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P J Apostolides

Publications and source records attributed to P J Apostolides.

At least 19 recordsLinked to original sources
PubMed1998

Herniated thoracic discs mimic cardiac disease: three case reports.

The authors report three patients (two males and one female) with herniated thoracic discs whose symptoms mimicked cardiac disease (severe intense stabbing pain beginning in the back and radiating to the lateral wall of the chest). They were evaluated for cardiac disease and angina, but the workup of the heart was negative. Magnetic resonance imaging and computed tomography myelography revealed the herniated thoracic discs. All patients underwent video-assisted endoscopic thoracic discectomy and recovered completely.

Adult↗
PubMed1998

Use of the BendMeister rod bender for occipitocervical fusion: technical note.

The creation of various curves in bendable metallic rods remains difficult. We describe a simple instrument that uses two bending levers to provide the mechanical advantage required to easily shape up to 5.5 mm diameter bendable metallic rods with precision, control, and minimal nicking or scratching of the metal surface. We have successfully used this tool to contour primary and secondary curvatures in threaded Steinmann pins and grooved titanium rods for occipitocervical fusion.

Bone Nails↗
PubMed1998

Surgical treatment of superficial siderosis associated with a spinal arteriovenous malformation. Case report.

In many patients with superficial siderosis of the central nervous system (CNS) no source of bleeding can be established, despite extensive examinations. The authors report a patient with superficial siderosis and a spinal arteriovenous malformation (AVM) that was not visible on magnetic resonance (MR) imaging or myelography but was identified on angiographic studies. This 71-year-old man presented with a 2-year history of progressive gait difficulties and hearing loss. Examination showed ataxia, hearing loss, and quadriparesis. On MR imaging superficial siderosis of the brain and spinal cord as seen; however, MR imaging of the CNS, as well as cerebral angiography and myelography studies, did not reveal the source of hemorrhage. Spinal angiography revealed a small slow-flow pial AVM at the C-5 level originating from the anterior spinal artery. A C-5 corpectomy was performed and the AVM was obliterated. The patient did well and reported no further progression of his symptoms during 3 months of follow up. Spinal angiography is indicated to complete the evaluation of patients with superficial siderosis, even if results of spinal MR imaging and myelography studies are normal. Obliteration of spinal AVMs may successfully prevent the progression of superficial siderosis.

Aged↗
PubMed1997

Triple anterior screw fixation of an acute combination atlas-axis fracture. Case report.

The authors report the successful treatment of an acute combination atlas-axis fracture in an 85-year-old man using anterior odontoid and C1-2 transarticular facet screw fixation and a Philadelphia collar. Treatment with halo brace immobilization failed, and the patient experienced recurrent episodes of oxygen desaturation when placed partially prone for chest physiotherapy. If a posterior approach is not feasible, an anterior odontoid and C1-2 transarticular facet screw fixation can be considered as a salvage procedure for patients with acute combination atlas-axis fractures.

Aged↗
PubMed1997

Thoracoscopic spinal surgery. Treatment of thoracic instability.

Thoracoscopic spinal surgery is technically feasible and can be performed safely with acceptable rates of morbidity and excellent clinical and neurologic results. Thoracoscopic techniques can be used for anterior decompression and internal fixation in cases in which pathologic processes lead to instability. This minimally incisional access technique can achieve the identical extent of spinal exposure, dissection, decompression, and reconstruction as those obtained with open techniques.

Adolescent↗
PubMed1996

Threaded steinmann pin fusion of the craniovertebral junction.

STUDY DESIGN: In a clinical retrospective study, the authors review long-term results of occipitocervical fusion using a wide diameter, contoured, threaded Steinmann pin. OBJECTIVES: To evaluate the clinical and radiographic results of occipitocervical fusion using this technique in a variety of abnormalities including rheumatoid arthritis. SUMMARY OF BACKGROUND DATA. The various surgical techniques and hardware developed for occipitocervical fusion have been associated with mixed results, particularly in patients with rheumatoid arthritis or basilar invagination. METHODS: Thirty-nine patients with occipitocervical instability were internally fixed with a wide diameter, contoured, threaded Steinmann pin wired to the occiput and cervical laminae or facets. Fusion was facilitated using autologous iliac crest bone graft and a cervical orthosis. Instability resulted from rheumatoid arthritis (n = 12), congenital anomalies (n = 12), trauma (n = 10), tumor (n = 4), or osteogenesis imperfecta (n = 1). Fifteen patients had radiographic evidence of basilar invagination. Long-term outcome (mean follow-up period, 38.9 months; range, 12-78 months) was based on clinical and radiographic review. RESULTS: Thirty-seven patients (97%) had a stable postoperative occipitocervical construct: there were 35 osseous unions, two fibrous unions, and one nonunion. There was on postoperative death from pulmonary complications. No patient developed evidence of new, recurrent, or progressive basilar invagination. CONCLUSION: The authors concluded that rigid segmental fixation of the craniovertebral junction using a wide diameter, contoured, threaded Steinmann pin and supplemental autograft creates excellent fusion with minimal complications. This technique is appropriate for a variety of abnormalities including rheumatoid arthritis.

