Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “DECOMPRESSION”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 667 records · Page 37Linked to original sources
PubMedDate not supplied

Arthroscopic subacromial decompression.

In this study, we analyzed the results of two series of patients treated for impingement syndrome by undergoing arthroscopic subacromial decompression (ASD). Patients had not responded to nonoperative treatment. Group 1 included 112 consecutive patients (average age, 41 years) with 96 (77%) patients available for 2-year follow-up. Group 2 (28 patients, 29 shoulders; average age, 43 years; range, 22 to 72) had ASD and the subacromial space digitally palpated to determine if adequate decompression was performed. Twenty-two (85%) of 26 shoulders were available for follow-up. At follow-up, pain, function, range of motion, strength, impingement signs, and patient satisfaction were assessed. In group 1, according to the Neer criteria, 48% of the patients were graded as satisfactory and 52% unsatisfactory. Workers' Compensation patients had a satisfactory rate of 32%, whereas non-Workers' Compensation patients had a satisfactory rate of 59%. Twenty patients had open acromioplasty after ASD. Inadequate decompression was noted in 14 of 20 failed patients. In group 2, 86% of the patients were graded as satisfactory according to the Neer criteria, with 14% unsatisfactory, which included the 2 failures. The 2 (9%) of 22 shoulders that failed the ASD went on to further surgical treatment. Average follow-up was 56 months (range, 13 to 78 months). The average American Shoulder and Elbow Society score at follow-up was 90.4. No difference between Workers' Compensation cases and the other cases was seen (P <.7). Finger palpation can help to improve outcomes by allowing the surgeon to assess the adequacy of decompression.

Acromion↗
PubMed2001

Long-term results in patients treated with thrombolysis, thoracic inlet decompression, and subclavian vein stenting for Paget-Schroetter syndrome.

PURPOSE: In an effort to minimize long-term disability related to effort thrombosis of the subclavian vein, selected patients were treated with thrombolysis, thoracic inlet decompression, percutaneous transluminal angioplasty (PTA), and subclavian vein stenting. We evaluated the long-term outcomes of patients treated with this algorithm. METHODS: Between 1994 and 2000, 23 patients were evaluated with effort thrombosis of the subclavian vein. Thrombolysis was instituted on an average of 9.4 days (range, 1-30 days) after initial onset of symptoms. Average time to clot lysis was 34 hours (range, 12-72 hours). After immediate supraclavicular thoracic inlet decompression, all patients underwent PTA. Fourteen patients with residual vein stenosis (>50%) after PTA underwent stenting of the subclavian vein. Complications in this series included three wound hematomas that required drainage in two patients and one subpleural hematoma that required thoracotomy for decompression. RESULTS: All patients who underwent PTA are patent, with a mean follow-up of 4 years (range, 2-6 years). In the veins treated with stents, 9 of 14 veins are patent, with a mean follow-up of 3.5 years (range, 1-6 years). Two veins had early occlusions (2 days); two veins occluded at 1 year; and seven veins occluded at 3 years. Three of the patients (including those patients who experienced the early failed procedures) were later identified with factor V Leiden. Early failures also had clot extending into the brachial vein. CONCLUSION: Patients with short-segment venous strictures after successful lysis and thoracic outlet decompression may safely be treated with subclavian venous stents and can expect long-term patency.

Activated Protein C Resistance↗
PubMed1999

Microsurgical endonasal decompression in dysthyroid orbitopathy.

