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PubMed2004

Exercise effects during diving and decompression on postdive venous gas emboli.

BACKGROUND: Exercise and diving have generally been associated with an increased risk of decompression sickness (DCS), thus accounting for the lack of studies involving exercise during decompression. However, theoretical and observational evidence contrary to this association motivated the present investigation on the effects of moderate, intermittent exercise during diving and/or during decompression on venous gas emboli (VGE) activity following a dive. HYPOTHESIS: VGE observed at both the precordium and subclavian vein sites after diving should be reduced if moderate exercise is performed during decompression vs. remaining inactive. METHODS: In a water-filled hyperbaric chamber, 39 healthy male subjects were compressed to a pressure of 450 kPa (45 msw) for 30 min followed by 55 min of staged decompression. Subjects were either active or inactive at the bottom phase (450 kPa) and/or during the decompression. Activity comprised three 5-min intervals of moderate arm or leg exercise at the bottom and five such intervals during decompression. After decompression, VGE were monitored at the precordium and subclavian vein sites using Doppler detection. Bubble activity scores were converted to various indices and analyzed using non-parametric statistics. RESULTS: VGE activity was invariant as to whether subjects were active or sedentary during the bottom phase of the dive. However, it was significantly lower for all indices examined (p < 0.05) after dives in which exercise was performed during decompression vs. inactive decompression. CONCLUSION: Moderate, intermittent physical activity during decompression decreases VGE activity after diving.

Adult↗

PubMed1987

Decompression of the spinal cord improves recovery after acute experimental spinal cord compression injury.

The value of decompression after spinal cord injury in patients is still an unresolved issue. It has previously been shown in our laboratory that functional recovery in rats after cord compression varied with both the force and time until decompression. However, the longest duration studied was only 15 minutes, which is far less than that usually encountered in clinical practice, and therefore, the present study was undertaken to determine the value of decompression after more prolonged periods of compression. A factorially designed experiment with five rats per cell was used with the clip compression injury model. Forces of 2.3, 16.9 or 53.0 gms were applied at C7-T1 until decompression was performed after 15, 60, 120, or 240 minutes of compression. Functional recovery was assessed weekly for 8 weeks using the inclined plane technique. Maximum and minimum performance limits were established in normal rats and rats with cord transection, respectively. Univariate analysis and multiple comparison tests were used to analyse the data. The major determinant of recovery was the force of the injury. For example, the animals injured by the 2.3 gm clip performed significantly better than those injured at higher forces for all times until decompression (p less than 0.0001), and there was a significant difference in recovery between the groups injured by the 16.9 and 53.0 gm clips, although only for the 15 minutes until decompression group (p less than 0.05). The time until decompression also affected recovery, but only for the lighter compression forces (2.3 and 16.9 gm). For example, animals decompressed after 60 minutes of 2.3 gm compression recovered significantly better than those decompressed after 240 minutes (p less than 0.05). Thus, if the initial injury force is small, decompression is beneficial even after prolonged injury.

Animals↗

PubMed2005

A traumatic central cord syndrome occurring after adequate decompression for cervical spondylosis: biomechanics of injury: case report.

STUDY DESIGN: Case report with review of the literature. OBJECTIVES: To present the first case of a central cord syndrome occurring after adequate decompression, and review the mechanics of the cervical spinal cord injury and postoperative biomechanical and anatomic changes occurring after cervical decompressive laminectomy. SUMMARY OF BACKGROUND DATA: Cervical spondylosis is a common pathoanatomic occurrence in the elderly population and is thought to be one of the primary causes for a central cord syndrome. Decompressive laminectomy with or without fusion has been a primary treatment for spondylotic disease and is thought to be protective against further injury. To our knowledge, there are no cases of a central cord syndrome occurring after adequate decompression reported in the literature. METHODS: Case study with extensive review of the literature. RESULTS: The patient underwent C3-C7 cervical laminectomy without complications. After surgery, the patient's spasticity and gait difficulties improved. She was discharged to inpatient rehabilitation for further treatment of upper extremity weakness. The patient fell in the rehabilitation center, with a central cord syndrome despite adequate decompression of her spinal canal. The patient was treated conservatively for the central cord and had minimal improvement. CONCLUSIONS: Decompressive laminectomy provides an immediate decompressive effect on the spinal cord as seen by the dorsal migration of the cord, however, the biomechanics of the cervical spine after decompressive laminectomy remain uncertain. This case supports the ongoing research and need for more intensive research on postoperative cervical spine biomechanics, including decompressive laminectomies, decompressive laminectomy and fusion, and laminoplasty.

