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Biomedical subjects

E C Benzel

Publications and source records attributed to E C Benzel.

At least 73 records · Page 4Linked to original sources
PubMed1993

Short-segment compression instrumentation for selected thoracic and lumbar spine fractures: the short-rod/two-claw technique.

The short-rod/two-claw (SRTC) technique of spine instrumentation was recently introduced for the treatment of thoracic and lumbar spine fractures. The use of this technique in 10 patients harboring wedge compression or burst fractures of the thoracic or lumbar spine is described. Of three patients treated with the construct placed in a distraction mode, the average follow-up loss of angle (the difference between the immediate postoperative and follow-up midsagittal angle as measured on x-ray films) was 18.3 degrees. Of the seven patients in whom the instrumentation was placed in a compression mode, the average observed loss of angle at follow-up examination was 1.6 degrees. Two patients had a preoperative scoliotic deformity at the fracture site, and both deformities were exaggerated by the placement of the SRTC technique in compression. Although no patient experienced an adverse outcome and all achieved a solid fusion, the application of the SRTC technique of universal spine instrumentation in distraction was associated with an exaggerated loss of angle. Loss of angle and deformity exaggeration are not desirable and are preventable by strict patient selection and by applying the construct in a compression mode. It is emphasized that few patients are candidates for this form of instrumentation. When applicable, however, the advantages of decreased pain and stiffness and the elimination of the need for instrumentation removal make the SRTC and related short-segment techniques desirable alternatives to traditional methods of spinal fixation.

Adolescent↗
PubMed1993

The sequential hook insertion technique for universal spine instrumentation application. Technical note.

A new technique of universal spine instrumentation insertion for the management of thoracic and lumbar spine instability is presented and the results in 10 patients are described. The technique involves the sequential insertion of Texas Scottish Rite Hospital (TSRH) central-post hooks, followed by hook fixation to the rod; force is then applied with correction of deformity, if needed. This allows for methodical, safe, and rapid instrumentation insertion. The new TSRH central-post hook configuration permits manipulation of the hook/rod relationships to the advantage of the surgeon (and patient) by providing more room for both hook insertion and hook/rod fixation. This technique has reduced operative time, facilitated ease of deformity correction, and provided uniformly acceptable early postsurgical results.

Equipment Design↗
PubMed1992

Slit ventricle syndrome in children: clinical presentation and treatment.

Symptomatic ventricular coaptation, or the slit ventricle syndrome, is frequently described and recognized as a clinical entity in the pediatric population. It is characterized by symptoms of shunt failure (i.e., ataxia, obtundation, nausea, vomiting, lethargy, irritability, and complaints of headache) and the CT findings of ventricular coaptation (slit-like ventricles). This study of twenty-two children with this syndrome reflects the variety of possible clinical presentations, and the variety of available treatment modalities. Multiple therapeutic approaches were required in seven of the patients. This illustrates not only an evolving treatment regimen, but also that a single treatment modality is not universally effective. Six patients needed only occasional symptomatic support. Blockage and/or removal of the shunt system was the definitive therapy in six patients, pressure augmentation in nine patients, and subtemporal craniectomy in one. This article outlines the theoretical pathophysiology, and a scheme for the management of patients with this syndrome.

Cerebral Hemorrhage↗
PubMed1992

Effects of naloxone and nalmefene in rat spinal cord injury induced by the ventral compression technique.

The neural injury prevention capabilities of narcotic antagonists have previously been reported. Of the available narcotic antagonists, naloxone has been the most widely studied. Other agents with higher potency, longer half-lives, and greater specificity, however, may be more desirable for the prevention of the "secondary injury" following a primary neural insult. The relative neural injury prevention efficacies of the various narcotic antagonists is not known. The establishment of the relative effectiveness of these drugs is warranted and is of potential clinical importance. Therefore, a study was undertaken to compare the effects of the two narcotic antagonists, naloxone and nalmefene, with respect to their neuro-protective efficacy following experimental spinal cord injury (SCI) in rats. Ninety adult Sprague-Dawley rats were divided into three groups--control; naloxone (2 mg/kg i.p., 45 min following injury); and nalmefene (0.1 mg/kg i.p., 45 min following injury)--following lesioning with the ventral SCI technique. Results were evaluated by the inclined-plane technique and neurologic examination at 1 day and 1 week following injury. Histomorphological evaluation of the injured segment of spinal cord was performed following euthanasia at 1 week following injury. A significant improvement (compared with the control group) was noted in both treatment groups. This was observed with respect to neurological examination and inclined-plane scores in both treatment groups at 24 h and 1 week following lesioning (with a significance level of at least p less than 0.001; analysis of variance). The nalmefene group demonstrated a greater level of function than the naloxone group at both 24 h and 1 week following injury (not significant; p greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Torulopsis glabrata vertebral osteomyelitis.

