Biomedical subjects

S A Rath

Publications and source records attributed to S A Rath.

27 records · Page 2Linked to original sources

PubMed1996

Findings and long-term results of subsequent operations after failed microvascular decompression for trigeminal neuralgia.

OBJECTIVE: To evaluate the indication of subsequent operations after failed microvascular decompression (MVD) for the treatment of trigeminal neuralgia, the intraoperative findings and long-term results of 16 subsequent operations are reported. METHODS: Subsequent exploration of the posterior fossa was performed for lack of pain relief (3 patients) and recurrent neuralgia (13 patients) after an average of 17 months (range, 4-62 mo). In all patients, typical arterial compression patterns at the root entry zone of the trigeminal nerve were found in the first procedure. The mean follow-up period after subsequent operation was 90 months (range, 78-104 mo). RESULTS: New arterial neurovascular conflicts were found in nine patients. After subsequent MVD procedures, seven patients were pain-free (with one recurrence after 6 mo), one had constant marked relief, and one was unchanged. Second exploration revealed no abnormalities in the other seven patients who experienced continued or recurrent pain; only careful neurolysis of the trigeminal nerve was performed in those patients. Initially, all seven patients obtained complete pain relief, but two experienced late recurrences after 64 and 68 months, respectively. Thus, subsequent operations failed in all 4 patients who had undergone prior destructive procedures but were successful in those 12 patients who had undergone only previous MVD. Two patients developed severe sequelae, and the other nine had minor complications, especially permanent (four patients) or transitory (three patients) ipsilateral trigeminal hypoesthesia. CONCLUSION: Subsequent MVD seems to have good long-term results. However, because of the significantly high incidence of complications, the indication for subsequent operations should be restricted to younger patients to avoid destructive procedures. In general, glycerol rhizolysis or radiofrequency rhizotomy may be the treatment of choice after failed MVD.

Adult↗

PubMed1994

[Intraoperative electrically evoked nerve action potentials in ulnar entrapment syndrome].

Many attempts have been made in the past to find predictive factors concerning patients operated on because of ulnar nerve entrapment at the elbow. The factors most frequently discussed in the literature are the patient's age, the importance of the preoperative neurological deficit, the duration of symptoms, accompanying diseases as diabetes mellitus or alcoholism and preoperative electrophysiological findings (EMG and conduction velocity measurements). With the exception of the electrophysiological findings, which uniformly are considered to be without predictive value, all other factors mentioned above are discussed controversly. In 1972 Kline and Nulsen [12] have shown, that intraoperatively evoked nerve action potentials across a traumatic nerve lesion can provide information about nerve regeneration. This information helps to choose the appropriate surgical procedure namely either neurolysis or neuroma resection and grafting. However there are no reports dealing with this method in nerve entrapment syndromes. We present the results of 17 patients with ulnar nerve entrapment at the elbow. They were operated on in our hospital between 1989 and 1992 by simple decompression or by anterior transposition of the nerve. In each of them we tried to record electrically evoked nerve action potentials intraoperatively and compared preoperative clinical findings with the potentials recorded. Our main interest was to find out, if the potentials have any predictive value regarding the clinical outcome. In 16 of 17 patients we were able to record a reproducable nerve action potential. Amplitudes varied between 3.4 and 140 uV. Conduction velocities of the fastest fibers ranged from 17 to 71 m/s, while potential duration varied between 1.3 to more than 8 ms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

[Transcranial Doppler sonography as a reliable diagnostic tool in craniocerebral trauma].

Transcranial Doppler sonography (TCD) is a simple, noninvasive bedside procedure that can be repeated any time for the measurement of cerebral blood flow velocity in the great basal cerebral arteries. It is practicable in most severely head-injured patients in critical care. Flow patterns and pulsatility index (PI) resulting from maximal systolic and diastolic flow velocities and representing cerebrovascular resistance give quite an accurate impression of potential intracranial hypertension and the dependent cerebral perfusion pressure (CPP). With increasing intracranial pressure (ICP) and decreasing CCP, diastolic flow is progressively reduced. If ICP reaches the systemic diastolic blood pressure level, diastolic flow disappears. Oscillating (reverberating) flow patterns are seen when ICP increases further up to the arterial mean pressure level. The authors' own studies on 20 comatose patients with raised ICP showed typical changes in TCD parameters following different therapies for intracranial hypertension. Under continuous TCD monitoring of the middle cerebral artery, increases in maximal flow velocity (from 4% up to 102%, on average 27%) and mean flow velocity (from 18% up to 153%, on averaged 73%) were always observed after osmotherapy. In addition, a variable increase in negative frequencies was noted, probably due to increased turbulences. After barbiturate administration (thiopentone bolus of 0.3 g) a flow reduction was always seen [from -2% up to -25% (on average -13%) for maximal flow velocity and from -9% up to -30% (on average -19%) for mean flow velocity].(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗

PubMed1993

[Intraoperative anatomic and pathologic findings in 1,420 initial operations in carpal tunnel syndrome].