Accidental Falls↗

PubMed2001

A randomized controlled trial of total colonic decompression after colonoscopy to improve patient comfort.

OBJECTIVES: Bloating occurring after colonoscopy may cause significant discomfort in some patients. We sought to determine whether total colonic decompression decreased bloating and improved comfort after colonoscopy. METHODS: Consecutive outpatients undergoing elective colonoscopy were randomized to total colonic decompression or to the control group after completion of the routine colonoscopy. The colonoscope was advanced again to the cecum and the air aspirated during withdrawal in patients randomized to decompression and the procedure was terminated without decompression in control patients. Pain and bloating was assessed in the recovery room and in 24-48 h using a five-point scale. RESULTS: Sixty-five patients were randomized to decompression and 61 were randomized to the control group. The baseline demographic and procedural characteristics were similar between the two groups, but decompression took significantly longer (median, 17 min vs 14 min, p = 0.0002). Seventy-five percent of the decompression group and 80% of the control group denied any pain during colonoscopy. Significantly fewer patients from the decompression group complained of bloating after the procedure (25% vs 59%, p < 0.001) when questioned in the recovery room. However, comparable patients complained of postprocedure bloating when questioned in 24-48 h after the procedure (45% of decompression group vs 47% of control group, p = 0.86). The nurse and the endoscopist were poor at predicting the patient's bloating and significantly overestimated the level of pain. CONCLUSIONS: Total colonic decompression does not significantly reduce bloating after colonoscopy when assessed 24-48 h after the procedure.

Abdominal Pain↗

PubMed2000

Reversal of dysthyroid optic neuropathy following orbital fat decompression.

AIMS: To document the successful treatment of five patients with dysthyroid optic neuropathy by orbital fat decompression instead of orbital bone decompression after failed medical therapy. METHODS: Eight orbits of five patients with dysthyroid optic neuropathy were selected for orbital fat decompression as an alternative to bone removal decompression. Treatment with systemic corticosteroids and/or orbital radiotherapy was either unsuccessful or contraindicated in each case. All patients satisfied clinical indications for orbital bone decompression to reverse the optic neuropathy. High resolution computerised tomographic (CT) scans were performed in all cases and in each case showed signs of enlargement of the orbital fat compartment. As an alternative to bone decompression, orbital fat decompression was performed on all eight orbits. RESULTS: Orbital fat decompression was performed on five patients (eight orbits) with optic neuropathy. Optic neuropathy was reversed in all cases. There were no cases of postoperative diplopia, enophthalmos, globe ptosis, or anaesthesia. All patients were followed for a minimum of 1 year. CONCLUSIONS: In a subset of patients with an enlarged orbital fat compartment and in whom extraocular muscle enlargement is not the solitary cause of optic neuropathy, fat decompression is a surgical alternative to bony decompression.

Adipose Tissue↗

PubMed1999

An evidence-based review of decompressive surgery in acute spinal cord injury: rationale, indications, and timing based on experimental and clinical studies.

OBJECT: The authors conducted an evidence-based review of the literature to evaluate critically the rationale and indications for and the timing of decompressive surgery for the treatment of acute, nonpenetrating spinal cord injury (SCI). METHODS: The experimental and clinical literature concerning the role of, and the biological rationale for, surgical decompression for acute SCI was reviewed. Clinical studies of nonoperative management of SCI were also examined for comparative purposes. Evidence from clinical trials was categorized as Class I (well-conducted randomized prospective trials), Class II (well-designed comparative clinical studies), or Class II (retrospective studies). Examination of studies in which animal models of SCI were used consistently demonstrated a beneficial effect of early decompressive surgery, although it is difficult to apply these data directly to the clinical setting. The clinical studies provided suggestive (Class III and limited Class II) evidence that decompressive procedures improve neurological recovery after SCI. However, no clear consensus can be inferred from the literature as to the optimum timing for decompressive surgery. Many authors have advocated delayed treatment to avoid medical complications, although good evidence from recent Class II trials indicates that early decompressive surgery can be performed safely without causing added morbidity or mortality. CONCLUSIONS: There is biological evidence from experimental studies in animals that early decompressive surgery may improve neurological recovery after SCI, although the relevant interventional timing in humans remains unclear. To date, the role of surgical decompression in patients with SCI is only supported by Class III and limited Class II evidence. Accordingly, decompressive surgery for SCI can only be considered a practice option. Furthermore, analysis of the literature does not allow definite conclusions to be drawn regarding appropriate timing of intervention. Hence, there is a need to conduct well-designed experimental and clinical studies of the timing and neurological results of decompressive surgery for the treatment of acute SCI.

