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Abhaya V Kulkarni - One of the best experts on this subject based on the ideXlab platform.
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the quality of youtube videos on Endoscopic Third Ventriculostomy and Endoscopic Third Ventriculostomy with choroid plexus cauterization procedures available to families of patients with pediatric hydrocephalus
Journal of Neurosurgery, 2020Co-Authors: Nicholas Sader, Abhaya V Kulkarni, Matthew E Eagles, Salim Ahmed, Jenna E Koschnitzky, Jay RivacambrinAbstract:OBJECTIVE YouTube has become an important information source for pediatric neurosurgical patients and their families. The goal of this study was to determine whether the informative quality of videos of Endoscopic Third Ventriculostomy (ETV) and Endoscopic Third Ventriculostomy with choroid plexus cauterization (ETV + CPC) is associated with metrics of popularity. METHODS This cross-sectional study used comprehensive search terms to identify videos pertaining to ETV and ETV + CPC presented on the first 3 pages of search results on YouTube. Two pediatric neurosurgeons, 1 neurosurgery resident, and 2 patient families independently reviewed the selected videos. Videos were assessed for overall informational quality by using a validated 5-point Global Quality Score (GQS) and compared to online metrics of popularity and engagement such as views, likes, likes/views ratio, comments/views ratio, and likes/dislikes ratio. Weighted kappa scores were used to measure agreement between video reviewers. RESULTS A total of 58 videos (47 on ETV, 7 on ETV + CPC, 4 on both) of 120 videos assessed met the inclusion criteria. Video styles included "technical" (62%), "lecture" (24%), "patient testimonial" (4%), and "other" (10%). In terms of GQS, substantial agreement was seen between surgeons (kappa 0.67 [95% CI 0.55, 0.80]) and excellent agreement was found between each surgeon and the neurosurgical resident (0.77 [95% CI 0.66, 0.88] and 0.89 [95% CI 0.82, 0.97]). Only fair to moderate agreement was seen between professionals and patient families, with weighted kappa scores ranging from 0.07 to 0.56. Academic lectures were more likely to be rated good or excellent (64% vs 0%, p < 0.001) versus surgical procedure and testimonial video types. There were significant associations between a better GQS and more likes (p = 0.01), views (p = 0.02), and the likes/dislikes ratio (p = 0.016). The likes/views ratio (p = 0.31) and comments/views ratio (p = 0.35) were not associated with GQS. The number of likes (p = 0.02), views (p = 0.03), and the likes/dislikes ratio (p = 0.015) were significantly associated with video style (highest for lecture-style videos). CONCLUSIONS Medical professionals tended to agree when assessing the overall quality of YouTube videos, but this agreement was not as strongly seen when compared to parental ratings. The online metrics of likes, views, and likes/dislikes ratio appear to predict quality. Neurosurgeons seeking to increase their online footprint via YouTube would be well advised to focus more on the academic lecture style because these were universally better rated.
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Endoscopic Third Ventriculostomy with choroid plexus cauterization etv cpc versus csf shunting
2019Co-Authors: Abhaya V KulkarniAbstract:Choroid plexus removal and cautery was described a century ago, but went out of vogue due to its technical difficulty and associated morbidity. From the 1950s to 2000s, cerebrospinal fluid shunts and Endoscopic Third Ventriculostomy (ETV) remained the mainstay of treatment for pediatric hydrocephalus, including infants. In the 2000s, Warf’s innovative development of the modern ETV with choroid plexus cauterization (CPC) technique and robust scientific study in the unique setting of the CURE Children’s Hospital of Uganda brought a renaissance of choroid plexus obliteration as a safe and effective treatment option. This chapter recounts the history of choroid plexus surgery, explains its biologic and pathophysiologic basis, describes the operative technique and outcome of ETV+CPC in the global setting, and compares it with other conventional treatments.
