which include general descriptions about the robot as workspace and therefore the development of the strategy of control with the definition of the rules in the fuzzification process is also included. Finally are shown the development and simulation of the controller using the fuzzy control toolbox of Matlab and the description of a implementation in a PLC.

  1. Valor de los metodos directos e indirectos de diagnóstico en las micosis sitémicas asociadas al SIDA Efficacy of different diagnosis methods in systemic mycoses associated with AIDS

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    A.I. Arechavala

    1993-04-01

    Full Text Available Durante 5 años se estudiaron 117 pacientes con micosis sistémicas asociadas al SIDA: 74 criptococosis, 39 histoplasmosis y 4 con ambas enfermedades. Para el diagnóstico analizamos los siguientes materiales: escarificaciones de lesiones cutáneas o mucosas, aspirados de médula ósea, secreciones bronquiales, biopsias de diversos órganos, líquido cefalorraquídeo, hemocultivos y sueros para determinaciones serológicas. Fueron estudiadas en total 203 muestras de pacientes con histoplasmosis, el 46.3% de las mismas acusó la presencia de H. capsulatum. Las escarificaciones cutáneas exhibieron la mayor sensibilidad (94.7%, seguidas por las biopsias (80% y los mielocultivos (42.1%. La demostración de anticuerpos circulantes por medio de 3 pruebas serológicas y con de 2 antígenos específicos dio resultados positivos en el 45.4% de los pacientes. Se estudiaron en total 413 especímenes de pacientes con criptococosis, la confirmación diagnóstica fue posible en el 69% de las muestras. El mayor rendimiento se obtuvo con el LCR (89.5%, le seguieron en sensibilidad los hemocultivos (61.2%, las escarificaciones cutáneas (42.9% y los urocultivos (41.7%. La búsqueda de antígeno en los fluidos orgánicos fue positiva en casi todos los casos. La revisión que presentamos permitirá una búsqueda más racional y rápida de los métodos de diagnóstico en las micosis asociadas al SIDA.One hundred and seventeen patients suffering systemic mycosis and AIDS were studied during 5 years in the Muñiz Hospital of Buenos Aires City. Seventy four of them presented cryptococcosis, 39 histoplasmosis and 4 both mycoses. The following specimens were studied for the diagnosis: skin and mucous membrane scrapings, bone marrow aspirations, bronchial secretions, biopsies of different organs, cerebral spinal fluid and blood cultures. Sera were also collected for serologic tests. A total of 203 samples from patients with histoplasmosis were studied, 46.3% of them showed H. capsulatum in microscopic examinations or in cultures, skin scraping was the most sensitive diagnostic method (94.7% of positive results, followed by biopsies (80% and bone marrow cultures (42.1%. Specific antibodies were detected in 45.4% of the patients with histoplasmosis, using 2 different antigens and 3 types of serologic reactions (complement fixation test, immunodiffusion and counterimmunoelectrophoresis. A total of 413 samples from patients with cryptococcosis were examined, 69% of them confirmed the diagnosis. The mycologic study of CSF was the most sensitive method of study, since it registered positive results in 89.5%, followed by blood cultures (61.2%, skin scrapings (42.9%, and urine cultures (41.7%. Polisaccharyde antigens from C. neoformans in organic fluids were detected in almost all the cases. The aim of this study is to compare all the suitable diagnostic methods which can be used in systemic mycosis associated with AIDS in order to find the most rapid way of diagnosis.

  2. [Informed Treatment Consent and Refusal in Advanced Endonasal Surgery: The Ethical Dilemma of Olfaction Sacrifice in Surgery for Chronic Rhinosinusitis with Polyposis].

    Science.gov (United States)

    Subtil, João; Araújo, João Pedro; Saraiva, José; Santos, Alberto; Vera-Cruz, Paulo; Paço, João; Pais, Diogo

    2015-01-01

    Olfaction is frequently affected in chronic rhino-sinusitis with polyposis and has been recognised to have important impact on quality of life. Surgical resolution on cases of maximal medical therapy failure is an option to relieve symptoms, with debates as to how extensive surgery should be. A more radical approach will achieve better disease control with less relapse, but can also compromise olfaction. This decision about a more radical surgical approach should be shared with the patient. Thorough informed consent regarding disease control and hyposmia should be taken. Literature review and consultation with a board of experts. We propose some elements to be included in the informed consent discussion, in order to broadly address the surgical limitations regarding anosmia as a frequent complaint, as well as the different options and their associated consequences. Radical surgery decision making should be shared with the patient and the informed consent should be as thorough as possible regarding disease control and hyposmia resolution.

  3. The Pedicled Buccal Fat Pad: Anatomical Study of the New Flap for Skull Base Defect Reconstruction After Endoscopic Endonasal Transpterygoid Surgery

    Science.gov (United States)

    Golbin, Denis A.; Lasunin, Nikolay V.; Cherekaev, Vasily A.; Polev, Georgiy A.

    2016-01-01

    Objectives To evaluate the efficacy and safety of using a buccal fat pad for endoscopic skull base defect reconstruction. Design Descriptive anatomical study with an illustrative case presentation. Setting Anatomical study was performed on 12 fresh human cadaver specimens with injected arteries (24 sides). Internal carotid artery was exposed in the coronal plane via the endoscopic transpterygoid approach. The pedicled buccal fat pad was used for reconstruction. Participants: 12 human cadaver head specimens; one patient operated using the proposed technique. Main outcome measures: Proximity of the buccal fat pad flap to the defect, compliance of the flap, comfort and safety of harvesting procedure, and compatibility with the Hadad–Bassagasteguy nasoseptal flap. Results: Harvesting procedure was performed using anterior transmaxillary corridor. The pedicled buccal fat pad flap can be used to pack the sphenoid sinus or cover the internal carotid artery from cavernous to upper parapharyngeal segment. Conclusion The buccal fat pad can be safely harvested through the same approach without external incisions and is compliant enough to conform to the skull base defect. The proposed pedicled flap can replace free abdominal fat in central skull base reconstruction. The volume of the buccal fat pad allows obliteration of the sphenoid sinus or upper parapharyngeal space. PMID:28180047

  4. Ectopic pituitary null cell adenoma arising from the infundibulum in the third ventricle: A successful endonasal transsphenoidal resection after long-term follow-up MR imaging – A technical note

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    Yuichiro Yoneoka, M.D., Ph.D.

    2017-12-01

    Conclusion: To our best knowledge, this is the first case with long-term preoperative follow-up images, which can bridge the knowledge gap in operations of third ventricle ectPA as following: (1 Truly third ventricle ectPA can exist, (2 the third ventricle ectPA extended into the sella turcica along the pituitary stalk, (3 this ectPA can arise from the suprasellar peri-infundibular ectopic pituitary cells or the pars tuberalis of the adenohypophysis, and therefore adhere to the optic chiasm, (4 thus neurosurgeons should take great care in resection of ectPA arising from the infundibulum, and (5 it can be resected through an endoscopic extended transsphenoidal approach.

  5. Characterization of Leucaena (Leucaena leucephala) oil by direct analysis in real time (DART) ion source and gas chromatography; Caracterización del aceite de Leucaena (Leucaena leucocephala) por análisis directo en tiempo real (DART) y cromatografía de gases

    Energy Technology Data Exchange (ETDEWEB)

    Alam, M.; Alandis, N.M.; Sharmin, E.; Ahmad, N.; Alrayes, B.F.; Ali, D.

    2017-07-01

    For the first time, we report the characterization of triacylglycerols and fatty acids in Leucaena (Leucaena leucephala) oil [LUCO], an unexplored nontraditional non-medicinal plant belonging to the family Fabaceae. LUCO was converted to fatty acid methyl esters (FAMEs). We analyzed the triacylglycerols (TAGs) of pure LUCO and their FAMEs by time-of-flight mass spectrometry (TOF-MS) followed by multivariate analysis for discrimination among the FAMEs. Our investigations for the analysis of LUCO samples represent noble features of glycerides. A new type of ion source, coupled with high-resolution TOF-MS was applied for the comprehensive analysis of triacylglycerols. The composition of fatty acid based LUCO oil was studied using Gas Chromatography (GC-FID). The major fatty acid components of LUCO oil are linoleic acid (52.08%) oleic acid (21.26%), palmitic acid (7.91%) and stearic acid (6.01%). A metal analysis in LUCO was done by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). The structural elucidation and thermal stability of LUCO were studied by FT-IR, 1H NMR, 13C NMR spectroscopic techniques and TGA-DSC, respectively. We also measured the cytotoxicity of LUCO [Spanish] Se presenta por primera vez la caracterización de triacilgliceroles y ácidos grasos del aceite de Leucaena (Leucaena leucephala) [LUCO], una planta no medicinal, no tradicional y no explorada, perteneciente a la familia Fabaceae. Se analizaron triacilgliceroles (TAGs) de LUCO y sus FAMEs por espectrometría de masas de tiempo de vuelo (TOF-MS) seguido de análisis multivariante para discriminación entre los FAME. Nuestras investigaciones para el análisis de muestras de LUCO presentaron características propias de los glicéridos. Un nuevo tipo de fuente de iones, junto con alta resolución TOF-MS se aplicó para el análisis exhaustivo de triacilgliceroles. La composición de aceite de LUCO basado en ácidos grasos se estudió usando Cromatografía de Gas (GC-FID). Los principales componentes de ácidos grasos del aceite LUCO fueron, linoleico (52,08%), oleico (21,26%), palmítico (7,91%) y esteárico 6,01%. El análisis de metales se realizó mediante Espectrometría de Plasma Acoplado Inductivamente a Masas (ICP-MS). La elucidación estructural y la estabilidad térmica de LUCO se estudiaron mediante FT-IR, 1H NMR, técnicas espectroscópicas de 13C NMR y TGA-DSC, respectivamente. También se midió la citotoxicidad de LUCO.

  6. Tratamento da espondilólise sintomática com reparo direto pela técnica de Buck modificada Tratamiento de la espondilolisis sintomática con preparo directo por la técnica de Buck modificada Modified Buck's direct repair to simptomatic spondylolysis treatment

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    Bruno Pinto Coelho Fontes

    2009-03-01

    Full Text Available OBJETIVO: justificar a reconstrução da pars interarticularis pela técnica modificada de Buck como método efetivo no tratamento de lombalgia por espondilólise ou espondilolistese tipo 1, refratárias ao tratamento conservador. MÉTODOS: avaliação retrospectiva de oito pacientes com idade entre 11 e 34 anos, operados e acompanhados no período de outubro de 2004 a maio de 2008 com a técnica de Buck utilizando-se parafusos canulados de titânio. Nenhum paciente foi imobilizado no pós-operatório. Os pacientes foram selecionados após serem submetidos a estudos por imagem utilizando radiografias e ressonância magnética. Também foram avaliados no pós-operatório, segundo os critérios de Henderson e quanto à satisfação com o tratamento, assim como o índice de consolidação. RESULTADOS: sete pacientes foram classificados como excelentes, retornando ao nível de prática esportiva e laboral prévia. Dentre eles, um evoluiu com parestesia transitória, com recuperação completa. A oitava paciente apresentou uma pseudartrose bilateral, mas com bom resultado do ponto de vista clínico. Todos os pacientes ficaram satisfeitos com o resultado. CONCLUSÃO: a reconstrução ístmica com parafusos de titânio atingiu excelentes resultados ao aliar biomecânica estável, dissecção mínima da musculatura, com preservação da anatomia e mobilidade do segmento.OBJETIVO: justificar la reconstrucción de la pars interarticularis por la técnica modificada de Buck como método efectivo en el tratamiento de la lumbalgia por espondilosis o espondilolistesis tipo 1, refractarias al tratamiento conservador. MÉTODOS: evaluación retrospectiva de ocho pacientes con edad entre 11 a 34 años, operados y acompañados en el periodo de Octubre de 2004 hasta Mayo de 2008 con la técnica de Buck usando tornillos canulados de titanio. Ningún paciente fue inmovilizado en el postoperatorio. Los pacientes fueron seleccionados después de ser sometidos a estudios por imagen utilizando radiografías y resonancias magnéticas. También fueron evaluados en el postoperatorio, según los criterios de Henderson y el grado de satisfacción con el tratamiento, así como también el índice de consolidación. RESULTADOS: siete pacientes fueron clasificados como excelentes, retornando al nivel de práctica deportiva y laboral previa. Dentro estos siete pacientes, uno evolucionó con parestesias transitorias, con recuperación completa. La octava paciente presentó una pseudoartrosis bilateral, pero con buen resultado desde el punto de vista clínico. Todos los pacientes quedaron satisfechos con el resultado. CONCLUSIÓN: la reconstrucción ístmica con tornillos de titanio tuvo excelentes resultados al juntar biomecánica estable, disección mínima de la musculatura, con preservación de la anatomía y modalidad del segmento.OBJECTIVE: to justify the modified Buck's technique of pars reconstruction as an effective method to spondylolysis and low grade spondylolisthesis treatment. METHODS: eight patients with ages 11 to 34 years were retrospectively evaluated from October 2004 to may 2008. They were operated with Buck´s technique using titanium canulated screws. Immobilization wasn't used in any patient in post-operative period. All patients were studied with magnetic resonance imaging. All patients were assessed in post-operative period with Henderson's criteria of functional capacity. RESULTS: seven patients were assessed as excellent. They didn´t complain pain and were able to return to former occupation and sportive activities. One patient presented temporary paresthesia and leg weakness, and one patient bilateral pseudoarthrosis that cursed with good grade functional capacity. All patients were satisfied with treatment. CONCLUSION: the isthmic reconstruction using titanium screws allowed excellent results allied with stable biomechanics, minimal injury to back muscles, preservation of anatomy and segmental mobility, and better operated spinal imaging.

  7. Effect of Including Extruded, Rolled or Ground Corn in Dairy Cow Diets Based on Direct Cut Grass Silage Efecto de la Inclusión de Maíz Extruido, Rolado o Molido en Dietas de Vacas Lecheras Basadas en Ensilaje de Pradera de Corte Directo

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    Christian Alvarado G

    2009-09-01

    Full Text Available A study was conducted to determine the effect of corn (Zea mays L. grain processing on intake, digestibility of nutrients and milk production and composition. The effect of extrusion on nutrient digestibility was evaluated in trial 1, using ground corn as a control. In trial 2, the effect of extrusion on intake was evaluated, comparing extruded corn of two densities (357 and 308 g L-1 with rolled corn (507 g L-1 as a control. In trial 3, the effects of extrusion on milk production, digestibility and intake were evaluated; using steam rolled corn and ground corn as controls. No effects on dry matter and metabolizable energy intakes due to differences in the extruded corn grains were observed. Digestibility of dry matter, organic matter, crude protein, gross energy and neutral detergent fiber did not differ among treatments, although a greater digestibility of non-fibrous carbohydrates was observed. Higher milk production was obtained in treatments including extruded and steam rolled corn (21.4 and 21.6 L d-1, compared to ground corn (20.5 L d-1 but differences disappeared when standardizing for fat content. Milk composition was not affected by treatments. Daily protein production was greater (P Se estudiaron los efectos del procesamiento del grano de maíz (Zea mays L. en el consumo y digestibilidad de la dieta, y en la composición y producción láctea. En el ensayo 1, se evaluó el efecto de la extrusión en la digestibilidad de la dieta utilizando maíz molido como control. En el ensayo 2, se evaluó el efecto de la extrusión en el consumo comparando maíz extruido de dos densidades (357 y 308 g L-1 usando maíz rolado (507 gL-1 como control. En el ensayo 3, se evaluó el efecto de la extrusión sobre la producción de leche, digestibilidad y consumo, empleando maíz rolado y maíz molido como controles. No se observaron diferencias en consumo de materia seca (MS ni de energía metabolizable atribuibles a diferencias de densidad del maíz extruido. La digestibilidad de la MS, materia orgánica, proteína bruta, energía bruta y fibra detergente neutro no difirió entre tratamientos, aunque se observó una mayor digestibilidad de los carbohidratos no fibrosos. Hubo mayor producción de leche en tratamientos donde se incluyó maíz extruido y maíz rolado (21,4 y 21,6 Ld-1, respecto del maíz molido (20,5 L d-1, pero esta diferencia no se mantuvo al corregir por contenido graso. Los tratamientos no afectaron la composición láctea. La producción diaria de proteína fue mayor (P < 0,01 en los tratamientos con maíz extruido y rolado y no hubo diferencias en la producción diaria de grasa. La urea y ß-hidroxibutirato sanguíneos y urea en leche se mantuvieron dentro de los valores de referencia. Se concluyó que el maíz extruido no tuvo efectos adversos sobre la digestibilidad, ni sobre el consumo de forraje y de alimento total, con una leve ventaja en la producción de proteína láctea al comparar con maíz molido, pero sin diferencias claras al comparar con maíz rolado al vapor.

  8. Evaluación nasal en el abordaje quirúrgico de la patología selar

    OpenAIRE

    Sariego R, Homero; Bogado C, Mariana

    2008-01-01

    Introducción: El abordaje quirúrgico de la hipófisis ha experimentado un importante desarrollo desde sus inicios; desde el abordaje transcraneal al transesfenoidal, siendo éste último el más utilizado para el tratamiento de la patología selar. Objetivo: Comunicar la experiencia quirúrgica del manejo del septum y fosas nasales, en el abordaje selar en el Instituto de Neurocirugía Dr. Alfonso Asenjo (INCA). Material y Método: Se realizó un estudio descriptivo-transversal de pacientes operados p...

  9. Coincident intrasellar persistent trigeminal artery and craniopharyngioma: case report and implications for transsphenoidal surgery

    Directory of Open Access Journals (Sweden)

    Justin Seltzer, B.A.

    2014-12-01

    Surgeons performing endonasal skull base operations should be vigilant for the presence of PTAs and related vascular anomalies on MR imaging. Noninvasive vascular imaging can confirm and assist with preoperative planning.

  10. Anatomical and computed tomographic analysis of the transcochlear and endoscopic transclival approaches to the petroclival region.

    Science.gov (United States)

    Mason, Eric; Van Rompaey, Jason; Carrau, Ricardo; Panizza, Benedict; Solares, C Arturo

    2014-03-01

    Advances in the field of skull base surgery aim to maximize anatomical exposure while minimizing patient morbidity. The petroclival region of the skull base presents numerous challenges for surgical access due to the complex anatomy. The transcochlear approach to the region provides adequate access; however, the resection involved sacrifices hearing and results in at least a grade 3 facial palsy. An endoscopic endonasal approach could potentially avoid negative patient outcomes while providing a desirable surgical window in a select patient population. Cadaveric study. Endoscopic access to the petroclival region was achieved through an endonasal approach. For comparison, a transcochlear approach to the clivus was performed. Different facets of the dissections, such as bone removal volume and exposed surface area, were computed using computed tomography analysis. The endoscopic endonasal approach provided a sufficient corridor to the petroclival region with significantly less bone removal and nearly equivalent exposure of the surgical target, thus facilitating the identification of the relevant anatomy. The lateral approach allowed for better exposure from a posterolateral direction until the inferior petrosal sinus; however, the endonasal approach avoided labyrinthine/cochlear destruction and facial nerve manipulation while providing an anteromedial viewpoint. The endonasal approach also avoided external incisions and cosmetic deficits. The endonasal approach required significant sinonasal resection. Endoscopic access to the petroclival region is a feasible approach. It potentially avoids hearing loss, facial nerve manipulation, and cosmetic damage. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  11. Prospective randomized investigation for evaluation of postoperative changes in the microbial climate of paranasal mucosa by the use of different dissoluting techniques during postoperative care.

    Science.gov (United States)

    Maune, S; Johannssen, V; Sahly, H; Werner, J A; Salhy, H

    1999-09-01

    Endonasal dissolution by the use of NaCl-solution is a common postoperative treatment of the nasal mucosa after endonasal surgery. These procedure involve for example endonasal shower and sterilized solutions. The contamination of nasal shower in case of unprofessional cleaning after treatment was an argument against this technique in earlier discussions. The danger of such an infection should be avoided by the use of sterilized solution. Therefore the dependence of nasal microbial climate on different nasal dissoluting techniques was investigated by the use of such named endonasal shower (Siemens und Co, Bad Ems, Germany) in comparison with sterilized solution (Rhinomer, Zyma SA, Nyon, France). Microbial cultures were investigated of 80 patients after endonasal surgery (53 m, 27 f; 31 +/- 21 age). Surgery was done for the treatment of chronic polypous sinusitis. Pre-, intra- and postoperative samples were taken in 640 cases to proceed microbial cultures. Material was transferred with the use of a Port-A-Cul-transport medium and preparation of the microbial cultures was done during the first four hours. As a result 895 bacterial clones were cultivated. These consisted of 87% aerob and 13% anaerob bacteria. Staphylococcus aureus (39%) and members of the family of Enterobactericae (30%) were the most common microbes. There was neither an evidence for postoperative microbes on the nasal mucosa nor a correlation between the dissoluting technique and the postoperative outcome. The use of sterilized solutions for the postoperative care of endonasal mucosa does not cause an additional worthful effect on neither the postoperative microbial climate nor the outcome in comparison to endonasal shower.

  12. ¿Qué es el aborto indirecto?: La prohibición del aborto y el principio del doble efecto

    OpenAIRE

    Miranda Montecinos,Alejandro

    2014-01-01

    Este trabajo estudia la distinción entre "aborto directo" y "aborto indirecto". El propósito del autor es clarificar el sentido de esta distinción y mostrar que existen argumentos filosóficos sólidos para justificar su relevancia moral. Para lograr este objetivo expone, en primer lugar, el principal argumento esgrimido por quienes consideran el aborto (directo) como un acto intrínsecamente injusto; en segundo, muestra cuál es el origen histórico de la distinción entre aborto directo y aborto ...

  13. Metástasis hipofisaria de carcinoma de mama debutando como diabetes insípida

    Directory of Open Access Journals (Sweden)

    Ana Arévalo

    2012-03-01

    Full Text Available Los tumores metastáticos que afectan a la glándula hipofisaria son hallazgos pocos comunes, presentándose en cerca del 1% de las cirugías hipofisarias. Los autores presentan el caso de una paciente mujer de 46 años que debuta con síntomas de diabetes insípida. Había sido tratada 3 años antes por un carcinoma ductal infiltrante de la mama derecha. Las imágenes de resonancia magnética cerebral mostraron una masa en la silla turca con extensión supraselar. La paciente fue sometida a resección tumoral vía transesfenoidal que demostró metástasis de carcinoma de mama.

  14. Esfenoidotomia anterior para acesso aos tumores selares: nota técnica

    Directory of Open Access Journals (Sweden)

    Landeiro José Alberto

    2001-01-01

    Full Text Available A dissecção da mucosa do septo nasal durante o acesso transesfenoidal tradicional tem significante morbidade. A técnica de acesso direto ao seio esfenoidal, sem descolamento da mucosa septal é descrita. Elimina complicações como perfuração de septo, perda do olfato, epistaxe, fístula oronasal e dormência nos lábios. A esfenoidotomia pode ser feita sob visão do microscópio cirúrgico, do endoscópio ou mesmo sob luz frontal, e proporciona um ótimo espaço para remoção dos tumores de origem selar.

  15. Concepción abstracta, edificio FIUC 1956 - 1967

    Directory of Open Access Journals (Sweden)

    Cristián Berríos Flores

    2005-12-01

    El presente escrito se desarrolla por medio de dos entrevistas efectuadas por e-mail desde Barcelona al arquitecto Osvaldo Cáceres, con las limitaciones que pueden originarse al no ser realizadas "en vivo y en directo".

  16. Persistent CSF Rhinorrhoea, Pneumocephalus, and Recurrent Meningitis Following Misdiagnosis of Olfactory Neuroblastoma

    Directory of Open Access Journals (Sweden)

    Neil Barua

    2010-01-01

    Full Text Available A 41-year-old female patient was admitted with streptococcal meningitis on a background of 5-month history of CSF rhinorrhoea. Imaging revealed an extensive skull base lesion involving the sphenoid and ethmoid sinuses, the pituitary fossa with suprasellar extension and bony destruction. Histological examination of an endonasal transethmoidal biopsy suggested a diagnosis of olfactory neuroblastoma. A profuse CSF leak occurred and the patient developed coliform meningitis. A second endonasal endoscopic biopsy was undertaken which demonstrated the tumour to be a prolactinoma. Following endonasal repair of the CSF leak and lumbar drainage, she developed profound pneumocephalus. The patient underwent three further unsuccessful CSF leak repairs. Definitive control of the CSF leak was finally achieved through a transcranial approach with prolonged lumbar drainage. This case illustrates some of the potentially devastating complications which can occur as a consequence of complex skull base lesions. A multidisciplinary approach may be required to successfully manage such cases.

  17. Endoscopic repair of transsellar transsphenoidal meningoencephalocele; case report and review of approaches

    Directory of Open Access Journals (Sweden)

    Maryam Jalessi, M.D.

    2015-06-01

    Full Text Available We present an extremely rare case of transsellar transsphenoidal meningoencephalocele in a 36-year-old woman with pituitary dwarfism complaining of nasal obstruction. Imaging studies showed a bony defect in the sellar floor and sphenoid sinus with huge nasopharyngeal mass and 3rd ventricle involvement. Using endoscopic endonasal approach the sac was partially removed and the defect was reconstructed with fat and fascial graft, and buttressed with titanium mesh and septal flap. Visual field improvement was noticed post-operatively and no complication was encountered during follow-up. So, endoscopic endonasal approach with partial resection of the sac is a safe and effective treatment for this disease

  18. Limiar anaeróbico: comparação entre os métodos directos e indirectos em nadadores de alta competição Portugueses(+(+ Trabalho apresentado sob forma de comunicação oral no II Congresso Hispano-Luso de Pneumologia. Sevilha, 21 de Abril de 1993 econcorrente ao Prémio Thomé Villar 1993 (Secção B. da SPPR.

    Directory of Open Access Journals (Sweden)

    Cecília Longo

    1995-01-01

    Full Text Available RESUMO: Com o objectivo de avaliar o limiar anaeróbico (AT compara-se o ponto de rotura ventilatória ou “limiar ventilatório” (ATV com a lactatémia de 4 mmol/1 (ATL. Realizou-se uma prova de esforço progressiva máxima (EOS Sprint Jaeger, em cicloergómetro, com carga inicial de 1 Watt/ Kg de peso e incrementos todos os dois minutos. Os lactatos foram determinados pelo método enzimático. A determinação do ATV foi efectuada por 2 observadores independentes. Estudámos para o efeito 23 nadadores de alta competição portugueses, submetidos a uma média de treino semanal de 15 h (mínimo 14 e máximo de 22 h. Destes, 16 eram do sexo masculino e 7 do feminino; tinham idades médias de 15.8 anos±2.5 (mínima 13 e máxima de 24 anos. A altura média era de 169 cm± 7.8 e o peso médio foi de 62Kg±10.09.Da análise das médias dos parâmetros cardiorespiratórios e carga aonível do ATL e do ATV encontrámos diferenças com significado estatístico em relação com: a carga em watt/ Kg: ATL 2.98±0.59 e ATV 3.45±0.64 (P =0.01; os watt totais: ATL 184.35±36.9 e ATV 214.8±46.3 (P =0.01; a ventilação minuto (V: ATL 53.85±10.7 e ATV 62.17±16 (P<0.05; a eliminação de CO2 1/ min (VCO2: ATL 2.22±.5 e ATV 2.61±.77 (P<0.05; os valores percentuais entre o consumo de O2 (VO2 ao nível do ATL e do ATV (1/ m e o VO2 máximo (P<0.05; a FC: ATL 147.2±12.3 e ATV 160.3±20 (P=0.01; o cociente respiratório (QR: ATL 0.94±0.06 e ATV 0.99±0.06 (P<0.05. Em relação aos parâmetros médios seguintes não se encontrou differenças estatísticamente significativas: VO2, VO2/FC/Kg, VO2/FC, equivalentes respiratórios para O2 e CO2 (ERO2 e ERCO2. Como a determinação do AT permite precisar a intensidade do exercício a partir do qual o metabolismo anaeróbico lactico é predominante, os resultados do nosso trabalho levam-nos a concluir que, ou o valor do ATL é superior ao convencionado classicamente em indivíduos treinados, ou então não há sobreposição entre o ATL e o ATV. ABSTRACT: We compare the ventililtory threshold (ATV with a 4 mmol/1 of the lactatemie (ATL during a progressive maximal shedule. Lactates were determined by the enzymatic method. ATV determination was done by two independent observers.We studied 23 portuguese elite swimmers, with an average training of 15 hours/week; 16 were male and 7 female. Mean age was 15.8 ±2.5 years old. When we compared cardiorespiratory parameters and load at the level of ATL and ATV, we found statistical significance in the following parameters:• p<0.01: the total load, the load/ kg of weight, heart frequency and• p<0.05: the minute ventilation, the VCO2, the relation of VO2 at AT and VO2 maximum in pourcentage, the respiratory ratio (QR.We conclude that in trained swimmers there are no superposition between ATL and ATV. Key-words: lactates, anaerobic threshold, ventilatory threshold, swimmers, Palavras-chave: lactatos, limiar anaeróbico, limiar ventilatório, nadadores

  19. Sinonasal metallic foreign body penetration of the anterior cranial fossa

    Directory of Open Access Journals (Sweden)

    Madeleine B. Samuelson

    2017-03-01

    Conclusion: Intracranial metallic foreign bodies may have significant potential morbidity. Recent advances in endonasal techniques for anterior skull base access may enhance outcomes through reduced morbidity and mortality, improved speed and precision, shorter hospital stays, and lower post-operative pain [1,2,4]. Technical nuances of these approaches and medical decision-making in the context of various neurosurgical considerations are discussed.