Acute Disease↗

PubMed2000

Decompression scenarios in a new underground transportation system.

BACKGROUND: The risks of a public exposure to a sudden decompression, until now, have been related to civil aviation and, at a lesser extent, to diving activities. However, engineers are currently planning the use of low pressure environments for underground transportation. This method has been proposed for the future Swissmetro, a high-speed underground train designed for inter-urban linking in Switzerland. HYPOTHESIS: The use of a low pressure environment in an underground public transportation system must be considered carefully regarding the decompression risks. Indeed, due to the enclosed environment, both decompression kinetics and safety measures may differ from aviation decompression cases. METHOD: A theoretical study of decompression risks has been conducted at an early stage of the Swissmetro project. A three-compartment theoretical model, based on the physics of fluids, has been implemented with flow processing software (Ithink 5.0). Simulations have been conducted in order to analyze "decompression scenarios" for a wide range of parameters, relevant in the context of the Swissmetro main study. RESULTS: Simulation results cover a wide range from slow to explosive decompression, depending on the simulation parameters. Not surprisingly, the leaking orifice area has a tremendous impact on barotraumatic effects, while the tunnel pressure may significantly affect both hypoxic and barotraumatic effects. Calculations have also shown that reducing the free space around the vehicle may mitigate significantly an accidental decompression. CONCLUSION: Numeric simulations are relevant to assess decompression risks in the future Swissmetro system. The decompression model has proven to be useful in assisting both design choices and safety management.

Accidents↗

PubMed2003

The risk of altitude decompression sickness at 12,000 m and the effect of ascent rate.

INTRODUCTION: Loss of aircraft cabin pressurization can result in very rapid decompression rates. The literature contains reports of increased or unchanged levels of altitude decompression sickness (DCS) resulting from increasing the rate of decompression. We conducted two prospective exposure profiles to quantify the DCS risk at 12,192 m (40,000 ft), and to determine if there was a greater DCS hazard associated with a much higher rate of decompression than typically used during past DCS studies. METHODS: The 63 human subjects participated in 80 altitude chamber decompression exposures to a simulated altitude of 12,192 m (2.72 psia; 18.75 kPa) for 90 min, following preoxygenation with 100% oxygen for 90 min. Half of the subject-exposures involved an 8-min decompression (1,524 mpm; 5,000 fpm) and the other half experienced a 30-s decompression (mean of 24,384 mpm; 80,000 fpm). Throughout each ascent and exposure, subjects were seated at rest and breathed 100% oxygen. At altitude, they were monitored for precordial venous gas emboli (VGE) and DCS symptoms. RESULTS: The higher decompression rate yielded 55.0% DCS and 72.5% VGE and the lower rate produced 47.5% DCS and 65.0% VGE. Chi square and log rank tests based on the Kaplan-Meier analyses indicated no difference in the incidence or onset rate of DCS or VGE observed during the two profiles. CONCLUSION: Decompression rate to altitude up to 24,384 mpm was found not to have an effect on DCS risk at altitude. However, research is needed to define the DCS risk with decompression rates greater than 24,384 mpm. It was also found that the onset time to DCS symptoms decreases as altitude increases.

Adult↗

PubMed2005

[Effect of combined decompression operation on middle and late stage cerebral herniation].

