Передняя атланто-аксиальная дислокация. Двухэтапное лечение посредством трансфарингеального эндоскопического доступа с последующим окципитоспондилодезом

Irreducible atlanto-axial dislocation with ventral spinal cord compression is difficult to treat. Traction is not uniformly successful at either reducing the dislocation or decompressing the spinal cord. Direct anterior decompression of the spinal cord may be necessary, in addition to the need for surgical stabilization of the upper cervical spine. Numerous methods have been described for surgical stabilization following transoral decompression, which generally require a second-stage posterior instrumentation and fusion procedure. Complication rates remain noteworthy for any of these strategies.Атланто-аксиальные дислокации – травматические смещения между атлантом и аксисом, делятся на передние, задние и боковые. Передние дислокации атланта, в свою очередь, подразделяются на чреззубовидные и чрезлигаментарные. Учитывая частое несрастание таких переломов и опасность вторичных смещений атланта, в последнее время многие отдают предпочтение оперативному вправлению вывиха с последующим окципитоспондилодезом или атланто-аксиальным спондилодезом. Во многих случаях наблюдается надобность прямой передней декомпрессии посредством трансфарингеального доступа и стабилизации верхнего отдела позвоночника. Вне зависимости от выбранного типа лечения, вероятность осложнений остается высокой

Трансоральная пункционная вертебропластика тела позвонка С2 при поражении метастатической ангиосаркомой: технические особенности

Catedra Neurochirurgie, USMF „Nicolae Testemiţanu”, Institutul de Neurologie şi Neurochirurgie, ChişinăuPercutaneous vertebroplasty (PVP) of the axis is a challenging procedure that may be performed by a percutaneous or a transoral approach. There are few reports of PVP at the C2 level. Percutaneous vertebroplasty was performed via a transoral route in a 24-year-old man with a C2 metastasis of angiosarcoma involving anterior vertebral elements. Near-complete pain relief was obtained after an uncomplicated, minimally invasive procedure. This preliminary experience demonstrates that a transoral approach under fluoroscopic control can provide safe access to the upper cervical spine at C2 level. Пункционная вертебропластика тела позвонка С2 является технически сложной процедурой которая может быть проведена либо чрескожно, либо трансорально. Публикации, посвященные вертеброластике на этом уровне, встречаются редко. В данной работе мы представляем клинический случай пациента 24-х лет поступившего в спинальное отделение с метастатическим поражением ангиосаркомой тела позвонка С2. Причиной поступления были выраженные боли в области шеи, не поддающиеся медикаментозному лечению. Была проведена без осложнений трансоральная вертебропластика тела С2, после чего было отмечено существенное снижение болей. Этот случай подтверждает данные о том что трансоральный доступ к телу С2, осуществляемый с использованием ЭОП контроля является приемлемым путем доступа к верхнему отделу позвоночника

Hemorrhagic transformation of ischemic stroke – prediction and evaluation with different computed tomography modalities

Department of Radiology and Neuroimaging, Department of Neurology Institute of Neurology and Neurosurgery, Chisinau, the Republic of MoldovaBackground: Hemorrhagic transformation (HT) of ischemic stroke is a complex and heterogeneous phenomenon, which involves numerous parameters whose knowledge remains partial. Large HT is often associated with poorer outcome and higher mortality, especially parenchymal hematoma type 2, that’s why the search of strong HT predictors is very important and can improve management of ischemic stroke patients. Our aim was to review the literature regarding computed tomography (CT) imaging predictors of HT and possible input of different computed tomography modalities in diagnosis and evaluation of HT following acute ischemic stroke. The contribution of non-contrast computed tomography, computed tomography angiography (CTA) and dynamic Perfusion CT (PCT) investigation in the prediction of the hemorrhagic transformation risk were studied. Multiple multicentre studies revealed useful information on different CT patterns predictors of symptomatic intracerebral hemorrhage after stroke, which is the most important type of hemorrhagic transformation from a clinician’s point of view. Conclusions: Data from the multiple studies and trials revealed that different CT modalities show high potency in HT prediction and evaluation. Non-contrast CT standard investigation showed high accuracy in HT prediction by assessment of early ischemic signs, quantification of the Alberta Stroke Program Early CT Score (ASPECTS), grading of leukoaraiosis severity. CTA is useful in HT prediction by the assessment of collateral vessels; intra-arterial occlusion and ASPECTS score calculated from the CTA source images. PCT showed the best predictive values by the measurement of blood-brain barrier permeability

The effects of market economy and foreign MNE subsidiaries on the convergence and divergence of HRM