  20. Endoscopic approach to the infratemporal fossa

    Directory of Open Access Journals (Sweden)

    Ahmed Youssef

    2014-06-01

    Conclusions: Endoscopic endonasal transpterygoid approach is considered one of the most useful surgical solutions to manage selected tumors that involve the infratemporal fossa. A good understanding of the endoscopic anatomy of infratemporal fossa allows safe and complete resection of lesions arising or extending to infratemporal fossa.

  1. Méningiome primitif ethmoïdonasal. | Touati | Journal Tunisien d ...

    African Journals Online (AJOL)

    Case report : 52-year-old patient, presented a bilateral nasal obstuction with hyposmie and epistaxis for 4 years, the endonasal examination showed a polypoid process occupying both nasal cavity, the CT examination showed a ethmoïdonasal tumoral process extending to sphenoid bones and both nasal cavity without ...

  2. Optic Nerve Atrophy Due to Long-Standing Compression by Planum Sphenoidale Meningioma.

    Science.gov (United States)

    Di Somma, Alberto; Kaen, Ariel Matias; Cárdenas Ruiz-Valdepeñas, Eugenio; Cavallo, Luigi Maria

    2018-05-01

    In this study we report an uncommon endoscopic endonasal image of an atrophic optic nerve as seen after surgical removal of a suprasellar meningioma. The peculiarity of this case is the long-lasting underestimated ocular symptomatology of the patient who reported a 15-year history of impairment of vision on her left eye. A 51-year-old woman was admitted to our hospital complaining of a 15-year history of impairment of vision on her left eye. After making serendipitously the diagnosis of a suprasellar mass, we performed endoscopic endonasal surgery. The tumor was reached from below and removed safely, without manipulation of the optic pathways. At the end of tumor removal, the impressive left optic nerve atrophy due to enduring local tumor compression was visualized. To the best of our knowledge, no endoscopic endonasal image with such features has been provided in the pertinent literature. Possibly, this contribution will help identify damaged optic nerves during endoscopic endonasal surgery. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. ESTHESIONEUROBLASTOME : DILEMME DIAGNOSTIC ET ...

    African Journals Online (AJOL)

    endoscopie nasale a trouvé un processus tumoral endonasal dans tous les cas. Des adénopathies cervicales ont été retrouvées dans un cas. Le scanner du massif facial et la biopsie tumorale, réalisés dans les trois cas, ont permis de classer ...

  4. Prospective randomized comparison of mitomycin C application in endoscopic and external dacryocystorhinostomy.

    Science.gov (United States)

    Mudhol, Rekha R; Zingade, N D; Mudhol, R S; Harugop, Anil S; Das, Amal T

    2013-08-01

    The aim of the study is to compare the subjective (relief of symptoms) and objective (endoscopic visualization of ostium patency at the time of syringing) outcomes at the end of two procedures-Endonasal DCR versus External DCR with Mitomycin C and to assess the role of Mitomycin C in maintaining patency of nasolacrimal drainage system. Prospective randomized comparative study was performed. Thirty-five patients were enrolled in each endoscopic and external dacryocystorhinostomy groups with Mitomycin C (MMC) application. The 37 eyes underwent endonasal DCR (28 unilateral primary eyes + 1 bilateral primary eyes + 5 unilateral revision eyes + 1 bilateral revision eye) while 35 eyes underwent external DCR (34 unilateral primary eyes + 1 unilateral revision eye). Mitomycin C 0.2 mg/ml was applied intra-operatively for 5 min to the ostium site at the end of endonasal or external DCR procedure. Objective assessment by syringing at the end of 1 year in the endonasal group showed 35 eyes (94%) were patent, 1 (3%) was partially blocked and 1(3%) was completely blocked; while in external group all 35 eyes (100%) were patent. Endoscopic visualization of the ostium at the time of syringing showed only one eye (3%) in the endonasal group was blocked while all the other eyes in both groups were patent. Both groups had a mean follow-up of 6-36 months. No complications were associated with use of Mitomycin C. In conclusion, intra-operative use of Mitomycin C in both endoscopic DCR and external DCR is safe and effective in increasing the success rate.

  5. Pneumatocele selar a tensión: Reporte de un caso y revisión de la literatura

    Science.gov (United States)

    Campero, Álvaro; Ajler, Pablo; Goldschmidt, Ezequiel; Bendersky, Damián; Campero, Abraham

    2012-01-01

    Introducción: El neumoencéfalo a tensión luego de la cirugía transesfenoidal es poco común. En la literatura existen pocos casos reportados en los cuales el aire se encuentra localizado exclusivamente en las regiones selar y supraselar, constituyendo un pneumatocele selar. En este artículo se describe un caso inusual de pneumatocele selar a tensión de presentación tardía. Descripción del caso: Una mujer de 57 años consultó por hemianopsia bitemporal. Previamente, ya se le había realizado una cirugía transnasal por un adenoma hipofisario y se le había colocado una derivación lumbo-peritoneal por la presencia de una fístula de líquido cefalorraquídeo. Además, se le había realizado una resección transcraneal de un componente intracavernoso del tumor y radiocirugía debido a la agresividad del mismo. Se llevó a cabo una resonancia magnética que demostró un pneumatocele selar y supraselar. Intervención: Se realizó un abordaje transciliar. La región selar estaba encapsulada por tejido cicatrizal debido a los procedimientos previos. Se abrió la cicatriz y el aire fue evacuado. Posteriormente, el piso selar fue cerrado con grasa y cola de fibrina. Despuós del procedimiento, su campo visual retornó a la normalidad. Un año después de su última cirugía, continua asintomática. Conclusión: El pneumatocele selar y supraselar a tensión es un hallazgo extremadamente raro luego de una cirugía transesfenoidal. Su manifestaciónw clínica sería la alteración visual debida a la compresión inferior de la vía óptica. El pneumatocele selar a tensión debe ser evacuado en un corto plazo. PMID:23596554

  6. Estimadores compuestos en estadística regional: una aplicación a la estimación de la tasa de variación de la ocupación en la industria

    OpenAIRE

    Costa, Àlex; Satorra, Albert; Ventura, Eva

    2002-01-01

    Este trabajo es parte de un proyecto que estudia la aplicación de estimadores compuestos (combinación de estimadores directos e indirectos) para áreas pequeñas en estadística regional. Comparamos tres estimadores: uno directo basado en datos muestrales de cada Comunidad Autónoma (CA), otro sintético (indirecto) que combina los datos estatales con información específica de las CCAA, y un tercer estimador, el compuesto, basado en un modelo estadístico que se concreta en una combinación lineal d...

  7. Estudio de las principales plagas de insectos chupadores en áreas verdes urbanas de la ciudad de València

    OpenAIRE

    CASTRO ARELLANO, EDISON MANUEL

    2016-01-01

    [ES] Las plagas de insectos chupadores que provocan más daños a las especies vegetales empleadas en áreas verdes urbanas en Valencia son los pulgones (Hemiptera, Aphidoidea) y las psilas (Hemiptera, Psylloidea). Estos insectos provocan daños directos e indirectos en las plantas. Los daños directos son debidos a las picaduras nutricionales que realizan para succionar savia de la planta de la que se alimenta, que provocan un debilitamiento general del árbol afectado. Los daños indirectos se de...

  8. Lealtad en el aire: Factores reales y ficticios de la formación de la lealtad del pasajero de líneas aéreas

    OpenAIRE

    Bravo, Mercedes; Vásquez-Párraga, Arturo Z.; Zamora González, Jorge

    2005-01-01

    Los estudios clásicos de la lealtad indican que éste es el resultado directo de la satisfacción del cliente, razón por la cual surgieron los "programas de lealtad." Este vínculo directo ha sido cuestionado en estudios recientes, según los cuales la lealtad se encuentra determinada por factores relacionales y no transaccionales. Este estudio explora dichos factores respecto de la lealtad del pasajero de líneas aéreas. Los datos primarios provienen de una encuesta en el Aeropuerto Internacional...

  9. La teoría del valor trabajo y los precios en China

    Directory of Open Access Journals (Sweden)

    César Sánchezc

    2015-08-01

    Full Text Available RESUMENLa propuesta de este trabajo es analizar, a partir de comprobaciones econométricas, el grado de relación entre valores y precios para la economía china. A pesar de ser un tema polémico en economía, fue realizado un esfuerzo para mensurar los precios directos y de producción, así como medir su grade de desviación. Los resultados apuntaron hacia una fuerte correlación entre el comportamiento entre los precios directos, de producción y mercado.

  10. Topes en prótesis parcial removible. Realización y diseño actual

    OpenAIRE

    Samsó Manzanedo, Jorge; Anglada Cantarell, José María; Salsench Cabré, Juan; Peraire Ardèvol, Maria

    1993-01-01

    El concepto de soporte fue introducido en relación con los retenedores directos por BONWILL, a finales del siglo XIX, cuando estableció los primeros principios fundamentales de los retenedores directos, indicando la absoluta necesidad de la confección del tope oclusal de los mismos para evitar el enclavamiento en la encía de los elementos retenedor y recíproco (3), así como de toda la prótesis en general(9)...

  11. Complementariedad, exenciones y tributación óptima

    OpenAIRE

    Schenone, Osvaldo H.; Rodríguez, Carlos Alfredo; Mantel, Rolf R.

    2001-01-01

    El debate entre impuestos directos versus impuestos indirectos se resolvió en la decáda de los años cincuenta, haciendo notar que la existencia de bienes no susceptibles de ser gravados destruye la presunción teórica que los impuestos directos son preferibles, desde el punto de vista de la eficiencia y el bienestar, a los impuestos indirectos. Como una consecuencia de este debate se estudió a la estructura tributaria óptima cuando ciertos bienes no son gravables. Utilizando un modelo con dos ...

  12. Primary Ectopic Ethmoidal Craniopharyngioma.

    Science.gov (United States)

    Preti, Andrea; Karligkiotis, Apostolos; Facco, Carla; Ottini, Giorgia; Volpi, Luca; Castelnuovo, Paolo

    2017-06-01

    Craniopharyngiomas are benign but aggressive epithelial tumors usually originating in the anterior lobe of the pituitary gland from squamous remnants of an incompletely involuted craniopharingeal duct developing from the Rathke pouch. To the authors' knowledge only 1 patient of a primary isolated ethmoidal craniopharyngioma has been reported in the literature.The authors report the case of a 17-year-old boy with a primary extracranial ethmoidal craniopharyngioma. An endoscopic endonasal approach was employed to resect the tumor. After 2 years of clinical and radiological follow-up no recurrence of disease was observed.Primary ethmoidal craniopharyngiomas are rare entities and biopsy is necessary for diagnosis. However, a preoperative assessment by means of nasal endoscopy, computed tomography scan, and enhanced magnetic resonance imaging is mandatory to better evaluate the extension and characteristics of the tumor. The endoscopic endonasal technique is a safe and effective approach for the treatment of these lesions.

  13. Fibrous dysplasia as a rare cause of nasolacrimal duct obstruction

    Directory of Open Access Journals (Sweden)

    Bahtiyar Polat

    2015-09-01

    Full Text Available Fibrous dysplasia of the paranasal sinuses is mostly asymptomatic, but sometimes may cause signs and symptoms de- pending on its location. We report two cases of maxillary fibrous dysplasia obstructing the lacrimal drainage system as a reason of chronic dacryocystitis, and reviewed the related literature. The first case underwent an endonasal endoscopic approach combined with external dacryocystorhinostomy. He had a patent lacrimal system at one-year follow-up. The le- sion was completely removed via an endonasal endoscopic approach in the second case, wherein the patient was asymp- tomatic of the six-month follow-up period. [Arch Clin Exp Surg 2015; 4(3.000: 172-175

  14. Science.gov (United States)

    McCLURG, S.W.; CARRAU, R.

    2014-01-01

    SUMMARY The paradigm for the management of epistaxis, specifically posterior epistaxis, has undergone significant changes in the recent past. Recent prospective and retrospective data has shown that the endonasal surgical management of posterior epistaxis is superior to posterior nasal packing and angiography/embolization with regards to various factors including pain, cost-effectiveness, risk and overall control of bleeding. Endonasal endoscopic surgical techniques for posterior epistaxis include direct cauterization and transnasal endoscopic sphenopalatine/ posterior nasal artery ligation or cauterization with or without control of the anterior ethmoidal artery. Despite the evidence provided by the current literature, a universal treatment protocol has not yet been established. This review article provides an up-to-date assessment of the available literature, and presents a structured paradigm for the management of posterior epistaxis. PMID:24711676

  15. Endoscopic management of Atypical sellar cavernous hemangioma: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    A.M. Al-Sharydah

    2018-01-01

    Conclusion: Seller cavernous hemangioma (SCH is an extremely rare lesion that can be misdiagnosed. It is characterized by clinico-radiological features similar to those of other lesions such as pituitary macroadenoma and should be included in the differential diagnosis. The endoscopic endonasal transsphenoidal (EET approach with subtotal/total resection appears to be a feasible option for debulking, with less surgical complications. Nonetheless, combining stereotactic radiosurgery will reduce postsurgical morbidities.

  16. [First branchial cleft cyst in nasopharynx: a case report].

    Science.gov (United States)

    2017-09-20

    We report a rare case of first branchial cleft cyst arising from the nasopharynx. A 47-year old woman with a six-month-history of right ear stuffy and hearing loss was studied. Electronic nasopharyngeal examination revealed a mass in the nasopharynx of this case. The tumor was removed endoscopically with endonasal approach. Postoperative pathological examination indicated that it was branchial cleft cyst. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

  17. Juvenile Nasophryngeal Angiofibroma,New Aspects in Management

    Directory of Open Access Journals (Sweden)

    Mojtaba Mohammadi Ardehali

    2011-03-01

    Full Text Available Juvenile nasopharyngeal angiofibroma (JNA is a rare, benign and locally invasive tumor. Massive bleeding because of vascularity of tumor and postoperative recurrence are potential problems of management. Endonasal approach reduces the rate of postoperative recurrence, intraoperative bleeding, and complications of surgery, time of operation and duration of hospitalization. In this article, we review the indications and contraindications of endoscopic surgery, indications of radiotherapy in treatment of JNA and our policy in postoperative follow-up and management of patients.

  18. Detection of an occult transclival cerebrospinal fluid fistula by CT and MRI

    International Nuclear Information System (INIS)

    Schick, B.; Brors, D.; Draf, W.; Goedecke, A.; Prescher, A.

    1998-01-01

    We describe an unusual occult transclival cerebrospinal fluid (CSF) fistula to the sphenoid sinus demonstrated by MRI. CT was performed because of a posterior cerebral infarct caused by cardiac arrhythmia. Axial sections showed fluid in the sphenoid sinus. High-resolution scans revealed a bony defect 3 mm in diameter of the posterior wall of the sphenoid sinus, and MRI showed a transclival CSF fistula. This occult lesion was confirmed by surgery and duraplasty was successfully performed via an endonasal approach. (orig.)

  19. Efficacy of complex treatment of glaucoma optical neuropathy by Cortexin

    Directory of Open Access Journals (Sweden)

    Shcherbinina I.V.

    2010-12-01

    Full Text Available The comparative analysis of efficacy of intranasal and intramuscular application of cortexin in combination with transcranial magnetotherapy in patients with primary open-angle glaucoma was conducted. 102 patients (182 eyes took part in research with primary open-angle glaucoma of I, II, III stages. The most considerable improvement of visual functions resulted from intramuscular and endonasal introductions of cortexin in combination with transcranial magnetotherapy; and longer stabilization of functional indicators was marked in this group

  20. Intracranial intrasellar kissing carotid arteries: case report Artérias carótidas intracranianas intra-selares "que se beijam": relato de caso

    Directory of Open Access Journals (Sweden)

    Arthur de Azambuja Pereira Filho

    2007-06-01

    Full Text Available Intracranial "kissing" carotid arteries are a rare variant of the carotid arteries, where both internal carotid arteries deviate medially and touch each other near the midline within the sphenoid sinus or the sphenoid bone, including the sella. This anomaly is particularly important since it may cause or mimic pituitary disease and also may complicate transsphenoidal surgery. We report a rare case of intracranial intrasellar kissing carotid arteries in a 57-years-old woman that was submitted to a computed tomography angiography during investigation of a sudden headache, and to discuss the clinical relevance of this radiological finding.Artérias carótidas intracranianas "que se beijam" representam rara variação da anatomia arterial, onde ambas as artérias carótidas internas desviam-se medialmente e tocam-se próximo à linha media dentro do seio esfenoidal ou do osso esfenóide, incluindo a sela túrcica. Essa anomalia é particularmente importante, pois pode causar ou simular doença pituitária e ainda pode complicar uma cirurgia transesfenoidal. Relatamos um raro caso de artérias carótidas intracranianas "que se beijam" em mulher de 57 anos, a qual foi investigada por angiotomografia por quadro de cefaléia súbita. Discutimos a relevância clínica desse achado radiológico.

  1. Basal encephalocele associated with morning glory syndrome: case report Encefalocele basal associada a síndrome "morning glory": relato de caso

    Directory of Open Access Journals (Sweden)

    Ivanete Minotto

    2007-12-01

    Full Text Available The basal encephaloceles refer to rare entities and they correspond to herniation of brain tissue through defects of skull along the cribiform plate or the sphenoid bone. A rare morning glory syndrome, with characteristic retinal defect has been reported in association with basal encephaloceles. Hypophysis hormonal deficiencies may occur. We accounted for a pituitary dwarfism with delayed diagnosed transsphenoidal encephalocele associated with morning glory syndrome, showing the alterations found in retinography, computed tomography and magnetic resonance imaging.As encefaloceles basais são entidades raras e correspondem a herniações do tecido cerebral através de um defeito do crânio, ao longo da lâmina crivosa etmoidal ou do osso esfenoidal. A rara síndrome morning glory, com alterações de fundo de olho características pode apresentar-se associada à encefalocele basal. Deficiências hormonais hipofisárias podem ocorrer. Relatamos caso de nanismo hipofisário com encefalocele transesfenoidal de diagnóstico tardio associada à síndrome de morning glory, mostrando as alterações na retinografia, tomografia computadorizada e ressonância magnética.

  2. An assessment of the isoniazid preventive therapy programme for ...

    African Journals Online (AJOL)

    March 2018, Vol. 108, No. 3. RESEARCH. Tuberculosis (TB) is a significant contributor to the international and national ... high-risk individuals, such as young children and HIV-infected individuals. .... directo rate to conduct research in the area. Results ..... Funding. This publication was made possible by funding from the.

  3. El manejo del área marina y costera protegida Actam Chuleb y los beneficios económicos que genera a los usuarios del municipio de San Felipe, Yucatán, México

    Directory of Open Access Journals (Sweden)

    Wilian de Jesús Aguilar Cordero

    2012-01-01

    Full Text Available El área marina y costera protegida (AMyCP Actam Chuleb se ubica en la costa oriente del estado de Yucatán, en el municipio de San Felipe, donde se realizó el estudio con el fin de caracterizar el manejo de los recursos naturales y estimar los beneficios de uso directo. La metodología se desarrolló en dos etapas; en la primera se identificaron y analizaron las prácticas de manejo y conservación, los bienes y los principales usuarios por medio de entrevistas semiestructuradas y un diagnóstico participativo; en la segunda etapa, se estimó el valor de los beneficios económicos de uso directo y su relevancia en la estructura de actividades económicas de la comunidad por medio una encuesta a los usuarios directos. Los resultados mostraron que no existe un plan de manejo comunitario, sólo se cuenta con una normativa que no es cumplida a cabalidad por la comunidad y que hay una falta de conocimientos, participación y comunicación de los actores sociales para el manejo adecuado y una correcta toma de decisiones. Existe una marcada centralización de poderes, además, los usuarios perciben con mayor facilidad los beneficios de uso directo, generados por la pesca y el turismo, debido a su tangibilidad.

  4. Costo-efectividad de la colecistectomía laparoscópica y de la abierta en una muestra de población colombiana

    Directory of Open Access Journals (Sweden)

    Roosevelt Fajardo

    2011-06-01

    Conclusiones. Hubo mayor estancia hospitalaria en la colecistectomía abierta frente a la mayor duración quirúrgica en la laparoscópica; en el costo directo de la laparoscópica: menor para IPS y pacientes; y en costo-efectividad equiparable para ambos procedimientos.

  5. María Capdevila D’oriola, pionera de la Matemática española

    Directory of Open Access Journals (Sweden)

    Juan Núñez Valdés

    2012-04-01

    Full Text Available En este artículo se muestra una breve biografía, obtenida a luz de la escasa documentación escrita existente y de conversaciones con familiares directos, de María Capdevila D’Oriola, catedrática de Matemáticas de Instituto y primera mujer española profesora universitaria.

  6. Palabras del presidente Carlos S. Menem, a 20 años de la muerte de Juan Domingo Perón

    OpenAIRE

    Menem, Carlos Saúl

    1994-01-01

    Radio Universidad Nacional de La Plata trasmite en directo y registra para su Archivo de la Palabra el mensaje oficial del presidente Carlos Saúl Menem, difundido por cadena nacional de radio y televisión, al cumplirse 20 años del fallecimiento del presidente Juan Domingo Perón.

  7. Tarkvara ja riistvara ei pea firma kapis seisma / Rein Türkson ; interv. Lemmi, Kann

    Index Scriptorium Estoniae

    Türkson, Rein

    2006-01-01

    Kui ettevõttel pole soovi infotehnoloogia tarvis spetsiaalset meeskonda pidada ning infrastruktuuri luua, on võimalik kogu majandustarkvara ning isegi selle majutus teenusena sisse osta. Tallinna kauplus E-Lux kasutab Gate Communicationsi loodud äritarkvara Directo. Skeem

  8. El contencioso de interpretación en materia fiscal y administrativa. Un modelo de justicia para México

    OpenAIRE

    Núñez Cué, Marco Aurelio

    2016-01-01

    El autor esboza sus reflexiones acerca de la conveniencia de la implementación en México del contencioso de interpretación en materia fiscal y administrativa, en la vía de recurso directo de interpretación, haciendo notar las ventajas y beneficios que dicho procedimiento proporcionaría a la justicia administrativa federal mexicana.

  9. Perfil de utilización de los anti-factor de necrosis tumoral en pacientes de Colombia

    Directory of Open Access Journals (Sweden)

    Jorge Machado

    2011-03-01

    Conclusiones. Los anti-TNF se emplearon a las dosis recomendadas, principalmente en artritis reumatoide y en combinación con otros antirreumáticos. El costo directo del tratamiento se consideró elevado para el sistema sanitario del país.

  10. Quenching of Emission and of Photochemistry for Aqueous Rh(NH3)5Cl(2+).

    Science.gov (United States)

    1979-04-01

    Hueneme, CalifornIa 93041 Attn: Dr. R. 3. Marcus 1 Attn: Mr. W. S. Haynes ONR Branch Offi ce Professor 0. Hein7 760 Market Street , Rm. 447...Peebles 1 WashI ngton, D.C. 20380 Directo r, Naval Research Laboratory Offi ce of Naval Researc hWashington, D.C. 20390 Arlington, VIrginia 22217

  11. Síntomas gastrointestinales en pediatría ¿conducen siempre al verdadero diagnóstico?

    Directory of Open Access Journals (Sweden)

    Wilson Daza

    2016-01-01

    Conclusión. El estreñimiento se ubica entre los primeros motivos de consulta y es el primer diagnóstico gastrointestinal directo con una asociación significativa entre ambos. Los profesionales de la salud deben estar atentos para detectar y diagnosticar esta entidad.

  12. Endoscopic transnasal repair of cerebrospinal fluid leaks with and without an encephalocele in pediatric patients: from infants to children.

    Science.gov (United States)

    Ma, Jingying; Huang, Qian; Li, Xiaokui; Huang, Dongsheng; Xian, Junfang; Cui, Shunjiu; Li, Yunchuan; Zhou, Bing

    2015-09-01

    The diagnosis and management of pediatric cerebrospinal fluid (CSF) leak and encephalocele are challenging. The current study aimed to identify patient characteristics, review operative techniques, and evaluate the efficacy and safety of endoscopic endonasal repair in a pediatric population. We retrospectively reviewed the records of pediatric patients who underwent transnasal endoscopic repair of CSF leak with or without a meningocele or an encephalocele at Beijing Tongren Hospital, Capital Medical University, between July 2003 and May 2014. All patients had preoperative radiological evaluations and underwent endoscopic endonasal repair of their skull base defects. Altogether, 23 children (mean age 7.0 years) underwent the procedures. Sixteen cases were congenital, and 7 patients had trauma history. The herniations or defects included meningoencephaloceles in 15 cases, meningoceles in 4 cases, and CSF leak in 4 cases (2 patients had bilateral leaks). The leak or herniation sites were ethmoid roof in 10 patients (one was bilateral), cribriform plate in 5, lateral to the foramen cecum in 3, posterior wall of the frontal sinus in 1, sphenoid sinus in 2, lateral recess of the sphenoid sinus in 1, and sella turcica base in 2. All subjects had favorable clinical outcomes without recurrence during a follow-up of 6-123 months (mean 61.1 months). The endoscopic endonasal approach was the preferred method for repairing CSF leaks with or without an encephalocele in pediatric patients. Compared to traditional operations, this endoscopic procedure is minimally invasive, efficient, and safe.

  13. Pyocele of the lachrymal sac: A late and unusual complication after surgery for a juvenile nasopharyngeal angiofibroma

    Directory of Open Access Journals (Sweden)

    Philippe Eloy

    2008-03-01

    Full Text Available Philippe Eloy, Vincent Bachy, Véronique Grulois, Bernard BertrandDepartment of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Mont-Godinne, Université Catholique de Louvain, Yvoir, BelgiumAbstract: JNA (Juvenile nasopharyngeal angiofibroma is a benign but highly vascular and aggressive tumor that takes its origin in the basisphenoid region close to the sphenopalatine foramen. It occurs invariably in male teenagers. Surgery is the treatment of choice. In the past, external transfacial approaches were recommended. Nowadays endonasal endoscopic approach is performed by experienced teams even for extended tumor. The authors report a case of a pyocele of the lachrymal sac occurring 60 years after a transantral surgery for a JNA. The patient was then successfully operated with an endonasal endoscopic dacryocystorhinostomy using a powered instrumentation and a navigation system. This case confirms the necessity of a long follow-up for all the patients who had a transantral surgery with resection of the medial wall of the maxillary sinus and dissection of the nasolacrymal duct.Keywords: pyocele of the lachrymal sac, complication, surgery for JNA, JNA, endonasal DCR, navigation system

  14. Multiport Combined Endoscopic Approach to Nonembolized Juvenile Nasopharyngeal Angiofibroma with Parapharyngeal Extension: An Emerging Concept

    Directory of Open Access Journals (Sweden)

    Tiruchy Narayanan Janakiram

    2016-01-01

    Full Text Available Background. Surgical approaches to the parapharyngeal space (PPS are challenging by virtue of deep location and neurovascular content. Juvenile Nasopharyngeal Angiofibroma (JNA is a formidable hypervascular tumor that involves multiple compartments with increase in size. In tumors with extension to parapharyngeal space, the endonasal approach was observed to be inadequate. Combined Endoscopic Endonasal Approaches and Endoscopic Transoral Surgery (EEA-ETOS approach has provided a customized alternative of multicorridor approach to access JNA for its safe and efficient resection. Methods. The study demonstrates a case series of patients of JNA with prestyloid parapharyngeal space extension operated by endoscopic endonasal and endoscopic transoral approach for tumor excision. Results. The multiport EEA-ETOS approach was used to provide wide exposure to access JNA in parapharyngeal space. No major complications were observed. No conversion to external approach was required. Postoperative morbidity was low and postoperative scans showed no residual tumor. A one-year follow-up was maintained and there was no evidence of disease recurrence. Conclusion. Although preliminary, our experience demonstrates safety and efficacy of multiport approach in providing access to multiple compartments, facilitating total excision of JNA in selected cases.

