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Biomedical subjects

E C Benzel

Publications and source records attributed to E C Benzel.

At least 109 records · Page 6Linked to original sources
PubMed1989

Postoperative stabilization of the posttraumatic thoracic and lumbar spine: a review of concepts and orthotic techniques.

A review of 109 case histories of patients who had undergone a spine fusion and/or posterior instrumentation procedure for thoracic and/or lumbar spine trauma was performed with respect to efficacy of several postoperative external splinting techniques. These data formed the basis for a review of external spinal splinting techniques. The type of orthosis that appears to offer the most efficacious immobilization and maximum patient comfort for fractures in the upper thoracic region in a body shell jacket extending from the submental and suboccipital regions to the lumbar region (modified Minerva jacket). To gain a lower point of fixation in patients with mid-to-low lumbar fractures, it was found that an extended body shell or an extension of a body jacket to one leg (hip spica) was necessary. Thoracic and thoracolumbar injuries may be stabilized with either a Jewett brace or a body jacket. The lack of maintenance of the cylindrical body shell, as well as excessive discomfort, make the Jewett brace and similar orthotic devices a second choice to body shell jackets for fractures in this region. The application of plastic polymer (Thermoplast) to spine splinting techniques offers the patient increased comfort and stability, as well as facilitating easy application and a more snug fit.

Equipment Design↗
PubMed1988

Nerve sheath tumors of the sciatic nerve and sacral plexus.

Eight patients with sciatic nerve and sacral plexus nerve sheath tumors, seen at Louisiana State University Medical Center in Shreveport, are presented. These cases illustrate the broad spectrum of pathology and modes of presentation of patients with nerve sheath tumors in this region. Patients can be divided into 4 groups. Group I includes subgluteal and/or thigh lesions with a well-defined mass on CT. Group II patients have neuroforaminal enlargement (defined by CT) and usually have radicular leg pain. Patients in group III have intrapelvic tumors with extension into the thigh. They usually have a poorly defined mass on CT. Group IV includes patients that have an intrapelvic mass (usually well defined) with radicular leg pain and/or mass effect. CT scanning proved to be the diagnostic procedure of choice. It delineated the location and extent of the tumor and thus was important in determining resectability. The variable course of these tumors is emphasized. A conservative nonoperative approach should be considered in asymptomatic and/or neurologically stable patients.

Adult↗
PubMed1988

Femoral obturator and sciatic neurectomy with iliacus and psoas muscle section for spasticity following spinal cord injury.

The treatment of severe refractory spasticity following spinal cord injury may raise challenging therapeutic problems. Classical approaches involve various types of myelotomies, rhizotomies and intrathecal injections of neurolytic substances. Alternative approaches include percutaneous rhizotomies and, more recently, the possible use of electrical stimulation of the spinal cord. Certain cases, however, may not be amenable to commonly accepted techniques. An operative technique is presented which involves a suprapubic incision for an infraperitoneal approach to a femoral and obturator neurectomy and an incision of the iliacus and psoas muscles bilaterally. This may be followed, when indicated, by a bilateral infragluteal section of the sciatic nerves. This technique offers a viable surgical alternative to the treatment of spasticity following spinal cord injury in cases where other traditional methods are contraindicated or have failed.

Adolescent↗
PubMed1988

Correlation between sex hormone binding and peritumoral edema in intracranial meningiomas.

Estrogen and progesterone receptor binding activity was measured in 22 intracranial meningioma surgical specimens. None of the tumors was estrogen receptor-positive, whereas 19 were progesterone receptor-positive. Of these 19 patients, all demonstrated significant computed tomographic (CT) evidence of peritumoral edema. None of the 3 patients who lacked progesterone receptor binding had CT evidence of peritumoral edema (P less than 0.005). Peritumoral edema associated with intracranial meningiomas seems to be related, at least in part, to progesterone binding activity. This implicates the potential use of progesterone antagonists for the treatment of incompletely resected or recurrent meningiomas.

Adenoma↗
PubMed1988

Ventriculo-pleural shunting for adult hydrocephalus.

In order to evaluate the efficacy and safety of ventriculo-pleural shunting as an alternative to conventional atrial and peritoneal procedures, we have carried out a retrospective study of 88 pleural shunting procedures. There was a 7% complication rate related to the use of the pleural space as the shunt terminus. Complications at the pleural end included shunt obstruction (functional or structural), pleural effusion, pneumothorax, and other technical problems. There were no deaths associated with shunt dysfunction or other complications. Ventriculo-pleural shunting for hydrocephalus, when used with appropriate precautions and with careful patient selection is a viable alternative for the treatment of adult hydrocephalus. The complications that are unique to this procedure are pneumothorax and pleural effusion. They were encountered infrequently in this series. Ventriculo-pleural shunting may be indicated when other routes are not available.

Adolescent↗
PubMed1988

Lymphocytic adenohypophysitis: clinical, radiological, and magnetic resonance imaging characterization.

Lymphocytic adenohypophysitis is a rare nonneoplastic cause of a pituitary mass. We report the case of an 18-year-old woman who presented with complaints of headaches and visual disturbances after an otherwise uncomplicated pregnancy and delivery. She had an elevated serum prolactin level and a pituitary mass visualized by magnetic resonance imaging (MRI). The tissue removed by transsphenoidal resection was an inflammatory mass composed of lymphocytes, plasma cells, and moderate fibrosis surrounding islands of hyperplastic lactotrophs. This is the first case of lymphocytic adenohypophysitis visualized by MRI. As in this case, lymphocytic adenohypophysitis is frequently confused with a prolactin-secreting pituitary tumor before operation and pathological examination of the tissue. The clinical characteristics and radiological features of and an approach to managing patients with lymphocytic adenohypophysitis are reviewed and discussed.

