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PubMed2005

Exercise during a 3-min decompression stop reduces postdive venous gas bubbles.

PURPOSE: Decompression sickness is initiated by the formation of gas bubbles in tissue and blood if the divers return to surface pressure too fast. The effect of exercise before, during, and after dive on bubble formation is still controversial. We have reported recently that strenuous aerobic exercise 24 h before simulated dive ameliorates venous bubble formation. The objective of this field study was to evaluate whether mild, continuous exercise during decompression has a similar impact. METHODS: Ten healthy, military male divers performed an open-sea field dive to 30 m of sea water breathing air, remaining at pressure for 30 min. During the bottom and decompression the subjects performed fin underwater swimming at about 30% of maximal oxygen uptake. Each diver underwent two randomly assigned dives, one with and one without exercise during the 3-min decompression period. Monitoring of venous gas emboli was performed in the right heart with ultrasonic scanner every 20 min for 60 min after reaching surface pressure in supine rest and during forced two-cough procedure. RESULTS: The study demonstrates that a mild, continuous exercise during decompression significantly reduced the average number of bubbles in the pulmonary artery from 0.9 +/- 0.8 to 0.3 +/- 0.5 bubbles per square centimeter in supine rest, as well as during two-cough procedure, which decreased from 4.6 +/- 4.5 to 0.9 +/- 0.9 bubbles per square centimeter. No symptoms of decompression sickness were observed in any subject. CONCLUSION: These results, obtained in the field conditions, indicate that a mild, underwater swimming during a 3-min decompression period reduces postdive gas bubbles formation.

Croatia↗
PubMed2002

Endoscopic orbital decompression for Graves' ophthalmopathy.

Graves' disease may occasionally result in significant proptosis that is either cosmetically unacceptable or causes visual loss. This has traditionally been managed surgically by external decompression of the orbital bony skeleton. Trans-nasal endoscopic orbital decompression is emerging as a new minimally-invasive technique, that avoids the need for cutaneous or gingival incisions. Decompression of the medial orbital wall can be performed up to the anterior wall of the sphenoid sinus. This can be combined with resection of the medial and posterior portion of the orbital floor (preserving the infra-orbital nerve). This technique produces decompression which is comparable to external techniques. We present a series of 10 endoscopic orbital decompressions with an average improvement of 4.4 mm in orbital proptosis. There was an improvement in visual acuity in all patients with visual impairment. Endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques.

Decompression, Surgical↗
PubMed2005

Neurological recovery after decompressive craniectomy for massive ischemic stroke.

INTRODUCTION: Decompressive craniectomy has demonstrated efficacy in reducing morbidity and mortality in critically ill patients with massive hemispheric cerebral infarction. However, little is known about the patterns of functional recovery that exist in patients after decompressive craniectomy, and controversy still exists as to whether craniotomy and infarct resection ("strokectomy") are appropriate alternatives to decompression alone. We therefore used functional magnetic resonance imaging (f-MRI) to assess the extent and location of functional recovery in patients after decompressive craniectomy for massive ischemic stroke. METHODS: f-MRI was obtained in three patients with massive nondominant cerebral infarction who had undergone decompressive craniectomy for severe cerebral edema 13 to 26 months previously. Brain activation was triggered by hand-gripping or foot- movement tasks. Imaging results were combined with periodic clinical follow-up to determine the extent of neurological recovery. RESULTS: Activation of the contralateral hemisphere was seen in the sensorimotor cortex, premotor, and supplementary motor areas. Lesser activation patterns were seen in equivalent regions of the infarcted hemisphere. Peri-infarct activation foci were seen in two of the three patients, but no activation occurred within the area of infarction as defined by the initial stroke seen on diffusion-weighted MRI. All three patients demonstrated some corresponding neurological improvement. CONCLUSION: After massive hemispheric cerebral infarction requiring decompressive craniectomy, patients may experience functional recovery as a result of activation in both the infarcted and contralateral hemispheres. The evidence of functional recovery in peri-infarct regions suggests that decompression alone may be preferable to strokectomy where the risk of damage to adjacent nonischemic brain may be greater.

Adult↗
PubMed2006

Orbital decompression: cadaver study.

