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PubMed1984

Colonoscopic decompression for acute pseudoobstruction of the colon (Ogilvie's syndrome). Report of 22 cases and review of the literature.

This report has described a series of 22 patients who underwent colonoscopic decompression for acute pseudoobstruction of the colon and summarizes those cases previously reported in the literature. Twenty of the 22 patients (91 percent) were successfully treated by decompression initially. Fifteen patients (68 percent) were cured with the initial procedure, and 4 patients (18 percent) experienced recurrence. Overall, in 17 patients (77 percent), the pseudoobstruction resolved completely with colonoscopic decompression. Three patients (14 percent) underwent operation because of cecal dilatation refractory to colonoscopic decompression, and in one patient (4.5 percent), the colonic dilatation resolved spontaneously after a failed colonoscopy. Complications resulted in the death of one patient (4.5 percent). Our data are similar to those in the literature and indicate that colonoscopic decompression is a safe and efficacious first line of treatment for acute pseudoobstruction of the colon.

Acute Disease↗
PubMed1992

Gliosis and ganglion cell death in the developing cat retina during hydrocephalus and after decompression.

Even after surgical decompression, infantile hydrocephalus often results in permanent neurological symptoms, including visual deficits. However, little is known about the cellular changes that may be responsible for these effects. The present study was designed to analyze the retinae of normal, mildly hydrocephalic, severely hydrocephalic and surgically decompressed kittens to determine if changes occur in the density and size of retinal ganglion cells. Hydrocephalus was induced in 10 day old kittens by intra-cisternal injection of kaolin. Kittens were allowed to survive from 7 to 28 days after injection. Animals that were decompressed received ventriculoperitoneal shunts 10-15 days after the induction of hydrocephalus and were sacrificed 10-14 days after shunt placement. The density and area of neuronal and glial cells were determined within a sample area in peripheral nasal retina. Total cell density was significantly increased in mildly and severely hydrocephalic animals but returned to normal following decompression. This change represents a significant increase in the glial population. In addition, there was a significant loss of ganglion cells in both the severely hydrocephalic and the shunted groups. Based on these findings, we conclude that gliosis occurs as a result of cell death in the retina following severe hydrocephalus, and decompression is unable to reverse these effects. Furthermore, gliosis occurs in mild cases of hydrocephalus, and may be an early indication that cellular degeneration will follow.

Analysis of Variance↗
PubMed1996

Active compression-decompression versus standard cardiopulmonary resuscitation in a porcine model: no improvement in outcome.

Active compression-decompression cardiopulmonary resuscitation (CPR) is a new innovative basic life-support technique during which the anterior chest wall is actively decompressed by a suction device. CPR techniques were studied in 36 swine to test the hypothesis that active compression-decompression CPR improves coronary perfusion pressure, myocardial blood flow during CPR, and 24-hour survival. After 30 seconds of untreated ventricular fibrillation, CPR was begun and continued for 12.5 minutes by one of the three following methods: (1) active compression-decompression CPR with a suction device modified to include a precision force transducer; (2) standard CPR performed with a force transducer device; and (3) standard manual CPR performed without a force transducer device. CPR-generated coronary perfusion pressure, myocardial blood flow, and the force of compression were measured at 3 and 10 minutes of resuscitation effort. Initial return of spontaneous circulation, 24-hour survival, and trauma scores were also evaluated. Active compression-decompression CPR produced consistently better results than did standard CPR performed with a force transducer, but not better than standard CPR performed manually without a force transducer. The use of a force-measuring device with standard CPR may compromise hemodynamic response and outcome.

Animals↗
PubMedDate not supplied

Percutaneous endoscopic gastrostomy for decompression of the stomach and small bowel.

Percutaneous endoscopic gastrostomies are used most commonly for enteral feeding. We report the use of such gastrostomies for decompression of the obstructed gastrointestinal tract. Percutaneous endoscopic gastrostomies were performed on 53 patients over a 2-year period for gastrointestinal decompression because of gastric or small bowel obstruction. Forty-six patients had malignant obstruction from a primary abdominal or metastatic carcinoma and 7 patients had non-malignant obstruction or stasis. Gastrostomy for decompression was successful in 41 of 46 (89%) cases of malignant obstruction and in all 7 of the non-malignant cases. Tube utilization for decompression averaged 60 +/- 91 days. A 28 F tube with a 4-inch perforated intragastric portion was fashioned to maximize drainage. This efficient decompression tube allowed oral intake of liquids and soft foods in 88% of patients. Complications, which occurred in 4%, included one case of fatal peritonitis and one case of cellulitis.

