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PubMed1990

[Intraoperative brainstem auditory evoked potential in the microvascular decompression of the 5th and 7th cranial nerves].

Microvascular decompression techniques are rational surgical procedures for treating trigeminal neuralgia and facial hemispasm, with results ranging from good to excellent in 90% of cases. Among the most frequent complications recorded in the literature concerning these decompressions, impairment of the facial nerve and auditory nerve account for 5% to 10% due to mechanical traction and/or vascular injury. The peroperative use of early brain-stem evoked potentials (BAEP) was performed on 17 patients in a series of 325 decompressions of the trigeminal nerve, and on 17 patients in a series of 25 decompressions for facial hemispasm. Such peroperative monitoring is considered to be most important in the surgical technique. The author reports on his experience and results.

Adult↗
PubMed1989

Osteonecrosis of the femoral head. Results of core decompression and grafting with and without electrical stimulation.

The effectiveness of core decompression and bone grafting with and without electrical stimulation was investigated in patients with avascular necrosis (AVN) of the femoral head. One hundred sixteen hips with AVN had decompression and grafting; 74 were also treated with direct current (DC). The DC stimulation was via a coil inserted directly into the femoral head. These were compared to 55 hips with AVN treated nonoperatively. Hips treated with electrical stimulation showed less roentgenographic progression and achieved a better clinical score than hips treated with decompression and grafting alone. Both groups had a significantly lower incidence of arthroplasty than the nonoperated controls. One patient developed a pulmonary embolus, but there were no fractures or other complications. Decompression and grafting are safe and reasonably effective in retarding the progression of AVN. Supplemental electrical stimulation seems to improve the results even further.

Arthroplasty↗
PubMed1988

[Endotoxinemia and bacteremia in manual oral decompression of ileus].

In the framework of the present clinical prospective study using a randomly selected patient collective, the question was pursued whether manual oral decompression (MOD), done in connection with surgical intervention in severely ill patients with ileus of the large and small intestine, leads to detectable bacteremia or higher concentrations of endotoxin in serum. From October, 1985 to March, 1987, bacteriological tests were conducted and the endotoxin concentrations in serum were measured in a total of 31 patients. 71% of the patients were female and 29% were male, aged 18-89. The endotoxin measurement was conducted with the aid of the limulus-amoebocyte-lysate (LAL) test, modified according to Piotrowicz. Additionally, bacteriological tests were done of the operation sites and the decompressed gastro-intestinal secretions. Simultaneously, cultures from the central blood stream were prepared. The tests showed that bacteremia and endotoxinemia occur in connection with manual oral decompression (MOD). Neither of the two, however, has any clinically relevant influence on the further post-operative course. Thus, manual oral decompression continues to represent an indispensable maneuver in the surgical management of an ileus.

Adolescent↗
PubMed1985

Anterior decompression of traumatic thoracolumbar fractures with incomplete neurological deficit using a retroperitoneal approach.

Between 1973 and 1981, seventy patients with a spinal cord injury secondary to a thoracolumbar fracture were treated by anterior spinal-canal decompression through a retroperitoneal approach. All of these patients had an incomplete neurological deficit caused by retropulsed vertebral-body fragments and intervertebral disc material in the spinal canal. Forty-eight patients have been followed for an average of 3.4 years (range, two to 8.6 years). Either computed tomography or lateral tomography, or both, was performed after surgery on these forty-eight patients, and confirmed the successful removal of the cause of compression in all of them. No patient lost further cord or cauda equina function after the anterior decompression. Thirty-seven of the forty-two patients who had a motor deficit improved by at least one class in motor strength. Fourteen of the thirty patients whose quadriceps and hamstrings were too weak to permit walking regained full independent walking ability. Twelve of the thirty-two patients who had a conus medullaris injury demonstrated neurogenic bowel and bladder recovery. The degree of neurological recovery of spinal cord injury after anterior spinal decompression of thoracolumbar fractures appears more favorable than after other, previously reported techniques that do not decompress the spinal canal.

Adolescent↗
PubMed1985

The effect of core decompression on femoral head blood flow in steroid-induced avascular necrosis of the femoral head.

Previous reports from this and other laboratories have shown that the histological changes in the femoral head that are associated with steroid treatment are consistent with avascular necrosis of the femoral head. In this experiment, we studied the effect of core decompression on femoral head blood flow in steroid-treated rabbits using the microsphere technique. The results showed that there was a gradual decline of femoral head blood flow in animals that received weekly injections of methylprednisolone without core decompression. The femoral head blood flow in animals that underwent core decompression after six weeks of steroid treatment showed a gradual normalization within four weeks after core decompression.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Clinical experience with subxyphoid pericardial decompression.

