Pediatric endocanalicular diode laser dacryocystorhinostomy: results of a minimally invasive surgical technique.

Science.gov (United States)

Uysal, Ismail Onder; Ozçimen, Muammer; Yener, Halil Ibrahim; Kal, Ali

2011-09-01

The purpose of this study was to evaluate the effectiveness of endocanalicular diode laser dacryocystorhinostomy (DCR), which is a minimally invasive surgical technique, in pediatric patients with congenital nasolacrimal duct obstruction (NLDO). A retrospective study was carried out on patients treated between October 2008 and August 2009 for nasolacrimal duct obstruction with an endocanalicular diode laser procedure. Patients diagnosed as having nasolacrimal duct obstruction were included in this study and an endocanalicular diode laser procedure was performed. The main outcome measures were patients' previous treatments, clinical presentation, operative and postoperative complications, postoperative follow-up and resolution of epiphora. Eighteen children (10 girls, 8 boys) with a mean age of 6.11 ± 2.08 years (range, 4-10) underwent 20 endocanalicular laser DCR operations for congenital NLDO. In all eyes (100%), there was a history of epiphora and chronic dacryocystitis; two (10%) presented with acute dacryocystitis. Previous procedures included probing and irrigation of all eyes (100%) and silicone tube intubation in nine eyes (45%). None of the patients underwent any previous DCR operations. During a mean postoperative follow-up period of 20.50 ± 3.24 months (range, 14-24 months), the anatomical success rate (patency of ostium on nasal endoscopy) was 100%, and the clinical success rate (resolution of epiphora) was 85%. Endocanalicular diode laser DCR is an effective treatment modality for pediatric patients with congenital NLDO that compares favorably with the reported success rates of external and endoscopic endonasal DCR. Moreover, it has an added advantage of shorter operative time, less morbidity and avoidance of overnight admission.

Endoscopic versus external approach dacryocystorhinostomy: A ...

African Journals Online (AJOL)

Endoscopic versus external approach dacryocystorhinostomy: A comparative analysis. Rinki Saha, Anuradha Sinha, Jyoti Prakash Phukan. Abstract. Background: Dacryocystorhinostomy (DCR) consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed ...

Treatment countermeasures for common problems in dacryocystorhinostomy under nasal endoscope

Directory of Open Access Journals (Sweden)

Zhong-Ling Luo

2014-04-01

Full Text Available AIM: To discuss the common problems and treatment countermeasures in dacryocystorhinostomy under nasal endoscope.METHODS: The clinical data of 37 cases(43 eyesof postoperative dacryocystorhinostomy under nasal endoscope, by using high-frequency electric knife to open the nasal mucosa, hemostasis in surgery, burning fixed lacrimal sac mucosal flap and nasal mucosal flap, methylene blue staining of the lacrimal sac, lacrimal drainage tube implanted and expansion foam support fixed anastomotic methods were reviewed in our hospital from Mar. 2011 to June. 2013. The effects of surgery were observed, and the intraoperative common questions and the treatments were discussed.RESULTS: In the 37 cases(43 eyes, 42 eyes(97.7%were cured, and 1 eye was improved, and the total efficiency was 100%. All operations were successfully completed without any serious complications during surgery.CONCLUSION: The common complication in dacryocystorhinostomy under nasal endoscope are effectively treated and the success rates of surgery are improved, by using high-frequency electric knife to open the nasal mucosa, hemostasis in surgery, burning fixed lacrimal sac mucosal flap and nasal mucosal flap, methylene blue staining of the lacrimal sac, lacrimal drainage tube implanted and expansion foam support fixed anastomotic methods. These methods are worthy of application and promotion.

Diode laser-assisted transcanalicular dacryocystorhinostomy: the effect of age on the results

Directory of Open Access Journals (Sweden)

Fahrettin Akay

2015-06-01

Full Text Available ABSTRACT Purpose: The aim of this study was to explore the effect of age on the success of transcanalicular diode laser-assisted dacryocystorhinostomy (TCDCR. Methods: Seventy patients (70 eyes who underwent transcanalicular diode laser-assisted dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction as a primary surgery were included in this retrospective, nonrandomized study. The patients were divided into two groups according to age. Mean ages were 21.3 ± 3.3 in group 1 and 60.3 ± 7.3 in group 2. The records of the 3-, 6-, and 12-month follow-up examinations were evaluated, and the anatomical and functional outcomes were noted. Functional success was defined as the absence of epiphora as indicated by the patient. Anatomical success was determined as patency of the neo-ostium with irrigation. Results: At the 3-month follow-up, 67% cases in group 1 showed anatomical success and 52% showed functional success; in group 2, the rates were 100% and 92%, respectively. Functional and anatomical success rates were the same for both the 6- and 12-month visits; 46% in group 1 and 76% in group 2. The results in group 2 were significantly better at all three follow-up visits (p<0.05. Conclusions: This study clearly showed that the older patients experienced better transcanalicular diode laser-assisted dacryocystorhinostomy results than the younger patients. The diminished inflammatory response in the older population may be a possible contributing factor to these results.

Endocanalicular diode laser dacryocystorhinostomy for nasolacrimal duct obstruction: short-term results of a new minimally invasive surgical technique.

Science.gov (United States)

Özçimen, Muammer; Uysal, Ismail Onder; Eryılmaz, Mehmet Akif; Kal, Ali

2010-11-01

To evaluate the results, complications, effectiveness, and operative results of the endocanalicular laser dacryocystorhinostomy (ECL DCR) in the distal obstructions of the lacrimal drainage system. Sixty eyes of 57 patients who had a diagnosis of distal obstruction of the lacrimal drainage system were evaluated retrospectively in this study. All patients underwent ECL DCR by diode laser between October 2008 and July 2009. Forty-nine patients (86%) were females, 8 patients (14%) were males, and age distribution was between 3 and 84 years old (median, 40 y). The canaliculi were intubated by a silicone tube. The patency of the nasolacrimal system was controlled by lacrimal lavage, loss of epiphora, and endoscopic evaluation of the endonasal rhinostomy site with routine follow-up scheduled at first day and 1-week, 1-month, and 3-month postoperative intervals. After the 60 ECL DCRs, 10 patients underwent revision ECL DCR because of the persistent epiphora. The patency of the nasolacrimal duct or the decrease of the symptoms was assigned as success. There were no symptoms at all in 83.3% of the patients. The ECL DCR in the treatment of the distal obstructions of the lacrimal drainage system was easily tolerated by the patients, cosmetically preferred because there was no incision and scar formation with high success rates, and a minimally invasive alternative technique.

Efficacy of External Dacryocystorhinostomy (DCR) with and without Mitomycin-C in Chronic Dacryocystitis

International Nuclear Information System (INIS)

Mukhtar, S. A.; Jamil, A. Z.; Ali, Z.

2014-01-01

Objective: To compare the efficacy of external dacryocystorhinostomy (DCR) with and without intraoperative application of mitomycin-C in patients with chronic dacryocystitis. Study Design: An experimental study. Place and Duration of Study: Department of Ophthalmology, Bahawal Victoria Hospital (BVH), Bahawalpur, from September 2009 to December 2010. Methodology: One hundred and sixty patients with chronic dacryocystitis undergoing external DCR were divided into two groups comprising of 80 patients each. Group A included patients, who underwent external DCR with intraoperative use of mitomycin-C. Group B included those patients who were not administered intraoperative mitomycin-C. Sociodemographic information and the data regarding the patency of the lacrimal drainage system by irrigation with normal saline were collected at the end of the third month after the surgery. Chi-square test was used, at 95% confidence level, as the test of significance to compare the success of surgery between the two groups. Results: Surgical success rate (efficacy) in group 'A' was found to be 97.5% and 86.25% in group 'B'. The difference in success rate was statistically significant (p=0.017). Conclusion: External dacryocystorhinostomy with intraoperative mitomycin-C is more efficacious in achieving lacrimal system patency than external dacryocystorhinostomy without mitomycin-C. (author)

Effect of Intraoperative mitomycin-c application in outcome of external dacryocystorhinostomy

International Nuclear Information System (INIS)

Jawad, M.; Ali, Z.; Aftab, H.

2015-01-01

Background: Patients develop postoperative fibrosis at the site of operation after dacryocystorhinostomy (DCR) which results in impairment of the osteum patency. This quasi-experimental study was undertaken to determine the role of intraoperative Mitomycin C (MMC) application in maintaining postoperative patency of the osteum. Methodology: The present study was conducted at the Eye department of Ayub Medical College, Abbottabad on patients in whom routine DCR was indicated. Subjects were divided into mitomycin C (Test) and non mitomycin C (Control) groups. In test group, Mitomycin C was applied to the anastomosed flaps and osteotomy site for 30 minutes. Postoperative patients were followed for up to 6 months and outcome of patency was documented. Results: A.total of 73 patients were included, divided into test (30) and control (43) groups. An overall success rate of 86.3 percentage was obtained for patent ostia; this was based on 96.67 percentage success in test group compared to 79.1 percentage in the control group (p=0.031). Conclusion: Intraoperative application of Mitomycin-C significantly improves the success rate in external dacryocystorhinostomy. (author)

Anterior ethmoid anatomy facilitates dacryocystorhinostomy.

Science.gov (United States)

Blaylock, W K; Moore, C A; Linberg, J V

1990-12-01

The ethmoid air cell labyrinth lies adjacent to the medial orbital wall, extending even beyond the sutures of the ethmoid bone. Its anatomic relationship to the lacrimal sac fossa is important in lacrimal surgery. We evaluated computed tomographic scans of 190 orbits with normal ethmoid anatomy to define the anatomic relationship of anterior ethmoid air cells to the lacrimal sac fossa. In 93% of the orbits, the cells extended anterior to the posterior lacrimal crest, with 40% entering the frontal process of the maxilla. This anatomic relationship may be used to facilitate the osteotomy during dacryocystorhinostomy. During a 10-year period (310 cases), one of us routinely entered the anterior ethmoid air cells to initiate the osteotomy during dacryocystorhinostomy. This technique has helped to avoid lacerations of the nasal mucosa.

Functional and cosmetic results of a lower eyelid crease approach for external dacryocystorhinostomy

Directory of Open Access Journals (Sweden)

Patricia Mitiko Santello Akaishi

2011-08-01

Full Text Available PURPOSE: External dacryocystorhinostomy is routinely performed through a cutaneous vertical incision placed on the lateral aspect of the nose. The lower eyelid crease approach has been seldom reported. The purpose of this study is to report the cosmetic and functional results of the lid crease approach for external dacryocystorhinostomy in a series of patients. METHODS: Prospective, interventional case series. Twenty-five consecutive patients (17 women ranging in age from 3 to 85 years (mean ± SD= 44.84 ± 23.67 were included in the study. All patients but one underwent unilateral external dacryocystorhinostomy with a 10 to 15 mm horizontal incision placed on a subciliary relaxed eyelid tension line. The inner canthus was photographed with a Nikon D70S digital camera with a macrolens and resolution of 3008 x 2000 pixels at 1, 3 and 6 months after surgery. The resulting scar was judged from the photographs by 3 observers (ophthalmologist, plastic and head and neck surgeons according to a four level scale (1= unapparent, 2= minimally visible, 3= moderately visible, 4= very visible. RESULTS: The surgery was easily performed in all patients with a 90.48% success. Three of the elderly patients (ages 61, 79 and 85 yr developed mild lacrimal punctum ectropion, which resolved with conservative treatment. One patient had a hypometric blink which spontaneously recovered within one month. The mean score for scar visibility was 2.19 (1st mo, 1.65 (3th mo and 1.44 (6th mo. CONCLUSIONS: The eyelid crease approach is an excellent option for external dacryocystorhinostomy. It leaves an unapparent scar since the first month after surgery, even in younger patients. The functional results are excellent and comparable to other techniques. Care should be taken in elderly patients with lower eyelid laxity in order to prevent lacrimal punctum ectropion.

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

Science.gov (United States)

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.

Outcome comparison between transcanalicular and external dacryocystorhinostomy

Institute of Scientific and Technical Information of China (English)

Gunay; Uludag; Baris; Yeniad; Erdinc; Ceylan; Ayse; Yildiz-Tas; Lale; Kozer-Bilgin

2015-01-01

AIM: To compare the outcomes achieved with external dacryocystorhinostomy(EX-DCR) and transcanalicular dacryocystorhinostomy(TC-DCR) using a multidiode laser in patients with bilateral nasolacrimal duct obstruction(NLDO).METHODS: This prospective study was conducted on38 eyes of 19 patients with bilateral NLDO. Simultaneous bilateral surgery was performed on all patients. TC-DCR(Group 1) with a diode laser was used in the right eye,and EX-DCR(Group 2) was used in the left eye. All patients were placed under general anesthesia. Routine follow-ups were scheduled at 1wk; 1, 3, 6 and 12 mo postoperative intervals. Objective(lacrimal system irrigation) and subjective [tearing, irritation, pain,discharge and visual analogue scale(VAS) score]outcomes were evaluated.RESULTS: The overall objective success rate at 12 mo was 73.7%(14/19) in Group 1 and 89.5 %(17/19) in Group2. This difference was statistically significant. There were no significant between-group differences in the subjective results, such as tearing, pain and irritation.Only the discharge scores were found to be significantly higher in Group 1 compared to Group 2 at the 1y followup. The average VAS score was 6.8 in Group 1 and 8.7 in Group 2, with no statistically significant differences.CONCLUSION: Although TC-DCR allows surgeons to perform a minimally invasive and safe procedure, EX-DCR offers better objective and subjective outcomes than TC-DCR.

Comprehensive review on endonasal endoscopic sinus surgery

Science.gov (United States)

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

Meningitis and Pneumocephalus. A rare complication of external dacryocystorhinostomy.

Science.gov (United States)

Usul, Haydar; Kuzeyli, Kayhan; Cakir, Ertugrul; Caylan, Refik; Imamoglu, H Ibrahim; Yazar, Ugur; Arslan, Erhan; Sayin, O Caglar; Arslan, Selcuk

2004-11-01

Meningitis due to fracture of the fovea ethmoidalis during external dacryocystorhinostomy is a rare complication. We report a case of pneumocephalus and meningitis in a 51-year-old female who underwent an external dacryocystorhinostomy (DCR). Although extracranial complications during or after external DCR have been well-described, only one case of meningitis has been reported in the literature. Physical examination, computerised tomography, lumbar puncture, and bacteriologic cultures were used to make the diagnosis. The patient responded well to antibiotic therapy. Her symptoms resolved immediately and she was discharged on the 21st post-operative day. This complication emphasises the importance of careful surgical technique and a thorough knowledge of regional anatomy, during DCR and similar procedures.

Dacryocystorhinostomy without intubation with intraoperative mitomycin-c

International Nuclear Information System (INIS)

Rahman, A.; Channa, S.; Memon, M.S.; Niazi, J.H.

2006-01-01

To evaluate the success rate and complications of intraoperative Mitomycin-C in dacryocystorhinostomy surgery. This study included total 90 eyes of 90 patients fulfilling the inclusion criteria.The surgical procedure of external DCR done with intraoperative Mitomycin-C with a neurosurgical cottonoid soaked with 0.2mg/ml. Mitomycin C was applied to the anastomosed flaps and osteotomy site for 10 minutes, without Silicon tube intubation. Surgery was done under local as well as general anesthesia. Patients were followed for 6 months. Out of 90 patients included in this study, only 2 patients complained of persistent epiphora after 6 months follow-up and were labeled as failed DCR. Remaining 88 had either no tearing or significant improvement of tearing after 6 months follow up and patent lacrimal system by syringing without pressure. Success rate in this procedure was 97.77% (p-value< 0.001). This study showed very high rate of success. Only complication noted was excessive nasal bleeding which was easily controlled. Intraoperative Mitomycin-C application in external DCR is safe, effective, cheap adjunct that helps to achieve good results of DCR surgery. (author)

Endoscopic Endonasal Management of Craniopharyngioma.

Science.gov (United States)

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.

Piezosurgery in External Dacryocystorhinostomy.

Science.gov (United States)

Czyz, Craig N; Fowler, Amy M; Dutton, Jonathan J; Cahill, Kenneth V; Foster, Jill A; Hill, Robert H; Everman, Kelly R; Nabavi, Cameron B

Dacryocystorhinostomy (DCR) can be performed via an external or endoscopic approach. The use of ultrasonic or piezosurgery has been well described for endoscopic DCRs but is lacking for external DCRs. This study presents a case series of external DCRs performed using piezosurgery evaluating results and complications. Prospective, consecutive case series of patients undergoing primary external DCR for lacrimal drainage insufficiency. A standard external DCR technique was used using 1 of 2 piezosurgery systems for all bone incision. All patients received silicone intubation to the lacrimal system. Surgical outcome was measured in terms of patient-reported epiphora as follows: 1) complete resolution, 2) improvement >50%, 3) improvement 50% improvement. There were 4 patients (7%) who had <50% improvement. There was 1 (2%) intraoperative complication and 2 (4%) postoperative complications recorded. Piezourgery is a viable modality for performing external DCRs. The lack of surgical complications shows a potential for decreased soft tissues damage. The surgical success rate based on patient-reported epiphora is similar to those published for mechanical external DCRs. This modality may benefit the novice surgeon in the reduction of soft and mucosal tissue damage.

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

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

NARCIS (Netherlands)

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

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

Science.gov (United States)

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.

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

Science.gov (United States)

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

Influence of Septal Deviation on the Prognosis of Transcanalicular Diode Laser-Assisted Dacryocystorhinostomy

Directory of Open Access Journals (Sweden)

Alberto Raposo

2016-01-01

Full Text Available Purpose. The objective of the present study is to determine whether the success rate in transcanalicular diode laser-assisted dacryocystorhinostomy (TCL DCR is influenced by the variant septal deviation (SD. Methods. Patients were divided into two groups: one including operated lacrimal pathways (LP with no anatomical nasosinusal variants and the other group of LP with SD. This study began on January 1, 2008, and ended on December 31, 2010, at Morales Meseguer Hospital. Variables were compared by means of ANOVA and a logistic regression model (LOGIT. Results. Out of the 159 LP operated on, 102 had no nasosinusal anatomic variant, but 39 LP were associated with SD. The first group evidenced a success rate of 67.64%, while the second group evidenced a success rate of 66.7%. Conclusion. We found no significant statistical differences between the success rates in the two groups (with SD and no anatomical variants. So we could avoid previous or concomitant septoplasty in some cases (mild and moderate SD.

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

Science.gov (United States)

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.

Endoscopic endonasal approach for mass resection of the pterygopalatine fossa

Directory of Open Access Journals (Sweden)

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.

Endoscopic endonasal approach for mass resection of the pterygopalatine fossa

Science.gov (United States)

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

Retained bone wax on CT at one year after dacryocystorhinostomy: A case report

International Nuclear Information System (INIS)

Kim, Seung Hyun; Park, Dong Woo; Jeong, Jin Yeok; Lee, Jong Ah; Lee, Young Jun

2015-01-01

A 71-year-old man with chronic rhinosinusitis presented with a purulent, foul-smelling nasal discharge and obstruction. One year earlier he had been treated with a dacryocystorhinostomy for nasolacrimal duct obstruction. During the procedure, bone wax had been used to control bleeding in the anterior upper nasal cavity. On computed tomographic imaging, a fat-density lesion was seen in the anterior upper sinonasal cavity and was found to be hypointense or signal-void on all magnetic resonance imaging sequences. The lesion, which proved to consist of bone wax, was surgically removed. Here, we present the imaging features of retained bone wax in a patient with clinically diagnosed chronic rhinosinusitis after dacryocystorhinostomy

Retained bone wax on CT at one year after dacryocystorhinostomy: A case report

Energy Technology Data Exchange (ETDEWEB)

Kim, Seung Hyun; Park, Dong Woo; Jeong, Jin Yeok [Guri Hospital, Hanyang University College of Medicine, Guri (Korea, Republic of); Lee, Jong Ah; Lee, Young Jun [Dept. of Radiology, Seoul Hospital, Hanyang University College of Medicine, Seoul (Korea, Republic of)

2015-09-15

A 71-year-old man with chronic rhinosinusitis presented with a purulent, foul-smelling nasal discharge and obstruction. One year earlier he had been treated with a dacryocystorhinostomy for nasolacrimal duct obstruction. During the procedure, bone wax had been used to control bleeding in the anterior upper nasal cavity. On computed tomographic imaging, a fat-density lesion was seen in the anterior upper sinonasal cavity and was found to be hypointense or signal-void on all magnetic resonance imaging sequences. The lesion, which proved to consist of bone wax, was surgically removed. Here, we present the imaging features of retained bone wax in a patient with clinically diagnosed chronic rhinosinusitis after dacryocystorhinostomy.

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

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.

Scintigraphic evaluation for tear drainage, after dacryocystorhinostomy, in relation to patient satisfaction

NARCIS (Netherlands)

Mansour, K.; Blanksma, L. J.; Vrakking, H.; Jager, P. L.

Aim To measure the degree of physiological patency of the tear drainage system using dacryoscintigraphy before and after external dacryocystorhinostomy (EDCR) in relation to patient complaints. Methods Prospective evaluation of 29 eyes of 24 patients with primary acquired nasolacrimal duct

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.

[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.

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

Directory of Open Access Journals (Sweden)

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.

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.

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

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.

Results of Endoscopic Dacryocystorhinostomy under Local Anesthesia with Minimal Sedation

Directory of Open Access Journals (Sweden)

Woong Chul Choi

2017-01-01

Full Text Available Purpose. We evaluated the tolerability and efficacy of endoscopic dacryocystorhinostomy (Endo-DCR in patients treated in the leaning position and under local anesthesia with minimal sedation (LAS. Study Design. Questionnaire to determine subjective success of Endo-DCR. Methods. From May 2013 to August 2014, a total of 95 eyes with epiphora presented to the Myoung Eye Plastic Surgery Clinic in Seoul, Korea, and were treated with Endo-DCR under LAS. Three nerve blocks were administered to achieve local anesthesia. Postoperatively, the wound site was packed with Nasopore to control bleeding and promote wound healing. Outcome measures included a patient questionnaire completed on postoperative day 7 to evaluate intraoperative and postoperative pain based on the VAS (0 to 10. Results. Mean intraoperative and postoperative pain scores were 1.03 and 1.64, respectively, for 95 eyes. Of the 95 eyes treated, the patients in 82 eyes (86.31% reported that they would prefer LAS over GA for a repeat Endo-DCR. The subjective and objective surgical success rates were 90.14% and 95.77%, respectively. Conclusions. Endo-DCR carried out under LAS with the patient in the leaning position is more useful, efficient, and feasible than Endo-DCR performed under GA with the patient in the supine position.

Expanded Endoscopic Endonasal Resection of Retrochiasmatic Craniopharyngioma.

Science.gov (United States)

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 .

A modified technique of retrograde intubation dacryocystorhinostomy for proximal canalicular obstruction

Directory of Open Access Journals (Sweden)

Nikolaos Trakos

2009-11-01

Full Text Available Nikolaos Trakos, Emmanouil Mavrikakis, Kostas G Boboridis, Marselos Ralidis, George Dimitriadis, Ioannis MavrikakisOculoplastic Service, Metropolitan Hospital, Athens, GreecePurpose: To describe a modification of the retrograde intubation dacryocystorhinostomy (DCR in patients with proximal canalicular obstruction.Materials and methods: Interventional case report of a 43-year-old female with a nine-month history of left epiphora following a road traffic accident involving the proximal lower canaliculus. An external DCR approach was performed. Following the creation of a lower canalicular pseudopunctum, the O’Donoghue silicone stent was introduced through the common ostium, out through the pseudopunctum of the lower canaliculus, and returned through the punctum of the normal upper canaliculus down through the common ostium into the nose.Results: The patient experienced complete resolution of symptoms and on her last follow-up, two years later, her lower canaliculus was patent to syringing.Conclusion: This modification of the retrograde intubation DCR is an effective technique which decreases the intraoperative time needed to insert the tubes and minimises further trauma to the newly created punctal area.Keywords: retrograde dacryocystorhinostomy, proximal canalicular obstruction, midcanalicular obstruction, conjuctivodacryocystorhinostomy

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

Directory of Open Access Journals (Sweden)

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.

Analysis of Age as a Possible Prognostic Factor for Transcanalicular Multidiode Laser Dacryocystorhinostomy

Directory of Open Access Journals (Sweden)

Emre Ayintap

2014-01-01

Full Text Available Purpose. To assess the prognostic value of age on the outcome of transcanalicular multidiode laser dacryocystorhinostomy (TCL-DCR in patients with acquired nasolacrimal duct obstruction (NLDO. Methods. The medical records of TCL-DCR performed between March 2009 and September 2013 were reviewed retrospectively. Inclusion criteria include over 20 years of age, similar mean follow-up period, and similar mean duration of stenting. The main outcome is surgical success. The effect of age on success rate is also evaluated. Results. The anatomical success was 52% in Group 1 (20–30 years, 56% in Group 2 (31–40 years, 64% in Group 3 (41–50 years, 76% in Group 4 (51–60 years, and 88% in Group 5 (over 60 years. The statistical difference among Group 1 and Group 5, in terms of surgical success rate, was found to be significant (P=0.009. Additionally, the 20–30-year-old patients had a failure rate 6.76 times higher than that of the over-60-year-old patients (P=0.009; 95% CI, 1.605–28.542. Conclusion. TCL-DCR is a surgical treatment option for NLDO for which a skin incision can be avoided. The success rate of TCL-DCR for younger population is lower when compared with elderly population.

Simplified local anesthesia technique for external dacryocystorhinostomy without nasal packing: a new technique and pilot study outcome

Directory of Open Access Journals (Sweden)

Tawfik HA

2013-11-01

Full Text Available Hatem A Tawfik,1 Osama R Youssef21Department of Ophthalmology, 2Department of Anesthesiology, Ain Shams University, Cairo, EgyptBackground: The purpose of this paper is to describe a simplified local anesthesia technique for external dacryocystorhinostomy (EXT-DCR.Methods: In this pilot, retrospective, noncomparative, interventional case series, 448 patients (480 eyes underwent EXT-DCR using a simplified local anesthesia technique. Nasal mucosal anesthesia was achieved using combined application of 6 mL of oxymetazoline 0.025% nasal spray and lidocaine 1% in the same spray bottle, without any packing of the nose with either pledgets or ribbon gauze. Local infiltration anesthesia consisted of subcutaneous injection of a 7 mL mixture of 2% lidocaine with 1:100,000 epinephrine injected on the flat side of the nose beneath the incision site, in addition to a second medial peribulbar injection (3 mL, 2% lidocaine without epinephrine.Results: Successful unilateral or bilateral EXT-DCR was achieved in 432/448 patients (96.4%. Four patients could not tolerate the procedure under local anesthesia and were converted to general anesthesia. Four patients required additional local anesthetic injections because of intolerable pain. Heavy sedation was essential in eight uncooperative patients because surgical manipulation was impossible. The remaining patients tolerated the procedure well. The intraoperative bleeding rate was very low except in one patient. Mean operative time was 16 minutes. Severe postoperative epistaxis was observed in four patients. Temporary anosmia developed in one patient.Conclusion: Our simplified local anesthesia approach of EXT-DCR is convenient for the patient because it avoids unnecessary nasal packing. It is also safe and effective, as evidenced by the high rate of successful completion of the procedure without conversion to general anesthesia or the need for supplemental local anesthesia.Keywords: local anesthesia, external

Comparison of Transcanalicular Multidiode Laser Dacryocystorhinostomy with and without Silicon Tube Intubation

OpenAIRE

Yildirim, Yildiray; Kar, Taner; Topal, Tuncay; Cesmeci, Enver; Kaya, Abdullah; Colakoglu, Kadir; Aksoy, Yakup; Sonmez, Murat

2016-01-01

Aim. To compare the surgical outcomes of surgery with and without bicanalicular silicon tube intubation for the treatment of patients who have primary uncomplicated nasolacrimal duct obstruction. Methods. This retrospective study is comprised of 113 patients with uncomplicated primary nasolacrimal duct obstruction. There were 2 groups in the study: Group 1 (n = 58) patients underwent transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation and Grou...

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

Effectiveness of caudal septal extension graft application in endonasal septoplasty

Directory of Open Access Journals (Sweden)

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

Mitomycin-C in dacryocystorhinostomy: From experimentation to implementation and the road ahead: A review

Directory of Open Access Journals (Sweden)

Akshay Gopinathan Nair

2015-01-01

Full Text Available Dacryocystorhinostomy (DCR is the procedure of choice in patients with epiphora due to primary acquired nasolacrimal duct obstruction. The evolution of surgical tools, fiber-optic endoscopes, effective anesthesia techniques, and the adjunct use of antimetabolites intraoperatively; namely mitomycin-C (MMC have significantly contributed to the advancement of DCR surgery. MMC is a systemic chemotherapeutic agent derived from Streptomyces caespitosus that inhibits the synthesis of DNA, cellular RNA, and protein by inhibiting the synthesis of collagen by fibroblasts. Even the cellular changes in the human nasal mucosal fibroblasts induced by MMC at an ultrastructural level have been documented. There, however, seems to be a lack of consensus regarding MMC: The dosage, the route of delivery/application, the time of exposure and subsequently what role each of these variables plays in the final outcome of the surgery. In this review, an attempt is made to objectively examine all the evidence regarding the role of MMC in DCR. MMC appears to improve the success rate of DCR.

Endoscopic Endonasal Approach for a Suprasellar Craniopharyngioma.

Science.gov (United States)

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 .

Expanded Endonasal Endoscopic Approach for Resection of an Infrasellar Craniopharyngioma.

Science.gov (United States)

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.

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

Directory of Open Access Journals (Sweden)

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

Comparison of impact of four surgical methods on surgical outcomes in endoscopic dacryocystorhinostomy.

Science.gov (United States)

Roh, Hyun Cheol; Baek, Sehyun; Lee, Hwa; Chang, Minwook

2016-06-01

To evaluate differences in the surgical outcomes of endoscopic dacryocystorhinostomy (DCR) according to four different surgical methods. This retrospective study included 222 patients who underwent endoscopic DCR from 2011 to 2013. All patients were assigned to one of four groups according to instruments for incision of nasal mucosa and the formation of mucosal flap: group 1, a sickle knife with mucosal flap; group 2, a sickle knife without mucosal flap; group 3, electrocautery with mucosal flap; and group 4, electrocautery without mucosal flap. The follow up period was at least 6 months. There were 33 eyes in group 1, 44 eyes in group 2, 49 eyes in group 3, and 97 eyes in group 4. There were no significant differences in success rate between groups (P = 0.878). Wound healing time was significantly different between groups (P knife may be more helpful and effective for shortening wound healing time rather than making mucosal flaps in endoscopic DCR. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Efficacy of adjunctive mitomycin C in transcanalicular diode laser dacryocystorhinostomy in different age groups.

Science.gov (United States)

Kar, Taner; Yildirim, Yildiray; Topal, Tuncay; Çolakoğlu, Kadir; Ünal, Melih Hamdi

2016-01-01

To evaluate the efficacy of adjunctive mitomycin C (MMC) in transcanalicular multidiode laser dacryocystorhinostomy (TCL-DCR) in different age groups. Ninety-six eyes of 96 patients who underwent TCL-DCR for the treatment of nasolacrimal duct obstruction were included in this retrospective, comparative study. Patients were divided into 4 groups based on age and intraoperative use of MMC: group 1, TCL-DCR without MMC in the 20- to 44-year age group; group 2, TCL-DCR with MMC in the 20- to 44-year age group; group 3, TCL-DCR without MMC in the 45- to 76-year age group; group 4, TCL-DCR with MMC in the 45- to 76-year age group. The postoperative evaluation consisted of calculating and comparing the success rates between groups. Success rates at the final visit were 50% for group 1, 66.66% for group 2, 79.16% for group 3, and 84.61% for group 4. The differences between group 1 and group 4, and group 1 and group 3, were significant (p = 0.01 and p = 0.038, respectively). Logistic regression showed that age group had significant effect on success rate (p = 0.013). However, use of MMC had no significant effect on success rate (p = 0.23). The success rates of the TCL-DCR with MMC application were found to be higher than those of TCL-DCR without MMC in different age groups. However, the differences did not reach statistical significance. In addition, our study demonstrated that age may be a significant factor influencing the surgical outcome of TCL-DCR.

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.

Etiologic analysis of 100 anatomically failed dacryocystorhinostomies

Science.gov (United States)

Dave, Tarjani Vivek; Mohammed, Faraz Ali; Ali, Mohammad Javed; Naik, Milind N

2016-01-01

Background The aim of this study was to assess the etiological factors contributing to the failure of a dacryocystorhinostomy (DCR). Patients and methods Retrospective review was performed in 100 consecutive patients who were diagnosed with anatomically failed DCR at presentation to a tertiary care hospital over a 5-year period from 2010 to 2015. Patient records were reviewed for demographic data, type of past surgery, preoperative endoscopic findings, previous use of adjuvants such as intubation and mitomycin C, and intraoperative notes during the re-revision. The potential etiological factors for failure were noted. Results Of the 100 patients with failed DCRs, the primary surgery was an external DCR in 73 and endoscopic DCR in 27 patients. Six patients in each group had multiple revisions. The mean ages at presentation in the external and endoscopic groups were 39.41 years and 37.19 years, respectively. All patients presented with epiphora. The most common causes of failure were inadequate osteotomy (69.8% in the external group and 85.1% in the endoscopic group, P=0.19) followed by inadequate or inappropriate sac marsupialization (60.2% in the external group and 77.7% in the endoscopic group, P=0.16) and cicatricial closure of the ostium (50.6% in the external group and 55.5% in the endoscopic group, P=0.83). The least common causes such as ostium granulomas and paradoxical middle turbinate (1.37%, n=1) were noted in the external group only. Conclusion Inadequate osteotomy, incomplete sac marsupialization, and cicatricial closure of the ostium were the most common causes of failure and did not significantly differ in the external and endoscopic groups. Meticulous evaluation to identify causative factors for failure and addressing them are crucial for subsequent successful outcomes. PMID:27555748

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

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.

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.