Digestive System Neoplasms↗
PubMed1997

Is nasogastric tube decompression necessary after major abdominal surgery in children?

Nasogastric (NG) decompression has traditionally been used after major abdominal surgery in pediatric patients. This study was designed to determine if NG tubes could be routinely omitted in pediatric patients undergoing major abdominal procedures. Between January 1993 and December 1995, 83 patients had follow-up prospectively without NG decompression after a variety of major abdominal surgeries. NG tubes were inserted for persistent vomiting or abdominal distension. Exclusion criteria included bowel obstruction, intestinal atresia, and perforation of the stomach or duodenum. Ages ranged from 13 days to 22 years. Seventy-four patients (89%) were treated successfully without postoperative NG decompression. There were no cases of pneumonia, wound dehiscence, anastomotic leak, or delay in return of gastrointestinal function. Nine patients required NG tubes for persistent vomiting or abdominal distension. An anastomotic leak developed in one patient after endorectal pull-through. NG decompression is unnecessary after most major abdominal operations in pediatric patients. The endorectal pull-through may represent a group of patients that benefit from routine decompression.

Adolescent↗
PubMed1995

Analysis of early failures after lumbar decompressive laminectomy for spinal stenosis.

OBJECTIVE: To determine why some patients have no improvement after surgical treatment of lumbar spinal stenosis. DESIGN: We conducted a retrospective study of patients who were referred to our institution between 1990 and 1993 because their symptoms were unchanged or worsened after lumbar decompressive laminectomy. MATERIAL AND METHODS: For the 45 study patients (25 women and 20 men; mean age, 70.8 years), preoperative and postoperative clinical status, preoperative and postoperative imaging studies, and operative reports were analyzed. RESULTS: Preoperatively, only 23 patients (51%) had the clinical syndrome of neurogenic claudication, and 15 (33%) had midline low-back pain without a radicular component. Three other patients had peripheral neuropathy, and three had atypical leg pain. Only 10 patients had radiographic evidence of severe lumbar canal stenosis; the others had moderate, mild, or no stenosis. In 10 patients, surgical decompression was inadequate. Only three patients had the triad of neurogenic claudication, radiographically confirmed severe lumbar stenosis, and adequate decompression of the lumbar canal and lateral recesses. CONCLUSION: The most common pattern in patients with early failure after lumbar laminectomy was the absence of actual neurogenic claudication coupled with the absence of severe stenosis on preoperative imaging studies. The most common technical error was inadequate neural decompression. These data suggest that the outcome may be improved by more careful selection of patients and by performance of an adequate surgical decompression.

Aged↗
PubMed1990

Orbital decompression for Graves' ophthalmopathy by inferomedial, by inferomedial plus lateral, and by coronal approach.

To test the efficacy and safety of orbital decompression for Graves' ophthalmopathy, the authors studied the records of 60 consecutive patients who were operated on for dysthyroid optic neuropathy or for rehabilitative purposes. Patients decompressed for neuropathy were older, had less proptosis, and a shorter duration of eye disease than patients operated on for disfigurement. The authors compared the results of three surgical procedures including the inferomedial, the inferomedial plus lateral, and the coronal approach. Regarding improvement of visual function, no difference was found between the three techniques. Patients in whom vision failed to recover had a high prevalence of diabetes mellitus. Proptosis reduction varied from 1 to 9 mm, depending on the number of walls decompressed. There was no net change in the prevalence of diplopia. Persistent complications were seen in less than 5% of all decompressions. The authors conclude that orbital decompression for Graves' ophthalmopathy is safe and efficacious, regardless of surgical procedure. However, the coronal approach gives the best cosmetic results.

Adult↗
PubMed1994

Orbital decompression for disfiguring exophthalmos in thyroid orbitopathy.