Between 1971 and 1981, 108 patients with pericardial effusion were treated by subxyphoid pericardial decompression. 68 patients (63%) had local anesthesia, while general anesthesia was used in 40 (37%). The total group included nonspecific (viral) pericarditis in 35 patients (32.4%), uremic pericarditis in 30 (27.8%); and 20 patients (18.5%) with a malignant etiology, traumatic in ten patients (9.3%), six patients (5.6%) following radiation for malignant disease, and seven patients (6.5%) due to other causes. Echocardiography was diagnostic in all cases. Acute cardiac tamponade necessitated pericardiocentesis as an initial procedure in seven patients (6.5%). Subxyphoid pericardial decompression included drainage of the pericardial fluid and performance of a 5 X 5 cm pericardial window and biopsy of all patients. There were two (1.8%) operative deaths in the general anesthesia group but none in the local anesthesia group. There were no major complication in the local anesthesia group, but one patient in the general anesthesia group, who was severely hypertensive preoperatively, developed hemiplegia on the left side. There were five recurrences (4.6%) requiring total pericardiectomy at a later date. Subxyphoid pericardial decompression under local anesthesia was seen to be a safe and effective procedure for primary decompression and diagnosis of acute or chronic pericardial effusion.

Adolescent↗
PubMed1985

[Posterior fossa microvascular decompression for hemifacial spasm and trigeminal neuralgia--some improvements on operative devices and technique].

Microvascular decompression has been widely used as a method for the treatment of hemifacial spasm and trigeminal neuralgia. We have experienced 30 such cases in the last 2 years; 25 of them were hemifacial spasm and 5 trigeminal neuralgia. Excellent results were obtained in 26 cases; the remaining two cases, both hemifacial spasm, were partially cured. Mild facial paresis appeared several days after the operation in 3 patients. In all the cases, the facial paresis recovered completely within several weeks. The cause of the facial paresis was not known. In 2 cases a slight hearing deficits were noticed after surgery, which has been gradually improving over several months. As this operation is functional surgery, operative complications must be avoided as much as possible. It has been our policy that we first try medical treatment and/or some kinds of nerve block and if no effects are obtained, we recommend the microvascular decompression. For microvascular decompression, suboccipital craniectomy is performed in lateral position. From the point of view of surgical technique, we stress several important points as follows: The head is elevated about 30 degrees, and it is kept approximately horizontal and should not be excessively rotated. Craniectomy is made as far laterally as the sigmoid sinus; its shape is elongated oval. Retraction of the cerebellum should not be done in the direction of the cranial nerves to avoid post-operative hearing deficit. Two tapered retractors are effectively used for cerebellar retraction. A third slim, tapered retractor is useful for holding an offending artery when exploring the root exit zone or placing a sponge for decompression.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

A randomized trial of gastric decompression after truncal vagotomy and anterior pylorectomy.

To test the assumption that gastric decompression is beneficial after TV, 66 patients who underwent elective TV plus anterior pylorectomy were randomly allocated into three groups immediately after completing pyloric reconstruction. Patients in group G had a tube gastrostomy, patients in group ND did not have gastric decompression and patients in group NGS were treated with nasogastric suction for 48 to 72 hours. Roentgenographically, greater gastric distension could be noted in patients in the ND group but this was not clinically significant. Patients in the NGS group had a high incidence of mechanical complications, especially when tubes were in place for more than 48 hours. Infections of the chest were not related to gastric decompression techniques. Patients in groups NGS and ND had significantly shorter hospital stays than patients in group G. During the immediate post-operative period after TV, we would recommend no gastric decompression or short term (less than 48 hours) nasogastric suction. Routine gastrostomy is unwarranted.

Adolescent↗
PubMed1984

[Prophylactic external decompression for massive cerebral infarction].

When cerebral infarct extends over a wide area and severe cerebral edema follows, there may be some cases where external decompression is necessarily indicated. Decompression is generally performed when signs of tentorial herniation appear and brainstem damage seems to be still reversible. We have been performing operations in such indication, but result of operations were poor. We were led to search for a accurate way to save acute massive cerebral infarction. A prophylactic external decompression being carried out just when a tentorial herniation is certainly imminent, could be an option. Analysis of serial CT scannings on infarction cases definitely revealed that before cerebral edema became manifest and tentorial herniation developed, there was a period when there were such findings as uniform: low density appears over the whole middle cerebral artery territory. this low density is homogeneous. lateral ventricle is slightly compressed and cortical sulci disappear suggesting slight cerebral edema. We have tried external decompression on three cases as soon as we found these CT findings, before there were signs of tentorial herniation and the outcome were satisfactory.

Adult↗
PubMed1981

Optic nerve decompression in benign intracranial hypertension.