BACKGROUND: Patients with Graves' ophthalmopathy may need surgical treatment to alleviate ophthalmologic complications. The degree of reduction in proptosis following surgical intervention remains difficult to predict. OBJECTIVES: To elaborate a human model using cadaver orbits to study surgical management of Graves' ophthalmopathy. To evaluate quantitatively the contribution of each orbital wall decompression and their combinations in reduction in proptosis. To improve the ability to predict the degree of proptosis reduction according to the wall(s) chosen for decompression. METHODS: Artificial exophthalmos was created in 12 cadavers' orbits by injecting a polysaccharide gel in the peribulbar and retrobulbar tissues. Proptosis reduction was measured following successive orbital decompression. RESULTS: Decompression of one wall produced a nonstatistical significant reduction in proptosis. The combination of the medial and lateral walls significantly reduced the proptosis by a mean of 4.2 mm. Three-wall decompression gave a mean significant reduction of 6.6 mm, and when combined with the advancement of the lateral wall, it reduced proptosis by 12.5 mm. CONCLUSIONS: We created an experimental model for research and didactic purposes for surgical mangement of Graves' ophthalmopathy. With this model, to obtain 5 mm or more of proptosis reduction, three-wall decompression is required. Advancement of the lateral wall achieved a further reduction in proptosis. For a proptosis reduction of less than 5 mm, decompression of the medial and lateral walls is appropriate.

Cadaver↗
PubMed2001

Effects of intraluminal distention and decompression on microvascular permeability and hemodynamics of the equine jejunum.

OBJECTIVE: To determine whether intraluminal distention and subsequent decompression of the equine jejunum affects intestinal blood flow, hemodynamics, and microvascular permeability. ANIMALS: 5 healthy adu t horses. PROCEDURES: Horses were anesthestized and underwent exploratory laparotomy. Two jejunal segments were identified as sham-operated or instrumented segments. After baseline values were obtained, intraluminal distention was created in the experimental segment to induce an ntraluminal pressure of 18 cm H2O. After 120 minutes of distention, the intestine was decompressed for 120 minutes. Mesenteric blood flow, oxygen delivery, oxygen consumption, microvascular permeability, wet weight-to-dry weight ratio, neutrophil infiltration, and vascular resistance were determined and comparisons made among control, sham-operated, and experimental segments. RESULTS: Mean jejunal blood flow was 21.4 ml/min per kg. There was a significant decrease in mesenteric bood flow to the distended intestine (13.4 ml/min per kg). Blood flow increased significantly during the decompression period (340% of baseline blood flow). Intraluminal distention and subsequent decompression resulted in a significant increase in microvascular permeability, as determined by the osmotic reflection coefficient. Oxygen delivery and oxygen content decreased significantly during the distention period and increased during decompression. Morphologic evaluation revealed a significant increase in edema and neutrophil infiltration after distention and decompression, compared with results for the sham-operated or control segments. CONCLUSIONS AND CLINICAL RELEVANCE: Intraluminal distention and decompression of the equine jejunum results in low-flow ischemia and edema, which may contribute to adhesions and ileus in the postoperative period after surgery for obstructions of the small intestines.

Animals↗
PubMed1999

Ventricular pressure monitoring during bilateral decompression with dural expansion.

OBJECT: The management of massive brain swelling remains an unsolved problem in neurosurgery. Despite newly developed medical and pharmacological therapy, the rates of mortality and morbidity caused by massive brain swelling remain high. According to many recent reports, surgical decompression with dural expansion is superior to medical management in patients with massive brain swelling. To show the quantitative effect of decompressive surgery on intracranial pressure (ICP), the authors performed a ventricular puncture and measured the ventricular ICP continuously during decompressive surgery and the postoperative period. METHODS: Twenty patients with massive brain swelling who underwent bilateral decompressive craniectomy with dural expansion were included in this study. In all patients, ventricular puncture was performed at Kocher's point on the side opposite the massive brain swelling. The ventricular puncture tube was connected to the continuous monitor via a transducer device. The ventricular pressure was monitored continuously, during the bilateral decompressive procedures and postoperative period. The initial ventricular ICP was variable, ranging from 16 to 65.8 mm Hg. Immediately after the bilateral craniectomy, the mean ventricular ICP decreased to 50.2+/-16.6% of the initial ICP (range 5-51.5 mm Hg). Additional opening of the dura decreased the mean ICP by an additional 34.5% and reduced the ventricular pressure to 15.7+/-10.7% of the initial pressure (range 0-15 mm Hg). Ventricular pressure measured postoperatively in the neurosurgical intensive care unit was lowered to 15.1+/-16.5% of the initial ICP. The ventricular ICP trend in the first 24 hours after decompressive surgery was an important prognostic factor; if it was greater than 35 mm Hg, the mortality rate was 100%. CONCLUSIONS: Bilateral decompression with dural expansion is an effective therapeutic modality in the control of ICP. To obtain favorable clinical outcomes in patients with massive brain swelling, early decision making and proper patient selection are very important.