BACKGROUND: Progressive exophthalmos from dysthyroid orbitopathy may result in marked disfigurement. Commonly affecting middle-aged women, it can be a significant social and psychologic handicap. Cosmesis is increasingly recognized as an indication for orbital decompression. Many argue, however, that decompression carries risks of operative complications which are only warranted where vision is threatened. METHODS: Between 1984 and 1990, the authors performed orbital decompression for cosmetic indications on 34 patients (65 orbits) with thyroid orbitopathy. The charts of these patients were reviewed to assess the results of surgery and the nature and incidence of complications. RESULTS: The mean retroplacement achieved was 4 mm (range, -1.0 to 10 mm). In 29 (85%) of the 34 patients, there was a difference of 1 mm or less in the proptosis of the two eyes postoperatively. Diplopia arose de novo in five (18%) previously asymptomatic patients. Postdecompression strabismus was managed successfully with adjustable surgery (mean, 1.3 operations per patient). With the exception of transient infra-orbital nerve hypoesthesia, there were no surgical complications. CONCLUSION: Decompression surgery is effective in reducing exophthalmos in dysthyroid orbitopathy. In this series of operations, complications were rare and treatable. Decompression is often the first of a series of operations that may be necessary to correct the cosmetic sequelae of this condition. It should be considered by experienced surgeons in carefully selected and counseled patients who have disfiguring thyroid orbitopathy.

Adult↗
PubMed1998

Sac-vein decompression for intractable Meniere's disease: two-year treatment results.

Surgical intervention has been offered to patients with Meniere's disease who have failed medical treatment and have disabling symptoms. Surgical options have included labyrinthectomy (mechanical and chemical), vestibular neurectomy, and endolymphatic sac surgery with or without shunting. We present a modification of endolymphatic sac decompression surgery that includes wide decompression of the sigmoid sinus, posterior cranial fossa dura, and endolymphatic sac (sac-vein decompression). Thirty-five patients underwent 37 primary procedures with 2 years of follow-up. Patients were evaluated according to the 1985 American Academy of Otolaryngology-Head and Neck Surgery criteria for assessing Meniere's disease. Vestibular symptom severity was resolved or mild in 92% and disability severity was none or mild in 95% of patients at 2 years after surgery. Vertigo control was complete or substantial in 85% and 100% of patients at 1 and 2 years after surgery. Audiologic data showed stable or improved hearing in 86% and 85% of patients at 1 and 2 years after surgery. In summary, wide decompression of the sigmoid sinus, posterior cranial fossa dura, and endolymphatic sac offers improved control of vertigo and hearing stabilization for intractable Meniere's disease compared with simple endolymphatic sac decompression or shunt surgery.

Adult↗
PubMed1995

Endoscopic orbital decompression under local anesthesia.

Orbital decompression for Graves' disease has traditionally been performed with the patient under general anesthesia. Endoscopic instrumentation allows for removal of the medial orbital wall and floor through an intranasal approach with local anesthetic techniques. Twelve endoscopic orbital decompressions were performed on awake patients with uncovered eyes so that vision could be monitored throughout the procedure. Simultaneous lateral decompressions were performed in 11 cases. No intraoperative or postoperative complications occurred. Visual acuity remained stable or improved in all cases. Proptosis was reduced an average of 5.5 +/- 1.6 mm. In a comparable series of 29 endoscopic decompressions performed with patients under general anesthesia, proptosis was reduced an average of 4.8 +/- 2.0 mm. Endoscopic orbital decompression with patients under local anesthesia appears to be an effective technique that may provide an additional margin of safety in prevention of injury to the optic nerve.

Adult↗
PubMed1998

Effect of different compression--decompression cycles on haemodynamics during ACD-CPR in pigs.

The haemodynamic effects of variations in the relative duration of the compression and active decompression (4 cm/2 cm) during active compression-decompression cardiopulmonary resuscitation (ACD-CPR), 30/70, 50/50 and 70/30, were tested in a randomized cross-over design during ventricular fibrillation in seven anaesthetized pigs (17-23 kg) using an automatic hydraulic chest compression-decompression device. Duty cycles of 50/50 and 70/30 gave significantly higher values than 30/70 for mean carotid blood flow (32 and 36 vs. 21 ml min-1, transit time flow probe, cerebral blood flow (30 and 34 vs. 19, radionuclide microspheres), mean aortic pressure (35 and 41 vs. 29 mmHg) and mean right atrial pressure (24 and 33 vs. 16 mmHg). A higher mean aortic, mean right atrial and mean left ventricular pressure for 70/30 were the only significant differences between 50/50 and 70/30. There were no differences in myocardial blood flow (radionuclide microspheres) or coronary perfusion pressure (CPP, aortic-right atrial pressure) between the three different duty cycles. CPP was positive in both the early and late compression period and during the whole decompression period. The expired CO2 was significantly higher with 70/30 than 30/70 during the compression phase of ACD-CPR. Beyond that no significant differences in the expired CO2 levels were observed. In conclusion a reduction of the compression period to 30% during ACD-CPR reduced the cerebral circulation, the mean aortic and right atrial pressures with no effect on the myocardial blood flow of varying the compression-decompression cycle.

