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PubMed1981

Transorbital approach to decompression in Graves' disease.

Patients with Graves' disease have an increased volume of orbital tissue that sometimes results in serious functional and cosmetic problems. Visual loss may result from optic nerve compression in the orbital apex. Surgical decompression provides space for expansion of orbital tissues and often results in dramatic improvement. A transorbital approach to decompression of the orbit, appropriate for the ophthalmologist with adequate orbital experience, is presented. A lower eyelid incision is used in the manner of exploring a blow-out fracture. The majority of the orbital floor and the entire ethmoidal complex are removed. Removal of bone to the orbital apex is emphasized in cases of optic neuropathy. A comparative study of the indications, results, and complications of this procedure vs other techniques of decompression for Graves' disease is presented in a companion article.

Ethmoid Bone↗
PubMed1985

An individualized approach to orbital decompression in Graves' orbitopathy.

With better understanding of the various techniques available for orbital decompression, the indications for surgical decompression in Graves' orbitopathy are now less rigid. Decompressions may be performed for (1) prolonged orbital congestion and pain, (2) orbital problems resistant to steroid treatment, (3) orbital problems where there have been steroid complications, (4) severe corneal exposure that cannot be treated with lid-lengthening surgery, and (5) the standard indication--Graves' optic neuropathy. Assessment of muscle size by computed tomographic scanning and ultrasound, as well as the measurement of orbital pressure, are important advances in the assessment of these patients. The lateral approach produces less strabismus and allows for exophthalmos reduction, especially if fascia temporalis is incised and if part of that muscle is removed. The inferomedial approach is advisable in patients with severe posterior optic neuropathy caused by apical crowding of the enlarged muscles, particularly the medial rectus. The two approaches may be combined in severe cases.

Female↗
PubMed1989

Superior and transantral orbital decompression procedures. Effects on increased intraorbital pressure and orbital dynamics.

Eight superior and eight transantral decompressions were performed in 16 fresh cadaver orbits in which intraorbital pressure was experimentally increased by adding 12 mL of volume to an intraorbital balloon. Each decompression yielded a mean pressure decrease of 225 mm Hg (85% of the total) in experimentally induced intraorbital pressure. The maximal pressure decrease occurred after the removal of the first complete orbital wall. However, incision of the periorbita was most effective in achieving globe recession and a decrease in exophthalmos. Although the steps of the superior and transantral decompression techniques are not comparable, there was no statistically significant difference between the total net pressure decreases achieved.

Biomechanical Phenomena↗
PubMed1977

Colonoscopic decompression of massive nonobstructive cecal dilation.

During the past three years, six patients with massive nonobstructive cecal dilation were treated by the surgical endoscopy service at the University of Michigan Medical Center. Case reports are presented on the five patients for whom decompression of the colon distention using the flexible fiberoptic colonoscope was successful. The sixth patient for whom nonoperative decompression was unsuccessful died following tube cecostomy. Colonoscopy, in our hands, has been a safe and effective method of nonoperatively decompressing the dilated cecum in seriously ill patients with a variety of severe associated conditions.

Aged↗
PubMed2005

Prophylactic nasogastric decompression after abdominal surgery.