Adolescent↗
PubMed2003

Improvement in brainstem auditory evoked potentials after suboccipital decompression in patients with chiari I malformations.

OBJECT: The optimal treatment for patients with symptoms related to Chiari I malformation remains controversial. Although a suboccipital decompression with duraplasty is most commonly performed, there may be a subset of patients who improve in response to bone decompression alone. In an initial attempt to identify such patients, we performed a continuous study of intraoperative brainstem auditory evoked potentials (BAEPs) in patients undergoing a standard decompression with duraplasty and compared conduction times at three different time points: 1) baseline while the patient is supine (before positioning); 2) immediately after opening of the bone and release of the atlantooccipital membrane (that is, the dural band); and 3) after opening of the dura mater. METHODS: Eleven children and young adults (mean age 9.8 years) with symptoms related to Chiari I malformation underwent suboccipital decompression and duraplasty with intraoperative monitoring of BAEPs and somatosensory evoked potentials (SSEPs). Six patients (55%) had associated syringomyelia. At baseline, the I to V interpeak latency (IPL) for both sides (total 21 BAEPs) was 4.19 +/- 0.22 msec (mean +/- standard deviation). After complete bone decompression and before the dura mater was opened, the I to V IPL decreased to 4.03 +/- 0.25 msec (p = 0.0005). When the dura was opened, however, no further decrease in the I to V IPL was detected (4.03 +/- 0.25 msec; p = 0.6). The SSEPs remained stable throughout the procedure. CONCLUSIONS: In children and young adults undergoing suboccipital decompression with duraplasty for Chiari I malformation, the vast majority of improvement in conduction through the brainstem occurs after bone decompressionand division of the atlantooccipital membrane, rather than after opening of the dura. Additional studies are needed to establish whether the improvement seen with BAEP monitoring during bone decompression will predict long-term clinical improvement in these patients.

Adolescent↗
PubMed2006

Retrograde suction decompression of giant paraclinoid aneurysms using a No. 7 French balloon-containing guide catheter. Technical note.

The treatment of large and giant paraclinoid carotid artery (CA) aneurysms often requires the use of suction decompression for safe and effective occlusion. Both open and endovascular suction decompression techniques have been described previously. In this article the authors describe a revised endovascular suction decompression technique that provides several advantages in the treatment of large and giant paraclinoid and CA aneurysms. A 51-year-old woman presented with a relatively brief history of progressive visual loss in the right eye, nonspecific headache, and an afferent pupillary defect. After angiography studies had been obtained, it was determined that she had a giant right paraclinoid internal CA aneurysm with a dome size of approximately 26 mm on the right and a neck diameter of 10 mm. A modified technique was performed in which suction decompression was used. With the aid of a No. 7 French Concentric balloon guide catheter (Concentric Medical, Inc., Mountain View, CA) and application of a temporary clip distal to the aneurysm, the aneurysm was trapped and decompressed using retrograde suction through the guide catheter when the balloon was inflated. After satisfactory placement of three permanent clips, an intraoperative angiogram obtained through the same guide catheter confirmed CA patency. The aneurysm was then punctured and aspirated, ensuring complete occlusion of the aneurysm sac and reconstruction of the parent vessel. The patient made an excellent recovery and did not suffer any complications. She did not experience worsening in her vision. This technical modification to endovascular suction decompression allows several potential advantages, including higher volume decompression and the ability to deliver endovascular devices to distal arterial locations.

Carotid Artery Diseases↗
PubMed2005

The therapeutic window for spinal cord decompression in a rat spinal cord injury model.