Linfoma não-Hodgkin de órbita: relato de caso Non-Hodgkin orbital lymphoma: case report

Directory of Open Access Journals (Sweden)

Cristiane do Prado Silva

2008-04-01

Full Text Available O objetivo é relatar manifestação incomum de linfoma não-Hodgkin de órbita. Paciente masculino, de 75 anos, se apresentou com queixa de lacrimejamento crônico bilateral. Havia feito dacriocistorrinostomia endonasal à direita e à esquerda por duas vezes, sem sucesso. Ao exame, massas de consistência fibroelástica, em topografia das "bolsas" de gordura das pálpebras inferiores e proptose axial. O paciente negava outros sintomas ou sinais sistêmicos. Hemograma sem alteração, hormônios tireoidianos normais. A tomografia computadorizada mostrava infiltrado difuso na órbita e proptose axial. Biópsia de gordura orbitária e de medula óssea diagnosticaram linfoma não-Hodgkin. O paciente foi tratado com quimioterapia, sendo em seguida submetido à cirurgia da via lacrimal bilateral, com resolução do quadro. A doença sistêmica que exigia diagnóstico e tratamento adequados para que se tivesse bom prognóstico estava mascarada pelo quadro de epífora bilateral.The purpose is to report an unusual case of orbital non-Hodgkin lymphoma. A 75-year-old man presented with bilateral chronic epiphora complaint and inferior eyelid tumors, axial proptosis, without previous systemic manifestation. The patient was submitted to bilateral endonasal dacryocystorhinostomy twice and the epiphora complaint persisted. The inferior eyelid and bone marrow biopsy revealed non-Hodgkin lymphoma. The patient was treated with systemic chemotherapy and dacryocystorhinostomy with good resolution. The precise diagnosis and the treatment were very important to reach a good resolution of the bilateral epiphora complaint.

Entire lacrimal sac within the ethmoid sinus: outcomes of powered endoscopic dacryocystorhinostomy

Directory of Open Access Journals (Sweden)

Ali MJ

2016-07-01

Full Text Available Mohammad Javed Ali, Swati Singh, Milind N NaikInstitute of Dacryology, LV Prasad Eye Institute, Hyderabad, India Background: The aim of this study was to report the outcomes of powered endoscopic dacryocystorhinostomy (PEnDCR in patients with lacrimal sac within the sinus.Materials and methods: Retrospective analysis was performed on all patients who underwent PEnDCR and were intraoperatively documented to have complete lacrimal sac in sinus. Data collected included demographics, clinical presentations, associated lacrimal and nasal anomalies, intraoperative findings, intraoperative guidance, complications, postoperative ostium behavior, and anatomical and functional success. A minimum follow-up of 6 months postsurgery was considered for final analysis.Results: A total of 17 eyes of 15 patients underwent PEnDCR using standard protocols, but with additional intraoperative guidance where required and careful maneuvering in the ethmoid sinus. The mean age of the patients was 37.2 (range 17–60 years. Of the unilateral cases, 69% (nine of 13 showed left-side predisposition; 80% of patients showed regurgitation on pressure over the lacrimal sac area. Associated lacrimal and nasal anomalies were observed in 13.3% (two of 15 and 40% (six of 15, respectively. At a mean follow-up of 6.6 months, anatomical and functional success were observed in 93.3% (14 of 15. One patient showed failure secondary to cicatricial closure of the ostium.Conclusion: An entire sac within an ethmoid sinus poses a surgical challenge. Good sinus-surgery training, thorough knowledge of endoscopic anatomy, careful maneuvering, and use of intraoperative navigation guidance result in good outcomes with PEnDCR.Keywords: lacrimal sac, ethmoid sinus, endoscopic, DCR

Management of functional epiphora in patients with an anatomically patent dacryocystorhinostomy.

Science.gov (United States)

Shams, Pari N; Chen, Philip G; Wormald, Peter J; Sloan, Brian; Wilcsek, Geoff; McNab, Alan; Selva, Dinesh

2014-09-01

Approximately 5% to 10% of patients continue to experience persistent epiphora following an anatomically successful dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction or stenosis. To investigate the management and success rate of so-called "functional failure" of DCR for nasolacrimal duct obstruction by experienced lacrimal surgeons. Multicenter retrospective case series including 5 Australian and New Zealand centers. Participants included 61 patients (71% women [n = 46]; mean age, 66 years) with functional epiphora after 65 DCRs (69% transnasal) who were recruited over a mean of 7.6 years. Inclusion criteria included confirmed preoperative diagnosis of nasolacrimal duct obstruction or stenosis, age greater than 18 years, recurrent or persistent epiphora after DCR, an anatomically successful DCR, and follow-up longer than 6 months. Exclusion criteria included evidence of lacrimal hypersecretion, eyelid malposition, and punctal or canalicular abnormalities. The number, type, timing, and success of all clinical interventions performed for the management of functional epiphora after DCR. Epiphora recurred a mean of 8.9 months after primary DCR; 89% of the cases (n = 58) had evidence of a patent ostium and 100% were patent on lacrimal irrigation. Intubation with a lacrimal stent was performed in 82% of the cases at the time of surgery, and all stents were removed a mean of 8 weeks postoperatively. Epiphora was reported immediately following DCR in 32% (n = 21) of the cases and within 6 weeks after removal of the stent in 31% (n = 20); late recurrence (>12 months after DCR) developed in 37% (n = 24) of the cases. In a total of 15% of the cases, participants declined any treatment following DCR. The remainder underwent a mean of 1.3 interventions (range, 1-3) during a mean of 23 to 41 months after primary DCR, following which 72% (n = 47) of the cases had a successful outcome; 12% (n = 8) failed to achieve improvement, and the patients declined further

[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.

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.

Outcomes following Purely Endoscopic Endonasal Resection of Pituitary adenomas

Directory of Open Access Journals (Sweden)

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.

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.

Clinical Pearls in Anaesthesia for Endoscopic Endonasal Transsphenoid Pituitary Macroadenoma Surgery

Directory of Open Access Journals (Sweden)

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.

[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.

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.

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 .

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.

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.

Dacryocystorhinostomy ostium: parameters to evaluate and DCR ostium scoring

Directory of Open Access Journals (Sweden)

Ali MJ

2014-12-01

Full Text Available Mohammad Javed Ali,1 Alkis James Psaltis,2 Peter John Wormald2 1Dacryology Service, L V Prasad Eye Institute, Hyderabad, Telangana, India; 2Department of Surgery–Otorhinolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, SA, Australia Aim: This study aims to provide a systematic protocol for the evaluation of a dacryocystorhinostomy (DCR ostium and to propose a scoring system to standardize the assessment.Methods: Retrospective evaluation of 125 consecutive lacrimal ostia post-DCR was performed. Medical records were screened, and photographs and videos were assessed to note the details of various ostial parameters. The major time points in evaluation were 4 weeks, 6 weeks, 3 months, and 6 months post-DCR. The ostia were defined and parameters like shape, size, location, and evolution of ostium were noted. Evaluation parameters were defined for internal common opening (ICO, ostium stents, and ostium granulomas. Ostium cicatrix and synechiae were graded based on their significance. Surgical success rates were computed and ostium characteristics in failed cases were studied.Results: A total of 125 ostia were evaluated on the aforementioned ostium parameters. Because five ostia showed a complete cicatricial closure with no recognizable features, the remaining 120 ostia were studied. The ostium location was anterior to the axilla of middle turbinate in 85.8% (103/120 of the cases. Moreover, 76.6% (92/120 of the ostia were circular to oval in shape, with a shallow base. The ostium size was >8×5 mm in 78.3% (94/120 of the cases. The ICO was found to be located in the central or paracentral basal area in 75.8% (91/120. The anatomical and functional success rates achieved were 96% and 93.6%, respectively. All the five cases with anatomical failures showed a complete cicatrization and the ICO movements were poor in all the three cases of functional failure.Conclusion: The article attempts to standardize the postoperative

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

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

Science.gov (United States)

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.

[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.

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

Directory of Open Access Journals (Sweden)

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.

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.

Long-term outcome of primary external dacryocystorhinostomy

International Nuclear Information System (INIS)

Baig, R.; Khan, Q.A.; Ahmad, K.

2013-01-01

Objective: To assess the long-term functional outcome of external dacryocystorhinostomy (DCR) in terms of epiphora. Study Design: Single-group cohort study. Place and Duration of Study: Section of Ophthalmology, The Aga Khan University Hospital, Karachi, from January 2000 to June 2010. Methodology: This study included adults who underwent external DCR surgery at the AKUH during January 2000 to June 2010. The main outcome measure was the proportion of patients reporting to have developed epiphora after surgery. During the telephonic interviews participants were asked if they had a recurrence (symptoms such as watering or discharge) after surgery. Individuals answering in affirmative were asked when the symptoms started. Data on age at surgery, gender and pre-operative symptoms were collected from medical records. Recurrence-free curves were calculated according to the Kaplan-Meier method. Results: A total of 44 persons who underwent DCR surgery were contactable by telephone in 2011 and all agreed to participate in the study. The mean age of the patients at the time of surgery was 48.0 A+- 15.8 years. Overall, 38.6% (17/44) participants reported having developed epiphora after surgery. The overall median recurrence-free time was 1.7 years; there was no statistically significant difference in the median recurrence-free time between men and women. Conclusion: The long-term functional outcome of external DCR surgery does not appear to be optimal and, in fact, far worse than the short-term results reported in the international literature. (author)

[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.

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.

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.

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

Directory of Open Access Journals (Sweden)

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.

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.

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

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.

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

Directory of Open Access Journals (Sweden)

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.

Aesthetic assessment in periciliary "v-incision" versus conventional external dacryocystorhinostomy in Asians.

Science.gov (United States)

Ng, Danny Siu-Chun; Chan, Edwin; Yu, Derek Kim-Hun; Ko, Simon Tak-Chuen

2015-10-01

To determine the functional and aesthetic outcomes of periciliary "v-incision" external dacryocystorhinostomy (DCR) and to compare with conventional approach. Charts review of consecutive cases of "v-incision" (VDCR) or conventional DCR performed in a single institute, between January 2007 and March 2014. All procedures were performed or supervised by a single surgeon. Two periciliary incisions were made near the skin-mucosal junction at the upper and lower eyelid margins medial to the punctum joining at the medial canthal angle to form a "v" shape. Subcutaneous dissection was carried out inferomedially to reach the anterior lacrimal crest. DCR was then performed in the usual manner. Functional success was defined as no persistent or recurrent epiphora and patency on irrigation of the lacrimal drainage system at least 6 months post-surgery. A cross-sectional aesthetic survey was conducted by asking the patients to rate their scar appearance satisfaction on a visual analogue scale (VAS). External photographs were graded by two independent, masked physicians using VAS as well as the Stony Brook scar evaluation scale (SBSES). Sixty-one patients with median age of 64 years met the inclusion criteria, with median follow-up duration of 28 months. Thirty-eight eyes underwent VDCR, and 23 had conventional DCR. The functional success rate for VDCR was 83.3, 95 % confidence intervals (95%CI) [lower 0.68, upper 0.92] and for conventional DCR was 73.9 %, 95%CI [lower 0.54, upper 0.87]; without statistically significant difference (p = 0.38). VDCR patients rated higher aesthetic outcome on VAS (mean scores 95.5 ± 16.8 vs 82.9 ± 25.1, p = 0.03). On the SBSES, both observers gave higher aesthetic scores to the VDCR group (observer #1 4.6 ± 1.1 and #2 4.7 ± 1.2, p aesthetic outcomes as reported by surgeons and patients. However, a higher proportion of trainees under supervision performed conventional DCR, and it is uncertain whether the outcomes were

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

Directory of Open Access Journals (Sweden)

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.

Comparison of Piezosurgery and Hammer-Chisel in Endoscopic Dacryocystorhinostomy.

Science.gov (United States)

Çukurova, Ibrahim; Bulğurcu, Suphi; Arslan, Ilker Burak; Dikilitaş, Bünyamin

2018-05-08

In this study, we compared the advantages and disadvantages of piezosurgery and hammer-chisel used in endoscopic dacryocystorhinostomy (EDCR). Between January 2012 and January 2016, 10 women and 8 men in whom piezosurgery was used (group 1) and 11 women and 7 men in whom hammer-chisel was used (group 2) during EDCR operations were compared retrospectively. Recurrence, operation time, postoperative bleeding, and operative cost were evaluated in patients who were followed for an average of 11.8 months. In addition, visual analogue scale (VAS) was used to assess pain at 6 hours postoperatively. No recurrence was observed in group 1, but recurrence was observed in 2 patients in group 2 (P = 0.685). There was no postoperative bleeding in both groups. The mean duration of operation was 30.6 ± 8.2 minutes in group 1 and 46.8 ± 9.5 minutes in group 2 (P = 0.038). The VAS score in group 1 was 2.7 ± 1.4 and the VAS score in group 2 was 5.8 ± 2.2 (P = 0.01). Piezosurgery costs an additional $325 for each patient while the use of the hammer-chisel does not incur additional costs. Piezosurgery causes shorter operation time, less recurrence, and less pain when compared with hammer-chisel.

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.

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

Directory of Open Access Journals (Sweden)

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

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

Science.gov (United States)

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

[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.

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.

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.

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

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

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.

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

Science.gov (United States)

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

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

Science.gov (United States)

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 .

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.

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.

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.

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

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.

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

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

Science.gov (United States)

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.

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.

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.

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

Science.gov (United States)

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.

Extended Endoscopic Endonasal Approach for Suprasellar Craniopharyngioma.

Science.gov (United States)

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 .

Endoscopic Endonasal Approach to a Suprasellar Craniopharyngioma.

Science.gov (United States)

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 .

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.

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.

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.

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.

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.

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

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.

External dacryocystorhinostomy in consultants and fellows - a comparison of the causes of failure.

Science.gov (United States)

Sullivan, L; Fearnley, T; Al-Maskari, A; El-Hindy, N; Kalantzis, G; Chang, B Y

2015-01-01

Failure of primary dacryocystorhinostomy (DCR) often requires revision surgery to inspect the cause of failure and re-establish anatomic patency. This study aims to specifcally compare the anatomical causes of failure noted during revision DCR of primary external DCR (EX-DCR) and compare the difference between consultants and fellows. A retrospective review of 37 patients who underwent revision of a primary external approach DCR over a 7-year-period in a University Hospital. All primary surgery was performed by either a consultant surgeon or senior oculoplastic fellow. Details of the initial pathology prior to primary DCR and grade of operating surgeon were collected along with perioperative surgical findings. The cause of failure of the initial surgery was classified according to perioperative findings. Failure was classified as either inappropriately sized/located ostium or fibrous/membranous soft tissue obstruction of the newly created ostium. The cause of failure of the initial surgery was soft tissue obstruction in 43.3% and an inappropriately sized/located ostium in 56.7%. In those patients whose primary surgery was performed by a consultant, 73.3% were found to have a soft tissue obstruction and 26.7% were found to have an inappropriately sized/ located ostium. In contrast, if initial surgery was performed by a fellow, 22.7% were found to have a soft tissue obstruction and 77.3% an inappropriately sized/ located ostium (p =0.002). Where the primary surgeon has been a trainee there is a trend toward inadequately sized or located ostium being the most likely causative factor in failure of primary EX-DCR.  Hippokratia 2015; 19 (3): 216-218.

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.

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.

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.

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.

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 .

Effects analysis of three kinds of operation methods in treatment of dacryocystitis

Directory of Open Access Journals (Sweden)

Wei Cui

2013-01-01

Full Text Available AIM: To investigate the effects on patients with chronic dacryocystitis treated with three methods: external dacryocystorhinostomy(EDCR, intranasal endoscopic dacryocystorhinostomy(IEDCRand Nd:YAG laser dacryoplasty, and to explore the best operation method. METHODS:Totally 182 cases(202 eyeswere randomly divided into three groups, using EDCR, IEDCR and Nd:YAG laser dacryoplasty respectively, postoperative follow- up lasted 6-24months.RESULTS: The success rate of three groups were 93.9%, 92.3% and 71.1% respectively. There was not significant difference between group EDCR and group IEDCR(P>0.05. There was significant difference between group Nd:YAG laser dacryoplasty and other two groups(PCONCLUSION: EDCR and IEDCR are effective methods. Especially IEDCR is minimal invasive technique and worthy of promotion and application.

[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.

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.

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

Complicações na dacriocistorrinostomia transcanalicular com laser diodo: complications Transcanalicular dacryocystorhinostomy with diode laser

Directory of Open Access Journals (Sweden)

Eduardo Alonso Garcia

2009-08-01

Full Text Available OBJETIVO: Analisar as complicações da aplicação do laser de diodo para o tratamento da obstrução nasolacrimal adquirida. MÉTODOS: Foram realizados 44 procedimentos (dacriocistorrinostomia transcanalicular com laser de diodo com intubação bicanalicular de silicone sob anestesia local entre fevereiro de 2002 a novembro de 2007 em 41 pacientes (3 bilateralmente, sendo 32 mulheres e 9 homens. RESULTADOS: As complicações mais frequentes no intraoperatório foram: dificuldade de passar a sonda de Crawford (13,6% e passagem da fibra óptica dificultada (11,3%. No pós-operatório, a epífora foi a ocorrência mais frequente (15,9%, seguida pela retirada acidental do silastic (11,3%. CONCLUSÃO: Os índices de complicações intra e pós-operatórias se equivalem aos artigos publicados com a mesma técnica cirúrgica (e mesmo tipo de laser.PURPOSE: To evaluate the complications of the use of diode laser in the treatment of acquired nasolacrimal obstruction. METHODS: Forty four procedures (transcanalicular dacryocystorhinostomy with diode laser with bicanalicular silicone tube intubation and local anesthesia where performed from February 2002 to November 2007 in 41 patients (3 bilaterally, 32 women and 9 men. RESULTS: The most common intraoperative complications were disability to pass the Crawford probe (13.6% and the laser probe (11.3%. Regarding postoperative complications, epiphora was the event of higher frequency (15.9% followed by the non-intentional silastic extrusion by the patient (11.3%. CONCLUSION: Intraoperative and postoperative complications rate were similar of others articles that demonstrated the same surgical technique (with same laser.

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

Science.gov (United States)

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

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

[Treatment choice in dacryostenosis based on single-photon emission computed tomography and X-ray computed tomography findings].

Science.gov (United States)

At'kova, E L; Yartsev, V D; Tomashevskiy, I O; Krakhovetskiy, N N

2016-01-01

To develop surgical indications in dacryostenosis within the vertical portion of lacrimal pathways that would consider findings of single-photon emission computed tomography (SPECT) combined with X-ray computed tomography (CT). A total of 96 patients with isolated vertical-portion dacryostenosis (127 cases) were enrolled. The examination included collecting Munk's scores for epiphora, optical coherence tomography of the lower tear meniscus, lacrimal scintigraphy, and SPECT/CT. Group 1 (40 cases) was composed of patients with lacrimal obstruction on CT, group 2 (87 cases) - of those whose lacrimal pathways proved passable. There were also 3 patients (4 cases) from group 1, whose lacrimal pathways, despite being blocked on CT, were still passable on SPECT. Surgeries performed in group 1 were endoscopic endonasal dacryocystorhinostomy (DCR) (36 cases) and pathways recanalization with bicanalicular intubation and balloon dacryoplasty (DCP) (4 cases). In group 2, all patients (87 cases) underwent recanalization with bicanalicular intubation (supplemented with balloon DCP in 32 cases). Surgical results were evaluated 8-12 months after the treatment. In group 2, particular attention was paid to the concordance in locations of dacryostenosis provided by CT and SPECT scans. Favorable outcomes of endoscopic endonasal DCR were obtained in as many as 32 cases from group 1 (88.9%), while in 4 cases (12.1%) the condition relapsed. Of those patients whose stenosis was not complete on SPECT, 3 cases (75.0%) improved, 1 (25.0%) - relapsed. In group 2, favorable outcomes were obtained in 65 cases (74.7%), relapses were 22 (25.3%). A high concordance in stenosis locations by CT and SPECT was noted in 60 cases of those who improved (92.3%) and 3 cases of those who relapsed (13.6%). The value of information provided by SPECT/CT has proved high in patients with nasolacrimal duct stenosis or obstruction. A combined scan allows to establish causal relationships between anatomical changes

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.

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.

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.

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.

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.

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.

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.

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

Directory of Open Access Journals (Sweden)

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

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)

Use of adjunctive mitomycin C in external dacryocystorhinostomy surgery compared with surgery alone in patients with nasolacrimal duct obstruction: A prospective, double-masked, randomized, controlled trial.

Science.gov (United States)

Ari, Seyhmus; Gun, Ramazan; Surmeli, Serdar; Atay, Ahmet Engin; Caca, Ihsan

2009-08-01

The most common cause for the failure of external dacryocystorhinostomy (DCR) surgery is the formation of granulation tissue at the osteotomy site or common canaliculus. The aims of this study were to assess the efficacy of intraoperative adjunctive mitomycin C (MMC) treatment in external DCR surgery and to compare this procedure with the standard DCR procedure alone in the long term (1 year). In this prospective, double-masked, randomized, controlled trial, patients with primary acquired nasolacrimal duct obstruction were randomized (using a random number table) into 2 groups based on surgical procedure. In the MMC group, intraoperative adjunctive MMC 0.2 mg/mL was applied to the osteotomy site for 30 minutes. The control group underwent standard DCR procedure only. The results of the DCR surgeries were assessed using objective findings (eg, cessation of excessive tearing via nasolacrimal duct irrigation and the improvement in height of tear meniscus) and subjective symptoms (asking patients to describe the degree of tearing improvement). Both the patients and the researchers who were assessing the study outcomes were masked to treatment group. One hundred eyes of 100 Turkish patients were assessed and equally randomized to the MMC (27 women, 23 men; mean [SD] age, 47.0 [7.6] years) and control (26 women, 24 men; mean age, 46.6 [8.8] years) groups. The follow-up period was not significantly different between the MMC and the control groups (13.1 [1.1] vs 13.2 [1.4] months). Significantly more eyes in the MMC group than the control group remained symptom-free throughout the 1-year follow-up period (45/50 [90%] vs 33/50 [66%]; P=0.005). Significantly more patients in the control group than the MMC group had an improvement in symptoms at the 1-year follow-up (8/50 [16%] vs 2/50 [4%] eyes; P=0.005). Based on the patency of the drainage system, the success rate was significantly greater in the MMC group than the control group (48/50 [96%] vs 42/50 [84%]; P=0.005). Based

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

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 .

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.

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.

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.

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.

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

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

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.

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.

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

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.

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.

Transcanalicular laser dacryocystorhinostomy using low energy 810 nm diode laser

Directory of Open Access Journals (Sweden)

Sanjiv K Gupta

2012-01-01

Conclusions: Transcanalicular Laser DCR can be safely performed using a low power 810 nm diode laser. The surgery is elegant, minimally invasive, allows fast rehabilitation, and has an excellent success rate.

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.

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.

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.

[Surgical treatment with dacryocystitis and retinal detachment in a patient with Wegener granulomatosis].

Science.gov (United States)

Metoki, Tomomi; Kubo, Masabumi; Takano, Yoshiko; Nakamura, Hideo; Nakazawa, Mitsuru

2003-06-01

We report surgical treatment of a patient with dacryocystitis and retinal detachment (RD), which are rare ophthalmic involvements of Wegener granulomatosis (WG). The patient was a 26-year-old man with WG. He was diagnosed as having WG 4 years ago and he has been treated by maintenance doses of predonisolone and cyclophosphamide. Rheumatoid factor and serum antinuclear antibody were negative. Cytoplasmic pattern-antineutrophil cytoplasmic antibody (C-ANCA) and renal function were normal. He was found to have nasolacrimal duct obstruction and lattice degeneration bilaterally, retinal tear with RD in the left eye and tear without RD in the right eye. No sign of vasculitis was found in fluorescein angiography. Bilateral dacryocystorhinostomy was performed without any sign of postoperative necrosis of the wound. After the surgery, epiphora and eye discharge disappeared and lacrimal passage has been maintained without obstruction. The pathological findings of his nasal mucosa and lacrimal sac showed chronic inflammation and no typical changes of WG. There was no abnormal change in the conjunctiva and sclera after an uncomplicated scleral buckling surgery. We conclude that operations such as dacryocystorhinostomy and scleral buckling surgery may be performed successfully when WG is controlled within the normal limits of C-ANCA.

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.

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.

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

Science.gov (United States)

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

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

Science.gov (United States)

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

A new permanent lacrimal stent: evaluation of a modification to dacryocystorhinostomy

Directory of Open Access Journals (Sweden)

Dikran G Hovaghimian

2015-01-01

Modified DCR with the new lacrimal silicone stent is technically quick and easy to perform and can be done for all age groups with a high success rate and could be considered as a good alternative to classic DCR surgery.

Bilateral congenital lacrimal fistulas in an adult as part of ectrodactyly-ectodermal dysplasia-clefting syndrome: A rare anomaly.

Science.gov (United States)

Ghosh, Debangshu; Saha, Somnath; Basu, Sumit Kumar

2015-10-01

Ectrodactyly-ectodermal dysplasia and clefting syndrome or "Lobster claw" deformity is a rare congenital anomaly that affects tissues of ectodermal and mesodermal origin. Nasolacrimal duct (NLD) obstruction with or without atresia of lacrimal passage is a common finding of such a syndrome. The authors report here even a rarer presentation of the syndrome which manifested as bilateral NLD obstruction and lacrimal fistula along with cleft lip and palate, syndactyly affecting all four limbs, mild mental retardation, otitis media, and sinusitis. Lacrimal duct obstruction and fistula were managed successfully with endoscopic dacryocystorhinostomy (DCR) which is a good alternative to lacrimal probing or open DCR in such a case.

Bilateral congenital lacrimal fistulas in an adult as part of ectrodactyly-ectodermal dysplasia-clefting syndrome: A rare anomaly

Directory of Open Access Journals (Sweden)

Debangshu Ghosh

2015-01-01

Full Text Available Ectrodactyly-ectodermal dysplasia and clefting syndrome or "Lobster claw" deformity is a rare congenital anomaly that affects tissues of ectodermal and mesodermal origin. Nasolacrimal duct (NLD obstruction with or without atresia of lacrimal passage is a common finding of such a syndrome. The authors report here even a rarer presentation of the syndrome which manifested as bilateral NLD obstruction and lacrimal fistula along with cleft lip and palate, syndactyly affecting all four limbs, mild mental retardation, otitis media, and sinusitis. Lacrimal duct obstruction and fistula were managed successfully with endoscopic dacryocystorhinostomy (DCR which is a good alternative to lacrimal probing or open DCR in such a case.

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.

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...

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.

Lacrimal system pathology in patients with malignant thyroid tumors after radioactive iodine therapy, and its correction methods

Directory of Open Access Journals (Sweden)

Natalya Yu. Beldovskaya

2017-12-01

Full Text Available Introduction. Radioactive iodine therapy after thyroidectomy is the standard of differentiated thyroid cancer treatment in the modern world. Main dose-dependent side effects described in the literature include: sialadenitis, xerostomia, taste and/or odor loss, swelling of surrounding tissues. Ophthalmic complications are rarely reported. Aim. To assess the lacrimal system condition in patients after radioactive iodine therapy for thyroid cancer. Material and methods. The study included 17 patients (34 eyes. There were female patients aged 19 to 43 years (mean age was 31 years who underwent a course of radioactive iodine therapy for thyroid cancer. All of them complained of periodic or constant tearing in the period from 2 months to 1 year after therapy course. In four patients, there was a permanent or periodic mucopurulent discharge when pressing on the lacrimal sac area. All patients underwent a standard ophthalmological examination, including visual acuity testing, anterior segment biomicroscopy, ophthalmoscopy, and tear production tests. Dye disappearance test, Jones I and II tests, lacrimal pathways irrigation, and, if necessary, cone-ray computer tomography with preliminary lacrimal pathways contrasting were performed to evaluate the tear outflow abnormalities. Results. Tear production disorders were detected in 20 eyes (58.8% (among them, moderate dry eye syndrome was diagnosed in 3 cases; tear outflow pathology was revealed in 14 eyes (41.2% (namely naso-lacrimal duct obstruction and stenosis, and chronic purulent dacryocystitis. For patients with tear production pathology artificial tears were prescribed, and endoscopic endonasal dacryocystorhinostomy was performed in cases of tear outflow disturbances. Conclusion. The use of radioactive iodine in doses exceeding 80 mCi leads to the development of lacrimal system pathology: dry eye syndrome of various severity, and tear outflow disorders. Lacrimal system pathology significantly worsens

Importance of imaging diagnostics and interventional therapy for diseases of the lacrimal drainage canals

International Nuclear Information System (INIS)

Bink, A.; Berkefeld, J.; Luechtenberg, M.

2008-01-01

Epiphora (continuous watering of the eyes) is frequently caused by obstruction of the lacrimal draining system. Radiographic imaging of the tear ducts after contrast injection with the DSA (digital subtraction angiography) dacryocystography technique is still the gold standard in patients with severe epiphora which does not respond to conservative therapy. Recent techniques, such as 3D rotational dacryocystography, MRI and CT are able to show the anatomic surroundings in addition to the ductal structures and are especially useful for planning endoscopic operations. Dacryocystographically assisted interventions, such as balloon dilatation or stenting of tear duct stenoses are technically feasible. Balloon dacryocystoplasty is especially successful in patients with incomplete or short distance obstructions of the nasolacrimal duct. Stenting may improve procedural success and patency rates. Minimally invasive interventional therapy is useful as an initial treatment in selected cases, however, long-term success rates may be limited and operative dacryocystorhinostomy still plays an important role. Comparative studies for evaluation of different therapeutic options are necessary. (orig.) [de

Aspirin Desensitization

Science.gov (United States)

... Nerve Decompression Dacryocystorhinostomy (DCR) Disclosure Statement Printer Friendly Aspirin Desensitization Kevin C. Welch, MD Zara Patel, MD Introduction The term "aspirin-sensitive asthma" (also known as "aspirin triad" or " ...

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.)

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.

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.

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.

Endoscopic intranasal findings in unilateral primary acquired nasolacrimal duct obstruction

Directory of Open Access Journals (Sweden)

Swati Singh

2017-07-01

Conclusion: Unilateral PANDO has a higher incidence of ipsilaterally deviated nasal septum. This association is significant. Routine nasal endoscopic examination should be performed in cases undergoing dacryocystorhinostomy to better plan a concomitant septoplasty if needed.

Progress in the clinical treatment of chronic dacryocystitis

Directory of Open Access Journals (Sweden)

Xiang-Lei Chen

2018-04-01

Full Text Available Chronic dacryocystitis is often seen in middle-aged and old women, especially in menopause. The opening of the obstruction of the nasolacrimal duct is the key to the treatment of chronic dacryocystitis. At present, surgical treatment is the main type of operation. The commonly used methods include the transnasal canthus skin dacryocystorhinostomy and the endoscopic dacryocystorhinostomy. With the development of technology, the application of laser technology and new lacrimal duct silicon rubber tube makes the clinical treatment of chronic dacryocystitis more perfect. Lacrimal endoscope technology can obtain more intuitive image of lacrimal duct data, to determine the nature, location and degree of obstruction of lacrimal passage and treatment plan is particularly important, is a major breakthrough in the field of diagnosis and treatment of lacrimal duct obstruction, diagnosis and treatment method is currently the most advanced in the field.

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

Pattern and outcome of surgical management of nasolachrymal duct ...

African Journals Online (AJOL)

The commonest complication noted was stent extrusion before 6 weeks in 17.6% of cases. Conclusion: NLDO was mostly of congenital origin and was characterized by delayed presentation. Patients have good outcome with external DCR. Keywords: Children, dacryocystorhinostomy, naso lachrymal duct, obstruction.

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.

Endoscopic transpterygoidal repair of a large cranial defect with cerebrospinal fluid leak in a patient with extensive osteoradionecrosis of the skull base: case report and technical note.

Science.gov (United States)

Brand, Y; Lim, E; Waran, V; Prepageran, N

2015-12-01

Endoscopic endonasal techniques have recently become the method of choice in dealing with cerebrospinal fluid leak involving the anterior cranial fossa. However, most surgeons prefer an intracranial approach when leaks involve the middle cranial fossa. This case report illustrates the possibilities of using endoscopic techniques for cerebrospinal fluid leaks involving the middle fossa. A 37-year-old male patient presented with multiple areas of cranial defect with cerebrospinal fluid leak due to osteoradionecrosis following radiation for nasopharyngeal carcinoma 4 years earlier. Clinical examination showed involvement of all cranial nerves except the IInd and XIth nerves on the left side. A prior attempt to repair the cerebrospinal fluid leak with craniotomy was not successful. This case demonstrates the successful endoscopic repair of a large cranial defect with cerebrospinal fluid leak.

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.

Ensuring a successful family business management succession

OpenAIRE

Desbois, Joris

2016-01-01

Succession is the biggest long-term challenge that most family businesses face. Indeed, leaders ‘disposition to plan for their succession is frequently the key factor defining whether their family business subsists or stops. The research seeks to find out how to manage successfully the business management succession over main principles. This work project aims at researching the key points relevant to almost all family firms, to have a viable succession transition and positioni...

The lacrimal system: diagnosis, management, and surgery

National Research Council Canada - National Science Library

Cohen, Adam J; Mercandetti, Michael; Brazzo, Brian G

2006-01-01

... and techniques presented represent the state of the art of lacrimal diagnosis and surgery. There is mention of lacrimal infection dating back to the Code of Hammurabi in 2250 BC, but it was not until the late 1800s that real progress began to be made. Toti, an ENT surgeon in Florence, Italy, described external dacryocystorhinostomy (DCR) with turb...

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.

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

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.

College Success Courses: Success for All

Science.gov (United States)

Coleman, Sandra Lee; Skidmore, Susan Troncoso; Weller, Carol Thornton

2018-01-01

College success courses (CSCs), or orientation courses, are offered by community colleges and universities to facilitate the success of first-time-in-college students. Primarily, these courses are designed to address students' nonacademic deficiencies, such as weak study habits and poor organizational skills, and to familiarize students with…

Tracing the origins of success: implications for successful aging.

