638 research outputs found
Quality of Life After Craniovertebral Junction Meningioma Resection: Shaping the Real Neurologic and Functional Expectancies About These Surgeries in a Contemporary Large Multicenter Experience
No full textObjective: Craniovertebral junction (CVJ) meningiomas are one of the most surgically complex conditions in neuro-oncologic surgery. The aim of this work is to correlate our data with clinical outcome to outline factors leading to a worse functional prognosis. Methods: We analyzed sex, age, clinical presentation, topography, surgical approach, Simpson grade resection, postoperative lower cranial nerve deficits, consistency, histology, site of origin, presence of a capsule, and radiologic and clinical follow-up at 1, 6, and 12 months of 61 patients affected by CVJ meningiomas, operated on in our institution from 1992 to 2014. Results: 78.7% of patients were women (mean age, 52.85 years); the onset symptom was pain in 65.5% of cases. The mean preoperative Nurick grade of the sample was 3.78; the most frequent histologic type was endotheliomatous (42.8%). We treated 22 patients with a posterior median approach (5 with lateral and 17 with posterolateral axial topography); in 39 cases (30 anterolateral and 9 anterior) we performed a posterolateral approach. Gross total removal was achieved in 85.2% of cases. We recorded a final follow-up step overall neurologic improvement in the cohort (average preoperative Nurick grade, 3.81, and at 12 months, 2.13). Twenty-nine patients presented with lower cranial nerve deficit (permanent or transient) and no statistically significant association was found between surgical approach and temporary or permanent postoperative complications. Conclusions: We selected, in our experience, some predictors of worse outcome: preoperative sphincter impairment, absence of a capsule, cranial site of origin, a poor preoperative functional status, and firm consistency of the tumor
Management of calcified thoracic disc herniation using ultrasonic bone curette SONO-PET®: technical description.
No full textThis paper describes the surgical management of a post-traumatic calcified thoracic disc herniation treated using ultrasonic bone curette SONO-PET®. The case described concerns a young man with a symptomatic calcified thoracic disc herniation, who underwent posterolateral approach and transversoarthropediculectomy. Patient underwent posterolateral approach with excellent postoperative results. Neurophysiological monitoring somato-sensory evoked potential (SSEP) and muscle motor evoked potentials (MMEP), inclination of 30° toward the unaffected side of the operating table, the use of Ultrasonic Bone-Curette SONO-PET® and proper reconstruction of the three floors of the back muscles allows the removal of the disc herniation safer and risk's free, and less invasive for the patient
Post-traumatic Collet-Sicard syndrome: personal observation and review of the pertinent literature with clinical, radiologic and anatomic considerations
No full textStudy design The lesion of the lower four cranial nerves,
commonly called Collet–Sicard syndrome, can be caused
by a blunt head and neck trauma. It may be associated to an
isolated fracture of the occipital condyle or of the atlas.
Objective The aim of this report is to assess the modality
of the trauma, the type of fracture, the anatomic characteristics,
the treatment and clinical results of this syndrome.
Summary of background data We discuss 14 cases of
fracture of occipital condyle and of atlas and 1 personal
case.
Methods We analyzed 14 cases collected from the literature
between 1925 and 2013, reported a further personal
case and performed an anatomical study of the paracondylar,
atlas and styloid process region. The anatomical
dissection was performed to assess the anatomic relationships
in the site of transit in which the nerves IX, X, XI and
XII are injured.
Results A total of 14 cases of p-CSS were collected: 9
caused by a condyle fracture and 5 by an atlas fracture. The
patients were 13 males and only 1 female, 10 of them had a
blunt trauma due to the result of axial loading (force directed
through the top of the head and through the spine) falling on
the head. The nine cases with a condyle fracture were
associated to the dislocation of part of it, while those with
atlas fractures showed the fracture and/or disjunction of the articular mass. The anatomical evaluations reveal that the
lower four cranial nerves, at their emergency, pass through a
close osteo-ligamentous space in relationship to the condyle.
Below they run through a little wider channel between the
articular mass of C1 and the styloid process. Two cases
underwent surgical procedure. All the other cases were
treated conservatively with immobilization of the cervical
spine. During follow-up three cases with condylar fractures
were found to be clinically unchanged and six showed
modest improvements while one case with atlas fracture had
a complete recovery and four improved significantly.