OBJECT: There are no clinically based guidelines to direct the spine surgeon as to the proper timing to undertake decompression after spinal cord injury (SCI) in patients with concomitant stenosis-induced cord compression. The following three factors affect the prognosis: (1) severity of SCI; (2) degree of extrinsic spinal cord compression; and (3) duration of spinal cord compression. METHODS: To elucidate further the relationship between varying degrees of spinal stenosis and a mild contusion-induced SCI (6.25 g-cm), a rat SCI/stenosis model was developed in which 1.13- and 1.24-mm-thick spacers were placed at T-10 to create 38 and 43% spinal stenosis, respectively. Spinal cord damage was observed after the stenosis-SCI that was directly proportional to the duration of spinal cord compression. The therapeutic window prior to decompression was 6 and 12 hours in the 43 and 38% stenosis-SCI lesions, respectively, to maintain locomotor activity. A significant difference in total lesion volume was observed between the 2-hour and the delayed time(s) to decompression (38% stenosis-SCI, 12 and 24 hours, p < 0.05; 43% stenosis-SCI, 24 hours, p < 0.05) indicating a more favorable neurological outcome when earlier decompression is undertaken. This finding was further supported by the animal's ability to support weight when decompression was performed by 6 or 12 hours compared with 24 hours after SCI. CONCLUSIONS: Analysis of the findings in this study suggests that early decompression in the rat improves locomotor function. Prolongation of the time to decompression may result in irreversible damage that prevents locomotor recovery.

Animals↗
PubMedDate not supplied

Study of long intestinal tube for decompression of obstructive left colon cancer.

BACKGROUND/AIMS: Recently, several reports have recommended primary resection, rather than a staged operation, for obstructive left colon cancer. However pre-operative decompression is important for reducing complications and improving the curability of primary resection. Among the many pre-operative decompression strategies reported, we selected the long intestinal tube and evaluated the effectiveness of this convenient strategy. METHODOLOGY: A long intestinal tube was inserted pre-operatively for decompression in 27 of 29 patients undergoing resection for obstructive left colon cancer (1991-1995). We retrospectively studied the clinical features (responders vs. non-responders) of the 27 patients. We also compared these 27 with 26 other pre-1990 patients, who did not receive pre-operative decompression, in term of post-operative morbidity. RESULTS: Twelve of the 27 patients were responders; success rate 44.4%. There were no blood profile differences between responders and non-responders, but the time from bowel movement cessation to intestinal tube insertion was 3 days or less in all responders but 4 days or more in non-responders (p<0.001). There was no significant difference in the rate of post-operative morbidity between those with and without pre-operative decompression. CONCLUSIONS: Decompression is likely to be successful, allowing elective primary resection, when initiated within 3 days of bowel movement cessation. However, more than 4 days post-onset, other decompression methods or emergency surgery is necessary.

Adenocarcinoma↗
PubMed1976

Decompression-induced bubble formation in salmonids: comparison to gas bubble disease.

The relationship of gas bubble disease (GBD) in fish to decompression-induced bubble formation was investigated with salmonids. Acute bioassays were used to determine equilibration times for critical effects in fish decompressed from depths to 200 fsw. It was found that equilibration of critical tissues was complete in 60-90 min. Salmonids and air-breathers are sensitive to decompressions at similar levels of supersaturation if elimination of excess gas following decompression is unrestricted. However, if elimination is restricted, bubble formation and growth increase accordingly. Tests with mixtures of He-O2, Ar-O2, N2-O2 (80% inert gas: 20% O2) and pure oxygen demonstrated that gas solubility as well as supersaturation (delta P), pressure ratio (initial pressure: final pressure), and absolute pressure must be considered in setting tolerance limits for any decompression. Gases with higher solubility are more likely to produce bubbles upon decompression. Oxygen, however, does not follow this relationship until higher pressures are reached, probably owing to its function in metabolism and in binding with hemoglobin. Tissue responses observed in both GBD and decompressed fish involved similar pathological effects at acute exposures. The circulatory system was consistently affected by bubbles that occluded vessels and blocked flow through the heart.

Animals↗
PubMed2000

Preliminary report: long-term results of transnasal orbital decompression in malignant Graves' ophthalmopathy.

