Supraorbital craniotomy to approach the sellar and the parasellar regions

We report on the experience with supraorbital minicraniotomy in a series of 36 operated cases with good results: 31 aneurysms, 4 pituitary adenomas, 1 anaplastic astrocytoma and 1 arachnoid cyst. One death occurred in this series. The technique is detailed. We conclude that the minicraniotomy is a safe method for the treatment of several parasellar pathologies.The efficacy must be evaluated in clinical trials concerning other approaches.Relatamos nossa experiência com a minicraniotomia supraorbital em uma série de 36 pacientes operados, com resultados satisfatórios. Foram operados 31 aneurismas 4 adenomas hipofisários, um astrocitoma anaplásico e um cisto aracnóide. Houve um óbito na série. A técnica foi descrita em detalhes. Concluimos que a minicraniotomia é um método seguro para o tratamento de várias patologias parasselares, devendo ser avaliada a sua eficácia em estudos comparativos com as técnicas tradicionais.Universidade Federal da Bahia Faculdade de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Aumento do volume de aneurisma após remoção de tumor cerebral: relato de caso

A rare case of rapid growth of an aneurysm after a posterior fossa meningioma removal in a 69-year-old lady is reported. Serial angiography, cerebral computed tomography and magnetic resonance imaging are presented. The patient harbored risk factors to both aneurysm formation and growth as current cigarette smoking, arterial hypertension, female sex and reduction of intracranial hypertension. One-year follow up after the first surgical procedure is presented.Um caso raro, em que ocorreu rápido aumento de volume de um aneurisma após a remoção de meningioma de fossa posterior em uma senhora de 69 anos de idade é relatado. Angiografias seriadas, tomografia computadorizada cerebral e ressonância magnética cerebral são apresentados. A paciente apresentava fatores de risco tanto para a formação como para o crescimento, de aneurismas cerebrais como hipertensão arterial, tabagismo, sexo feminino, aliados à redução da pressão intracraniana. É apresentada a evolução pós-operatória de um ano após a primeira cirurgia.Federal University of São Paulo Department of NeurosurgeryMedical Superintendent of Santa Casa de Santo Amaro Head of Department of Neurology and Neurosurgery Hospital MontrealUNIFESP, Department of NeurosurgerySciEL

Análise da melhor alternativa terapêutica para malformações arteriovenosas durais intracranianas

The material for this research consisted of 93 patients with dural arteriovenous malformations (DAVMs) who were studied retrospectively with regards to therapeutic success and failure, who had undergone either neurosurgery, or embolization or a combination of both methods and whose disease was located in the cavernous sinus, the superior sagittal sinus, the transverse-sigmoid sinus of the anterior fossa and the tentorium. Thus, it was possible to arrive at the following conclusions: treatment of the DAVMs must be indicated, jointly, by an interventionist neuroradiologist and a neurosurgeon; DAVMs of the transverse-sigmoid sinus were better treated when a combination of both methods was used; DAVMs of the tentorium were also better treated with a combined method; the endovascular method ensured only a 50% chance of therapeutic success for DAVMs of the superior sagittal sinus; DAVMs of the cavernous sinus are better treated when the endovascular method was used with a transvenous approach, relative to the transarterial approach.O material utilizado consistiu de 93 pacientes portadores de malformações arteriovenosas durais (MAVDs) estudados retrospectivamente em relação ao sucesso e ao fracasso terapêutico submetidos aos métodos neurocirúrgico ou endovascular ou, ainda, combinação entre ambos, em que a doença se localizou nas regiões do seio cavernoso, do seio sagital superior, do seio transverso-sigmóide, da fossa anterior e do tentório. As conclusões foram as seguintes: o tratamento das MAVDs deve ser indicado pelo neurorradiologista intervencionista e pelo neurocirurgião, conjuntamente; as MAVDs do seio transverso-sigmóide foram melhor tratadas através do método combinado; as MAVDs do tentório foram melhor tratadas através do método combinado; as MAVDs do seio sagital superior tratadas por método endovascular asseguraram apenas 50% de sucesso terapêutico; as MAVDs do seio cavernoso são melhor tratadas por método endovascular empregando-se a via transvenosa quando comparadas com a via transarterial.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)Institute of GoiâniaUniversity of São PauloUNIFESP, EPMSciEL