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outcome of treatment after failed Endoscopic Third Ventriculostomy etv in infants with aqueductal stenosis results from the international infant hydrocephalus study iihs
Childs Nervous System, 2017Co-Authors: Abhaya V Kulkarni, Spyros Sgouros, Shlomi ConstantiniAbstract:Introduction After an Endoscopic Third Ventriculostomy (ETV) fails, it is unclear how well subsequent treatment fares, especially in comparison to shunts inserted as primary treatment. In this study, we present a further analysis of the infants enrolled a prospective multicentre study who failed ETV and describe the outcome of their subsequent treatment, comparing this to those who received shunt as their primary treatment.
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international infant hydrocephalus study initial results of a prospective multicenter comparison of Endoscopic Third Ventriculostomy etv and shunt for infant hydrocephalus
Childs Nervous System, 2016Co-Authors: Abhaya V Kulkarni, Spyros Sgouros, Shlomi Constantini, Iihs InvestigatorsAbstract:Introduction The IIHS is an international, prospective, multicenter study to compare Endoscopic Third Ventriculostomy (ETV) and shunt in infants (<24 months old) with symptomatic triventricular hydrocephalus from aqueductal stensosis. Recruitment started in 2004, and here, we present the first results of IIHS.
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evaluating the children s hospital of alabama Endoscopic Third Ventriculostomy experience using the Endoscopic Third Ventriculostomy success score an external validation study
Journal of Neurosurgery, 2011Co-Authors: Robert P Naftel, Abhaya V Kulkarni, Gavin T Reed, John C WellonsAbstract:Object Endoscopic Third Ventriculostomy (ETV) success is dependent on patient characteristics including age, origin of hydrocephalus, and history of shunt therapy. Using these factors, an Endoscopic Third Ventriculostomy Success Score (ETVSS) model was constructed to predict success of therapy. This study reports a single-institution experience with ETV and explores the ETVSS model validity. Methods A retrospective chart review identified 151 consecutive patients who underwent ETV at a pediatric hospital between August 1995 and December 2009. Of these 151, 136 patients had at least 6 months of clinical follow-up. Data concerning patient characteristics, operative characteristics, radiological findings, complications, and success of ETV were collected. The actual success rates were compared with those predicted by the ETVSS model. Results The actual success rate of ETV at 6 months was 68.4% (93 of 136 patients), which compared well to the predicted ETVSS of 76.5% ± 12.5% (± SD). The C-statistic was 0.74 (9...
Mark M Souweidane - One of the best experts on this subject based on the ideXlab platform.
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pineal region tumors simultaneous Endoscopic Third Ventriculostomy and tumor biopsy
World Neurosurgery, 2013Co-Authors: Peter F Morgenstern, Mark M SouweidaneAbstract:Objective Advances in neuroendoscopy have accommodated the development of intraventricular techniques that enhance the management of multiple disease processes. Tumors of the pineal region are amenable to Endoscopic management in that they are accessible through the Third ventricle and commonly cause hydrocephalus that can be alleviated by Endoscopic Third Ventriculostomy (ETV). We describe the indications for and procedure of simultaneous ETV and biopsy of pineal region tumors, as well as the clinical features favoring different approaches to this procedure. Methods The current literature on Endoscopic management of pineal region tumors and the senior author's clinic experience with current techniques are reviewed. Results Simultaneous tumor biopsy with ETV following initial evaluation with tumor markers and imaging can be accomplished using a single or dual entry approach. The choice of approach is dependent on multiple clinical factors including massa intermedia size, goals of surgery, degree of hydrocephalus, and the relationship between the tumor and massa intermedia. Conclusions Simultaneous ETV and tumor biopsy is a valuable technique that can be used to manage hydrocephalus and establish diagnosis in patients with newly diagnosed pineal region tumors, potentially avoiding traditional craniotomy and ventriculoperitoneal shunt placement. It is favored as an early step in the management of patients with marker-negative tumors.