In order to demonstrate the safety and efficacy of transnasal orbital decompression for malignant Graves' ophthalmopathy, we carried out a retrospective chart review and clinical follow-up examination of 78 consecutive patients who were operated on for compressive optic neuropathy (CON) with loss of visual acuity or visual field defects. The intervention - strictly transnasal, endoscopically controlled, bilateral decompression of the medial and inferomedial wall of the orbit - was performed when medical and radiation therapy had failed. A total of 145 endonasal decompressions were performed on 78 patients (63 female, 15 male, 52. 2 +/- 10.5 yrs.) over 9 years. Of these, 65 were operated bilaterally, 15 required only unilateral decompression; 4 had repeated surgery. Visual acuity increased from an average of 0.50 +/- 0.27 (range, 0.01 - 1.25) to 0.75 +/- 0.21 (range, 0.01 - 1.25). Proptosis decreased by an average of 3.94 +/- 2.73 mm (range, -1.0 - 11.0 mm), from a mean preoperative Hertel measurement of 22.19 +/- 3. 13 mm (range, 15 - 34 mm) to a mean postoperative Hertel measurement of 18.3 +/- 2.65 mm (range, 10 - 26 mm). Ocular motility was corrected by recession of the medial rectus muscle in 58 cases, in 26 cases immediately after decompression in the same surgical session. The transnasal orbital decompression procedure improved vision, decreased proptosis in a range comparable to more invasive techniques and had favorable cosmetic results without additional disfiguring by scars. Post-decompression strabismus was successfully managed by recession of both medial orbital muscles in the same surgical session.

Decompression, Surgical↗
PubMed2000

Computation of decompression tables using continuous compartment half-lives.

There is no consensus on the number of compartments and the half-lives (T1/2) used in the calculation of inert gas exchange and decompression sickness (DCS) boundary in existing dive tables and decompression computers. We propose the use of a continuous variable for the tissue half-lives, allowing the simulation of an infinite number of compartments and reducing the discrepancy between different algorithms to a single DCS boundary expression. Our computational method is based on the premise that M-values can be expressed in terms of T1/2 and ambient pressure (D). We combined the surfaces defined by M(D,T1/2) and tissue tension H(t,T1/2) to plan decompression. The efficiency and applicability of the method is investigated with four different DCS boundaries. The first two utilize the M-value relations proposed by Bühlmann and Wienke to derive no-D limits for sea level. The third boundary is defined by a surface fitted to the empirical M-values of US Navy, Bühlmann tables, US Air Force, and our altitude diving data. This expression was used to design the decompression procedure for a multilevel dive at 11,429-ft altitude and was used in six man dives in the Kaçkar Mountains, Turkey. Although precordial bubbles were observed in two dives, there were no cases of DCS. The fourth DCS boundary is constructed with the addition of a constraint that forces calculated M-values to stay below the available M-values. This constraint aims the highest degree of "conservatism". As an application of the new boundary, the method is used to derive decompression stop diving schedules for 11,429-ft altitude. The concept of continuous tissue half-lives is applicable to different types of gas exchange and DCS boundary functions or to a combination of different models with a desired level of conservatism. It has proved to be a useful tool in planning decompression for undocumented modes of diving such as decompression stop diving or multilevel diving at altitude. The algorithm can easily be incorporated into dive computers.

Algorithms↗
PubMed2001

[Results of arthroscopic subacromial decompression in 50-year-old patients].