Fourteen patients with benign intracranial hypertension who failed to respond to medical treatment, were treated with optic nerve decompression to prevent the sequelae of chronic unrelieved papilloedema. The mechanism by which optic nerve decompression protects the optic nerve is uncertain. These patients were reviewed to evaluate the efficacy of the procedure in the treatment of benign intracranial hypertension and to assess its mechanism of action. Preoperatively all patients had papilloedema, 11 patients had visual obscurations and 6 patients had evidence of visual failure. Postoperatively, visual obscurations and papilloedema resolved in all patients, and 5 of 6 patients had no further deterioration of visual function. Six patients had symptoms of raised intracranial pressure preoperatively and in 3 the symptoms resolved after surgery. Three patients had unilateral optic nerve decompression and papilloedema resolved in both eyes. In 1 patient intracranial pressure monitoring revealed raised pressure preoperatively with no significant change in the first 24 hours after surgery. We conclude that optic nerve decompression is effective in the treatment of benign intracranial hypertension, has its effect locally, and in some patients may lower the intracranial pressure.

Adult↗
PubMed1995

[One-year follow-up of 466 nerve decompressions in 123 lepers during multidrug therapy in Madagascar].

Surgical decompression of nerves in patients with leprosy is a simple procedure that can be used in developing countries. At the leprosy center of Ambatoabo on the east coast of Madagascar, 466 nerve decompressions were performed on 123 subjects and results were evaluated by the same examiner 15 months later. All subjects were undergoing multidrug therapy at the time of the procedure. The decision to perform surgery was based on recent onset of sensory and motor neurologic signs and on progression or persistence of symptoms despite administration of prednisolone. Decompression led to pain relief in 100% of cases and regression of sensory disturbances in 97%. Sensory recovery in the plantar ulcers of the foot was obtained in 80% of cases and motor performance improved in 61%. These favorable results confirm the value of surgical decompression to prevent sequels of leprosy and the feasibility of this procedure in remote areas.

Adolescent↗
PubMed1995

External radiotherapy for biliary decompression of hilar cholangiocarcinoma.

Obstructive jaundice due to hilar cholangiocarcinoma is difficult to decompress because of the location of the tumor. We used external radiation alone for biliary decompression and reviewed its efficacy in this study. Subjects comprised 14 patients diagnosed as having inoperable hilar cholangiocarcinoma by ultrasonography, percutaneous transhepatic cholangiography, and CT scanning. The total bilirubin level on admission ranged from 0.4 to 34.6 mg/dl (mean: 11.0 mg/dl). These patients were irradiated with a 4MeV linear accelerator using parallel opposing fields measuring from 7 x 7 cm to 8 x 10 cm. The total radiation dose ranged from 50 Gy to 60 Gy and in fractions of 1.8-2.0 Gy per day. No patient underwent further biliary decompression after percutaneous transhepatic cholangiography, and irradiation was performed immediately after diagnosis. Eleven of the 14 patients received the full dose of external radiation. Three patients discontinued radiotherapy because of severe vomiting and nausea, pneumonia, and a hemorrhagic gastric ulcer. In 10 of the 11 patients, the serum total bilirubin level returned to normal (p < 0.005) and no cholangitis occurred. Obstructive jaundice recurred in one patient, and serum total bilirubin returned to normal again after further irradiation. Eight of the 11 patients could be discharged from hospital and returned to society. The survival time of the 11 patients ranged from 3 to 25 months and the 12-month survival rate was 50% (Kaplan-Meier method). This study suggests that external radiation therapy is an effective treatment for biliary decompression in patients with unresectable hilar cholangiocarcinoma.

Aged↗
PubMed1995

Preventing collapse in early osteonecrosis of the femoral head. A randomised clinical trial of core decompression.

We performed a randomised trial on 37 hips (33 patients) with early-stage osteonecrosis (ON). After the initial clinical evaluation, including plain radiography and MRI, 18 hips were randomly assigned to a core-decompression group and 19 to a conservatively-treated group. All the patients were regularly followed up by clinical evaluation, plain radiography and MRI at intervals of three months. Hip pain was relieved in nine out of ten initially symptomatic hips in the core-decompression group but persisted in three out of four initially painful hips in the conservatively-treated group at the second assessment (p < 0.05). At a minimum follow-up of 24 months, 14 of the 18 core-decompressed hips (78%) and 15 of the 19 non-operated hips (79%) developed collapse of the femoral head. By survival analysis, there was no significant difference in the time to collapse between the two groups (log-rank test p = 0.79). Core decompression may be effective tin symptomatic relief, but is of no greater value than conservative management in preventing collapse in early osteonecrosis of the femoral head.

Adolescent↗
PubMed1995

Partial portal decompression alleviates thrombocytopenia of portal hypertension.