  15. Validation of a tactical analysis methodology for the study of pick and roll in basketball

    Directory of Open Access Journals (Sweden)

    Alejandro Vaquera

    2013-01-01

    Full Text Available El objetivo de esta investigación se centra en el diseño y validación de una propuesta metodológica de análisis táctico para el estudio del bloqueo directo en baloncesto, aplicando los principios de la metodología observacional y el registro contextualizado de acciones. Se han desarrollado tres fases: Fase 1 Identificación y selección de variables, donde se han definido y catalogado las variables conductuales (bloqueo directo, contextuales (zona del campo, tiempo de posesión y periodo de juego y evaluativas (resultado de la acción. Fase 2 Creación ad hoc de instrumentos de registro, en la que se ha adaptado una herramienta informática (software VA-Sports: Baloncesto para atender a las particularidades y necesidades específicas del estudio de acciones de bloqueo directo. Fase 3 Control de la calidad del dato, en la que se fijaron los criterios de selección de la muestra, se desarrolló el proceso de entrenamiento de observadores, y se verificó el nivel de acuerdo interno o concordancia intraobservador, para evaluar la fiabilidad de la propuesta metodológica. Fueron analizadas un total de 192 acciones de bloqueo directo correspondientes a 6 partidos completos de la Liga ACB española. Se pudo constatar una elevada fiabilidad de la propuesta metodológica diseñada que, en su conjunto obtuvo un elevado valor promedio de Kappa (0.994, lo que permite concluir que las variables de análisis propuestas resultan precisas, en su definición y categorización para estudiar acciones de bloqueo directo. Las variables tiempo de posesión, periodo de juego y resultado de la acción, han evidenciado un nivel de concordancia máximo (valor Kappa de 1.000, al tiempo que las variables bloqueo directo y zona del campo, también han evidenciado un grado de objetividad elevado (valores de Kappa de .990 y .981 respectivamente.

  16. Australian Principal Instructional Leadership: Direct and Indirect Influence

    Directory of Open Access Journals (Sweden)

    David Gurr-Mark

    2010-01-01

    Full Text Available A partir de los estudios de caso del Proyecto Internacional de Dirección Exitosa de Escuelas, y en relación con un modelo de liderazgo exitoso en escuelas derivado de estudios de caso australianos, en este artículo se presentan tres ejemplos de liderazgo en la enseñanza en escuelas de Australia, tratando tanto el liderazgo directo como el liderazgo indirecto. La dirección de escuelas es un asunto complejo y, aunque hay ejemplos de liderazgo directo en la enseñanza por los directores, el camino más común es el indirecto, trabajando con y por intermedio de terceros. Se encontró que los aspectos comunes del trabajo de los directores fueron los valores y las visiones claramente definidas, el fomento de buenas relaciones, el desarrollo personal de los empleados y el entendimiento de contextos amplios alrededor de las escuelas.

  17. Australian Principal Instructional Leadership: Direct and Indirect Influence

    Directory of Open Access Journals (Sweden)

    David Gurr-Mark

    2010-06-01

    Full Text Available A partir de los estudios de caso del Proyecto Internacional de Dirección Exitosa de Escuelas, y en relación con un modelo de liderazgo exitoso en escuelas derivado de estudios de caso australianos, en este artículo se presentan tres ejemplos de liderazgo en la enseñanza en escuelas de Australia, tratando tanto el liderazgo directo como el liderazgo indirecto. La dirección de escuelas es un asunto complejo y, aunque hay ejemplos de liderazgo directo en la enseñanza por los directores, el camino más común es el indirecto, trabajando con y por intermedio de terceros. Se encontró que los aspectos comunes del trabajo de los directores fueron los valores y las visiones claramente definidas, el fomento de buenas relaciones, el desarrollo personal de los empleados y el entendimiento de contextos amplios alrededor de las escuelas.

  18. Validez de los títulos de adenosina deaminasa en el diagnóstico de la pleuresía tuberculosa en el Hospital San Juan de Dios

    Directory of Open Access Journals (Sweden)

    Azael de Jesús Hernández Castilla

    1995-01-01

    Full Text Available Se tomaron 46 pacientes adultos hospitalizados y ambulatorios con síndrome de derrame pleural y con aceptación para la práctica de toracentesis, biopsia pleural y estudio bioquímico, Se les practicó estudio citoquímico de líquido pleural; determinación de proteínas totales y de DLH en suero sanguíneo; luego biopsia pleural con estudio microscopio y examen directo y cultivo para BK; además  examen directo y cultivo para BK en líquido pleural y determinación de adenosina deaminasa en líquido pleural y suero sanguíneo.

  19. El éxito de los procesos de fusión en el mercado de auditoría: el caso de PriceWaterhouseCoopers

    Directory of Open Access Journals (Sweden)

    Cristina de Fuentes

    2015-01-01

    Los resultados revelan que PriceWaterhouse y Coopers & Lybrand hubiesen alcanzado una cuota de mercado y una facturación inferior a la de sus competidores más directos en caso de no haberse fusionado, aunque las diferencias no son significativas. Por otra parte, la firma fusionada alcanzó una facturación y cuota de mercado significativamente superior a la de sus competidoras más relevantes, siendo en este caso las diferencias estadísticamente significativas. Así pues, este trabajo nos permite concluir que la firma resultante de la fusión, PriceWaterhouseCoopers, ha alcanzado un grado de penetración en el mercado de auditoría mayor que el de sus competidores más directos.

  20. Efectos de la imagen corporativa en el comportamiento del consumidor. Un estudio aplicado a la banca comercial

    Directory of Open Access Journals (Sweden)

    Rafael Bravo

    2011-06-01

    Full Text Available En este trabajo se analiza el efecto de las dimensiones de imagen corporativa sobre la satisfacción, compromiso y lealtad del cliente hacia su entidad bancaria, así como el efecto moderador de las variables sexo, edad y tipo de entidad en estas relaciones. A través de un estudio empírico se muestra que la dimensión relacionada con el personal es la que tiene un mayor efecto directo sobre la satisfacción y la lealtad. Asimismo, la dimensión de justicia en precios es la que tiene un mayor efecto directo sobre el compromiso. El análisis comparativo por grupos de sexo y edad señala diferencias en los efectos de algunas de las dimensiones de imagen, si bien no se observan diferencias significativas entre los bancos y las cajas de ahorros.

  1. Apoplejía pituitaria con parálisis del III par craneal: Reporte de caso

    Directory of Open Access Journals (Sweden)

    Miguel Pinto Valdivia

    2011-10-01

    Full Text Available Se describe el caso de un varón de 65 años de edad, sin antecedentes patológicos de importancia, que acudió a emergencia del Hospital Nacional Cayetano Heredia por presentar cefalea intensa y ptosis palpebral izquierda. El examen físico mostró parálisis aislada del III par craneal izquierdo. Los análisis de laboratorio mostraron hiponatremia e hipopituitarismo y la resonancia magnética nuclear un adenoma pituitario con áreas de hemorragia e invasión de los senos cavernosos. El tratamiento incluyó glucocorticoides y descompresión quirúrgica transesfenoidal. La anatomía patológica confirmó el diagnóstico de infarto hemorrágico de un adenoma pituitario. El paciente fue dado de alta con terapia sustitutiva de levotiroxina y prednisona. La ptosis palpebral izquierda se recuperó en forma parcial. La apoplejía pituitaria es un síndrome clínico producido por un proceso expansivo dentro de la silla turca, secundario a hemorragia o infarto de un adenoma pituitario, que se caracteriza por cefalea, déficit visual, oftalmoplejía y alteración del nivel de conciencia. Este proceso expansivo puede comprimir los pares craneales en los senos cavernosos, produciendo diferentes grados de parálisis de los músculos oculomotores. La parálisis aislada del III par craneal es rara.(Rev Med Hered 2011;22:186-189.

  2. Arquitectura vernácula y tecnología: De la piedra a la nube de puntos, templo nuevo de San Roque de Peine, Salar de Atacama, Chile

    Directory of Open Access Journals (Sweden)

    Sergio Alfaro Malatesta

    2015-06-01

    Para obtener una evaluación sistemática es necesario basarse en un levantamiento crítico a partir del reconocimiento directo del edificio. Hoy es posible incorporar herramientas digitales cuyas tecnologías están diseñadas para obtener lecturas detalladas y fidedignas de cada una de las partes y elementos del edificio. La interface entre el edificio y el ordenador es aquí definida como una nube de puntos 3D.

  3. Efectos del ataque de fitófagos perforadores en el fruto de la encina (Quercus rotundifolia Lam.)

    OpenAIRE

    Soria Iglesias, Francisco Javier; Cano Sánchez, Esperanza; Ocete Rubio, María Elvira

    1996-01-01

    En el presente trabajo se realizan pruebas de germinación de frutos de encina (Quercus rotundifolia Lam.) afectadas por los fitófagos Curculio elephas Gyll. (COL., CURCULIONIDAE) y las especies del género Cydia, C. penkleriana (D. & Schiff.) y C. fagiglandana (Zel.) (LER, TORTRICIDAE). También recoge una serie de mediciones del fruto cuya finalidad es valorar los daños directos de estas especies.

  4. Crítica y apología en la historiografía de los novatores

    Directory of Open Access Journals (Sweden)

    Ángel MESTRE

    2009-11-01

    Full Text Available Sin duda alguna los ilustrados españoles eran muy conscientes de la decadencia cultural española. Decadencia, no sólo en el campo estrictamente científico, sino también en los aspectos culturales en general. Pero es conveniente constatar que, en esta conciencia, los ilustrados eran los herederos directos del planteamiento de los novatores. Estos intentaron superar la decadencia por dos medios.

  5. Identificación de las principales competencias del personal de ventas de una empresa de consumo masivo y su relación con los resultados de alto desempeño

    OpenAIRE

    Candia Zegarra, Edgardo; Venegas Palomino, Jean Pablo

    2016-01-01

    La presente investigación nace con la finalidad de identificar cuáles son las principales de competencias del personal de ventas del sector de consumo masivo, un sector de constante crecimiento y dinamismo en el mercado peruano. En este documento se exploran las competencias de 48 vendedores de una empresa distribuidora de productos de consumo masivo, quienes laboran en el canal directo (venta mayorista) y canal indirecto (venta distribuidoras). La información sobre sus competencias se obtuvo...

  6. Información financiera al servicio de la imagen. Estados contables del nuevo banco español de San Fernando y su sucesor el Banco de España, en la etapa previa al privilegio de emisión (1847-1873

    Directory of Open Access Journals (Sweden)

    Rafael Moreno Fernández

    2008-12-01

    cualitativo y diferente del puramente contable o legalista, que es el que se practicaba en la época, y también con posterioridad. En el mundo actual con la normalización contable de los estados financieros, no puede hacerse, en general, este tipo de análisis directo, si bien la imagen exterior que se transmite en la Memorias de cualquier empresa no suele dejarse al azar, puesto que es componente de su reputación.

  7. Carlos Vesga Duarte

    Directory of Open Access Journals (Sweden)

    Pedro Medina Avendaño

    1981-01-01

    Full Text Available Carlos Vega Duarte tenía la sencillez de los seres elementales y puros. Su corazón era limpio como oro de aluvión. Su trato directo y coloquial ponía de relieve a un santandereano sin contaminaciones que amaba el fulgor de las armas y se encandilaba con el destello de las frases perfectas

  8. El impacto del envejecimiento sobre el sistema de salud colombiano

    Directory of Open Access Journals (Sweden)

    Diego Rosselli

    2016-12-01

    Full Text Available Como circuló ampliamente en las redes sociales, la directo­ra del Fondo Monetario Internacional, Christine Lagarde, dijo hace unos me­ses: “los ancianos viven demasiado y eso es un riesgo para la economía global”. Aunque las palabras de esta abogada y política francesa no hayan sido bien recibidas, en el fondo tienen mucho de verdad…

  9. El impacto de las redes sociales en la función consumo

    OpenAIRE

    Jiménez Nieto, Sara; Jiménez Ruiz, Cristian Camilo

    2013-01-01

    El trabajo evalúa el impacto de las redes sociales en el volumen de ventas en el mercado de consumo masivo directo B2C (Business to consumer), medido a través de la manera en que las redes sociales afectan las preferencias del consumidor y por esta vía su función de consumo en la población

  10. La responsabilidad social empresarial frente a la colectividad laboral en el Perú

    OpenAIRE

    Lapa Salinas, Luz Rosanna

    2014-01-01

    Desarrolla el punto de partida para emprender otras investigaciones sobre la aplicación de los principios económicos, financieros y sociales en cuanto a la aplicación de la Responsabilidad Social Empresarial que se enmarca dentro de un contexto de mejoramiento de la competitividad de las empresas que puede tener impacto directo en la vida de gran cantidad de personas y sus familias.

  11. Remesas y Migración Internacional en América Latina: Simulación de los Efectos en la Pobreza y la Desigualdad

    OpenAIRE

    Battistón, Diego

    2010-01-01

    Este trabajo realiza un estudio comparativo del impacto de las remesas y la migración internacional sobre la pobreza y la desigualdad en cuatro países latinoamericanos con importantes procesos migratorios (Ecuador, El Salvador, Honduras y Nicaragua). A partir de encuestas de hogares se estiman los cambios producidos sobre estas dos dimensiones utilizando diferentes microsimulaciones. La metodología utilizada también permite descomponer los cambios totales en efectos directos e indirectos. Los...

  12. Comercializacion Directa de Alimentos Locales: Diferencias entre los Consumidores de los CSA y los Consumidores de los Mercados de Granjeros y Agricultores

    OpenAIRE

    Curtis, Kynda

    2011-01-01

    Los programas de extensión enfocados en asistir a los agricultores en movilizar o expandir sus esfuerzos de mercadeo directo a menudo consideran todos los mercados de comercialización directa (mercado de agricultores, programas de agricultura sustentada por la comunidad (CSA por sus siglas en inglés), puestos de granja, etc.) y consumidores asociados como una canal o grupo de comercialización general.

  13. Variación de diferentes parámetros de humificación durante dos tipos de compostaje con residuos lignocelulósicos de rosas

    Directory of Open Access Journals (Sweden)

    Diana María Farías Camero

    2010-11-01

    Full Text Available Se llevaron a cabo dos procesos de compostaje a partir de residuos lignocelulósicos de rosas durante 165 días aproximadamente. En uno de los procesos la descomposición del material fue realizada sólo por microorganismos (compostaje directo y en el otro fuera de los microrganismos se adicionaron lombrices de tierra Eisenia foetida (compostaje indirecto.

  14. Infinitivo simple y compuesto con predicados declarativos

    OpenAIRE

    Rodríguez Espiñeira, María José

    2012-01-01

    Este trabajo se centra en las diferencias semánticas y sintácticas que presentan las construcciones de infinitivo simple y compuesto que actúan como objeto directo de predicados declarativos. El tema despierta interés por varios motivos: (1) Se trata de un subconjunto de verbos que subordinan infinitivos simples de un elenco restringido, pero que admiten regularmente infinitivos compuestos.

  15. Micetoma por Nocardia brasiliensis: reporte de caso

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    Miriam Guevara R

    2003-07-01

    Full Text Available Se presenta el caso de un paciente peruano, agricultor, con una infección cutánea de origen traumático causada por Nocardia brasiliensis, que evolucionó hacia la amputación del miembro inferior afectado. El diagnóstico se realizó por examen directo y cultivo del espécimen.

  16. Métodos y Procesos Multicriterio para la Evaluación Social de las Políticas Públicas

    OpenAIRE

    Munda, Giuseppe

    2004-01-01

    Cualquier problema de decisión social se caracteriza por conflictos entre valores e intereses que compiten y diferentes grupos y comunidades que los representan. Por ejemplo, en la gestión ambiental, las metas de biodiversidad, los objetivos del paisaje, los servicios directos de diferentes entornos como fuentes de recursos y como sumideros de desechos, los significados históricos y culturales que los lugares tienen para las comunidades, las opciones recreativas que proporcionan los entornos,...

  17. El interés procesal

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    Juan Carlos Riofrío Martínez-Villalba

    2008-01-01

    Full Text Available El presente trabajo pretende esclarecer el concepto de interés procesal y de sistematizar los diferentes tipos de interés requeridos por las leyes de nuestro ordenamiento jurídico (interés legítimo, directo, serio, difuso, colectivo, mutuo, general, público, etc., a fin de facilitarle al operador de la ley la determinación de la existencia de éste.

  18. Participación de agentes en mercados financieros: aplicación de los modelos Chakraborty-Ray y Dornbusch

    OpenAIRE

    Giovanni Reyes

    2011-01-01

    La finalidad fundamental de este estudio es establecer modelos sobre el comportamiento, factores que influyen, y condicionantes generales macroeconómicas, que afectan la conducta de agentes financieros en dos ambientes diferenciados: (i) financiamiento directo; y (ii) financiamiento indirecto. Se considera el comportamiento de trabajadores con excedentes, inversionistas profesionales e intermediarios financieros, en particular instituciones bancarias. Se hace una aplicación de los modelos de ...

  19. Reasons and results of endoscopic surgery for prolactinomas: 142 surgical cases.

    Science.gov (United States)

    Akin, Safak; Isikay, Ilkay; Soylemezoglu, Figen; Yucel, Taskin; Gurlek, Alper; Berker, Mustafa

    2016-05-01

    We report herein a retrospective analysis of the results of 142 consecutive prolactinoma cases operated upon using an endoscopic endonasal trans-sphenoidal approach over a period of 6 years. Medical records of 142 cases were analysed with respect to indications for surgery, duration of hospital stay, early remission rates, failures and recurrence rates during a median follow-up of 36 months. On the basis of magnetic resonance imaging (MRI) data, 19 patients (13.4 %) had microadenoma, 113 (79.6 %) had macroadenoma, and the remaining 10 (7.0 %) had giant adenomas. Cavernous sinus invasion was identified in 25 patients by MRI and confirmed during surgery. Atypical adenoma was diagnosed in 16 patients. Sparsely granulated prolactin adenoma was identified in 99 patients (69.7 %). Our results demonstrate that male sex and higher preoperative prolactin levels are independent factors predicting persistent disease. The post-surgical complications are as follows: 2.8 % patients had meningitis, 2.1 % patients had postoperative cerebrospinal fluid leak and 2.1 % patients had panhypopituitarism. At the end of follow-up, 74.6 % patients went into remission. During follow-up period, five patients who had initial remission developed recurrence. Our series together with literature data suggest that an endoscopic endonasal trans-sphenoidal approach in the treatment of proloctinomas has a favourable rate of remission. According to the findings of this study, endoscopic endonasal trans-sphenoidal surgery might be an appropriate therapy choice for patients with prolactinoma who could not have been managed with recommended therapeutic modalities.

  20. Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

    Science.gov (United States)

    Dlouhy, Brian J.; Madhavan, Karthik; Clinger, John D.; Reddy, Ambur; Dawson, Jeffrey D.; O’Brien, Erin K.; Chang, Eugene; Graham, Scott M.; Greenlee, Jeremy D. W.

    2012-01-01

    Object Postoperative CSF leakage can be a serious complication after a transsphenoidal surgical approach. An elevated body mass index (BMI) is a significant risk factor for spontaneous CSF leaks. However, there is no evidence correlating BMI with postoperative CSF leak after transsphenoidal surgery. The authors hypothesized that patients with elevated BMI would have a higher incidence of CSF leakage complications following transsphenoidal surgery. Methods The authors conducted a retrospective review of 121 patients who, between August 2005 and March 2010, underwent endoscopic endonasal transsphenoidal surgeries for resection of primarily sellar masses. Patients requiring extended transsphenoidal approaches were excluded. A multivariate statistical analysis was performed to investigate the association of BMI and other risk factors with postoperative CSF leakage. Results In 92 patients, 96 endonasal endoscopic transsphenoidal surgeries were performed that met inclusion criteria. Thirteen postoperative leaks occurred and required subsequent treatment, including lumbar drainage and/or reoperation. The average BMI of patients with a postoperative CSF leak was significantly greater than that in patients with no postoperative CSF leak (39.2 vs 32.9 kg/m2, p = 0.006). Multivariate analyses indicate that for every 5-kg/m2 increase in BMI, patients undergoing a transsphenoidal approach for a primarily sellar mass have 1.61 times the odds (95% CI 1.10–2.29, p = 0.016, by multivariate logistic regression) of having a postoperative CSF leak. Conclusions Elevated BMI is an independent predictor of postoperative CSF leak after an endonasal endoscopic transsphenoidal approach. The authors recommend that patients with BMI greater than 30 kg/m2 have meticulous sellar reconstruction at surgery and close monitoring postoperatively. PMID:22443502

  1. Surgical management of cerebrospinal fluid rhinorrhea under endoscopic control Oclusão das fístulas liquóricas nasais sob visão endoscópica

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    José Alberto Landeiro

    2004-09-01

    Full Text Available The surgical management of cerebrospinal fluid (CSF rhinorrhea has changed after the introduction of functional endoscopic sinus surgery.The following three cases illustrate the repair of CSF leaks with the use of rigid endoscope. Two patients had the diagnosis and the site confirmed after intrathecal fluoresceine saline injection. The obliteration of the CSF was achieved with fat free, mucoperichondrial or mucoperiostal free grafts taken from middle or inferior turbinate and kept in place by fibrin glue. Primary closure was achieved in all patients. The repair of the CSF rhinorrhea by endonasal endoscopic surgery is safe, effective and is a valid alternative to the cranial approach.Descrevemos a técnica de oclusão endoscópica por via endonasal de fístula liquórica proveniente do andar anterior em três pacientes. Dois pacientes tiveram o diagnóstico e os orifícios da fístula localizados após injeção intratecal de fluoresceína sódica. A oclusão foi obtida com enxerto de gordura livre, fragmentos de mucopericôndrio septal ou mucoperiósteal retirado do corneto médio ou inferior e selados com o auxílio de cola de fibrina. A cirurgia endoscópica endonasal é técnica segura e eficaz no tratamento da fístula esfeno-etmoidal, constituindo alternativa à abordagem craniana.

  2. Endoscopic repair of an injured internal carotid artery utilizing femoral endovascular closure devices.

    Science.gov (United States)

    Van Rompaey, Jason; Bowers, Greg; Radhakrishnan, Jay; Panizza, Benedict; Solares, C Arturo

    2014-06-01

    Injury to the internal carotid artery is a feared complication of endoscopic endonasal surgery of the skull base. Such an event, although rare, is associated with high morbidity and mortality. Even if bleeding is controlled, permanent neurological defects frequently persist. Many techniques have been developed to manage internal carotid artery rupture with varying degrees of success. The purpose of this study was to explore endoscopic management of arterial damage with endovascular closure devices used for a femoral arteriotomy. The ability to remotely suture a damaged artery permits the possible adaptation of this technology in managing endoscopic arterial complications. Technical note. After the creation of an endoscopic endonasal corridor in a cadaveric specimen, an arteriotomy was created at the cavernous portion of the internal carotid artery. The Angio-Seal, StarClose, and MynxGrip vascular closure devices were utilized under endoscopic guidance to repair the arteriotomy. Angiography was then done on a cadaver sutured with the StarClose. Both the Angio-Seal and StarClose were deployed quickly and appeared to provide sufficient closure of the arteriotomy. The Angio-Seal required the use of a guidewire and was longer to deploy when compared with the StarClose. The StarClose deployment was quick and facile. The MynxGrip also deployed without difficulty. The Angio-Seal and StarClose systems were both successfully deployed utilizing an endoscopic endonasal approach. The MynxGrip was the easiest to deploy and has the greatest potential to be of benefit in this application. Further studies with hemodynamic models are required to properly assess the appropriateness in this setting. NA. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  3. ESTIMACIÓN DE PARÁMETROS GENÉTICOS PARA PESO AL DESTETE EN GANADO BLANCO OREJINEGRO (BON EN EL NOROCCIDENTE COLOMBIANO

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    Jhon Cañas Á

    2008-04-01

    Full Text Available Objetivo. Estimar los componentes de varianza genético aditivo directo y materno para peso al destete en ganado criollo Blanco Orejinegro (BON. Materiales y métodos. Se utilizaron 356 registros entre los años 1988 al 2007, del núcleo de animales BON puro de la hacienda Vegas de la Clara de la Universidad de Antioquia. El análisis fue realizado utilizando un modelo animal incluyendo los efectos fijos de sexo y época de destete, y como covariable la edad al destete y los efectos aleatorios genético directo, genético materno, ambiente permanente y residual. Resultados. El peso promedio al destete fue de 196.3 ± 31.4 kg, a una edad promedio de 271.8 ± 13.5 días. Se encontraron 21 animales endogámicos con un coeficiente de endogamia de 24.5%. La heredabilidad directa y materna fueron de 0.63 ± 0.36 y 0.22 ± 0.19 con una correlación entre el efecto directo y el materno de -0.78 ± 0.21. Conclusión. De acuerdo a los resultados, existe variabilidad genética en el núcleo BON para esta característica.

  4. Primary clival mucocele: case report.

    Science.gov (United States)

    Fujimoto, Yasunori; Harada, Yu; Toyota, Shingo; Wakayama, Akatsuki; So, Hiroyuki; Yoshimine, Toshiki

    2011-01-01

    A 40-year-old man presented with a history of diplopia due to left abducens nerve palsy persisting for a few days. Neuroimaging examinations revealed a cystic mass in the clivus and erosion of its posterior wall. Drainage of the lesion was accomplished through a small bone defect in the anterior wall of the clivus using the endoscopic endonasal transsphenoidal approach. This procedure improved the symptoms of the patient. Intraoperative and histological findings led to a diagnosis of mucocele. A mucocele localized only in the clivus is uncommon and the pathogenesis may be closely related to pneumatization of the clivus.

  5. Detection of an occult transclival cerebrospinal fluid fistula by CT and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Schick, B.; Brors, D.; Draf, W. [Department of Ear, Nose and Throat Diseases, Head, Neck and Facial Plastic Surgery, Marburg Univ. (Germany); Goedecke, A. [Department of Radiology, Academic Teaching Hospital, Fulda (Germany); Prescher, A. [Department of Anatomy and Embryology, University Medical School, RWTH, Aachen (Germany)

    1998-12-01

    We describe an unusual occult transclival cerebrospinal fluid (CSF) fistula to the sphenoid sinus demonstrated by MRI. CT was performed because of a posterior cerebral infarct caused by cardiac arrhythmia. Axial sections showed fluid in the sphenoid sinus. High-resolution scans revealed a bony defect 3 mm in diameter of the posterior wall of the sphenoid sinus, and MRI showed a transclival CSF fistula. This occult lesion was confirmed by surgery and duraplasty was successfully performed via an endonasal approach. (orig.) With 3 figs., 19 refs.