PURPOSE OF THE STUDY: The study presents results of the surgical treatment of subacromial impingement syndrome in patients between fifty and sixty years of age using the technique of a two-step arthroscopic subacromial decompression. MATERIAL: Arthroscopic subacromial decompression was used for the operation on 12 shoulders in 12 patients. All of them underwent minimally half a year of conservative treatment. The average age of patients at the time of operation was 51 years. The youngest was 43 years, the remaining patients were older than 49 years. Only in 4 patients the subacromial impingement was not associated with another diagnosis. The group included also 2 patients with an associated diagnosis which resulted in the failure of arthroscopic technique. The follow-up ranges between 6 to 22 months. METHODS: The applied technique of arthroscopics subacromial decompression has two phases. Distal acromioplasty uses the dorsal edge of the acromion as a cutting block necessary for smoothing its inferior surface: By anterior acromioplasty was removed the anterior part of lateral clavicle prominent to the anterior edge of acromion. Part of the technique is resection of the accessible portion of the coracoacromial ligament. The difference between systolic pressure of the patient and the pressure in the subacromial space above 50 mm Hg significantly reduces bleeding. The precision of the technique is supported by a careful preoperative planning of the extent of resection on special x-ray projections. Strict observation of the schedule of postoperative physiotherapy is a necessary precondition of a successful result. The result of arthroscopic subacromial decompression is evaluated on the basis of UCLA score which allows comparison with the groups of patients of other authors. RESULTS: Using UCLA score the group of patients operated on included 3 excellent, 4 good, 3 satisfactory and 2 poor results. The first failure was recorded in a 50-year old man with a finding of a massive rupture of the rotator cuff and with an associated diagnosis of the fracture of clavicle healed in dislocation. After 6 months open acromioplasty and reconstruction of the rotator cuff was performed in this patient. Another poor result was recorded in a 57-year old female patient with an associated diagnosis of tendinitis calcarea of m. supraspinatus which was caused by the failure to remove calcification and insufficient extent of the resection of acromion. After the interval of 3 months also here open acromioplasty was performed. Ten out of twelve patients are satisfied and do not require another treatment. It means that also three satisfactory results (according to UCLA score) mean a marked pain relief and improvement of the function of the shoulder of not very active 50-year old individuals. DISCUSSION: Other authors report the frequency of good and excellent results they achieved in the range of 73-94%. Objectively evaluated arthroscopic subacromial decompression in our group of patients is not so successful as the operation performed in younger age groups. However, the subjective evaluation of the operation is very favourable. This satisfaction results from realistic expectations of patients who were not active sportsmen. In young patients active in sport with a primary subacromial impingement syndrome the arthroscopic method is a gold standard method. It is a mistake not to indicate the reconstruction of the ruptured rotator cuff in active patients under the age of 50. In the sixth decade, however, no outstanding results can be expected of it. Therefore in this group a precisely performed arthroscopic subacromial decompression has a very favourable effect mainly due to a shorter time of physiotherapy. CONCLUSION: The success of arthroscopic subacromial decompression is conditioned by a careful indication of the type of surgery, preoperative planning, precise technique of the actual operation and a strict observation of individual steps of postoperative physiotherapy of the shoulder. The operation may significantly relieve the pain and improve the function of the shoulder and at the same time it does not weaken the acromial origin of the m. deltoideus. It reduces the time of recovery and reduces also the risk of arthrofibrosis which endangers mainly older less active patients.

Acromion↗
PubMedDate not supplied

[Transoral decompression of the brain stem in a basilar impression secondary to rheumatoid arthritis. Description of a case and survey of the literature].

INTRODUCTION: The vertical subluxation or translocation of the odontoid process producing a basilar impression with compression of the brain stem is a late phenomenon in the course of rheumatoid arthritis; the appearance of symptoms in the spinal cord and the lower pairs of spinal nerves is a specific sign of this disorder. In this situation, the standard surgical aims are the decompression of the affected nerve structures followed by craniocervical stabilisation. The objective of this paper is to report on the improvement of the neurological deficit after decompressive transoral surgery (odontoidectomy), without associating any internal fixation system, in a female patient with a long history of rheumatoid arthritis and anterior compression of the brain stem caused by basilar impression and rheumatoid pannus. A survey of the literature showed that, with the odd isolated clinical case, there are no papers which describe the post operative development of surgical decompression of the brain stem carried out through an anterior approach in patients with rheumatoid subluxation of the odontoid process, without associating any internal stabilisation system. CASE REPORT: Female aged 65, diagnosed as suffering from rheumatoid arthritis at the age of 25, who was admitted with symptoms of compression of the medulla oblongata secondary to a vertical subluxation of the odontoid process. She was submitted to transoral decompression of the brain stem (odontoidectomy and removal of pannus without posterior fixation), and made surprisingly favourable post operative progress. At 15 months after the surgical decompression she led an independent life. CONCLUSIONS: The neurological improvement of our patient after the decompressive odontoidectomy suggests that the mechanical compression of the odontoid process with impaction of the brain stem was the predominant aetiological factor causing the symptoms in the medulla oblongata. Her clinical stabilisation, on the other hand, can be explained by a mechanism involving the spontaneous autofusion of the lateral masses of the atlas with the occipital condyle and with the axis. Lastly, we consider that, in certain cases of rheumatoid patients with atlantoaxial subluxation, impaction of the odontoid process in the foramen magnum and clinical features involving compression of the medulla oblongata, transoral decompression of the brain stem through an odontoidectomy is the choice initial surgical procedure, since it affords neurological improvement and clinical stabilisation. In any case, a strict neurological and radiological post operative follow up is needed in view of a possible craniocervical fixation occurring in the future.