Thrombocytopenia due to splenic sequestration of platelets occurs commonly in patients with portal hypertension. Partial portal decompression for bleeding esophagogastric varices, via the small diameter H-graft portacaval shunt (HGPS), is intended to partially decompress the portal system below bleeding threshold but also to maintain a degree of portal hypertension sufficient to maintain prograde portal perfusion. This study was undertaken to determine whether the reduction of portal pressures seen in patients undergoing HGPS is sufficient to relieve the thrombocytopenia seen in patients with portal hypertension. A total of 74 patients underwent small diameter HGPS for bleeding esophagogastric varices not amenable to medical management. Thirty-four (46%) patients had thrombocytopenia (platelet count < 80,000/mL) before shunting. Platelet counts were obtained preshunt, at discharge, and from 1 to 3 years after shunting. Portal pressures decreased significantly from 30mm Hg +/- 5.6 (SD) pre shunt to 19mm Hg +/- 5.8 (SD) after shunting (P < 0.001). Platelet counts increased from a pre-shunt value of 61,000/mL +/- 2,700 (SEM) to a platelet count of 139,000/mL +/- 21,800 (SEM) at discharge (P < 0.006) and to 102,000/mL +/- 17,500 (SEM) 1 to 3 years after shunting (P < 0.001). Patients undergoing portasystemic shunting for bleeding esophagogastric varices are frequently thrombocytopenic. Partial portal decompression using the 8 mm HGPS is sufficient to alleviate thrombocytopenia associated with portal hypertension immediately following HGPS and for years to follow. The presence of thrombocytopenia does not preclude the use of partial portal decompression in patients with bleeding varices requiring operative intervention.

Adult↗
PubMed1993

[Orbital decompression by pterional approach in dysthyroid orbitopathies].

The etiology of the endocrine orbitopathy is still unknown and thereby their treatment remains symptomatic. The surgical decompression is achieved in resecting lateral wall, roof and partly bottom of the orbit. We treated 23 eyes in 14 patients and in only one patient the decompression obtained with this method was insufficient. This patient underwent additionally transantral transethmoidal decompression. One patient had a complete loss of vision after surgery probably due to direct lesion of the optic nerve. The decompression of the orbit is indicated in fast progressive endocrine orbitopathies with impairment of the visual function.

Adult↗
PubMed1993

Evaluation of the microcirculation of the equine small intestine after intraluminal distention and subsequent decompression.

Effects of intraluminal distention (25 cm of H2O, 120 minutes) and subsequent decompression (60 minutes) on intramural vascular patterns of the small intestine was evaluated in 7 anesthetized horses. Intraluminal distention (25 cm of H2O, 120 minutes) was created in 2 jejunal segments in each horse. Experimental and control segments were removed either immediately after the experimental period or after 60 minutes of decompression. The vascular system of experimental and control jejunal segments was lavaged with NaCl, then was injected with a blue-colored radiopaque medium for microangiography or with a diluted methyl methacrylate for scanning electron microscopy of microcorrosion vascular casts. After angiographic evaluation, tissue sections were prepared for light microscopic evaluation to assess vascular filling and tissue morphology. The distended segments had short villi, which were separated by expanded crypts, and had mesothelial cell loss, neutrophil infiltration, and edema in the seromuscular layer. The number of perfused vessels was significantly (P < 0.05) decreased in the seromuscular layer and, to a lesser extent, in the mucosal layer of the distended segments, compared with controls. After decompression, the morphologic lesions progressed in mucosal and serosal layers and the number of observed vessels increased in all intramural layers; however, vascular density did not return to the predistention state. These results identify altered intramural vascular patterns in the equine jejunum during luminal distention and subsequent decompression.

Animals↗
PubMed1993

[Internal decompression with hippocampectomy for massive cerebral infarction].

Massive cerebral infarction due to the occlusion of a main cerebral artery is often unresponsive to medical treatment. Internal decompression with hippocampectomy was tried for two patients and satisfactory results were obtained without advancing cerebral edema. External decompression was also performed on 12 patients, but it was accompanied by intensified edema postoperatively. Satisfactory results were obtained in four cases, but three patients remained in vegetative states, and five patients died. The internal decompression with immediate hippocampectomy resolves compression to the brain stem without aggravating cerebral edema and may be more effective in preserving life than external decompression.

Aged↗
PubMed1993

[Significance of simultaneous fusion and surgical decompression in lumbar spinal stenosis].

In a prospective study 45 patients with clinically relevant spinal stenosis of the lumbar spine were randomized in three groups. Group 1 underwent isolated decompression without fusion, group 2 had decompression and selected fusion, and group 3 underwent fusion of all decompressed segments. Patients with previous surgery of the lumbar spine or obvious instability, such as spondylolisthesis, were excluded from the study. The results were dominated by the relevant clinical improvement in the symptoms of spinal stenosis in all three groups. There were no statistical significant differences in the clinical results between the patients with and without fusion. We conclude that in the absence of obvious segmental instability, no fusion is required for decompressive surgery in degenerative lumbar spinal stenosis.

Aged↗