Adolescent↗
PubMed1996

Thoracic vertebrectomy and reconstruction using a microsurgical thoracoscopic approach.

A video-assisted thoracoscopic microsurgical approach was developed in the laboratory and subsequently used clinically to resect abnormalities of the thoracic vertebrae, to decompress the thoracic spinal cord, and to reconstruct the thoracic vertebral bodies. This report describes the development of the clinical operative techniques for microsurgical thoracoscopic vertebrectomy, neural decompression, and spinal reconstruction. This minimally incisional approach was clinically used in 17 patients to treat vertebral osteomyelitis, tumors, and compression fractures. Microsurgical thoracoscopic techniques were performed using several narrow, flexible, working portals placed in small incisions in the intercostal spaces. Access to the thoracic spine was achieved through the pleural cavity after temporary deflation of one lung using a double-lumen endotracheal tube. The parietal pleura, segmental vessels, and rib heads were dissected off the surfaces of the involved vertebrae to expose the region of interest. Long narrow spine dissection tools were used to perform the spinal decommpression and reconstruction. This technique achieved the same amount of spinal dissection as that achieved with conventional open spinal procedures and used microsurgical visualization techniques. The small incisions with reduced soft tissue dissection may reduce postoperative pain, shorten the length of hospitalization, and have cosmetic and functional advantages. Thoracoscopic vertebrectomies and reconstruction of the spine were technically feasilble procedures that were performed with excellent clinical results. This minimally incisional technique provides a viable alternative to thoracotomy or to posterolateral approaches for thoracic vertebrectomy and vertebral body reconstruction.

Adult↗
PubMed1996

Intra-aortic balloon pump counterpulsation in the management of concomitant cerebral vasospasm and cardiac failure after subarachnoid hemorrhage: technical case report.

We report two patients who had symptomatic cerebral vasospasm and cardiac failure after aneurysmal subarachnoid hemorrhage and who were treated successfully with intra-aortic balloon pump counterpulsation therapy. Both patients developed congestive heart failure and pulmonary edema while receiving postoperative hypertensive, hypervolemic, hemodilutional (Triple-H) therapy for symptomatic cerebral vasospasm. Both cases of cardiac failure were refractory to maximum pressor and inotropic infusions. Intra-aortic balloon pump counterpulsation was used to optimize cardiac performance to allow continuation of Triple-H therapy and to maintain adequate cerebral perfusion in an attempt to decrease the risk of cerebral ischemic complications. Both patients have had good long-term outcomes. These two cases illustrate the potential usefulness of the intra-aortic balloon pump as an adjunct to Triple-H therapy in patients with symptomatic cerebral vasospasm and cardiac failure. To our knowledge, this report documents the first clinical application of this adjunctive therapy for vasospasm after aneurysmal subarachnoid hemorrhage.

Aged↗
PubMed1996

Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies.

Pseudotumor cerebri (PTC), or idiopathic intracranial hypertension, is a syndrome associated with multiple clinical conditions. We hypothesize that most if not all etiologies result in an increase in intracranial venous pressure as a final common pathway. We studied 10 patients with PTC. Five had dural venous outflow obstruction as demonstrated by venography, and the five remaining patients had normal venous anatomy. Pressure measurements, made during venography in eight patients, all showed elevated pressures. Pressure measurements in the superior sagittal sinus ranged from 13 to 24 mm Hg (mean, 16.6 mm HG). Patients with obstruction tended to have a high pressure gradient across the stenotic segment. Five patients with normal dural venous anatomy had elevated right atrial pressures (range, 6 to 22 mm Hg; mean, 11.8 mm Hg), which were transmitted up to the intracranial venous sinuses. Endovascular techniques, including angioplasty and infusion of thrombolytic agents in some cases, improved outlet obstruction from a hemodynamic perspective but were ineffective in consistently and reliably alleviating the clinical manifestations of PTC. Patients in both groups tended to respond well to conventional CSF diversion procedures. Our study suggests that elevated intracranial venous pressure may be a universal mechanism in PTC of different etiologies. This elevated venous pressure leads to elevation in CSF and intracranial pressure by resisting CSF absorption. Although the mechanism leading to venous hypertension in the presence of outflow obstruction is obvious, the etiology of increased intracranial and central systemic venous pressure in PTC remains obscure.

Adolescent↗
PubMed1996

Thoracic disc.

Explore the source record for details and available documents.

Humans↗
PubMed1995

Ectomesenchymal hamartoma (benign "ectomesenchymoma") of the VIIIth nerve: case report.

We report a previously undescribed hamartoma of the VIIIth nerve, consisting of adipose tissue, Schwann cells associated with myelinated nerve fibers, well-differentiated smooth and striated muscle fibers, and rare ganglion cells. The tumor was found in a 35-year-old Caucasian female who presented with right-sided hearing loss. The mass, which we designate an "ectomesenchymal" hamartoma, most likely developed from pluripotent neural crest cells ("ectomesenchyme"), which are capable of differentiating into a variety of neuroectodermal and mesenchymal cell types. The development of the neural crest, the concept of "ectomesenchyme," and the histogenesis of this tumor are reviewed.

Adult↗