Animals↗
PubMed1994

Arthroscopic subacromial decompression in the treatment of full thickness rotator cuff tears: a 3- to 6-year follow-up.

Arthroscopic subacromial decompression has become an accepted treatment for patients with impingement syndrome; however, its use for full thickness rotator cuff tears continues to be controversial. The purpose of this study is to determine if the results of arthroscopic subacromial decompression alone for full thickness rotator cuff tears deteriorate at long-term follow-up. We reevaluated all 25 patients with full thickness rotator cuff tears who underwent arthroscopic subacromial decompression from our original study group. Based on the University of California at Los Angeles shoulder rating, 68% of patients were rated as excellent or good at the present mean follow-up of 45.8 months (range 36-72 months). This represents a significant decrease from our initial report of 84% satisfactory results at a mean follow-up of 24.6 months. There was a significant decrease in ratings with regard to pain and function; however, no significant deterioration was noted with regard to motion and strength. Two additional patients required open rotator cuff repair since the time of initial follow-up for a total of six. Large and massive rotator cuff tears fared worse over time as compared with small and moderate size tears. Although 1- to 3-year results of arthroscopic subacromial decompression and rotator cuff debridement were favorable, the long-term follow-up demonstrates deterioration of results. We therefore cannot support the use of decompression and debridement alone in the treatment of repairable full thickness rotator cuff tears.

Adult↗
PubMed2000

Endoscopic decompression procedure in acute obstructing colorectal cancer.

BACKGROUND AND STUDY AIMS: In the treatment of acute obstructing colorectal cancer, a nasoenteric ileus tube is not capable of providing sufficient decompression of the enlarged intestine immediately, and it may cause the patients throat pain. We therefore assessed the effectiveness of an endoscopic decompression procedure using a transanal ileus tube for acute obstructing colorectal cancer. PATIENTS AND METHODS: Five patients (five women, mean age 62) with colorectal cancer ileus underwent endoscopic decompression procedures between July 1994 and March 1999. The stricture was first negotiated using a guide wire 300 cm in length, and was then dilated using 8 Fr and 26 Fr dilating catheters. Immediately after a transanal ileus tube 120 cm in length with an outside diameter of 22 Fr was inserted, the intestinal tract was cleaned. RESULTS: No leakage from a colorectal anastomosis occurred during this endoscopic decompression procedure. Immediately after insertion of a decompression procedure tube, radical surgery could be performed after adequate preoperative examination and colorectal preparation. CONCLUSIONS: This procedure may be helpful in allowing immediate preoperative examination and scheduling of a radical operation for acute obstructing colorectal disease.

Acute Disease↗
PubMed1982

Decompression of the left ventricle in the recovery period during myocardial revascularization.

Effective left heart decompression is essential for the reduction of myocardial oxygen consumption during recovery from an induced ischemic insult. During the early postischemic recovery phase of patients undergoing aorto-coronary bypass surgery, left ventricular, left atrial and aortic pressures were measured in non-vented hearts and in 2 types of left ventricular decompression. The following findings were made: Total cardiopulmonary bypass with effective decompression of the left ventricle decreases peak systolic left ventricular pressure, thereby reducing oxygen consumption of the myocardium. In this way adequate conditions are provided for recovery of the myocardium after unclamping of the aorta. The best method for decompression appears to be the placing of a large-lumen cannula in the left ventricle and allowing the blood to pour freely from the vent. The zero or near zero left ventricular filling pressure achieved with total cardiopulmonary bypass but without ventricular decompression does not prevent the chamber from producing isometric pressure work with peak systolic pressure reaching 80 to 90 torr. The hazard of air embolism may be reduced by precautionary measures. Left atrial monitoring permits recognition of pressure decreases to negative values. Active suction of the blood from the left ventricle is dangerous and should be avoided.

Blood Pressure↗
PubMed1996

The long-term outcome of microvascular decompression for trigeminal neuralgia.