Diagnosis of thyroid eye disease can be established by its history, signs, symptoms, clinical and laboratory findings of an autoimmune thyroid disease. Therapy for this disease is limited to a few options, which should be administered depending on its stage and inflammatory activity. When medication and radiation therapy fail indications for decompression are: loss of visual acuity or visual field defects, increasing strabism and severe keratopathy due to eyelid retraction. Numerous surgical decompression techniques have been described in endocrine orbitopathy. We have adopted endonasal microsurgery, because this technique gives the freedom to work bimanually, ensures a stereomicoscopic view of the intranasal landmarks of orbital walls and allows simultaneous decompression of the medial and inferior orbital wall as well as a good relief of pressure at the orbital apex. Decompressions were performed on 27 orbits in 17 patients, via the endonasal microsurgical, 3 via external approach. The microscopic approach was entirely comparable with regard to reduction of proptosis with a mean improvement of 4.1 mm against a mean of 4.7 mm by external approach and a mean 0.2 of better visual acuity in both procedures. The microsurgical technique is considered superior to an external approach avoiding external scars, neural pains and reportedly less diplopia. Also, trauma to the nalolacrimal and nasofrontal ducts are avoided. The healing phase and the hospitalization time is shorter.

Adult↗
PubMed2001

Bifrontal decompressive craniectomy in the management of posttraumatic intracranial hypertension.

Bifrontal decompressive craniectomy has been used on an ad hoc basis for the treatment of post-traumatic intracranial hypertension for more than thirty years. In this observational study we report the clinical outcome and physiological effects of the procedure in a series of 26 patients with refractory intracranial hypertension treated on a protocol driven basis. Bifrontal decompressive craniectomy was associated with significant reductions in mean ICP from 37.5 to 18.1 mmHg (p = 0.003). In addition, craniectomy reduced the amplitude of ICP waves (p < 0.02) and increased compensatory reserve (p < 0.05). A favourable outcome was achieved in 69% of patients; 8% were severely disabled and 23% died. We conclude that this study provides pathophysiological evidence that bifrontal decompressive craniectomy significantly reduces posttraumatic intracranial hypertension and improves pressure dynamics. Our results support the continued use of bifrontal decompressive craniectomy in selected patients after head injury.

Adolescent↗
PubMed2005

Efficacy of surgical decompression in the setting of complete thoracic spinal cord injury.

BACKGROUND/OBJECTIVE: An assessment of neurological improvement after surgical intervention in the setting of traumatic thoracic spinal cord injury (SCI). METHODS: A retrospective evaluation of a nonconsecutive cohort of patients with a thoracic SCI from T2 to T11. The analysis included a total of 12 eligible patients. The neurologic and functional outcomes were recorded from the acute hospital admission to the most recent follow-up. Data included patient age, level of injury, neurologic examination according to the Frankel grading system, the performance of surgery, and the mechanism of the time-related SCI decompression. RESULTS: All patients had a complete thoracic SCI. The median interval from injury to surgery was 11 days (range, 1-36 days). Decompression, bone fusion, and instrumentation were the most common surgical procedures performed. The median length of follow-up was 18 months after surgery (range, 9-132 months). Motor functional improvement was seen in 1 patient (Frankel A to C). CONCLUSION: Surgical decompression and fusion imparts no apparent benefit in terms of neurologic improvement (spinal cord) in the setting of a complete traumatic thoracic SCI. To better define the role of surgical decompression and stabilization in the setting of a complete SCI, randomized, controlled, prospective studies are necessary.

Adolescent↗
PubMed2002

Lumbar percutaneous KTP532 wavelength laser disc decompression and disc ablation in the management of discogenic pain.

The objective of this research was to determine the outcome of laser disc decompression and laser disc ablation in the management of painful degenerative disc disease with or without associated disc prolapse. Nonendoscopic percutaneous laser disc decompression was performed under x-ray control via the posterolateral approach with side-firing probes. All patients with chronic back pain who had reproduced pain during discography of a nature, pattern, and distribution similar to what they experienced normally were included in the study. Magnetic resonance which confirmed stenosis and sequestrated discs, and patients with acute neurological findings were excluded from the study. Laser disc decompression or ablation was done using the KTP532 wavelength. The functional outcome was assessed prospectively using the Oswestry Disability Index. Clinical benefit was considered significant in those patients with a percentage change in the index of > or =50% at review 3-9 years (mean, 5.33 years) following surgery. A total of 52% of patients demonstrated a sustained significant clinical benefit, with an additional 21% in whom functional improvement was noted. Cohort integrity was 67%. Long-term benefit of the laser disc ablation and decompression for discogenic pain suggests a mechanism other than principally mechanical as a cause of chronic back and sciatic pain. It may suggest that efficacy occurs by reduction in the intradiscal production of irritative products and by an effect upon discal and annular neoneuralization. The sustained nature of the benefit after long-term preoperative symptoms (mean, 4.7 years) rules out any placebo effect. Selection should be restricted to patients without significant lateral recess stenosis, retrolisthesis or olisthesis of > or =3 mm, significant dorsal or foraminal osteophytosis, extrusion, or sequestration.