Conclusions The p-CSS is caused by force directed through
the top of the head.Wesuppose that the nerve injuries are due
to their laceration caused by a displacement of a condyle
fragment or to their compression and stretching when they
pass between the lateral mass of the atlas and the styloid
process. Thesemodalities of traumaexplain the better clinical
results in patients affected by C1 fractures. Conservative
treatment is the option of choice. Surgical option, when
choosed, is not considered to fix nerve damages
First description of cervical intradural thymoma metastasis
No full textThymoma and thymic carcinoma are rare epithelial tumors, which originate from the thymus gland. According to the World Health Organization there are "organotypic" (types A, AB, B1, B2, and B3) and "non-organotypic" (thymic carcinomas) thymomas. Type B3 thymomas are aggressive tumors, which can metastasize. Due to the rarity of these lesions, only 7 cases of extradural metastasis are described in the literature. We report the first and unique case of a man with cervical intradural B3 thymoma metastasis. A 46-year-old man underwent thymoma surgical removal. The year after the procedure he was treated for a parietal pleura metastasis. In 2006 he underwent cervical-dorsal extradural metastasis removal and C5-Th1 stabilization. Seven years after he came to our observation complaining left cervicobrachialgia and a reduction of strength of the left arm. He underwent a cervical spine magnetic resonance imaging, which showed a new lesion at the C5-C7 level. The patient underwent a surgery for the intradural B3 thymoma metastasis. Neurological symptoms improved although the removal was subtotal. He went through postoperative radiation therapy with further mass reduction. Spinal metastases are extremely rare. To date, only 7 cases of spinal extradural metastasis have been described in the literature. This is the first case of spinal intradural metastasis. Early individuation of these tumors and surgical treatment improve neurological outcome in patients with spinal cord compression. A multimodal treatment including neoadjuvant chemotherapy, surgery and postoperative radiation therapy seems to improve survival in patients with metastatic thymoma
DEMO and Security
No full textThis thesis is aimed at exploring how security aspects within organizations can be addressed at a very high level: an ontological level that encapsulates construction and operation issues of organizations with no reference to implementation concerns. To do this, DEMO (Dynamic Engineering and Modeling for Organizations) has been found as the relevant methodology to use. The thesis has mainly four contributions. (1) First, it identifies the thread that connects DEMO with security. It does that by performing a thorough study of information systems security issues and DEMO. The research brings forward the current state in the information systems security field and concludes by pointing out the connection between DEMO and security - responsibility. (2) Second, based on the results of the previous investigation, it analyses various approaches to model security starting from responsibility with emphasis on their strengths, week points, similarities and differences. (3) Third, it performs a critical analysis of DEMO from a security perspective. The findings are analyzed and discussed and DEMO’s approach to responsibility is compared with the previous analyzed security modeling approaches based on responsibility. The results of this comparison constitute the (4) fourth contribution of the thesis: a starting point for modeling security within DEMO. Two case studies will be used for illustration purposes of the proposed method.Information ArchitectureComputer ScienceElectrical Engineering, Mathematics and Computer Scienc
The adoption of DEMO in practice
No full textDEMO is a methodology for designing and engineering organizations which is mostly used for Information System Development (ISD) and redesigning the business processes. DEMO has the ability to reduce the complexity of an organization by providing an ontological model of that organization. Although DEMO has promising advantages and has provided successful outcome in practice, it hasn’t received the deserved attention from The individuals in practical fields. While many of the competitor methodologies are more successful and accepted among the practitioners, DEMO is at the risk of being forgotten among all other methodologies in the methodology jungle. It seems trivial to use effective tactics to increase the acceptance of DEMO among individuals in practice. These tactics can only be effective if they take the reasons behind this specific point of view about DEMO into account. Various factors from a technical anomalies to opinion of others can influence the perception of people about a methodology. While the acceptance of DEMO by people in practice is very important in the success of the methodology in practical fields, no research was found in the literature that the statistics on reports the adoption rate of DEMO in practice and identifies the reasons behind certain adoption behavior. Therefore, alongside providing such statistics the main goal of this thesis is to identify the factors that can determine certain behavior towards DEMO and propose recommendations to increase the adoption of DEMO based on these factors. We conducted this research in three phases: Theoretical, Quantitative and qualitative analysis. In theoretical analysis we have identified the factors that were proven to influence the adoption of other methodologies. In quantitative analysis we have tried to find out whether these factors have any influence on the adoption of DEMO. At the end, we captured the actual experience of the individuals in practice with DEMO. In this research we were able to identify several factors that influence the adoption of DEMO. We realized that the support of DEMO by management, coworkers, other individuals with the same skills as the individual and the eagerness of the individual to keep him self updated about DEMO can increase the adoption of DEMO to a great extent. Furthermore, uncertainty one’s position in the organization has a negative effect on the adoption of DEMO. Finally, the ability of the methodology to produce results in a way that can be communicated with all the individuals with different levels of knowledge about DEMO is also influencing the adoption of DEMO.Information ArchitectureComputer ScienceElectrical Engineering, Mathematics and Computer Scienc