OBJECTIVE: To observe the effect of combined decompression operation on patients with severe traumatic brain injury complicated by tentorial cerebral herniation. METHODS: Ninety-seven patients with an admission Glasgow Coma Scale score 3-5 were randomly divided into two groups: combined decompression group (n=46), in whom tentorium cerebelli was incised (2-4 cm) combined with bone flap craniectomy decompression [(10-15)cm x (15-17)cm], and conventional temporoparietal craniectomy group (n=51). CT scanning was performed in the patients before and after the operation. The patients of both groups received routine treatment and followed up for 1-32 months (mean 7 months) after the operation. The clinical symptoms, change in intracranial pressure and incidence of complications were compared between the two groups. RESULTS: The efficacious rate was 80.4% (37/46) in the combined decompression group, and among them 27 patients were cured (58.7%) and 10 patients remained to have moderate disability(21.7%). Nine patients (19.6%) died after combined decompression. However, in patients with conventional temporoparietal craniectomy decompression, favorable outcome was only found in 6 cases(11.8%), moderate disability accounted for 21.6% of patients, and 34 patients died(66.6%). In patients with combined decompression, the intracranial pressure was more efficiently lowered compared with conventional craniectomy decompression(P<0.01). Furthermore the incidence of acute brain edema, incisional herniation, traumatic epilepsy, occipital cerebral infarct and cerebro-spinal fluid(CSF) leakage were lower in combined decompression group compared with conventional craniectomy group (P<0.05 or P<0.01). The incidence of intracranial infection was not significantly different between two groups (P>0.05). CONCLUSION: Combined decompression is preferable to routine temporoparietal craniectomy for patients with severe head injury complicated by tentorial herniation.

Adolescent↗

PubMed2006

Posterolateral spinal cord decompression in patients with metastasis: an endoscopic assisted approach.

Spinal tumors that are radioresistant or cause bony compression of the spinal cord often require surgical decompression to protect or restore neurological function. Metastatic lesions and primary tumors such as multiple myeloma usually arise in the vertebral body, which can collapse and become unstable, and can compress the anterior columns of the cord. Laminectomy is often ineffective in these patients, and direct anterior decompression through thoracotomy is the widely-accepted solution to the neurological problem. The anterior surgical approach is particularly challenging in the upper thoracic spine. Patients with limited pulmonary reserve due to pneumonectomy or pulmonary metastasis might not tolerate the loss of lung capacity necessitated by either thoracotomy or thoracoscopy. Because posterior instrumentation is usually needed to provide stability following corpectomy and spinal cord decompression, posterolateral approaches to spinal cord decompression have gained favor in recent years. Posterolateral decompression offers advantages over the combined anterior and posterior approach, reducing operative time, morbidity, and hospital stay. Drawbacks to traditional posterolateral decompressions include poor visualization of the tumor immediately anterior to the spinal cord and the need to manipulate the spinal cord to completely remove a tumor adherent to the dura. Endoscopically assisted posterolateral decompression allows decompression of the anterior surface of the spinal cord, the point of pressure in most circumstances. Endoscopic video assistance facilitates vertebrectomy, cord decompression, and anterior reconstruction, all performed through the same posterior incision. Endoscopic assisted spinal cord decompression dramatically reduces morbidity, ICU requirements, and inpatient hospitalization and has proven useful for a variety of metastatic tumors at every level of the spinal column.

Adolescent↗

PubMed1996

Effects of various degrees of compression and active decompression on haemodynamics, end-tidal CO2, and ventilation during cardiopulmonary resuscitation of pigs.

UNLABELLED: The effects of various degrees of compression and active decompression during cardiopulmonary resuscitation were tested in a randomized cross-over-design during ventricular fibrillation in eight pigs using an automatic hydraulic chest compression device. Compared with 4/0 (compression/decompression in cm), mean carotid arterial blood flow rose by 60% with 5/0, by 90% with 4/2 and 4/3, and 105% with 5/2. Two cm active decompression increased mean brain and myocardial blood flow by 53% and 37%, respectively, as compared with 4/0. Increasing standard compression from 4 to 5 cm caused no further increase in brain or heart tissue blood flow whether or not combined with active decompression. Tissue blood flow remained unchanged or decreased when active decompression (4/3) caused that 50% of the pigs were lifted from the table due to the force required. Myocardial blood flow was reduced with 5/0 vs. 4/0 despite no reduction in end decompression coronary perfusion pressure ((aortic-right atrial pressure) (CPP), (7 +/- 8 mmHg with 4/0, 14 +/- 11 mmHg with 5/0)(NS)). End decompression CPP increased by 186% with 4/2 vs. 4/0, by 200% with 4/3, and by 300% with 5/2. Endo-tracheal partial pressure of CO2 was significantly increased during the compression phase of active decompression CPR compared with standard CPR. Active decompression CPR generated an significantly increased ventilation compared with standard CPR. CONCLUSION: Carotid and tissue blood flow, ventilation, and CPP increase with 2 cm of active decompression. An attempt to further increase the level of active decompression or increasing the compression depth from 4 to 5 cm did not improve organ blood flow.