Adolescent↗
PubMed2006

Effect of early and delayed decompressive craniectomy on secondary brain damage after controlled cortical impact in mice.

The timing of decompressive craniectomy for the treatment of increased intracranial pressure (ICP) after traumatic brain injury (TBI) is a widely discussed clinical issue. Although we showed recently that early decompression is beneficial following experimental TBI, it remains unclear to what degree decompression craniectomy reduces secondary brain damage and if craniectomy is still beneficial when it is delayed by several hours as often inevitable during daily clinical practice. The aim of the current study was therefore to investigate the influence of craniectomy on secondary contusion expansion and brain edema formation and to determine the therapeutic window of craniectomy. Male C57/Bl6 mice were subjected to controlled cortical impact injury. Contusion volume, brain edema formation, and opening of the blood-brain barrier were investigated 2, 6, 12, and 24 h and 7 days after trauma. The effect of decompression craniectomy on secondary brain damage was studied in control mice (closed skull) and in animals craniotomized immediately or with a delay of 1, 3, or 8 h after trauma. Twenty-four hours after trauma, the time point of maximal lesion expansion (+60% vs. 15 min after trauma) and brain edema formation (+3.0% water content vs. sham), contusion volume in craniotomized mice did not show any secondary expansion; that is, contusion volume was similar to that observed in mice sacrificed immediately after trauma (18.3 +/- 5.3 vs. 22.2 +/- 1.4 mm(3)). Furthermore, brain edema formation was reduced by 52% in craniotomized animals. The beneficial effect of craniectomy was still present even when treatment was delayed by up to 3 h after trauma (p < 0.05). The current study clearly demonstrates that early craniectomy prevents secondary brain damage and significantly reduces brain edema formation after experimental TBI. Evaluation of early craniectomy as a therapeutic option after TBI in humans may therefore be indicated.

Animals↗
PubMed2001

The effects of positive end-expiratory pressure during active compression decompression cardiopulmonary resuscitation with the inspiratory threshold valve.

UNLABELLED: The use of an inspiratory impedance threshold valve (ITV) during active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) improves perfusion pressures, and vital organ blood flow. We evaluated the effects of positive end-expiratory pressure (PEEP) on gas exchange, and coronary perfusion pressure gradients during ACD + ITV CPR in a porcine cardiac arrest model. All animals received pure oxygen intermittent positive pressure ventilation (IPPV) at a 5:1 compression-ventilation ratio during ACD + ITV CPR. After 8 min, pigs were randomized to further IPPV alone (n = 8), or IPPV with increasing levels of PEEP (n = 8) of 2.5, 5.0, 7.5, and 10 cm H(2)O for 4 consecutive min each, respectively. Mean +/- SEM arterial oxygen partial pressure decreased in the IPPV group from 150 +/- 30 at baseline after 8 min of CPR to 110 +/- 25 torr at 24 min, but increased in the PEEP group from 115 +/- 15 to 170 +/- 25 torr with increasing levels of PEEP (P <0.02 for comparisons within groups). Mean +/- SEM diastolic aortic minus diastolic left ventricular pressure gradient was significantly (P < 0.001) higher after the administration of PEEP (24 +/- 0 vs 17 +/- 1 mm Hg with 5 cm H(2)O of PEEP, and 26 +/- 0 vs 17 +/- 1 mm Hg with 10 cm H(2)O of PEEP), whereas the diastolic aortic minus right atrial pressure gradient (coronary perfusion pressure) was comparable between groups. Furthermore, systolic aortic pressures were significantly (P < 0.05) higher with 10 cm H(2)O of PEEP when compared with IPPV alone (68 +/- 0 vs 59 +/- 2 mm Hg). In conclusion, when CPR was performed with devices designed to improve venous return to the chest, increasing PEEP levels improved oxygenation. Moreover, PEEP significantly increased the diastolic aortic minus left ventricular gradient and did not affect the decompression phase aortic minus right atrial pressure gradient. These data suggest that PEEP reduces alveolar collapse during ACD + ITV CPR, thus leading to an increase in indirect myocardial compression. IMPLICATIONS: Inspiratory impedance during active compression-decompression cardiopulmonary resuscitation improves perfusion pressures, and vital organ blood flow during cardiac arrest. Increasing levels of positive end-expiratory pressure during performance of active compression-decompression cardiopulmonary resuscitation with an inspiratory impedance valve improves oxygenation, and increases the diastolic aortic-left ventricular pressure gradient and systolic arterial blood pressure.