Adolescent↗
PubMed1987

Management of a large skull defect utilizing a vascularized free omental transfer.

A patient who underwent prior cranial surgery and radiation therapy and had the loss of his bone and skin flaps is presented. Basal cell carcinoma of a skin graft, placed on the dura mater and osteomyelitis of the surrounding cranium subsequently occurred. This problem of infection, neoplasia, cerebral protection, coverage, and cosmesis was managed successfully with a complex repair. The repair utilized autogenous fascia lata for the replacement of dura mater, rib and iliac crest bone for an autogenous cranioplasty, a free vascularized omental transfer for soft tissue bulk overlying the cranioplasty, and an autogenous split thickness skin graft over the omentum for coverage. Subsequent partial resorption of the autogenous cranioplasty necessitated the placement of a methyl methacrylate cranioplasty.

Adult↗
PubMed1987

Computed tomography number correlations for metrizamide computed tomographic ventriculography.

The authors describe a method that permits the determination of the precise intraventricular iodine concentration after metrizamide computed tomographic ventriculography. There is an observed linear relationship between computed tomography number (Hounsfield units) and iodine concentration. This relationship may be used to provide the basis for a method of evaluating ventricular fluid dynamics. This, in turn, is useful for the determination of the indications for a shunting procedure and for the evaluation of shunt function in a patient with an existing shunt.

Cerebral Ventricles↗
PubMed1987

Complete homonymous hemianopsia: reversal with arterial bypass.

In the case presented, gradual reversal of a fixed neurologic deficit followed a superficial temporal artery-middle cerebral artery microvascular bypass procedure. This case illustrates well the zone of penumbra concept. Fixed neurologic deficits may be treated in some cases by bypass procedures.

Cerebral Arteries↗
PubMed1987

Combined CT metrizamide syringography and needle aspiration of cystic intramedullary spinal cord lesions.

A modified spinal cord puncture technique that was combined with CT metrizamide syringography for the evaluation of potentially cystic spinal cord lesions has been used in 5 patients. This procedure proved to be safe and efficacious in the preoperative differentiation of cystic neoplasms from syringohydromyelia. It also aided in planning a surgical approach by revealing details of the tumor location and/or syrinx dynamics. Spinal cord puncture associated with CT metrizamide syringography has a role in the diagnosis and therapy of patients with cystic spinal cord lesions.

Adult↗
PubMed1987

Holocord astrocytoma: a two-staged operative approach.

Biopsy or subtotal resection followed by radiation for intramedullary astrocytomas of the spinal cord offer palliation but not cure. A treatment modality using an ultrasonic suction device has revolutionized the treatment of these tumors and has been extended to include the treatment of intramedullary tumors involving the entire length of the spinal cord (holocord tumors) with evident success. An alternative to this technique, a two-staged microsurgical approach, allows complete excision of the tumor and thus offers a chance for cure. Two patients have been treated in this manner, and more than 3 years after the operations, both patients were still improving neurologically without any evidence of tumor recurrence.

Adult↗
PubMed1987

Civilian gunshot wounds to the spinal cord and cauda equina.

We evaluated 42 patients with neurological deficits after civilian gunshot wounds to the spine. Thirty-five of these patients (the study population presented here) received their initial and follow-up care at Louisiana State University Medical Center in Shreveport over a 4-year period. Each patient had incurred a single gunshot wound to the spinal cord or cauda equina with an accompanying neurological deficit. The patient population was divided into three groups. Group 1 patients had incurred a complete motor and sensory loss below the injury (20 patients (57%]. Group 2 patients had incurred incomplete spinal cord injuries (9 patients (26%], whereas Group 3 patients had cauda equina injuries (6 patients (17%]. Myelography was performed for all Group 2 and 3 patients as well as Group 1 patients in whom the trajectory of the bullet did not explain a higher level of neurological injury (3 patients (15%]. A decompressive operation was performed in the patients whose myelography showed neural compression. Three patients in Group 1 (15%), 5 patients in Group 2 (56%), and 5 Group 3 patients (83%) underwent operation. All 3 Group 1 patients who underwent operation had some improvement of nerve root function postoperatively. All operated Group 2 and 3 patients had improvement of myelopathic or radicular function postoperatively. All began improving within several days of operation, implying a cause and effect relationship. None of the 17 nonoperated Group 1 patients improved neurologically, whereas 3 of the 4 nonoperated Group 2 patients improved. The single nonoperated Group 3 patient improved neurologically.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Functional recovery after decompressive spine operation for cervical spine fractures.

Ninety-nine patients with cervical spine fractures from C-4 through C-7 were operated upon from 1975 to 1981. Operation was performed to restore normal relationships between the spinal cord and roots and the spinal canal and foramina and to maintain these relationships by fusion when necessary. Neurological function was recorded pre- and postoperatively using a functional scale. Satisfactory fusion without adverse change in vertebral alignment was achieved in each patient. The average interval between injury and operation was 29 days. When neurological recovery was observed, it began promptly after operation, suggesting a cause and effect relationship.

Cervical Vertebrae↗
PubMed1986

Blastomycotic meningitis.

A difficult and tragic case of central nervous system blastomycosis is presented as the basis for a review of the diagnostic criteria required to establish this diagnosis and to present a scheme for the diagnosis and therapy of chronic meningitis. The diagnosis in our case was complicated by preexisting inadequately treated tuberculosis; a prepontine mass; and a cervical intradural, extramedullary, circumferential mass. This exceptional case of chronic basilar meningitis with cervical myelopathy was caused by Blastomyces dermatitidis.

Adult↗