This study explores patterns of human resource management (HRM) practices across market economies, and between indigenous firms and foreign MNE subsidiary operations, offering a novel perspective on convergence and divergence. Applying institutional theorizing to improve our understanding of convergence/ divergence as a process and an outcome, data collected from nine countries at three points in time over a decade confirm that convergence and divergence occur to different extents in a non-linear fashion, and vary depending on the area of HRM practice observed. Patterns of adoption and convergence/ divergence are explained through the effect of institutional constraints, which vary between liberal and coordinated market economies, and between indigenous firms and foreign MNE subsidiaries. The study contributes a more graded conceptualization of convergence/ divergence, which reflects the complex dynamic reality of international business

The function of fear in institutional maintenance: Feeling frightened as an essential ingredient in haute cuisine

Fear is a common and powerful emotion that can regulate behaviour. Yet institutional scholars have paid limited attention to the function of fear in processes of institutional reproduction and stability. Drawing on an empirical study of elite chefs within the institution of haute cuisine, this article finds that the multifaceted emotion of fear characterised their experiences and served to sustain their institution. Chefs’ individual feelings of fear prompted conformity and a cognitive constriction, which narrowed their focus on to the precise reproduction of traditional practices whilst also limiting challenges to the norms underpinning the institution. Through fear work, chefs used threats and violence to connect individual experiences of fear to the violation of institutionalized rules, sustaining the conditions in which fear-driven maintenance work thrived. The study also suggests that fear is a normative element of haute cuisine in its own right, where the very experience and eliciting of fear preserved an essential institutional ingredient. In this way, emotions such as fear do not just accompany processes of institutionalization but can be intimately involved in the maintenance of institutions

Productive resistance within the public sector: exploring organisational culture

The article examines how South Korean civil servants responded to the introduction of pay for performance. Drawing upon 31 in-depth interviews with career civil servants, it identifies what became known as 1/n, a form of ‘discreet resistance’ that emerged and evolved. The analytical framework allows productive resistance to be seen as ebbing and flowing during organisational change that sees institutionalisation, deinstitutionalisation and re-institutionalisation. In understanding the cultural context of organisational resistance the contribution is three-fold. First, a nuanced definition and understanding of productive resistance. Second, it argues that productive resistance must be seen as part of a process that does not simply reflect ‘offer and counter-offer’ within the change management process. Thirdly, it identifies differences within groups and sub-cultures concerning commitment towards resistance and how these fissures contribute towards change as new interpretive schemes and justifications are presented in light of policy reformulations

Maintenance of cross-sector partnerships: the role of frames in sustained collaboration

We examine the framing mechanisms used to maintain a cross-sector partnership (XSP) that was created to address a complex long-term social issue. We study the first eight years of existence of an XSP that aims to create a market for recycled phosphorus, a nutrient that is critical to crop growth but whose natural reserves have dwindled significantly. Drawing on 27 interviews and over 3,000 internal documents, we study the evolution of different frames used by diverse actors in an XSP. We demonstrate the role of framing in helping actors to avoid some of the common pitfalls for an XSP, such as debilitating conflict, and in creating sufficient common ground to sustain collaboration. As opposed to a commonly held assumption in the XSP literature, we find that collaboration in a partnership does not have to result in a unanimous agreement around a single or convergent frame regarding a contentious issue. Rather, successful collaboration between diverse partners can also be achieved by maintaining a productive tension between different frames through ‘optimal’ frame plurality – not excessive frame variety that may prevent agreements from emerging, but the retention of a select few frames and the deletion of others towards achieving a narrowing frame bandwidth. One managerial implication is that resources need not be focussed on reaching a unanimous agreement among all partners on a single mega-frame vis-à-vis a contentious issue, but can instead be used to kindle a sense of unity in diversity that allows sufficient common ground to emerge, despite the variety of actors and their positions

Swimming in a Sea of Shame: Incorporating Emotions into Explanations of Institutional Reproduction and Change

We theorize the role in institutional processes of what we call the shame nexus, a set of shame-related constructs: felt shame, systemic shame, sense of shame, and episodic shaming. As a discrete emotion, felt shame signals to a person that a social bond is at risk and catalyzes a fundamental motivation to preserve valued bonds. We conceptualize systemic shame as a form of disciplinary power, animated by persons’ sense of shame, a mechanism of ongoing intersubjective surveillance and self-regulation. We theorize how the duo of the sense of shame and systemic shame drives the self-regulation that underpins persons’ conformity to institutional prescriptions and institutional reproduction. We conceptualize episodic shaming as a form of juridical power used by institutional guardians to elicit renewed conformity and reassert institutional prescriptions. We also explain how episodic shaming may have unintended effects, including institutional disruption and recreation, when it triggers sensemaking among targets and observers that can lead to the reassessment of the appropriateness of institutional prescriptions or the value of social bonds. We link the shame nexus to three broad categories of institutional work