Science.gov (United States)

Peterson, Nora M; Martin, Peter

2015-02-01

This paper addresses the debate about the use of the term "successful aging" from a humanistic, rather than behavioral, perspective. It attempts to uncover what success, a term frequently associated with aging, is: how can it be defined and when did it first come into use? In this paper, we draw from a number of humanistic perspectives, including the historical and linguistic, in order to explore the evolution of the term "success." We believe that words and concepts have deep implications for how concepts (such as aging) are culturally and historically perceived. We take a comparative approach, turning to the etymological roots of this term in British, French, and German literature. According to the earliest entries of the term in the Oxford English Dictionary, events can have good or bad success. Another definition marks success as outcome oriented. Often used in the context of war, religion, and medicine, the neutral, but often negative, use of "success" in literature of the Renaissance demonstrates the tensions that surround the word, and suggests that success is something to be approached carefully. Ignoring the ambiguous origins of success erases the fact that aging in earlier centuries echoes much of the same ambivalence with which many people discuss it today. Attending to the origins of success can help gerontologists understand the humanistic tradition behind their inquiry into what successful aging means today. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Patients Undergoing Dacryocystorhinostomy Surgery in Northern ...

African Journals Online (AJOL)

the excess overflow of tears called Epiphora.[1] A disorder of the tear drainage is either functional or anatomical abnormalities. In terms of functional disorder, pumping dysfunction is the problem, which may be due to poor function of lacrimal punctum, eyelid laxity or orbicularis muscle weakness or facial nerve palsy. In the ...

Educational Attainment: Success to the Successful

Science.gov (United States)

Anthony, Peter; Gould, David; Smith, Gina

2013-01-01

Systems archetypes are patterns of structure found in systems that are helpful in understanding some of the dynamics within them. The intent of this study was to examine educational attainment data using the success-to-the-successful archetype as a model to see if it helps to explain the inequality observed in the data. Data covering 1990 to 2009…

Information Systems Success: An empirical study on the appropriate success criteria and the real value of critical success factors

OpenAIRE

Skovly, Jørgen

2013-01-01

Success is a complex concept, that people have been trying to understand for some time. Extensive research has been conducted in order to improve our understanding, and thus increase our chances for achieving success. However, as projects still continue to fail, the real value of this research seems unclear. This thesis emphasizes the distinction between variables that may cause success (success factors), and variables that are part of success (success criteria). Success is not a 'black and w...

The efficacy of sleeve technique in primary nasolacrimal duct obstruction with a high lacrimal sac

Directory of Open Access Journals (Sweden)

Kyoung-Nam Kim

2014-01-01

Full Text Available Purpose: To evaluate the efficacy of a sleeve technique during endoscopic dacryocystorhinostomy (DCR in primary nasolacrimal duct obstruction (NLDO patients with a high lacrimal sac. Materials and Methods: The medical records of 45 patients (49 cases undergoing endoscopic DCR for primary NLDO with a high lacrimal sac were retrospectively reviewed. In 19 patients (21 cases, the thick maxilla covering the common canalicular opening was removed using a drill and a bicanalicular silicone tube was inserted (group 1. In 26 patients (28 cases, instead of removal of the thick maxilla, a sleeve was inserted into the bicanalicular silicone tube (group 2. At 6 months postoperatively, the success rate was evaluated and the size of the intranasal mucosal ostium was measured. Results: The success rates in group 1 and 2 was 90.5% and 96.4%, respectively (P = 0.400. The intranasal mucosal ostium in group 1 and 2 measured 1.7 ± 0.7 mm and 3.1 ± 1.0 mm, respectively, and the difference was significant (P = 0.042. Conclusions: In primary NLDO patients with a high lacrimal sac, DCR inserting a silicone tube and a sleeve together had a satisfactory success rate without using a drill. In comparison with traditional surgical methods, it helped enlarge the size of the intranasal mucosal ostium.

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.

Attitudes of Success.

Science.gov (United States)

Pendarvis, Faye

This document investigates the attitudes of successful individuals, citing the achievement of established goals as the criteria for success. After offering various definitions of success, the paper focuses on the importance of self-esteem to success and considers ways by which the self-esteem of students can be improved. Theories of human behavior…

SUCCESSION MANAGEMENT: UPAYA HUMAN RESOURCE PLANNING MENUJU SUCCESS CORPORATE

Directory of Open Access Journals (Sweden)

Rini Kuswati

2010-06-01

create a more flexible and dynamic approach for preparing future executive and have the leadership necessary ready to meet the business challenges of the remainder of the decade and beyond. Succession management allows the corporate leadership to instill a more dynamic process became easier to integrate with the firm’s strategic initiatives. It better aligns organizational thinking with the external environment where the discontinuities make it possible to anticipate the full spectrum of change that a corporation will confront. It is the leadership and succession philosophy that focuses on developing the creativity and flexibility that allows for a more rapid response to change. So succession management as one way to became the success corporate.

Success in Science, Success in Collaboration

Energy Technology Data Exchange (ETDEWEB)

Johnston, Mariann R. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2016-08-25

This is a series of four different scientific problems which were resolved through collaborations. They are: "Better flow cytometry through novel focusing technology", "Take Off^®: Helping the Agriculture Industry Improve the Viability of Sustainable, Large-Production Crops", "The National Institutes of Health's Models of Infectious Disease Agent Study (MIDAS)", and "Expanding the capabilities of SOLVE/RESOLVE through the PHENIX Consortium." For each one, the problem is listed, the solution, advantages, bottom line, then information about the collaboration including: developing the technology, initial success, and continued success.

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

Building Successful Information Systems – a Key for Successful Organization

Directory of Open Access Journals (Sweden)

Doina ROSCA

2010-12-01

Full Text Available Building Successful Information Systems – a Key for Successful OrganizationAbstract: An Information System (IS can have a major impact on corporate strategy and organizational success. The involvement of managers and decision makers in all aspects of information systems is a major factor for organizational success, including higher profits and lower costs. Some of the benefits business organization seek to achieve through information systems include: better safety, competitive advantage, fewer errors, greater accuracy, higher quality products, improved communications, increased efficiency and productivity, more efficient administration, superior financial and managerial decision making.

Determining Success Criteria and Success Factors for International Construction Projects for Malaysian Contractors

Directory of Open Access Journals (Sweden)

Ali Mohammed Alashwal

2017-06-01

Full Text Available The success of international construction projects is fraught with various challenges such as competitiveness, lack of resources, versatile global economy, and specific conditions in the host country. Malaysian contractors have been venturing into global construction market since early 1980s. However, their venturing was not successful all the time. The number of international projects awarded to Malaysian contractors has reduced drastically during the past decade. Taking advantage of this experience, this paper aims to identify the success criteria and success factors of international construction projects. The data was collected from 120 respondents using a questionnaire survey and analysed using principal component analysis and regression analysis. The results revealed three principal criteria of project success namely, Management Success, Functional Success, and Organisation Success. The main components of success factors include Team Power and Skills, Resource Availability, External Environment, Organisation Capability, Project Support, and Project Organisation. Further analysis emphasized the importance of strong financing capacity of contractors, project social environment, and competence of the project manager in achieving project success. The results of this paper can serve as a guideline for contractors and project managers to achieve success in this context. Future studies may provide in-depth analysis of success criteria and success factors specific for construction project type and host-country location.

Redefining reproductive success in songbirds: Moving beyond the nest success paradigm

Science.gov (United States)

Streby, Henry M.; Refsnider, Jeanine M.; Andersen, David E.

2014-01-01

One of the most commonly estimated parameters in studies of songbird ecology is reproductive success, as a measure of either individual fitness or population productivity. Traditionally, the “success” in reproductive success refers to whether, or how many, nestlings leave nests. Here, we advocate that “reproductive success” in songbirds be redefined as full-season productivity, or the number of young raised to independence from adult care in a breeding season. A growing body of evidence demonstrates interdependence between nest success and fledgling survival, and emphasizes that data from either life stage alone can produce misleading measures of individual fitness and population productivity. Nest success, therefore, is an insufficient measure of reproductive success, and songbird ecology needs to progress beyond this long-standing paradigm. Full-season productivity, an evolutionarily rational measure of reproductive success, provides the framework for appropriately addressing unresolved questions about the adaptive significance of many breeding behaviors and within which effective breeding-grounds conservation and management can be designed.

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

Directory of Open Access Journals (Sweden)

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.

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.

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.

Research into Success

Directory of Open Access Journals (Sweden)

Bogomir Novak

1997-12-01

Full Text Available As competition is becoming ever more fierce, research into the prerequisites for success is gaining ground. By most people, success is perceived as an external phenomenon, but it is in fact the consequence of a person's readiness to perform in the world (of business. In the paper, Novak distinguishes between internal, external and group success. The essence of interna!success, which is the condition for the other two types of success, is assuming responsibility for, and exercising self-control over one's psychic phenomena. This in fact means that one needs to "reprogramme" the old patterns of behaviour and substitute them for the new, which leads to personality changes based on the understanding and acceptance of the self and others as they are. In realizing personal abilities, motives and goals, mental guiding laws must also be taken into account. Nowadays, the overall success of an organization is an important indicator of the quality of gro up work. The working patterns of individuals comply with the patterns used by his or her colleagues. When we do something for ourselves, we do it for others. In certain organizations, through accepted ways of communication all people become successful, and no body needs to be paid off. Employees wholly identify themselves with their organization, and vice versa. This three-part paradigm (I-Others-Community is the basis for various models of practical training for success, which are often idealized, but are primarily aimed at abolishing passivity and flaws in the system and its wider environment.

Successful ageing

DEFF Research Database (Denmark)

Bülow, Morten Hillgaard; Söderqvist, Thomas

2014-01-01

Since the late 1980s, the concept of ‘ successful ageing’ has set the frame for discourse about contemporary ageing research. Through an analysis of the reception to John W. Rowe and Robert L. Kahn's launch of the concept of ‘ successful ageing’ in 1987, this article maps out the important themes...... and discussions that have emerged from the interdisciplinary field of ageing research. These include an emphasis on interdisciplinarity; the interaction between biology, psycho-social contexts and lifestyle choices; the experiences of elderly people; life-course perspectives; optimisation and prevention...... strategies; and the importance of individual, societal and scientific conceptualisations and understandings of ageing. By presenting an account of the recent historical uses, interpretations and critiques of the concept, the article unfolds the practical and normative complexities of ‘ successful ageing’....

The Project of Success

DEFF Research Database (Denmark)

Kreiner, Kristian

more complicated matter than meeting targets. While success may ultimately be justified in terms of a correspondence between aims and achievements, the understanding of both aspects is highly dependent on the project process. An example of a successful project that did not meet the original performance...... targets will serve to show that success is at matter of perspective as much as it is a matter of achievement. Other types of research, e.g. social psychology, have addressed the issue of success more explicitly. I draw on such literature to conceptualize project success anew and to reestablish...

Paving the Road to Success: A Framework for Implementing the Success Tutoring Approach

Directory of Open Access Journals (Sweden)

Spark Linda

2017-12-01

Full Text Available The exponential growth of higher education enrolment in South Africa has resulted in increased diversity of the student body, leading to a proliferation of factors that affect student performance and success. Various initiatives have been adopted by tertiary institutions to mitigate the negative impact these factors may have on student success, and it is suggested that interventions that include aspects of social integration are the most successful. This paper outlines an approach called Success Tutoring (a non-academic tutorial approach used as part of a student success and support programme in the Faculty of Commerce, Law, and Management at the University of the Witwatersrand, which is underscored by empirical evidence drawn from evaluation data collected during Success Tutor symposia. The authors draw conclusions and make recommendations based on a thematic analysis of the dataset, and ultimately provide readers with a framework for implementing Success Tutoring at their tertiary institutions.

Citation Success

DEFF Research Database (Denmark)

Vaio, Gianfranco Di; Waldenström, Daniel; Weisdorf, Jacob Louis

2012-01-01

This study examines the determinants of citation success among authors who have recently published their work in economic history journals. Besides offering clues about how to improve one's scientific impact, our citation analysis also sheds light on the state of the field of economic history...... find similar patterns when assessing the same authors' citation success in economics journals. As a novel feature, we demonstrate that the diffusion of research — publication of working papers, as well as conference and workshop presentations — has a first-order positive impact on the citation rate........ Consistent with our expectations, we find that full professors, authors appointed at economics and history departments, and authors working in Anglo-Saxon and German countries are more likely to receive citations than other scholars. Long and co-authored articles are also a factor for citation success. We...

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.

Predictors of successful external cephalic version and assessment of success for vaginal delivery.

Science.gov (United States)

Salzer, Liat; Nagar, Ran; Melamed, Nir; Wiznitzer, Arnon; Peled, Yoav; Yogev, Yariv

2015-01-01

To identify predictors of successful external cephalic version (ECV) and to compare delivery outcome between women who had a successful ECV and women with spontaneous vertex presentation. A retrospective cohort study of all women who underwent ECV in a single tertiary medical center between 2007 and 2011. Delivery outcome was compared between women who underwent a trial of vaginal delivery following successful ECV with that of a control group in a 2:1 ratio. Multivariate analysis was used to identify predictors of successful ECV. Overall 287 were eligible for the study group. Of these 130 (45.3%) had a successful ECV. Polyhydramnios was the strongest factor associated with successful ECV (OR=3.1, 95%-CI 1.4-7.2), followed by transverse lie (versus breech presentation, OR=2.6, 95%-CI 1.2-6.7) and a posterior placenta (OR=1.7, 95%-CI 1.1-3.9), while nulliparity was associated with a lower likelihood of successful ECV (OR=0.4, 95%-CI 0.2-0.6). Women who had a successful ECV and underwent a trial of labor were more likely to deliver by operative vaginal delivery (OVD) (OR=1.8, 95%-CI 1.2-3.6), mainly due to a higher rate of prolonged 2nd, but were not at an increased risk for CS (OR=0.9, 95%-CI 0.4-2.4). Counselling to women prior to ECV should address the likelihood of success based on the predicting factors described above, as well as the increased risk for OVD in the case of successful ECV.

What Does Successful Aging Mean? Lay Perception of Successful Aging Among Elderly Singaporeans.

Science.gov (United States)

Feng, Qiushi; Straughan, Paulin Tay

2017-03-01

We explore the culturally specific meaning of successful aging in Singapore, an ethnically diverse city-state in Asia. We aim to investigate lay perceptions of successful aging among the elderly individuals in Singapore and further examine variations of these perceptions. We applied a mixed-method research design. Firstly, we conducted qualitative interviews with 49 elderly respondents, generating 12 main subjective components of successful aging. Next, we did a national survey with a sample of 1,540 local residents aged 50 to 69 years, in which respondents were asked to evaluate the importance of each subjective component of successful aging. We used the regression models and latent class analysis to analyze the correlatives of successful aging and to classify the elderly individuals by perception types. Among 12 components of successful aging, those related to self-sufficiency received the highest acknowledgment among the elderly individuals in Singapore. At least half of them simultaneously highlighted independence from family and dependence on family. Malays and Indians in Singapore valued more of the roles of spouse and children in successful aging, as compared with Chinese. The latent class analysis classified four groups of the elderly individuals according to their lay views on successful aging. As compared with the western model of successful aging, the elderly individuals in Singapore perceived successful aging with a strong focus on familism. These lay perceptions also significantly varied among these elderly individuals. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Rail roading technique for intubation of the canaliculi with sutupak in cases of common canalicular duct obstruction.

Science.gov (United States)

Sahdev, S; Motwane, S

1991-01-01

A variety of methods and materials have been used for the treatment of the problems relating to the canalicular system. An insight into the rail roading technique for intubation of the canaliculi with sutupak in cases of common canalicular duct obstruction is presented here. About 30 patients with block at the common canalicular duct, which was detected by dacryocystography were operated for dacryocystorhinostomy with intubation of both the canaliculi with sutupak No. 0 by rail roading technique with good results.

Rail roading technique for intubation of the canaliculi with sutupak in cases of common canalicular duct obstruction

Directory of Open Access Journals (Sweden)

Sahdev Saroj

1991-01-01

Full Text Available A variety of methods and materials have been used for the treatment of the problems relating to the canalicular system. An insight into the rail roading technique for intubation of the canaliculi with sutupak in cases of common canalicular duct obstruction is presented here. About 30 patients with block at the common canalicular duct, which was detected by dacryocystography were operated for dacryocystorhinostomy with intubation of both the canaliculi with sutupak No. 0 by rail roading technique with good results.

Studies of key success factors of product development success: A reinterpretation of results

DEFF Research Database (Denmark)

Plichta, Kirsten; Harmsen, Hanne

In this paper the general validity of the research area of key factors of success in product development is discussed. To be more specific we argue that validity hinges on the causal relation between success and success factrors ­ a relation that unaccounted for in the empirical studies....... The theoretical tradition of the resource-based perspective provides ­ at least to some extent ­ an account of this causality. An important point in the paper is that the key factors of success in the empi studies are not factors causally related to success, but at the most a number of valuable resources and thus......, but in the studies problems concerning implementation are not discussed. When the lists factors of success are interprested as valuable resources and capabilities, we show that some implications on the implementability might be deduced from the resource-based perspective....

Business Intelligence Success Factors

DEFF Research Database (Denmark)

Gaardboe, Rikke; Jonasen, Tanja Svarre

2018-01-01

Business intelligence (BI) is a strategically important practice in many organizations. Several studies have investigated the factors that contribute to BI success; however, an overview of the critical success factors (CSFs) involved is lacking in the extant literature. We have integrated...... 34 CSFs related to BI success. The distinct CSFs identified in the extant literature relate to project management skills (13 papers), management support (20 papers), and user involvement (11 papers). In the articles with operationalized BI success, we found several distinct factors: system quality...

Successful project management

CERN Document Server

Young, Trevor L

2016-01-01

Successful Project Management, 5th edition, is an essential guide for anyone who wants to improve the success rate of their projects. It will help managers to maintain a balance between the demands of the customer, the project, the team and the organization. Covering the more technical aspects of a project from start to completion it contains practised and tested techniques, covering project conception and start-up, how to manage stake holders, effective risk management, project planning and launch and execution. Also including a brand new glossary of key terms, it provides help with evaluating your project as well as practical checklists and templates to ensure success for any ambitious project manager. With over one million copies sold, the hugely popular Creating Success series covers a wide variety of topic, with the latest editions including new chapters such as Tough Conversations and Treating People Right. This indispensable business skills collection is suited to a variety of roles, from someone look...

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.

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.

Mergers: Success versus failure

International Nuclear Information System (INIS)

Carley, G. R.

1997-01-01

Successful mergers in the context of long-term value creation, as measured by return realized on investor-provided capital, were discussed. In essence, a successful merger is characterized by being motivated by a sound business reason and strategy for the merger, a reasonable price and sound execution. The acquiror's pre-merger success in managing a company is a good indicator of future success. Poorly managed companies that acquire other companies generally continue to be poorly managed with no significant increase in shareholder value. Prior to the acquisition, identification of the potential target, assessment of the people involved on both sides of the transaction, thorough knowledge of the target's potential for value creation, financial implications (debt, equity, terms and demand, tax implications, the potential effect of the proposed acquisition on the acquiror's business plan) and finally the execution of the process itself, are the important determinants of successful mergers

Human Resource Outsourcing Success

Directory of Open Access Journals (Sweden)

Hasliza Abdul-Halim

2014-07-01

Full Text Available The existing literature on partnership seems to take the relationship between partnership quality and outsourcing success for granted. Therefore, this article aims at examining the role of service quality in strengthening the relationship between partnership quality and human resource (HR outsourcing success. The samples were obtained from 96 manufacturing organizations in Penang, Malaysia. The results showed that partnership quality variables such as trust, business understanding, and communication have significant positive impact on HR outsourcing success, whereas in general, service quality was found to partially moderate these relationships. Therefore, comprehending the HR outsourcing relationship in the context of service quality may assist the organizations to accomplish HR outsourcing success by identifying areas of expected benefits and improvements.

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 ...

Success-Breeds-Success in Collective Political Behavior: Evidence from a Field Experiment

NARCIS (Netherlands)

Van De Rijt, Arnout; Akin, Idil; Willer, Robb; Feinberg, Matthew

2016-01-01

Scholars have proposed that the emergence of political movements is highly pathdependent, such that early mobilization successes may lead to disproportionately greater eventual success. This article replicates a unique field experiment testing for positive feedback in internet petition signing (van

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

Group cohesion and starting status in successful and less successful elite volleyball teams.

Science.gov (United States)

Spink, K S

1992-08-01

The main purpose of this study was to examine the relationship between members' perceptions of group cohesion and starting status in elite volleyball teams. The results of the study revealed that the form of the cohesion-starting status relationship was moderated by the variable of success. The results for less successful teams revealed that differences did emerge between specific measures of cohesion endorsed by starters and non-starters. No such differences in cohesion emerged when the starters and non-starters on successful teams were compared. These results provide initial support for the suggestion that the most successful teams are the ones where the perceptions of cohesiveness by starters and non-starters are similar. A secondary purpose of the study was to determine whether those teams that were the most successful and similar in their members' perceptions of cohesiveness, were also the teams whose members have the most positive outcome expectancy. The results supported this prediction.

Successful Enterprise System Re-Implementation

DEFF Research Database (Denmark)

Svejvig, Per

2017-01-01

Achieving success in enterprise systems (ES) implementations is challenging. The success rate is not high in view of the sums invested by many organizations in these companywide systems. The literature is charged with reasons for unsuccessful implementations, such as a lack of top management...... support and insufficient change management. Contrary to this research, empirical data from an ES re-implementation in a Scandinavian high-tech company shows successful implementation despite many problematic shifts in outsourcing partners. Therefore, it is natural to ask: why was the re......-implementation of the ES at SCANDI successful despite the major troubles encountered during the project? Building an analysis based on ten Critical Success Factors (CSFs) combined with an investigation into the institutional structures at play, we present several reasons for the successful implementation. The CSF analysis...

Clinical research of the micro-invasive treatments for chronic dacryocystitis with the fifth generation lacrimal endoscope

Directory of Open Access Journals (Sweden)

Yong-Zhe Tang

2015-06-01

Full Text Available AIM: To investigate the methods, effect and security of the micro-invasive treatments for chronic dacryocystitis with the fifth generation lacrimal endoscope, and to evaluate its clinical application.METHODS:In this case-control study, 120 patients(120 eyeswith chronic dacryocystitis were collected from April 2013 to July 2014 in our department. The patients were randomly divided into observation group(the fifth generation endoscopic lacrimal microdrill with full intubation group, 62 cases 62 eyesand control group(external dacryocystorhinostomy group, 58 cases 58 eyes. The effective rate and complication were observed and compared between two groups after operation. Statistical package SPSS 13.0 was used for statistical analysis.RESULTS: The effective rate of observation group was 91.9%, and control group was 96.6%, there was no statistically significant difference between the two groups(P>0.05. Hemorrhage occurred in observation group and control group was 35.5% and 79.3%, respectively, additionally palpebral oedema was 19.4% and 55.2%, respectively, there were statistically significant differences between the two groups(PCONCLUSION: The fifth generation lacrimal endoscope is more flexible than traditional one-piece lacrimal endoscope during the operation, it can treat chronic dacryocystitis by directly observing nasolacrimal duct obstruction site and dredge the obstruction under microdrilling with full lacrimal intubation. It was not only good clinical curative effect, but also safer, more efficient than the external dacryocystorhinostomy, visualization and micro-invasive are its special advantage, and worthy for further clinical application.

Balloon dacryocystoplasty study in the management of adult epiphora.

LENUS (Irish Health Repository)

Fenton, S

2012-02-03

PURPOSE: To determine the efficacy of dacryocystoplasty with balloon dilation in the treatment of acquired obstruction of the nasolacrimal system in adults. METHODS: Balloon dacryocystoplasty was performed in 52 eyes of 42 patients under general anaesthetic. A Teflon-coated guidewire was introduced through the canaliculus and manipulated through the nasolacrimal system and out of the nasal aperture. A 4 mm wide 3 cm coronary angioplasty balloon catheter was threaded over the guidewire in a retrograde fashion and dilated at the site of obstruction. RESULTS: There was complete obstruction in 30% of cases and partial obstruction in 70%. The most common site of obstruction was the nasolacrimal duct. The procedure was technically successful in 94% of cases. The overall re-obstruction rate was 29% within 1 year of the procedure. There was an anatomical failure rate of 17% for partial obstruction and 69% for complete obstruction within 1 year. CONCLUSIONS: Balloon dacryocystoplasty has a high recurrence rate. There may be a limited role for this procedure in partial obstructions. Further refinements of the procedure are necessary before it can be offered as a comparable alternative to a standard surgical dacryocystorhinostomy.

Examining Productive Failure, Productive Success, Unproductive Failure, and Unproductive Success in Learning

Science.gov (United States)

Kapur, Manu

2016-01-01

Learning and performance are not always commensurable. Conditions that maximize performance in the initial learning may not maximize learning in the longer term. I exploit this incommensurability to theoretically and empirically interrogate four possibilities for design: productive success, productive failure, unproductive success, and…

Auditing Marketing Strategy Implementation Success

OpenAIRE

Herhausen, Dennis; Egger, Thomas; Oral, Cansu

2014-01-01

What makes a marketing strategy implementation successful and how can managers measure this success? To answer these questions, we developed a two-step audit approach. First, managers should measure the implementation success regarding effectiveness, efficiency, performance outcomes, and strategic embeddedness. Second, they should explore the reasons that have led to success or failure by regarding managerial, leadership, and environmental traps. Doing so will also provide corrective action p...

Endoscopic Resection of Skull Base Teratoma in Klippel-Feil Syndrome through Use of Combined Ultrasonic and Bipolar Diathermy Platforms

Directory of Open Access Journals (Sweden)

Justin A. Edward

2017-01-01

Full Text Available Klippel-Feil syndrome (KFS is associated with numerous craniofacial abnormalities but rarely with skull base tumor formation. We report an unusual and dramatic case of a symptomatic, mature skull base teratoma in an adult patient with KFS, with extension through the basisphenoid to obstruct the nasopharynx. This benign lesion was associated with midline palatal and cerebral defects, most notably pituitary and vertebrobasilar arteriolar duplications. A multidisciplinary workup and a complete endoscopic, transnasal surgical approach between otolaryngology and neurosurgery were undertaken. Out of concern for vascular control of the fibrofatty dense tumor stalk at the skull base and need for complete teratoma resection, we successfully employed a tissue resection tool with combined ultrasonic and bipolar diathermy to the tumor pedicle at the sphenoid/clivus junction. No CSF leak or major hemorrhage was noted using this endonasal approach, and no concerning postoperative sequelae were encountered. The patient continues to do well now 3 years after tumor extirpation, with resolution of all preoperative symptoms and absence of teratoma recurrence. KFS, teratoma biology, endocrine gland duplication, and the complex considerations required for successfully addressing this type of advanced skull base pathology are all reviewed herein.

Is international junior success a reliable predictor for international senior success in elite combat sports?

Science.gov (United States)

Li, Pingwei; De Bosscher, Veerle; Pion, Johan; Weissensteiner, Juanita R; Vertonghen, Jikkemien

2018-05-01

Currently in the literature, there is a dearth of empirical research that confirms whether international junior success is a reliable predictor for future international senior success. Despite the uncertainty of the junior-senior relationship, federations and coaches still tend to use junior success as a predictor for long-term senior success. A range of former investigations utilising a retrospective lens has merely focused on success that athletes attained at junior level competitions. Success that was achieved at senior-level competitions but at a junior age was relatively ignored. This study explored to what extent international senior success can be predicted based on success that athletes achieved in either international junior level competitions (i.e. junior medalists) or senior competitions at a junior age (i.e. early achievers). The sample contains 4011 international male and female athletes from three combat sports (taekwondo, wrestling and boxing), who were born between 1974 and 1990 and participated in both international junior and senior-level competitions between 1990 and 2016. Gender and sport differences were compared. The results revealed that 61.4% of the junior medalists and 90.4% of the early achievers went on to win international medals at a senior age. Among the early achievers, 92.2% of the taekwondo athletes, 68.4% of the wrestling athletes and 37.9% of the boxing athletes could be reliably "predicted" to win international senior medals. The findings demonstrate that specific to the three combat sports examined, international junior success appears to be an important predictor to long-term international senior success.

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 ...

Success-slope effects on the illusion of control and on remembered success-frequency

Directory of Open Access Journals (Sweden)

Anastasia Ejova

2013-07-01

Full Text Available The illusion of control refers to the inference of action-outcome contingency in situations where outcomes are in fact random. The strength of this illusion has been found to be affected by whether the frequency of successes increases or decreases over repeated trials, in what can be termed a ``success-slope'' effect. Previous studies have generated inconsistent findings regarding the nature of this effect. In this paper we present an experiment (N = 334 that overcomes several methodological limitations within this literature, employing a wider range of dependent measures (measures of two different types of illusory control, primary (by self and secondary (by luck, as well as measures of remembered success-frequency. Results indicate that different dependent measures lead to different effects. On measures of (primary, but not secondary control over the task, scores were highest when the rate of success increased over time. Meanwhile, estimates of success-frequency in the task did not vary across conditions and showed trends consistent with the broader literature on human memory.

Social-philosophical practices of success

Directory of Open Access Journals (Sweden)

S. R. Karpenko

2017-01-01

Is social-philosophical experts of success represent the complicated system of various world outlook, speech, mental factors and events in life of the various professional, age and subcultural bunches producing assessments under different visual angles, from positions of various social installations and identity in what the social philosophy of success expresses. In the course of forming social an expert (both in daily, and in an institutional discourse are shaped also theoretical ideas success: instrumental, is social-philosophical, is social-psychological, world outlook, historical and cultural, etc., characterising thereby various systems of a social discourse. Examination is social-philosophical the success expert shows the real complexity and ambiguity of the given appearance. Besides the presented typology constructed as the most approximate abstract plan, in each separate case probably build-up of typological models according to a principle ad hoc. It looks quite justified, considering that circumstance that representations about success and the successful person are constantly transformed and acquire new performances. Efficiency of the further examinations of a discourse and a success expert will depend on accepting of new heuristic approaches, capable to consider multidimensionality and ambiguity of the given phenomenon.

The characteristics of successful entrepreneurs

Directory of Open Access Journals (Sweden)

Pokrajčić Dragana M.

2004-01-01

Full Text Available This paper examines the economic, psychological and social-behavioral theories of the entrepreneur in order to determine the characteristics of a successful entrepreneur. The major contribution of economic theories of the entrepreneur is better understanding of the entrepreneur and his/her role in economic development. The psychological characteristic theory of entrepreneur argues that successful entrepreneurs possess certain personality traits that mark them out as special, and tries to determine and to evaluate these special traits. The social-behavioral theories stress the influence of experience, knowledge, social environment and ability to learn on the entrepreneur’s success as well as his/her personality traits. Neither of the examined theories of entrepreneur gives a satisfactory explanation of the entrepreneur’s success, but taken as a whole, they can explain key factors of entrepreneur’s success. The entrepreneur’s success comes about as a result of his/her personality traits, ability to learn from experience and ability to adjust to his/her environment.

Successful removable partial dentures.

Science.gov (United States)

Lynch, Christopher D

2012-03-01

Removable partial dentures (RPDs) remain a mainstay of prosthodontic care for partially dentate patients. Appropriately designed, they can restore masticatory efficiency, improve aesthetics and speech, and help secure overall oral health. However, challenges remain in providing such treatments, including maintaining adequate plaque control, achieving adequate retention, and facilitating patient tolerance. The aim of this paper is to review the successful provision of RPDs. Removable partial dentures are a successful form of treatment for replacing missing teeth, and can be successfully provided with appropriate design and fabrication concepts in mind.

Behind the Exporters’ Success: Analysis of Successful Hungarian Exporter Companies From a Strategic Perspective

Directory of Open Access Journals (Sweden)

Annamaria Kazai Onodi

2014-09-01

Full Text Available The purpose of the study is to provide an overview of export success from a strategic management perspective. The paper empirically tested the relationships between the firm’s export performance, strategic thinking, adaptation to the changing environment and companies’ capabilities. The research is based on the Hungarian Competitiveness Research database of 2013 that consists of 300 firms. Cluster analysis differentiated successful export-oriented and stagnant companies. Both of them had high export intensity (higher than 75%, but significant differences could be observed in export volume and profitability. More than 90Ťn of total export revenue belonged to the successful export-oriented cluster. Successful export oriented companies proved to be more proactive and innovative than stagnant, thus they were capable of adapting to the changing environment better. The study highlighted that appropriate strategic thinking could play a significant role in improving export success. The implication of the study is that stagnant companies need to develop their forecast abilities, flexibility to adapt to the changing environment and operational efficiency. Stagnant companies lagged behind successful exporters concerning industry forecast, production level, number of innovations, competitive prices and employee qualifications.

North Country Successes: Case Studies of Successful Entrepreneurs in the ANCA Region.

Science.gov (United States)

Chugh, Ram L.; Gandhi, Prem P.

This study identifies the characteristics of both successful small businesses and their entrepreneurial owners in a 14-county area of the Adirondack North Country Association (ANCA). Of the 100 survey respondents representing successful small businesses, 50% had been in business for less than 14 years; 38% were in manufacturing; 48% employed more…

Analysis of successive data sets

NARCIS (Netherlands)

Spreeuwers, Lieuwe Jan; Breeuwer, Marcel; Haselhoff, Eltjo Hans

2008-01-01

The invention relates to the analysis of successive data sets. A local intensity variation is formed from such successive data sets, that is, from data values in successive data sets at corresponding positions in each of the data sets. A region of interest is localized in the individual data sets on

Analysis of successive data sets

NARCIS (Netherlands)

Spreeuwers, Lieuwe Jan; Breeuwer, Marcel; Haselhoff, Eltjo Hans

2002-01-01

The invention relates to the analysis of successive data sets. A local intensity variation is formed from such successive data sets, that is, from data values in successive data sets at corresponding positions in each of the data sets. A region of interest is localized in the individual data sets on

The seven S's for successful management.