Air Pressure↗
PubMed2002

Anatomic variations related to decompression of the common peroneal nerve at the fibular head.

Peroneal nerve decompression at the fibular head may be anticipated to be performed more often because lower extremity peripheral nerve surgery is used to restore sensation to the feet of diabetic patients. Although the basic concept of releasing the fascia of the peroneus longus is well-known, anatomic variants related to the peroneus muscle have been identified that must be included in the technique for decompression of this nerve. A comparison of these anatomic variants was done between a random selection of 29 cadavers (bilateral) and 65 patients who underwent unilateral peroneal decompression to treat symptoms of that compression. A fibrous band on the undersurface of the superficial head of the peroneus longus was found in 30% of the cadavers and it was found in 78.5% of the patients. The mean width of the band in cadavers was 9.1 mm and in patients it was 10.1 mm. A fibrous band on the superficial surface of the deep head of the peroneus longus was found in 43% of cadavers, and it was found in 20% of the patients. The soleus muscle origin was joined to the peroneus muscle origin in 9% of cadavers and it was noted in 6% of the patients. It is suggested that during surgical decompression of the common peroneal nerve at the fibular head, the surgeon be aware of these anatomic variants so that they may be released appropriately.

Decompression, Surgical↗
PubMed2002

Fully endoscopic vascular decompression of the glossopharyngeal nerve.

Microvascular decompression of the glossopharyngeal nerve is an effective treatment of patients with glossopharyngeal neuralgia in whom compression of the nerve by a blood vessel is implicated in the pathogenesis of the disease. The standard surgical technique uses a binocular operating microscope for intra-operative visualization. Growing experience with posterior fossa endoscopy, however, has suggested that endoscopes may provide more comprehensive anatomical views of cerebellopontine angle. This report describes the case of a patient suffering from glossopharyngeal neuralgia who underwent fully endoscopic vascular decompression of the glossopharyngeal nerve. During this procedure the endoscope was used to survey the posterior fossa, guide the placement of insulating sponges, and conduct a final assessment of the intervention. We found the endoscope ideally suited to the constricted operating space of the posterior fossa, allowing for accurate localization and careful separation of the pathological vascular conflict with minimal brain retraction and no damage to surrounding structures. The versatility of endoscopy allows for superior visual appreciation of neurovascular conflicts in the posterior fossa. To date, endoscopy has primarily been used to supplement microscopy in cranial nerve decompression surgery. This report demonstrates how the endoscope can be used as the sole imaging modality in glossopharyngeal nerve decompression, with excellent results.

Adult↗
PubMed2001

Changes in the extrinsic and intrinsic coagulation pathways in humans after decompression following saturation diving.