  6. Primary Atypical Meningioma of the Nasal Cavity: A Case Report and Review of the Literature

    Science.gov (United States)

    Neupane, Yogesh; Pradhan, Bibhu

    2018-01-01

    Background Meningioma is a central nervous system tumor that typically arises in proximity to meninges. Extracranial primary atypical meningioma of sinonasal tract is a rare one. Methods We discuss the clinical, radiological, and histological presentation of an elderly female with primary atypical meningioma of the nasal cavity, which was excised via endoscopic endonasal approach. Results There was no recurrence even up to 20 months of follow-up after endoscopic excision. Conclusion Extracranial primary atypical meningioma should be kept in mind as one of the differential diagnoses of nasal mass. Histopathological diagnosis along with immunohistochemistry should be used for definitive diagnosis. PMID:29682381

  7. Isolated petrous apex ectopic craniopharyngioma

    Directory of Open Access Journals (Sweden)

    Julius July

    2015-12-01

    Full Text Available Primary ectopic craniopharyngioma is a rare entity. Isolated petrous apex bone location has not been reported previously. This study reports a case of 26-year-old male with right abducent nerve palsy. CT and MRI imaging reveal right petrous apex cystic lesion. No sellar or suprasellar region involvement was found. Endoscopic endonasal transphenoid approach has been successfully performed. Histopathology examination confirms the diagnosis of adamantinomatous craniopharyngioma. So far, it’s probably the first case report of primary ectopic craniopharyngioma isolated in the petrous apex. This case report supports the premise that primary ectopic craniopharyngioma is a multifactorial process that starts with an error from migrated embryological cells.

  8. Endoscopic graduated multiangle, multicorridor resection of juvenile nasopharyngeal angiofibroma: an individualized, tailored, multicorridor skull base approach.

    Science.gov (United States)

    Liu, James K; Husain, Qasim; Kanumuri, Vivek; Khan, Mohemmed N; Mendelson, Zachary S; Eloy, Jean Anderson

    2016-05-01

    OBJECT Juvenile nasopharyngeal angiofibromas (JNAs) are formidable tumors because of their hypervascularity and difficult location in the skull base. Traditional transfacial procedures do not always afford optimal visualization and illumination, resulting in significant morbidity and poor cosmesis. The advent of endoscopic procedures has allowed for resection of JNAs with greater surgical freedom and decreased incidence of facial deformity and scarring. METHODS This report describes a graduated multiangle, multicorridor, endoscopic approach to JNAs that is illustrated in 4 patients, each with a different tumor location and extent. Four different surgical corridors in varying combinations were used to resect JNAs, based on tumor size and location, including an ipsilateral endonasal approach (uninostril); a contralateral, transseptal approach (binostril); a sublabial, transmaxillary Caldwell-Luc approach; and an orbitozygomatic, extradural, transcavernous, infratemporal fossa approach (transcranial). One patient underwent resection via an ipsilateral endonasal uninostril approach (Corridor 1) only. One patient underwent a binostril approach that included an additional contralateral transseptal approach (Corridors 1 and 2). One patient underwent a binostril approach with an additional sublabial Caldwell-Luc approach for lateral extension in the infratemporal fossa (Corridors 1-3). One patient underwent a combined transcranial and endoscopic endonasal/sublabial Caldwell-Luc approach (Corridors 1-4) for an extensive JNA involving both the lateral infratemporal fossa and cavernous sinus. RESULTS A graduated multiangle, multicorridor approach was used in a stepwise fashion to allow for maximal surgical exposure and maneuverability for resection of JNAs. Gross-total resection was achieved in all 4 patients. One patient had a postoperative CSF leak that was successfully repaired endoscopically. One patient had a delayed local recurrence that was successfully resected

  9. [Invasive aspergillosis of sphenoidal sinus in a patient in Djibouti, revealed by palsy of cranial nerves: a case report].

    Science.gov (United States)

    Crambert, A; Gauthier, J; Vignal, R; Conessa, C; Lombard, B

    2013-05-01

    The authors report a case of invasive aspergillosis of a sphenoid sinus mucocele revealed in a patient with diabetes in Djibouti by homolateral palsy of the 3rd, 4th, 5th and 6th nerves. This rare condition occurs preferentially in immunodeficient subjects. Because of its clinical polymorphism, its diagnosis is difficult and is often not made until complications develop. Endonasal surgery with anatomopathological and mycological examination is both a diagnostic and therapeutic procedure. It must be performed early, to avoid functional or even life-threatening complications.

  10. Pituitary Apoplexy due to the Diagnostic Test in a Cushing"s Disease Patient.

    Science.gov (United States)

    Kuzu, Fatih; Unal, Mustafa; Gul, Sanser; Bayraktaroglu, Taner

    2018-01-01

    Pituitary apoplexy is a medical condition that needs urgent diagnosis and treatment. It may occur spontaneously or may be precipitated by a variety of reasons including dynamic endocrine tests. Although pituitary apoplexy is usually seen in nonfunctional pituitary adenoma, it can also be seen in ACTH secreting macroadenomas. ACTH secreting adenomas present usually as microadenomas and in these patients apoplexy is rarely seen. In this paper we present a 30-year-old male patient with a history of Cushing"s disease who suffered from pituitary apoplexy after the 1 mg dexamethasone suppression test. He underwent endoscopic endonasal transsphenoidal surgery and his symptoms and signs were significantly improved.

  11. Primary Atypical Meningioma of the Nasal Cavity: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Leison Maharjan

    2018-01-01

    Full Text Available Background. Meningioma is a central nervous system tumor that typically arises in proximity to meninges. Extracranial primary atypical meningioma of sinonasal tract is a rare one. Methods. We discuss the clinical, radiological, and histological presentation of an elderly female with primary atypical meningioma of the nasal cavity, which was excised via endoscopic endonasal approach. Results. There was no recurrence even up to 20 months of follow-up after endoscopic excision. Conclusion. Extracranial primary atypical meningioma should be kept in mind as one of the differential diagnoses of nasal mass. Histopathological diagnosis along with immunohistochemistry should be used for definitive diagnosis.

  12. Efficacy of Chistonos for Children in the Treatment and Prevention of Acute Respiratory Viral Infections in Preschool Children

    Directory of Open Access Journals (Sweden)

    I.V. Dahaieva

    2016-02-01

    Full Text Available The complex of treatment of acute respiratory viral infection (ARVI, acute rhinitis in 43 preschool children was supplemented by endonasal irrigations of Chistonos for children, which is a dosing gel spray containing sea salt, β-carotene, aloe and calendula extracts. A marked local symptomatic relief was registered, as well as an acceleration of the regression of inflammatory changes in the nasal cavity and a significant decrease in the number of complications after acute respiratory disease. Prophylactic use of the product in the preseason allowed to decrease the ARVI (including influenza morbidity rate and to reduce the incidence of the severe form of the disease.

  13. Intrasphenoidal encephalocele and spontaneous CSF rhinorrhoea.

    Science.gov (United States)

    Daniilidis, J; Vlachtsis, K; Ferekidis, E; Dimitriadis, A

    1999-12-01

    Intrasphenoidal encephalocele is a rare clinical entity. In the international literature only 16 cases have been reported up today, with female predominance. Clinically they manifest at middle and advanced ages (40-67 years), when spontaneous CSF rhinorrhoea or recurrent meningitis occurs. We present our case, a 46 years old female, who had CSF rhinorrhoea from the right vestibule for 10 months. The diagnosis was based on the history and the high-resolution brain and skull base CT-scanning in conjunction with opaque fluid injection in the subarachnoidal space through a lumbar puncture. She was successfully treated with an operation, through an endonasal trans-ethmoid microendoscopic approach, using the Draf and Stammberger technique. We discuss the pathogenesis of the intrasphenoidal encephalocele, the existence of small occult defects in the skull base, which cause, at the middle and advanced ages, CSF fistula with spontaneous CSF rhinorrhoea and/or recurrent meningitis. Finally we emphasize the advantages of the endonasal surgical approach for the treatment of this condition.

  14. Efficacy of sellar opening in the pituitary adenoma resection of transsphenoidal surgery influences the degree of tumor resection.

    Science.gov (United States)

    Wang, Shousen; Qin, Yong; Xiao, Deyong; Wei, Liangfeng

    2017-07-24

    Endonasal transsphenoidal microsurgery is often adopted in the resection of pituitary adenoma, and has showed satisfactory treatment and minor injuries. It is important to accurately localize sellar floor and properly incise the bone and dura matter. Fifty-one patients with pituitary adenoma undergoing endonasal transsphenoidal microsurgery were included in the present study. To identify the scope of sellar floor opening, CT scan of the paranasal sinus and MRI scan of the pituitary gland were performed for each subject. Intraoperatively, internal carotid artery injury, leakage of cerebrospinal fluid, and tumor texture were recorded, and postoperative complications and residual tumors were identified. The relative size of sellar floor opening significantly differed among the pituitary micro-, macro- and giant adenoma groups, and between the total and partial tumor resection groups. The ratio of sellar floor opening area to maximal tumor area was significantly different between the total and partial resection groups. Logistic regression analysis revealed that the ratio of sellar floor opening area to the largest tumor area, tumor texture, tumor invasion and age were independent prognostic factors. The vertical distance between the top point of sellar floor opening and planum sphenoidale significantly differed between the patients with and without leakage of cerebrospinal fluid. These results together indicated that relatively insufficient sellar floor opening is a cause of leading to residual tumor, and the higher position of the opening and closer to the planum sphenoidale are likely to induce the occurrence of leakage of cerebrospinal fluid.

  15. Successful application of endoscopic modified medial maxillectomy to orbital floor trapdoor fracture in a pediatric patient.

    Science.gov (United States)

    Matsuda, Yasunori; Sakaida, Hiroshi; Kobayashi, Masayoshi; Takeuchi, Kazuhiko

    2016-10-01

    Although surgical treatment of orbital floor fractures can be performed by many different approaches, the application of endoscopic modified medial maxillectomy (EMMM) for this condition has rarely been described in the literature. We report on a case of a 7-year-old boy with a trapdoor orbital floor fracture successfully treated with the application of EMMM. The patient suffered trauma to the right orbit floor and the inferior rectus was entrapped at the orbital floor. Initially, surgical repair via endoscopic endonasal approach was attempted. However, we were unable to adequately access the orbital floor through the maxillary ostium. Therefore, an alternative route of access to the orbital floor was established by EMMM. With sufficient visualization and operating space, the involved orbital content was completely released from the entrapment site and reduced into the orbit. To facilitate wound healing, the orbital floor was supported with a water-inflated urethral balloon catheter for 8 days. At follow-up 8 months later, there was no gaze restriction or complications associated with the EMMM. This case illustrates the efficacy and safety of EMMM in endoscopic endonasal repair of orbital floor fracture, particularly for cases with a narrow nasal cavity such as in pediatric patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. The Posterior Transpetrosal Approach in a Case of Large Retrochiasmatic Craniopharyngioma: Operative Video and Technical Nuances.

    Science.gov (United States)

    Labidi, Moujahed; Watanabe, Kentaro; Loit, Marie-Pier; Hanakita, Shunya; Froelich, Sébastien

    2018-02-01

    Objectives  To discuss the use of the posterior petrosal approach for the resection of a retrochiasmatic craniopharyngioma. Design  Operative video. Results  In this case video, the authors discuss the surgical management of a large craniopharyngioma, presenting with mass effect on the third ventricle and optic apparatus. A first surgical stage, through an endoscopic endonasal transtubercular approach, allowed satisfactory decompression of the optic chiasma and nerves in preparation for adjuvant therapy. However, accelerated growth of the tumor, with renewed visual deficits and mass effect on the hypothalamus and third ventricle, warranted a supplementary resection. A posterior transpetrosal 1 2 (also called "retrolabyrinthine transtentorial") was performed to obtain a better exposure of the tumor and the surrounding anatomy (floor and walls of the third ventricle, perforating vessels, optic nerves, etc.) 3 . Nuances of technique and surgical pearls related to the posterior transpetrosal are discussed and illustrated in this operative video, including the posterior mobilization of the transverse-sigmoid sinuses junction, preservation of the venous anatomy during the tentorial incision, identification and preservation of the floor of the third ventricle during tumor resection, and a careful multilayer closure. Conclusion  Retrochiasmatic craniopharyngiomas are difficult to reach tumors that often require skull base approaches, either endoscopic endonasal or transcranial. The posterior transpetrosal approach is an important part of the surgical armamentarium to safely resect these complex tumors. The link to the video can be found at: https://youtu.be/2MyGLJ_v1kI .

  17. Endoscopic treatment of trans-sellar trans-sphenoidal encephalocele associated with morning glory syndrome presenting with non-traumatic cerebrospinal fluid rhinorrhea.

    Science.gov (United States)

    Sasani, M; Ozer, A F; Aydin, A L

    2009-03-01

    Basal encephaloceles are rare, accounting for about 1.5% of all encephaloceles. The trans-sellar trans-sphenoidal encephalocele variety is the rarest. Morning glory syndrome is often associated with basal encephalocele. Spontaneous cerebrospinal fluid (CSF) rhinorrheas are the least common of these, accounting for only 3% to 5% of all CSF rhinorrheas. The authors describe the outcome of a 10-year follow-up study of a 26-year-old male patient with a spontaneous CSF rhinorrhea occurring trans-sphenoidal encephalocele associated with bilateral morning glory syndrome that was treated with an endoscopic endonasal approach. Endoscopic exploration of the sella floor was performed and closed with abdomen fat packing and muscle fascia. The postoperative course was uneventful. A follow-up magnetic resonance (MR) image at 6 months postoperatively showed extension of encephalocele in the sphenoidal sinus, which was repaired. The patient had no further CSF rhinorrhea and showed no ophthalmologic changes over a follow-up period of over 10 years. Ophthalmologic findings such as strabismus, in association with anomalies of the optic nerve, should alert the physician to the possible presence of an unrecognized skull base midline defect and encephalocele before CSF leakage is seen. The authors believe that a surgeon who has equal confidence in performing the endoscopic endonasal and conventional microscopic trans-sphenoidal approaches should choose the less invasive surgery.

  18. Ethmoidal encephalocele associated with cerebrospinal fluid fistula: indications and results of mini-invasive transnasal approach.

    Science.gov (United States)

    Fraioli, Mario Francesco; Umana, Giuseppe Emanuele; Fiorucci, Giulia; Fraioli, Chiara

    2014-03-01

    Anterior skull base defects with encephalocele in adults are quite rare and can be a cause of spontaneous rhinoliquorrhea; however, cerebrospinal fluid (CSF) fistula can be not rarely misdiagnosed for several months or years. Five adult patients affected by ethmoidal encephalocele with CSF fistula were treated in our institute from 2006 through to 2011. Onset of clinical history was represented by rhinoliquorrhea, which was precociously recognized in only 1 patient; in the other 4, it was misdiagnosed for a period ranging from 11 months to 5 years. After clinical diagnosis of CSF fistula and after brain magnetic resonance imaging, ethmoidal encephalocele was evident in all patients; preoperative study was completed by spiral computed tomography scan, to clearly identify the skull base bone defect. All patients were operated on by transsphenoidal endonasal endoscope-assisted microsurgical approach through 1 nostril. The herniated brain was coagulated and removed, and reconstruction of cranial base was performed. Postoperative rhinoliquorrhea or other complications did not occur in any patient at short and late follow-up. All patients were discharged after a few days. Endonasal endoscope-assisted microsurgical approach was effective in exposing and repairing the ethmoidal bone defect; tridimensional vision and wide lateral and superior exposition of the operative field were possible in each patient, thanks to the use of microscope and angulated endoscope.

  19. Trigeminocardiac reflex during endoscopic juvenile nasopharyngeal angiofibroma surgery: an appraisal.

    Science.gov (United States)

    Sharma, Shilpee Bhatia; Janakiram, Trichy Narayanan; Baxi, Hina; Chinnasamy, Balamurugan

    2017-07-01

    Juvenile nasopharyngeal angiofibroma is a locally aggressive benign tumour which has propensity to erode the skull base. The tumour spreads along the pathways of least resistance and is in close proximity to the extracranial part of trigeminal nerve. Advancements in expanded approaches for endoscopic excision of tumours in infratemporal fossa and pterygopalatine fossa increase the vulnerability for the trigeminocardiac reflex. The manipulation of nerve and its branches during tumour dissection can lead to sensory stimulation and thus inciting the reflex. The aim of our study is to report the occurrence of trigeminocardiac reflex in endoscopic excision of juvenile nasopharyngeal angiofibroma. To describe the occurence of trigeminocardiac reflex during endoscopic endonasal excision of juvenile nasopharyngeal angiofibroma. We studied the occurrence of TCR in 15 patients (out of 242 primary cases and 52 revision cases) operated for endoscopic endonasal excision of JNA. The drop in mean arterial blood pressure and heart rate were observed and measured. To the best of our knowledge of English literature, this is the first case series reporting TCR as complication in endoscopic excision of JNA. occurence of this reflex has been mentioned in various occular, maxillofacial surgeries but its occurence during endoscopic excision of JNA has never been reported before. Manifestation of trigeminocardiac reflex during surgery can alter the course of the surgery and is a potential threat to life. It is essential for the anesthetist and surgeons to be familiar with the presentations, preventive measures and management protocols.

  20. Surgical Management of Juvenile Nasopharyngeal Angiofibroma Without Angiographic Embolization

    Directory of Open Access Journals (Sweden)

    Raja Ahmad

    2008-10-01

    Full Text Available Juvenile nasopharyngeal angiofibroma (JNA is a rare benign neoplasm that occurs almost exclusively in the nasopharynx of adolescent males. Surgery remains the primary treatment of choice. JNA has always presented a management challenge to surgeons because of its vascular nature, site of occurrence, and local tissue destruction. The surgical approaches are either standard open method which include external or intraoral incisions, or the recent advanced approach, i.e. via using the endonasal endoscope. It is widely accepted that the use of preoperative angiographic embolization reduces the occurrence of intraoperative bleeding and facilitates tumour removal. However, angiographic embolization is not available at all centres. The purpose of this article is to present our experience with five patients diagnosed with JNA who were resected without embolization, using various surgical approaches. Two tumours were removed via endonasal endoscopic surgery. None of the tumours were embolized prior to surgery. We highlight the preoperative evaluation of tumour extent, using both computed tomography (CT and magnetic resonance angiography, and the importance of temporary clamping of the external carotid artery intraoperatively. Our results suggest that the latter procedure is a safe and effective means of facilitating surgery and reducing intraoperative bleeding.

  1. Traction suture modification to tongue-in-groove caudal septoplasty.

    Science.gov (United States)

    Indeyeva, Y A; Lee, T S; Gordin, E; Chan, D; Ducic, Y

    2018-02-01

    Caudal septal deviation leads to unfavorable esthetic as well as functional effects on the nasal airway. A modification to the tongue-in-groove (TIG) technique to correct these caudal septal deformities is described. With placement of a temporary suspension suture to the caudal septum, manual traction is applied, assuring that the caudal septum remains in the midline position while it is being secured with multiple through-and-through, trans-columellar and trans-septal sutures. From 2003 to 2016, 148 patients underwent endonasal septoplasty using this modified technique, with excellent functional and cosmetic outcomes and a revision rate of 1.4%. This modified TIG technique replaces the periosteal suture that secures the caudal septum to the midline nasal crest in the original TIG technique. This simplifies the procedure and minimizes the risk of securing the caudal septum off-midline when used in endonasal septoplasty. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  2. Comparison of Voice Quality Between Patients Who Underwent Inferior Turbinoplasty or Radiofrequency Cauterization.

    Science.gov (United States)

    Göker, Ayşe Enise; Aydoğdu, İmran; Saltürk, Ziya; Berkiten, Güler; Atar, Yavuz; Kumral, Tolgar Lütfi; Uyar, Yavuz

    2017-01-01

    The aim of this study was to analyze and compare the vocal quality in patients who underwent either submucosal turbinectomy or radiofrequency cauterization. In this study, we enrolled 60 patients diagnosed with inferior concha hypertrophy. These patients were divided into two groups by using computer program "Research Randomizer." Of the 60 patients, 30 underwent submucosal inferior turbinoplasty and 30 underwent radiofrequency cauterization. The control group was composed of 30 healthy adults with no nasal or upper aerodigestive system pathology. The patients were checked at weeks 1, 2, and 4. Voice records were taken before the procedure and at week 4 postprocedure. The mean age of patients in the inferior turbinoplasty group was 29.4 years (range: 19-42 years); in the radiofrequency group, it was 30.30 years (range: 18-50 years). There was no statistical difference in age between groups. In the inferior turbinoplasty group, there were 16 male and 14 female patients, and in the radiofrequency group, there were 13 male and 17 female patients. There was no significant difference in the number of males and females between groups. Voice professionals, especially singers, actors, and actresses, should be informed about possible voice changes before undergoing endonasal surgery because these individuals are more sensitive to changes in resonance organs. We believe that voice quality should be regarded as a highly important parameter when measuring the success of endonasal surgery. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  3. Basilar expansion of the human sphenoidal sinus: an integrated anatomical and computerized tomography study

    International Nuclear Information System (INIS)

    Haetinger, Rainer G.; Navarro, Joao A.C.; Liberti, Edson A.

    2006-01-01

    Basilar expansion of the sphenoidal sinus (BESS) was studied in order to demonstrate its critical relevance in endoscopic or microscopic endonasal surgical interventions, including access to the sphenoidal sinus itself or in transsphenoidal pituitary approaches. Direct evaluation of anatomical specimens (25 dry skulls and 25 formalin-fixed hemi heads) and the use of computerized tomography (CT) (50 dry skulls and 750 patients) showed a high BESS frequency (69%). The authors considered BESS to be critical when the posterior wall of the clivus was 2-mm thick and found a high incidence of this important anatomical variation (44%). This study also evaluated the relationship between the sinonasal septa, the clivus, and the internal carotid arteries, and a considerable regularity in the location of these structures was seen. The septa were anatomically related to the internal carotid arteries in 55% and to the clivus in 33% of the cases. In conclusion, the high frequency of critical BESS here described is relevant to endoscopic or microscopic endonasal surgical interventions, including access to the sphenoidal sinus itself or in transsphenoidal pituitary approaches. (orig.)

  4. Traumatic epistaxis: Skull base defects, intracranial complications and neurosurgical considerations.

    Science.gov (United States)

    Veeravagu, Anand; Joseph, Richard; Jiang, Bowen; Lober, Robert M; Ludwig, Cassie; Torres, Roland; Singh, Harminder

    2013-01-01

    Endonasal procedures may be necessary during management of craniofacial trauma. When a skull base fracture is present, these procedures carry a high risk of violating the cranial vault and causing brain injury or central nervous system infection. A 52-year-old bicyclist was hit by an automobile at high speed. He sustained extensive maxillofacial fractures, including frontal and sphenoid sinus fractures (Fig. 1). He presented to the emergency room with brisk nasopharyngeal hemorrhage, and was intubated for airway protection. He underwent emergent stabilization of his nasal epistaxis by placement of a Foley catheter in his left nare and tamponade with the Foley balloon. A six-vessel angiogram showed no evidence of arterial dissection or laceration. Imaging revealed inadvertent insertion of the Foley catheter and deployment of the balloon in the frontal lobe (Fig. 2). The balloon was subsequently deflated and the Foley catheter removed. The patient underwent bifrontal craniotomy for dural repair of CSF leak. He also had placement of a ventriculoperitoneal shunt for development of post-traumatic hydrocephalus. Although the hospital course was a prolonged one, he did make a good neurological recovery. The authors review the literature involving violation of the intracranial compartment with medical devices in the settings of craniofacial trauma. Caution should be exercised while performing any endonasal procedure in the settings of trauma where disruption of the anterior cranial base is possible. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  5. Cerebrospinal fluid fistula as the presenting manifestation of pituitary adenoma: case report with a 4-year follow-up Fístula liquórica como manifestação inicial de macroadenoma hipofisário: relato de caso com 4 anos de seguimento

    Directory of Open Access Journals (Sweden)

    Ricardo Alexandre Hanel

    2001-06-01

    Full Text Available We report the case of a young woman who presented with cerebrospinal fluid (CSF rhinorrhea due to an undiagnosed and untreated pituitary adenoma. The tumor had extended well beyond sella turcica and caused bony erosion. The patient initially refused surgery and was treated with bromocriptine and a radiation therapy. CSF leakage did not improved and she was submitted to surgery by the transsphenoidal approach with removal of a tumor mass located in sphenoid sinus and sellar region. Origin of the leak was localized and repaired with fascia lata and a lumbar subarachnoid drain was left in place for 5 days. After 4 years she has normal serum PRL levels and no rhinorrhea. The management, complications and mechanisms involved in this rare condition are discussed.Relatamos o caso de uma paciente que se apresentou com fístula liquórica devido a macroadenoma de hipófise sem diagnóstico e/ou tratamento prévio. O tumor estendia-se além dos limites da sela túrcica, causando erosão óssea. A paciente inicialmente recusou tratamento cirúrgico e foi então tratada com bromocriptina e radioterapia convencional. O fluxo de liquor da fístula não diminuiu e desta feita a paciente concordou com a realização da cirurgia. Realizou-se acesso transesfenoidal com remoção da massa tumoral do seio esfenoidal e selar. A origem da fístula foi reparada com enxerto autólago de fascia lata. Drenagem liquórica lombar foi utilizada por 5 dias. Atualmente, após 4 anos de seguimento, a paciente se apresenta com níveis normais de prolactina e sem sinais de fístula liquórica. Discutimos o mecanismo fisiopatológico desta rara apresentação dos tumores hipofisários bem como seu manejo e complicações.

  6. SUNCT syndrome associated with pituitary tumor: case report Síndrome SUNCT associada a tumor de hipófise: relato de caso

    Directory of Open Access Journals (Sweden)

    Pedro A.S. Rocha Filho

    2006-06-01

    Full Text Available For twelve years, the subject of this report, a 38-year-old man, presented a clinical condition compatible with the SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome. He presented a stabbing and intense daily pain located in the left pre-auricular and temporal regions. Each of these intense pain attacks lasted around one minute and presented a frequency of two to eight times per day. The pain was associated with ipsilateral lacrimation, conjunctival injection and rhinorrhea. MRI revealed a pituitary tumor with little suprasellar extent. The subject’s serial assays of prolactin, GH, TSH and ACTH were within normal levels. Following transsphenoidal hypophysectomy, with complete removal of the tumor, the subject no more presented pain. The pathological diagnosis was non-secreting adenoma. Fourteen months after the surgery, he remains symptom-free.O paciente relatado neste artigo apresentou uma condição clínica compatível com síndrome SUNCT (cefaléia de curta duração, unilateral, neuralgiforme com hiperemia conjuntival e lacrimejamento. Ele referia dor diária, intensa, em facada, localizada na região pré-auricular e temporal esquerdas. Cada ataque de dor permanecia por cerca de um minuto, com freqüência de duas a oito vezes por dia. A dor se acompanhava de lacrimejamento ipsolateral, congestão conjuntival e rinorréia. A RM mostrou um tumor de hipófise com pouca extensão suprasselar. Dosagens de prolactina, GH, TSH e ACTH estavam em níveis normais. Foi então submetido a hipofisectomia transesfenoidal com remoção completa do tumor após o que a dor cessou completamente. O diagnóstico anátomo-patológico foi adenoma não secretor. Quatorze meses após a cirurgia, o paciente permanecia livre de dor.

  7. Gêmeas idênticas discordantes para a doença de Cushing: relato de caso Identical twins discordant for Cushing's disease: case report

    Directory of Open Access Journals (Sweden)

    MARCELO MAIA PINHEIRO

    1999-09-01

    Full Text Available A doença de Cushing é rara em crianças e sua ocorrência em gêmeos é ainda mais rara. O presente estudo relata a ocorrência de gêmeas idênticas discordantes quanto à doença de Cushing. Uma das gêmeas, desenvolveu síndrome de Cushing aos 10 anos de idade. Sua investigação demonstrou cortisol urinário elevado, ACTH sérico elevado e testes de supressão com dexametasona compatíveis com doença de Cushing. A RMN mostrou macroadenoma hipofisário que foi operado por via transesfenoidal. O estudo imuno-histoquímico confirmou a presença de células produtoras de ACTH. A paciente entrou em remissão clínica e laboratorial desde a cirurgia. Após o desaparecimento dos estigmas do Cushing, a paciente reiniciou ganho estatural, mas permanece menor que sua irmã gêmea. Esta última permanece saudável 4 anos após o início da doença de sua irmã. Este é o terceiro caso do gênero relatado na literatura. Estes achados sugerem que fatores não genéticos estão envolvidos na gênese da doença de Cushing.Cushing's disease is rare in children and its ocurrence in identical twins is extremely rare. This paper reports on identical twins discordant for Cushing's disease. One of them first presented with a cushingoid phenotype by the age of 10. Her evaluation showed an increased urinary free-cortisol and serum ACTH. Her pattern in the dexametazone supression tests was compatible with Cushing's disease. MRI disclosed a pituitary macroadenoma which was removed by the transesphenoidal approach. Immunohistochemical studies of the tumor showed the presence of ACTH-producing cells. The patient went into clinical and laboratorial remission after surgery. She re-started to grow after the disappearance of the Cushing's phenotype but she is still shorter than her healthy sister. The latter remains disease-free 4 years after her sister's diagnosis. This represents the third such case reported in the literature. Our findings suggest that acquired

  8. Infrecuencia de la tricomoniasis como causa de uretritis masculina Estudio por cultivo

    Directory of Open Access Journals (Sweden)

    Federico Díaz G.