Science.gov (United States)

Davidhizar, R

1995-03-01

Becoming a successful manager in a health care agency is, for most new managers, an awesome goal. Successful management is more than knowledge of leadership roles and management functions that can be learned in school or educational workshops. Successful management involves effective use of both the manager's affective and cognitive domains. Mentoring and apprenticeship with a successful nurse leader is for many novice managers a highly valuable way to learn management skills since this allows for techniques with a successful nurse manager to be visualized and then modeled. "Seven S's" that provide a framework for managerial success are discussed.

Ingredients for successful partnerships

NARCIS (Netherlands)

S.M. Pfisterer (Stella)

2011-01-01

textabstractFor the development of new cross-sector partnerships it is required to know what the essence of successful partnership projects is. Which factors influence success or failure of partnerships is highly related to the specific context where partnerships operate. The literature on critical

Examining Management Success Potential.

Science.gov (United States)

Quatrano, Louis A.

The derivation of a model of management success potential in hospitals or health services administration is described. A questionnaire developed to assess management success potential in health administration students was voluntarily completed by approximately 700 incoming graduate students in 35 university health services administration programs…

Successful ageing for psychiatrists.

Science.gov (United States)

Peisah, Carmelle

2016-04-01

This paper aims to explore the concept and determinants of successful ageing as they apply to psychiatrists as a group, and as they can be applied specifically to individuals. Successful ageing is a heterogeneous, inclusive concept that is subjectively defined. No longer constrained by the notion of "super-ageing", successful ageing can still be achieved in the face of physical and/or mental illness. Accordingly, it remains within the reach of most of us. It can, and should be, person-specific and individually defined, specific to one's bio-psycho-social and occupational circumstances, and importantly, reserves. Successful professional ageing is predicated upon insight into signature strengths, with selection of realistic goal setting and substitution of new goals, given the dynamic nature of these constructs as we age. Other essential elements are generativity and self-care. Given that insight is key, taking a regular stock or inventory of our reserves across bio-psycho-social domains might be helpful. Importantly, for successful ageing, this needs to be suitably matched to the professional task and load. This lends itself to a renewable personal ageing plan, which should be systemically adopted with routine expectations of self-care and professional responsibility. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Post-Mergers and Acquisitions: The Motives, Success Factors and Key Success Indicators

Directory of Open Access Journals (Sweden)

Hatem El Zuhairy

2015-07-01

Full Text Available There is a wide body of evidence showing a significant increase in the adoption of mergers and acquisitions (M&A worldwide. Moreover, research confirms that the integration and implementation stage (post-M&A has a major impact on the success or failure of a merger or acquisition. Therefore it has become increasingly important to explore the post-M&A phase further in order to support the management teams of organizations pursuing a merger or acquisition in meeting all their desired objectives. This paper proposes a framework to help in the successful execution of M&A. The framework contains three main elements: the motives, success factors and key success indicators (KSI. A qualitative research approach using the multiple case study methodology was conducted to test the framework. Ten case studies were selected from the industrial sector in Egypt and used to validate the research. The final version of the M&A framework was provided after applying the research results. Considering the practical implications of the M&A framework, a tool was proposed for its application in light of the balanced scorecard (BSC methodology. The proposed M&A scorecard tool should be used in the strategic planning and execution of M&A. Both the proposed M&A framework and the M&A scorecard tool should be used to guide the implementation of M&A in order to increase the success rate enjoyed by organizations.

Priority setting: what constitutes success? A conceptual framework for successful priority setting.

Science.gov (United States)

Sibbald, Shannon L; Singer, Peter A; Upshur, Ross; Martin, Douglas K

2009-03-05

The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries). This paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism. The ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts.

Biosphere reserves: Attributes for success.

Science.gov (United States)

Van Cuong, Chu; Dart, Peter; Hockings, Marc

2017-03-01

Biosphere reserves established under the UNESCO Man and the Biosphere Program aim to harmonise biodiversity conservation and sustainable development. Concerns over the extent to which the reserve network was living up to this ideal led to the development of a new strategy in 1995 (the Seville Strategy) to enhance the operation of the network of reserves. An evaluation of effectiveness of management of the biosphere reserve network was called for as part of this strategy. Expert opinion was assembled through a Delphi Process to identify successful and less successful reserves and investigate common factors influencing success or failure. Ninety biosphere reserves including sixty successful and thirty less successful reserves in 42 countries across all five Man and the Biosphere Program regions were identified. Most successful sites are the post-Seville generation while the majority of unsuccessful sites are pre-Seville that are managed as national parks and have not been amended to conform to the characteristics that are meant to define a biosphere reserve. Stakeholder participation and collaboration, governance, finance and resources, management, and awareness and communication are the most influential factors in the success or failure of the biosphere reserves. For success, the biosphere reserve concept needs to be clearly understood and applied through landscape zoning. Designated reserves then need a management system with inclusive good governance, strong participation and collaboration, adequate finance and human resource allocation and stable and responsible management and implementation. All rather obvious but it is difficult to achieve without commitment to the biosphere reserve concept by the governance authorities. Copyright © 2016 Elsevier Ltd. All rights reserved.

High-Impact Succession Management. Executive Summary

Science.gov (United States)

Lamoureux, Kim; Campbell, Michael; Smith, Roland

2009-01-01

Most companies have an opportunity to improve their succession management programs. The number one challenge for succession management (as identified by both HR leaders and executives) is developing a succession planning strategy. This comprehensive industry study sets out to determine how succession management (when done well) helps improve…

Strategic Success Of SRI Lankan Government Against LTTE Remains Tentative Despite Military Success

Science.gov (United States)

2016-02-13

approach. While the SLG achieved a military success it has had difficulty translating the triumph into a strategic success through the application of...2004, based upon the tragedy and impact of a tsunami, the Indonesian government and insurgent forces negotiated a peace settlement for the greater

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.)

The International Successful School Principalship Project: Success Sustained?

Science.gov (United States)

Moos, Lejf; Johansson, Olof

2009-01-01

Purpose: The purpose of this paper is to synthesize the findings of the follow-up studies of successful school principals in six countries: Australia, Denmark, England, Norway, Sweden, and the USA. Design/methodology/approach: Data were categorized according to stakeholder expectations, the concept and practice of leadership, and the…

Human Resource Outsourcing Success

OpenAIRE

Hasliza Abdul-Halim; Elaine Ee; T. Ramayah; Noor Hazlina Ahmad

2014-01-01

The existing literature on partnership seems to take the relationship between partnership quality and outsourcing success for granted. Therefore, this article aims at examining the role of service quality in strengthening the relationship between partnership quality and human resource (HR) outsourcing success. The samples were obtained from 96 manufacturing organizations in Penang, Malaysia. The results showed that par...

Planning for College Success

Science.gov (United States)

PEPNet, 2009

2009-01-01

"Planning for College Success" (PCS) is a curriculum model designed by Sharon Downs, M.S., for a course intended to assist deaf and hard of hearing students during their initial introduction to college life. This program allows students to work one-on-one with a counselor to plan for their college success. The program includes short-term goals and…

Leadership succession patterns in the apostolic church as a template for critique of contemporary charismatic leadership succession patterns

Directory of Open Access Journals (Sweden)

Cephas Tushima

2016-06-01

Full Text Available The pattern of leadership succession observed globally in most contemporary Pentecostal movements and churches can be characterised as dynastic succession. Yet historic modern Pentecostalism (in the Azusa tradition prided itself on being biblical. This article explores the biblical sources, examining first the leadership structure and then the leadership succession patterns in the apostolic church as well as the extra-biblical sources of the apostolic patristic era. Our findings from this New Testament (and patristic sources survey of leadership succession in the apostolic church and post-apostolic churches furnish a template for critical evaluation of the prevalent succession approaches of contemporary Pentecostal groups. Critical elements of apostolic and leadership structure and succession patterns are highlighted, and needed inferences are drawn for the re-shaping of leadership and its succession in contemporary Christian ministries and churches. Keywords: Azusa; Apostolic Leadership; Leadership Succession; Pentecostalism; Evangelicals; Leadership Patterns

Self-Presentation Strategies, Fear of Success and Anticipation of Future Success among University and High School Students

Science.gov (United States)

Kosakowska-Berezecka, Natasza; Jurek, Paweł; Besta, Tomasz; Badowska, Sylwia

2017-01-01

The backlash avoidance model (BAM) suggests women insufficiently self-promote because they fear backlash for behavior which is incongruent with traditional gender roles. Avoiding self-promoting behavior is also potentially related to associating success with negative consequences. In two studies we tested whether self-promotion and fear of success will be predictors of lower salaries and anticipation of lower chances of success in an exam. In study 1, prior to the exam they were about to take, we asked 234 students about their predictions concerning exam results and their future earnings. They also filled scales measuring their associations with success (fear of success) and tendency for self-promotion. The tested model proved that in comparison to men, women expect lower salaries in the future, anticipate lower test performance and associate success with more negative consequences. Both tendency for self-promotion and fear of success are related to anticipation of success in test performance and expectations concerning future earnings. In study 2 we repeated the procedure on a sample of younger female and male high school pupils (N = 100) to verify whether associating success with negative consequences and differences in self-promotion strategies are observable in a younger demographic. Our results show that girls and boys in high school do not differ with regard to fear of success, self-promotion or agency levels. Girls and boys anticipated to obtain similar results in math exam results, but girls expected to have higher results in language exams. Nevertheless, school pupils also differed regarding their future earnings but only in the short term. Fear of success and agency self-ratings were significant predictors of expectations concerning future earnings, but only among high school boys and with regard to earnings expected just after graduation. PMID:29163271

Self-Presentation Strategies, Fear of Success and Anticipation of Future Success among University and High School Students.

Science.gov (United States)

Kosakowska-Berezecka, Natasza; Jurek, Paweł; Besta, Tomasz; Badowska, Sylwia

2017-01-01

The backlash avoidance model (BAM) suggests women insufficiently self-promote because they fear backlash for behavior which is incongruent with traditional gender roles. Avoiding self-promoting behavior is also potentially related to associating success with negative consequences. In two studies we tested whether self-promotion and fear of success will be predictors of lower salaries and anticipation of lower chances of success in an exam. In study 1, prior to the exam they were about to take, we asked 234 students about their predictions concerning exam results and their future earnings. They also filled scales measuring their associations with success (fear of success) and tendency for self-promotion. The tested model proved that in comparison to men, women expect lower salaries in the future, anticipate lower test performance and associate success with more negative consequences. Both tendency for self-promotion and fear of success are related to anticipation of success in test performance and expectations concerning future earnings. In study 2 we repeated the procedure on a sample of younger female and male high school pupils ( N = 100) to verify whether associating success with negative consequences and differences in self-promotion strategies are observable in a younger demographic. Our results show that girls and boys in high school do not differ with regard to fear of success, self-promotion or agency levels. Girls and boys anticipated to obtain similar results in math exam results, but girls expected to have higher results in language exams. Nevertheless, school pupils also differed regarding their future earnings but only in the short term. Fear of success and agency self-ratings were significant predictors of expectations concerning future earnings, but only among high school boys and with regard to earnings expected just after graduation.

Self-Presentation Strategies, Fear of Success and Anticipation of Future Success among University and High School Students

Directory of Open Access Journals (Sweden)

Natasza Kosakowska-Berezecka

2017-10-01

Full Text Available The backlash avoidance model (BAM suggests women insufficiently self-promote because they fear backlash for behavior which is incongruent with traditional gender roles. Avoiding self-promoting behavior is also potentially related to associating success with negative consequences. In two studies we tested whether self-promotion and fear of success will be predictors of lower salaries and anticipation of lower chances of success in an exam. In study 1, prior to the exam they were about to take, we asked 234 students about their predictions concerning exam results and their future earnings. They also filled scales measuring their associations with success (fear of success and tendency for self-promotion. The tested model proved that in comparison to men, women expect lower salaries in the future, anticipate lower test performance and associate success with more negative consequences. Both tendency for self-promotion and fear of success are related to anticipation of success in test performance and expectations concerning future earnings. In study 2 we repeated the procedure on a sample of younger female and male high school pupils (N = 100 to verify whether associating success with negative consequences and differences in self-promotion strategies are observable in a younger demographic. Our results show that girls and boys in high school do not differ with regard to fear of success, self-promotion or agency levels. Girls and boys anticipated to obtain similar results in math exam results, but girls expected to have higher results in language exams. Nevertheless, school pupils also differed regarding their future earnings but only in the short term. Fear of success and agency self-ratings were significant predictors of expectations concerning future earnings, but only among high school boys and with regard to earnings expected just after graduation.

Healthcare succession planning: an integrative review.

Science.gov (United States)

Carriere, Brian K; Muise, Melanie; Cummings, Greta; Newburn-Cook, Chris

2009-12-01

Succession planning is a business strategy that has recently gained attention in the healthcare literature, primarily because of nursing shortage concerns and the demand for retaining knowledgeable personnel to meet organizational needs. Little research has been conducted in healthcare settings that clearly defines best practices for succession planning frameworks. To effectively carry out such organizational strategies during these challenging times, an integrative review of succession planning in healthcare was performed to identify consistencies in theoretical approaches and strategies for chief nursing officers and healthcare managers to initiate. Selected articles were compared with business succession planning to determine whether healthcare strategies were similar to best practices already established in business contexts. The results of this integrative review will aid leaders and managers to use succession planning as a tool in their recruitment, retention, mentoring, and administration activities and also provide insights for future development of healthcare succession planning frameworks.

Critical success factors of Indian Entrepreneurs

Directory of Open Access Journals (Sweden)

Alex Antonites

2013-12-01

Full Text Available This research seeks to explore the critical success factors that influence the success of Indian small business owners in the largest metropolitan area in South Africa. To achieve this, the objective of the study was to confirm whether there are significant differences between a successful and less successful group of business owners in terms of general management skills, personal characteristics, and entrepreneurial orientation and financing of the business. Through analysing secondary evidence and empirical results it was possible to facilitate a better understanding of how Indian entrepreneurs operating in small and medium enterprises sustain success, thus contributing to the body of knowledge relating to entrepreneurship development in the domain of entrepreneurship. From the literature it became clear that cultural dimensions have an impact on the entrepreneurial process. The arrival of Indians in South Africa has contributed to a unique Indian culture. The characteristics that describe ethnic entrepreneurs and success factors attributed to their success are described. Small and medium enterprises (SMEs are crucial for the development of any country as they offer benefits of economic growth and employment generation. The success factors to sustain SMEs are also described. The findings of the study indicate that there are no significant differences between the comparable groups in relation to management skills and finance factors. There are, however, significant differences relating to personal factors, such as the level of education, family support and experience. Finally, an important learning is that the Indian entrepreneurs in this study are similar to ethnic entrepreneurs reviewed in literature. The study was conducted in Tshwane, the largest metropolitan area in South Africa, and amongst the largest in the world. Keywords: Culture, ethnic entrepreneurship, Indian entrepreneurship, critical success factors, small and medium enterprises

Critical success factors in ERP implementation

Directory of Open Access Journals (Sweden)

Blerta Abazi Chaushi

2016-11-01

Full Text Available This study conducts state of the art literature review of critical success factors for enterprise resource planning systems implementation success. Since research on critical success factors for ERP implementation success is very rare and fragmented, this study provides a more comprehensive list of ten factors that companies that have adopted and struggle with the implementation, as well as companies who are in the process of considering implementation of ERP system can easily adopt and follow. The main contribution of this paper is that these ten new critical success factors are identifi ed through a thorough analysis of 22 selected research papers and is more comprehensive and straightforwardly employable for use.

Bangladesh becomes "success story".

Science.gov (United States)

1999-01-01

The State Minister for Health and Family of Bangladesh, Dr. Mohammed Amanullah, highlighted some of the successes being achieved by his country in lowering fertility and improving the lives of the people since the 1994 International Conference on Population and Development. Some of these successes include practical measures to eliminate violence against women; introduction of a quota for women in public sector employment; and launching of the Health and Population Sector Program to provide a one-stop, full range of essential reproductive health, family planning and child health services through an integrated delivery mechanism. Moreover, the Minister informed the Forum participants that their success is attributable to many factors which include support from the government, from non-governmental organizations, civil society, mass media, religious and other community leaders, intersectoral collaboration, microcredit and income-generation activities.

Citation Success

DEFF Research Database (Denmark)

Di Vaio, Gianfranco; Waldenström, Daniel; Weisdorf, Jacob Louis

affects citations. In regard to author-specific characteristics, male authors, full professors and authors working economics or history departments, and authors employed in Anglo-Saxon countries, are more likely to get cited than others. As a ‘shortcut' to citation success, we find that research diffusion...

Successful ageing

DEFF Research Database (Denmark)

Kusumastuti, Sasmita; Derks, Marloes G. M.; Tellier, Siri

2016-01-01

BACKGROUND: Ageing is accompanied by an increased risk of disease and a loss of functioning on several bodily and mental domains and some argue that maintaining health and functioning is essential for a successful old age. Paradoxically, studies have shown that overall wellbeing follows a curvili...

Successful modeling?

Science.gov (United States)

Lomnitz, Cinna

Tichelaar and Ruff [1989] propose to “estimate model variance in complicated geophysical problems,” including the determination of focal depth in earthquakes, by means of unconventional statistical methods such as bootstrapping. They are successful insofar as they are able to duplicate the results from more conventional procedures.

Human capital and career success

DEFF Research Database (Denmark)

Frederiksen, Anders; Kato, Takao

capital formally through schooling for career success, as well as the gender gap in career success rates. Second, broadening the scope of human capital by experiencing various occupations (becoming a generalist) is found to be advantageous for career success. Third, initial human capital earned through......Denmark’s registry data provide accurate and complete career history data along with detailed personal characteristics (e.g., education, gender, work experience, tenure and others) for the population of Danish workers longitudinally. By using such data from 1992 to 2002, we provide rigorous...... formal schooling and subsequent human capital obtained informally on the job are found to be complements in the production of career success. Fourth, though there is a large body of the literature on the relationship between firm-specific human capital and wages, the relative value of firm-specific human...

A Model of Successful School Leadership from the International Successful School Principalship Project

Directory of Open Access Journals (Sweden)

David Gurr

2015-03-01

Full Text Available The International Successful School Principalship Project (ISSPP has been actively conducting research about the work of successful principals since 2001. Findings from four project books and eight models derived from this project are synthesised into a model of successful school leadership. Building on Gurr, Drysdale and Mulford’s earlier model, the work of school leaders is described as engaging within the school context to influence student and school outcomes through interventions in teaching and learning, school capacity building, and the wider context. The qualities a leader brings to their role, a portfolio approach to using leadership ideas, constructing networks, collaborations and partnerships, and utilising accountability and evaluation for evidence-informed improvement, are important additional elements. The model is applicable to all in leadership roles in schools.

Successful aging: considering non-biomedical constructs

Directory of Open Access Journals (Sweden)

Carver LF

2016-11-01

Full Text Available Lisa F Carver,1 Diane Buchanan2 1Department of Sociology, Queen’s University Kingston, ON, Canada; 2School of Nursing, Queen’s University Kingston, ON, Canada Objectives: Successful aging continues to be applied in a variety of contexts and is defined using a number of different constructs. Although previous reviews highlight the multidimensionality of successful aging, a few have focused exclusively on non-biomedical factors, as was done here. Methods: This scoping review searched Ovid Medline database for peer-reviewed English-language articles published between 2006 and 2015, offering a model of successful aging and involving research with older adults. Results: Seventy-two articles were reviewed. Thirty-five articles met the inclusion criteria. Common non-biomedical constructs associated with successful aging included engagement, optimism and/or positive attitude, resilience, spirituality and/or religiosity, self-efficacy and/or self-esteem, and gerotranscendence. Discussion: Successful aging is a complex process best described using a multidimensional model. Given that the majority of elders will experience illness and/or disease during the life course, public health initiatives that promote successful aging need to employ non-biomedical constructs, facilitating the inclusion of elders living with disease and/or disability. Keywords: successful aging, resilience, gerotranscendence, engagement, optimism

Success tree method of resources evaluation

International Nuclear Information System (INIS)

Chen Qinglan; Sun Wenpeng

1994-01-01

By applying the reliability theory in system engineering, the success tree method is used to transfer the expert's recognition on metallogenetic regularities into the form of the success tree. The aim of resources evaluation is achieved by means of calculating the metallogenetic probability or favorability of the top event of the success tree. This article introduces in detail, the source, principle of the success tree method and three kinds of calculation methods, expounds concretely how to establish the success tree of comprehensive uranium metallogenesis as well as the procedure from which the resources evaluation is performed. Because this method has not restrictions on the number of known deposits and calculated area, it is applicable to resources evaluation for different mineral species, types and scales and possesses good prospects of development

Success and Women's Career Adjustment.

Science.gov (United States)

Russell, Joyce E. A.; Burgess, Jennifer R. D.

1998-01-01

Women still face barriers to career success and satisfaction: stereotypes, assumptions, organizational culture, human resource practices, and lack of opportunities. Despite individual and organizational strategies, many women leave to become entrepreneurs. There is a need to investigate how women define career success. (SK)

Four malaria success stories: how malaria burden was successfully reduced in Brazil, Eritrea, India, and Vietnam.

Science.gov (United States)

Barat, Lawrence M

2006-01-01

While many countries struggle to control malaria, four countries, Brazil, Eritrea, India, and Vietnam, have successfully reduced malaria burden. To determine what led these countries to achieve impact, published and unpublished reports were reviewed and selected program and partner staff were interviewed to identify common factors that contributed to these successes. Common success factors included conducive country conditions, a targeted technical approach using a package of effective tools, data-driven decision-making, active leadership at all levels of government, involvement of communities, decentralized implementation and control of finances, skilled technical and managerial capacity at national and sub-national levels, hands-on technical and programmatic support from partner agencies, and sufficient and flexible financing. All these factors were essential in achieving success. If the goals of Roll Back Malaria are to be achieved, governments and their partners must take the lessons learned from these program successes and apply them in other affected countries.

MODEL OF TRAINING OF SUCCESS IN LIFE

Directory of Open Access Journals (Sweden)

Екатерина Александровна Лежнева

2014-04-01

Full Text Available The article explains the importance of the development of motive to succeed in adolescence. It is determined the value of the motive to achieve success in the further development of the teenager: a motive to achieve effective internal forces mobilized for the implementation of successful operation ensures the active involvement of teenagers in social and interpersonal relationships. As the primary means of motive development success is considered training. The author provides a definition of "training for success in life," creates a model of training for success in life, and describes its units (targeted, informative, technological, productive, reveals the successful development of the technology life strategy used during the training (self-presentation, targets, incentives, subject-orientation. The author pays attention to the need for a future psychologist to develop teenagers’ motive to achieve success through the mastery of competence in constructing a model of training for success in life, and its implementation in the course of professional activities. The main means of training students of psychology to the use of training success in life identified the additional educational programs and psychological section.DOI: http://dx.doi.org/10.12731/2218-7405-2013-9-77

Organizational Climate for Successful Aging

Science.gov (United States)

Zacher, Hannes; Yang, Jie

2016-01-01

Research on successful aging at work has neglected contextual resources such as organizational climate, which refers to employees’ shared perceptions of their work environment. We introduce the construct of organizational climate for successful aging (OCSA) and examine it as a buffer of the negative relationship between employee age and focus on opportunities (i.e., beliefs about future goals and possibilities at work). Moreover, we expected that focus on opportunities, in turn, positively predicts job satisfaction, organizational commitment, and motivation to continue working after official retirement age. Data came from 649 employees working in 120 companies (Mage = 44 years, SD = 13). We controlled for organizational tenure, psychological climate for successful aging (i.e., individuals’ perceptions), and psychological and organizational age discrimination climate. Results of multilevel analyses supported our hypotheses. Overall, our findings suggest that OCSA is an important contextual resource for successful aging at work. PMID:27458405

Organizational Climate for Successful Aging.

Science.gov (United States)

Zacher, Hannes; Yang, Jie

2016-01-01

Research on successful aging at work has neglected contextual resources such as organizational climate, which refers to employees' shared perceptions of their work environment. We introduce the construct of organizational climate for successful aging (OCSA) and examine it as a buffer of the negative relationship between employee age and focus on opportunities (i.e., beliefs about future goals and possibilities at work). Moreover, we expected that focus on opportunities, in turn, positively predicts job satisfaction, organizational commitment, and motivation to continue working after official retirement age. Data came from 649 employees working in 120 companies (M age = 44 years, SD = 13). We controlled for organizational tenure, psychological climate for successful aging (i.e., individuals' perceptions), and psychological and organizational age discrimination climate. Results of multilevel analyses supported our hypotheses. Overall, our findings suggest that OCSA is an important contextual resource for successful aging at work.

Nurse manager succession planning: a concept analysis.

Science.gov (United States)

Titzer, Jennifer L; Shirey, Maria R

2013-01-01

The current nursing leadership pipeline is inadequate and demands strategic succession planning methods. This article provides concept clarification regarding nurse manager succession planning. Attributes common to succession planning include organizational commitment and resource allocation, proactive and visionary leadership approach, and a mentoring and coaching environment. Strategic planning, current and future leadership analysis, high-potential identification, and leadership development are succession planning antecedents. Consequences of succession planning are improved leadership and organizational culture continuity, and increased leadership bench strength. Health care has failed to strategically plan for future leadership. Developing a strong nursing leadership pipeline requires deliberate and strategic succession planning. © 2013 Wiley Periodicals, Inc.

Status and Mating Success Amongst Visual Artists

Science.gov (United States)

Clegg, Helen; Nettle, Daniel; Miell, Dorothy

2011-01-01

Geoffrey Miller has hypothesized that producing artwork functions as a mating display. Here we investigate the relationship between mating success and artistic success in a sample of 236 visual artists. Initially, we derived a measure of artistic success that covered a broad range of artistic behaviors and beliefs. As predicted by Miller’s evolutionary theory, more successful male artists had more sexual partners than less successful artists but this did not hold for female artists. Also, male artists with greater artistic success had a mating strategy based on longer term relationships. Overall the results provide partial support for the sexual selection hypothesis for the function of visual art. PMID:22059085

Endoscopic Third Ventriculostomy: Success and Failure.

Science.gov (United States)

Deopujari, Chandrashekhar E; Karmarkar, Vikram S; Shaikh, Salman T

2017-05-01

Endoscopic third ventriculostomy (ETV) has now become an accepted mode of hydrocephalus treatment in children. Varying degrees of success for the procedure have been reported depending on the type and etiology of hydrocephalus, age of the patient and certain technical parameters. Review of these factors for predictability of success, complications and validation of success score is presented.

Succession Planning in Australian Farming

Directory of Open Access Journals (Sweden)

John Hicks

2012-11-01

Full Text Available The theme of this paper is that succession planning in Australian farming is under-developed.It may be linked to economic and social change which suggests that farmers need to adapt togenerational change but this is being resisted or ignored. The implications of this are the slowdecline of family farming, a poor transfer of skills and knowledge to subsequent generationsof farmers in some parts of the agricultural sector and the potential for an extension of thefinancial services industry to develop a more effective raft of succession planning measuresto mitigate the effects of a traditional approach to succession in agriculture.

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.

Qualitative Characteristic of Sociability in Groups of Successful and Less Successful Learners of Foreign Languages

Directory of Open Access Journals (Sweden)

G V Zarembo

2011-06-01

Full Text Available The article deals with a qualitative characteristic of sociability for successful and less successful learners of foreign languages. The statistical estimate showing the differences between average figures on sociability and effectiveness in the second language learning is also given.

Investigating critical success factors in tile industry

Directory of Open Access Journals (Sweden)

Davood Salmani

2014-04-01

Full Text Available This paper presents an empirical investigation to determine critical success factors influencing the success of tile industry in Iran. The study designs a questionnaire in Likert scale, distributes it among some experts in tile industry. Using Pearson correlation test, the study has detected that there was a positive and meaningful relationship between marketing planning and the success of tile industry (r = 0.312 Sig. = 0.001. However, there is not any meaningful relationship between low cost production and success of tile industry (r = 0.13 Sig. = 0.12 and, there is a positive and meaningful relationship between organizational capabilities and success of tile industry (r = 0.635 Sig. = 0.000. Finally, our investigation states that technology and distributing systems also influence on the success of tile industry, positively. The study has also used five regression analyses where the success of tile industry was the dependent variable and marketing planning, low cost production and organizational capabilities are independent variables and the results have confirmed some positive and meaningful relationship between the successes of tile industry with all independent variables.

Succession Planning for Library Instruction

Science.gov (United States)

Sobel, Karen; Drewry, Josiah

2015-01-01

Detailed succession planning helps libraries pass information from one employee to the next. This is crucial in preparing for hiring, turnover, retirements, training of graduate teaching assistants in academic libraries, and other common situations. The authors of this article discuss succession planning for instruction programs in academic…

Higher survival drives the success of nitrogen-fixing trees through succession in Costa Rican rainforests.

Science.gov (United States)

Menge, Duncan N L; Chazdon, Robin L

2016-02-01

Trees capable of symbiotic nitrogen (N) fixation ('N fixers') are abundant in many tropical forests. In temperate forests, it is well known that N fixers specialize in early-successional niches, but in tropical forests, successional trends of N-fixing species are poorly understood. We used a long-term census study (1997-2013) of regenerating lowland wet tropical forests in Costa Rica to document successional patterns of N fixers vs non-fixers, and used an individual-based model to determine the demographic drivers of these trends. N fixers increased in relative basal area during succession. In the youngest forests, N fixers grew 2.5 times faster, recruited at a similar rate and were 15 times less likely to die as non-fixers. As succession proceeded, the growth and survival disparities decreased, whereas N fixer recruitment decreased relative to non-fixers. According to our individual-based model, high survival was the dominant driver of the increase in basal area of N fixers. Our data suggest that N fixers are successful throughout secondary succession in tropical rainforests of north-east Costa Rica, and that attempts to understand this success should focus on tree survival. © 2015 The Authors. New Phytologist © 2015 New Phytologist Trust.

Diagnostic reasoning strategies and diagnostic success.

Science.gov (United States)

Coderre, S; Mandin, H; Harasym, P H; Fick, G H

2003-08-01

Cognitive psychology research supports the notion that experts use mental frameworks or "schemes", both to organize knowledge in memory and to solve clinical problems. The central purpose of this study was to determine the relationship between problem-solving strategies and the likelihood of diagnostic success. Think-aloud protocols were collected to determine the diagnostic reasoning used by experts and non-experts when attempting to diagnose clinical presentations in gastroenterology. Using logistic regression analysis, the study found that there is a relationship between diagnostic reasoning strategy and the likelihood of diagnostic success. Compared to hypothetico-deductive reasoning, the odds of diagnostic success were significantly greater when subjects used the diagnostic strategies of pattern recognition and scheme-inductive reasoning. Two other factors emerged as independent determinants of diagnostic success: expertise and clinical presentation. Not surprisingly, experts outperformed novices, while the content area of the clinical cases in each of the four clinical presentations demonstrated varying degrees of difficulty and thus diagnostic success. These findings have significant implications for medical educators. It supports the introduction of "schemes" as a means of enhancing memory organization and improving diagnostic success.

Biofilm community succession: a neutral perspective.

Science.gov (United States)

Woodcock, Stephen; Sloan, William T

2017-05-22

Although biofilms represent one of the dominant forms of life in aqueous environments, our understanding of the assembly and development of their microbial communities remains relatively poor. In recent years, several studies have addressed this and have extended the concepts of succession theory in classical ecology into microbial systems. From these datasets, niche-based conceptual models have been developed explaining observed biodiversity patterns and their dynamics. These models have not, however, been formulated mathematically and so remain untested. Here, we further develop spatially resolved neutral community models and demonstrate that these can also explain these patterns and offer alternative explanations of microbial succession. The success of neutral models suggests that stochastic effects alone may have a much greater influence on microbial community succession than previously acknowledged. Furthermore, such models are much more readily parameterised and can be used as the foundation of more complex and realistic models of microbial community succession.

Does Happiness Promote Career Success?

Science.gov (United States)

Boehm, Julia K.; Lyubomirsky, Sonja

2008-01-01

Past research has demonstrated a relationship between happiness and workplace success. For example, compared with their less happy peers, happy people earn more money, display superior performance, and perform more helpful acts. Researchers have often assumed that an employee is happy and satisfied because he or she is successful. In this article,…

Medical abortion. defining success and categorizing failures

DEFF Research Database (Denmark)

Rørbye, Christina; Nørgaard, Mogens; Vestermark, Vibeke

2003-01-01

. The difference in short- and long-term success rates increased with increasing gestational age. The majority of failures (76%) were diagnosed more than 2 weeks after initiation of the abortion. At a 2-week follow-up visit, the women who turned out to be failures had a larger endometrial width, higher beta......-hCG values and smaller reductions of beta-hCG than those treated successfully. To optimize comparison of success rates after different medical abortion regimens, we suggest that the criteria for success are stated clearly, that the success rates are stratified according to gestational age...

Key Success Factors in Business Intelligence

Directory of Open Access Journals (Sweden)

Szymon Adamala

2011-12-01

Full Text Available Business Intelligence can bring critical capabilities to an organization, but the implementation of such capabilities is often plagued with problems. Why is it that certain projects fail, while others succeed? The aim of this article is to identify the factors that are present in successful Business Intelligence projects and to organize them into a framework of critical success factors. A survey was conducted during the spring of 2011 to collect primary data on Business Intelligence projects. Findings confirm that Business Intelligence projects are wrestling with both technological and non-technological problems, but the non-technological problems are found to be harder to solve as well as more time consuming than their counterparts. The study also shows that critical success factors for Business Intelligence projects are different from success factors for Information Systems projects in general. Business Intelligences projects have critical success factors that are unique to the subject matter. Major differences can be found primarily among non-technological factors, such as the presence of a specific business need and a clear vision to guide the project. Success depends on types of project funding, the business value provided by each iteration in the project and the alignment of the project to a strategic vision for Business Intelligence at large. Furthermore, the study provides a framework for critical success factors that, explains sixty-one percent of variability of success for projects. Areas which should be given special attention include making sure that the Business Intelligence solution is built with the end users in mind, that the Business Intelligence solution is closely tied to the company’s strategic vision and that the project is properly scoped and prioritized to concentrate on the best opportunities first.

A statistical analysis of individual success after successful completion of Defense Language Institute Foreign Language Center Training

OpenAIRE

Hinson, William B.