A case of Torulopsis glabrata osteomyelitis of the thoracic spine producing spinal cord compression and myelopathy is reported. The patient displayed several of the predisposing factors to T. glabrata infection, including diabetes mellitus, a history of abdominal surgery, and intravenous catheterization with hyperalimentation. The patient was successfully managed with surgical decompression, debridement, and curettage of the affected bone, postoperative immobilization, and systemic amphotericin B therapy. Her pain was relieved, spinal cord function recovered, and the vertebrae healed uneventfully. T. glabrata osteomyelitis is a rare and unpredictably progressive infection. This case demonstrates that it requires prompt therapy and close observation.

Aged↗
PubMed1992

Histological comparison of autogenous canine fascia lata, Gore-Tex, lyophilized human fascia lata, and autogenous canine vein for vascular patch graft material in a canine arteriotomy model.

Autogenous fascia lata has found little clinical use as a vascular patch graft material. Previous experience, however, suggests that it possesses attributes that might make it useful in this regard. To assess its efficacy as a vascular patch graft, nine adult mongrel dogs each underwent four arteriotomies with placements of patch grafts. The four sites included both carotid arteries and both femoral arteries. In each animal, one of four patch graft materials (autogenous canine fascia lata, Gore-Tex, lyophilized human fascia lata, and autogenous canine vein) were placed as patch material at the arteriotomy site utilizing 7-0 running sutures and loop magnification. The site for placement of each graft material was rotated serially in the animals so that each site would have equal numbers of all four graft materials applied. The animals were killed at either 6 to 8 weeks or 11 to 12 weeks after angiography of all four vessels. The specimens were then evaluated histologically. No difference was observed among any of the patch graft materials with regard to myofibroblast plaque formation. Inflammatory responses were noted to be substantially less in the canine fascia lata group than in the other three groups. Granuloma formation, however, appeared to be most significant in the autogenous canine vein group. Only one vessel was occluded. Aneurysm or pseudoaneurysm formation was not noted in any specimen. It appears from the above results that autogenous fascia lata may be an appropriate alternative to currently utilized arterial patch graft materials and that it should be evaluated further for this purpose.

Animals↗
PubMed1992

The role of early tracheotomy in the management of the neurosurgical patient.

Neurosurgical patients often require prolonged laryngeal intubation. The literature regarding the management of these patients is controversial, with some series reporting increased benefits of early tracheotomy and others reporting similar benefits of prolonged transtracheal intubation. One hundred sixteen consecutive neurosurgical patients who had tracheotomies performed during a 5-year period are presented in order to clarify some of the factors involved with these issues. The complications that occurred in this series were less frequent than those reported in most of the published series. Of the 116 patients, 7 had posttracheotomy complications. These complications included stomal infections (4 patients), hemorrhage (1 patient), subglottic granulation tissue (1 patient), and tracheitis (1 patient). All complications were easily treated and caused no significant long-term morbidity. Furthermore, pulmonary care was universally facilitated by the placement of a tracheotomy. The performance of an early postinjury tracheotomy may prevent the known complications of prolonged endotracheal intubation while providing effective ventilation and pulmonary toilet through safe and comfortable access to the airway. Early postinjury tracheotomy is not associated with a high incidence of significant complications in the neurosurgical patient population.

Adolescent↗
PubMed1992

Apnea testing for the determination of brain death: a modified protocol. Technical note.

The absence of spontaneous respirations at a PaCO2 of 60 mm Hg or above has traditionally been accepted as the respiratory criteria for the determination of brain death. The testing of patients for the presence or absence of apnea has been complicated because the rate of PaCO2 elevation may vary substantially from patient to patient, and a nonlinear relationship exists between the rate of PaCO2 increase and the duration of apnea. In an attempt to refine the apnea test and to further elucidate the physiology of hypercapnia in humans, 11 patients who met all but the respiratory criteria for brain death were evaluated using a modification of a previously utilized apnea testing protocol. All patients were brought to a PaCO2 of 40 mm Hg or above prior to the apnea test. Baseline PaCO2 ranged from 40 to 45 mm Hg in six patients (Group I) and from 46 to 51 mm Hg in five patients (Group II). The mean rate of PaCO2 increase was 5.1 +/- 1.4 mm Hg/min in Group I and 6.7 +/- 3.1 mm Hg/min in Group II. No problems with cardiovascular instability or hypoxia were encountered during testing in this series. This refinement of the apnea test allows for a streamlined and safe approach to brain death detection.

Adolescent↗
PubMed1992

Childhood odontoid fractures evaluated with computerized tomography. Case report.

A case is presented that illustrates the use of computerized tomography for the evaluation of an odontoid fracture in a child. Such a "fracture" may actually represent a "synchondrotic slip" of the odontoid and C-2 vertebral body between the neural arches of C-2. Treatment should almost always be conservative. Complete healing of the injury is expected.

Child, Preschool↗
PubMed1992

The thermoplastic Minerva body jacket: a clinical comparison with other cervical spine splinting techniques.