BACKGROUND: Several surgical procedures to treat trigeminal neuralgia (tic douloureux) are available, but most reports provide only short-term follow-up information. METHODS: We describe the long-term results of surgery in 1185 patients who underwent microvascular decompression of the trigeminal nerve for medically intractable trigeminal neuralgia. The outcome of the procedure was assessed prospectively with annual questionnaires. RESULTS: Of the 1185 patients who underwent microvascular decompression during the 20-year study period, 1155 were followed for 1 year or more after the operation. The median follow-up period was 6.2 years. Most postoperative recurrences of tic took place in the first two years after surgery. Thirty percent of the patients had recurrences of tic during the study period, and 11 percent underwent second operations for the recurrences. Ten years after surgery, 70 percent of the patients (as determined by Kaplan-Meier analysis) had excellent final results-that is, they were free of pain without medication for tic. An additional 4 percent had occasional pain that did not require long-term medication. Ten years after the procedure, the annual rate of the recurrence of tic was less than 1 percent. Female sex, symptoms lasting more than eight years, venous compression of the trigeminal-root entry zone, and the lack of immediate postoperative cessation of tic were significant predictors of eventual recurrence. Having undergone a previous ablative procedure did not lessen a patient's likelihood of having a cessation of tic after microvascular decompression, but the rates of burning and aching facial pain, as reported on the last follow-up questionnaire, were higher if a trigeminal-ganglion lesion had been created with radiofrequency current before microvascular decompression. Major complications included two deaths shortly after the operation (0.2 percent) and one brain-stem infarction (0.1 percent). Sixteen patients (1 percent) had ipsilateral hearing loss. CONCLUSIONS: Microvascular decompression is a safe and effective treatment for trigeminal neuralgia, with a high rate of long-term success.

Adolescent↗
PubMed1985

Pressure-volume orbital measurement comparing decompression approaches.

Commonly used orbital decompressions are lateral wall, antral-ethmoidal, "three-wall," and "four-wall" decompressions. Bladders filled with saline were placed in intact bony orbits before and after decompression for comparison of compliance curves by these four methods. The lateral wall decompressions produced the least volume change, while the four-wall produced the most. The three-wall decompression provided next best pressure reduction.

Graves Disease↗
PubMed1996

Core decompression versus nonoperative management for osteonecrosis of the hip.

A complete review of the literature disclosed that there were 42 reports of 2025 hips treated by either core decompression (1206 hips) or nonoperative management (819 hips), excluding electrical stimulation, for osteonecrosis of the femoral head. The peer-reviewed published reports included general surveys, prospective studies, and multicenter studies, but excluded case reports. Satisfactory clinical results were reported in 63.5% of hips in 24 studies of core decompression and in 22.7% of hips in 21 studies of nonoperative management. When looking at only precollapse hips, there were 71% versus 34.5% good results, respectively. Recalculation excluding reports by the 4 centers that do the most core decompressions (and report the best results) showed a clinical success rate for core decompression of 53% versus 22.7% for the nonoperatively treated group. Investigators of multiple studies have reported that nonoperative management leads to extremely poor results. Core decompression has been reported to have a notable effect on the natural history and clinical progression in early stages of osteonecrosis of the femoral head. In view of the limitations of this data, further clarification of this effect only can be obtained by large prospective randomized studies.

Femur Head Necrosis↗
PubMed1990

Posttraumatic atlanto-axial subluxation and myelopathy. Efficacy of anterior decompression.

Compression of the neuraxis may occur after displaced fractures of the dens. Nonunion or malunion increases the risk of developing neurologic complications because of the resulting atlanto-axial instability. Posterior decompression has generally been the surgical solution to myelopathy at this level. Two patients with cervical myelopathy due to displaced ununited dens fractures were treated with posterior fossa decompression and high cervical laminectomy. Both patients deteriorated after the surgery. Most of their neurologic deficits finally resolved after microsurgical transoral decompression (by resection of the dens). In those patients in whom atlanto-axial instability causes primarily anterior compression of the neuraxis, especially by a bony lesion, decompression posteriorly may not achieve the desired effect, and, instead, may cause a deterioration in the patient's condition. Anterior atlanto-axial subluxation effectively lengthens the bony spinal canal, which results in stretching of the relatively inelastic spinal cord over the bony deformity. If indirect methods of reduction fail to relieve the condition, then anterior transoral decompression is recommended.

Atlanto-Axial Joint↗