DEMO applied to Financial Services
No full textOften organizations do not exactly know what they desire, when it comes to information systems. Professional companies like ForMetis are needed to give advice and design tailor made information systems for organizations that have the need of it. To do so, one usually uses a software developing methodology. ForMetis has developed such a methodology with their ten year of experience (The ForMetis methodology). The DEMO methodology is a powerful tool that has proven itself successful in the modeling of organizations. DEMO methodology models the essence of an organization and claims to be coherent, consistent, comprehensive and concise. It is a very powerful tool for identifying transaction of an organization and also the communication with the external actors. DEMO can be used as an aid to design information systems and can check the completeness of these systems whether it covers the essential business processes. The ForMetis methodology consists of the following phases: planning, analysis, design, implementation and system. The analysis and design phase are the most important phases. In these phases requirements are retrieved in an informal way and are written on large sheets, which are not reusable. Informal specifications are made and often the implementation is the specification. The new, so called F-DEMO methodology was discussed and a postmortem case (intermediary) was used to illustrate the added value of DEMO. The new methodology is the ForMetis methodology extended with DEMO in the analysis and design phase. In these phases the Construction Model, Proces Model and the State Model are added. These models are a valuable addition to the derivation of requirements and the making of specifications. In order to evaluate the use of F-DEMO a survey was held to check how many of the findings that were raised when producing the information system at the intermediary could be prevented. The findings were categorized in implementation, requirements, usability, misunderstandings, wishes and irrelevant types. From all these findings 33,1 percent could be prevented using the new methodology. The project time is also reduced. Therefore, the recommendation is to start using the F-DEMO methodology in future projects.Software TechnologyElectrical Engineering, Mathematics and Computer Scienc
DEMO applied to Quality Management Systems
No full textQuality Management Systems are to be found in different lines of business and it is quite a challenge to describe an organization's processes as clearly and compactly as possible and such that they still remain comprehensible. The DEMO methodology models the essence of an organization and claims to be coherent, consistent, comprehensive and concise. In addition, DEMO aims to define an organization in such a way that it is compatible with the Quality Management System. The challenges that exist in describing the processes and the advantages that DEMO claims to bring makes it interesting to research DEMOs added value to QMS. In this master thesis, DEMO representation techniques will be compared and used for the construction of a QMS handbook in order to assess the added value of DEMO.Electrical Engineering, Mathematics and Computer Scienc
How the DEMO methodology could be a valuable addition to a testing framework
No full textBecause many errors still exist in information systems for organizations, professional companies like CEPO are needed for testing information systems on their fit to the organization. To do so, one usually applies a testing framework. The existing (CEPO-way) framework is the result of ten years of experience. The DEMO methodology (Dietz [1]) is a methodology that has proven itself successful in modelling organizations. DEMO is a powerful tool for identifying all important transactions of an organization (as well as communication with external actors). From this point of view, it could be possible to use DEMO as an aid to check the completeness of an information system, i.e. whether it covers the essential business processes. Note that the coverage need not be full; in particular for small and medium-sized enterprises it may be partial. The existing CEPO-way framework is based on the DEMO methodology, but on only one model. In this study two models were added. The new, so-called DEMO-way, framework was discussed and one test case was used to demonstrate the added value. The new framework is supported by a tool that was built by the author, DEMO-way Script Creator (DSC tool). This tool is a valuable addition to the derivation of testing scripts, because the process model as well as the state model can be placed into the scripts with little effort. Several criteria were determined at the start of this study in order to evaluate the use of extra DEMO models in the framework: development time, walkthrough time, understandability, reproduction possibilities and lacking functionality / error detection. Ultimately, the DEMO-way scored better for many of these criteria, especially the detection of lacking functionality / errors in information systems. Although the DEMO testing script encompasses more testing instructions than the CEPO testing script, the testers did not spend more time walking through the scripts, due to more detailed navigation. Therefore, the recommendation is to start using the two extra DEMO models in combination with DSC tool.Electrical Engineering, Mathematics and Computer Scienc
Using DEMO to Specify the Semantics of Data Message
No full textEffective communication is required for a successful service execution. It can be achieved when both the service consumer and service provider understand the exchanged data message in the same way. Therefore, the specification of the semantics of data message needs to be explicitly defined in the service specification. Six requirements for specifying the semantics of data message are formulated based on the data modeling approach. DEMO is selected to be the methodology for representing the semantics of data message. Since one of the requirements is not completely fulfilled by DEMO; DEMO is extended by using ORM. Finally, the specification of the semantics of the data message of a case study is implemented by using DEMO. It indicates the DEMO usability for specifying the semantics of data messages.Software TechnologyElectrical Engineering, Mathematics and Computer Scienc
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