2005-01-01

"The Defense Language Institute Foreign Language Center (DLIFLC) trains students in various foreign languages and dialects for the Department of Defense (DOD). The majority of students are firstterm enlistees in the basic program. This study uses classification trees and logistic regression to understand the military, academic and personal characteristics that influence first-term success after successfully completing DLIFLC training. Success was defined as completing a firstterm enlistme...

Styles of success

DEFF Research Database (Denmark)

Dahlgaard, Jens Jørn; Nørgaard, Anders; Jakobsen, Søren

1997-01-01

Corporate success stories tend to emphasize the "great men" theory of history. But now a European research project established the managerial attributes that can turn an ordinary leader into one ideal for the pursuit of business excellence. The emergence of five leadership styles as crucial drivers...... of business excellence points to a clear agenda for success. Setting clear strategic goals and the ability to take a long-term view of an organization's direction, combined with other leadership attributes such as creativity, teambuilding and learning, are principal keys to creating an excellent organization....... Leaders seeking to achive business excellence must view the high-level attainment of these sets of leadership competencies as their paramount objective. In striving for business excellence, European leaders may encounter resistance among their employees. Crucially, European employees place a markedly...

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.

A STUDY OF DACRYOCYSTITIS IN PAEDIATRIC AGE GROUP

Directory of Open Access Journals (Sweden)

Ravi Kumar

2016-03-01

Full Text Available BACKGROUND Dacryocystitis in infants is a serious complication of congenital, but seldom of acquired nasolacrimal duct obstructions. If conservative treatment fails, dacryocystorhinostomy (DCR appears to be effective. The indications, special clinical history and results will be reviewed. PATIENTS AND METHODS From January 2006 to December 2010, a total of 30 children prospectively were involved in the study (26 male, 4 female with persistent dacryocystitis (4 patients were treated surgically by DCR and were continuously documented. The patients ranged in age from 10 months to 14 years old (mean age 4.9 years. Included in our study were 16 children (12 male, 4 female with 4 surgically treated lacrimal ducts. RESULTS The cause of dacryocystitis was congenital obstruction in 13 children and trauma (maxillary fracture in 1 child, respectively. Of these, 2 children (15% had additional anomalies of the lacrimal system, 1 (7.6% systemic malformations and 8 out of the 30 children (26% had a family history of nasolacrimal duct obstruction. We found a functional success rate (with complete resolution of symptoms of 90% (27 out of 30 lacrimal ducts over follow-up periods ranging from 1 month to 4 years (average 1 years. 8 children probing were done and remaining 18 children were managed conservatively. CONCLUSION Patients with persistent dacryocystitis due to congenital nasolacrimal duct obstruction have a prevalence of further nasolacrimal abnormalities and a family history In the case of persistent dacryocystitis, DCR is indicated after the age of 1 year and has the same success rate in infants as in adults (90-95%.

Success of Chemotherapy in Soft Matter

OpenAIRE

Trifonova, I.; Kurteva, G.; Stefanov, S. Z.

2014-01-01

The success of chemotharapy in soft matter as a survival is found in the paper. Therefore, it is found the analogous tumor stretching force in soft matter; ultrasonography is performed for this tumor; restoration in soft matter with such a tumor is found; Bayes estimate of the probability of chemotherapy success is derived from the transferred chemical energy and from soft matter entropy; survival probability is juxtaposed to this probability of success.

Behind the Exporters’ Success: Analysis of Successful Hungarian Exporter Companies From a Strategic Perspective

OpenAIRE

Annamaria Kazai Onodi; Krisztina Pecze

2014-01-01

The purpose of the study is to provide an overview of export success from a strategic management perspective. The paper empirically tested the relationships between the firm’s export performance, strategic thinking, adaptation to the changing environment and companies’ capabilities. The research is based on the Hungarian Competitiveness Research database of 2013 that consists of 300 firms. Cluster analysis differentiated successful export-oriented and stagnant companies. Both of them had high...

Navy Contracting Analyzing Critical Success Factors and Perceived Impact on Success within an Organization

OpenAIRE

Hill, Josh R.; McGraw, Kevin L.

2012-01-01

MBA Professional Report Approved for public release, distribution unlimited Critical Success Factors (CSF) are essential ingredients within an organization that are necessary to meet critical mission objectives. Identifying those factors can be a vital asset and assist leadership in achieving successful outcomes in contract management. This report will focus on three major contracting commands within the United States Navy Naval Supply Systems Command, Global Logistics Support (NAVSUP-G...

Project Success in IT Project Management

OpenAIRE

Siddiqui, Farhan Ahmed

2010-01-01

The rate of failed and challenged Information Technology (IT) projects is too high according to the CHAOS Studies by the Standish Group and the literature on project management (Standish Group, 2008). The CHAOS Studies define project success as meeting the triple constraints of scope, time, and cost. The criteria for project success need to be agreed by all parties before the start of the project and constantly reviewed as the project progresses. Assessing critical success factors is another ...

Critical success factors for managing purchasing groups

NARCIS (Netherlands)

Schotanus, Fredo; Telgen, Jan; de Boer, L.

2010-01-01

In this article, we identify critical success factors for managing small and intensive purchasing groups by comparing successful and unsuccessful purchasing groups in a large-scale survey. The analysis of our data set suggests the following success factors: no enforced participation, sufficient

Key performance indicators for successful simulation projects

OpenAIRE

Jahangirian, M; Taylor, SJE; Young, T; Robinson, S

2016-01-01

There are many factors that may contribute to the successful delivery of a simulation project. To provide a structured approach to assessing the impact various factors have on project success, we propose a top-down framework whereby 15 Key Performance Indicators (KPI) are developed that represent the level of successfulness of simulation projects from various perspectives. They are linked to a set of Critical Success Factors (CSF) as reported in the simulation literature. A single measure cal...

Defining successful aging: a tangible or elusive concept?

Science.gov (United States)

Martin, Peter; Kelly, Norene; Kahana, Boaz; Kahana, Eva; Willcox, Bradley J; Willcox, D Craig; Poon, Leonard W

2015-02-01

Everyone wants to age successfully; however, the definition and criteria of successful aging remain vague for laypersons, researchers, and policymakers in spite of decades of research on the topic. This paper highlights work of scholars who made significant theoretical contributions to the topic. A thorough review and evaluation of the literature on successful aging was undertaken. Our review includes early gerontological definitions of successful aging and related concepts. Historical perspectives reach back to philosophical and religious texts, and more recent approaches have focused on both process- and outcome-oriented models of successful aging. We elaborate on Baltes and Baltes' theory of selective optimization with compensation [Baltes, P. B., & Baltes, M. M. (1990a). Psychological perspectives on successful aging: The model of selective optimization with compensation. In P. B. Baltes & M. M. Baltes (Eds.), Successful aging: Perspectives from the behavioral sciences (pp. 1-34). United Kingdom: Cambridge University Press], Kahana and Kahana's preventive and corrective proactivity model [Kahana, E., & Kahana, B. (1996). Conceptual and empirical advances in understanding aging well through proactive adaptation. In V. Bengtson (Ed.), Adulthood and aging: Research on continuities and discontinuities (pp. 18-40). New York: Springer], and Rowe and Kahn's model of successful aging [Rowe, J. W., & Kahn, R. L. (1998). Successful aging. New York: Pantheon Books], outlining their commonalities and differences. Additional views on successful aging emphasize subjective versus objective perceptions of successful aging and relate successful aging to studies on healthy and exceptional longevity. Additional theoretical work is needed to better understand successful aging, including the way it can encompass disability and death and dying. The extent of rapid social and technological change influencing views on successful aging also deserves more consideration. © The Author

Crop succession requirements in agricultural production planning

NARCIS (Netherlands)

Klein Haneveld, W.K.; Stegeman, A.

2005-01-01

A method is proposed to write crop succession requirements as linear constraints in an LP-based model for agricultural production planning. Crop succession information is given in the form of a set of inadmissible successions of crops. The decision variables represent the areas where a certain

[Effects of climate change on forest succession].

Science.gov (United States)

Wang, Jijun; Pei, Tiefan

2004-10-01

Forest regeneration is an important process driven by forest ecological dynamic resources. More and more concern has been given to forest succession issues since the development of forest succession theory during the early twentieth century. Scientific management of forest ecosystem entails the regulations and research models of forest succession. It is of great practical and theoretical significance to restore and reconstruct forest vegetation and to protect natural forest. Disturbances are important factors affecting regeneration structure and ecological processes. They result in temporal and spatial variations of forest ecosystem, and change the efficiencies of resources. In this paper, some concepts about forest succession and disturbances were introduced, and the difficulties of forest succession were proposed. Four classes of models were reviewed: Markov model, GAP model, process-based equilibrium terrestrial biosphere models (BIOME series models), and non-linear model. Subsequently, the effects of climate change on forest succession caused by human activity were discussed. At last, the existing problem and future research directions were proposed.

Successful international negotiations

International Nuclear Information System (INIS)

Gerry, G.

1997-01-01

These remarks on successful international trade negotiations deal with the following topics: culture and differences in psychology; building friendly relationships and letting both sides appear to win; well written proposals; security of negotiating information; the complexity and length of nuclear negotiations

Measuring strategic success.

Science.gov (United States)

Gish, Ryan

2002-08-01

Strategic triggers and metrics help healthcare providers achieve financial success. Metrics help assess progress toward long-term goals. Triggers signal market changes requiring a change in strategy. All metrics may not move in concert. Organizations need to identify indicators, monitor performance.

Incumbent Decisions about Succession Transitions in Family Firms

DEFF Research Database (Denmark)

Boyd, Britta; Botero, Isabel C.; Fediuk, Tomasz A.

2014-01-01

in (i.e., intra-family succession, out of family succession, or no succession). Building on the theory of planned behavior and the socioemotional wealth framework (SEW), this manuscript presents a conceptual framework to understand the factors that influence succession transitions and the role...... that contextual factors can play in this decision-making process. We present theory driven propositions and discuss the implications for understanding and evaluation of the succession process....

Fear of success among business students.

Science.gov (United States)

Rothman, M

1996-06-01

The concept of "Fear of Success" was measured with 352 male and female business students using the prompt, After first term finals, Ann(John) finds her(him)self at the top of her(his) Medical/Nursing school class. Analysis indicated a greater frequency of fear-of-success imagery among men than women and in particular to the John in Medical school and Ann in Nursing school cues. In addition, the Ann cue and the Medical school cue generated more fear-of-success responses among men than women.

Successfully combating prejudice

Indian Academy of Sciences (India)

Lawrence

Sir Jagdish Chandra Bose, and fascinated by his work that showed that plants were ... U.S., in 1972, I was invited to take up a faculty position at the newly established ... success because of their different social commitments. Today when I look ...

Project Success in Agile Development Software Projects

Science.gov (United States)

Farlik, John T.

2016-01-01

Project success has multiple definitions in the scholarly literature. Research has shown that some scholars and practitioners define project success as the completion of a project within schedule and within budget. Others consider a successful project as one in which the customer is satisfied with the product. This quantitative study was conducted…

Reframing Success and Failure of Information Systems

DEFF Research Database (Denmark)

Cecez-Kecmanovic, Dubravka; Kautz, Karlheinz; Abrahall, Rebecca

2014-01-01

-networks of developers, managers, technologies, project documents, methodologies, and other actors. Drawing from a controversial case of a highly innovative information system in an insurance company-considered a success and failure at the same time- the paper reveals the inherent indeterminacy of IS success and failure......he paper questions common assumptions in the dominant representational framings of information systems success and failure and proposes a performative perspective that conceives IS success and failure as relational effects performed by sociomaterial practices of IS project actor...... that performed both different IS realities and competing IS assessments. The analysis shows that the IS project and the implemented system as objects of assessment are not given and fixed, but are performed by the agencies of assessment together with the assessment outcomes of success and failure. The paper...

The characteristics of successful entrepreneurs

OpenAIRE

Pokrajčić Dragana M.

2004-01-01

This paper examines the economic, psychological and social-behavioral theories of the entrepreneur in order to determine the characteristics of a successful entrepreneur. The major contribution of economic theories of the entrepreneur is better understanding of the entrepreneur and his/her role in economic development. The psychological characteristic theory of entrepreneur argues that successful entrepreneurs possess certain personality traits that mark them out as special, and tries to dete...

Fast Success and Slow Failure

DEFF Research Database (Denmark)

Mors, Louise; Waguespack, David

Full Abstract: Do the benefits of cross boundary collaborations outweigh the costs? We seek to answer this question by examining 5079 collaborations in the Internet Engineering Task Force (IETF). Our findings suggest that crossing formal boundaries is positively related to success and efficiency ...... of success, suggesting that firms are better off investing in nondiverse projects. This finding has important implications for how we think about the benefits of seeking novelty....

Population dynamics along a primary succession gradient: do alpine species fit into demographic succession theory?

Science.gov (United States)

Marcante, Silvia; Winkler, Eckart; Erschbamer, Brigitta

2009-05-01

Understanding processes and mechanisms governing changes in plant species along primary successions has been of major importance in ecology. However, to date hardly any studies have focused on the complete life cycle of species along a successional gradient, comparing pioneer, early and late-successional species. In this study it is hypothesized that pioneer species should initially have a population growth rate, lambda, greater than one with high fecundity rates, and declining growth rates when they are replaced by late-successional species. Populations of late-successional species should also start, at the mid-successional stage (when pioneer species are declining), with growth rates greater than one and arrive at rates equal to one at the late successional stage, mainly due to higher survival rates that allow these species to persist for a long time. The demography of pioneer- (Saxifraga aizoides), early (Artemisia genipi) and late-successional species (Anthyllis vulneraria ssp. alpicola) was investigated together with that of a ubiquitous species (Poa alpina) along the Rotmoos glacier foreland (2300-2400 m a.s.l., Central Alps, Austria) over 3 years. A matrix modelling approach was used to compare the main demographic parameters. Elasticity values were plotted in a demographic triangle using fecundity, individual growth and survival as vital rates contributing to the population growth rates. The results largely confirmed the predictions for population growth rates during succession. However, high survival rates of larger adults characterized all species, regardless of where they were growing along the succession. At the pioneer site, high mortality rates of seedlings, plantlets and young individuals were recorded. Fecundity was found to be of minor relevance everywhere, but it was nevertheless sufficient to increase or maintain the population sizes. Demographically, all the species over all sites behaved like late-successional or climax species in secondary

Success in Entrepreneurship

DEFF Research Database (Denmark)

Iversen, Jens; Malchow-Møller, Nikolaj; Sørensen, Anders

2016-01-01

What makes a successful entrepreneur? Using Danish register data, we find strong support for the hypothesis that theoretical skills from schooling and practical skills acquired through wage-work are complementary inputs in the human capital earnings function of entrepreneurs. In fact, we find tha...

International Student Success

Science.gov (United States)

Smith, Clayton

2016-01-01

This article, with a focus on North American postsecondary education, identifies international students as a strategic enrollment management institutional priority; presents themes in the international student retention, satisfaction, and success research literature; and describes related best practices. It also presents the findings from an…

A Framework for successful new product development

Directory of Open Access Journals (Sweden)

Nadia Bhuiyan

2011-12-01

Full Text Available Purpose: The purpose of this paper is to propose a framework of critical success factors, metrics, and tools and techniques for implementing metrics for each stage of the new product development (NPD process.Design/methodology/approach: To achieve this objective, a literature review was undertaken to investigate decades of studies on NPD success and how it can be achieved. These studies were scanned for common factors for firms that enjoyed success of new products on the market.Findings: The paper summarizes NPD success factors, suggests metrics that should be used to measure these factors, and proposes tools and techniques to make use of these metrics. This was done for each stage of the NPD process, and brought together in a framework that the authors propose should be followed for complex NPD projects.Research limitations/implications: Several different research directions could provide additional useful information both to firms finding critical success factors (CSF and measuring product development success as well as to academics performing research in this area. The main research opportunity exists in implementing or testing the proposed framework.Practical implications: The framework can be followed by managers of complex NPD projects to ensure success.Originality/value: While many studies have been conducted on critical success factors for NPD, these studies tend to be fragmented and focus on one or a few phases of the NPD process. To the authors’ knowledge, this is the first time a framework that synthesizes these studies into a single framework.

Exploring Career-Life Success and Family Social Support of Successful Women in Canada, Argentina and Mexico

Science.gov (United States)

Lirio, Pamela; Lituchy, Terri R.; Monserrat, Silvia Ines; Olivas-Lujan, Miguel R.; Duffy, Jo Ann; Fox, Suzy; Gregory, Ann; Punnett, B. J.; Santos, Neusa

2007-01-01

Purpose: The purpose of this paper is to examine career-life issues of successful women in the Americas. Design/methodology/approach: A total of 30 interviews were conducted with successful women in Canada, Argentina and Mexico. Themes were pulled from the interview transcripts for each country, analyzed and then compared across countries, looking…

Success factors in technology development

Science.gov (United States)

Preston, John T.

1995-01-01

Universities in the U.S. have a significant impact on business through the transfer of technology. This paper describes goals and philosophy of the Technology Licensing Office at the Massachusetts Institute of Technology. This paper also relates the critical factors for susscessful technology transfer, particularly relating to new business formation. These critical factors include the quality of the technology, the quality of the management, the quality of the investor, the passion for success, and the image of the company. Descriptions of three different levels of investment are also given and the most successful level of investment for starting a new company is reviewed. Licensing to large companies is also briefly reviewed, as this type of licensing requires some different strategies than that of licensing to start-up companies. High quality critical factors and intelligent investment create rewards for the parties and successful ventures.

What a successful grasp tells about the success chances of grasps in its vicinity

DEFF Research Database (Denmark)

Bodenhagen, Leon; Detry, Renaud; Piater, Justus

2011-01-01

Infants gradually improve their grasping competences, both in terms of motor abilities as well as in terms of the internal shape grasp representations. Grasp densities provide a statistical model of such an internal learning process. In the concept of grasp densities, kernel density estimation...... probabilities representing grasp success in the neighborhood of a successful grasp. The anisotropy has been determined utilizing a simulation environment that allowed for evaluation of large scale experiments. The anisotropic kernel has been fitted to the conditional probabilities obtained from the experiments...

Structural Validity of the Fear of Success Scale

Science.gov (United States)

Metzler, Jonathan N.; Conroy, David E.

2004-01-01

Fear of success is a dispositional form of anxiety that can have harmful effects on athletes' motivation and performance; however, empirical research on fear of success in sport has been limited. Zuckerman and Allison's (1976) Fear of Success Scale (FOSS) has been the most popular fear of success measure used in sport, yet it is laden with…

Nurse manager succession planning: A cost-benefit analysis.

Science.gov (United States)

Phillips, Tracy; Evans, Jennifer L; Tooley, Stephanie; Shirey, Maria R

2018-03-01

This commentary presents a cost-benefit analysis to advocate for the use of succession planning to mitigate the problems ensuing from nurse manager turnover. An estimated 75% of nurse managers will leave the workforce by 2020. Many benefits are associated with proactively identifying and developing internal candidates. Fewer than 7% of health care organisations have implemented formal leadership succession planning programmes. A cost-benefit analysis of a formal succession-planning programme from one hospital illustrates the benefits of the programme in their organisation and can be replicated easily. Assumptions of nursing manager succession planning cost-benefit analysis are identified and discussed. The succession planning exemplar demonstrates the integration of cost-benefit analysis principles. Comparing the costs of a formal nurse manager succession planning strategy with the status quo results in a positive cost-benefit ratio. The implementation of a formal nurse manager succession planning programme effectively reduces replacement costs and time to transition into the new role. This programme provides an internal pipeline of future leaders who will be more successful than external candidates. Using an actual cost-benefit analysis equips nurse managers with valuable evidence depicting succession planning as a viable business strategy. © 2017 John Wiley & Sons Ltd.

Predictors of procedural success and improvement of left ventricular ejection fraction after successful recanalization of coronary chronic total occlusion (CTO

Directory of Open Access Journals (Sweden)

Ahmed Magdy

2017-04-01

Conclusion: PCI for CTO lesions has achieved a better chance for success especially with modern facilities, but we should revise criteria of success and failure as this success has a considerable effect on LV function and patient outcome.

The Extended Family and Children's Educational Success

DEFF Research Database (Denmark)

Jæger, Mads Meier

2012-01-01

Research on family background and educational success focuses almost exclusively on two generations and on parents and children. This paper argues that the extended family makes up a significant part of the total effect of family background on educational success. Empirical results based...... on the Wisconsin Longitudinal Study show that, net of family factors shared by siblings from the same immediate family, factors shared by first cousins from the same extended family account for a nontrivial part of the total variance in children’s educational success. Results also show that while socioeconomic...... characteristics of grandparents and aunts and uncles have few direct effects on educational success, resources in the extended family compensate lacking resources in low-SES families, which in turn promote children’s educational success. The main conclusion is that the total effect of family background...

Tacit acceptance of the succession

Directory of Open Access Journals (Sweden)

Ioana NICOLAE

2012-01-01

Full Text Available This paper examines some essential and contradictory aspects regarding the issue of tacit acceptance of succession in terms of distinction between documents valuing tacit acceptance of succession and other acts that would not justify such a solution. The documents expressly indicated by the legislator as having tacit acceptance value as well as those which do not have such value are presented and their most important legal effects are examined and discussed.

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 .

Critical success factors in infrastructure projects

Science.gov (United States)

Zakaria, Siti Fairus; Zin, Rosli Mohamad; Mohamad, Ismail; Balubaid, Saeed; Mydin, Shaik Hussein; Mohd Rahim, E. M. Roodienyanto

2017-11-01

Construction of infrastructure project is different from buildings. The main difference is term of project site where infrastructure project need to command a long stretch while building mostly confine to a limited area. As such factors that are critical to infrastructure project may not be that significant to building project and vice versa. Flood mitigation can be classified under infrastructure projects under which their developments are planned by the government with the specific objective to reduce or avoid the negative effects of flood to the environment and livelihood. One of the indicators in project success is delay. The impact of project delay in construction industry is significant that it decelerates the projects implementation, specifically the government projects. This study attempted to identify and compare the success factors between infrastructure and building projects, as such comparison rarely found in the current literature. A model of flood mitigation projects' success factors was developed by merging the experts' views and reports from the existing literature. The experts' views were obtained from the responses to open-ended questions on the required fundamentals to achieve successful completion of flood mitigation projects. An affinity analysis was applied to these responses to develop the model. The developed model was then compared to the established success factors found in building project, extracted from the previous studies to identify the similarities and differences between the two models. This study would assist the government and construction players to become more effective in constructing successful flood mitigation projects for the future practice in a flood-prone country like Malaysia.

Small(pox) success?

Science.gov (United States)

Birn, Anne-Emanuelle

2011-02-01

The 30th anniversary of the World Health Organization's (WHO) official certification of smallpox eradication was marked by a slew of events hailing the campaign's dramatic tale of technological and organizational triumph against an ancient scourge. Yet commemorations also serve as moments of critical reflection. This article questions the acclaim showered upon smallpox eradication as the single greatest public health success in history. It examines how and why smallpox eradication and WHO's concurrent social justice-oriented primary health care approach (following from the Declaration of Alma-Ata) became competing paradigms. It synthesizes critiques of eradication's shortcomings and debunks some of the myths surrounding the global eradication campaign as a public health priority and necessity, and as a Cold War victory of cooperation. The article concludes with thoughts on integrating technical and social-political aspects of health within the context of welfare states as the means to achieving widespread and enduring global public health success.

Small(pox success?

Directory of Open Access Journals (Sweden)

Anne-Emanuelle Birn

Full Text Available The 30th anniversary of the World Health Organization's (WHO official certification of smallpox eradication was marked by a slew of events hailing the campaign's dramatic tale of technological and organizational triumph against an ancient scourge. Yet commemorations also serve as moments of critical reflection. This article questions the acclaim showered upon smallpox eradication as the single greatest public health success in history. It examines how and why smallpox eradication and WHO's concurrent social justice-oriented primary health care approach (following from the Declaration of Alma-Ata became competing paradigms. It synthesizes critiques of eradication's shortcomings and debunks some of the myths surrounding the global eradication campaign as a public health priority and necessity, and as a Cold War victory of cooperation. The article concludes with thoughts on integrating technical and social-political aspects of health within the context of welfare states as the means to achieving widespread and enduring global public health success.

5 CFR 412.201 - Management succession.

Science.gov (United States)

2010-01-01

... programs must be supported by employee training and development programs. The focus of the program should... learning experiences throughout an employee's career, such as details, mentoring, coaching, learning groups..., MANAGEMENT, AND EXECUTIVE DEVELOPMENT Succession Planning § 412.201 Management succession. The head of each...

Resultados e complicações da entubação bicanalicular em dacriocistorrinostomia externa Results and complications of bicanalicular intubation in external dacryocystorhinostomy

Directory of Open Access Journals (Sweden)

Gisele Scholte de Souza Vieira

2008-08-01

Full Text Available OBJETIVO: Analisar a taxa de sucesso e complicações em pacientes com obstrução lacrimal, submetidos à entubação bicanalicular na cirurgia de dacriocistorrinostomia externa (DCR-Ex. MÉTODOS: Foram analisados os dados dos pacientes operados no Hospital do Servidor Público Estadual de São Paulo. A entubação lacrimal foi realizada com tubo de silicone, removido após oito semanas. O sucesso da cirurgia foi considerado nos casos de pacientes sem epífora ou secreção ocular no pós-operatório, com boa passagem de fluido para a narina ou orofaringe. As complicações relacionadas com o tubo de silicone foram agrupadas em uma tabela. RESULTADOS: Os pacientes foram operados no período de abril de 2002 a julho de 2006, com tempo de seguimento médio de três meses. Do total de 65 olhos obteve-se uma taxa de sucesso de 89,2%. Sete pacientes apresentaram epífora no pós-operatório, dos quais 5 foram reoperados. Em 7 olhos houve extrusão do silicone com menos de 15 dias de pós-operatório, e neste grupo 1 paciente necessitou de reoperação. Seis olhos apresentaram complicações com o silicone: prolapso do tubo (4 casos, formação de granuloma na cavidade nasal (1 caso e aderência dos pontos lacrimais (1 caso. COCLUSÕES: Este grupo de pacientes apresentou taxa elevada de sucesso (89,2% com a cirurgia de DCR-Ex associada à entubação bicanalicular. A entubação intra-operatória com tubo de silicone não é isenta de complicações.PURPOSE: To analyze the success rate and complications in patients with lacrimal obstruction submitted to surgeries. METHODS: The data of patients operated in the "Hospital do Servidor Público Estadual of São Paulo" were analyzed. The lacrimal intubation was performed with a silicone tube, removed after 8 weeks. Surgeries were considered successful in those cases where patients had no postoperative epiphora or ocular secretion, and with a good passage of fluid to the nose or oropharynx. The

America's Success Syndrome

Science.gov (United States)

Duplisea, Eric A.

1974-01-01

America's earliest schools taught career awareness and job skills, but for 200 years it was a speciality curriculum--cultivating a classical heritage predominated. Recently the hard sell message is that schooling and credentialism ensure entry into the "successful life". Vocational educators must become leaders, explode this myth, and redefine…

Leading to Success

Science.gov (United States)

Koballa, Thomas R., Jr.; Bradbury, Leslie U.

2009-01-01

Teacher mentoring has its unique challenges that are often associated with the teachers' content specialties. For this reason, the involvement and support of school leaders is essential to teachers' mentoring success. Regardless of content specialty, all teachers face challenges that should be considered when organizing and implementing mentoring.…

Establishing a Successful Smart Card Program.

Science.gov (United States)

Wiens, Janet

2001-01-01

Discusses how to run a successful smart card program through a comprehensive approach that includes a detailed plan for the present and future, high level support from school administration, and extensive user input. Florida State University is used to illustrate a successfully implemented smart card program. (GR)

Success and Motivation among College Students

Science.gov (United States)

Schweinle, Amy; Helming, Luralyn M.

2011-01-01

The present research explores college students' explanations of their success and failure in challenging activities and how it relates to students' efficacy, value, and engagement. The results suggest most students hold one primary reason for success during the challenging activity, including grade/extrinsic, mastery/intrinsic,…

Critical success factors for renewable energy projects

International Nuclear Information System (INIS)

1995-01-01

This project highlighted best practice in the planning and assessment of proposals with the aim of: encouraging more successful renewable energy projects and proposals; lowering financial and other barriers; and stimulating a climate for success. Based on the analysis of a number of case studies, data was collected through a series of extensive interviews to identify why certain schemes were considered successful, what might have been done differently and which factors were considered important when entering a market. The Critical Success Factors can be broken down into five groups: Universal CSFs; CSFs for funding bodies; CSFs for managing agencies; CSFs for niche markets; CSFs for individual technologies. (author)

Duplicating Research Success at Xerox

Science.gov (United States)

Hays, Dan A.

2003-03-01

The genesis of Xerox is rooted in the invention of xerography by physicist Chester Carlson in 1938. The initial research by Carlson can be viewed as the first of four successful xerographic research eras that have contributed to the growth of Xerox. The second era began in 1944 when Carlson established a working relationship with Battelle Memorial Institute in Columbus, OH. Due to many research advances at Battelle, the Haloid Corporation in Rochester, NY acquired a license to the xerographic process in 1947. The name of the company was changed to Xerox Corporation in 1961 following the wide market acceptance of the legendary Xerox 914 copier. Rapid revenue growth of Xerox in the mid-'60s provided the foundation for a third successful research era in the '70s and '80s. A research center was established in Webster, NY for the purpose of improving the design of xerographic subsystems and materials. These research efforts contributed to the commercial success of the DocuTech family of digital production printers. The fourth successful research era was initiated in the '90s with the objective of identifying a high-speed color xerographic printing process. A number of research advances contributed to the design of a 100 page per minute printer recently introduced as the Xerox DocuColor iGen3 Digital Production Press. To illustrate the role of research in enabling these waves of successful xerographic products, the physics of photoreceptors, light exposure and development subsystems will be discussed. Since the annual worldwide revenue of the xerographic industry exceeds 100 billion dollars, the economic return on Carlson's initial research investment in the mid-'30s is astronomical. The future for xerography remains promising since the technology enables high-speed digital printing of high-quality color documents with variable information.

Ending the CEO succession crisis.

Science.gov (United States)

Charan, Ram

2005-02-01

The CEO succession process is broken. Many companies have no meaningful succession plans, and few of the ones that do are happy with them. CEO tenure is shrinking; in fact, two out of five CEOs fail in their first 18 months. It isn't just that more CEOs are being replaced; it's that they're being replaced badly. The problems extend to every aspect of CEO succession: internal development programs, board supervision, and outside recruitment. While many organizations do a decent job of nurturing middle managers, few have set up the comprehensive programs needed to find the half-dozen true CEO candidates out of the thousands of leaders in their midst. Even more damaging is the failure of boards to devote enough attention to succession. Search committee members often have no experience hiring CEOs; lacking guidance, they supply either the narrowest or the most general of requirements and then fail to vet eitherthe candidates or the recruiters. The result is that too often new CEOs are plucked from the well-worn Rolodexes of a remarkably small number of recruiters. These candidates may be strong in charisma but may lack critical skills or otherwise be a bad fit with the company. The resulting high turnover is particularly damaging, since outside CEOs often bring in their own teams, can cause the company to lose focus, and are especially costly to be rid of. Drawing on over 35 years of experience with CEO succession, the author explains how companies can create a deep pool of internal candidates, how boards can consistently align strategy and leadership development, and how directors can get their money's worth from recruiters. Choosing a CEO should be not one decision but an amalgam ofthousands of decisions made by many people every day over years.

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.

Orchiopexy for intra-abdominal testes: factors predicting success.

Science.gov (United States)

Stec, Andrew A; Tanaka, Stacy T; Adams, Mark C; Pope, John C; Thomas, John C; Brock, John W

2009-10-01

Intra-abdominal testes can be treated with several surgical procedures. We evaluated factors influencing the outcome of orchiopexy for intra-abdominal testis. We retrospectively reviewed 156 consecutive orchiopexies performed for intra-abdominal testis, defined as a nonpalpable testis on examination and located in the abdomen at surgery. All surgical approaches were included in the study. Primary outcome was the overall success rate and secondary outcomes were success based on surgical approach, age and a patent processus vaginalis. Success was considered a testis with normal texture and size compared to the contralateral testis at followup. Multivariate analysis was performed to determine factors predictive of success. The overall success rate of all orchiopexies was 79.5%. Median patient age at orchiopexy was 12 months and mean followup was 16 months. Of the patients 117 had a patent processus vaginalis at surgery. One-stage abdominal orchiopexy was performed in 92 testes with 89.1% success. Of these cases 32 were performed laparoscopically with 96.9% success. One-stage Fowler-Stephens orchiopexy was performed in 27 testes and 2-stage Fowler-Stephens orchiopexy was performed in 37 with success in 63.0% and 67.6%, respectively. Multivariate analysis revealed that 1-stage orchiopexy without vessel division had more successful outcomes than 1 and 2-stage Fowler-Stephens orchiopexy (OR 0.24, p = 0.007 and 0.29, p = 0.19, respectively). Neither age at surgery nor an open internal ring was significant (p = 0.49 and 0.12, respectively). The overall success of orchiopexy for intra-abdominal testis is 79.5%. While patient selection remains a critical factor, 1-stage orchiopexy without vessel division was significantly more successful and a laparoscopic approach was associated with the fewest failures for intra-abdominal testes.

The Entrepreneurial Subjectivity of Successful Researchers

Science.gov (United States)

Sinclair, Jennifer; Cuthbert, Denise; Barnacle, Robyn

2014-01-01

This article begins the work of examining what kind of doctoral experiences positively influence researcher development, and what other attributes may contribute to a successful research career. It reports preliminary findings from the analysis of survey responses by a sample of successful mid-career researchers. Positive doctoral experiences and…

Succession Planning Demystified. IES Report 372.

Science.gov (United States)

Hirsh, W.