    1983-09-01

    Full Text Available En sólo 3 de 92 hombres (3.3% con uretritis no gonocócica (UNG se halló la Trichomonas vaginalis por cultivo; en dos de ellos el examen directo había revelado el parásito; estos resultados confirman la baja frecuencia, previamente informada, de este protozoo en casos de UNG y permiten proponer que el cultivo para Trichomonas no esta justificado en hombres con tal cuadro clínico.

  9. SISTEMA HÍBRIDO FOTOVOLTAICO-EÓLICO PARA LA GENERACIÓN DE ENERGÍA ELÉCTRICA

    OpenAIRE

    Raúl Castillo Meraz; Roberto Carlos Martínez Montejano; Finees Delgado Aranda; Isaac Campos Cantón

    2013-01-01

    El uso de energías fotovoltaica y eólica ha crecido de manera importante en las últimas décadas dados los beneficios directos económicos y ambientales que traen consigo. Una parte importante en estos sistemas de energías renovables son los inversores multinivel. Un inversor multinivel es todo aquel dispositivo que cambia el voltaje de corriente directa (CD) a alterna (CA) de forma escalonada. El puente H es una opción atractiva por sus diversas ventajas, respecto a las otras topologías. En el...

  10. Texto guía de estática y resistencia de materiales

    OpenAIRE

    De la Cruz Morales, Claudia Jenny

    1996-01-01

    El siguiente trabajo consta de la unión de la estática como asignatura con la resistencia de materiales que se dictan en la carrera de ingeniería civil. En su primera etapa se presentan unas generalidades de la estática en cuando al manejo de vectores, cuerpo rígido, equilibrio de cuerpo rígido, etc. y algunos ejemplos. El tema de elementos prismáticos sometidos a fuerza axial ya inicia un acercamiento a la resistencia de materiales, más directo, en forma genérica se plantea el estado ...

  11. Optimización energética para la producción simultánea de azúcar y alcohol en Tucumán, R. Argentina Energetic optimization for simultaneous sugar and alcohol production

    OpenAIRE

    Oscar A. Diez; Carolina Cruz; Gerónimo J. Cárdenas

    2011-01-01

    En este trabajo, se analiza la producción simultánea de azúcar y alcohol en la industria azucarera de la provincia de Tucumán, R. Argentina, y se establece una metodología analítica que permite determinar los rangos productivos para cada uno de los productos finales, minimizando el consumo energético de la planta. Se trabajó sobre un modelo productivo de azúcar blanco directo con destilería anexa. Para lograr los resultados expuestos, se partió de datos históricos o relevados de la planta y d...

  12. Integración de las técnicas de mercadeo y la relación estratégica comunitaria

    OpenAIRE

    Quiroga Naranjo, Diego Fernando

    2015-01-01

    Con el siguiente proyecto se pretende explicar cómo se realiza la integración de las técnicas de mercadeo y la relación estratégica comunitaria, debido a que las organizaciones utilizan conceptos comunitarios. Se analizan las principales estrategias de mercadeo como marketing mix, geomarketing, mercadeo de servicios, mercadeo relacional y mercadeo social. Se explican las técnicas de mercadeo como mercadeo directo, diferenciación de productos, segmentación de mercado, investigación de mercados...

  13. Vestigios invisibles : fotografía y grabado

    OpenAIRE

    Calderón Esteban, Cecilia

    2017-01-01

    El proyecto desarrolla las ideas que fundamentan la obra plástica, la cual ha servido para expresar las inquietudes personales que tanto me preocupan desde que tengo consciencia: viaje y memoria. A partir de una base fotográfica, se han realizado dibujos digitales donde se aísla a la figura principal, capturada en un momento y lugar, previamente con la cámara. Esas ilustraciones han sufrido un tratamiento plástico directo posterior: han sido talladas en linóleo para, más adelante, estam...

  14. Proyección Memoria

    OpenAIRE

    Heilbron Jácome, Ana María; Hernández Delatorre, Juliana; Herrera Dimaté, Daniela

    2015-01-01

    El proyecto consiste en realizar una proyección de videomapping acompañada por una agenda cultural que busca promover a través del video y la tecnología la construcción colectiva de memoria histórica compartida y con perspectiva de futuro, inicialmente a una población que no ha tenido contacto directo con la guerra (población de Bogotá de alto poder adquisitivo). Se analiza el arte como factor generador de empatía entre ciudadanos.

  15. Análisis de la comunicación publicitaria de Apple: La construcción de imagen de marca a través de la creatividad

    OpenAIRE

    Senovilla Rodríguez, Samuel

    2014-01-01

    La imagen de marca de Apple Inc. es uno de los pilares más fuertes que sostienen a la empresa estadounidense. Esta sólida imagen de marca, se ha construido a lo largo de los años y desde 1976 a través de una amplia política de comunicación. Esta mezcla de promoción se nutre de diversas herramientas como la venta personal, la promoción de ventas, las relaciones públicas, el marketing directo, el merchandising o la publicidad y, sin duda, en el caso de Apple Inc. debemos subrayar...

  16. Desbalance del empleo en el sector turístico colombiano

    OpenAIRE

    Manuel Leguizamón

    2009-01-01

    Es aceptado que la actividad turística por excelencia es un generador de empleo directo, sin embargo, los cambios en la prestación de los servicios originados por la creciente mediación de las modernas tecnologías, las nuevas tendencias en los comportamientos de consumo de los turistas, las innovaciones introducidas por las organizaciones prestadoras de servicios turísticos con el fin de mejorar su posición competitivas inducen a reflexionar sobre la actual demanda de capital humano por el se...

  17. Aplicación de la Teoría de Restricciones y su Incidencia en los Costos de Producción en la Empresa MIVIRN, de la ciudad de Riobamba provincia de Chimborazo.

    OpenAIRE

    Guananga Díaz, Freddy Román

    2017-01-01

    El presente proyecto de investigación tuvo como objetivo la elaboración una propuesta de mejora para la empresa MIVIRN aplicando la Metodología de la Teoría de Restricciones (TOC), para minimizar los costos de producción. En el desarrollo de la investigación se logra establecer la demanda histórica y en base a esta se proyecta la demanda futura, que permite evaluar y determinar los tiempos estándar, se costea los centros de producción mediante el costeo directo, con estos ...

  18. Programa de capacitación para la profesionalización de la fuerza de ventas en empresas comercializadoras del sector industrial del Distrito Federal.

    OpenAIRE

    Torres Colunga, Oscar Daniel

    2014-01-01

    La venta de productos industriales presenta características que requieren un estudio particular. Los factores que determinan la compra de estos productos son distintos de los que deciden al comprador productos de gran consumo. Por otra parte aquel a quien se confía la misión de compra de estos productos usualmente no es el consumidor directo. Las compras industriales están determinadas mas por el costo de utilización que por el precio de la oferta y la calidad aquí adquiere un ...

  19. La realidad aumentada en la expresión gráfica

    OpenAIRE

    Silva Recio, Diego

    2016-01-01

    El siguiente Trabajo Final de Máster desarrolla una serie de ejercicios prácticos de sistema diédrico directo, sistema de representación que por su abstracción, representación en un espacio plano los objetos rígidos que tienen hasta seis dimensiones, supone una gran dificultad al inicio de su aprendizaje. Los ejercicios que se plantean constan de unos marcadores de realidad virtual que los alumnos podrán enfocar con sus dispositivos móviles para visualizar los modelos 3D. De esta manera los a...

  20. Modelo de Gestión Administrativa Turística en la Parroquia Santiago de Quito del Cantón Colta Provincia de Chimborazo Periodo 2013

    OpenAIRE

    Arias Guadalupe, Lorena del Carmen

    2015-01-01

    La investigación sobre la aplicación de un modelo de Gestión administrativa para la parroquia Santiago de Quito, en el Cantón Colta en la Provincia de Chimborazo es el resultado de un esfuerzo conjunto con el departamento de turismo del GAD municipal del Cantón Colta, la participación de los servidores turísticos y los aportes dados por los involucrados directos e indirectos con la actividad. Su alcance está definido por las capacidades y potencialidades turísticas propias de la Parroquia y l...

  1. Análisis del uso de herramientas de marketing online por parte del sector fundacional

    OpenAIRE

    Carretero Hidalgo, Patricia

    2018-01-01

    El uso de herramientas de marketing online se ha visto incrementado en los últimos años por parte del sector fundacional con el fin de dar a conocer sus objetivos y fines entre los sociospero también para mejorar la comunicación y poder estar en contacto directo con los mismos. Actualmente, cada vez son más las empresas conectadas a la red y sus usuarios a través de páginas web, redes sociales y plataformas sociales. En el sector fundacional, las fundaciones llevan a cabo distintas ...

  2. Diseño e implementación de un sistema para la segmentación de clientes de una operadora celular

    OpenAIRE

    Cabrera Cuenca, Fabian; Leon Garcia, Sergio Jonathan; Ycaza Diaz, Ilse Lorena; Alvarado Ortega, Juan Aurelio

    2009-01-01

    La Operadora Celular “VIVO”, está operando desde 1993, siendo en la actualidad la empresa líder en el mercado servicios de telecomunicaciones. La compañía comercializa sus productos y servicios mediante varios canales de distribución directos e indirectos, posicionándose en el mercado como líder en la prestación de servicios de telecomunicaciones gracias a su cobertura y número de abonados. Uno de los principales segmentos de la Operadora Celular son sus clientes pospago, los cuales tie...

  3. Abejita Chicolon

    OpenAIRE

    Malaver Izquierdo, Leoncio

    2013-01-01

    La apicultura es el arte y la técnica de cuidar a las abejas, con fines profesionales para la venta de los productos como miel, polen, propóleo, jalea real y cera, obtenidos en la colmena. De allí que se dice que es un arte porque la apicultura no consiste en el cuidado directo de las abejas en comparación a otras especies de animales, porque las abejas son insectos socialmente muy evolucionados, con unas estrategias desarrolladas a un nivel muy alto para conseguir su supervivencia. El arte d...

  4. Intervención de enfermería en Atención Primaria en el cuidador principal del enfermo de Parkinson

    OpenAIRE

    Núñez Castaño, María Cristina

    2014-01-01

    Se propone una intervención de enfermería aplicable en el ámbito de la Atención Primaria dirigida a mejorar la calidad de vida de los cuidadores de enfermos de Parkinson. Para la evaluación de la eficacia de la intervención se llevará a cabo un estudio experimental que incluirá una muestra de 196 enfermos de Parkinson con cuidadores principales jóvenes (35-64 años) que sean familiares directos (hijos o pareja). A cada cuidador se asigna aleatoriamente a una de las dos condiciones experimental...

  5. Desarrollo de plan de marketing para elaboración y posicionamiento en el mercado de tarjeta con beneficios precargados

    OpenAIRE

    Faggliolini, Federico

    2015-01-01

    El desarrollo de una tarjeta con beneficios pre cargados para turistas que visitan la ciudad de Mar del Plata es un negocio atractivo e innovador que permite a todos sus actores beneficiarse. Por esta razón, el estudio de este negocio permitirá vislumbrar las ventajas del ingreso de inversionistas a este segmento del mercado. Por un lado, al momento de análisis, no hay existencia de competidores directos en este segmento, dado que no reúnen las características que brinda este producto/bene...

  6. Estudio sobre la generación de empleo para personas con discapacidad a partir de la computación en la nube

    OpenAIRE

    CERMI

    2014-01-01

    Realizado por el CERMI, con la colaboración de Fundosa Technosite y de diferentes expertos en la materia, el objetivo general de este informe es conocer las posibilidades que puede ofrecer la computación en la nube para la generación de empleos, tanto directos como indirectos, para el colectivo de personas con discapacidad. En cuanto a los objetivos específicos, se plantean los siguientes: identificar y analizar la documentación existente sobre las posibilidades laborales de la computación e...

  7. Ocurrencia de Argyrotaenia sphaleropa Meyrick (1909 (Lepidoptero: Tortricidae en Caesalpinia spinosa (Molina Kuntze Britton & Rose (1824

    Directory of Open Access Journals (Sweden)

    Hipólito Murga Orrillo

    2015-01-01

    Full Text Available Los derivados de las vainas de tara (Caesalpinia spinosa (Molina Kuntze Britton & Rose (1824, presentan crecientes demandas industriales. En octubre del 2015 en la provincia de San Marcos, región Cajamarca, se verificó la ocurrencia de ataque de Argyrotaenia aphaleropa Meyrick (1909 a vainas de tara, produciendo daños directos, interfiriendo en su desarrollo y crecimiento, depreciando comercialmente el producto, generando restricciones en las exportaciones; por lo que esta plaga demanda su manejo integrado para disminuir la incidencia y evitar el ingreso a otras regiones libres de ataques.

  8. Calidad De Servicio Asociada A La Satisfacción Del Usuario Externo En El Área De Niños Del Servicio De Medicina Física Del Hospital Regional Lambayeque Chiclayo – 2017

    OpenAIRE

    Costa Gonzáles, Beatriz Lucciana

    2017-01-01

    Con el objetivo de determinar la asociación entre la calidad de servicio con la satisfacción del usuario externo en el área de niños del servicio de medicina Física del Hospital Regional Lambayeque, 2017, se realizó el presente estudio de tipo descriptivo, prospectivo, transversal, cuantitativo, con una población de 80 usuarios familiares directos (madres) de niños con rehabilitación y una muestra de 63 usuarios del servicio de fisioterapia y rehabilitación durante Marzo 2017 a Mayo 2017, me...

  9. El campesinado gallego y su rechazo a la escuela primaria (1868-1874

    Directory of Open Access Journals (Sweden)

    Mercedes SUÁREZ PAZOS

    2010-03-01

    Full Text Available RESUMEN: Con la nueva política de descentralización educativa, nacida al amparo de la «revolución» de septiembre de 1868, los Ayuntamientos y las Juntas locales de Instrucción Primaria fueron responsables directos de numerosas supresiones de escuelas en el ámbito rural gallego y de los graves problemas que se ocasionaban en el pago de las dotaciones escolares: supresiones, reducciones y atrasos, a pesar de que tales modificaciones no se podían llevar a cabo sin la aprobación de la respectiva Diputación provincial.

  10. El documento electrónico en la Comunidad Andina de Naciones

    OpenAIRE

    Matos Jaqui, Ena G.

    2007-01-01

    Si definimos al comercio electrónico como: ¨Cualquier forma de transacción de negocios en la cual las partes interactúan electrónicamente, en vez de hacerse mediante intercambios o contacto físico directo¨, está claro que el mismo no es nada nuevo, pues en su evolución ha utilizado diversos instrumentos como soporte, desde el teléfono hasta el internet, pasando por el télex y el fax. Con el advenimiento del internet y su extraordinaria difusión vino a reducir de manera consi...

  11. Prevalencia y distribución espacial de brucelosis, leucosis bovina, diarrea viral bovina y rinotraqueítis infecciosa bovina a partir del análisis ELISA de estanques prediales en lecherías de la IX Región, Chile Prevalence and space distribution of brucellosis, bovine leukaemia, bovine viral diarrhea and infectious bovine rhinotracheitis by using bulk milk ELISA test in dairy herds of the IX Region, Chile

    OpenAIRE

    R Felmer; J Zúñiga; A López; H Miranda

    2009-01-01

    Chile es reconocido internacionalmente por poseer una buena situación sanitaria pues el país ha podido alcanzar y mantener el estado de oficialmente libre de las principales enfermedades de la lista de la OIE. Sin embargo, aún coexisten en nuestros rebaños bovinos una serie de enfermedades, las cuales tienen un directo impacto en la producción, por cuanto disminuyen la fertilidad, producen pérdidas por aborto, alargan el lapso interparto y fundamentalmente constituyen barreras sanitarias para...

  12. Prevalencia y distribución espacial de brucelosis, leucosis bovina, diarrea viral bovina y rinotraqueítis infecciosa bovina a partir del análisis ELISA de estanques prediales en lecherías de la IX Región, Chile

    OpenAIRE

    Felmer, R; Zúñiga, J; López, A; Miranda, H

    2009-01-01

    Chile es reconocido internacionalmente por poseer una buena situación sanitaria pues el país ha podido alcanzar y mantener el estado de oficialmente libre de las principales enfermedades de la lista de la OIE. Sin embargo, aún coexisten en nuestros rebaños bovinos una serie de enfermedades, las cuales tienen un directo impacto en la producción, por cuanto disminuyen la fertilidad, producen pérdidas por aborto, alargan el lapso interparto y fundamentalmente constituyen barreras sanitarias para...

  13. Preparación, caracterización y actividad catalítica de CuFe2O4 para el control de emisiones atmosféricas

    OpenAIRE

    Tasca, Julia E.

    2010-01-01

    El término de “contaminación atmosférica” hace referencia a sustancias que ocasionan daños directos sobre animales, plantas y personas, es decir, ejercen un efecto local o regional. Durante siglos, y especialmente en las ciudades, la contaminación del aire no fue un problema. Sin embargo, la expansión de la población y el desarrollo industrial ha modificado la naturaleza de la contaminación del aire. La presencia de grupos con alto consumo de materia y energía conduce necesariamente a la emis...

  14. Protector bucal por laminado a presión en paciente deportista

    OpenAIRE

    Corral, Camila; Mercado, Montserrat; Latapiat, André; Veliz, Andrea; Garrido, Mauricio; de Oliveira Jr, Osmir Batista

    2017-01-01

    RESUMEN: El traumatismo dentoalveolar incluye un conjunto de lesiones que afectan a los dientes y/o estructuras de soporte a consecuencia de un impacto violento directo o indirecto. Debido a que por lo general comprometen el sector anterior generan cambios físicos, fonéticos, psicológicos y dietarios, que pueden afectar significativamente la calidad de vida de pacientes afectados por este traumatismo. Los protectores bucales son considerados la principal medida para minimizar y/o evitar estos...

  15. Ejes de Vigilancia Tecnológica Aplicados en Universidades con Estudios a Distancia (Axes of Technological Surveillance Applied in Distance Learning Universities)

    OpenAIRE

    Arlin J. Izarra Reverol; José G. Sánchez Morles; Norma M. Caira Tovar

    2014-01-01

    Spanish Abstract. El objetivo de la presente investigación es determinar los ejes de la vigilancia tecnológica aplicados en las Universidades del Municipio Maracaibo que ofrecen estudios a distancia, siguiendo los aportes teóricos de López et al. (2007), Palop y Vicente (1999), Martinet y Ribault (1989), Escorsa y Valls (2005), Fundación COTEC (1999) y Jakobiak (1995). La investigación es descriptiva, con un diseño no experimental transeccional de campo. La población la conforman doce directo...

  16. Desarrollo regional y competitividad: la agroindustria azucarera en México

    OpenAIRE

    Lisbeily Domínguez Ruvalcaba

    2005-01-01

    En este artículo se hace un análisis de las principales tendencias de la industria azucarera mexicana durante las últimas dos décadas, a fin de entender el desarrollo y evolución competitiva de esta industria en México, bajo los actuales desafíos que le imprime la globalización de los mercados y sus efectos a nivel local-regional. Se estima que esta industria genera cerca de tres millones de empleos directos e indirectos con una fuerte concentración regional en el estado de Veracruz, el cual ...

  17. Sucesos estresantes y sus impactos en mujeres y jóvenes de la comunidad de cuitzeo, Michoacán: El ciclo de la migración México-EUA en sus familias

    Directory of Open Access Journals (Sweden)

    Nydia Obregón-Velasco

    Full Text Available El presente trabajo describe algunos sucesos de vida estresantes y los impactos que tienen en la salud de las mujeres y sus hijos jóvenes, a partir de la migración hacia EUA de algunos de sus familiares directos, lo cual favorece el ciclo de migración en la familia. Se utilizó la metodología cualitativa con un enfoque de participación-acción, aplicando grupos focales, entrevistas y observación participante durante diferentes actividades realizadas en la comunidad de Cuitzeo, Michoacán, tales como conferencias y talleres.

  18. El rol del apoyo parental, las actitudes hacia la escuela y la autoestima en la violencia escolar en adolescentes

    Directory of Open Access Journals (Sweden)

    Belén Martínez-Ferrer

    2008-01-01

    la autoestima escolar se encuentra negativamente asociada con la violencia. La autoestima familiar se asocia en sentido negativo con la violencia y la percepción de injusticia. Además, el apoyo del padre influye en la violencia de modo directo y a través de su relación con la autoestima familiar y escolar, mientras que el apoyo de la madre se asocia negativamente con la minusvaloración de los estudios y positivamente con la autoestima familiar y la escolar. Finalmente, se discuten los resultados y sus posibles implicaciones.

  19. Efecto del entrenamiento físico sobre los factores endoteliales en el sistema arterial de conejo

    OpenAIRE

    Marchio, Patricia

    2015-01-01

    Las enfermedades cardiovasculares constituyen una de las primeras causas de mortalidad en la población occidental y prácticamente el 50% se podrían prevenir con modificaciones del estilo de vida. En este sentido, la práctica regular de ejercicio físico se asocia con una reducción de entre un 20 a un 40% de la incidencia de eventos vasculares primarios y secundarios y del riesgo de muerte por enfermedad cardiovascular. Parte de estos beneficios estarían relacionados con los efectos directos y ...

  20. Orfeo o el nuevo lenguaje de la pasión

    OpenAIRE

    Otero Álvarez, Joel

    2010-01-01

    Si Freud, en cambio de Edipo, hubiera nucleado su propuesta apelando a otra leyenda ¿qué hubiera acontecido? ¿Si, dése, por caso, como Camus, reflexionara lo humano desde Sísifo; o para pensar lo femenino, retomara las figuras prototípicas de Venus, Hera o Ariadna; si, para no optar por el parricidio, hubiera partido, como Nietzsche, de la contraposición entre Apolo y Dioniso; o, del despedazamiento de este último por los Titanes, antepasados directos de los humanos, precisamente a partir de ...

  1. Calidad de vida de las(os) profesionales de enfermería y sus consecuencias en el cuidado

    OpenAIRE

    ROMERO B, MARÍA NUBIA; MESA M, LORENA; GALINDO H, SOLANYE

    2008-01-01

    Las precarias condiciones laborales en las cuales ejercen el y la profesional de enfermería, manifiestas en la pérdida de estabilidad laboral, de prestaciones sociales y de pago de recargos nocturnos y festivos, en el incremento de la jornada laboral y en el escaso tiempo de dedicación al cuidado directo, entre otros, expresan los efectos del modelo neoliberal aplicado al sector salud e impactan negativamente el cuidado y la calidad de vida personal y familiar de los profesionales, porque res...

  2. Calidad de vida de las(os) profesionales de enfermería y sus consecuencias en el cuidado Qualidade de vida das(os) profissionais da enfermagem e suas conseqüências na atenção Quality of life of nursing professionals and effects for the care they provide

    OpenAIRE

    MARÍA NUBIA ROMERO B; LORENA MESA M; SOLANYE GALINDO H

    2008-01-01

    Las precarias condiciones laborales en las cuales ejercen el y la profesional de enfermería, manifiestas en la pérdida de estabilidad laboral, de prestaciones sociales y de pago de recargos nocturnos y festivos, en el incremento de la jornada laboral y en el escaso tiempo de dedicación al cuidado directo, entre otros, expresan los efectos del modelo neoliberal aplicado al sector salud e impactan negativamente el cuidado y la calidad de vida personal y familiar de los profesionales, porque res...

  3. ACTIVIDAD ANTAGÓNICA DE Trichoderma spp. SOBRE Alternaria porri Y SU EFECTO EN LA ACTIVIDAD ENZIMÁTICA DE CEBOLLA

    OpenAIRE

    Camacho Luna, Valeria

    2015-01-01

    Los hongos del género Trichoderma son utilizados por su actividad antagónica para controlar fitopatógenos ya sea por ataque directo contra el patógeno ó por inducción de la resistencia sistémica de las plantas. Alternaria porri es un patógeno foliar de la cebolla que ocasiona la enfermedad “mancha púpura” que afecta a toda la planta. En este trabajo se identificó morfológicamente aislamientos de T. asperellum obtenidas de raíz de cebolla (TC1, TC2 Y TC3); y T. atroviridae y T. ...

  4. Integración de Modelos de Planeamiento y Scheduling en Sistemas de Información Empresariales

    OpenAIRE

    Vidoni, Melina; Rodriguez, Maria Analia; Vecchietti, Aldo

    2016-01-01

    La aplicación e implementación de modelos matemáticos tendientes a colaborar con la toma de decisiones no resulta un proceso sencillo y directo: existen diversos factores que dificultan la integración de los modelos matemáticos desarrollados con los sistemas de información empresariales. ERP 2 Optimizer Linkage (E2OL) es un sistema que acopla un modelo matemático al sistema empresarial o ERP utilizado, proveyendo las interfaces necesarias para la adecuada visualización y facilitando el modela...

  5. Trabajo y sociedad en América Latina: Introducción

    Directory of Open Access Journals (Sweden)

    Julio César Neffa

    2016-01-01

    Full Text Available La problemática del trabajo humano ha sufrido grandes transformaciones a nivel globaldesde mediados de la década de 1970. Y esa dinámica continúa en nuestros días.Por una parte, desde la emergencia de la crisis en esa época y junto con elestancamiento económico, termina en los países capitalistas industrializados el períododel pleno empleo y el incremento real de los salarios directos e indirectos.

  6. Nº 1. Inicio de la vida de cada ser humano. ¿Qué hace humano el cuerpo del hombre?

    OpenAIRE

    Natalia López Moratalla; Esteban Santiago; Gonzalo Herranz Rodríguez

    2011-01-01

    La Biología aporta un conocimiento directo y objetivo acerca del comienzo de la vida de cada concebido de nuestra especie. Desde la fase de zigoto estamos en presencia de un cuerpo humano en los procesos temporales de la transmisión de la vida. Afirma que el mismo individuo humano es el que existe en la vida embrionaria, en la juventud o en la ancianidad. Aunque el cuerpo cambia continuamente, desde el inicio a la muerte a través de las etapas embrionarias, fetales y después del nacimiento, s...

  7. Modelo de intervención en el espacio público de la ciudad histórica basado en el análisis paramétrico de sus transformaciones, funcionalidad y calidad ambiental : caso estudio de la ciudad de Cartagena

    OpenAIRE

    Melgarejo Torralba, María del Mar

    2017-01-01

    La vida en la calle es la base de la sociabilidad humana, por eso el espacio público va unido al hombre desde el arranque de las civilizaciones. El diseño urbano ha tenido poca influencia en el uso cotidiano que de él hacen los habitantes de la ciudad, por lo tanto determinar el porqué de su éxito permite conectar con los más directos beneficiarios: los ciudadanos. Esta tesis doctoral trata de encontrar las claves del funcionamiento del espacio público urbano para asentar unas bases de cómo a...

  8. Factores críticos de éxito y su influencia en el desarrollo turístico competitivo: caso comunidades de los Uros-Puno periodo 2008-2009

    OpenAIRE

    Arohuanca Percca, Paula Andrea

    2010-01-01

    Este trabajo de Investigación Titulado: "Factores Críticos de Éxito y su influencia en el desarrollo turístico competitivo: caso Comunidad de los Uros-Puno periodo 2008-2009", basado en el tema de desarrollo local y competitividad de territorios subnacionales, con el uso de la metodologia participativa denominada la brújula de competitividad, la que permitió trabajar con los actores directos involucrados en el tema de desarrollo económico local de la comunidad de los Uros. Se trabajó en funci...