Animals↗

PubMed1997

Intraoperative ultrasound for immediate evaluation of anterior cervical decompression and discectomy.

STUDY DESIGN: An evaluation of whether the immediate operative results can be improved in anterior cervical surgery in patients in whom disc fragments could remain hidden behind a vertebral body or far laterally in the foramen or in canal stenosis that involved a significant amount of a vertebral body. OBJECTIVES: To determine whether intraoperative ultrasonography can provide immediate evaluation of the decompression. SUMMARY OF BACKGROUND DATA: The anterior cervical approach has anatomic limitations that prevent good visualization of deep structures. Sequestered disc fragments can be hidden behind the bone of the vertebral body. Even careful preoperative measurements cannot ensure adequate length and width of decompression for stenotic lesions. METHODS: Three groups of patients were studied. Group 1 contained seven patients with soft disc herniations that were either behind the vertebral body or extended laterally into the neural foramen. Group 2 consisted of five patients with canal stenosis involving at least one third of the length of a vertebral body and causing myelopathic signs and symptoms. Group 3 consisted of four patients with radicular and cord symptoms. All were studied with either magnetic resonance imaging or computed tomography myelography or both. The size of the desired decompression was measured from these studies. A standard anterior decompression using magnification was performed that satisfied the surgeon's visual and tactile evaluation. The operative site was imaged ultrasonically and the decompression extended until preset imaging criteria were met. These criteria were clear root visualization for radiculopathy and good dural pulsations for stenotic lesions. RESULTS: Twelve of the 16 patients did not meet the set criteria on initial imaging, and 11 had their decompression extended. A hidden lateral disc fragment was found in one. In this selected group of 16 patients with complicated cervical pathology, 14 improved neurologically after the use of ultrasonic guidance intraoperatively. One error of interpretation was made. One patient who did not meet the ultrasonic decompression criteria and did not have the decompression extended did not improve after surgery. CONCLUSIONS: In complicated anterior cervical decompressions, intraoperative ultrasonic imaging provides immediate evaluation of the extent of the decompressive procedure and may improve the operative result.

Cervical Vertebrae↗

PubMedDate not supplied

Evaluation of safety of hypobaric decompressions and EVA from positions of probabilistic theory.

Formation and subsequent evolution of gas bubbles in blood and tissues of subjects exposed to decompression are casual processes in their nature. Such character of bubbling processes in a body predetermines probabilistic character of decompression sickness (DCS) incidence in divers, aviators and astronauts. Our original probabilistic theory of decompression safety is based on stochastic models of these processes and on the concept of critical volume of a free gas phase in body tissues. From positions of this theory, the probability of DCS incidence during single-stage decompressions and during hypobaric decompressions under EVA in particular, is defined by the distribution of possible values of nucleation efficiency in "pain" tissues and by its critical significance depended on the parameters of a concrete decompression. In the present study the following is shown: 1) the dimensionless index of critical nucleation efficiency for "pain" body tissues is a more adequate index of decompression stress in comparison with Tissue Ratio, TR; 2) a priory the decompression under EVA performed according to the Russian protocol is more safe than decompression under EVA performed in accordance with the U.S. protocol; 3) the Russian space suit operated at a higher pressure and having a higher "rigidity" induces a stronger inhibition of mechanisms of cavitation and gas bubbles formation in tissues of a subject located in it, and by that provides a more considerable reduction of the DCS risk during real EVA performance.

Aerospace Medicine↗

PubMed1996

Cardiopulmonary changes with moderate decompression in rats.