This book, which is designed for human resource (HR) practitioners, details the principles and applications of succession planning, shows how succession planning is conducted, and explains its place in relation to other HR processes and business priorities. The introduction describes the book's intended audience and provides a brief overview of…

A framework for successful hotel developments

Directory of Open Access Journals (Sweden)

Chris E Cloete

2013-04-01

Various critical success factors for hotel development are identified in this article, and incorporated into a hotel property development framework, establishing a practical ‘road map’ for successful hotel developments. The validity of the proposed hotel property development framework has been assessed by intensive direct interviews with hotel development professionals.

Enterprise architecture for business success

CERN Document Server

Wijegunaratne, Inji; Evans-Greenwood, Peter

2014-01-01

Enterprise Architecture (EA) has evolved to become a prominent presence in today's information systems and technology landscape. The EA discipline is rich in frameworks, methodologies, and the like. However, the question of 'value' for business ;professionals remains largely unanswered - that is, how best can Enterprise Architecture and Enterprise Architects deliver value to the enterprise? Enterprise Architecture for Business Success answers this question. Enterprise Architecture for Business Success is primarily intended for IT professionals working in the area of Enterprise Architectu

Focus on Success

Science.gov (United States)

Frey, Susan

2011-01-01

Successful middle schools do not happen by accident--they happen through leadership. Principals promote a shared vision that empowers school staffs to set high standards and continuously improve student achievement. And these middle grade educators also try to help their adolescent students see the connection between their work in school and their…

Narrative intelligence and pedagogical success in english

Directory of Open Access Journals (Sweden)

Pishghadam, Reza

2011-01-01

Full Text Available The present study intends to investigate the relationship between English as a Foreign Language (EFL teachers’ narrative intelligence and their pedagogical success. Eighty EFL teachers along with 673 EFL learners participated in this study. Narrative Intelligence Scale (NIS and the Characteristics of the Successful Teachers Questionnaire (CSTQ were utilized to gather data in this study. The results revealed that there exists a significant association between EFL teachers’ pedagogical success and their narrative intelligence. Moreover, Genre-ation, among the subscales of narrative intelligence, was found to be the best predictor of teacher success. Finally, the results were discussed and pedagogical implications were provided in the context of language learning and teaching

Successful Climate Science Communication Strategies

Science.gov (United States)

Sinclair, P.

2016-12-01

In the past decade, efforts to communicate the facts of global change have not successfully moved political leaders and the general public to action. In response, a number of collaborative efforts between scientists and professional communicators, writers, journalists, bloggers, filmmakers, artists and others have arisen seeking to bridge that gap. As a result, a new cadre of science-literate communicators, and media-savvy scientists have made themselves visible across diverse mainstream, traditional, and social media outlets. Because of these collaborations, in recent years, misinformation, and disinformation have been successfully met with accurate and credible rebuttals within a single news cycle.Examples of these efforts is the Dark Snow Project, a science/communication collaboration focusing initially on accelerated arctic melt and sea level rise, and the Climate Science Rapid Response team, which matches professional journalists with appropriate science experts in order to respond within a single news cycle to misinformation or misunderstandings about climate science.The session will discuss successful examples and suggest creative approaches for the future.

Estimating raptor nesting success: old and new approaches

Science.gov (United States)

Brown, Jessi L.; Steenhof, Karen; Kochert, Michael N.; Bond, Laura

2013-01-01

Studies of nesting success can be valuable in assessing the status of raptor populations, but differing monitoring protocols can present unique challenges when comparing populations of different species across time or geographic areas. We used large datasets from long-term studies of 3 raptor species to compare estimates of apparent nest success (ANS, the ratio of successful to total number of nesting attempts), Mayfield nesting success, and the logistic-exposure model of nest survival. Golden eagles (Aquila chrysaetos), prairie falcons (Falco mexicanus), and American kestrels (F. sparverius) differ in their breeding biology and the methods often used to monitor their reproduction. Mayfield and logistic-exposure models generated similar estimates of nesting success with similar levels of precision. Apparent nest success overestimated nesting success and was particularly sensitive to inclusion of nesting attempts discovered late in the nesting season. Thus, the ANS estimator is inappropriate when exact point estimates are required, especially when most raptor pairs cannot be located before or soon after laying eggs. However, ANS may be sufficient to assess long-term trends of species in which nesting attempts are highly detectable.

Impact of Stakeholder Psychological Empowerment on Project Success

Directory of Open Access Journals (Sweden)

Herry Pintardi Chandra

2011-05-01

Full Text Available The relationship between psychological empowerment of stakeholders and project success is an important thing that must be known by project manager. This research developed and tested the model to predict how well the impact of stakeholder psychological empowerment on project success. Stakeholder psychological empowerment was defined to have five indicator variables covering intrinsic motivation, opportunity to perform, ability to perform, task behaviors, and contextual behaviors. Meanwhile, project success can be measured by cost performance, time performance, quality performance, profitability, and customer satisfaction. In this study, it was hypothesized that stakeholder psychological empowerment influenced project success. Based on the data obtained from a questionnaire survey carried out to 204 respondents, structural equation modeling (SEM was used for predicting the performance of project success. It was found that stakeholder psychological empowerment influenced project success, especially on the ability to perform of stakeholders.

Modeling Student Success in Engineering Education

Science.gov (United States)

Jin, Qu

2013-01-01

In order for the United States to maintain its global competitiveness, the long-term success of our engineering students in specific courses, programs, and colleges is now, more than ever, an extremely high priority. Numerous studies have focused on factors that impact student success, namely academic performance, retention, and/or graduation.…

Telling Successes of Japanese Foreign Aid

DEFF Research Database (Denmark)

Hansen, Annette Skovsted

Stakeholders of two success story events negotiated an idea of development as individual entrepreneurship. The sixty-five-year-old Japanese Foreign Aid history includes stories of successes told by professionals from developing countries throughout the world. Their stories reflect the cultural...... sector training programs partly financed by Japanese Official development Assistance (ODA)....

[Succession of chitinolytic microorganisms in chernozem soil].

Science.gov (United States)

Manucharova, N A; Belova, E V; Vorob'ev, A V; Polianskaia, L M; Stepanov, A L

2005-01-01

The chitinolytic prokaryotic and eukaryotic microbial complex of chernozem soil has been investigated in the course of a succession initiated by the introduction of chitin and humidification. The dynamics of the cell numbers of chitinolytic microorganisms and of their biomass was assessed by fluorescent microscopy and by inoculation of selective media. Emission of carbon dioxide and nitrous oxide, as well as dinitrogen fixation, was assessed by gas chromatography. It was found that, when the succession was initiated by the introduction of both chitin and humidification, it resulted in greater cell numbers and biomass of chitinolytic microorganisms and higher levels of CO2 and N2O emission and of nitrogen fixation than when the succession was initiated by humidification alone. As compared to the control samples, a significant (twofold) increase in the prokaryote cell number and biomass was found on the fourth day of the succession initiated by humidification and introduction of chitin. One week after the initiation of succession, the fungal biomass and length of mycelium were twice as high as those in the control samples. These results led to the conclusion that chitin utilization in chernozem soil starts during the initial stages of succession and is performed by both prokaryotic and eukaryotic microorganisms.

The Comparison of Early Maladaptive Schema’s Domains Between Successful And Non-Successful Opiate Addicts and Non-Clinical Persons

Directory of Open Access Journals (Sweden)

Bahram Sahand

2009-10-01

Full Text Available Introduction: The current research was done in order to compare the early maladaptive schema’s domains between successful and non-successful opiate addicts and non-clinical persons in Tehran. Method: The research design was causal effect method. In this purpose 90 men (include successful and non-successful opiate addicts, and non-clinical persons (30 for each group, were selected by the available sampling method. Young Schema Questionnaire (YSQ-RE2R, General Health Questionnaire (GHQ, and Personal Characteristic Questionnaire were administered among selected sample. The results were analyzed by ANOVA, chi square, MANOVA, and tukey test. Results: The findings of this research indicated that there was a significant difference on “Early Maladaptive Schema’s domains” between these three groups. Conclusion: The results have important clinical interpretations. It is assumed that medical interference with the aim of modifying and correcting the “Early Maladaptive Schema’s domains” can be effective on the level of success for opiate addicts to give up their addiction.

Reading Strategy Use and Comprehension Performance of More Successful and Less Successful Readers: A Think-Aloud Study

Science.gov (United States)

Wang, Yen-Hui

2016-01-01

This study explores the differences between more successful and less successful EFL readers in their comprehension performance and abilities to use reading strategies in interaction with English texts through thinking aloud while reading in pairs. Ten freshman high school students participated in pairs in four think-aloud reading tasks to think…

Passport to Success

Science.gov (United States)

Tomlinson, Nigel

2002-01-01

Looks at the "Passport to Success" scheme introduced by the Sheffield Chamber of Commerce in a bid to address the employability skills problem among young people. States that the scheme was launched in September 2001 in partnership with a local comprehensive school with the intention of helping pupils make the transition from school into…

A Partial Theory of Executive Succession.

Science.gov (United States)

Thiemann, Francis C.

This study has two purposes: (1) To construct a partial theory of succession, and (2) to utilize a method of theory construction which combines some of the concepts of Hans Zetterberg with the principles of formal symbolic logic. A bibliography on succession in complex organizations with entries on descriptive and empirical studies from various…

Succession planning: a call to action for nurse executives.

Science.gov (United States)

Trepanier, Sylvain; Crenshaw, Jeannette T

2013-10-01

To discuss the organisational benefits of strategic succession planning in acute care hospital settings as a responsibility of chief nurse executives. A formal succession planning process is crucial to the financial and operational viability and sustainability of acute care hospitals. A succession plan is an essential business strategy that promotes effective leadership transition and continuity while maintaining productivity. Nursing and business literature were reviewed; reports contrasting institutions with and without succession plans were examined; and, operational implications were considered. It is imperative that chief nurse executives respond to the business benefits of an effective succession planning programme, identify common barriers and solutions, and implement best practices for a successful strategic succession planning programme. A strategic succession planning programme may offer many benefits to an acute care hospital, including improved retention rates, increased staff engagement and enhanced financial performance. Considering the ageing nursing workforce and the potential increase in demand for nursing services in the near future, nurse executives and other nurse leaders must actively engage in a formal succession planning process. A formal succession planning programme will help to provide strategic leadership continuity, operational effectiveness and improved quality of care. © 2013 John Wiley & Sons Ltd.

The Value of Successful MBSE Adoption

Science.gov (United States)

Parrott, Edith

2016-01-01

The value of successful adoption of Model Based System Engineering (MBSE) practices is hard to quantify. Most engineers and project managers look at the success in terms of cost. But there are other ways to quantify the value of MBSE and the steps necessary to achieve adoption. The Glenn Research Center (GRC) has been doing Model-Based Engineering (design, structural, etc.) for years, but the system engineering side has not. Since 2010, GRC has been moving from documents centric to MBSE/SysML. Project adoption of MBSE has been slow, but is steadily increasing in both MBSE usage and complexity of generated products. Sharing of knowledge of lessons learned in the implementation of MBSE/SysML is key for others who want to be successful. Along with GRC's implementation, NASA is working hard to increase the successful implementation of MBSE across all the other centers by developing guidelines, templates and libraries for projects to utilize. This presentation will provide insight into recent GRC and NASA adoption efforts, lessons learned and best practices.

Understanding the Entrepreneur: An Index of Entrepreneurial Success

OpenAIRE

Fried, Harold O.; Tauer, Loren W.

2009-01-01

A measure of entrepreneur success is important to identify current and future successful ventures, to further our understanding of the entrepreneurial process and to guide public policies to improve the success rate of start-ups. In this paper we propose an index of entrepreneur success that accommodates multiple inputs and outputs, that is predicated on inputs and that mitigates the impact of outliers. We relate the index to characteristics of the entrepreneur and the venture: age, experienc...

A Multidimensional Approach to Succession in Family Firms

DEFF Research Database (Denmark)

Boyd, Britta; Fediuk, Tomasz A.; Botero, Isabel C.

In family firms succession is often defined as the transition of leadership and ownership between a family member and the next generation. Traditionally research on succession in family firms has focused on the family member as they enter the leadership role (i.e., how family firms successfully...... transition to the next generation). From our point of view this is a one-dimensional perspective of succession with a focus on the family or the non-family member that will take over the leadership role. However, we found evidence in Danish family business research that such an approach is restrictive...... in a way that concern for the family is not the only consideration for organizational development in the succession process. Building on conflict management literature, we examine the succession process from a multi-dimensional approach where concern for the family is one dimension, and a second dimension...

Attributions to Success and Failure in English Language Learning: The Effects of Gender, Age and Perceived Success

Science.gov (United States)

Genç, Gülten

2016-01-01

The main purpose of this study is to analyze Turkish tertiary level EFL learners' attributions to success and failure and the effects of gender, age, and perceived success on their attributions. The results indicated that EFL learners respectively attributed interest, ability, task difficulty, effort, luck and the influence of teacher and school…

The phylogenetics of succession can guide restoration

DEFF Research Database (Denmark)

Shooner, Stephanie; Chisholm, Chelsea Lee; Davies, T. Jonathan

2015-01-01

Phylogenetic tools have increasingly been used in community ecology to describe the evolutionary relationships among co-occurring species. In studies of succession, such tools may allow us to identify the evolutionary lineages most suited for particular stages of succession and habitat...... rehabilitation. However, to date, these two applications have been largely separate. Here, we suggest that information on phylogenetic community structure might help to inform community restoration strategies following major disturbance. Our study examined phylogenetic patterns of succession based...... for species sorting along abiotic gradients (slope and aspect) on the mine sites that had been abandoned for the longest. Synthesis and applications. Understanding the trajectory of succession is critical for restoration efforts. Our results suggest that early colonizers represent a phylogenetically random...

ORGANIZATIONAL CULTURE IN THE SUCCESSFUL GLOBAL BUSINESS

OpenAIRE

Eliyana, Anis

2009-01-01

A successful business becomes the goal of each individual who is involved in anorganizational business. The capability of business organization to enter and compete inthe global market is one of those ways often used by businessmen to both maintain andachieve a successful organization. With respect to the said issue, the writer would like toanswer the following subject matter: How to understand the organizational culture inorder to be success in global business? And does the organizational cu...

A Conceptual Exploration of Succession Intent in Family Firms

DEFF Research Database (Denmark)

Boyd, Britta; Botero, Isabel; Fediuk, Tomasz

Succession has been the most studied topic in family firms. The reason for this is that many family firms fail during the transition of leadership and ownership between the current owner/manager and the next generation. Traditionally research on succession has focused on the family member...... as they enter the leadership role (i.e., how a family firm successfully transition to the next generation) or on the different issues that affect the succession process. In this approach there seems to be an underlying assumption that family business owners have the intent to engage in succession efforts. We...... believe that this is not always the case. Thus, we suggest that to better understand the succession process in family firms we first need to understand succession intent and the factors that influence an owner’s intent to pass on the business. This manuscript defines succession intent and provides...

Goodbye Career, Hello Success.

Science.gov (United States)

Komisar, Randy

2000-01-01

Success in today's economy means throwing out the old career rules. The "noncareer" career is driven by passion for the work and has the fluidity and flexibility needed in the contemporary workplace. (JOW)

Nurse manager succession planning: synthesis of the evidence.

Science.gov (United States)

Titzer, Jennifer; Phillips, Tracy; Tooley, Stephanie; Hall, Norma; Shirey, Maria

2013-10-01

The literature supporting nurse manager succession planning is reviewed and synthesised to discover best practice for identifying and developing future nurse managers. Healthcare succession planning practices are lacking. Nurse managers are historically selected based on clinical skills and lack formal leadership preparation. A systematic literature search appraises and summarises the current literature supporting nurse manager succession planning. Multiple reviewers were used to increase the reliability and validity of article selection and analysis. New nurse managers require months to adapt to their positions. Deliberate nurse manager succession planning should be integrated in the organisation's strategic plan and provide a proactive method for identifying and developing potential leaders. Organisations that identify and develop internal human capital can improve role transition, reduce nurse manager turnover rates and decrease replacement costs. Despite the clear benefits of succession planning, studies show that resource allocation for proactive, deliberate development of current and future nurse leaders is lacking. Additionally, systematic evaluation of succession planning is limited. Deliberate succession planning efforts and appropriate resource allocation require strategic planning and evaluation methods. Detailed evaluation methods demonstrating a positive return on investment utilising a cost-benefit analysis and empirical outcomes are necessary. © 2013 John Wiley & Sons Ltd.

Performance success from self-assessments

International Nuclear Information System (INIS)

Hughes, G.

1996-01-01

This paper provides information on and successes of self-assessments completed at the Callaway plant. It stresses the vital needs and substantial benefits from these continual self-improvement efforts. The Callaway plant staff use a variety of methods and techniques to do self-assessments with the focus on performance outcomes. Self-assessments help Callaway focus on the priority issues and direct resources properly. Callaway's success has been due to this learning culture. The Callaway plant is a Westinghouse four-loop plant in the state of Missouri and has been operational since 1984

The Strategic Value of Succession Planning for Department Chairs.

Science.gov (United States)

Rayburn, William; Grigsby, Kevin; Brubaker, Linda

2016-04-01

Most faculty who aspire to be department chairs are unaware of succession processes at their institution. This Commentary highlights the importance of succession planning, emphasizing the general need for transparency. Succession planning provides institutional leaders the opportunity to optimize, renew, and revitalize their organization by ensuring successful leadership transitions. In contrast to leadership pathways in the military, corporate business, and hospital administration, planned succession of medical school department chairs has received little attention. Different approaches to succession planning are essential for emergency and planned transitions. Emergency succession plans should be in place at all times, regularly revisited, and modified as needed. Department chairs should begin considering their planned succession between one and five years after their initial appointment. The succession discussion between a chair and medical school dean requires cautious, thoughtful, and open discussions. Intradepartmental annual faculty performance evaluations permit the chair to mentor potential successors in acquiring future-oriented, institution-based leadership qualities necessary to be considered for a future department chair position. If health and time permit, the successful chair should remain in his or her current position until a successor is named or, preferably, is in place. Appointment of an interim chair as part of succession planning can be useful for on-the-job training of an internal candidate, yet awkwardness might ensue if there is more than one internal candidate.Succession development offers the great advantage of maintaining smooth organizational performance while optimizing talent management and exploring opportunities for transitioning individuals into leadership roles.

Successful aging and the epidemiology of HIV

Directory of Open Access Journals (Sweden)

Vance DE

2011-06-01

Full Text Available David E Vance1, Teena McGuinness1, Karen Musgrove3, Nancy Ann Orel4, Pariya L Fazeli21School of Nursing, 2Department of Psychology and Center for Research in Applied Gerontology, University of Alabama at Birmingham, 3Birmingham AIDS Outreach, Birmingham, AL, USA; 4Gerontology Program, Bowling Green State University, Bowling Green, OH, USAAbstract: By 2015, it is estimated that nearly half of those living with HIV in the US will be 50 years of age and older. This dramatic change in the demographics of this clinical population represents unique challenges for patients, health care providers, and society-at-large. Fortunately, because of highly active antiretroviral therapy (HAART and healthy lifestyle choices, it is now possible for many infected with HIV to age successfully with this disease; however, this depends upon one’s definition of successful aging. It is proposed that successful aging is composed of eight factors: length of life, biological health, cognitive efficiency, mental health, social competence, productivity, personal control, and life satisfaction. Unfortunately, HIV and medication side effects can compromise these factors, thus diminishing one’s capacity to age successfully with this disease. This article explores how HIV, medication side effects from HAART, and lifestyle choices can compromise the factors necessary to age successfully. Implications for practice and research are posited.Keywords: HIV, AIDS, successful aging, spirituality, depression, hardiness

Fertility Clinic Success Rates

Science.gov (United States)

... Defects ART and Autism 2013 Assisted Reproductive Technology Fertility Clinic Success Rates Report Recommend on Facebook Tweet ... Additional Information About ART in the United States. Fertility Clinic Tables Introduction to Fertility Clinic Tables [PDF - ...

Leadership and Project Success in Development Sector

Directory of Open Access Journals (Sweden)

Saghir Ahmed

2017-10-01

Full Text Available Aim/purpose - The study aims to investigate the relationship among the leadership, operational efficiency and project success in general and the impact of transformational leadership and operational efficiency on project success in particular. Design/methodology/approach - Mean comparison from descriptive statistics and multiple linear regression from inferential statistics was used to determine the association between variables and further impact of the transformational leadership and operational efficiency on project success in the development sector. The paper presents the results of a survey conducted among 200 employees from the top, middle & lower management levels of various national & international development organizations working in Pakistan like Microfinance Banks and other Rural Support Programs. Statistical Package for Social Sciences (SPSS was used to process data. Findings - The result shows positive association among transformational leadership, operational efficiency and project success. In addition, it was found that transformational leadership and operational efficiency have a positive and statistically significant impact on the project success. It is concluded that both transformational leadership and operational efficiency are vital to achieving the optimum level of success in any project, especially in the development sector. Research implications/limitations - The integral limitation of the study was the respondents because most of the development organizations have their operations in rural areas where access was difficult because of limited time and resources. In addition, such organizations are always reluctant to provide survey feedback. Originality/value/contribution - The paper contribution is in the theoretical and practical knowledge of the project success factors in the development sector which is still a somehow unexplored area. Regulators of the development sector may be benefited from this study.

Strategic Intent, Confucian Harmony and Firm Success

OpenAIRE

Edward J. Romar

2009-01-01

This paper argues that by using the Confucian concept of harmony as its strategicintent a firm can be both ethical and successful. Using the work of Peter F. Drucker,Michael Porter, and Gary Hamel and C. K. Prahalad the paper discusses the role ofstrategic intent as a contributing factor to firm success. The paper then discusses how theConfucian concept of harmony fulfills the concept of strategic intent and how harmony cancontribute to the development of a successful and ethical organization...

The Influence of Quality on E-Commerce Success: An Empirical Application of the Delone and Mclean IS Success Model

OpenAIRE

Ultan Sharkey; Murray Scott; Thomas Acton

2010-01-01

This research addresses difficulties in measuring e-commerce success by implementing the DeLone and McLean (D&M) model of IS success (1992, 2003) in an e-commerce environment. This research considers the influence of quality on e-commerce success by measuring the information quality and system quality attributes of an e-commerce system and the intention to use, user satisfaction and intention to transact from a sample of respondents. This research provides an empirical e-commerce application ...

Examining the Planning and Management of Principal Succession

Science.gov (United States)

Zepeda, Sally J.; Bengtson, Ed; Parylo, Oksana

2012-01-01

Purpose: The purpose of this study is to examine principal succession planning and management by analyzing current practices of handling school leader succession in four Georgia school systems. Design/methodology/approach: Looking through the lens of organizational leadership succession theory, the practices of school systems as they experienced…

"STEMulating" success factors: An investigation of the academic talents of successful Black male college graduates from STEM programs

Science.gov (United States)

Hendricks, Jill T.

This phenomenological research study explored the contributing factors experienced by Black males that epitomized their academic success in a STEM (Science, Technology, Engineering, and Mathematics) area of study. During this investigative project, eleven Black male students were interviewed to determine how they were able to successfully navigate and complete a STEM degree. The data was collected through a qualitative inquiry, which involved interviewing students and collecting the data and organizing their perspectives into common themes. The principal findings in this study suggest that Black males can excel when primary influential people establish high expectations and believe and encourage Black males to succeed by providing the essential educational support models requisite to warrant success; the Black male maintains and affirms a self-assured self-worth in himself; the Black male is exposed to these fields and professions early on in their educational quest to enable them to witness first hand powerful and productive opportunities and pathways to academic success; exposure to other Black successful male role models who can mentor and show positive proof that with effort, these fields can become a reality; increase in academic motivation and recommendations from educators and counselors who direct and guide students into and away from these rigorous career fields. An analysis of the students' individual stories gave a revealing look into the pathways of their consciousness, emotional growth, and perspectives about being a successful STEM major. This kind of insight can be a constructive diagnostic tool for students, educators, counselors, and administrators who want to motivate and influence future students to major in STEM fields of study.

The value of success: acquiring gains, avoiding losses, and simply being successful.

Directory of Open Access Journals (Sweden)

Samantha M Mowrer

Full Text Available A large network of spatially contiguous, yet anatomically distinct regions in medial frontal cortex is involved in reward processing. Although it is clear these regions play a role in critical aspects of reward-related learning and decision-making, the individual contributions of each component remains unclear. We explored dissociations in reward processing throughout several key regions in the reward system and aimed to clarify the nature of previously observed outcome-related activity in a portion of anterior medial orbitofrontal cortex (mOFC. Specifically, we tested whether activity in anterior mOFC was related to processing successful actions, such that this region would respond similarly to rewards with and without tangible benefits, or whether this region instead encoded only quantifiable outcome values (e.g., money. Participants performed a task where they encountered monetary gains and losses (and non-gains and non-losses during fMRI scanning. Critically, in addition to the outcomes with monetary consequences, the task included trials that provided outcomes without tangible benefits (participants were simply told that they were correct or incorrect. We found that anterior mOFC responded to all successful outcomes regardless of whether they carried tangible benefits (monetary gains and non-losses or not (controls. These results support the hypothesis that anterior mOFC processes rewards in terms of a common currency and is capable of providing reward-based signals for everything we value, whether it be primary or secondary rewards or simply a successful experience without objectively quantifiable benefits.

Successful and unsuccessful psychopaths: a neurobiological model.

Science.gov (United States)

Gao, Yu; Raine, Adrian

2010-01-01

Despite increasing interest in psychopathy research, surprisingly little is known about the etiology of non-incarcerated, successful psychopaths. This review provides an analysis of current knowledge on the similarities and differences between successful and unsuccessful psychopaths derived from five population sources: community samples, individuals from employment agencies, college students, industrial psychopaths, and serial killers. An initial neurobiological model of successful and unsuccessful psychopathy is outlined. It is hypothesized that successful psychopaths have intact or enhanced neurobiological functioning that underlies their normal or even superior cognitive functioning, which in turn helps them to achieve their goals using more covert and nonviolent methods. In contrast, in unsuccessful, caught psychopaths, brain structural and functional impairments together with autonomic nervous system dysfunction are hypothesized to underlie cognitive and emotional deficits and more overt violent offending.

Succession planning for technical experts

International Nuclear Information System (INIS)

Kirk, Bernadette Lugue; Cain, Ronald A.; Dewji, Shaheen A.; Agreda, Carla L.

2017-01-01

This report describes a methodology for identifying, evaluating, and mitigating the loss of key technical skills at nuclear operations facilities. The methodology can be adapted for application within regulatory authorities and research and development organizations, and can be directly applied by international engagement partners of the Department of Energy’s National Nuclear Security Administration (NNSA). The resultant product will be of direct benefit to two types of NNSA missions: (1) domestic human capital development programs tasked to provide focused technical expertise to succeed an aging nuclear operations workforce, and (2) international safeguards programs charged with maintaining operational safeguards for developing/existing nuclear power program in nations where minimal available resources must be used effectively. This report considers succession planning and the critical skills necessary to meet an institution’s goals and mission. Closely tied to succession planning are knowledge management and mentorship. In considering succession planning, critical skill sets are identified and are greatly dependent on the subject matter expert in question. This report also provides examples of critical skills that are job specific.

Succession planning for technical experts

Energy Technology Data Exchange (ETDEWEB)

Kirk, Bernadette Lugue [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Cain, Ronald A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Dewji, Shaheen A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Agreda, Carla L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

2017-07-01

This report describes a methodology for identifying, evaluating, and mitigating the loss of key technical skills at nuclear operations facilities. The methodology can be adapted for application within regulatory authorities and research and development organizations, and can be directly applied by international engagement partners of the Department of Energy’s National Nuclear Security Administration (NNSA). The resultant product will be of direct benefit to two types of NNSA missions: (1) domestic human capital development programs tasked to provide focused technical expertise to succeed an aging nuclear operations workforce, and (2) international safeguards programs charged with maintaining operational safeguards for developing/existing nuclear power program in nations where minimal available resources must be used effectively. This report considers succession planning and the critical skills necessary to meet an institution’s goals and mission. Closely tied to succession planning are knowledge management and mentorship. In considering succession planning, critical skill sets are identified and are greatly dependent on the subject matter expert in question. This report also provides examples of critical skills that are job specific.

Success According to Professionals in the Fashion Industry

Science.gov (United States)

Gerber, Tara; Saiki, Diana

2010-01-01

The purpose of this study was to examine career success perceived by professionals in the fashion industry. Two sets of open-ended interviews were conducted with 33 fashion industry professionals. The interviews were analyzed for success themes using a grounded approach methodology. External definitions of success mentioned were salary,…

Profile of success

DEFF Research Database (Denmark)

Dahlgaard, Jens Jørn; Nørgaard, Anders; Jakobsen, Søren

1998-01-01

What management skills must Europe's business leaders improve to achieve business excellence? Which country's leaders are best placed for success? Does the next generation have what it takes to compete? In the second half of their study of the leadership styles that drive business excellence, Jens...... Dahlgaard, Anders Nørgaard and Søren Jakobsen describe an excellent leadership profile that provides the answers....

Designing for success

Energy Technology Data Exchange (ETDEWEB)

Altounyan, P.; Hurt, K.; Bigby, D. [Rock Mechanics Technology, Stanhope Bretby (United Kingdom)

1999-07-01

Successful underground coal mining is dependent on a number of key factors, particularly geotechnical suitability. The impact of rock mechanics on underground mine design and mining methods is discussed in this article. Methods on minimising stress effects in room and pillar mining, and longwall mining are outlined. The use of computer numerical modelling in mine design is mentioned. 8 figs.

The Effect of Prior Task Success on Older Adults' Memory Performance: Examining the Influence of Different Types of Task Success.

Science.gov (United States)

Geraci, Lisa; Hughes, Matthew L; Miller, Tyler M; De Forrest, Ross L

2016-01-01

Negative aging stereotypes can lead older adults to perform poorly on memory tests. Yet, memory performance can be improved if older adults have a single successful experience on a cognitive test prior to participating in a memory experiment (Geraci & Miller, 2013, Psychology and Aging, 28, 340-345). The current study examined the effects of different types of prior task experience on subsequent memory performance. Before participating in a verbal free recall experiment, older adults in Experiment 1 successfully completed either a verbal or a visual cognitive task or no task. In Experiment 2, they successfully completed either a motor task or no task before participating in the free recall experiment. Results from Experiment 1 showed that relative to control (no prior task), participants who had prior success, either on a verbal or a visual task, had better subsequent recall performance. Experiment 2 showed that prior success on a motor task, however, did not lead to a later memory advantage relative to control. These findings demonstrate that older adults' memory can be improved by a successful prior task experience so long as that experience is in a cognitive domain.

Success and anomy of the corporal

Directory of Open Access Journals (Sweden)

Larisa Viktorovna Efimova

2015-11-01

Full Text Available The success and its anomichny manifestation in modern society becomes object of research of article. The success represents material prosperity and high position of the person in society, but ways of its achievement connected with knowledge, professionalism, working capacity, ability to make decisions and creativity are held back, negatively affecting interpretative practicians of a phenomenon mass consciousness. In the most Russian society the anomichnost of a state in which the dialectic interrelation of its social and individual modes is highlighted is found today. The anomy acts as an indicator of a mismatch of the purposes and standards of life, causing violations traditional, standard правовового, axiological. And individual acts as the most indicative illustration of an anomichnost of the social corporal as a component of modern success. The corporality is located in a discourse sexual today that involves artificial transformations of a body and as a result brings to a body/corporality razjyatiya from the owner. The success anomichnost situation by means of corporal transformations demands revival reflexive, traditional, moral and legal, restrictions manipulative the practician of mass media.

Social Success and Happiness in Korean Higher Education

Science.gov (United States)

Lee, Jeong-Kyu

2017-01-01

This paper discusses the relevance between social success and happiness in Korea from the perspective of Korean higher education. To review this study systematically, three research questions are stated. First of all, what is social success? Second, is social success able to provide happiness for us? Last, what is the relevance between social…

Elementary Schoolchildren's Self- and Social Perceptions of Success

Science.gov (United States)

Määttä, Elina; Mykkänen, Arttu; Järvelä, Sanna

2016-01-01

The purpose of this study was to investigate children's self- and social perceptions of success to identify how success could be promoted in a classroom context. Using a participatory approach, this study explored children's subjective experiences with success in 41 learning situations selected by researchers (Phase 1: self-perceptions) and 48…

Successive Standardization of Rectangular Arrays

Directory of Open Access Journals (Sweden)

Richard A. Olshen

2012-02-01

Full Text Available In this note we illustrate and develop further with mathematics and examples, the work on successive standardization (or normalization that is studied earlier by the same authors in [1] and [2]. Thus, we deal with successive iterations applied to rectangular arrays of numbers, where to avoid technical difficulties an array has at least three rows and at least three columns. Without loss, an iteration begins with operations on columns: first subtract the mean of each column; then divide by its standard deviation. The iteration continues with the same two operations done successively for rows. These four operations applied in sequence completes one iteration. One then iterates again, and again, and again, ... In [1] it was argued that if arrays are made up of real numbers, then the set for which convergence of these successive iterations fails has Lebesgue measure 0. The limiting array has row and column means 0, row and column standard deviations 1. A basic result on convergence given in [1] is true, though the argument in [1] is faulty. The result is stated in the form of a theorem here, and the argument for the theorem is correct. Moreover, many graphics given in [1] suggest that except for a set of entries of any array with Lebesgue measure 0, convergence is very rapid, eventually exponentially fast in the number of iterations. Because we learned this set of rules from Bradley Efron, we call it “Efron’s algorithm”. More importantly, the rapidity of convergence is illustrated by numerical examples.

ACTS – SUCCESS STORY

Indian Academy of Sciences (India)

First page Back Continue Last page Overview Graphics. ACTS – SUCCESS STORY. Totally 103 experiments were conducted and the programme succeeded in the areas. Medicine; Education; Defence; Emergency Response; Maritime and Aeronautical Mobile Communications; Science and Astronomy.

Succession planning : phase II.

Science.gov (United States)

2008-06-01

Succession planning is an organizational investment in the future. Institutional : knowledge is a critical ingredient in the culture of an organization, and its intangible : value becomes significant when an organization is faced with the need to pas...

Dietary patterns as predictors of successful ageing.