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pineal region tumors an optimal approach for simultaneous Endoscopic Third Ventriculostomy and biopsy
Neurosurgical Focus, 2011Co-Authors: Peter F Morgenstern, Nathan Osbun, Theodore H Schwartz, Jeffrey P Greenfield, Apostolos John Tsiouris, Mark M SouweidaneAbstract:Object Simultaneous Endoscopic Third Ventriculostomy (ETV) and tumor biopsy is a widely accepted therapeutic and diagnostic procedure for patients with noncommunicating hydrocephalus secondary to a pineal region tumor. Multiple approaches have been advocated, including the use of a steerable fiberoptic or rigid lens endoscope via 1 or 2 trajectories. However, the optimal approach has not been established based on the individual anatomical characteristics of the patient. Methods A retrospective review of patients undergoing simultaneous ETV and tumor biopsy was undertaken. Preoperative MR images were examined to measure the width of the anterior Third ventricle and maximal diameters of the tumor, Monro foramen (right), and massa intermedia. The distances between the tumor and massa intermedia, tumor and anterior commissure, midbrain and massa intermedia, and the dorsum sella and anterior commissure were also recorded. Single and dual trajectory approaches were compared using paired t-tests for each paramet...
Giuseppe Cinalli - One of the best experts on this subject based on the ideXlab platform.
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long term results of Endoscopic Third Ventriculostomy an outcome analysis
Journal of Neurosurgery, 2015Co-Authors: Sonja Vulcu, Giuseppe Cinalli, Leonie Eickele, Wolfgang Wagner, Joachim OertelAbstract:OBJECT Endoscopic Third Ventriculostomy (ETV) is the procedure of choice in the treatment of obstructive hydrocephalus. The excellent clinical and radiological success rates are well known. Nevertheless, very few papers have addressed the very long term outcomes of the procedure in very large series. The authors present a large case series of 113 patients who underwent 126 ETVs, and they highlight the initial postoperative outcome after 3 months and long-term follow-up with an average of 7 years. METHODS All patients who underwent ETV at the Department of Neurosurgery, Mainz University Hospital, between 1993 and 1999 were evaluated. Obstructive hydrocephalus was the causative pathology in all cases. RESULTS The initial clinical success rate was 82% and decreased slightly to 78% during long-term follow-up. Long-term success was analyzed using Kaplan-Meier curves. Overall, ETV failed in 31 patients. These patients underwent a second ETV or shunt treatment. A positive impact on long-term success was seen for...
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Endoscopic Third Ventriculostomy for idiopathic aqueductal stenosis.
World Neurosurgery, 2013Co-Authors: Pietro Spennato, Giuseppe Cinalli, Sanna Tazi, Olivier Bekaert, Philippe DecqAbstract:Background Idiopathic aqueductal stenosis is a cause of noncommunicating hydrocephalus, which actual treatment with Endoscopic Third Ventriculostomy (ETV) could assess without any interference with the etiology. The results of ETV in this indication therefore could be interpreted as the result of the surgical procedure alone, without any additional factors related to the etiology of the cerebrospinal fluid pathway obstruction, such as hemorrhage, infection, brain malformations, or brain tumors or cysts. Methods After a brief description of pathogenesis of hydrocephalus in aqueductal stenosis, the authors review the literature for studies on ETV, extrapolating patients with idiopathic aqueductal stenosis in infancy, childhood, and adulthood. Differences in outcome between patients treated with ETV and patients treated with ventriculoperitoneal shunt (VPS) are also reviewed. Results The overall success rates of ETV range between 23% to 94%, with a mean of 68%; when only patients affected by obstructive triventricular hydrocephalus secondary to aqueductal stenosis are considered, the success rate is actually quite homogeneous and stable, being above 60% at any age, even if a trend in lower success rate in very young infants (younger than 6 months of age) is noticeable. The few reports on intellectual outcome failed to demonstrate differences between ETV and VPS. Conclusions Several issues, such as the cause of failures in well-selected patients, long-term outcome in infants treated with ETV, effects of persistent ventriculomegaly on neuropsychological developmental, remain unanswered. Larger and more detailed studies are needed.