Sprague-Dawley rats were compressed to 616 kPa (a) for 120 min then decompressed at 38 kPa/min to assess the cardiovascular and pulmonary responses to moderate decompression stress. In one series of experiments the rats were chronically instrumented with Doppler ultrasonic probes for simultaneous measurement of blood pressure, cardiac output, heart rate, left and right ventricular wall thickening fraction, and venous bubble detection. Data were collected at baseline, throughout the compression/decompression protocol, and for 120 min post decompression. In a second series of experiments the pulmonary responses to the decompression protocol were evaluated in non-instrumented rats. Analyses included blood gases, pleural and bronchoalveolar lavage (BAL) protein and hemoglobin concentration, pulmonary edema, BAL and lung tissue phospholipids, lung compliance, and cell counts. Venous bubbles were directly observed in 90% of the rats where immediate post-decompression autopsy was performed and in 37% using implanted Doppler monitors. Cardiac output, stroke volume, and right ventricular wall thickening fractions were significantly decreased post decompression, whereas systemic vascular resistance was increased suggesting a decrease in venous return. BAL Hb and total protein levels were increased 0 and 60 min post decompression; pleural and plasma levels were unchanged. BAL white blood cells and neutrophil percentages were increased 0 and 60 min post decompression and pulmonary edema was detected. Venous bubbles produced with moderate decompression profiles give detectable cardiovascular and pulmonary responses in the rat.

Animals↗

PubMed1998

Ocular bubble formation as a method of assessing decompression stress.

Tear film bubble formation and ultrasound reflectivity of the lens-vitreous humor compartments were monitored following simulated dives in a hyperbaric chamber. the sensitivity of these methods in determining decompression stress was compared with the results of precordial Doppler ultrasound. In addition, the utility of these diagnostic techniques in testing decompression dive profiles was evaluated. Eleven divers completed two series of chamber dives according to the decompression schedule of the Professional Association of Diving Instructors. The first dive series comprised dives to 70 feet of seawater (fsw) for 15, 29, and 40 min. The second series comprised maximum duration no-stop decompression dives to 40 fsw for 140 min, 70 fsw for 40 min, 90 fsw for 25 min, and 120 fsw for 13 min. Before and immediately after each dive, the following measurements were obtained from each subject: eye surface tear film bubble counts with a slit-lamp microscope, lens and vitreous humor reflectivity using A- and B-mode ophthalmic ultrasonic scan, and precordial Doppler ultrasonic detection of venous gas bubbles. Tear film bubble assessment and ocular scanning ultrasound were observed to be more sensitive in detecting decompression stress than the conventional Doppler ultrasonic surveillance of the precordial region. In contrast to precordial Doppler ultrasonic surveillance, which failed to detect any significant changes in circulating bubbles, tear film bubble formation displayed a dose-response relationship with increasing duration of the 70-fsw dives. Reflectivity changes of the lens-vitreous humor interface were not significant until the no-stop decompression limit was reached. In addition, for each of the no-stop decompression limit dives, increases in the average tear film bubble formation and lens-vitreous humor interface reflectivity were similar. Ocular bubble observations may provide a practical and objective ocular bubble index for analyzing existing decompression schedules and predicting individual susceptibility to decompression sickness.

Adolescent↗

PubMed2005

Simultaneous orbital decompression and correction of upper eyelid retraction versus staged procedures in thyroid-related orbitopathy.

PURPOSE: To evaluate the outcome of eyelid retraction surgery in thyroid-related orbitopathy (TRO) patients in 2 different surgical settings: done simultaneously with orbital decompression or as a staged procedure after orbital decompression. DESIGN: Retrospective, comparative, nonrandomized clinical study. PARTICIPANTS: Ninety-six patients (158 eyes). METHODS: A review of electronic medical records of TRO patients who underwent surgery for upper eyelid retraction and orbital decompression at the Jules Stein Eye Institute in 1999 to 2003 was performed. Data regarding eyelid position, comprehensive eye examination, surgical outcome, and complications were analyzed. MAIN OUTCOME MEASURES: Anatomical and functional success based on margin reflex distance (MRD1; < or = 5 mm was graded as mild retraction; > 5 mm and < 7 mm, moderate; and > 7 mm, severe), and patients' discomfort. RESULTS: One hundred fifty-eight eyelid retraction surgeries were performed on 96 TRO patients (18 male and 78 female; mean age, 48 years); mean follow up time was 15 (+/-12) months. Group 1 consisted of patients undergoing simultaneous eyelid retraction surgery and orbital decompression and comprised 97 cases (surgeries). Group 2 included 61 cases of staged surgery: orbital decompression and eyelid retraction at a later stage. The groups had similar surgical outcomes, and > 85% had a better eyelid position postoperatively. Reoperation rates for residual or recurrent eyelid retraction were similar, overcorrection was higher in group 2 (5% vs. 0%, P = 0.03). Changes in MRD1, lagophthalmos, and exophthalmos were similar (P > 0.05, independent samples t test). Correction of eyelid retraction was effective in treating patients' discomfort and exposure keratopathy (P = 0.04, chi2). No severe complications occurred after orbital decompression or eyelid retraction surgery in this group of patients. CONCLUSIONS: Transconjunctival Muller's muscle recession for correction of eyelid retraction in mild to moderate TRO patients, performed simultaneously with deep lateral wall orbital decompression, resulted in acceptable eyelid position in two thirds of our patients. Overcorrection and consecutive ptosis occurred less often after combined orbital decompression and eyelid retraction surgery than after isolated eyelid repositioning surgery. If confirmed in prospective controlled studies, eyelid-repositioning surgery performed at the time of orbital decompression may decrease the number of total procedures and compress the time needed for surgical rehabilitation.