Science.gov (United States)

Hodge, A M; O'Dea, K; English, D R; Giles, G G; Flicker, L

2014-03-01

To examine associations between dietary patterns identified by factor analysis, and successful ageing. Prospective cohort study with diet measured in 1990-4, and successful ageing in 2003-7. Ordered logistic regression with outcome determined as dead/usual ageing/successful ageing was used to examine associations with quintile groups of dietary factor scores. Men and women (n=6308), without history of major illness at baseline, and aged >70 years at follow-up, or who had died before follow-up but would have been aged >70 at the commencement of follow-up, from the Melbourne Collaborative Cohort Study. Frequencies of intake of 121 foods at baseline were collected in a food frequency questionnaire. Anthropometry and other health and lifestyle data were collected. At follow-up, questionnaire data relating to mental health, physical function and medical history were used to define successful ageing. Four dietary factors were identified, characterized by higher loadings for (1) vegetables; (2) fruit, (3) feta, legumes, salad, olive oil, and inverse loadings for tea, margarine, cake, sweet biscuits and puddings; (4) meat, white bread, savoury pastry dishes and fried foods. In models excluding body size, the second factor 'Fruit' was positively associated with successful ageing (OR in top 20% vs lowest 20% of score 1.31, 95%CI (1.05-1.63), p trend across quintile groups 0.001); while the fourth factor 'Meat/fatty foods' was inversely associated (OR in top 20% vs lowest 20% of score 0.69, 95%CI (0.55-0.86), p trend across quintile groups 0.001). Factors 1 and 3 did not show significant associations with successful ageing. The association for 'Fruit' was little altered after adjustment for body size, while for 'Meat/fatty foods' the association was somewhat attenuated. A dietary pattern including plenty of fruit while limiting meat and fried foods may improve the likelihood of ageing successfully.

Giant Bilateral Renal Angiomyolipomas and Lymphangioleiomyomatosis Presenting after Two Successive Pregnancies Successfully Treated with Surgery and Rapamycin

Directory of Open Access Journals (Sweden)

Ramón Peces

2011-01-01

Full Text Available We report the case of a 25-year-old woman who presented with abdominal and flank pain with two successive pregnancies and was diagnosed of giant bilateral renal AMLs and pulmonary LAM associated with TSC in the post-partum of her second pregnancy. This case illustrates that in women with TSC rapid growth from renal AMLs and development of LAM may occur with successive pregnancies. It also stresses the potential for preservation of renal function despite successive bilateral renal surgery of giant AMLs. Moreover, the treatment with a low-dose rapamycin may be an option for LAM treatment. Finally, a low-dose rapamycin may be considered as an adjuvant treatment together to kidney-sparing conservative surgery for renal AMLs.

Health information systems: failure, success and improvisation.

Science.gov (United States)

Heeks, Richard

2006-02-01

The generalised assumption of health information systems (HIS) success is questioned by a few commentators in the medical informatics field. They point to widespread HIS failure. The purpose of this paper was therefore to develop a better conceptual foundation for, and practical guidance on, health information systems failure (and success). Literature and case analysis plus pilot testing of developed model. Defining HIS failure and success is complex, and the current evidence base on HIS success and failure rates was found to be weak. Nonetheless, the best current estimate is that HIS failure is an important problem. The paper therefore derives and explains the "design-reality gap" conceptual model. This is shown to be robust in explaining multiple cases of HIS success and failure, yet provides a contingency that encompasses the differences which exist in different HIS contexts. The design-reality gap model is piloted to demonstrate its value as a tool for risk assessment and mitigation on HIS projects. It also throws into question traditional, structured development methodologies, highlighting the importance of emergent change and improvisation in HIS. The design-reality gap model can be used to address the problem of HIS failure, both as a post hoc evaluative tool and as a pre hoc risk assessment and mitigation tool. It also validates a set of methods, techniques, roles and competencies needed to support the dynamic improvisations that are found to underpin cases of HIS success.

RELATION CONATIVE CHARACSTERISTICS AND SUCCESS IN GYMNASTICS

Directory of Open Access Journals (Sweden)

Katarina Herodek

2013-07-01

Full Text Available The young gymnasts from seven cities in the Republic of Serbia at the age of 8-12 years was covered with programmed gymnastic training 3-4 times a week for 90 minutes and the system of competition within the "C" program GSS. The case studies are examined relationships conative characteristics modified by Catel 16PF questionnaire with success in gymnastics, which is estimated to success in the competition in the "C" program of the Gymnastics Federation of Serbia. Using canonical correlation analysis of the data show that in the space of conative characteristics examined were found to be factors I-sensitivity-sharp temper, H- fearlessness and Q1- openness to change. Success in gymnastics was defined positive relations with disciplines Rings (.77, Pommel horse and Bar (.73 and Vault (.63. The hypothesis that says "conative characteristics have a positive relationship with success in gymnastics" can not be accepted because there is a statistically positive relationship that is explained with 83%. Young gymnasts who show a sharp temper and willingness to learn new cause the contents with strong courage, can successfully realizes "C" program GS Serbia in gymnastics.

Critical success factors in information technology projects

Directory of Open Access Journals (Sweden)

Ayesha

2017-02-01

Full Text Available The purpose of this study is to determine the critical success factors (CSF of IT projects in Pa-kistan. The identified factors cannot only be functional to exact type IT projects but also to all types of IT projects, their success directly affects the achievement of whole organization. The proposed study of this paper has determined 15 factors influencing the most on the success of IT projects through multiple regression analysis. The survey has disclosed that many CSFs were found related to IT projects but these 15 factors are also the backbone of IT projects. The re-search results obtained clearly indicated that the Leadership Qualities played a significant role in obtaining Top Management support in order to access to resources however, the Leadership Qualities did not play any role on the trained and capable Project Team Members. Besides, it is undoubtedly defined effective communication of the project was established to be influential on the conclusion and contributing factor towards the Success of IT projects in Pakistan. Top Man-agement Support as a whole was not found to play a key role in the IT Project Success.

Evaluating the Success of Peace Operations | Garb | Scientia ...

African Journals Online (AJOL)

Questioning and investigating the success of peace operations is not a new research activity. However, there are still many open questions, because the surveys do not show the same results. One of the crucial points in the analysis of the success of peace operations is a definition of such success. In this article, firstly, ...

Soil invertebrate fauna enhances grassland succession and diversity.

Science.gov (United States)

De Deyn, Gerlinde B; Raaijmakers, Ciska E; Zoomer, H Rik; Berg, Matty P; de Ruiter, Peter C; Verhoef, Herman A; Bezemer, T Martijn; van der Putten, Wim H

2003-04-17

One of the most important areas in ecology is to elucidate the factors that drive succession in ecosystems and thus influence the diversity of species in natural vegetation. Significant mechanisms in this process are known to be resource limitation and the effects of aboveground vertebrate herbivores. More recently, symbiotic and pathogenic soil microbes have been shown to exert a profound effect on the composition of vegetation and changes therein. However, the influence of invertebrate soil fauna on succession has so far received little attention. Here we report that invertebrate soil fauna might enhance both secondary succession and local plant species diversity. Soil fauna from a series of secondary grassland succession stages selectively suppress early successional dominant plant species, thereby enhancing the relative abundance of subordinate species and also that of species from later succession stages. Soil fauna from the mid-succession stage had the strongest effect. Our results clearly show that soil fauna strongly affects the composition of natural vegetation and we suggest that this knowledge might improve the restoration and conservation of plant species diversity.

Comparative effectiveness of the methods adenoidectomy in cнildren with exudative otitis media

Directory of Open Access Journals (Sweden)

Gusakov A.

2016-03-01

Full Text Available Actuality: A thorough sanation of the nasopharynx is essential for successful treatment of the exudative otitis media (EOM. The literature describes in detail the state of the nasopharynx after different types of adenoidectomy. The classifications of the location of the remnants of lymphoid tissue and the extent of scarring in the nasopharynx are given.The subject of this work is to trace the relationship of postoperative nasopharyngeal changes with recurrent EOM. Objective: To study the immediate and long-term results of different methods of surgical treatment of hypertrophy of the nasopharyngeal lymphoid tissue in children with exudative otitis media. Materials and Methods: This paper presents information on the results of treatment of 62 children of 5–7 years suffering from exudative otitis media. Observations were carried out in two groups of patients. The first group included 28 children previously undergone adenoidectomy, with the signs of recurrent exudative otitis. The second group included 34 children with exudative otitis previously untreated surgically. The task of the investigation is to study the effectiveness of endonasal and extranasal methods of surgical removal of nasopharengeal lymphoid tissue with a minimum probability of scar obliteration of the mouth of the Eustachian tube. Results and discussion: The priority method in nasopharengeal surgery in children is extranasal access with shaver technology in conjunction with cold plasma surgery. The using of these methods gives a clear visualization of the operating field under conditions of moderately bleeding wound. On the other hand, endonasal approach is associated with traumatization of the nasal mucosa with incomplete volume visualization of the surgical field. This combination can result in a longer healing of the surgical wound, the formation of adhesions of the nasal cavity and scarring in the nasopharynx. Complete visualization of the operating field significantly

Investigation on the Success of Peasant Entrepreneurs

Science.gov (United States)

Li, Guohao; Wu, Bing; Bai, Guanglin

Peasant entrepreneurs are one important force to promote the development of new rural construction, so it has practical significance to study success factors of peasant entrepreneurs. 40 cases involving peasant entrepreneurs are studied through content analysis method and the results show that: (1) Making good use of existing resources in rural areas is a key factor for peasant entrepreneurs; (2) hard work, strong willness, tactics and courage, social responsibility are four most important success factors; (3) 23 items of success factor can be summarized into three categorized, personality traits, abilities, and behavior characteristics.

Succession status on mountain farms in Slovenia

Directory of Open Access Journals (Sweden)

Boštjan Kerbler-Kefo

2008-12-01

Full Text Available This paper is based on the hypothesis that the offi cial statistical data does not refl ect actual succession status on mountain farms in Slovenia and also on Slovene farms in general, since the census criteria defi ning succession are still incomplete. With the purpose of confi rming our assumption, we formulated more accurate criteria and also determined as to what is the real status of succession on mountain farms in Slovenia. It has proved to be more favourable, than it is presented by the offi cial statistics.

Successes and Challenges of Emerging Economy Multinationals

DEFF Research Database (Denmark)

Successes and Challenges of Emerging Economy Multinationals investigates a broad variety of cases presenting clear evidence of fast successful internationalization of emerging economy multinationals originating not only from big economic players such as China, India and Russia but also from other...... successfully internationalizing emerging countries, namely South Africa and Poland. In terms of size, the firms vary from huge multinational firms such as Huawei, Tata and Gazprom, to really small high technology firms. The in-depth analysis conducted in this book leads to the indication of numerous novel...

Knowledge Transfer in Family Business Successions

DEFF Research Database (Denmark)

Boyd, Britta; Royer, Susanne; Pei, Rong

Knowledge often is the fundament for strategic competitive advantage. Thus, it is highly relevant to understand better how knowledge is transferred from one generation to the next in family businesses. Building on the contingency model of family business succession (Royer, Simons, Boyd & Rafferty......, 2008) knowledge transfer in different cultures is investigated in this paper. From a resource-oriented perspective two family businesses with a similar industry background from China and Europe are compared regarding education processes and knowledge transfer in the context of family firm succession...... taking into account the respective transaction atmosphere. For the European family business from the Danish-German border region twelve successions were investigated in a former study: Access to experiential knowledge was found to be a driver of competitive advantage with a shift towards the relevance...

Modeling student success in engineering education

Science.gov (United States)

Jin, Qu

In order for the United States to maintain its global competitiveness, the long-term success of our engineering students in specific courses, programs, and colleges is now, more than ever, an extremely high priority. Numerous studies have focused on factors that impact student success, namely academic performance, retention, and/or graduation. However, there are only a limited number of works that have systematically developed models to investigate important factors and to predict student success in engineering. Therefore, this research presents three separate but highly connected investigations to address this gap. The first investigation involves explaining and predicting engineering students' success in Calculus I courses using statistical models. The participants were more than 4000 first-year engineering students (cohort years 2004 - 2008) who enrolled in Calculus I courses during the first semester in a large Midwestern university. Predictions from statistical models were proposed to be used to place engineering students into calculus courses. The success rates were improved by 12% in Calculus IA using predictions from models developed over traditional placement method. The results showed that these statistical models provided a more accurate calculus placement method than traditional placement methods and help improve success rates in those courses. In the second investigation, multi-outcome and single-outcome neural network models were designed to understand and to predict first-year retention and first-year GPA of engineering students. The participants were more than 3000 first year engineering students (cohort years 2004 - 2005) enrolled in a large Midwestern university. The independent variables include both high school academic performance factors and affective factors measured prior to entry. The prediction performances of the multi-outcome and single-outcome models were comparable. The ability to predict cumulative GPA at the end of an engineering

Definition of successful defibrillation

NARCIS (Netherlands)

Koster, Rudolph W.; Walker, Robert G.; van Alem, Anouk P.

2006-01-01

OBJECTIVES: The definition of defibrillation shock "success" endorsed by the International Liaison Committee on Resuscitation since the publication of Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiac Care has been removal of ventricular fibrillation at 5 secs after shock

Model of key success factors for Business Intelligence implementation

Directory of Open Access Journals (Sweden)

Peter Mesaros

2016-07-01

Full Text Available New progressive technologies recorded growth in every area. Information-communication technologies facilitate the exchange of information and it facilitates management of everyday activities in enterprises. Specific modules (such as Business Intelligence facilitate decision-making. Several studies have demonstrated the positive impact of Business Intelligence to decision-making. The first step is to put in place the enterprise. The implementation process is influenced by many factors. This article discusses the issue of key success factors affecting to successful implementation of Business Intelligence. The article describes the key success factors for successful implementation and use of Business Intelligence based on multiple studies. The main objective of this study is to verify the effects and dependence of selected factors and proposes a model of key success factors for successful implementation of Business Intelligence. Key success factors and the proposed model are studied in Slovak enterprises.

Successful online learning the five Ps

OpenAIRE

Jim FLOOD

2004-01-01

Successful online learning the five Ps Jim FLOOD E-learning Consultant-UK Key learning points An important aspect of design for online learning is visual ergonomics. Learning theories offer poor predictive power in terms of how learners work and learn. Success at learning is closely related to emotional engagementand learning designers tend to ignore this aspect. Online learning poses a challenging experience for learnersand they need support t...

Creating a culture for information systems success

CERN Document Server

Belkhamza, Zakariya

2015-01-01

It has been widely reported that issues related to organizational context appear frequently in discussions of information systems success. The statement that the information system did not fit the behavioral context in an organization is often part of the explanation of why particular information system encountered unanticipated resistance and never met expectation. While this context has been intensively studied, we still lack evidence on how this organizational context is affecting the success of information system from a managerial action perspective. This type of managerial involvement is often neglected to the extent that it became an essential obstacle to organizational performance. The objective of Creating a Culture for Information Systems Success is to assist CIOs and IT managers on how to use their managerial actions to create a suitable cultural environment in the organization, which leads to a successful implementation of information systems. This  book will also provide guidelines fo...

Prerequisites for successful nuclear generation in southern Africa

International Nuclear Information System (INIS)

Semark, P.

1990-01-01

The prerequisites and the requisites for successful nuclear powered electricity generation in southern Africa are explored. There are four elements essential to success, namely, the mission or vision; the appropriate means; the right and sufficient time, and the skilled, committed executor. The ongoing success of nuclear powered electricity generation in South Africa is discussed in the light of these four elements. 2 ills

The relationship between negotiations success and leadership style

OpenAIRE

2011-01-01

D.Phil. Both leadership and negotiations constitute key success factors for organisations. Previous studies on leadership suggest that leadership effectiveness differentiates successful organisations from others. Equally, negotiations success constitutes a key distinguishing factor separating developed countries from the developing and the under-developed ones. A perusal of available literature and previous research on leadership and negotiations reveals a historical tendency by writers an...

Galectin-3, osteopontin and successful aging.

Science.gov (United States)

Sanchis-Gomar, Fabian; Santos-Lozano, Alejandro; Pareja-Galeano, Helios; Garatachea, Nuria; Alis, Rafael; Fiuza-Luces, Carmen; Morán, María; Emanuele, Enzo; Lucia, Alejandro

2016-05-01

Individuals who reach exceptional longevity (100+ years of age) free of common chronic age diseases (i.e. 'dodgers') arguably represent the paradigm of successful aging in humans. As such, identification of potential biomarkers associated with this phenomenon is of medical interest. We measured serum levels of galectin-3 and osteopontin, both of which have been shown to be linked with major chronic or aging-related disorders in younger populations, in centenarian 'dodgers' (n=81; 40 men; 100-104 years) and healthy controls (n=41; 24 men, 70-80 years). Both biomarkers showed significantly lower values (p<0.001) in the former (galectin-3: 2.4±1.7 vs. 4.8±2.8 ng/mL; osteopontin: 38.1±27.7 vs. 72.6±33.1 μg/mL). Logistic regression analysis identified the combination of these two biomarkers as a significant predictor variable associated with successful aging regardless of sex (p<0.001). The area under the curve (AUC) classified the ability of galectin-3 and osteopontin to predict the likelihood of successful aging as 'fair' (AUC=0.75) and 'good' (AUC=0.80), respectively. Particularly, the combination of the two biomarkers showed good discriminatory power for successful aging (AUC=0.86), with sensitivity=83% and specificity=74%. Lower levels of both galectin-3 and osteopontin are associated with successful aging, representing potential biomarkers of this condition. Our cross-sectional data must be however approached with caution. Further research is necessary to replicate the present preliminary results in other cohorts and to identify the potential use of galectin-3 and osteopontin as potential targets (or at least predictors) in future personalized anti-aging therapies.

Surgical treatment for obesity: ensuring success.

Science.gov (United States)

Andris, Deborah A

2005-01-01

In the United States, obesity has reached epidemic proportions. Serious medical complications, impaired quality of life, and premature mortality are all associated with obesity. Medical conditions such as type 2 diabetes mellitus, hypertension, hyperlipidemia, or sleep apnea can improve or be cured with weight loss. Medical treatment programs focused on diet, behavior modification, and/or pharmacologic intervention have met with limited long-term success. Although surgical treatments for obesity have become popular in recent years, they should only be used as a last resort for weight loss. Not all patients can be considered appropriate candidates for surgery; therefore, guidelines based on criteria from the National Institutes of Health should be used preoperatively to help identify suitable persons. Most individuals who opt for weight-loss surgery have usually struggled for many years with losing weight and keeping it off, but surgery alone will not ensure successful weight loss. Patient education is imperative for long-term success. Moreover, any such educational regimen should include information on diet, vitamin and mineral supplementation, and lifestyle changes, as well as expected weight-loss results and improvements in comorbid conditions. Patients must be willing to commit to a long-term follow-up program intended to promote successful weight loss and weight maintenance and to prevent metabolic and nutritional complications.

Potential success factors in brand development

DEFF Research Database (Denmark)

Esbjerg, Lars; Grunert, Klaus G.; Poulsen, Carsten Stig

2005-01-01

to the marketing of the brand." The branding literature mentions many important aspects, factors, issues, brand requirements, steps, building blocks or guidelines for building strong brands. However, these are all quite general and abstract. Given the substantial body of literature on branding, surprisingly few......? This is the question we want to answer. More specifically, we want to identify potential success factors in building strong brands, understood as brands with high consumer-based brand equity. Keller (1993, p. 2) defined customer-based brand equity as "the differential effect of brand knowledge on consumer response...... of this paper is to identify potential success factors in developing strong brands and to test whether these factors can be used to discriminate between strong and weak brands. It does so through a review of the literature for potential success factors. Furthermore, to ensure that important factors have...

Factors favorable to public participation success

International Nuclear Information System (INIS)

Peelle, E.; Schweitzer, M.; Munro, J.; Carnes, S.; Wolfe, A.

1996-01-01

Categories of factors linked to successful public participation (PP) program outcomes include PP process, organizational context, sociopolitical context, strategic considerations and unique (special circumstances) factors. We re-order the long list factors according to how essential, important, and unique they are and discuss their significance and interrelationships. It is argued that bureacratic structure and operational modes are basically in conflict with features of successful PP programs (openness, two-way education, communication with nonexpert outsiders). If this is so, then it is not surprising that the factors essential for PP success in bureacracies involve extraordinary management efforts by agencies to bypass, compensate for, or overcome structural constraints. We conclude by speculating about the long-term viability of PP practices in the agency setting as well as the consequences for agencies that attempt the problematic task of introducing PP into their complex, mission-oriented organizations

Factors favorable to public participation success

Energy Technology Data Exchange (ETDEWEB)

Peelle, E.; Schweitzer, M.; Munro, J.; Carnes, S.; Wolfe, A.

1996-05-01

Categories of factors linked to successful public participation (PP) program outcomes include PP process, organizational context, sociopolitical context, strategic considerations and unique (special circumstances) factors. We re-order the long list factors according to how essential, important, and unique they are and discuss their significance and interrelationships. It is argued that bureacratic structure and operational modes are basically in conflict with features of successful PP programs (openness, two-way education, communication with nonexpert outsiders). If this is so, then it is not surprising that the factors essential for PP success in bureacracies involve extraordinary management efforts by agencies to bypass, compensate for, or overcome structural constraints. We conclude by speculating about the long-term viability of PP practices in the agency setting as well as the consequences for agencies that attempt the problematic task of introducing PP into their complex, mission-oriented organizations.

Functional roles affect diversity-succession relationships for boreal beetles.

Directory of Open Access Journals (Sweden)

Heloise Gibb

Full Text Available Species diversity commonly increases with succession and this relationship is an important justification for conserving large areas of old-growth habitats. However, species with different ecological roles respond differently to succession. We examined the relationship between a range of diversity measures and time since disturbance for boreal forest beetles collected over a 285 year forest chronosequence. We compared responses of "functional" groups related to threat status, dependence on dead wood habitats, diet and the type of trap in which they were collected (indicative of the breadth of ecologies of species. We examined fits of commonly used rank-abundance models for each age class and traditional and derived diversity indices. Rank abundance distributions were closest to the Zipf-Mandelbrot distribution, suggesting little role for competition in structuring most assemblages. Diversity measures for most functional groups increased with succession, but differences in slopes were common. Evenness declined with succession; more so for red-listed species than common species. Saproxylic species increased in diversity with succession while non-saproxylic species did not. Slopes for fungivores were steeper than other diet groups, while detritivores were not strongly affected by succession. Species trapped using emergence traps (log specialists responded more weakly to succession than those trapped using flight intercept traps (representing a broader set of ecologies. Species associated with microhabitats that accumulate with succession (fungi and dead wood thus showed the strongest diversity responses to succession. These clear differences between functional group responses to forest succession should be considered in planning landscapes for optimum conservation value, particularly functional resilience.

Strategies for successful software development risk management

Directory of Open Access Journals (Sweden)

Marija Boban

2003-01-01

Full Text Available Nowadays, software is becoming a major part of enterprise business. Software development is activity connected with advanced technology and high level of knowledge. Risks on software development projects must be successfully mitigated to produce successful software systems. Lack of a defined approach to risk management is one of the common causes for project failures. To improve project chances for success, this work investigates common risk impact areas to perceive a foundation that can be used to define a common approach to software risk management. Based on typical risk impact areas on software development projects, we propose three risk management strategies suitable for a broad area of enterprises and software development projects with different amounts of connected risks. Proposed strategies define activities that should be performed for successful risk management, the one that will enable software development projects to perceive risks as soon as possible and to solve problems connected with risk materialization. We also propose a risk-based approach to software development planning and risk management as attempts to address and retire the highest impact risks as early as possible in the development process. Proposed strategies should improve risk management on software development projects and help create a successful software solution.

Five Strategies of Successful Part-Time Work.

Science.gov (United States)

Corwin, Vivien; Lawrence, Thomas B.; Frost, Peter J.

2001-01-01

Identifies commonalities in the approaches of successful part-time professionals. Discusses five strategies for success: (1) communicating work-life priorities and schedules to the organization; (2) making the business case for part-time arrangements; (3) establishing time management routines; (4) cultivating advocates in senior management; and…

Determinants of distribution, abundance and reproductive success ...

African Journals Online (AJOL)

... while local vegetation structure determines the abundance of locally established populations. The abundance of trees affects nest site availability and breeding success, based on observations at two oases. Blackbird nests were usually situated on pomegranate trees and olive trees. The Common Blackbird is a successful ...

CRITICAL SUCCESS FACTORS FOR INFRASTRUCTURE EUROPEAN FUNDED PROJECTS

Directory of Open Access Journals (Sweden)

Sebastian-Ion Ceptureanu

2016-07-01

Full Text Available Absorption of European funds is on top of Romania’s public agenda for the last years although the first programming period has ended and the necessary lessons were learned so far. To have a high degree of absorption of funds provided by the EU must be of quality projects and their implementation to be successful. Through this work we aimed to investigate the success factors of infrastructure projects with European funding in Romania, Bulgaria, Moldova, Ukraine, Serbia and Kosovo, and identify critical success factors of these projects through a research surveying the teams of consultants and support personnel from the countries in an international consulting company. The research results are therefore constitute the empirical evidence of what constitutes critical success factors of infrastructure projects financed by the European Union and can be used as a starting point for scientific studies of the management of European projects or other actions that investigates measures that can be taken to improve the success rate of projects implemented in the area mentioned above.One of the contributions of this paper is to identify the critical success factors of success factors present in literature. With more so as they are critical success factors of infrastructure projects with European funding still required field studies and analysis performed in the present context. In addition, the critical factors were operationalized in a conceptual framework. Moreover, this framework includes leadership style of project manager as critical success factor has been identified in the research as the most important in the context in which it was conducted. As such, this paper demonstrates, with the necessary limitations, the importance of management style of project managers in the context of specific European funded infrastructure projects. And this is happening even though there are sophisticated project management tools availabe and relevant knowledge exists

Understory succession in post-agricultural oak plantations

DEFF Research Database (Denmark)

Brunet, Jörg; Valtinat, Karin; Mayr, Marian Lajos

2011-01-01

The herbaceous understory forms the richest stratum in temperate broadleaved forests in terms of plant diversity. Understanding the process of understory succession is thus of critical importance for the development of management guidelines for biodiversity restoration in post-agricultural planta......The herbaceous understory forms the richest stratum in temperate broadleaved forests in terms of plant diversity. Understanding the process of understory succession is thus of critical importance for the development of management guidelines for biodiversity restoration in post...... forested stands, which maintained differences in species composition. The development of a shrub layer seemed to imply a competitive advantage for forest specialists compared to generalist species. For successful recovery of a rich understory, we suggest that post-arable plantations should be established......, and woody species. The group of forest specialists may approach the richness of continuously forested sites after 60-80 years in non-fragmented plantations, but many forest species were sensitive to habitat fragmentation. Open-land species richness decreased during succession, while the richness of woody...

Mechanisms of herbaceous vegetation restoration successions

Science.gov (United States)

Pankratova, Lubov

2017-04-01

The vegetation dynamics study is an important sector of research in phytocenology. The changing vegetation mechanisms' studying with the purpose of forecasting and management processes is an urgent theoretical and practical task. We consider succession as successive series of composition changes and phytocenoses structure caused by internal reasons and external ones. In this case, we are dealing with natural, secondary and progressive successions. The rapid sequential change of associations aimed at restoring coenotic environment and not resulting in ecogenesis stage changes is called demattia. Fully restored coenotic environment corresponds to vegetation sublimation. The way to this most stable state goes via a number of derived associations, each of them can be seen as long phytocenotic sustainable phenomenon, but different in time. The ability of living beings to reproduce in one way or another, their spreading, filling the space and confrontation to adverse conditions presents an important preservation mechanism and biodiversity increase, as well as its sustainability. The bio-diversity indicator is very significant for stability maintainment and phytocenosis estimation. Succession mechanisms classification provides three categories of relationships between organisms in the successional series: model relief or stimulation corresponds to the phase of endoecological succession which means that early settlers in their activities change the environment, making it available for the next wave of colonists. The model of tolerance manifests itself in the form of competitive relationships, resulting in selection of more competitive species with a pronounced feature S. According to the inhibition model, all types of community are able to colonize open spaces, they are resistant to competitors invasion, but the later species are able to inhabit and increase their number only after the loss of any of the predecessors. The predecessors change environment settings making it

Predicting Commissary Store Success

Science.gov (United States)

2014-12-01

stores or if it is possible to predict that success. Multiple studies of private commercial grocery consumer preferences , habits and demographics have...appropriate number of competitors due to the nature of international cultures and consumer preferences . 2. Missing Data Four of the remaining stores

Beyond Success and Failure

NARCIS (Netherlands)

Etalle, Sandro; Jaffar, Joxan; van Raamsdonk, Femke

We study a new programming framework based on logic programming where success and failure are replaced by predicates for adequacy and inadequacy. Adequacy allows to extract a result from a partial computation, and inadequacy allows to flexibly constrain the search space. In this parameterized

Characteristics of Successful Entrepreneurs.

Science.gov (United States)

McClelland, David C.

1987-01-01

Comparison of characteristics of 12 average and 12 superior small business people in three developing nations (India, Malawi, and Ecuador) found proactive qualities such as initiative and assertiveness, achievement orientation, and commitment to others characteristic of successful entrepreneurs. Other expected qualities (self-confidence,…

Intubation Success in Critical Care Transport: A Multicenter Study.

Science.gov (United States)

Reichert, Ryan J; Gothard, Megan; Gothard, M David; Schwartz, Hamilton P; Bigham, Michael T

2018-02-21

Tracheal intubation (TI) is a lifesaving critical care skill. Failed TI attempts, however, can harm patients. Critical care transport (CCT) teams function as the first point of critical care contact for patients being transported to tertiary medical centers for specialized surgical, medical, and trauma care. The Ground and Air Medical qUality in Transport (GAMUT) Quality Improvement Collaborative uses a quality metric database to track CCT quality metric performance, including TI. We sought to describe TI among GAMUT participants with the hypothesis that CCT would perform better than other prehospital TI reports and similarly to hospital TI success. The GAMUT Database is a global, voluntary database for tracking consensus quality metric performance among CCT programs performing neonatal, pediatric, and adult transports. The TI-specific quality metrics are "first attempt TI success" and "definitive airway sans hypoxia/hypotension on first attempt (DASH-1A)." The 2015 GAMUT Database was queried and analysis included patient age, program type, and intubation success rate. Analysis included simple statistics and Pearson chi-square with Bonferroni-adjusted post hoc z tests (significance = p success was lowest in neonates (59.3%, 617 attempts), better in pediatrics (81.7%, 519 attempts), and best in adults (87%, 2900 attempts), p success versus pediatric- and neonatal-focused teams (86.9% vs. 63.5%, p success (86.5% vs. 75.3%, p success are higher in adult patients and adult-focused CCT teams. TI success rates are higher in CCT than other prehospital settings, but lower than in-hospital success TI rates. Identifying factors influencing TI success among high performers should influence best practice strategies for TI.

Subintimal angioplasty: predictors of long-term success.

LENUS (Irish Health Repository)

Keeling, Aoife N

2009-08-01

To determine the clinical outcomes and success rates after percutaneous subintimal angioplasty (SIA) in patients with lower-limb occlusive lesions causing intermittent claudication (IC) or critical limb ischemia (CLI) at midterm to long-term follow-up. The secondary aim was to elicit factors predictive of a successful outcome.

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

Factors predicting labor induction success: a critical analysis.

Science.gov (United States)

Crane, Joan M G

2006-09-01

Because of the risk of failed induction of labor, a variety of maternal and fetal factors as well as screening tests have been suggested to predict labor induction success. Certain characteristics of the woman (including parity, age, weight, height and body mass index), and of the fetus (including birth weight and gestational age) are associated with the success of labor induction; with parous, young women who are taller and lower weight having a higher rate of induction success. Fetuses with a lower birth weight or increased gestational age are also associated with increased induction success. The condition of the cervix at the start of induction is an important predictor, with the modified Bishop score being a widely used scoring system. The most important element of the Bishop score is dilatation. Other predictors, including transvaginal ultrasound (TVUS) and biochemical markers [including fetal fibronectin (fFN)] have been suggested. Meta-analyses of studies identified from MEDLINE, PubMed, and EMBASE and published from 1990 to October 2005 were performed evaluating the use of TVUS and fFN in predicting labor induction success in women at term with singleton gestations. Both TVUS and Bishop score predicted successful induction [likelihood ratio (LR)=1.82, 95% confidence interval (CI)=1.51-2.20 and LR=2.10, 95%CI=1.67-2.64, respectively]. As well, fFN and Bishop score predicted successful induction (LR=1.49, 95%CI=1.20-1.85, and LR=2.62, 95%CI=1.88-3.64, respectively). Although TVUS and fFN predicted successful labor induction, neither has been shown to be superior to Bishop score. Further research is needed to evaluate these potential predictors and insulin-like growth factor binding protein-1 (IGFBP-1), another potential biochemical marker.

Demystifying the institutional repository for success

CERN Document Server

Buehler, Marianne

2013-01-01

Institutional repositories remain key to data storage on campus, fulfilling the academic needs of various stakeholders. Demystifying the Institutional Repository for Success is a practical guide to creating and sustaining an institutional repository through marketing, partnering, and understanding the academic needs of all stakeholders on campus. This title is divided into seven chapters, covering: traditional scholarly communication and open access publishing; the academic shift towards open access; what the successful institutional repository looks like; institutional repository collaboratio

Keys to the success of the CB Conquero

Directory of Open Access Journals (Sweden)

C. Fernández-Espínola

2016-12-01

Full Text Available When a team gets sport successes to level profesional, generates the topics that will be investigated such as the key factors of the succes. The main aim of this study is to analyze the influencie of different factors like the sports context, the social context and training aspects in the success of the Club Baloncesto Conquero through direct perception of thirteen informants associated with the team and the basketball in Huelva. An interview was carried out, related with those factors and the keys to success. The results revealed that workforce planning along the great work of coaching staff, medical staff and physical trainer have been key to the team gets sport successes.

SUPERCOLLIDER: String test success

International Nuclear Information System (INIS)

Anon.