  9. La crisis financiera global de los noventa bajo la sombra de los derivados financieros

    OpenAIRE

    Ayca Sarialioglu - Hayali

    2010-01-01

    El objetivo de este artículo es analizar el papel de los instrumentos financieros derivados en las crisis financieras internacionales del mundo en desarrollo en los noventa, tales como la crisis del sureste de Asia en 1997 y la crisis brasileña en 1999, etc. Al respecto, este artículo analiza el papel de los derivados financieros en las crisis internacionales, en términos de los efectos directos de crisis como el elemento principal para crear vulnerabilidad y disparar una masiva y rápida sali...

  10. Proyecto de factibilidad para la implantación de un sistema de recolección de residuos sólidos en la ciudad de Quito parroquia calderón

    OpenAIRE

    Jaramillo Narváez, Sandy Viviana; Vinueza Bracero, Diana Carolina

    2013-01-01

    Actualmente el sistema de Recolección de Desechos Sólidos presenta deficiencias en su manejo, ocasionando, así, problemas directos sobre la población, por este motivo el presente documento se ha elaborado con el objetivo de analizar la factibilidad de implantación de un servicio de soporte para el actual sistema de recolección de desechos sólidos en el cantón de Quito, parroquia Calderón, el cual consiste en la propuesta de un servicio de contenedore...

  11. Interfaces para control cerebral

    OpenAIRE

    Spinelli, Enrique Mario

    2000-01-01

    La función de una interfaz para control cerebral basada en señales de electroencefalograma (EEG), en forma general denominada BCI (Brain control Interface), es establecer un enlace directo entre el cerebro y una máquina, sin utilizar acciones motoras directas. Una BCI permite realizar operaciones simples a partir de la interpretación de las señales de EEG. Su desarrollo está principalmente orientado hacia la ayuda a personas con discapacidades motoras severas, que poseen deterioros en el sist...

  12. Efectos de cruzamiento para producción de leche y características de crecimiento en bovinos de doble propósito en el trópico húmedo

    OpenAIRE

    Sergio Iván Román-Ponce; Felipe de Jesús Ruiz-López; Hugo H. Montaldo; Rita Rizzi; Heriberto Román-Ponce

    2013-01-01

    Con el objetivo de evaluar los efectos de cruzamiento en tres subpoblaciones de ganado bovino cruzados de doble propósito en el trópico húmedo se utilizaron 5,040 lactancias y pesajes corporales al nacimiento [4,429] y pesos ajustados a 205 [3.878], 365 [3,017] y 540 [2,276] días (PN, P205, P365 y P540, respectivamente) de Cebú (CE) y sus cruzas con Holstein (HS), Suizo Pardo (SP) y Simmental (SM). Los efectos aditivos directos de raza (PG), heterocigocidad (HT) y pérdidas por recombinación (...

  13. Los derechos del niño y sus espacios mediáticos en sectores marginados

    OpenAIRE

    Iasenza, Sebastián

    2010-01-01

    El proyecto de extensión “Espacio grande por los derechos de los chicos” se inserta en el área de desarrollo social y fue acreditado y subsidiado por la Universidad Nacional de La Plata en la convocatoria 2009. Está dirigido a chicos y chicas de 6 a 18 años que concurren diariamente a comedores comunitarios y copas de leche de la ciudad de La Plata; y a integrantes estudiantes, graduados y docentes universitarios. Se considera a los primeros, destinatarios directos junto a los coordinadores d...

  14. Búsqueda de equivalentes diagnósticos para el síndrome de burnout desde la medicina tradicional china y acupuntura como una alternativa terapéutica para profesionales del área de la salud / Search equivalents diagnostics for the burnout syndrome from traditional chinese medicine and acupuncture as an alternative therapy for professionals in health area

    OpenAIRE

    Negrete Mendoza, Martha Cecilia

    2012-01-01

    El Síndrome de Burnout o Síndrome de Desgaste Profesional, es un síndrome que tiene múltiples causas siendo la principal la exposición crónica a stress. Es muy frecuente en los profesionales que están en contacto directo con la persona a quien brindan la atención, presentan una adaptación patológica a las diferentes situaciones que se acontecen en su trabajo diario, lo que termina por afectar su estado físico, emocional, y desempeño laboral. Teniendo en cuenta que este síndrome...

  15. La Section d´Or y Juan Gris: Un camino hacia un cubismo espiritual

    OpenAIRE

    Sarriugarte Gómez, Iñigo

    2016-01-01

    [ES] El artista de origen madrileño Juan Gris tuvo la oportunidad de ser testigo directo de la gestación del cubismo a raíz de su estancia en 1906 en la capital francesa. A partir de aquí, comienza a relacionarse con distintos pintores y críticos vanguardistas, que le ofertarán nuevas posibilidades aperturistas para su posterior involucración cubista. El año 1912 marca su definitiva integración bajo la estela pictórica del cubismo sintético, destacando igualmente su relación con el g...

  16. Efecto magnetocalórico en aleaciones ferromagnéticas con memoria de forma monocristalinas de NiFeCoGa.

    OpenAIRE

    Vázquez Risco, Alain

    2017-01-01

    Este trabajo se centrará en el estudio del efecto magnetocalórico de una aleación monocristalina ferromagnética de composición Ni-Fe-Co-Ga. Este tipo de material entra dentro de las denominadas aleaciones con memoria de forma o SMA (Shape Memory Alloys). Estas aleaciones presentan los efectos de memoria de forma de las propias SMA y otras características como las uperelasticidad, los efectos magnetocalóricos directo e inverso. El interés de estos materiales se debe a que pued...

  17. Formación de un banco de adn en la especie cucurbita moschata (duchesne ex lam.) duchesne ex poir y evaluación de ocho marcadores moleculares como código de barras para su autenticación

    OpenAIRE

    Cañar Serna, Dubert Yamil; Vallejo Cabrera, Franco Alirio; Muñoz Florez, Jaime Eduardo

    2014-01-01

    En Colombia, Cucurbita moschata es la especie domesticada de mayor importancia por su área de siembra, producción, versatilidad y consumo directo (Vallejo y Estrada, 2004). Como método de conservación, los bancos de ADN en plantas son el equivalente a las bibliotecas que contienen colecciones de alícuotas vegetales viables, con el propósito de mantener vivo este material y preservar sus características para el beneficio futuro de la humanidad y el medio ambiente (Painting et al., 1995). Actua...

  18. Estudio del soporte tecnológico al Comercio Electrónico e implementación en un caso práctico

    OpenAIRE

    Campoverde Espinoza, Adrián Eugenio; Tenesaca Landi, César Giovanni

    2008-01-01

    El e-commerce o comercio electrónico comprende la realización de cualquier transacción comercial utilizando medios electrónicos, constituidos por dispositivos informáticos, software y redes, en especial Internet, permitiendo el enlace entre compradores y vendedores a través de una interfaz, en la que se efectuará todo o parte del proceso de compraventa. En caso de que el proceso completo se realice de forma online se denomina comercio electrónico directo, esto es posible solo para productos ...

  19. Electrooxidación del etanol y bioetanol sobre catalizadores de naturaleza amorfa de composición Ni59Nb40Pt1 y Ni59Nb39Pt2

    OpenAIRE

    Artutxa, E.; Pierna, A.; Lorenzo, A.; del Val, J.

    2014-01-01

    La ecotoxicidad de las disoluciones provenientes de las pilas de combustible de etanol directo (DEFC) disminuyetras el proceso de electrooxidación con electrodos de naturalezaamorfa. Esta disminución es función del potencialaplicado y de la composición del electrodo utilizado.El proceso de electrooxidación del etanol y bioetanol, sucedetras una secuencia de reacciones, donde se formanvarios productos intermedios que pueden afectar al procesogeneral de electrooxidación de los alcoholes.El bioe...

  20. El enfrentamiento y el conflicto: Factores que intervienen en la depresión

    OpenAIRE

    García-Méndez,Mirna; Rivera Aragón,Sofía; Reyes-Lagunes,Isabel; Díaz-Loving,Rolando

    2011-01-01

    Con el propósito de establecer si el enfrentamiento y el conflicto, intervienen en la depresión, 405 participantes respondieron de manera voluntaria, la escala multidimensional multisituacional de enfrentamiento (Góngora, 1996), la de conflicto (Rivera, Cruz, Arnaldo, & Díaz-Loving, 2004) y el BDI-II (Beck, Steer & Brown, 2006). Resultado de una regresión múltiple paso a paso, la depresión es predicha por estrategias de vida emocional-negativo [β = .405**], pareja directo-revalor...

  1. El enfrentamiento y el conflicto: Factores que intervienen en la depresión

    OpenAIRE

    García-Méndez, Mirna; Rivera Aragón, Sofía; Reyes-Lagunes, Isabel; Díaz-Loving, Rolando

    2011-01-01

    Con el propósito de establecer si el enfrentamiento y el conflicto, intervienen en la depresión, 405 participantes respondieron de manera voluntaria, la escala multidimensional multisituacional de enfrentamiento (Góngora, 1996), la de conflicto (Rivera, Cruz, Arnaldo, & Díaz-Loving, 2004) y el BDI-II (Beck, Steer & Brown, 2006). Resultado de una regresión múltiple paso a paso, la depresión es predicha por estrategias de vida emocional-negativo [β = .405**], pareja directo-revalorativo [β = -....

  2. Expansión global y desarrollo local de proveedores en Tijuana

    OpenAIRE

    Alejandro Mungaray; César Benítez

    2000-01-01

    Con el estudio de caso de una importante empresa global de origen asiático, líder en el sector electrónico de videograbadoras y localizada en Tijuana, se demuestra que su estrategia competitiva internacional tiende a desarrollar una cultura de proveedores industriales de importancia regional. Sin embargo, con la simulación de costos de un lote anual de producción en condiciones de gravamen directo, frente a un gravamen preferencial, se demuestra cómo las posibilidades de una política industri...

  3. Análisis descriptivo de la vacunación antigripal en España: evolución farmacoeconómica: periodo 2002-2007

    OpenAIRE

    Vázquez Valcuende, Jorge

    2010-01-01

    La gripe sigue siendo un importante problema de salud pública, como consecuencia de las altas tasas de morbilidad que produce durante las ondas epidémicas anuales. El incremento en la carga asistencial de consultas y hospitalizaciones, junto con el elevado número de días de absentismo laboral por la enfermedad, supone elevados costes directos e indirectos para la sociedad. La importancia que reviste la vacunación antigripal como medida eficiente en salud pública está bien probada. Se efectúa ...

  4. Análisis y estructuración de un sistema de codificación de bajo costo para una empresa de retail y distribución de calzado hecho a mano

    OpenAIRE

    Restrepo Soto, Juan Camilo

    2016-01-01

    La presente investigación aplicada pretende analizar y estructurar un sistema de codificación de productos para una comercializadora de calzado artesanal con 67 años de experiencia en el sector y con compras de hasta 100.000 pares anuales a 7 talleres de manufactura exclusiva, contando con más de 150 empleados directos e indirectos -- Desde hace tres años la empresa cuenta con un sistema de codificación hexadecimal que rápidamente se obsoletizó al no poder caracterizar completamente los produ...

  5. ¿Cómo prevenir conductas abusivas y delitos tecnológicos en la empresa? Estudio interdisciplinar sobre políticas de uso de las TIC, prevención y gestión de “conflictos” en una muestra de empresas españolas

    OpenAIRE

    Jose R. Agustina

    2013-01-01

    El estudio de las conductas desviadas de los trabajadores en el empleo de los recursos informáticos que la empresa pone a su disposición (el ordenador, el correo electrónico, el teléfono móvil, las PDA…) constituye un área de investigación de creciente interés, en buena medida por su impacto económico, directo e indirecto, en los beneficios empresariales. En este artículo se analizan las estrategias de prevención y control del uso de las nuev...

  6. Optimización y estandarización de procesos para el área de mantenimiento en una compañía minera

    OpenAIRE

    Terbullino Carbajal, Manuel Vladimir; Terbullino Carbajal, Manuel Vladimir

    2008-01-01

    En una compañía minera el área de Mantenimiento asegura la disponibilidad de los activos para que Operaciones cumpla con los planes de producción de mineral. Disponibilidades deficientes en los equipos principales inciden directamente en las metas de producción. Mantener los activos en una empresa minera representa alrededor del 30% - 40% del costo total de la empresa; en virtud del efecto directo que tiene la disponibilidad y los costos en la rentabilidad de una Empresa Minera el área de ...

  7. Condiciones de trabajo en Venezuela en el período 1999-2005: un balance de la cuestión laboral en el proceso bolivariano

    OpenAIRE

    Medialdea García , Bibiana

    2006-01-01

    En esta ponencia trataremos de aportar algunos elementos que contribuyan al balance de la evolución de las condiciones laborales de los trabajadores venezolanos durante los años de proceso bolivariano. Para ello, abordaremos la cuestión sindical, así como la configuración del nuevo marco legal que regula las relaciones laborales en el país. A continuación analizaremos tres aspectos básicos: la informalidad, el desempleo, y los salarios directos. Su situación actual así como su evolución a lo ...

  8. Perfil logístico del sector del cemento en Colombia

    OpenAIRE

    Londoño Floréz, Manuela; Pinto Cortes, Andres Felipe

    2015-01-01

    Este proyecto caracteriza la industria del cemento en Colombia a partir de la contextualización y descripción de esta actividad en el mundo y en el país, describiendo y analizando asuntos relacionados con la cadena de suministro de esta. Teniendo en cuenta los actores directos e indirectos que en esta interactúan y temas como el comercio internacional, el desempeño y la competitividad regional de la industria nacional, la percepción empresarial y factores como la responsabilidad social y las ...

  9. Estudio citogenético en Physalis peruviana l. “Uchuva” (Solanaceae

    Directory of Open Access Journals (Sweden)

    Nohra Cecilia Rodríguez Castillo

    2004-07-01

    los datos citogenéticos. Sé evalúo la acción de la colchicina, para inducir la poliploidización en esta especie, para ello se eligieron frutos del ecotipo “Colombia” con un alto contenido de azúcares y sus semillas se cultivaron in vitro con el inhibidor mitótico, obteniéndose un diploide directo de este ecotipo. Se recomendó hacer un seguimiento de este material, para evaluar esta técnica dentro del programa de fitomejoramiento.

  10. ¿Comprendemos realmente el significado del ALCA?

    OpenAIRE

    Orlando Zelaya Martínez; Luis Murillo Orozco

    2004-01-01

    Después de finalizada la segunda guerra mundial, Estados Unidos se convierte en el gendarme del mundo tanto en lo económico como en lo político, razón por cual decide no únicamente convertirse en el banquero del mundo, sino en su salvador ante el potencial peligro que representaba el comunismo como sistema. De esta forma crea un nuevo tipo de guerra de intensidad en el enfrentamiento directo, pero trasladando tal circunstancia al campo de la amenaza nuclear. Nos estamos refiriendo a la "Guerr...

  11. Parásitos intestinales en inmigrantes de la República Popular China residentes en Ciudad Bolívar, Venezuela

    OpenAIRE

    BLANCO, YTALIA; GUERRERO, LINDARLING; HERRERA, LUISANA; AMA YA, IVAN; DEVERA, RODOLFO

    2007-01-01

    El objetivo de este estudio fue determinar la prevalencia de parásitos intestinales en inmigrantes chinos que trabajan en comercios y restaurantes de Ciudad Bolívar, Venezuela. Entre agosto y septiembre de 2005 se evaluaron 76 muestras fecales, mediante la técnica de examen directo, los métodos de concentración de Kato, Formol-Éter y coloración de Kinyoun. Este grupo fue pareado de acuerdo a la edad y el sexo con 76 residentes autóctonos de Ciudad Bolívar formando así un grupo control. La pre...

  12. La arquitectura de la naturaleza: complejidad y fragilidad en redes ecológicas

    OpenAIRE

    Montoya Terán, José María; Solé, Ricard V.; Rodríguez Fernández, Miguel Ángel

    2001-01-01

    Algo que caracteriza a los ecosistemas en el presente es su acelerada pérdida de biodiversidad. Dentro de cien mil años un paleontólogo clasificaría nuestra época de la historia de la Tierra en el grupo de las extinciones en masa. Algunos efectos directos de esta pérdida de biodiversidad, por ejemplo, la reducción de la productividad primaria, son relativamente conocidos. Otros, de carácter más indirecto pero no por ello menos relevantes, aún son prácticamente desconocidos. Nos referimos a la...

  13. Éxito o fracaso: los servicios de marketing relacional de las cadenas hoteleras. Una aproximación al caso AC

    OpenAIRE

    Hernández Mogollón, José Manuel; Folgado Fernández, José Antonio; Jiménez Caballero, José Luis (Coordinador)

    2009-01-01

    Durante muchos años atrás, la actividad del sector hotelero vivía de espaldas al conocimiento proactivo de sus clientes. En medio de crecientes opciones hoteleras donde no siempre prima la fidelidad hacia una marca, se busca por parte de las enseñas ejercer acciones muy sofisticadas de retención para influir en su decisión final de compra. El objetivo que es entablar contacto directo con el cliente para profundizar en su conocimiento y así poder facilitarle ofertas persona...

  14. Eriptosis. Mecanismos involucrados y efecto protector de la eritropoyetina

    OpenAIRE

    Vota, Daiana Marina

    2012-01-01

    Los procesos inflamatorios, frecuentemente asociados a anemia de enfermedades crónicas, podrían cumplir un rol en la inhibición de la eritropoyesis. La existencia de señales intracelulares comunes entre los procesos que regulan la eritropoyesis y la respuesta inflamatoria sugiere que la desregulación de un sistema podría explicar la disminución de la función del otro. Por otro lado, un daño directo sobre los eritrocitos maduros en circulación, causado por factores presentes en dichos procesos...

  15. Influencia de la edad y la menopausia en el origen de la Dehiscencia del Canal Semicircular Superior

    OpenAIRE

    Fernández Castaño, Carmen

    2014-01-01

    145 p. : il., col. La dehiscencia del canal semicircular superior (DCSS) es una forma de vestibulopatía periférica caracterizada por la ausencia de cobertura ósea en el techo de dicho canal, de este modo su luz interior queda anormalmente abierta al espacio intracraneal en contacto directo con la meninge que tapiza el suelo de la fosa media. Esta dehiscencia se limitaría a la cápsula ótica y no afectaría, aparentemente, al laberinto membranoso. Su presentación clínica es variable, siendo ...

  16. La mejor experiencia

    Directory of Open Access Journals (Sweden)

    Héctor Rojas Herazo

    1966-10-01

    Full Text Available He conocido personas obsesivamente apasionadas por toda clase de conocimiento científico - son eruditos, por ejemplo, en los sistemas de nutrición o en las más insospechadas enfermedades del trópico o en el anecdotario de remotísimas civilizaciones- que, sin embargo, no manifiestan el menor interés por el conocimiento directo e inmediato del hombre, del hombre con quien hablan, discuten y se saludan todos los días.

  17. Lo que posiblemente no conoce del tabaco

    Directory of Open Access Journals (Sweden)

    María Del Rosario Alvarez-Ramirez

    2004-12-01

    Full Text Available El consumo de tabaco afecta tanto a hombres como a mujeres en cualquier grupo de edad, por contacto directo e indirecta. Actualmente el 30% de los adolescentes entre 13 y 18 años son potencialmente fumadores. El fumador habitual puede estar asociado con enfermedades: cardiovasculares, pulmonares, cáncer y desnutrición. Entre 1978 y 1992 el tabaco fue responsable de 621.678 muertes. El 30% de las muertes por cáncer en Europa son causadas por el tabaco. El tabaco causa más de 10.000 muertes diarias en el mundo.

  18. Plan de negocios Oshian Group

    OpenAIRE

    Castillo Bolivar, Evelyn Johana; Charry López, Ingrid Milena

    2013-01-01

    Plan de negocios para crear una empresa de servicios de importación con contacto directo con proveedores y empresarios chinos para el sector de las Pymes Bogotanas. Oshian Group S.A.S., es una empresa importadora, ubicada en el barrio Chico; inicialmente operará en la ciudad de Bogotá, esto no limita el mercado sino que también se podrá expandir a clientes de otras ciudades del país en mediano o largo plazo. Diferentes sectores económicos como las Pymes han mostrado un avance a través de ...

  19. Minería informal e ilegal y contaminación con mercurio en Madre de Dios: Un problema de salud pública

    OpenAIRE

    Osores Plenge, Fernando; Rojas Jaimes, Jesús Eduardo; Manrique Lara Estrada, Carlos Hermógenes

    2012-01-01

    La minería aluvial del oro que se ejecuta tanto informal como ilegalmente en el corredor minero y zonas de exclusión total para la minería en Madre de Dios, viene generando impactos directos e indirectos sobre la salud no sólo de los mineros que trabajan en condiciones de riesgo elevado a la exposición al polvo, la radiación solar excesiva, la humedad, el ruido, traumatismo mecánico vibratorio, exposición directa al mercurio especialmente en estado gaseoso presente en los lugares de compra de...

  20. CDC Signos Vitales: Mortalidad por choques automovilísticos (Motor Vehicle Crash Deaths)

    Centers for Disease Control (CDC) Podcasts

    2016-07-06

    Este podcast se basa en la edición de julio de 2016 del informe Signos Vitales de los CDC. En los Estados Unidos, aproximadamente 90 personas mueren en choques automovilísticos cada día y miles sufren lesiones, lo cual resulta en cientos de millones de dólares en costos médicos directos cada año. Sepa qué puede hacer para mantenerse seguro.  Created: 7/6/2016 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 7/6/2016.

  1. Nodo sensor para la medida ambiental de CO2, temperatura y humedad

    OpenAIRE

    Jara Burgos, Marcos

    2007-01-01

    En este documento se describe el diseño y la implementación de un nodo sen-sor para la medida ambiental del nivel de CO2, la temperatura y la humedad relativa. El sistema se basa en un interfaz directo sensor a microcontrolador para las medidas de temperatura y humedad relativa, mientras que para el sensor de CO2 se basa en una conversión analógica digital. El sistema utiliza un sensor resistivo para medir la temperatura, un sensor capacitivo para medir la humedad relativa y un sensor...

  2. El acoso sexual en el trabajo: el caso de las empresas del sector turístico

    OpenAIRE

    García García, Vanessa

    2016-01-01

    En los últimos años, hemos visto como se han incrementado los casos de acoso sexual en las empresas de cualquier sector. Hacemos hincapié en las empresas del sector turístico, puesto que mantienen un contacto más directo con el cliente y hay mayor presencia femenina. Sin embargo, no sólo nos vamos centrar en casos de acoso sexual hacía mujeres, sino también hacía hombres aunque sea algo más minoritario y poco habitual, como según se ha demostrado en varias investigaciones....

  3. Redes alimentarias alternativas en grandes ciudades: los mercados de productores agrarios en Madrid

    OpenAIRE

    Ricardo Méndez Gutiérrez del Valle; Obdulia Monteserín Abella

    2017-01-01

    Las redes alimentarias alternativas constituyen una temática de investigación emergente en los estudios urbanos, que cuestiona los modelos dominantes de producción, distribución y consumo de alimentos. Una de sus manifestaciones son los mercados de productores, que ponen en contacto directo a productores periurbanos y rurales con consumidores urbanos, favoreciendo las relaciones de proximidad y los circuitos cortos. El artículo investiga los mercados de productores en Madrid mediante una estr...

  4. CDC Signos Vitales: Mortalidad por choques automovilísticos (Motor Vehicle Crash Deaths)

    Centers for Disease Control (CDC) Podcasts

    Este podcast se basa en la edición de julio de 2016 del informe Signos Vitales de los CDC. En los Estados Unidos, aproximadamente 90 personas mueren en choques automovilísticos cada día y miles sufren lesiones, lo cual resulta en cientos de millones de dólares en costos médicos directos cada año. Sepa qué puede hacer para mantenerse seguro.

  5. La tendencia mundial es la intensificación… ¿y el bienestar?

    OpenAIRE

    Amores, Mária José

    2014-01-01

    Actualmente, la producción de alimentos enfrenta grandes retos: un mercado de consumidores con un crecimiento incesante, una diversificación de los gustos de los demandantes, un incremento de las zonas de producción de biocombustibles que compiten con la producción de alimentos, una aceleración en la tasa de deforestación en zonas sensibles y un aumento indiscriminado de las emisiones de metano (entre otros contaminantes directos e indirectos) a la atmósfera, el agua y los suelos, por parte d...

  6. Reseña del libro: Las Laurencias. Violencia sexual y de género en el terrorismo de Estado uruguayo de Soledad Gonzalez Baica y Mariana Risso (comps.)

    OpenAIRE

    Alonso, Jimena; Larrobla, Carla

    2014-01-01

    El siguiente artículo se propone realizar un recorrido analítico de los distintos momentos atravesados por la memoria femenina del terrorismo de Estado en Uruguay. A partir de 1985 fueron emergiendo memorias del horror desde los espacios que se iban habilitando para ellas. Pocos fueron sin embargo los relatos escritos por los protagonistas directos, y menos los de las mujeres. La característica fundamental, de todas estas producciones, fue su carácter esencialmente masculino. Con un relato ba...

  7. Clima organizacional y disposici?n al cambio en una entidad sin ?nimo de lucro

    OpenAIRE

    G?nzalez-Rubio, Daniella; Quintanilla, Karen

    2017-01-01

    El prop?sito de la investigaci?n fue describir el clima organizacional y la actitud hacia el cambio de los colaboradores de la Fundaci?n Compasi?n y Amor, entidad sin ?nimo de lucro, con el fin de generar una propuesta que contribuya al desarrollo organizacional. Se realiz? una investigaci?n cuantitativa y descriptiva con 15 colaboradores de la Fundaci?n, los que tienen contrato directo y est?n en cargo administrativo y los voluntarios que no tienen contrato. Se dise?? y aplic? una bater?a c...

  8. La experiencia en Buchenwald. Estudio comparativo de cinco obras de Jorge Semprún

    OpenAIRE

    Serrano Garrido, Silvia María

    2017-01-01

    Este Trabajo Fin de Máster consiste en un estudio comparativo de las cinco obras de tema concentracionario del escritor e intelectual español Jorge Semprún, el cual fue víctima del régimen nazi entre los años 1943-1945. En estas fechas estuvo deportado en el campo de concentración de Buchenwald, pero sobrevivió para poder contar su experiencia como testigo directo en El largo viaje, Aquel domingo, La escritura o la vida, Viviré con su nombre, morirá con el mío y Ejercicios de supervivencia. ...

  9. RESPONSABILIDAD SOCIAL EMPRESARIAL EN LA DIMENSIÓN LABORAL: CASO BANCOLOMBIA Y BBVA

    Directory of Open Access Journals (Sweden)

    YENNI VIVIANA DUQUE OROZCO

    2012-01-01

    tomando como referente las propuestas por el Suplemento sobre el Sector de Servicios Financieros del Global Reporting Initiative- GRI. Los resultados muestran en ambos casos una fuerte preocupación en los aspectos de formación, salud y seguridad laboral; sin embargo, la brecha salarial entre hombres y mujeres, y la inexistente participación de las minorías son aspectos que aún no han superado. Las diferencias entre las dos entidades radican en las relaciones empresa- trabajadores y los beneficios sociales directos en forma de contribución monetaria.

  10. Aspectos determinantes en la presentación de la enfermedad infecciosa de la bursa

    OpenAIRE

    Jaimes-Olaya, Javier Andrés; Álvarez Espejo, Diana Claudia; Correa, Jairo Jaime; Vera Alfonso, Víctor Julio

    2009-01-01

    La enfermedad infecciosa de la bursa, o enfermedad de Gumboro, es una patología inmunosupresiva de las aves de gran importancia en la industria avícola, debido a las grandes pérdidas económicas que produce no sólo por su efecto directo, sino por la predisposición a infecciones secundarias y a la interferencia con las vacunas comerciales, disminuyendo la eficacia de éstas. Es producida por el virus de la enfermedad infecciosa de la bursa (IBDV), el cual es un birnavirus de genoma RNA, con alta...

  11. Intoxicación suicida por paracetamol Suicidal poisoning with paracetamol

    OpenAIRE

    J. Blanco Pampín; N. Morte Tamayo

    2002-01-01

    La intoxicación por paracetamol es un hecho verdaderamente infrecuente, debido sobre todo al elevado rango terapéutico que posee. Los efectos letales de su ingestión a menudo son el resultado de las complicaciones que originan, aunque por efecto directo del fármaco (intoxicación aguda) se producen tanto en suicidios como a causa de sobredosis en búsqueda de analgesia (intoxicación medicamentosa accidental). El presente artículo expone el caso de una mujer joven con antecedentes psiquiátricos,...