A retrospective analysis of the efficacy of a variety of external stabilization techniques used in 155 cases of unstable cervical spine injuries is presented. The movement at each intervertebral level was evaluated during thermoplastic Minerva body jacket stabilization in 18 additional patients. Many currently available approaches to external stabilization of the cervical spine were, thus, assessed. Thermoplastic Minerva body jacket stabilization offered superior segmental immobilization compared with published data for the halo. It is concluded that some unstable injuries to the high cervical spine might best be treated with a halo device, whereas mid to low cervical injuries and the remaining upper cervical spine injuries appear to be optimally treated with a Minerva jacket. Lesser injuries may be treated with a variety of available orthoses. The thermoplastic Minerva body jacket offers a superior limitation of intervertebral movement compared with other commonly used braces, including the halo jacket, for most cervical spine injuries. The technique of application of the thermoplastic Minerva body jacket is reviewed.

Braces↗
PubMed1991

Factors associated with postoperative hypertension complicating carotid endarterectomy.

Blood pressure lability following carotid endarterectomy is a commonly observed phenomenon. Distinct hypertensive and hypotensive responses exist. Unlike postoperative hypotension, the etiology of postoperative hypertension remains unclear. In order to examine factors associated with hypertension following carotid endarterectomy, 100 carotid endarterectomies were examined retrospectively. The variables evaluated included pre- and postoperative blood pressure, age, sex, race, the use of an indwelling shunt, and complications. Postoperative hypertension (defined as systolic blood pressure greater than or equal to 200 mm Hg, diastolic blood pressure greater than 100 mm Hg, or any BP requiring intravenous infusion of antihypertensive agents for control), was observed in 35% of all patients. Postoperative hypertension was significantly associated with both preoperative systolic and diastolic blood pressure elevation, as well as the use of indwelling shunts. Increased age and race (black) were also associated with an increased incidence of postoperative hypertension. No correlation existed with respect to postoperative complications. In view of an observed lack of correlation with postoperative complications, a cautious and conservative therapeutic approach must be undertaken for postoperative hypertension. It is suggested that, perhaps, the utilization of transcutaneous doppler evaluations may be useful for assessing the clinical significance of postoperative hypertension.

Adult↗
PubMed1991

Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy.

Seventy-five patients who underwent surgical treatment for cervical spondylotic myelopathy were evaluated with respect to the operative procedure performed and their outcome. Forty patients underwent a laminectomy plus dentate ligament section (DLS), 18 underwent laminectomy alone, and 17 underwent an anterior cervical decompression and fusion (ACDF). The patients were evaluated postoperatively for both stability and for neurologic outcome using a modification of the Japanese Orthopaedic Association Assessment Scale. Functional improvement occurred in all but one patient in the laminectomy plus DLS group. The average improvement was 3.1 +/- 1.5 points in this group; whereas the average improvement in the laminectomy and the ACDF groups was 2.7 +/- 2.0 and 3.0 +/- 2.0 points respectively. All of the patients who improved substantially (greater than or equal to 6 points) in the laminectomy plus DLS and the laminectomy alone groups had normal cervical spine contours (lordosis). The remainder had either a normal lordosis or no curve (no kyphosis or lordosis). All patients in the ACDF group had either a straight spine or a cervical kyphosis. These factors implicate spine curvature, in addition to choice of operation, as factors which are important in outcome determination. No problems with instability occurred in either the laminectomy or the laminectomy plus DLS group. Two patients incurred problems with stability in the ACDF group. Both required reoperation. In addition, four patients in this group who initially improved, subsequently deteriorated. Six patients in the laminectomy plus DLS group had a several day febrile episode related to an aseptic meningitis process. Laminectomy plus DLS is a safe and efficacious alternative to laminectomy for the treatment of cervical spondylotic myelopathy. The data presented here suggests that myelopathic patients with a cervical kyphosis are best treated with an ACDF and that patients with a normal cervical lordosis are best treated with a posterior approach. Although some selected patients may benefit from DLS, no criteria are available which differentiate this small subset of patients.

Adult↗
PubMed1991

Civilian craniocerebral gunshot wounds.

Experience with 120 patients who incurred a gunshot wound to the head with dural penetration is presented. All of the patients were managed by a standard resuscitation protocol and assigned a clinical grade based on their level of consciousness both at the time of presentation and at 2 to 4 months after injury. Fifty patients (42%) underwent surgery. Twenty-eight patients (23%) had a good recovery, 19 (16%) were moderately disabled, 6 (5%) were severely disabled, and 67 (56%) died. All patients who were alert and awake with a normal or near normal neurological examination at the time of admission survived with a good outcome. All but 4 patients who were comatose at the time of admission died. Nine patients, however, who were not comatose at the time of admission died from potentially preventable causes. In 3 of these patients, a more aggressive diagnostic approach (including cerebral angiography) may have altered their ultimate outcome. An expeditious approach to the trauma victim with a comprehensive management scheme after injury may have altered the course in the remainder of these patients.

Adult↗
PubMed1991

A new method of methyl methacrylate fixation in skull reconstruction.

Fifty-two methyl methacrylate cranioplasties were performed in 47 patients over a 5-year period. The indications for the original craniectomy fell into four categories. Nine patients had a craniectomy for tumor, 32 for trauma, 5 for infection, and 1 for aneurysm. A new approach, which eliminates the need for suture or wire fixation and which facilitates intraoperative calvarial contouring, is presented. An excellent cosmetic result is the norm with this technique.

Adolescent↗