We have investigated the effect of simulated saturation diving on the activation of intrinsic and extrinsic coagulation pathways. Thirty-one male divers divided into two groups were tested in decompression habitat LSH-200. The first group of 16 divers was subjected to hyperbaric exposure at pressure of 180 kPa with air as a breathing mixture, and the second group of 15 divers, exposed to a pressure of 400 kPa with a heliox breathing mixture (helium-oxygen mixture: pO2, 40 kPa; pN2, 40 kPa; pHe, 420 kPa). The concentrations of tissue factor, tissue factor pathway inhibitor, factors XII, X, VII, and I, prothrombin fragment F1 + 2, and thrombin-antithrombin complex as well as platelet count, prothrombin time, activated partial thromboplastin time, plasmin-antiplasmin complex (PAP) and D-dimers were measured. We did not detect activation of the extrinsic coagulation pathway after decompression. There was a statistically significant decrease in platelet counts and factor I, XII and X concentrations after air-diving, and a potent and statistically significant increase of PAP concentration in both groups of divers. We suggest that saturated air or heliox diving followed by decompression have little if any effect on thrombin generation. Saturated air diving, however, may induce a decrease in platelet count and factor XII concentration. The observed elevation of PAP concentrations in both groups of divers suggests possible activation of fibrinolysis. The exact effect of diving and decompression on fibrinolytic system has to be further investigated.

Adult↗
PubMed2000

Modified orbital decompression for dysthyroid orbitopathy.

PURPOSE: The transantral approach to orbital decompression remains useful for the management of exophthalmos associated with dysthyroid orbitopathy. However, the risk of postoperative diplopia is a concern. Preservation of the anterior periorbita may help support the orbital contents and decrease the incidence of diplopia. METHODS: The medical records were reviewed of 15 consecutive patients who underwent 30 transantral orbital decompressions for proptosis associated with dysthyroid orbitopathy. The procedures were completed in standard fashion, including removal of the inferomedial bony strut between the medial orbital wall and the floor. However, stripping of the periorbita was only done posteriorly; the anterior 10 to 15 mm of periorbita were left intact. RESULTS: Six patients had preoperative diplopia that persisted after decompression. Of the nine patients without diplopia preoperatively, none developed diplopia. Proptosis was reduced a mean of 3.5 +/- 2.6 mm. CONCLUSIONS: Preservation of the anterior periorbita during transantral orbital decompression reduces the risk of postoperative diplopia. An adequate reduction in proptosis is also achieved.

Adolescent↗
PubMed2004

Core decompression for osteonecrosis of the hip.

The ultimate goal of treatment of patients with osteonecrosis of the hip is preservation of the femoral head. However, the development of a successful strategy to treat this disease has been difficult because neither the etiology nor the natural history of osteonecrosis of the hip has been defined clearly. Core decompression of the hip is one of the most commonly done surgical procedures to treat the early stages of osteonecrosis of the femoral head. However, there is no general consensus among investigators regarding either the specific indications for this procedure, or the specific technique of core decompression that would optimize results. The data available suggest that core decompression is more effective than nonoperative treatment particularly for patients with limited involvement of the femoral head and with an area of sclerosis surrounding the necrotic bone. The combination of core decompression with the use of osteoinductive or angiogenic agents to enhance bone formation and repair may enhance the results of this surgical procedure in the future.

Decompression, Surgical↗
PubMed1998

Portal decompression by transjugular intrahepatic portosystemic shunt and changes in serum-ascites albumin gradient.