BACKGROUND: Routine use of nasogastric tubes after abdominal operations is intended to hasten the return of bowel function, prevent pulmonary complications, diminish the risk of anastomotic leakage, increase patient comfort and shorten hospital stay. OBJECTIVES: To investigate the efficacy of routine nasogastric decompression after abdominal surgery in achieving each of the above goals. SEARCH STRATEGY: Search terms were nasogastric, tubes, randomised, using MEDLINE, EMBASE, Cochrane Controlled Trials Register, and references of included studies. SELECTION CRITERIA: Patients having abdominal operations of any type, emergency or elective, who were randomised prior tot he completion of the operation to receive a nasogastric tube and keep it in place until intestinal function had returned, versus those receiving either no tube or early tube removal, in surgery, in recovery or within 24 hours of surgery. Excluded will be randomised studies involving laparoscopic abdominal surgery and patient groups having gastric decompression through gastrostomy. DATA COLLECTION AND ANALYSIS: Data were abstracted onto a form that assessed study eligibility, as defined above, quality related to randomizations, allocation concealment, study size and dropouts, interventions, including timing and duration of intubation, outcomes that included time to flatus, pulmonary complications, wound infection, anastomotic leak, length of stay, death, nausea, vomiting, tube reinsertion, subsequent ventral hernia. MAIN RESULTS: 28 studies fulfilled eligibility criteria, encompassing 4194 patients, 2108 randomised to routine tube use, and 2087 randomised to selective or No Tube use. Patients not having routine tube use had an earlier return of bowel function (p<0.00001), an insignificant trend toward decrease in pulmonary complications (p=0.07) and an insignificant trend toward increase in risk of wound infection (p=0.08) and ventral hernia (0.09). Anastomotic leak was no different between groups (p=0.70). Patient comfort, nausea, vomiting and length of stay seemed to favour No Tube, but the heterogeneity encountered in these analyses make rigorous conclusion difficult to draw for these outcomes. No adverse events specifically related to tube insertion (direct tube trauma) were reported. Other outcomes were reported with insufficient frequency to be informative. AUTHORS' CONCLUSIONS: Routine nasogastric decompression does not accomplish any of its intended goals and so should be abandoned in favour of selective use of the nasogastric tube.

Abdomen↗
PubMed1994

Effect of tarsal tunnel decompression in the streptozotocin-induced diabetic rat.

The streptozotocin-induced diabetic rat has changes in the hind-foot walking track pattern that are progressive over time. The present study investigated the effect of microsurgical neurolysis of the posterior tibial nerve and its branches in the tarsal tunnel on this pattern. The tarsal tunnel decompression was done at the time of onset of diabetes. The results of the study confirmed the progressive pattern of track abnormalities in this rat model, P < .05. The results demonstrated that rats in which the tarsal tunnel had been decompressed at the onset of their diabetes did not develop the characteristically abnormal diabetic walking track pattern. Rather, the track patterns of the decompressed tarsal tunnel diabetic rats were not significally different from a nondiabetic control population.

Animals↗
PubMed1993

Microsurgical vascular decompression (MVD) in trigeminal and glosso-vago-pharyngeal neuralgias. A twenty year experience.

Report of the results of treatment in 1380 cases with trigeminal neuralgia and 14 cases with glosso-vago-pharyngeal neuralgia. Trigeminal neuralgia was treated by percutaneous thermorhizotomy in 960 cases and by open micro-approach to the cerebellopontine angle in 420 cases. In cases treated by microsurgical vascular decompression, cure rate was 91%, partial relief 5%, failure 4%. Recurrence occurred in 6%. Glossopharyngial neuralgia was treated by percutaneous thermocoagulation of the Andersch ganglion in 3 cases and by a direct approach to the jugular foramen in 11 cases, in 9 of them with micro-vascular decompression. With microsurgical vascular decompression, all cases had total pain relief without recurrence.

Female↗
PubMedDate not supplied

Nasointestinal tube for decompression or enteroclysis: experience with 150 patients.

The initial clinical experience with the use of a triple lumen long tube designed for gastrointestinal decompression and enteroclysis is reported in 150 patients. Based on clinical observations, this tube is effective in suctioning retained gastric and intestinal fluid but requires frequent irrigation of the sump port for effective decompression of distended small bowel. In all patients with a preexisting nasogastric tube, the replacement by the decompression/enteroclysis tube was considered more comfortable by the patients. Successful placement of the tube in the jejunum was achieved in 147 of 150 consecutive patients on the initial attempt. The use of this tube obviates dual intubations for decompression and enteroclysis, the attendant discomfort on the patient, and it expedites subsequent performance of enteroclysis if needed. The complications reported with other long intestinal tubes were not observed with this device.