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Endoscopic Third Ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children
Childs Nervous System, 2004Co-Authors: Claudio Ruggiero, Giuseppe Cinalli, Pietro Spennato, Ferdinando Aliberti, Emilio Cianciulli, Vincenzo Trischitta, Giuseppe MaggiAbstract:Object The purpose of the present study is to assess the effectiveness of Endoscopic Third Ventriculostomy (ETV) in children with hydrocephalus related to posterior fossa tumors.
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Endoscopic Third Ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children
Childs Nervous System, 2004Co-Authors: Claudio Ruggiero, Giuseppe Cinalli, Pietro Spennato, Ferdinando Aliberti, Emilio Cianciulli, Vincenzo Trischitta, Giuseppe MaggiAbstract:The purpose of the present study is to assess the effectiveness of Endoscopic Third Ventriculostomy (ETV) in children with hydrocephalus related to posterior fossa tumors. Between September 1999 and December 2002, 63 children with posterior fossa tumors were treated at Santobono Hospital in Naples, Italy. Twenty-six patients had severe hydrocephalus. In order to relieve intracranial hypertension before tumor removal, 20 were treated with ETV, and 6 with ventriculo-peritoneal (VP) shunts. Twenty patients with mild hydrocephalus were treated with diuretics, corticosteroid agents, and early posterior fossa surgery, and 17 patients who did not have hydrocephalus were treated by elective posterior fossa surgery. Another 4 ETV were performed in the management of postoperative hydrocephalus. Preoperative ETV procedures were technically successful. One was complicated by intraventricular bleeding. The successful 19 preoperative ETV resolved intracranial hypertension before posterior fossa surgery in all cases. Three of these 19 patients developed postoperative hydrocephalus and were treated by VP shunt insertion after posterior fossa surgery. Out of the 4 ETV performed after posterior fossa surgery, only 2 were successful, both when the shunt malfunctioned. Endoscopic Third Ventriculostomy should be considered as an alternative procedure to ventriculo-peritoneal shunting and external ventricular draining for the emergency control of severe hydrocephalus caused by posterior fossa tumors, since it can quickly eliminate symptoms, and hence, can delay surgery scheduling if required. Even though ETV does not prevent postoperative hydrocephalus in all cases, it does protect against acute postoperative hydrocephalus due to cerebellar swelling. In addition, it eliminates the risks of cerebrospinal fluid (CSF) infection related to external drainage and minimizes the risk of overdrainage because it provides more physiological CSF drainage than the other procedures. Since postoperative hydrocephalus is very often physically obstructive, ETV should always be considered a possible treatment procedure.
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management of hydrocephalus in pediatric patients with posterior fossa tumors the role of Endoscopic Third Ventriculostomy
Journal of Neurosurgery, 2001Co-Authors: Christian Sainterose, Giuseppe Cinalli, Michel Zerah, Paul Chumas, Franck E Roux, William Maixner, Maheir Mansour, Alexandre Carpentier, Marie Bourgeois, Alain PierrekahnAbstract:Object. The authors undertook a study to evaluate the effectiveness of Endoscopic Third Ventriculostomy in the management of hydrocephalus before and after surgical intervention for posterior fossa tumors in children. Methods. Between October 1, 1993, and December 31, 1997, a total of 206 consecutive children with posterior fossa tumors underwent surgery at Hopital Necker—Enfants Malades in Paris. Excluded were 10 patients in whom shunts had been placed at the referring hospital. The medical records and neuroimaging studies of the remaining 196 patients were reviewed and categorized into three groups: Group A, 67 patients with hydrocephalus present on admission in whom Endoscopic Third Ventriculostomy was performed prior to tumor removal; Group B, 82 patients with hydrocephalus who did not undergo preliminary Third Ventriculostomy but instead received conventional treatment; and Group C, 47 patients in whom no ventricular dilation was present on admission. There were no significant differences between pat...