The present paper, based on intraoperative findings in 1420 primary operations for carpal tunnel syndrome demonstrates the frequency of rare causes of median nerve compression in the carpal canal. Some previously unpublished anatomical and pathological variants will be presented.

Carpal Tunnel Syndrome↗

PubMed1992

[Stress-induced carpal tunnel syndrome in athletes--exemplified by 3 kinds of sports].

As is generally known in occupational medicine, exposure to repetitive wrist movements, to vibration and heavy manual work may cause a carpal tunnel-syndrome (CTS). The examination of three kinds of sport (swimming, moto-cross-riding, body-building), each typical for one of the described reasons of high risk for an exercise-induced CTS, showed on 18 sports-women and 54 sportsmen that prolonged practice of one of these kinds of sport may indeed lead to CTS among young people. Six of the examined persons on the typical symptoms of CTS. The electrophysiological main feature of CTS, namely the distal motor latency of the median nerve, was had nine other sportsmen significantly longer than the age-specific normal value (according to Ludin). A clear positive correlation between the estimated total duration of training and the distal motor latency of the median nerve was found.

Adult↗

PubMed1989

Removal of tumors in the III ventricle using the lamina terminalis approach. Three cases of isolated growth of craniopharyngiomas in the III ventricle.

Tumors in the III ventricle were totally removed in three children using a route through the lamina terminalis. The cases are discussed on the basis of computed tomography and intraoperative findings. It seems that tumors 4 x 2 cm in size can be successfully removed via this relatively small opening if the neuroradiological findings and the probable histology (craniopharyngioma) provide secure evidence that the tumor site and growth matrix are located in the frontal and lower portion of the III ventricle. Besides the advantage of requiring no transparenchymal access, this quick axial (orthograde) approach exerts no pressure on the hypothalamus, a complication which cannot always be avoided with the transcallosal route or the route through the foramen of Monro. Furthermore, the immediate location of the tumor behind the usually protruding lamina terminalis permits a rapid operation without exploratory characteristics. The distance between the brain surface and the tumor with this procedure is 0 cm; however, it can be up to 9 cm, depending on the age of the patient, with other approaches.

Adolescent↗

PubMed1989

Late brain abscess years after severe cerebrocranial trauma with fronto-orbitobasal fracture.

An 8-year-old boy suffered severe craniocerebral trauma with left-sided fronto-orbitobasal fracture. The CT scan showed minor subdural air inclusions. The child recovered well and had no clinical signs of aftereffects. Eight years after the accident, symptoms of intracranial pressure developed progressively with nuchal rigidity and elevated temperature. The CT showed an extensive left fronto-orbitobasal abscess. The intraoperative finding was a brain prolapse both into the frontal sinus and into the ethmoidal cavity with a large dura-bone defect at the site of the former fracture line, which was closed with refobacin-bone-meal fibrin sealant plasty and glued periostal patch. The postoperative course was unremarkable. Evidently, the accident had caused a brain prolapse into the bone defect, which prevented liquorrhea. Due to the lack of bone and dura barrier, a late brain abscess developed in the course of sinusitis. In such cases, primary surgical revision seems to be indicated.

Brain Abscess↗

PubMed1988

The use of EEG spectral analysis after thiopental bolus in the prognostic evaluation of comatose patients with brain injuries.

The value of EEG data and evoked potentials (EP), combined with the patient's clinical status, are important parameters used to document decerebration, but their reliability is at its best when the decerebration is nearly complete. Based on spectral analysis of the EEG we compiled criteria for the cerebral function with application of agents known to alter the normal EEG. We found very distinct and different pattern responses in spectral analysis of the EEG after the bolus injection of 100-500 mg Thiopental, correlating well with the patient's prognosis. In a study with 40 patients, those who showed a significant increase of power in all frequencies, especially a short lasting increase in beta (3-7 min) survived in 84%. On the other hand, all the patients who had a decrease of absolute power in all frequency band died, even when brainstem reflexes and various pain reactions were still present. Spectral analysis after Thiopental bolus injection also permits a very immediate assessment of slight improvements or deteriorations in the clinical course.

Adolescent↗

PubMedDate not supplied

[Body building--effect on neural conduction velocity of the median nerve in the carpal tunnel].

The examination of 30 body builders showed that prolonged practice of this sport may lead to exercise-induced carpal tunnel syndrome (CTS). Three of these body builders demonstrated typical symptoms of CTS. It was shown that, especially when training had lasted for more than 6 years, the distal motor latency (DML) of the median nerve increased significantly. A clear correlation between the estimated total duration of training and the DML was found.

Adult↗