Adult↗

PubMed2000

Sigmoid stiffener for decompression tube placement in colonic pseudo-obstruction.

BACKGROUND AND STUDY AIMS: Decompression tube placement improves outcome in colonic pseudo-obstruction (CP) which is refractory to conservative measures, especially if the decompression tube is placed proximal to the hepatic flexure. We evaluate the ability of a sigmoid stiffener to facilitate more proximal colonoscopy and decompression tube placement. PATIENTS AND METHODS: A sigmoid stiffener is used in the standard fashion during colonoscopic decompression for pseudo-obstruction. After cecal wire placement, the colonoscope is withdrawn, leaving the stiffener and wire in place. By passing through the stiffener, an over-wire decompression tube can avoid sigmoid looping. We compared proximal extent of colonoscopy, tube position, endoscopy time, and patient outcomes using a sigmoid stiffener, with a control group of patients treated previously. Patients with colonic ischemia were excluded. RESULTS: Using this technique, nine consecutive colonoscopies and decompression tube placements reached the right colon. Significantly, only three of seven control colonoscopies and two control decompression tubes did so. However, improvements in procedural time and patient outcome did not reach statistical significance. No complications occurred. CONCLUSION: The use of a sigmoid stiffener during colonic decompression allows more proximal colonoscopy and decompression tube placement, with possible clinical benefit. We do not use this technique in the setting of left colon ischemia.

Adult↗

PubMed1998

Cervical arachnoid cysts after craniocervical decompression for Chiari II malformations: report of three cases.

OBJECTIVE AND IMPORTANCE: We describe three cases in which ventrally situated cervical arachnoid cysts led to spinal cord or cervicomedullary compression after repeat craniocervical decompression for Chiari II malformations. CLINICAL PRESENTATION: All three patients underwent craniocervical decompression when their Chiari malformations became symptomatic. The first patient developed chronic vertiginous spells and headache and was treated with repeated craniocervical decompression procedures during several years. Seven months after undergoing her third decompression procedure, she developed severe dizzy spells, which were determined to be of brain stem origin. The second patient had a small, asymptomatic arachnoid cyst anterior to the brain stem discovered at age 6 years. After undergoing repeat craniocervical decompression for headaches 8 years after undergoing his first procedure, the patient developed severe neck pain and acute quadraparesis. A third patient underwent repeat craniocervical decompression at age 14 years for cranial nerve dysfunction. Postoperatively, he acutely developed paresis of extraocular movements and incoordination of the upper extremities. All three patients were found to have anteriorly situated arachnoid cysts compressing the brain stem and/or cervical spinal cord. INTERVENTION AND TECHNIQUE: Fenestration of the arachnoid cyst or drainage with cystoperitoneal shunting adequately treated acute brain stem or cervical spinal cord compression. All three patients had achieved satisfactory relief from their acute symptoms of neural compression at their follow-up examinations. CONCLUSION: An association between spinal arachnoid cysts and neural tube defects has previously been reported. However, the development of previously undetected spinal arachnoid cysts after craniocervical decompression was unexpected. We hypothesize that extensive craniocervical decompression may alter the cerebrospinal fluid pressure dynamics in such a way that the anterior subarachnoid space, previously compressed, may dilate. Occasionally, because of perimedullary arachnoiditis, the cerebrospinal fluid may become loculated and act as a mass. Direct fenestration or shunting may successfully treat this problem, and less extensive craniocervical decompression may avoid it.

Adolescent↗