Adolescent↗
PubMed1995

Posterior fossa decompression for Chiari I deformity, including resection of the cerebellar tonsils.

This is an analysis of 19 consecutive cases of symptomatic patients with Chiari I deformities, undertaken to evaluate the long-term effect of posterior fossa decompression and duraplasty, assessed by postoperative imaging. Sixteen of the patients had syringomyelia and three had foramen magnum syndromes without a syrinx. Eighteen patients underwent posterior fossa craniectomy, subpial resection of the cerebellar tonsils, and duraplasty. Four patients were 16 years of age or younger. One of the children with syringomyelia had a posterior fossa decompression without resection of the tonsils. In the 15 patients with syringomyelia whose surgery included resection of the tonsils, the syrinx was reduced or resolved in 14. The patient whose syrinx did not change was a child with a lumbosacral lipoma. Three patients had syndromes of the foramen magnum without a syrinx, and of these only a patient with prior chemical and bacterial meningitis caused by a lumboureteral shunt failed to improve dramatically. When our patients are combined with 40 in the literature treated by decompression and duraplasty, 51 of 55 patients had reduction or resolution of the syrinx. Although it does not clearly affect the result, resection of the tonsils can be done safely.

Adolescent↗
PubMed1990

Total decompression of the spinal cord for combined ossification of posterior longitudinal ligament and yellow ligament in the thoracic spine.

One of the causes of hyperostosis in the spinal canal, ossification of the posterior longitudinal ligament (OPLL) combined with ossification of the yellow ligament (OYL) in the thoracic spine, can result in serious myelopathy, leading to sandwich-type compression of the spinal cord from anterior and posterior. For such cases we devised a treatment of total decompression of the spinal cord and intervertebral body fusion. This operation consists of two steps. The first step is designed for posterior and lateral decompression of the spinal cord by removal of the OYL following wide laminectomy. The second step is removal of the OPLL anteriorly for anterior decompression, followed by interbody fusion. As the final procedure of the first step, two deep parallel gutters, covering the extent of the OPLL to be removed anteriorly, are drilled down from the rear into the vertebral body along both sides of the dura. This pre-treatment makes removal of the OPLL anteriorly during the second stage much easier, faster, and safer. This operation is lengthy and demanding. However, based on our experience so far, it appears to be a promising surgical procedure.

Adult↗
PubMed1994

Shoulder joint stability after arthroscopic subacromial decompression.

In 55 patients with type I or type II impingement lesions we performed arthroscopic subacromial decompression. Fifty-two patients are followed up 1 year postoperatively. In all patients the condition of the affected shoulder before and after decompression was documented using a 100-point shoulder score (pain on activity, 15 points; pain without activity, 15 points; function, 20 points; weight lifting, 10 points; muscle strength, 15 points; range of motion, 25 points). At follow-up we also documented the extent of passive inferior shift of the humeral head by ultrasound. The mean score preoperatively was 60.9 (+/- 13.8). Postoperatively there was a significant increase to 84.7 (+/- 12.5). The average postoperative hospital stay was 8.8 days (+/- 2.1). In 12 patients (23%) the postoperative score was less than 85 points, and in these the treatment was considered to have failed. Comparison of these patients as a group with those in whom the treatment was successful revealed no difference in age, a small but not significant difference in the preoperative duration of shoulder complaints, and no difference in the postoperative length of stay in hospital. However, there was a significant difference in the extent of passive inferior shift of the humeral head: in the failure group the mean inferior shift was 4.6 +/- 1.9 mm, while in the other patients the shift was only 2.7 +/- 1.0 mm. This difference was statistically highly significant. There was a statistical highly significant negative Pearson correlation coefficient of -5.56 between postoperative score and inferior shift of the humeral head. We conclude that patients with subacromial pathology and hypermobile glenohumeral joints may not be good candidates for subacromial decompression.