Práticas de marketing educacional nas escolas públicas

O presente trabalho tem como objetivo identificar práticas de Marketing Educacional nas escolas públicas. Tendo por base razões pessoais, profissionais, teóricas e legais que justificam estudos sobre as práticas de Marketing Educacional nas escolas públicas, revê-se a literatura sobre a evolução do marketing (geral) até à emergência do marketing societal e do Marketing Educacional. Partindo dos normativos legais e da literatura, exploram-se as fontes de informação, a autonomia das escolas, a accountability, o planeamento estratégico e evidências dessas práticas associadas ao Marketing Educacional. Para o efeito, optou-se, metodologicamente, por realizar uma pesquisa quantitativa através de um inquérito por questionário realizado junto dos(as) diretores(as) dos agrupamentos de escolas e escolas não agrupadas de Portugal Continental. No que respeita aos principais resultados obtidos, é possível concluir que, apesar de haver evidências de predominar a orientação da gestão para a “produção” do serviço educativo, há práticas de Marketing Educacional nas escolas públicas. Contudo, as escolas têm ainda uma consciência míope do que é o Marketing Educacional, pois há défice na identificação e na implementação dessas práticas. Verifica-se que as escolas fazem estudos de suporte a decisões sobre oferta formativa, de avaliação institucional e de satisfação junto dos alunos e restante comunidade educativa. Definem e implementam estratégias não só para cumprir os normativos legais, mas também adequar os serviços aos alunos, tornando-os parte ativa da coprodução do serviço educativo. Com base nas conclusões e nas opções de concordância do(a)s diretores(as), foi delineado um plano de ação de intervenção de Marketing Educacional.This project aims to identify educational marketing practices in state schools. Based on personal, professional, theoretical and legal reasons that justify studies on Educational Marketing practices in state schools, we'll be reviewing the literature on the evolution of marketing, and of general marketing until the emergence of Educational Marketing. Starting from legal requirements and literature, we will explore information sources, school autonomy, accountability, strategic and practical evidence associated with Educational Marketing. For this purpose, it was decided, as far as methodology is concerned, to carry out a quantitative research through a survey with the School Directors/headmasters of the school groupings and schools in mainland Portugal. Concerning the main results obtained, it is possible to conclude that, although there is evidence of a predominant management orientation towards the “production” of the educational service, it is undeniable that there are Educational Marketing practices in state schools. However, schools still have a short-sighted awareness of what Educational Marketing is, as there is a deficit in identifying and implementing these practices. In fact, schools carry out surveys that support decisions on training courses, institutional assessment and satisfaction among students and the rest of the educational community. They define and implement strategies not only to comply with legal regulations, but also to adapt services to students, making them an active part of the co-production of the educational service. Based on the headmasters' conclusions and agreement options, an Educational Marketing action plan was outlined. KEYWORDS: Educational Marketing

Measuring and Estimating GFR and Treatment Effect in ADPKD Patients: Results and Implications of a Longitudinal Cohort Study

Trials failed to demonstrate protective effects of investigational treatments on glomerular filtration rate (GFR) reduction in Autosomal Dominant Polycystic Kidney Disease (ADPKD). To assess whether above findings were explained by unreliable GFR estimates, in this academic study we compared GFR values centrally measured by iohexol plasma clearance with corresponding values estimated by Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) and abbreviated Modification of Diet in Renal Disease (aMDRD) formulas in ADPKD patients retrieved from four clinical trials run by a Clinical Research Center and five Nephrology Units in Italy. Measured baseline GFRs and one-year GFR changes averaged 78.6±26.7 and 8.4±10.3 mL/min/1.73 m2 in 111 and 71 ADPKD patients, respectively. CKD-Epi significantly overestimated and aMDRD underestimated baseline GFRs. Less than half estimates deviated by <10% from measured values. One-year estimated GFR changes did not detect measured changes. Both formulas underestimated GFR changes by 50%. Less than 9% of estimates deviated <10% from measured changes. Extent of deviations even exceeded that of measured one-year GFR changes. In ADPKD, prediction formulas unreliably estimate actual GFR values and fail to detect their changes over time. Direct kidney function measurements by appropriate techniques are needed to adequately evaluate treatment effects in clinics and research