  12. El contexto familiar como factor fundamental en la violencia filio-parental

    OpenAIRE

    Lema-Moreira, Estefanía

    2015-01-01

    Revista de psicologia da criança e do adolescente. - ISSN 1647-4120. - V. 5, n. 1 (Janeiro-Junho 2014). - p. 267-275. La violencia filio-parental, en adelante VFP, se trata de una forma de violencia en la que los progenitores son víctimas directos de sus hijos. Es sabido que el seno familiar es un contexto de socialización sumamente importante (Musitu Ochoa, Estévez López, y Jiménez Gutiérrez, 2010) y por ello la influencia de este proceso en el desarrollo emocional es indiscutible (Sprint...

  13. Seguridad funcional de sensores de gas

    OpenAIRE

    Vega Remesal, Ángel; Medic Pejic, Ljiljana; Garcia Torrent, Javier

    2013-01-01

    La protección adecuada de los equipos o sistemas que han de trabajar en atmósferas potencialmente explosivas no es suficiente cuando se trata de la seguridad frente a posibles explosiones o a la prevención de potenciales riesgos directos de las personas, en cuyo caso deben estar amparados también por la llamada seguridad funcional que exige una serie de requisitos adicionales, cuya documentación debe proporcionar el fabricante de los equipos, junto con su manual de instrucciones.

  14. Plan de empresa de una productora audiovisual de nueva creación en la ciudad de Valencia

    OpenAIRE

    BARBA MUÑOZ, SARA

    2013-01-01

    [ES] El presente trabajo ha sido un recorrido acerca de la realización de un plan de empresa audiovisual situada en Valencia. Hemos ideado una empresa audiovisual especialmente dirigida a ofrecer sus productos a las medianas empresas. Hemos analizado el sector audiovisual como un ente en constante crecimiento dado su relación con las nuevas tecnologías; lo que le da categoría de un sector generador de empleo directo; especialmente en los jóvenes que en la actualidad es un...

  15. Arritmias en el embarazo: ¿Cómo y cuándo tratar?

    OpenAIRE

    Gómez Flores,Jorge R; Márquez,Manlio F

    2007-01-01

    El embarazo puede favorecer la presencia de arritmias cardíacas que no se habían presentado previamente en individuos aparentemente sanos. Los factores que potencialmente pueden promover la presencia de arritmias en el embarazo y durante la labor y el parto se atribuyen a los efectos electrofisiológicos cardíacos directos de las hormonas, cambios en el tono autonómico, alteraciones hemodinámicas, hipokalemia del embarazo y enfermedad cardíaca subyacente. Tanto la taquicardia paroxística supra...

  16. La percepción de la imagen de marca. Tratamiento por borrosidad.

    OpenAIRE

    Lozano Gutierrez, María del Carmen; Fuentes Martín, Federico

    2003-01-01

    Los sistemas basados en la lógica difusa o borrosa resultan especialmente adecuados en el tratamiento de procesos que están gobernados por reglas intuitivas y que difícilmente pueden expresarse matemáticamente. La gran potencia de esta metodología se debe a la posibilidad de expresar operaciones y controlar las reglas del sistema mediante palabras de uso cotidiano. La lógica borrosa elimina los altos contenidos de la matemática y va directo al nivel en el que el sistema trabaja...

  17. Ingeniería Civil, 2010-11

    OpenAIRE

    Villarino Otero, Alberto

    2010-01-01

    I. Materiales de clase: Tema 1. Maquinaria de Obra Civil; Tema 2. Materiales de Construcción; Tema 3. Muros; Tema 4. Cimentaciones; Tema 5. Presas; Tema 6. Carreteras; Tema 7. Puentes; Tema 8. Teoría y Cálculo de Estructuras; Tema 9. Proyectos. II. Bibliografía. El curso Ingeniería Civil engloba un campo extensísimo, constituyendo el curso un breve resumen, intentado tratar los temas de mayor relevancia y con los cuales el ingeniero tendrá contacto directo en su vida profesional. El cu...

  18. Valoración de impacto ambiental en el Puerto Moa-Holguín

    OpenAIRE

    Guilarte, A; Díaz, A; Nápoles, J; Fernández, O; Abalos, A; Pérez, R.M

    2015-01-01

    Las operaciones de descarga de los buques-tanques, la recepción y distribución de productos derivados del crudo de petróleo en el área de almacenamiento, el movimiento de insumos como el carbón antracita, amoniaco y azufre, la carga de lotes de minerales así como el mantenimiento de los tanques, conducen al vertimiento directo de hidrocarburos que afectan los diferentes ecosistemas en los cuales se encuentra situada la fuente contaminante. Se presenta la caracterización de los ecosistemas afe...

  19. Proceso de obtención de derivados de azetidinas

    OpenAIRE

    Boto, Alicia; Gallardo, Juan Antonio; Álvarez, Eleuterio

    2010-01-01

    Procedimiento de obtención de derivados de azetidinas. La presente invención se refiere a un procedimiento de síntesis de azetidina basado en reacciones de escisión radicalarias, que es más sencillo y directo que los métodos utilizados habitualmente. En dicho procedimiento se hace reaccionar un compuesto que contiene un alquilo C2 sustituido o sin sustituir, con un nucleófilo que contiene un grupo -CH=CH-Z, donde Z puede ser arilo o heteroarilo.

  20. Las instituciones de la democracia directa

    Directory of Open Access Journals (Sweden)

    Daniel Zovatto Garetto

    2015-07-01

    Full Text Available Estudia el nivel de institucionalización de la democracia directa en los sistemas políticos latinoamericanos. Toma en cuenta como democracia directa las diversas modalidades de la participación política a través del ejercicio del voto directo y universal (plebiscito, referéndum y revocatoria de mandato, sin dejar de lado la iniciativa legislativa considerada un procedimiento político de participación ciudadana directa que puede afectar al conjunto de la población e impactar al sistema político

  1. El acto de incoación y las esferas jurídicas de los sujetos intervinientes en el procedimiento administrativo

    OpenAIRE

    Vignolo Cueva, Orlando

    2011-01-01

    El análisis del inicio del procedimiento administrativo plantea una serie de interrogantes que no solo deben responder a las implicancias adjetivas que tiene esta etapa procedimental, sino a sus dos modos de plasmación —o, en un sentido más extenso, a su impacto directo sobre diversos términos y actuaciones posteriores que pueden surgir alrededor de la tramitación de este cauce formal—. Los argumentos y las respectivas conclusiones deben tratar de ubicarse más allá de la figura como un...

  2. Plan estratégico para McDonald's Perú : gestión de una cadena de suministros sostenible 2008-2010

    OpenAIRE

    Delgado Baca, Edwin; Flores Morante, Grace Milagros; Ninahuanca Ortiz, Sandra Cecilia

    2016-01-01

    El trabajo de investigación plantea el desarrollo de un Plan Estratégico para McDonald’s Perú, en base al caso de McDonald’s Corporation: gestión de una cadena de suministros sostenible. McDonald’s Corporation es una empresa multinacional dedicada a la venta de comida rápida que cuenta con franquiciados y operadores directos. Una de sus franquicias más grande es Operaciones Arcos Dorados (con sede en Argentina) que comprende, entre otras divisiones, en la parte sur de Latinoamérica a la di...

  3. INTERACCIÓN DE LA BACTERIA Gluconacetobacter diazotrophicus Y HORTALIZAS DE RAÍZ

    OpenAIRE

    Yoania Ríos Rocafull; Bernardo Dibut Álvarez; Marcia Rojas Badía; Marisel Ortega García; Noel Arozarena Daza; Janet Rodríguez Sánchez

    2016-01-01

    Gluconacetobacter diazotrophicus es una bacteria endófita que presenta dentro de sus características metabólicas, mecanismos directos e indirectos de estimulación del crecimiento vegetal. Se han obtenido resultados positivos por su aplicación, fundamentalmente, en gramíneas y viandas tropicales. Sin embargo, en hortalizas, las investigaciones de esta interacción plantamicroorganismo son escasas. El presente trabajo tuvo como objetivo evaluar el efecto de cuatro cepas de G. diazotrophicus aisl...

  4. Rehabilitación neuropsicológica en el maltrato infantil

    OpenAIRE

    Fares Otero, Natalia Elena

    2016-01-01

    El maltrato infantil es uno de los problemas de salud pública más graves en el mundo, que afecta a millones de niños y adolescentes de todas las sociedades y culturas. Existen varias modalidades que incluyen el maltrato físico, psicológico, el abuso sexual, la negligencia y la violencia doméstica. Las víctimas generalmente son vulnerables al maltrato en su propio hogar y los maltratadores son familiares directos. El maltrato crónico provoca una activación frecuente y prolongada de los sistema...

  5. Educación ambiental: itinerario en la naturaleza y su relación con conectividad, preocupaciones ambientales y conducta

    OpenAIRE

    Olivos-Jara, Pablo; Aragonés, Juan-Ignacio; Navarro-Carrascal, Oscar

    2013-01-01

    Resumen Las excursiones e itinerarios a través de entornos naturales son frecuentes en la educación ambiental, pero existe poca evidencia empírica de investigaciones que aporten resultados que permitan comprender mejor los efectos de las experiencias de contacto directo con ambientes naturales, y menos aún acerca de su relación con la conectividad con la naturaleza, las preocupaciones ambientales y el comportamiento proambiental. Se llevan a cabo dos estudios, en el primero participan 286 est...

  6. Educación ambiental: itinerario en la naturaleza y su relación con conectividad, preocupaciones ambientales y conducta

    OpenAIRE

    Pablo Olivos-Jara; Juan-Ignacio Aragonés; Oscar Navarro-Carrascal

    2013-01-01

    Las excursiones e itinerarios a través de entornos naturales son frecuentes en la educación ambiental, pero existe poca evidencia empírica de investigaciones que aporten resultados que permitan comprender mejor los efectos de las experiencias de contacto directo con ambientes naturales, y menos aún acerca de su relación con la conectividad con la naturaleza, las preocupaciones ambientales y el comportamiento proambiental. Se llevan a cabo dos estudios, en el primero participan 286 estudiantes...

  7. Factores limitantes en la adopción del sistema de riego tecnificado por los agricultores del valle Chancay Lambayeque 2009-2012

    OpenAIRE

    Pantaleón Santa María, Alberto Luis

    2015-01-01

    Universidad Nacional Agraria La Molina. Escuela de Posgrado. Maestría en Producción Agrícola La presente investigación se realizó con agricultores del Valle Chancay Lambayeque en la Región Lambayeque durante los años 2009 al 2012 quienes fueron los beneficiarios directos del Programa de Capacitación y Asistencia Técnica para la Agricultura con Riego Tecnificado, llamado Componente C2, el cual muestra la estrategia de intervención del mencionado programa y el proceso de adopción del sistema...

  8. El uso de fuentes periodísticas en las secciones de Política, Economía y Cultura en el Periodismo de Proximidad Español

    OpenAIRE

    Pérez Curiel, Concha; Gutiérrez Rubio, David; Sánchez González, Teresa; Zurbano-Berenguer, Belén

    2015-01-01

    Periodismo Especializado y Periodismo de Proximidad conforman un tándem que puede reforzar un tratamiento de calidad de las fuentes periodísticas. La posibilidad de informar de temas cercanos a los ciudadanos, de ser testigo directo de los acontecimientos, de contrastar con más de una fuente favorece el rigor, la veracidad y la democracia informativa. Este punto de la investigación contempla el análisis específico del uso de las fuentes, tipos, características y protagonismo en el ámbito de l...

  9. Uso de cidofovir en la papilomatosis respiratoria recurrente

    OpenAIRE

    Brunetto M,Beatriz; Zelada B,Ursula

    2007-01-01

    La Papilomatosis Respiratoria Recurrente (PRR) es una enfermedad causada por el virus papiloma humano (VPH) que se caracteriza por la presencia de tumores epiteliales en la vía aérea. Su principal mecanismo de contagio es por contacto directo, la zona más frecuentemente afectada es la laringe, pero puede comprometer cualquier lugar de la vía aéreo-digestiva. Sus manifestaciones van desde la disfonía a la obstrucción completa de la vía aérea, causando incluso la muerte. En algunas ocasiones lo...

  10. Análisis de factibilidad de introducir en el mercado ecuatoriano una marca nueva de lubricantes automotrices fabricada localmente.

    OpenAIRE

    Egas Mendoza, Julio

    2014-01-01

    Un lubricante es una película que separa dos superficies (las cuales se pueden encontrar en constante movimiento), a fin de disminuir el impacto directo, el desgaste protegiendo al motor de fricciones o daños. Son derivados de petróleo mezclados con aditivos para realzar su calidad. (Albarracín, 2007). Bases lubricantes marcan el tipo de Viscosidad, la resistencia a la oxidación, y el punto de fluidez que tendrá en aceite final para establecer su aplicación, uso y calidad. Estas Bases pueden ...

  11. La identidad Social de las audiencias

    Directory of Open Access Journals (Sweden)

    Eduardo Arriagada Cardini

    2016-11-01

    Full Text Available Hasta la irrupción de las redes sociales, el individuo solo recibia la información echado. Ahora se incorpora y con una segunda pantalla en sus manos participa comentando, valorando, compartiendo o criticando. Reacciona en directo ante lo que ve en los medios tradicionales e interactúa con aquellos que tienen intereses comunes, le importan o le interesan. Con la ayuda de tres imágenes ilustraré cómo la todavía -a veces pasiva- audiencia de los medios tradicionales ha empezado a actuar en forma activa y participante.

  12. EL AHORRO DE LOS HOGARES EN COLOMBIA

    OpenAIRE

    Ligia Melo B.; Héctor Zárate S.; Juana Tellez C.

    2006-01-01

    En este documento se presenta un análisis del comportamiento del ahorro de los hogares y sus determinantes, considerando una perspectiva de largo plazo para el periodo 1950-2004 y una de corto plazo a nivel microeconómico, utilizando la información de las encuestas de calidad de vida de 1997 y 2003. A nivel agregado, con base en un análisis de cointegración se encontró una relación de largo plazo entre la tasa de ahorro de los hogares, el PIB per-cápita, los impuestos directos y una medida de...

  13. The Effects of Government Policies towards Contraception Use in Women

    Directory of Open Access Journals (Sweden)

    Audrey Janet Núñez Gough

    2008-01-01

    Full Text Available La educación es considerada un factor muy importante en la relación entre el nivel de natalidad y el uso de anticonceptivos en un país. El propósito de este artículo es analizar si los niveles de natalidad son reducidos debido a las políticas gubernamentales, específicamente, el apoyo directo hacia el control de natalidad en comparación a los países que dan apoyo indirecto. Por lo tanto, en el presente documento se comparan Honduras y Belice, que proporcionan apoyo directo e indirecto a la anticoncepción, respectivamente. Primero, el coeficiente en la variable de nacionalidad nos dice si las mujeres en Honduras están usando más anticonceptivos que las mujeres en Belice. Segundo, después de utilizar un modelo Poisson, encontramos que aunque Honduras da apoyo directo para el uso de métodos anticonceptivos, no hay diferencia entre los niveles de natalidad en Honduras en comparación con Belice, .188 (p<0.1 Tercero, aunque Honduras da subsidios directos para anticonceptivos y Belice da subsidios indirectos, no hay diferencia en la frecuencia de uso de anticonceptivos entre las mujeres de Honduras en comparación con las mujeres de Belice, 0.567 (p<0.1. Como el coeficiente en nacionalidad resultó estadísticamente insignificante en los dos modelos, podemos concluir que el factor determinante en la reducción de los niveles de natalidad en los países es la efectividad de los programas de anticoncepción, sin importar el tipo de apoyo que el gobierno da a las mujeres. Los gobiernos pueden hacer sus programas más efectivos si los complementan con la escolaridad. Estos programas de educación adjunto con programas de anticoncepción efectivos, pueden enseñar tanto a las niñas como a las mujeres los beneficios que se obtienen al limitar su comportamiento reproductivo.

  14. Factores de riesgo para progresión de cefalea primaria tipo migraña o tipo tensión episódica a cefalea crónica diaria en una población adulta de Bogotá - Colombia

    OpenAIRE

    Riveros Santoya, Sandra Viviana

    2017-01-01

    La cefalea crónica diaria es una entidad que afecta hasta el 4% de los pacientes con cefalea primaria episódica especialmente a la población adulta joven, económicamente activa, generando impacto económico y aumento de gastos directos e indirectos en salud. El objetivo es establecer los factores de riesgo que favorecen la aparición de cefalea crónica diaria en pacientes con diagnóstico de cefalea tipo migraña y cefalea tipo tensión, que asisten a un centro de referencia para patología neur...

  15. Nuclear analytical techniques in Cuban Sugar Industry

    International Nuclear Information System (INIS)

    Diaz Riso, O.; Griffith Martinez, J.

    1996-01-01

    This paper is a review concerning the applications of Nuclear Analytical Techniques in the Cuban sugar industry. The most complete elemental composition of final molasses (34 elements ) and natural zeolites (38) this last one employed as an auxiliary agent in sugar technological processes has been performed by means of Instrumental Neutron Activation Analysis (INAA) and X-Ray Fluorescence Analysis (XRFA). The trace elements sugar cane soil plant relationship and elemental composition of different types of Cuban sugar (rawr, blanco directo and refine) were also studied. As a result, valuable information referred to the possibilities of using these products in animal and human foodstuff so as in other applications are given

  16. Modelo De Programa De Educación Y Difusión En Salud Sexual Y Reproductiva, Con Enfoque Intercultural Para Adolescentes De La Comunidad De Gualsaqui Perteneciente Al Canton Otavalo Provincia De Imbabura.

    OpenAIRE

    Mogrovejo, Ligia

    2013-01-01

    La propuesta sobre salud sexual y reproductiva estructurada con talleres, se aplica a las y los adolescentes de la comunidad de Gualsaquí, considerando a los grupos de mestizos, indígenas con educación e indígenas analfabetos, quienes serán los beneficiarios directos de éste programa de difusión; además quienes se beneficiarán de ésta propuesta serán las familias y comunidad en general. Este estudio permitió identificar limitaciones existentes: como es ...

  17. Indicadores económicos ganaderos de los sistemas agropecuarios extensivos del partido de Saavedra (Buenos Aires)

    OpenAIRE

    Gargano, Alfredo O.; Saldungaray, María C.; Chimeno, Patricia; Conti, Viviana P.; Adúriz, Miguel A.

    2004-01-01

    p.227-236 El objetivo fue determinar los resultados económicos ganaderos de los agrosistemas del partido de Saavedra (Buenos Aires) y compararlos con los de la agricultura. Se calcularon los ingresos netos (IN), costos directos (CD), márgenes brutos (MB) y la relación IN-CD. Los MB de los conglomerados, subsistemas ganaderos y estratos por superficie tuvieron mayor dependencia de los IN que de los CD. Los MB de los conglomerados, promedios de las áreas edáficas homogéneas (AEH), oscilaron ...

  18. Bajo un sol desconocido: László Hudec, Antonin Raymond y la construcción de la arquitectura moderna en Asia Oriental

    OpenAIRE

    Anghel, Anamaría Andreea

    2015-01-01

    La arquitectura es un reflejo directo de la cultura, siempre cambiando, con el fin de adaptarse a las necesidades de la época. La sociedad china sufrió cambios inesperados, a lo largo de los fines del siglo XIX y principios del XX, marcada por las invasiones de los poderes occidentales, La Primera y La Segunda Guerras Mundiales, rebeliones, derrumbes de viejos regímenes y de la fundación de la Nueva China en 1949. En comparación con China, Japón se enfrenta a constantes problemas de terremoto...

  19. Turismo de reuniones en la ciudad de Murcia. Un enfoque desde el tejido empresarial involucrado

    OpenAIRE

    Ponce Sánchez, María Dolores

    2007-01-01

    La importancia y dinamismo del turismo de reuniones en el contexto nacional e internacional nos conduce a analizar la capacidad de la ciudad de Murcia para afrontar los retos continuos que le presenta un mercado tan globalizado y competitivo como el actual. Por tanto, esta investigación presenta una aproximación a la situación de la actividad en la ciudad, desde la visión particular de sus beneficiarios directos, empresarios asociados a Murcia Convention Bureau (Oficina de Cong...

  20. empresarial involucrado

    Directory of Open Access Journals (Sweden)

    María Dolores Ponce Sánchez

    2007-01-01

    Full Text Available La importancia y dinamismo del turismo de reuniones en el contexto nacional e internacional nos conduce a analizar la capacidad de la ciudad de Murcia para afrontar los retos continuos que le presenta un mercado tan globalizado y competitivo como el actual. Por tanto, esta investigación presenta una aproximación a la situación de la actividad en la ciudad, desde la visión particular de sus beneficiarios directos, empresarios asociados a Murcia Convention Bureau (Oficina de Congresos de Murcia. capital imagen, capital económico, planes estratégicos.

  1. Aleyrodes proletella (Linnaeaus, 1758) (Homoptera: Aleyrodidae) puede desarrollarse en plantas de tomate en condiciones controladas

    OpenAIRE

    Alonso, D.; Gómez, Azahara A.; Nombela, Gloria; Muñiz, Mariano

    2007-01-01

    La mosca blanca de la col, Aleyrodes proletella L. causa importantes daños directos en cultivos del género Brassica en Europa, entre los que se incluyen la coliflor, brócoli, lombarda y romanesco. En España se ha observado un incremento de sus poblaciones, especialmente en Islas Canarias, Navarra y Murcia. La aplicación prolongada de plaguicidas de amplio espectro origina la aparición de poblaciones resistentes y efectos medioambientales adversos. Tras una infestación accidental de adult...

  2. GESTIÓN DE RESIDUOS SÓLIDOS EN CADENAS DE SUMINISTRO DE CICLO CERRADO DESDE LA PERSPECTIVA DE LA INVESTIGACIÓN DE OPERACIONES

    OpenAIRE

    Peña-Montoya, Claudia Cecilia; Osorio-Gómez, Juan Carlos; Vidal-Holguín, Carlos Julio; Torres-Lozada, Patricia; Marmolejo-Rebellón, Luis Fernando

    2015-01-01

    La integración de los flujos reversos y directos en la cadena de suministro, trae beneficios al reducir costos y evitar el daño ambiental porque se recupera valor de los residuos sólidos; esta integración se conoce como la cadena de suministro de ciclo cerrado. La mayoría de experiencias que relacionan cadena de suministro de ciclo cerrado y decisiones de gestión de residuos sólidos, provienen de países desarrollados con estrictas regulaciones ambientales y usan técnicas de invetigación de op...

  3. Modelo de control y vigilancia en sanidad ambiental basados en sistemas de autocontrol

    OpenAIRE

    Loreto Santa Marina Rodríguez; Elena Serrano Ibarbia

    2006-01-01

    En el ámbito ambiental el control de los riesgos para la salud está experimentando cambios importantes en lo referente a su concepción y a la forma de gestión de los mismos desde lo servicios de salud pública. Tradicionalmente la Administración Sanitaria ha asumido el papel de garante de las condiciones higiénico-sanitarias de las instalaciones, estableciendo sistemas de control y vigilancia. La tendencia actual es que sean los responsables directos de las instalaciones los que valoren los ri...

  4. AGRICULTURIZACION E IMPACTOS AMBIENTALES EN EL PARTIDO DE NECOCHEA, PROVINCIA DE BUENOS AIRES, ARGENTINA - AGRICULTURIZATION AND ENVIRONMENTAL IMPACTS IN NECOCHEA COUNTY, BUENOS AIRES, ARGENTINA

    OpenAIRE

    Patricia Vazquez; Laura Zulaica; Belen Benavidez

    2017-01-01

    El modelo actual de producción agropecuaria de la región pampeana argentina, ha mostrado una tendencia a la agriculturización, con un efecto directo sobre la dinámica de los agroecosistemas, generando impactos ambientales con consecuencias sobre la base de los recursos naturales. Tomando el partido de Necochea inserto en la región, esta investigación propone analizar los cambios en el uso del suelo en dicho Partido entre 2003-2011, mediante sensores remotos, y estimar los impactos ambientales...

  5. Correlación y concordancia entre el peso fetal estimado por ecografía y el peso real obtenido por báscula de los recién nacidos a término en el Hospital Vicente Corral Moscoso durante el 2012

    OpenAIRE

    Becerra Pino, Iván Oliver

    2013-01-01

    Antecedentes: El ultrasonido prenatal permite el cálculo directo del tamaño del fetal y la predicción de su peso con un intervalo de confianza del 95%. Es importante conocer con anticipación el peso fetal, porque permite incrementar las probabilidades de sobrevivir que tiene un RN.- Objetivos: determinar la correlación y la concordancia entre el peso fetal estimado por ecografía y el peso real obtenido al nacer.- Materiales y métodos: Se realizó un diseño descriptivo observacional y trans...

  6. Diseño de ventilación en profundización de mina

    OpenAIRE

    Oyola Gonzáles, Hernán Gabriel; Oyola Gonzáles, Hernán Gabriel; Oyola Gonzáles, Hernán Gabriel

    2009-01-01

    El presente estudio ha sido realizado y se desarrolla en base a los siguientes criterios La ventilación en interior mina tomando en cuenta la calidad en el trabajo, confort del personal, un mejor ambiente físico en el trabajo haría mejorar la calidad de la supervisión ya que el ingeniero o supervisor podrá pasar más tiempo a gusto en las labores. La mejora en los índices de seguridad. Se reducirán los riesgos directos implícitos por las condiciones de ventilación; la ocurrencia y exposi...

  7. Medición de la relación que existe entre el nivel de satisfacción y la fidelidad de los clientes, aplicada a las salas de belleza y peluquerías ubicadas en los centros comerciales ubicados entre la Av. El Inca y Av. Patria de la ciudad de Quito, y diseño de estrategias de fidelidad a través del servicio brindado

    OpenAIRE

    Carrión Torres, Verónica Cristina

    2013-01-01

    El presente documento trata sobre la relación existente entre el nivel del servicio al cliente y la fidelidad de éste a su proveedor habitual del servicio, referido a uno de los negocios más tradicionales en la sociedad respecto al cuidado de imagen personal, específicamente a las salas de belleza y peluquerías, en las que el contacto persona a persona es directo, por lo que la buena atención por parte del personal del servicio, las instalaciones, equipos y promociones enfocado...

  8. De la apropiación terrateniente a la expansión del capital: notas desde una visión histórica sobre la concentración y los conflictos por la tierra

    OpenAIRE

    Martínez Dougnac, Gabriela

    2014-01-01

    Se abordan algunas notas y reflexiones que resultan de una investigación en curso acerca de los procesos de concentración de la tierra agrícola en nuestro país. El tema se aborda desde una perspectiva histórica, intentando explicar el actual acaparamiento y el despojo a los productores directos y a la sociedad que de éste resulta, atendiendo tanto a las tendencias de larga duración propias del desarrollo del capitalismo en al agro y a sus condiciones presentes, como a las formas act...

  9. Progresos alcanzados en el proyecto universitario cohete sonda ULA

    OpenAIRE

    Marcano, Vicente; Benítez, Pedro; La Rosa, Carlos; La Cruz, Leonardo; Parco, María Alejandra; Ferreira, Jhon; Andressen, Rigoberto; Serra Valls, Alberto; Peñaloza, Marcos; Rodríguez, Lester; Cárdenas, Julio Emerio; Minitti, Vicente; Rojas, Juan José

    2009-01-01

    La primera iniciativa científica en Venezuela, por parte de las universidades, para el desarrollo de cohetes sondas totalmente diseñados y construidos en Venezuela, proviene de la Universidad de Los Andes con el apoyo directo del Rectorado, como parte de las actividades que desarrolla la Comisión Rectoral del Programa de Ciencias Espaciales y el Proyecto Centro de Investigaciones Atmosféricas y del Espacio (CIAE). A partir de enero de 2006, se conformó un equipo de investigadores multi- e int...

  10. Principales insectos plaga, invertebrados y vertebrados que atacan el cultivo del arroz en Ecuador

    OpenAIRE

    MSc. Irán Rodríguez Delgado; Dr. C. Hipólito Israel Pérez Iglesias; Dr. C. Alejandro Rafael Socorro Castro

    2018-01-01

    El trabajo ofrece una revisión bibliográfica actualizada relacionada con la caracterización de los principales insectos plaga, invertebrados y vertebrados que pueden afectar al cultivo del arroz, así como los daños que ocasionan y medidas para su control en Ecuador. La mayor afectación en el cultivo del arroz es ocasionada por la sogata (Tagosodes orizicolus Muir.), que provoca daños directos, producidos por la picadura al momento de alimentarse, o indirectos, al transmitir el virus de la hoj...