1992-01-01

On 14 August at the Superconducting Supercollider (SSC) Laboratory in Ellis County, Texas, the Accelerator Systems String Test (ASST) successfully met its objective by operating a half-cell of five collider dipole magnets, one quadrupole magnet, and two spool pieces at the design current of 6500 amperes

Circuit with a successive approximation analog to digital converter

NARCIS (Netherlands)

Louwsma, S.M.; Vertregt, Maarten

2011-01-01

During successive approximation analog to digital conversion a series of successive digital reference values is selected that converges towards a digital representation of an analog input signal. An analog reference signal is generated dependent on the successive digital reference values and

Circuit with a successive approximation analog to digital converter

NARCIS (Netherlands)

Louwsma, S.M.; Vertregt, Maarten

2010-01-01

During successive approximation analog to digital conversion a series of successive digital reference values is selected that converges towards a digital representation of an analog input signal. An analog reference signal is generated dependent on the successive digital reference values and

Association of postoperative nausea/vomiting and pain with breastfeeding success

Directory of Open Access Journals (Sweden)

Ramon Abola

2017-11-01

Full Text Available Abstract Background Successful breastfeeding is a goal set forth by the World Health Organization to improve neonatal care. Increasingly, patients express the desire to breastfeed, and clinicians should facilitate successful breastfeeding. The primary aim of this study is to determine if postoperative nausea and vomiting (PONV or postoperative pain are associated with decreased breastfeeding success after cesarean delivery. Methods This is a historical cohort study using the Stony Brook Elective Cesarean Delivery Database. Self-reported breastfeeding success at 4 weeks postoperative was analyzed for associations with postoperative antiemetic use and postoperative pain scores. Breastfeeding success was also analyzed for associations with patient factors and anesthetic medications. Results Overall, 86% of patients (n = 81 who intended on breastfeeding reported breastfeeding success. Breastfeeding success was not associated with postoperative nausea or vomiting as measured by post anesthesia care unit antiemetic use (15% use in successful vs. 18% use in unsuccessful, p = 0.67 or 48-h antiemetic use (28% use in successful group vs 36% use in unsuccessful group, p = 0.732. Pain visual analog scale scores at 6, 12 and 24 h postoperatively were not significantly different between patients with or without breastfeeding success. Breastfeeding success was associated with having had at least 1 previous child (86% vs 36%, p < 0.001. Patients with asthma were less likely to have breastfeeding success (45% vs 4%, p = 0.002. Conclusions Efforts to improve PONV and pain after cesarean delivery may not be effective in improving breastfeeding success. To possibly improve breastfeeding rates, resources should be directed toward patients with no previous children and patients with asthma.

[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.

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

Rock Sparrow Song Reflects Male Age and Reproductive Success

DEFF Research Database (Denmark)

Nemeth, Erwin; Kempenaers, Bart; Matessi, Giuliano

2012-01-01

The evolution of mating signals is closely linked to sexual selection. Acoustic ornaments are often used as secondary sexual traits that signal the quality of the signaller. Here we show that song performance reflects age and reproductive success in the rock sparrow (Petronia petronia...... nests. Older males could be distinguished from yearlings by singing at lower rate and higher amplitudes. Our findings suggest that song rate may be used as a signal of age and together with song pitch as a signal of reproductive success in this species. Alternatively, younger and less successful males...... success. Males with higher breeding success sang at a lower rate and with a higher maximum frequency. We found also that older males gained more extra-pair young and had a higher overall breeding success, although they also differed almost significantly by having a higher loss of paternity in their own...

Practitioner and scientist perceptions of successful amphibian conservation.

Science.gov (United States)

Meredith, Helen M R; St John, Freya A V; Collen, Ben; Black, Simon A; Griffiths, Richard A

2018-04-01

Conservation requires successful outcomes. However, success is perceived in many different ways depending on the desired outcome. Through a questionnaire survey, we examined perceptions of success among 355 scientists and practitioners working on amphibian conservation from over 150 organizations in more than 50 countries. We also sought to identify how different types of conservation actions and respondent experience and background influenced perceptions. Respondents identified 4 types of success: species and habitat improvements (84% of respondents); effective program management (36%); outreach initiatives such as education and public engagement (25%); and the application of science-based conservation (15%). The most significant factor influencing overall perceived success was reducing threats. Capacity building was rated least important. Perceptions were influenced by experience, professional affiliation, involvement in conservation practice, and country of residence. More experienced practitioners associated success with improvements to species and habitats and less so with education and engagement initiatives. Although science-based conservation was rated as important, this factor declined in importance as the number of programs a respondent participated in increased, particularly among those from less economically developed countries. The ultimate measure of conservation success-population recovery-may be difficult to measure in many amphibians; difficult to relate to the conservation actions intended to drive it; and difficult to achieve within conventional funding time frames. The relaunched Amphibian Conservation Action Plan provides a framework for capturing lower level processes and outcomes, identifying gaps, and measuring progress. © 2017 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

Build an Early Foundation for Algebra Success

Science.gov (United States)

Knuth, Eric; Stephens, Ana; Blanton, Maria; Gardiner, Angela

2016-01-01

Research tells us that success in algebra is a factor in many other important student outcomes. Emerging research also suggests that students who are started on an algebra curriculum in the earlier grades may have greater success in the subject in secondary school. What's needed is a consistent, algebra-infused mathematics curriculum all…

The Professional Success of Higher Education Graduates

Science.gov (United States)

Schomburg, Harald

2007-01-01

Measures of professional success provided by surveys on higher education graduates can be divided into objective (e.g. income or professional position) and subjective (e.g. job satisfaction, reported use of knowledge and skills, work autonomy) indicators. In this article a broad range of measures of professional success is used to describe aspects…

Critical Success Factors in Online Language Learning

Science.gov (United States)

Alberth

2011-01-01

With the proliferation of online courses nowadays, it is necessary to ask what defines the success of teaching and learning in these new learning environments exactly. This paper identifies and critically discusses a number of factors for successful implementation of online delivery, particularly as far as online language learning is concerned.…

Information technology boosts contractor's economic success

International Nuclear Information System (INIS)

Penny, M.; Vasey, G.M.

1995-01-01

This article will discuss the advantages of Information Technology (IT) and how one drilling contractor, Global Marine, has applied this technology. The company has applied it in an efficient manner which has provided business benefits and cost reductions that have helped its operations be more successful. The following are the different aspects of information technology that led to the contractor's success: cost reduction measures; migration to a client/server IT infrastructure; IT business benefits; and keys to obtaining business benefits from IT

Mindfulness and Student Success

Science.gov (United States)

Leland, Matt

2015-01-01

Mindfulness has long been practiced in Eastern spiritual traditions for personal improvement, and educators and educational institutions have recently begun to explore its usefulness in schools. Mindfulness training can be valuable for helping students be more successful learners and more connected members of an educational community. To determine…

DETERMINATION OF SOCIAL ECONOMIC AND ENVIRONMENTAL SUCCESS OF PRODUCTS:

Directory of Open Access Journals (Sweden)

ESEN GÜRBÜZ

2013-06-01

Full Text Available An Empirical Investigation on the Turkish Food Industry Altough there are studies which evaulate and explain the importance of environmental, social and economic success of a product, it is important to evaluate the considerable success of these three variables together. This paper aims to evaluate economic, social and environmental success of a product all together (but not seperatly by conducting a research.  In this paper for some sample firms operating in the Turkish Food Industry, the variables, which effect the products’ economic, social and enviromental successes, are defined theoretically and the research results are explained investigating if there is a relationship between enviromental, social, economic success criteria and firm size, export, import use of intermediary.

Effects of Risk Management Practices on IT Project Success

Directory of Open Access Journals (Sweden)

Pimchangthong Daranee

2017-03-01

Full Text Available Successful management of an information technology (IT project is the most desirable for all organisations and stakeholders. Many researchers elaborated that risk management is a key part of project management for any project size. Risk management is so critical because it provides project managers with a forward-looking view of both threats and opportunities to improve the project success. The objectives of this research are to explore organisational factors affecting IT project success and risk management practices influencing IT project success. Risk management practices include risk identification, risk analysis, risk response planning, and risk monitoring and control. The IT project success is measured by process performance and product performance. Data are collected from 200 project managers, IT managers, and IT analysts in IT firms through questionnaires and analysed using Independent Sample t-test, One-way ANOVA, and Multiple Linear Regression at the statistical significance level of 0.05. The results show that the differences in organisational types affect IT project success in all aspects, while the differences on organisational sizes affect IT project success in the aspect of product performance and total aspects. Risk identification and risk response planning influence the process performance and the total aspects of IT project success. Risk identification has the highest positive influence on product performance, followed closely by risk response, while risk analysis negatively influences product performance.

Is There Successful Aging for Nonagenarians? The Vitality 90+ Study

Directory of Open Access Journals (Sweden)

Lily Nosraty

2012-01-01

Full Text Available Objectives. This study was designed (1 to estimate the prevalence of successful aging among nonagenarians based on six different models and (2 to investigate whether successful aging is associated with socio-demographic factors. Methods. A mailed survey was conducted with people aged 90+ in Tampere in 2010. Responses were received from 1283 people. The prevalence of successful aging was measured by six multidimensional models including physical, social, and psychological components. Age, sex, marital status, level of education, and place of living were studied as factors associated with successful aging. Results. The prevalence of successful aging varied from 1.6% to 18.3% depending on the model applied. Successful aging was more prevalent in men, and also more prevalent among community-living people. In most models, successful aging was also associated with younger age, being married, and a higher level of education. Discussion. Models which emphasize the absence of disease and activity as criteria for successful aging may not be the most relevant and applicable in oldest old. Instead, preference should be given to models that focus more on autonomy, adaptation and sense of purpose. Age-sensitive approaches would help us better understand the potential of successful aging among individuals who already have success in longevity.

Institutionalization and Organizational Long-term Success

Directory of Open Access Journals (Sweden)

Denise L. Fleck

2007-05-01

Full Text Available Institutionalization processes have an ambivalent effect on organizational long-term success. Even though they foster organizational stability and permanence, they also bring about rigidity and resistance to change. As a result, successful organizations are likely to lose their competitive advantage over time. The paper addresses this issue through the investigation of the institutionalization processes of two long-lived companies: General Electric, a firm that has been a long-term success and its rival, Westinghouse, which was broken up after eleven decades of existence. The longitudinal, multilevel analysis of firms and industry has identified two different modes of organizational institutionalization. The reactive mode gives rise to rigidity and change resistance, much like institutional theory predicts; the proactive mode, on the other hand, neutralizes those negative effects of institutionalization processes. In the reactive mode, structure predominates. In the proactive mode, agency plays a major role in organizational institutionalization, and in managing the organization’s relations with the environment, clearly contributing to environmental institutionalization.

COMMUNICATING SUCCESSFULLY WHEN MANAGING MULTICULTURAL TEAMS

Directory of Open Access Journals (Sweden)

Alexandra IOANID

2014-11-01

Full Text Available Day by day globalization covers new areas of life and calls for continuous learning and adjusting to new cultural dimensions. Managers are expected to display adaptation to new ways of working, cultural sensitivity, cultural intelligence and to posses multicultural competencies communication skills. Understanding the impact of cultural diversity on the communication within the organization is essential for the success of a company. Especially in multinational companies, when departments working on the same projects are located in different countries, the managers rely more and more on cultural- specific country characteristics in order to chose the best negotiation and communication techniques. The aim of this paper is to show how the country specific cultural characteristics impact on the success or failure of a business and the organizations’ challenge with preparing managers for success in international business environment. The paper is based on literature review and on authors’ experience in managing multicultural project teams, in international environment.

Love Influences Reproductive Success in Humans

Science.gov (United States)

Sorokowski, Piotr; Sorokowska, Agnieszka; Butovskaya, Marina; Karwowski, Maciej; Groyecka, Agata; Wojciszke, Bogdan; Pawłowski, Bogusław

2017-01-01

As love seems to be universal, researchers have attempted to find its biological basis. However, no studies till date have shown its direct association with reproductive success, which is broadly known to be a good measure of fitness. Here, we show links between love, as defined by the Sternberg Triangular Theory of Love, and reproductive success among the Hadza—traditional hunter-gatherer population. We found that commitment and reproductive success were positively and consistently related in both sexes, with number of children showing negative and positive associations with intimacy and passion, respectively, only among women. Our study may shed new light on the meaning of love in humans' evolutionary past, especially in traditional hunter-gatherer societies in which individuals, not their parents, were responsible for partner choice. We suggest that passion and commitment may be the key factors that increase fitness, and therefore, that selection promoted love in human evolution. However, further studies in this area are recommended. PMID:29209243

Pathways to Success for Michigan's Opportunity Youth

Science.gov (United States)

American Youth Policy Forum, 2015

2015-01-01

Each young person must navigate his/her own pathway into and through postsecondary education and the workforce to long-term success personalized to his/her own unique needs and desires. The pathway to long-term success is often articulated as a straight road through K-12 education into postsecondary education (either academic or technical…

77 FR 64400 - Order of Succession for HUD Region VII

Science.gov (United States)

2012-10-19

... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [FR-5550-D-10] Order of Succession for HUD Region VII... Offices (Region VII). This Order of Succession supersedes all previous Orders of Succession for HUD Region...). This publication supersedes all previous Orders of Succession for Region VII. Accordingly, the...

An investigation of the impact of succession planning on the success of small and medium-sized family businesses / Hilton Edwin Nell

OpenAIRE

Nell, Hilton Edwin

2014-01-01

The objective of this study is to assess the role that succession planning plays in family businesses in the Sedibeng region of the Gauteng province in South Africa. According to Netsiande (2008:1) family businesses should anticipate, recognise, understand and work pro-actively on issues, learn from other businesses and find their own unique solution.to ensure sustainability. Management succession and succession planning is very important and it has a significant impact on family member...

Successfully Adapting to Change.

Science.gov (United States)

Baird, James R.

1989-01-01

Describes methods used to successfully adapt to reductions in budget allocations in the University of Utah's Instructional Media Services Department. Three main areas of concern are addressed: morale and staff development; adapting to change in the areas of funding, control, media priorities, and technology; and planning for the future. (LRW)

Successful introduction of innovation

International Nuclear Information System (INIS)

Schoots, K.; Jeeninga, H.

2008-01-01

The introduction of new technology sometimes proceeds sluggishly due to discontinuity in incentive schemes. Estimating in advance which means are required, what a realistic time span is for the incentive scheme and continuing this scheme until the technology is marketable can significantly increase the success of innovation trajectories. [mk] [nl

Succession Planning and Financial Performance: Does Competition Matter?

Science.gov (United States)

Patidar, Nitish; Gupta, Shivani; Azbik, Ginger; Weech-Maldonado, Robert

2016-01-01

Succession planning has been defined as the process by which one or more successors are identified for key positions, development activities are planned for identified successors, or both. Limited research exists pertaining to the relationship between hospital succession planning and financial performance, particularly in the context of market competition. We used the resource-based view framework to analyze the differential effect of succession planning on hospitals' financial performance based on market competition. According to RBV, organizations can achieve higher performance by using their superior resources and capabilities. We used a panel design consisting of a national sample of hospitals in the United States for 2006-2010. We analyzed data using multivariate linear regression with facility random effects and year and state fixed effects. The sample included 22,717 hospital-year observations; more than one half of the hospitals (55.4%) had a succession planning program. The study found a positive relationship between the presence of succession planning and financial performance (β = 1.41, p planning programs on the basis of competition in their market.

Perspectives on projects, project success and team work

OpenAIRE

Thompson, Karen

2015-01-01

This paper brings together perspectives on projects, project success and team work as a background to two graphical tools for considering project success and individual capabilities for working in a project team.

Radiographic examination for successful dental implant

International Nuclear Information System (INIS)

Lee, Sam Sun; Choi, Soon Chul

2005-01-01

Recently implant has become an important field in dental clinic. Radiographic examination of pre- and post-operation is essential for successful treatment. Clinicians should have knowledge about the purpose of the radiographic examination, suitable imaging modality for the cases, anatomic landmarks of tooth and jaw bone, advantage and limitation of panoramic radiographic examination for implant, principle and interpretation of cross-sectional imaging, bone mineral density, post-operative radiographic examination. This paper will be helpful to get above information for dentists who want to do dental implant successfully.

European Success Stories in Industrial Mathematics

CERN Document Server

Esteban, Maria J; Lery, Thibaut; Maday, Yvon

2011-01-01

This unique book presents real world success stories of collaboration between mathematicians and industrial partners, showcasing first-hand case studies, and lessons learned from the experiences, technologies, and business challenges that led to the successful development of industrial solutions based on mathematics. It shows the crucial contribution of mathematics to innovation and to the industrial creation of value, and the key position of mathematics in the handling of complex systems, amplifying innovation. Each story describes the challenge that led to the industrial cooperation, how the

Assessing eGovernment Systems Success: A Validation of the DeLone and McLean Model of Information Systems Success

Science.gov (United States)

Wang, Yi-Shun; Liao, Yi-Wen

2008-01-01

With the proliferation of the Internet and World Wide Web applications, people are increasingly interacting with government to citizen (G2C) eGovernment systems. It is therefore important to measure the success of G2C eGovernment systems from the citizen's perspective. While general information systems (IS) success models have received much…

Factors Driving Learner Success in Online Professional Development

Directory of Open Access Journals (Sweden)

Phu Vu

2014-07-01

Full Text Available This study examined factors that contributed to the success of online learners in an online professional development course. Research instruments included an online survey and learners’ activity logs in an online professional development course for 512 in-service teachers. The findings showed that there were several factors affecting online learners’ success in online professional development. In addition, there were also significant differences between successful and unsuccessful online learners in terms of course login frequency and learning activities viewed.

MOOC Success Factors: Proposal of an Analysis Framework

Directory of Open Access Journals (Sweden)

Margarida M. Marques

2017-10-01

Full Text Available Aim/Purpose: From an idea of lifelong-learning-for-all to a phenomenon affecting higher education, Massive Open Online Courses (MOOCs can be the next step to a truly universal education. Indeed, MOOC enrolment rates can be astoundingly high; still, their completion rates are frequently disappointingly low. Nevertheless, as courses, the participants’ enrolment and learning within the MOOCs must be considered when assessing their success. In this paper, the authors’ aim is to reflect on what makes a MOOC successful to propose an analysis framework of MOOC success factors. Background: A literature review was conducted to identify reported MOOC success factors and to propose an analysis framework. Methodology: This literature-based framework was tested against data of a specific MOOC and refined, within a qualitative interpretivist methodology. The data were collected from the ‘As alterações climáticas nos média escolares - Clima@EduMedia’ course, which was developed by the project Clima@EduMedia and was submitted to content analysis. This MOOC aimed to support science and school media teachers in the use of media to teach climate change Contribution: By proposing a MOOC success factors framework the authors are attempting to contribute to fill in a literature gap regarding what concerns criteria to consider a specific MOOC successful. Findings: This work major finding is a literature-based and empirically-refined MOOC success factors analysis framework. Recommendations for Practitioners: The proposed framework is also a set of best practices relevant to MOOC developers, particularly when targeting teachers as potential participants. Recommendation for Researchers: This work’s relevance is also based on its contribution to increasing empirical research on MOOCs. Impact on Society: By providing a proposal of a framework on factors to make a MOOC successful, the authors hope to contribute to the quality of MOOCs. Future Research: Future

Successful time management

CERN Document Server

Forsyth, Patrick

2016-01-01

Packed with tips and techniques, Successful Time Management serves as a guide to reviewing and assessing new work practices to improve time management. It includes great time-saving ideas, practical solutions, checklists, and advice on controlling paperwork, delegating and working with others, prioritizing to focus on key issues, and getting and staying organized. This new third edition contains new practical tips on using email in a time effective manner and dealing with other internet-based tools and apps to help productivity.

Successful Swiss solar bicycles in Australia

International Nuclear Information System (INIS)

Hansen, K.

2000-01-01

The article takes a look at the Swiss 'Spirit of Bike' team's success in the 'Power Challenge' race across Australia using solar-bicycles based on commercially available models. Apart from the sporting aspects of race, technical details on the cycles and their supply of solar power are given. Also, the history behind the success of the team is presented and the monitoring of man (and woman) and machine during the race is described. The article also discusses the electric bicycles that are commercially available and the potential of these energy-efficient vehicles in Switzerland

Hemi-transseptal Approach for Pituitary Surgery: A Follow-Up Study

Science.gov (United States)

Fnais, Naif; Maio, Salvatore Di; Edionwe, Susan; Zeitouni, Anthony; Sirhan, Denis; Valdes, Constanza J.; Tewfik, Marc A.

2016-01-01

Objectives The hemi-transseptal (Hemi-T) approach was developed to overcome the potential drawbacks of the nasoseptal flap (NSF) in endoscopic endonasal transsphenoidal skull base surgery. In this study, we describe further refinements on the Hemi-T approach, and report long-term outcomes as compared with traditional methods of skull base reconstruction. Design A retrospective case-control study. Setting Montreal Neurological Institute and Jewish General Hospital, Montreal, Canada. Participants Patients who underwent endoscopic endonasal transsphenoidal approach to skull base pathology. Main Outcome Measures Operative time, CSF rhinorrhea, and postoperative nasal morbidity. Results A total of 105 patients underwent the Hemi-T approach versus 40 controls. Operative time was shorter using the Hemi-T technique (180.51 ± 56.9 vs. 202.9 ± 62 minutes; p = 0.048). The rates of nasal morbidity (septal perforation [5/102 vs. 6/37; p = 0.029] and mucosal adhesion [11/102 vs. 10/39 p = 0.027]), fascia lata harvest (21/100 vs. 18/39; p = 0.0028), and postoperative CSF leak rates (7/100 vs. 9/38; p = 0.006) were lower in the Hemi-T group. Conclusion Advantages of the Hemi-T approach over traditional exposure techniques include preservation of the nasal vascular pedicle, shorter operative time, reduced fascia lata harvest rates, and decreased nasal morbidity. PMID:28321378

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.

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.

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.

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...

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.

Successful introduction of innovations

International Nuclear Information System (INIS)

Schoots, K.; Jeeninga, H.

2008-01-01

The introduction of new technology is sometimes troubled by discontinuity in incentive schemes. By making prior assessments of the necessary means, the real time span for the incentive scheme and by maintaining this scheme until the technology is mature enough to enter the market, the success of innovation trajectories can be increased significantly. [mk] [nl

Success in Transdisciplinary Sustainability Research

Directory of Open Access Journals (Sweden)

Tobias Luthe

2017-01-01

Full Text Available The complexity of sustainable development and societal transitions require both analytical understandings of how coupled human-environment systems function and transdisciplinary science-to-practice approaches. The academic discourse has advanced in developing a framework for defining success in transdisciplinary research (TDR. Further empirical evidence is needed to validate the proposed concepts with TDR case studies. This paper applies a widely used TDR framework to test and critically evaluate its design principles and criteria of success with five TDR case studies the author is intimately familiar with. Overall, the design principles of the framework are validated for the five cases. Additional design principles are derived from the case analysis and proposed to complement the applied framework: (1 A project origin from society as opposed to with and for society; (2 Quickly available initiation funding; (3 Flexibility in time, objectives and methods throughout the research process; (4 Acceptance of process vs. project results; (5 Inclusion of public science communication; and (6 A demand-driven transition to a prolonged or new project partnership. The complementing principles are proposed for integration in the applied framework and are subject to further empirical testing. The reflexive empirical approach I have taken in this paper offers a key step towards removing institutional barriers for successful TDR, demonstrating how conceptual frameworks can be applied.

Understanding Megaproject Success beyond the Project Close-Out Stage

Directory of Open Access Journals (Sweden)

Johan Fahri

2015-08-01

Full Text Available Project success has always been an important topic in the project management literature. One of the main discussions is concerned with how a project’s success is evaluated and what factors lead to achieving this success. Traditionally project success has been measured at the point where the project outputs are handed over, after the close out phase. Recently, questions have been raised in the literature as to whether we should be evaluating project success beyond the close out phase, to better account for organizational and societal outcomes.  However, not much has been published about how the long term impacts and outcomes are measured. This is of particular concern in megaprojects as they often attract a high level of public attention and political interest, and have both direct and indirect impacts on the community, environment, and national budgets. In this paper the authors review success factors and criteria that are applicable to projects in general and megaprojects in particular. They identify the significance of evaluating outcomes and impact and propose an ex-post project evaluation (EPPE framework for megaprojects.

LEIR commissioning successfully completed

CERN Multimedia

2006-01-01

An important milestone has been passed in the preparation of the injector complex to supply ions to the LHC experiments. The LEIR lead-ion beam, seen on one of the control screens just before the PS injection region. The Low-Energy Ion Ring - LEIR for short - has passed its first tests with flying colours. On 12 May, the ring that will accumulate lead ions for the LHC was shut down after seven months of tests (see Bulletin 44/2005). 'The commissioning phase was a resounding success,' enthuses a satisfied Michel Chanel, head of the LEIR construction project. After several months of fine-tuning, the LEIR team has achieved its aim of producing the kind of beam required for first lead-ion collisions in the LHC in 2008. This involved creating bunches containing 230 million ions, in line with the specifications for those first beams. This success can be put down to the machine's outstanding design and components. 'It's a great achivement by all the teams involved in the machine's construction,' underlines Christian...

The program success story: a valuable tool for program evaluation.

Science.gov (United States)

Lavinghouze, Rene; Price, Ann Webb; Smith, Kisha-Ann

2007-10-01

Success stories are evaluation tools that have been used by professionals across disciplines for quite some time. They are also proving to be useful in promoting health programs and their accomplishments. The increasing popularity of success stories is due to the innovative and effective way that they increase a program's visibility, while engaging potential participants, partners, and funders in public health efforts. From the community level to the federal level, program administrators are using success stories as vehicles for celebrating achievements, sharing challenges, and communicating lessons learned. Success stories are an effective means to move beyond the numbers and connect to readers-with a cause they can relate to and want to join. This article defines success stories and provides an overview of several types of story formats, how success stories can be systematically collected, and how they are used to communicate program success.

Measuring The Impact Of Innovations On Efficiency In Complex Hospital Settings

Directory of Open Access Journals (Sweden)

Bonća Petra Došenović

2015-12-01

Full Text Available In this paper the authors propose an approach for measuring the impact of innovations on hospital efficiency. The suggested methodology can be applied to any type of innovation, including technology-based innovations, as well as consumer-focused and business model innovations. The authors apply the proposed approach to measure the impact of transcanalicular diode laser-assisted dacryocystorhinostomy (DCR, i.e. an innovation introduced in the surgical procedure for treating a tear duct blockage, on the efficiency of general hospitals in Slovenia. They demonstrate that the impact of an innovation on hospital efficiency depends not only on the features of the studied innovation but also on the characteristics of hospitals adopting the innovation and their external environment represented by a set of comparable hospitals.

The succession process at social enterprises in Brazil

Directory of Open Access Journals (Sweden)

Edileusa Godói-de-Sousa

2012-09-01

Full Text Available This research was based on a study of social enterprises in Brazil, to find out if and how these organizations plan and manage the succession process for their senior positions. The study investigated the subset of the associations dedicated to collectively producing goods and services, because they are formally set up and aimed at speeding up the dynamism of local development. The empirical research consisted of two stages. The first was a survey covering a sample of 378 organizations, to find out which of those had already undergone or were undergoing a succession process. The second interviewed the main manager of 32 organizations, to obtain a description of their succession experience. In this stage, the research aimed to analyze how the Individual, Organization and Environment dimensions interact to configure the succession process, identifying which factors of each of these dimensions can facilitate or limit this process. The following guiding elements were taken as the analytical basis: Individual dimension - leadership roles, skill and styles; Organization dimension - structure, planning, advisory boards, communication (transparency, control and evaluation; and Environment dimension - influence of the stakeholders (community, suppliers, clients, and business partners on the succession process. The results indicated that succession in the researched associations is in the construction stage: it adapts to the requirements of current circumstances but is evidently in need of improvement in order for more effective planning and shared management of the process to be achieved.

What drives continuous improvement project success in healthcare?

Science.gov (United States)

Stelson, Paul; Hille, Joshua; Eseonu, Chinweike; Doolen, Toni

2017-02-13

Purpose The purpose of this paper is to present findings from a study of factors that affect continuous improvement (CI) project success in hospitals. Design/methodology/approach Quantitative regression analysis was performed on Likert scale survey responses. Qualitative thematic analysis was performed on open-ended survey responses and written reports on CI projects. Findings The paper identifies managerial and employee factors that affect project success. These factors include managerial support, communication, and affective commitment. Affective commitment is the extent to which employees perceive the change as being needed or necessary. Practical implications The results highlight how managerial decisions, approaches to communication - including communication before, during and after CI projects affect project success. The results also show that success depends on the way employees perceive proposed changes. This suggests the need for a more individualized approach to CI, lean, and broader change initiatives. Originality/value This research is the first to fuse project success and sustainability theory to CI projects, beyond Kaizen events, in healthcare environments. The research is particularly important at a time when healthcare organizations are required to make rapid changes with limited resources as they work toward outcome-based assessment and reimbursement rules.

A Look at Success for Data Portals (Invited)

Science.gov (United States)

White, C. E.

2013-12-01

As a member of Esri's Geoportal Server team for the past six years, I have been involved in hundreds of customer portal, geoportal, and spatial data infrastructure implementations. Our team's goal for each implementation is - of course- for it to be successful. A successful data portal can be defined by a number of indicators. The foremost measure of success is that the target end users are able to easily find and access data that meets their needs. Other indicators are effectiveness of the user interface, interoperability mechanisms to enhance discoverability and usability across contexts, compliance with data sharing mandates, extendibility/portability of the system as technology evolves, and staff expertise to maintain the system. Further, some data portals have not only been successful by these measures but have also challenged and expanded the state of the art in the areas of discovery, access, and managing data. This talk will address models, principles, and best practices for deploying data portals that are successful by these measures, identify examples of excellence in the field, and discuss upcoming advances in portal technology to support scientists in sharing their work.

A Compendium of Energy Conservation Success Stories

Science.gov (United States)

1988-09-01

Three-quarters of DOE's Conservation R and D funds have been devoted to technology research and development: basic and applied research, exploratory R and D, engineering feasibility studies, pilot-scale prototype R and D, and technology demonstration. Non R and D projects have involved technology assessment program planning and analysis, model development, technology transfer and consumer information, health effects and safety research, and technical support for rule making. The success stories summarized in this compendium fall into three general categories: Completed Technology Success Stories, projects that have resulted in new energy-saving technologies that are presently being used in the private sector; Technical Success Stories, projects that have produced or disseminated important scientific/technical information likely to result in future energy savings; Program Success Stories, non-R and D activities that have resulted in nationally significant energy benefits. The Energy Conservation research and development program at DOE is managed by the Office of Conservation under the direction of the Deputy Assistant Secretary for Conservation. Three subordinate Program Offices correspond to the buildings, transportation, and industrial end-use sectors. A fourth subordinate Program Office{endash}Energy Utilization Research{endash}sponsors research and technical inventions for all end-use sectors.

Ecological succession as an energy dispersal process.

Science.gov (United States)

Würtz, Peter; Annila, Arto

2010-04-01

Ecological succession is described by the 2nd law of thermodynamics. According to the universal law of the maximal energy dispersal, an ecosystem evolves toward a stationary state in its surroundings by consuming free energy via diverse mechanisms. Species are the mechanisms that conduct energy down along gradients between repositories of energy which consist of populations at various thermodynamic levels. The salient characteristics of succession, growing biomass production, increasing species richness and shifting distributions of species are found as consequences of the universal quest to diminish energy density differences in least time. The analysis reveals that during succession the ecosystem's energy transduction network, i.e., the food web organizes increasingly more effective in the free energy reduction by acquiring new, more effective and abandoning old, less effective species of energy transduction. The number of species does not necessarily peak at the climax state that corresponds to the maximum-entropy partition of species maximizing consumption of free energy. According to the theory of evolution by natural selection founded on statistical physics of open systems, ecological succession is one among many other evolutionary processes. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

The Role of Involvement in Learning Management System Success

Science.gov (United States)

Klobas, Jane E.; McGill, Tanya J.

2010-01-01

Learning management systems (LMS) have been adopted by the majority of higher education institutions and research that explores the factors that influence the success of LMS is needed. This paper investigates the roles of student and instructor involvement in LMS success, using the DeLone and McLean (2003) model of information systems success as a…

Success Teaching Spelling with Music.

Science.gov (United States)

Martin, Mariellen

1983-01-01

A spelling approach which incorporates music on a cassette with spelling, pronunciation, and definition of specific words was successful in improving junior high learning disabled students' spelling performance, self-esteem, and sequential memories. (CL)

Success Factors of Business Process Management Systems Implementation

NARCIS (Netherlands)

Johan Versendaal; J.P.P. Ravesteijn

2007-01-01

In this research (critical) success factors for Business Process Management Systems implementation are identified and qualitatively validated. Furthermore a list of critical success factors is constructed. Based on the identified factors a BPMS implementation approach is suggested. Future research

Setting the stage for master's level success

Science.gov (United States)

Roberts, Donna

Comprehensive reading, writing, research, and study skills play a critical role in a graduate student's success and ability to contribute to a field of study effectively. The literature indicated a need to support graduate student success in the areas of mentoring, navigation, as well as research and writing. The purpose of this two-phased mixed methods explanatory study was to examine factors that characterize student success at the Master's level in the fields of education, sociology and social work. The study was grounded in a transformational learning framework which focused on three levels of learning: technical knowledge, practical or communicative knowledge, and emancipatory knowledge. The study included two data collection points. Phase one consisted of a Master's Level Success questionnaire that was sent via Qualtrics to graduate level students at three colleges and universities in the Central Valley of California: a California State University campus, a University of California campus, and a private college campus. The results of the chi-square indicated that seven questionnaire items were significant with p values less than .05. Phase two in the data collection included semi-structured interview questions that resulted in three themes emerged using Dedoose software: (1) the need for more language and writing support at the Master's level, (2) the need for mentoring, especially for second-language learners, and (3) utilizing the strong influence of faculty in student success. It is recommended that institutions continually assess and strengthen their programs to meet the full range of learners and to support students to degree completion.