Down syndrome-recent progress and future prospects

Down syndrome (DS) is caused by trisomy of chromosome 21 (Hsa21) and is associated with a number of deleterious phenotypes, including learning disability, heart defects, early-onset Alzheimer's disease and childhood leukaemia. Individuals with DS are affected by these phenotypes to a variable extent; understanding the cause of this variation is a key challenge. Here, we review recent research progress in DS, both in patients and relevant animal models. In particular, we highlight exciting advances in therapy to improve cognitive function in people with DS and the significant developments in understanding the gene content of Hsa21. Moreover, we discuss future research directions in light of new technologies. In particular, the use of chromosome engineering to generate new trisomic mouse models and large-scale studies of genotype-phenotype relationships in patients are likely to significantly contribute to the future understanding of DS

18FDG-PET and large vessel vasculitis: preliminary data on 25 patients

Objective: To evaluate the predictive value of clinical and biochemical features when compared to 18FDG-PET in the diagnostic work-up of large vessel vasculitis (LVV). Methods: Twenty-five patients underwent 18FDG-PET for the clinical suspect of LVV. All of them presented history of systemic symptoms lasting ≥6 months and laboratoristic evidence of persistently high markers of inflammation. The patients were stratified according with: i) clinical manifestations, defined as presence of one or more ACR criteria for the classification of LVV; ii) laboratory investigations: Erythrocyte Sedimentation Rate (ESR) higher or lower than 50 mm/h, C-Reactive Protein (CRP) higher or lower than 2 mg/dl; iii) prednisone dose in the 4 weeks preceding PET examination. Results: The total number of positive PET was higher in the group without clinical ACR criteria and in the group with inflammation markers under the established cut-off. The number of scans consistent with LVV was higher in the groups presenting one or more clinical criteria for LVV but in those with very high ESR and CRP. In all the cases differences between groups were not statistically significative. A clear cut negative correlation between steroid dose and number of scans suggestive for LVV has been observed. Conclusions: Diagnosis of LVV remains challenging, especially in patients presenting with a constellation of non-specific symptoms and laboratory findings. In this study, both clinical and biochemical features show low correlation with a vasculitic pattern of FDG uptake. In our experience 18FDG-PET represents an useful diagnostic tool in early stages of LVV and a powerful instrument to follow the treatment responses

First bounds on the very high energy gamma-ray emission from Arp 220

Using the Major Atmospheric Gamma Imaging Cherenkov Telescope (MAGIC), we have observed the nearest ultra-luminous infrared galaxy Arp 220 for about 15 hours. No significant signal was detected within the dedicated amount of observation time. The first upper limits to the very high energy $\gamma$-ray flux of Arp 220 are herein reported and compared with theoretical expectations.Comment: Accepted for publication in Ap

MAGIC observations of very high energy gamma-rays from HESS J1813-178

Recently, the HESS collaboration has reported the detection of gamma-ray emission above a few hundred GeV from eight new sources located close to the Galactic Plane. The source HESS J1813-178 has sparked particular interest, as subsequent radio observations imply an association with SNR G12.82-0.02. Triggered by the detection in VHE gamma-rays, a positionally coincident source has also been found in INTEGRAL and ASCA data. In this Letter we present MAGIC observations of HESS J1813-178, resulting in the detection of a differential gamma-ray flux consistent with a hard-slope power law, described as dN/(dA dt dE) = (3.3+/-0.5)*10^{-12} (E/TeV)^{-2.1+/-0.2} cm^(-2)s^(-1)TeV^(-1). We briefly discuss the observational technique used, the procedure implemented for the data analysis, and put this detection in the perspective of multifrequency observations.Comment: Accepted by ApJ Letter

First bounds on the high-energy emission from isolated Wolf-Rayet binary systems

High-energy gamma-ray emission is theoretically expected to arise in tight binary star systems (with high mass loss and high velocity winds), although the evidence of this relationship has proven to be elusive so far. Here we present the first bounds on this putative emission from isolated Wolf-Rayet (WR) star binaries, WR 147 and WR 146, obtained from observations with the MAGIC telescope.Comment: (Authors are the MAGIC Collaboration.) Manuscript in press at The Astrophysical Journal Letter