Spyros Sgouros - One of the best experts on this subject based on the ideXlab platform.
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outcome of treatment after failed Endoscopic Third Ventriculostomy etv in infants with aqueductal stenosis results from the international infant hydrocephalus study iihs
Childs Nervous System, 2017Co-Authors: Abhaya V Kulkarni, Spyros Sgouros, Shlomi ConstantiniAbstract:Introduction After an Endoscopic Third Ventriculostomy (ETV) fails, it is unclear how well subsequent treatment fares, especially in comparison to shunts inserted as primary treatment. In this study, we present a further analysis of the infants enrolled a prospective multicentre study who failed ETV and describe the outcome of their subsequent treatment, comparing this to those who received shunt as their primary treatment.
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international infant hydrocephalus study initial results of a prospective multicenter comparison of Endoscopic Third Ventriculostomy etv and shunt for infant hydrocephalus
Childs Nervous System, 2016Co-Authors: Abhaya V Kulkarni, Spyros Sgouros, Shlomi Constantini, Iihs InvestigatorsAbstract:Introduction The IIHS is an international, prospective, multicenter study to compare Endoscopic Third Ventriculostomy (ETV) and shunt in infants (<24 months old) with symptomatic triventricular hydrocephalus from aqueductal stensosis. Recruitment started in 2004, and here, we present the first results of IIHS.
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complications of Endoscopic Third Ventriculostomy
World Neurosurgery, 2013Co-Authors: Triantafyllos Bouras, Spyros SgourosAbstract:Background The treatment of choice for several types of obstructive hydrocephalus is Endoscopic Third Ventriculostomy (ETV). However, in certain cases ETV is not clearly superior to shunt placement, and a question of choice arises. Apart from the possibility of success in each case, knowledge of complication rates is of major importance as well. Material Several series of ETVs have been published by various specialized centers. The reported overall complication rate is usually between 5% and 15%, and related permanent morbidity lower than 3%. The reported mortality of ETV is lower than 1%. Results The most frequent intraoperative complications of ETV are hemorrhage (the most severe being due to basilar rupture) and injury of neural structures. In the immediate postoperative period, hematomas, infections, and cerebrospinal fluid leaks may present. Morbidity can be neurological and/or hormonal. Systemic complications are related more to the patient's general status and less to the procedure itself. Late sudden deterioration, leading as a rule to a patient's death, has been reported. Its incidence is not exactly known, but probably is lower than 0.1%. Nevertheless, the severity of this complication necessitates alertness and informing the patient. Conclusions The complication rate of ETV is low, and rarely is a reason for choosing shunt placement instead. However, as a method it requires considerable experience, and several studies report a relation of experience not only with success rates but also with complication avoidance.
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complications of Endoscopic Third Ventriculostomy
Journal of Neurosurgery, 2011Co-Authors: Triantafyllos Bouras, Spyros SgourosAbstract:Object Endoscopic Third Ventriculostomy (ETV) is an established treatment for hydrocephalus. Most studies focus on success rate, and complications are insufficiently documented. The aim of this study was to perform a systematic review of ETV complications. Methods A Medline search discovered 34 series of ETV with detailed complications reports (17 series involving exclusively pediatric patient populations, 6 series involving exclusively adults, and 11 series involving mixed adult and pediatric populations). Results The analysis included 2985 ETVs performed in 2884 patients. The cause of hydrocephalus was aqueductal stenosis in 29.3% of patients, tumor in 37.6%, meningomyelocele in 7.6%, cysts in 2.6%, cerebellar infarct in 0.9%, Dandy-Walker malformation in 0.6%, and Chiari malformation Type I in 0.4%; 7.4% of the patients had posthemorrhagic hydrocephalus, 1.8% had postinfectious hydrocephalus, and 1.2% had normal pressure hydrocephalus. Hydrocephalus was due to other causes in 1.3% of cases and the caus...