The serum ascites albumin gradient (SAAG) is widely used to help determine the cause of ascites formation. A serum ascites albumin gradient of > or = 1.1 g/dL reliably distinguishes portal hypertension-related ascites from other causes. To date, there are no published data on the impact of portal decompression on this gradient. The recent development of transjugular intrahepatic portosystemic shunt (TIPS) allows for nonsurgical decompression of portal hypertension by radiologically creating a portosystemic shunt. This study examines the short-term impact of portal decompression on the serum ascites albumin gradient (SAAG) in patients with portal hypertension-related ascites undergoing transjugular intrahepatic portosystemic shunt. Portal pressure measurements were obtained before and after TIPS placement. Serum ascites albumin gradient was determined before and at 6 and 24 hours post-TIPS placement. Fifteen patients were enrolled in the study. The mean portosystemic gradient (PSG) before TIPS was 21.0 +/- 9.2 mmHg, whereas the post-TIPS mean PSG was reduced to 11.0 +/- 6.3 mmHg, consistent with portal decompression (p = 0.005). The mean pre-TIPS serum ascites albumin gradient was 1.9 +/- 0.5 g/dL and was reduced to 1.7 +/- 0.5 g/dL at 6 hours (p = 0.003) and 1.4 +/- 0.4 g/dL at 24 hours (p = 0.002) after TIPS placement. These findings further solidify the association between the SAAG and portal hypertension.

Adult↗
PubMed1999

Course of proptosis in patients with Graves' disease after endoscopic orbital decompression.

AIM: To evaluate the results of follow-up and postoperative course of proptosis in patients with Graves' disease who underwent combined transconjunctival and transnasal endoscopic orbital decompression. METHODS: Charts of patients with Graves' disease who underwent orbital decompression using combined transconjunctival and transnasal endoscopic technique were reviewed. The surgical technique involved preservation of the strut of bone between the lamina papyracea of the ethmoid and floor of the orbit of the maxilla. Data pertaining to patient demographics, previous treatments for orbital manifestations of Graves' disease, and preoperative and postoperative otolaryngologic and ophthalmologic examination findings were obtained. Postoperative course of reduction in proptosis was evaluated based on Hertel exophthalmometry measurements obtained in four intervals: 1) 0 to 1 month, 2) 1 month to 3 months, 3) 3 to 6 months, 4) 6 to 12 months. RESULTS: Twenty-eight orbital decompressions were performed on 15 patients. All patients were unresponsive to corticosteroids and orbital irradiation. Ten orbits exhibited preoperative and postoperative visual acuity of 20/20. Vision improved in nine orbits and did not change in six orbits. Proptosis was reduced in 25 orbits. Postoperative course of reduction in proptosis varied within year 1, with the smallest proptosis measurements documented between 6 and 12 months. CONCLUSIONS: Combined transconjunctival and transnasal endoscopic orbital decompression with preservation of the strut resulted in regression of proptosis, marked reduction in postoperative diplopia development, and improvement of visual acuity in patients with Graves' disease. Course of reduction in proptosis varied within postoperative 1 year, with the biggest reduction occurring between 6 and 12 months.

Adolescent↗
PubMed2001

Inner ear decompression sickness in sport compressed-air diving.

OBJECTIVE: We report our experience over the past 12 years with recreational diving-related inner ear decompression sickness (IEDCS). STUDY DESIGN: Retrospective, consecutive case series. METHODS: Twenty-four divers, representing 29 cases of IEDCS, are presented with regard to evaluation, treatment, and follow-up. RESULTS: These 29 cases represent 26% of the severe decompression sickness (DCS) cases treated in that period. The patient group includes 22 divers who had a single event of IEDCS, one diver who had two events, and one with five repeated episodes. The cause of injury in 23 cases (79%) was violation of the decompression schedule. The mean time from surfacing to appearance of symptoms was 47 +/- 65 minutes. In 83%, symptoms appeared within 1 hour of ascent, in 97% within 2 hours, and in only one diver after 5.5 hours. Ten divers (34%) had pure vestibular involvement, 4 (14%) had cochlear insult alone, and 15 (52%) had combined vestibulo-cochlear injury. Except for one patient who had central as well as peripheral vestibulo-cochlear DCS, all the remaining patients had end organ involvement only, as demonstrated by physical examination and laboratory test results. Fifteen (52%) had isolated IEDCS, whereas 14 had additional symptoms of DCS. Twenty-six cases were treated by hyperbaric oxygenation with supplementary daily hyperbaric sessions. Of the 25 cases with vestibular injury and the 19 with cochlear damage, only 7 (28%) and 6 (32%), respectively, made a full recovery, whereas the others remained with residual damage. Of the 17 treated within 6 hours of symptom appearance, 9 (53%) were cured, compared with one of the 9 treated later (P <.05). CONCLUSIONS: IEDCS related to compressed-air recreational diving is more common than previously thought, and might occur even when no decompression schedule violation took place. Prompt diagnosis leading to the early commencement of hyperbaric oxygen recompression therapy is the key to complete recovery of cochlear and vestibular function.