  11. El uso de manipulables para propiciar la comprensión del significado de ecuaciones lineales y cuadráticas, y de sistemas de ecuaciones lineales en la escuela secundaria

    OpenAIRE

    García, Paola; Vargas, Jorge

    2014-01-01

    El presente trabajo es una investigación en curso, en donde se pretende analizar el papel que juega la utilización de manipulables (balanzas concretas y balanzas simuladas utilizando GeoGebra) como recurso didáctico para propiciar la comprensión del significado de ecuaciones lineales, cuadráticas y sistemas de ecuaciones lineales en estudiantes de secundaria, de entre 13 y 15 años de edad, mediante una manipulación activa de dichos aparatos a través del contacto directo de estos con los estud...

  12. Estudio del grado de madurez y/o maduración de tomates empleando técnicas espectroscópicas moleculares

    OpenAIRE

    Jurado Capel, Laura

    2012-01-01

    Este Trabajo Fin de Máster versa sobre el estudio de la madurez en tomates evaluando la evolución de distintos pigmentos (carotenos, tocoferoles, flavonoides)y otros compuestos como el glutamato monosódico. Para ello se hace uso de técnicas espectroscópicas moleculares donde el análisis de la muestra se aborda a través de dos estrategias diferentes que permita comparar el análisis directo sobre la piel del fruto mediante ATR-FTIR y análisis de extractos metanólicos de la piel mediante Fluore...

  13. Francisco Giner de los Ríos en el campo.

    OpenAIRE

    Anónimo (siglo XX)

    2010-01-01

    1 fot.; papel. - Hombre mayor sentado en campo.Francisco Giner de los Rios, filósofo, ensayista y pedagogo. Fundador y director de la Institución Libre de Enseñanza. (Emulsión de plata de ennegrecimiento directo montada sobre cartulina del mismo tamaño. Imagen muy arrugada y dañada en márgenes. Pequeña pérdida de materia en centro de lateral derecho. Imagen amarillenta y desvanecida). - Procedencia: fondo Miguel de Unamuno. - Buena Conservación.

  14. Determinantes de la pérdida esperada en la cartera de clientes de una Institución Prestadora de Servicios de Salud

    OpenAIRE

    Correa Barragán, Carlos Julio

    2016-01-01

    La estimación de la pérdida esperada en las cuentas por cobrar de una empresa y la modelación de las variables que la determinan constituyen una importante herramienta de medición de riesgo, con efecto directo en el desempeño del patrimonio -- En este trabajo se realiza la estimación mediante un modelo econométrico logit para datos agrupados, en una institución prestadora de servicios de salud ubicada en Colombia -- Se presenta una selección de cuatro modelos basados en la metodología logit p...

  15. Modelo de asociatividad en la cadena productiva en las Mipymes agroindustriales

    OpenAIRE

    Bada Carbajal, Lila Margarita; Rivas Tovar, Luis Arturo; Littlewood Zimmerman, Herman Frank

    2017-01-01

    Resumen Esta investigación tiene como objetivo proponer un modelo de asociatividad en cadena productiva de las micro, pequeñas y medianas empresas (MIPYMES) agroindustriales de cítricos en el norte del estado de Veracruz, México, con el propósito de explicar en qué medida los actores directos, los servicios de apoyo, el entorno, las relaciones y las políticas de gobierno determinan la asociatividad en la cadena productiva. La problemática que origina esta investigación es el desconocimiento d...

  16. Los costos de alimentación en relación con los costos totales en establecimientos típicos de tambo en países del Mercosur

    OpenAIRE

    Ostrowski, Bernardo

    2003-01-01

    p.1-10 Se analizan doce modelos de tambos típicos en la región MERCOSUR, desagregando los costos de alimentación en pastoreo directo, reservas forrajeras y concentrados, diferenciando entre verdeos anuales y pasturas perennes para el primero de los rubros especificados. Se relacionan los costos de la alimentación con los niveles de productividad media de los rodeos, con la escala de la empresa, con diferentes tecnologías y con los costos de los factores de producción intervinientes en la p...

  17. Síndrome de abstinência neonatal : um estudo retrospectivo : experiência profissionalizante na vertente de farmácia comunitária, hospitalar e investigação

    OpenAIRE

    Moreira, Marta Antunes

    2012-01-01

    Um futuro farmacêutico, pelo seu nível de conhecimento técnico e científico, deve demonstrar ser capaz de se integrar em equipas multidisciplinares, com as quais interage, visando o bem-estar do utente. Neste âmbito, e atendendo à pluralidade de áreas em que o farmacêutico pode exercer, foi relevante a realização do estágio curricular em duas vertentes distintas. Se, na perspectiva hospitalar, foi possível um relacionamento com terapias farmacológicas exclusivas; o contacto directo com o u...

  18. Problemas de sintaxis y traducción : el caso del participio presente en español

    OpenAIRE

    Azofra Sierra, María Elena

    2006-01-01

    En este trabajo se estudia la adaptación de los participios de presente latinos en español, a través de la comparación de la traduccción de Juan de Mena del Omero romançado con la versión latina que toma como modelo. A pesar de que las traducciones siempre están más sometidas al influjo del modelo directo, comprobamos que Mena es más respetuoso con la sintaxis del español que otros autores de su época.

  19. Formulação analítica de um elemento de barra para o cálculo elastoplástico de estruturas de aço porticadas planas

    OpenAIRE

    Baptista, A. M.; Muzeau, J. P.

    2007-01-01

    O presente trabalho apresenta as bases do desenvolvimento de um modelo analítico para o cálculo dos deslocamentos (rotação, flecha e deslocamento axial) numa secção transversal qualquer de uma viga de aço submetida a uma força axial constante e a um momento flector em cada uma das suas extremidades. Entre outras aplicações, este modelo permite efectuar o cálculo directo dos deslocamentos nodais no referencial local de um elemento de viga inserido numa estrutura, em regime elástico ou elastopl...

  20. Estudio de las instalaciones eléctricas bajo la influencia de las descargas atmosféricas y la selección, forma y requerimientos de la aplicación del pararrayos para la aplicación de instalaciones

    OpenAIRE

    Gonzalez Gonzalez, Rusbel A.; Minchala Valencia, Henry A.; Gallo Galarza, Juan

    2009-01-01

    El fenómeno de las descargas atmosféricas ha sido a la largo de los años una molestia de grandes magnitudes respecto a las consecuencias que se encuentran asociadas al impacto de las mismas, ya sea para las instalaciones eléctricas en casi todas las industrias como para las personas que laboran allí. El objetivo del presente estudio tiene como finalidad conocer más a profundo sobre los parámetros y peligros que se pueden presentar debido a impactos directos o cercanos a las instalaciones o...

  1. Remoción de Cd y Pb y reducción de Cr(VI) en agua sintética y residual de una industria de galvanoplastia utilizando biomasa bacteriana

    OpenAIRE

    Ceron Rios, Cecilia Araceli

    2015-01-01

    La contaminación del agua por metales pesados tales como Cd, Pb y Cr(VI) se ha incrementado en forma paralela a la actividad industrial debido a la falta de cumplimiento de la normatividad en la materia y a la inadecuada disposición y manejo de desechos industriales, la exposición a metales pesados en determinadas circunstancias es la causa de la degradación y muerte de la vegetación, ríos, animales e incluso, de daños directos en el hombre. Cierto grupo de bacterias presentan la capacidad d...

  2. The role of high-fat diet in an APP/PS1 model of familial Alzheimer disease = Efecto de una dieta rica en grasas en ratones APP/PS1, modelo familiar de la enfermedad de Alzheimer

    OpenAIRE

    Petrov, Dmitry

    2015-01-01

    La obesidad es una pandemia mundial, la cual según estudios recientes afecta a más de 2.000 millones de personas en todo el mundo y conlleva una fuerte presión de los sistemas sanitarios globales. El problema se ve aumentado no sólo por los costes directos asociados al sobrepeso, sino también por las comorbilidades relacionadas, entre ellas el incremento del riesgo de desarrollo de enfermedades neurodegenerativas, como por ejemplo la enfermedad de Alzheimer (EA), principal causa de demencia s...

  3. Impacto de la cadena productiva de la quinua en el distrito de Cabana

    OpenAIRE

    Flores Ortega, Ada Luz

    2011-01-01

    La investigación se realizó para analizar el impacto de la cadena productiva de la quinua en el distrito de Cabana región Puno. Se aplicó un cuestionario para medir las características socio económicas, tomando una muestra de 39 productores de quinua. Se ha analizado la cadena comercializadora y la estructura de la cadena productiva de la quinua. Los resultados fueron que existe un impacto directo de los componentes de la cadena productiva de la quinua en el distrito de Cabana; llegándose a l...

  4. Assessing the economic impact of cancer in Chile: a direct and indirect cost measurement based on 2009 registries

    OpenAIRE

    Camilo Cid; Cristian Herrera; Gabriel Bastías; Jorge Jiménez

    2016-01-01

    Resumen OBJETIVO Este trabajo pretende determinar el impacto económico del cáncer en Chile, junto con estimar la proporción del costo total atribuible a los principales tipos de cáncer y su distribución entre el sector de aseguramiento público y privado de salud. MÉTODOS Se utilizó la metodología de costo de enfermedad, a través de la valoración de los costos directos e indirectos asociados al cáncer usando datos del Ministerio de Salud y de la Superintendencia de Salud del Chile...

  5. Informe científico de investigador: Tognetti, Jorge Alberto (2015-2016)

    OpenAIRE

    Tognetti, Jorge Alberto

    2016-01-01

    Se investigan efectos directos de la disponibilidad de fotoasimilados, especialmente sacarosa, sobre el desarrollo, morfo-fisiología, y producción y calidad de biomasa en varias especies de importancia agronómica en el sudeste de la provincia de Buenos Aires, entre ellas girasol, trigo, arándano y otras especies fruti-hortícolas. Los trabajos actuales incluyen: a) ensayos con perfusión de sacarosa; b) cultivos en hidroponia o in vitro, con suministro exógeno de sacarosa; c) manipulación de de...

  6. Influencia de la responsabilidad social en la lealtad: aplicación en el mercado de servicios

    OpenAIRE

    García de los Salmones Sánchez, María del Mar; Rodríguez del Bosque Rodríguez, Ignacio Alfredo

    2011-01-01

    El presente trabajo analiza la influencia de la responsabilidad social corporativa en el comportamiento del consumidor mediante su inclusión en los modelos tradicionales de lealtad. Para ello, se parte de una revisión de la literatura sobre el concepto que da pie al planteamiento de varias hipótesis de investigación relativas a la influencia del comportamiento socialmente responsable en la valoración de un servicio y en la imagen corporativa, antecedentes directos, junto con...

  7. Impactos distributivos sobre los hogares de la reforma fiscal 2010 en México

    OpenAIRE

    Carlos ABSALÓN; Carlos URZÚA

    2013-01-01

    El trabajo analiza los impactos en la distribución del ingreso y la progresividad de la reforma fiscal de 2010 en México, empleando para ello modelos de microsimulación del isr y del iva, y los resultados se comparan con el estado que guardaban los hogares bajo el esquema fiscal 2008. Se observa que el esquema tributario aprobado para 2010, considerando tanto la estructura de impuestos directos como los indirectos, tiene una relativa tendencia a la progresividad, la cual supera...

  8. Percepción de los afroamericanos por parte del migrante laboral mexicano en Estados Unidos

    OpenAIRE

    Ricardo CONTRERAS-SOTO; Roberto HERNÁNDEZ-SAMPIERI

    2011-01-01

    La presente investigación forma parte de un estudio más amplio donde se analiza la percepción de distintas alteridades por parte de inmigrantes mexicanos en Estados Unidos, con testimonios de 1 265 migrantes procedentes principalmente de la región del corredor industrial abajeño de Guanajuato. El tratamiento de la información por medio de entrevistas se apoya en la hermenéutica profunda. Los testimonios directos sobre identidades culturales suman 76 casos, que conforman seis por ciento de ...

  9. LEARNING CURVE IN ENDOSCOPIC TRANSNASAL SELLAR REGION SURGERY

    Directory of Open Access Journals (Sweden)

    Ananth G

    2016-07-01

    Full Text Available BACKGROUND The endoscopic endonasal approach for the sellar region lesions is a novel technique and an effective surgical option. The evidence thus far has been conflicting with reports in favour and against a learning curve. We attempt to determine the learning curve associated with this approach. METHODS Retrospective and prospective data of the patients who were surgically treated for sellar region lesions between the year 2013 and 2016 was collected, 32 patients were operated by the endoscopic endonasal approach at Vydehi Institute of Medical Sciences and Research Centre, Bangalore. Age, sex, presenting symptoms, length of hospital stay, surgical approach, type of dissection, duration of surgery, sellar floor repair, intraoperative and postoperative complications were noted. All the procedures were performed by a single neurosurgeon. RESULTS A total of 32 patients were operated amongst which 21 patients were non-functioning pituitary adenomas, 2 were growth hormone secreting functional adenomas, 1 was an invasive pituitary adenoma, 4 were craniopharyngiomas, 2 were meningiomas, 1 was Rathke’s cleft cyst and 1 was a clival chordoma. Headache was the mode of presentation in 12 patients, 12 patients had visual deficits, 6 patients presented with hormonal disturbances amongst which 4 patients presented with features of panhypopituitarism and 2 with acromegaly. Amongst the 4 patients with panhypopituitarism, 2 also had DI, two patients presented with CSF rhinorrhoea. There was a 100% improvement in the patients who presented with visual symptoms. Gross total resection was achieved in all 4 cases of craniopharyngiomas and 13 cases of pituitary adenomas. Postoperative CSF leak was seen in 4 patients who underwent re-exploration and sellar floor repair, 9 patients had postoperative Diabetes Insipidus (DI which was transient, the incidence of DI reduced towards the end of the study. There was a 25% decrease in the operating time towards the end of

  10. Diode laser-induced tissue effects: in vitro tissue model study and in vivo evaluation of wound healing following non-contact application.

    Science.gov (United States)

    Havel, Miriam; Betz, Christian S; Leunig, Andreas; Sroka, Ronald

    2014-08-01

    The basic difference between the various common medical laser systems is the wavelength of the emitted light, leading to altered light-tissue interactions due to the optical parameters of the tissue. This study examines laser induced tissue effects in an in vitro tissue model using 1,470 nm diode laser compared to our standard practice for endonasal applications (940 nm diode laser) under standardised and reproducible conditions. Additionally, in vivo induced tissue effects following non-contact application with focus on mucosal healing were investigated in a controlled intra-individual design in patients treated for hypertrophy of nasal turbinate. A certified diode laser system emitting the light of λ = 1470 nm was evaluated with regards to its tissue effects (ablation, coagulation) in an in vitro setup on porcine liver and turkey muscle tissue model. To achieve comparable macroscopic tissue effects the laser fibres (600 µm core diameter) were fixed to a computer controlled stepper motor and the laser light was applied in a reproducible procedure under constant conditions. For the in vivo evaluation, 20 patients with nasal obstruction due to hyperplasia of inferior nasal turbinates were included in this prospective randomised double-blinded comparative trial. The endoscopic controlled endonasal application of λ = 1470 nm on the one and λ = 940 nm on the other side, both in 'non-contact' mode, was carried out as an outpatient procedure under local anaesthesia. The postoperative wound healing process (mucosal swelling, scab formation, bleeding, infection) was endoscopically documented and assessed by an independent physician. In the experimental setup, the 1,470 nm laser diode system proved to be efficient in inducing tissue effects in non-contact mode with a reduced energy factor of 5-10 for highly perfused liver tissue to 10-20 for muscle tissue as compared to the 940 nm diode laser system. In the in vivo evaluation scab formation

  11. [Extensive tumor of the skull base: sphenoid sinus adenocarcinoma].

    Science.gov (United States)

    Kallel, Souha; Sellami, Moncef

    2017-01-01

    We report a rare case of adenocarcinoma of the sphenoid sinus manifesting as extended skull base tumor. The patient included in the study was a 42-year old woman presenting with unilateral right symptomatology consisting of nasal obstruction, diplopia and hemifacial neuralgias. Clinical examination showed paralysis of the cranial nerve pairs V and VI. Brain scanner showed voluminous heterogeneous sphenoid and clival mass reaching the right cavernous sinus, with a peripheral tissue component at the level of the sphenoid sinus. Biopsy was performed under general anesthesia, through endonasal sphenoidotomy approach. Histological examination showed non-intestinal adenocarcinoma. The patient died due to impaired general condition occurred during examinations. Skull base adenocarcinomas mainly occur in the ethmoid bone. Sphenoid origin is exceptional. Radiological appearance is not specific and suggests malignancy. Diagnosis should be suspected in patients with aggressive tumor, even when it occurs in the midline skull base.

  12. Delayed Onset of Isolated Unilateral Oculomotor Nerve Palsy Caused by Post-Traumatic Pituitary Apoplexy: A Case Report

    Directory of Open Access Journals (Sweden)

    Tomoki Ishigaki

    2017-09-01

    Full Text Available Post-traumatic pituitary apoplexy is uncommon, most of which present with a sudden onset of severe headache and visual impairments associated with a dumbbell-shaped pituitary tumor. We experienced an unusual case of post-traumatic pituitary apoplexy with atypical clinical features. A 66-year-old man presented with mild cerebral contusion and an incidentally diagnosed intrasellar tumor after a fall accident with no loss of consciousness. The patients denied any symptoms before the accident. After 4 days, the left oculomotor nerve palsy developed and deteriorated associated with no severe headache. Repeated neuroimages suggested that pituitary apoplexy had occurred at admission and showed that the tumor compressed the left cavernous sinus. The patient underwent endonasal transsphenoidal surgery at 6 days after head injury, and the mass reduction improved the oculomotor nerve palsy completely within the following 14 days. The pathologic diagnosis was nonfunctioning pituitary adenoma with hemorrhage and necrosis.

  13. Endocrinological outcomes following endoscopic and microscopic transsphenoidal surgery in 113 patients with acromegaly.

    Science.gov (United States)

    Sarkar, Sauradeep; Rajaratnam, Simon; Chacko, Geeta; Chacko, Ari George

    2014-11-01

    To describe outcomes and complications in patients undergoing transsphenoidal surgery for acromegaly using the 2010 consensus criteria for biochemical remission. Retrospective review of 113 treatment naïve patients who underwent transsphenoidal surgery with the endoscopic (n=66) and the endonasal microscopic technique (n=47). Cure was defined if the age and sex-adjusted IGF-1 level was normal and either the basal GH was transsphenoidal surgery did not differ significantly overall (28.8% versus 36.2%). On univariate analysis, a preoperative GH level Transsphenoidal surgery remains the first line of treatment for patients with acromegaly, but invasive adenomas will frequently require adjuvant therapy. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. A combination of modified transnasal endoscopic maxillectomy via transnasal prelacrimal recess approach with or without radiotherapy for selected sinonasal malignancies.

    Science.gov (United States)

    He, Shuangba; Bakst, Richard L; Guo, Tao; Sun, Jingwu

    2015-10-01

    An external approach for resection of sinonasal tumors is associated with increased morbidity. Therefore, we employed a modified transnasal endoscopic maxillectomy combined with pre and/or postoperative radiotherapy for early stage maxillary carcinomas. It aims to evaluate our early experience with endoscopic resection of selected malignant sinonasal tumors. The medical and radiology records of patients who underwent endonasal endoscopic resection of malignant sinonasal tumors between 2008 and 2012 were retrospectively reviewed. Ten cases of selected malignant tumor were performed to resect by modified transnasal endoscopic maxillectomy. All the patients were without evidence of disease at a mean follow-up of 26.8 months. No major complications were recorded. The mean hospitalization stay was 6.6 days. In very carefully selected cases of malignant tumors, modified transnasal endoscopic maxillectomy is acceptable. The postoperative complication rate is low, cosmetic outcome is excellent and patients do not require a long hospitalization.

  15. Analisando a dacriocistorrinostomia endoscópica: dificuldades e soluções Analyzing endoscopic dacryocystorhinostomy: difficulties and solutions

    Directory of Open Access Journals (Sweden)

    Denis Knijnik

    2007-06-01

    Full Text Available OBJETIVO: Verificar a incidência de dificuldades operatórias em dacriocistorrinostomias endoscópicas, assim como propor soluções. MÉTODOS: Estudo retrospectivo que verificou nossos registros de 268 dacriocistorrinostomias endoscópicas endonasais, em 241 pacientes, realizadas de outubro de 1999 a agosto de 2005. A idade dos pacientes variou de 2 a 92 anos (média: 49,1 anos. A uncinectomia (remoção de parte do processo uncinado foi utilizada como acesso à fossa lacrimal, não havendo necessidade de brocas. RESULTADOS: Houve dificuldades operatórias em 37 (13,8% procedimentos. As dificuldades mais comuns foram: hemorragia (n=12 e anormalidades da anatomia nasal (n=14. Houve ainda dificuldade em alguns casos de mucocele, células etmoidais anteriores e processo uncinado resistente. Das alterações nasais que dificultaram a cirurgia, a mais comum foi desvio de septo, seguida de pólipos, hipertrofia da concha média e fratura da parede lateral. Complicações ocorreram em apenas 5 (1,9% casos, incluindo epistaxe pós-operatória (n=3, enfisema subcutâneo na face e deslocamento do tubo de silicone. CONCLUSÃO: A dacriocistorrinostomia endoscópica endonasal com uncinectomia mostrou-se segura, com um mínimo de complicações no pós-operatório. Embora a maioria das cirurgias tenha transcorrido sem dificuldades, este procedimento pode ser tecnicamente difícil, principalmente na presença de hemorragia ou espaço nasal reduzido.PURPOSE: To assess the incidence of operative difficulties in endonasal endoscopic dacryocystorhinostomies, as well as to suggest solutions. METHODS: This retrospective study searched for reports of complications and intraoperative difficulties in our records of 268 endoscopic endonasal dacryocystorhinostomies, in 241 patients, performed from October 1999 to August 2005. The patients' age ranged from 2 to 92 years (mean: 49.1 years. Uncinectomy (partial excision of the uncinate process was employed as the entry to

  16. Infrasellar craniopharyngioma

    International Nuclear Information System (INIS)

    Akimura, T.; Kameda, H.; Abiko, S.; Aoki, H.; Kido, T.

    1989-01-01

    A rare case of infrasellar craniopharyngioma mainly occupying the paranasal sinuses, the infratemporal fossa and the skull base is presented. The patient had been treated by an otolaryngologist as a case of mucocele of the sphenoid and ethmoid sinuses because the biopsy specimens obtained at endonasal surgery failed to confirm the true diagnosis. Computed tomography (CT) scan showed multilobulated lowdensity cysts in the paranasal sinuses, infratemporal fossa and skull base, and the cyst wall was enhanced. Magnetic resonance Imaging (MRI) revealed the cysts to have high intensity in both T1- and T2-weighted images, and excellent three-dimensional visualization was obtained. Characteristic motor-oil-like fluid was aspirated during transnasal surgery and the diagnosis of craniopharyngioma was confirmed by histological examination. (orig.)

  17. Infrasellar craniopharyngioma

    Energy Technology Data Exchange (ETDEWEB)

    Akimura, T.; Kameda, H.; Abiko, S.; Aoki, H.; Kido, T.

    1989-05-01

    A rare case of infrasellar craniopharyngioma mainly occupying the paranasal sinuses, the infratemporal fossa and the skull base is presented. The patient had been treated by an otolaryngologist as a case of mucocele of the sphenoid and ethmoid sinuses because the biopsy specimens obtained at endonasal surgery failed to confirm the true diagnosis. Computed tomography (CT) scan showed multilobulated lowdensity cysts in the paranasal sinuses, infratemporal fossa and skull base, and the cyst wall was enhanced. Magnetic resonance Imaging (MRI) revealed the cysts to have high intensity in both T1- and T2-weighted images, and excellent three-dimensional visualization was obtained. Characteristic motor-oil-like fluid was aspirated during transnasal surgery and the diagnosis of craniopharyngioma was confirmed by histological examination.

  18. Bilateral nasolabial cysts associated with recurrent dacryocystitis.

    Science.gov (United States)

    Kyrmizakis, Dionysios E; Lachanas, Vassilios A; Benakis, Antonios A; Velegrakis, George A; Aslanides, Ioannis M

    2005-05-01

    Nasolabial cysts are rare, nonodontogenic, soft-tissue, developmental cysts occurring inferior to the nasal alar region. They are thought to arise from remnants of the nasolacrimal ducts and they are frequently asymptomatic. We report a rare case of bilateral nasolabial cysts accompanied by bilateral chronic dacryocystitis. A 48-year-old woman suffering from bilateral chronic dacryocystitis was referred to our department for endonasal dacryocystorhinostomy. She had undergone external dacryocystorhinostomy on the left side a few years earlier. Physical examination and computed tomography scan revealed nasolabial cysts bilaterally inferior to the nasal alar region. The cysts were removed via a sublabial approach and endoscopic dacryocystorhinostomy was performed on the right side. Ten months after surgery, the patient was asymptomatic. There may be a correlation, due to embryological reasons, between the presence of nasolabial cysts and the presence of chronic dacryocystitis. Both can be corrected surgically, under the same anaesthesia, without visible scar formation.

  19. Anatomical variations of paranasal sinuses: what to inform the otolaryngologist?; Variacoes anatomicas dos seios paranasais: o que informar ao otorrinolaringologista?

    Energy Technology Data Exchange (ETDEWEB)

    Villela, Caroline Laurita Batista Couto, E-mail: carollaurita@hotmail.com [Radiologia e Diagnostico por Imagem da Santa Casa de Misericordia do Rio de Janeiro, Rio de Janeiro, RJ (Brazil); Gomes, Natalia Delage; Gaiotti, Juliana Oggioni; Costa, Ana Maria Doffemond; Ribeiro, Marcelo Almeida; Motta, Emilia Guerra Pinto Coelho; Moreira, Wanderval; Ramos, Laura Filgueiras Mourao; Diniz, Renata Lopes Furletti Caldeira [Radiologia e Diagnostico por Imagem do Hospital Mater Dei - Mater Imagem, Belo Horizonte, MG (Brazil)

    2012-07-15

    Anatomic variations of paranasal sinuses are common findings in daily practice. For a radiologist, to know these variations is necessary because of the pathological conditions related to them, and also because they are import for planning a functional endoscopic endonasal surgery, the procedure of choice for diagnosis, biopsy and treatment of various sinonasal diseases. To assure that this surgery is done safely, preventing iatrogenic injuries, it is essential that the surgeon has the mapping of these structures. Thus, a CT is indispensable for preoperative evaluation of paranasal sinuses. Since a general radiologist is expected to know these changes and their relationship to pathological conditions, a literature review and a iconographic essay were conducted with the aim of discussing the importance of major anatomic variations of paranasal sinuses. (author)

  20. Anatomical variations of paranasal sinuses: what to inform the otolaryngologist?

    International Nuclear Information System (INIS)

    Villela, Caroline Laurita Batista Couto; Gomes, Natalia Delage; Gaiotti, Juliana Oggioni; Costa, Ana Maria Doffemond; Ribeiro, Marcelo Almeida; Motta, Emilia Guerra Pinto Coelho; Moreira, Wanderval; Ramos, Laura Filgueiras Mourao; Diniz, Renata Lopes Furletti Caldeira

    2012-01-01

    Anatomic variations of paranasal sinuses are common findings in daily practice. For a radiologist, to know these variations is necessary because of the pathological conditions related to them, and also because they are import for planning a functional endoscopic endonasal surgery, the procedure of choice for diagnosis, biopsy and treatment of various sinonasal diseases. To assure that this surgery is done safely, preventing iatrogenic injuries, it is essential that the surgeon has the mapping of these structures. Thus, a CT is indispensable for preoperative evaluation of paranasal sinuses. Since a general radiologist is expected to know these changes and their relationship to pathological conditions, a literature review and a iconographic essay were conducted with the aim of discussing the importance of major anatomic variations of paranasal sinuses. (author)