Aged↗
PubMed2003

[Observation of clinical results of orbital decompression in 30 cases of malignant exophthalmos].

OBJECTIVE: To evaluate the effectiveness and safety of orbital decompression for the treatment of malignant exophthalmos. METHODS: Thirty four eyes of malignant exophthalmos were followed-up for 3 months to 9 years (averaged 6 years) after orbital decompression (two walls decompression in 22 eyes, three walls decompression in 12 eyes). The postoperative vision, protrusion value and appearance of the patients were examined and analyzed. RESULTS: Complete closure of palpebral fissure was attained in all cases and the visual acuity was increased in 25 eyes, remained the same in 5 eyes and decreased in 4 eyes. The mean recession of exophthalmos after operation was 3.8 mm in two walls decompression and 7.1 mm in three walls decompression, respectively. CONCLUSION: Orbital decompression is an effective method for the treatment of malignant exophthalmos.

Adult↗
PubMedDate not supplied

[Importance of early operative decompression of spinal cord after cervical spine injuries].

BACKGROUND AND PURPOSE: There is no standard timing of the spinal cord decompression. Experimental animal models and clinical investigations on Methylprednisolone (NASCIS-2 and -3) indicate that the time up to 8 hours is the optimal therapeutic window for the early spinal cord decompression. We accepted this time window in our practice. A retrospective clinical evaluation of the early (up to 8 hours) operative decompression of the injured cervical spinal cord was undertaken. MATERIAL AND METHODS: The early operative decompression (range of 2-8 hours) of the cervical spinal cord was done in 32 patients (82% of operated cervical spinal cord injured patients). The neurologic clinical status of patients was assessed according to the ASIA impairment scale. In neurological terms 7 patients were completely and 25 incompletely impaired. Cervical spine injuries included 26 fractures and fracture-dislocations and the rest (6 cases) involved dislocations and disc ruptures. The mean patient age was 31.2 years (range of 16-69) and the average follow-up time was 13 months (range of 6-24). Methylprednisolone standard treatment was applied in all patients on admission to hospital. After diagnostic examinations patients were qualified and immediately operated. We performed 25 corpectomies, 6 discectomies and 1 decompressive laminectomy with stabilization in all cases. RESULTS: The final assessment covers 29 patients because 3 (9.4%) of them died during 4-6 weeks after operation. One patient has not improved and still had A degree but 28 remaining patients (94.5%) have improved neurologically at follow-up. 69% of them recovered by one degree and 27.6% by two degrees on the ASIA scale. In the early postoperative stage during their hospital stay 47% of patients had one degree improvement. CONCLUSIONS: The early cervical spinal cord decompression creates optimal conditions for the neurological recovery. Encouraging results presented in the paper indicate the purposefulness of the decompression performed as fast as possible and indicate the necessity to make emergency services more efficient in order to shorten delivery time to specialized spine centers.

Adolescent↗
PubMed2002

[Comparison of curative effect between decompression and incision of endolymphytic sac].

OBJECTIVE: We compared the curative effect between endolymphytic sac decompression and incision of endolymphytic sac to explore a simple, effective surgical way with less complication. METHOD: 23 endolymphatic sac decompression and 22 incision of endolymphatic sac were performed routinely under general anesthesia. RESULT: 41 of 45 patients were followed up more than 2 years after the surgical procedure, 21 of which received endolymphatic sac decompression, while others received incision of endolymphatic sac. According to Chinese Meniere disease's diagnosis and curative effect standard evaluation criteria tried out in 1996, 13 got grade A(completely controlled), 4 got grade B (fundamentally controlled), 3 got grade C (partially controlled) while 1 got grade D (not controlled) among 21 patients who received endolymphatic sac decompression. The fully control rate is 61.9%. Among 20 patients who received incision of endolymphatic sac, 12 got grade A (completely controlled), 5 got grade B (fundamentally controlled), 2 got grade C (partially controlled) while 1 got grade D (not controlled). The fully control rate is 60%. CONCLUSION: There is no significant difference between endolymphatic sac decompression and incision of endolymphatic sac in curative effect,but endolymphatic sac decompression is more convenient,safe and has less complication compared with incision of endolymphatic sac. From this,we favor endolymphatic sac decompression in selection of surgical method.

Adult↗