Adult↗
PubMed2003

Endoscopic and transconjunctival orbital decompression for thyroid-related orbital apex compression.

OBJECTIVE: To evaluate the efficacy and safety of a combined endoscopic and transconjunctival orbital decompression in patients with thyroid-related orbitopathy with orbital apex compression. STUDY DESIGN: Retrospective review. METHODS: A sequential series of patients with thyroid-related orbitopathy presenting with orbital apex compressive myopathy with and without optic neuropathy who were undergoing combined endoscopic and transconjunctival decompression by the same surgeons from 1992 to 2001 was reviewed. Patients were regularly evaluated preoperatively and postoperatively over a 3- to 55-month period to record the effects of this approach on visual acuity, Hertel exophthalmometry, and diplopia. Complications and secondary ophthalmological procedures were reviewed. RESULTS: Between 1992 and 2001, 72 combined endoscopic and transconjunctival decompressions were performed on 41 patients with orbital apex compression. Visual acuity improved in 89.3% of the patients with compressive optic neuropathy (P <.0005) and in 34.1% of those without neuropathy. Proptosis was reduced by 3.65 mm, on average. There was one case of transient intraoperative cerebrospinal fluid extravasation at the site of the optic nerve decompression, and one patient developed epistaxis. CONCLUSIONS: The study supports the treatment of thyroid-related orbital apex compression with and without compressive optic neuropathy by a combined transconjunctival and endoscopic approach. This approach offers short hospital stays, excellent visual recovery, and minimal complications in patients with thyroid-related orbital apex compressive myopathy and related compressive optic neuropathy. The beneficial effects observed in the patients with visual loss continued to improve over time and were significant (P <.001).

Adult↗
PubMed2003

Inner ear decompression sickness and inner ear barotrauma in recreational divers: a long-term follow-up.

OBJECTIVES/HYPOTHESIS: The objectives were to report the authors' experience with the long-term follow-up of patients with diving-related inner ear decompression sickness and inner ear barotrauma and to discuss residual cochlear and vestibular damage in relation to the question of fitness to dive. STUDY DESIGN: Retrospective consecutive case series. METHODS: Eleven recreational divers with inner ear decompression sickness and nine with inner ear barotrauma (IEB) were followed. A complete otoneurological physical examination and laboratory evaluation were carried out. The latter included audiometry, electronystagmography, a rotatory chair test using the sinusoidal harmonic acceleration protocol, and computerized dynamic posturography. RESULTS: Residual cochleovestibular deficits were found in 10 (91%) of the patients with inner ear decompression sickness and 3 (33%) of those with IEB (P <.02, Fisher's Exact test; odds ratio, 20). A significantly shorter follow-up period was required for the inner ear barotrauma group (P <.05, simple t test) because three patients (33%) recovered completely within 1 month of the diving accident. Eight patients had residual vestibular deficits on follow-up, but only one (12.5%) was symptomatic. However, five (56%) of the nine patients who had a cochlear insult, as documented by follow-up audiometry, complained of significant hearing loss and tinnitus. CONCLUSION: Inner ear decompression sickness carries a high risk for residual inner ear damage despite hyperbaric oxygen recompression therapy. A favorable prognosis might be anticipated for inner ear barotrauma. The finding that most patients with residual vestibular deficits were asymptomatic at the time of follow-up emphasizes the need for a complete vestibular evaluation, including specific bedside testing and laboratory examinations, before a return to diving activity may be considered.

Adult↗