[Chemonucleolysis in the treatment of lumbar nucleus pulposus hernia in young patients].
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Biomedical subjects
Publications and source records attributed to R Deutman.
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Computed tomography (CT) was performed on 30 patients with herniated lumbar discs before chemonucleolysis and at three and 12 months postinjection. At three months the compression produced by the herniated disc was reduced in 20 of the 30 patients; at 12 months there was complete relief of compression in all but four patients. Twenty-four patients developed diffuse bulging of the annulus. There was good correlation between the clinical results at three months and the reduction in compression as shown by the CT scan. At 12 months, no correlation was found between the remaining focal abnormalities and the clinical result. None of the patients developed epidural fibrosis. Chemonucleolysis has thus been shown to be an effective treatment of herniated lumbar discs, but it is definitely not indicated in cases where compression of the nerve root or dural sac is due to a bulging annulus.
Computerised tomography (CT) was performed in 30 patients with herniated lumbar discs; this was done both before chemonucleolysis and three months after. In 20 of the 28 patients who were CT positive, the compression produced by the herniated disc was eliminated or reduced. Twenty-three of the 28 patients developed diffuse bulging of the annulus. There was good correlation between the clinical results at three months and the alteration in compression as shown by the CT scan. No evidence of alteration in the bony relationship was seen in the scan and none of the patients developed epidural fibrosis. Chemonucleolysis has thus been shown to be an effective treatment of herniated lumbar discs, but it is definitely not indicated in cases where compression of the nerve root or dural sac is due to a bulging annulus.
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Of 212 patients undergoing total hip replacement who were tested preoperatively for sensitivity to nickel, chromium, and cobalt, fourteen showed sensitivity. No sensitivity to the bone cement was recorded. Of 173 patients who had never had a metal implant before, 5.8 per cent showed a positive reaction. Two patients out of fifteen with a failed McKee-Farrar prosthesis were found to be sensitive. Of six patients who had a stable McKee-Farrar prosthesis in the other hip, none showed sensitivity to the metal. In four of sixty-six patients, sensitivity to nickel or cobalt developed after the implantation of a metal-to-plastic prosthesis. No patients were sensitized to the cement. The consequences of proved hypersensitivity in patients with metal-to-plastic prostheses, either present prior to insertion of the prosthesis or evoked by the implant material, are not known.
Sixty-six patients who had to undergo total hip replacement by means of a metal-to-plastic Stanmore prosthesis, were patch-tested prior to and 6 to 12 months after surgery with the standard ICDRG all allergens series and with acrylic monomer 5% in acetone. In 62 patients the history of metal allergy as well as the patch tests to all tested allergens were negative. One patient with a history of metal allergy reacted negatively before surgery; about 6 months after surgery the patch test to nickel sulphate was positive (2 plus). Three other patients developed positive patch test reaction after surgery: two reacted positively to nickel sulphate (2 plus) and one to cobalt chloride (2 plus). In none of the 66 patients have local side effects of the prostheses been found to date.
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