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Endoscopic Third Ventriculostomy in the treatment of childhood hydrocephalus
The Journal of Pediatrics, 2009Co-Authors: Abhaya V Kulkarni, James M Drake, Conor Mallucci, Spyros Sgouros, Jonathan Roth, Shlomi ConstantiniAbstract:Objective To develop a model to predict the probability of Endoscopic Third Ventriculostomy (ETV) success in the treatment for hydrocephalus on the basis of a child's individual characteristics. Study design We analyzed 618 ETVs performed consecutively on children at 12 international institutions to identify predictors of ETV success at 6 months. A multivariable logistic regression model was developed on 70% of the dataset (training set) and validated on 30% of the dataset (validation set). Results In the training set, 305/455 ETVs (67.0%) were successful. The regression model (containing patient age, cause of hydrocephalus, and previous cerebrospinal fluid shunt) demonstrated good fit (Hosmer-Lemeshow, P = .78) and discrimination (C statistic=0.70). In the validation set, 105/163 ETVs (64.4%) were successful and the model maintained good fit (Hosmer-Lemeshow, P = .45), discrimination (C statistic=0.68), and calibration (calibration slope=0.88). A simplified ETV Success Score was devised that closely approximates the predicted probability of ETV success. Conclusions Children most likely to succeed with ETV can now be accurately identified and spared the long-term complications of CSF shunting.
Peter F Morgenstern - One of the best experts on this subject based on the ideXlab platform.
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pineal region tumors simultaneous Endoscopic Third Ventriculostomy and tumor biopsy
World Neurosurgery, 2013Co-Authors: Peter F Morgenstern, Mark M SouweidaneAbstract:Objective Advances in neuroendoscopy have accommodated the development of intraventricular techniques that enhance the management of multiple disease processes. Tumors of the pineal region are amenable to Endoscopic management in that they are accessible through the Third ventricle and commonly cause hydrocephalus that can be alleviated by Endoscopic Third Ventriculostomy (ETV). We describe the indications for and procedure of simultaneous ETV and biopsy of pineal region tumors, as well as the clinical features favoring different approaches to this procedure. Methods The current literature on Endoscopic management of pineal region tumors and the senior author's clinic experience with current techniques are reviewed. Results Simultaneous tumor biopsy with ETV following initial evaluation with tumor markers and imaging can be accomplished using a single or dual entry approach. The choice of approach is dependent on multiple clinical factors including massa intermedia size, goals of surgery, degree of hydrocephalus, and the relationship between the tumor and massa intermedia. Conclusions Simultaneous ETV and tumor biopsy is a valuable technique that can be used to manage hydrocephalus and establish diagnosis in patients with newly diagnosed pineal region tumors, potentially avoiding traditional craniotomy and ventriculoperitoneal shunt placement. It is favored as an early step in the management of patients with marker-negative tumors.
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pineal region tumors an optimal approach for simultaneous Endoscopic Third Ventriculostomy and biopsy
Neurosurgical Focus, 2011Co-Authors: Peter F Morgenstern, Nathan Osbun, Theodore H Schwartz, Jeffrey P Greenfield, Apostolos John Tsiouris, Mark M SouweidaneAbstract:Object Simultaneous Endoscopic Third Ventriculostomy (ETV) and tumor biopsy is a widely accepted therapeutic and diagnostic procedure for patients with noncommunicating hydrocephalus secondary to a pineal region tumor. Multiple approaches have been advocated, including the use of a steerable fiberoptic or rigid lens endoscope via 1 or 2 trajectories. However, the optimal approach has not been established based on the individual anatomical characteristics of the patient. Methods A retrospective review of patients undergoing simultaneous ETV and tumor biopsy was undertaken. Preoperative MR images were examined to measure the width of the anterior Third ventricle and maximal diameters of the tumor, Monro foramen (right), and massa intermedia. The distances between the tumor and massa intermedia, tumor and anterior commissure, midbrain and massa intermedia, and the dorsum sella and anterior commissure were also recorded. Single and dual trajectory approaches were compared using paired t-tests for each paramet...