Acromion↗
PubMed1995

Pioneers in the history of orbital decompression for Graves' ophthalmopathy. R.U. Kroenlein (1847-1910), O. Hirsch (1877-1965) and H.C. Naffziger (1884-1961).

Orbital decompression for Graves' ophthalmopathy began in 1890 when Dollinger adapted Kroenlein's technique for removal of an orbital dermoid cyst to decompress into the subtemporal fossa. Modifications occurred over the years to decompress the orbit into the paranasal sinuses and/or the anterior cranial fossa. The lives of three surgeons who initially performed these operative procedures are reported.

California↗
PubMed1994

Cranio-cervical decompression for Chiari I malformation. A retrospective evaluation of functional outcome with particular attention to the motor deficits.

We report a series of 26 patients affected by a Chiari I malformation treated at our department between 1987 and 1993. All patients underwent pre- and postoperative evaluation by magnetic resonance imaging (MRI). Sequential perioperative motor evoked potential (MEP) recordings were performed in 8 patients. The preoperative symptoms can be divided into four subgroups: cephalgias (84.6%), cranial nerve deficits (69.2%), motor deficits (76.9%), sensory deficits (73%). Twenty-five out of 26 patients underwent craniovertebral decompression, 1 a transoral anterior decompression. One patient died 2 months after surgery because of progressive pulmonary failure. We registered following postoperative complications transient hypoglossal palsy (1 case), vertigo (2 cases), meningitis (1 case), minor CSF leaks (3 cases). Cephalgias subsided in 17 and improved in 4 out of 22 patients. Cranial nerve deficits improved in 8 and were stabilized in 7 out of 18 patients. A limited recovery of trigeminal function was possibly due to nuclear lesions. Five patients whose vestibular disturbances were not relieved by surgery were put on a course of carbazepine. Vertigo resolved in one case and in two others improved. While hypesthesia improved after decompression, the other sensory deficits were stabilized in 5% of the patients. Spasticity improved in 12 out of 18 patients, but weakness only in 7 out of 17 patients. Motor disturbances were always detected by MEP-recording. MEP-characteristics were not specific, resembling those of patients with other intra-, extramedullary myelopathies. Functional recovery was not matched by an improvement of the MEP parameters. MEP may be used as tool for surveillance of patients whose clinical findings are not progressive and are not at first surgical candidates.

Adult↗
PubMed1978

The influence of the decompressive operation on the intracranial pressure and the pressure-volume relation in patients with severe head injuries.

Measurements of intracranial pressure by ventricular catheter were performed in 47 patients with severe head injuries. Thirty-three patients with decompressive operations such as osteoclastic craniotomy and dilatation by means of duraplastic have been compared with 14 patients with closed heads with regard to volume pressure response (intracranial elasticity). This was determined either by intraventricular injection of 2ml saline or by drainage of cerebrospinal fluid. The examination clearly shows that patients with closed heads have a much higher intracranial elasticity than patients who have decompressive operations, so that in the first group minor differences of the intracranial volume cause extreme deviations of the intracranial pressure. Therefore, the decompressive operation has been advised in severe head injuries with increased intracranial pressure as a measure additional to high dose dexamethasone therapy and hyperventilation.

Brain Injuries↗
PubMed1991

Percutaneous decompression and irrigation for large bowel obstruction. New approach.

This investigation introduces percutaneous decompression and irrigation of the obstructed large bowel as a simple and safe procedure that can be undertaken for the emergency situation. This procedure was performed in 28 patients who presented with colonic obstruction caused by sigmoidal or rectosigmoidal carcinoma without any complications. It allowed patients to be properly prepared and investigated and then to receive definitive colonic surgery 36-48 hours after the decompression. Therefore, it is concluded that percutaneous decompression and irrigation can on one hand defer emergency surgery for colonic obstruction and on the other hand enable a one-stage definitive procedure to be undertaken during the same admission.

Adenocarcinoma↗
PubMed1986

Intracranial microvascular decompression for "cryptogenic" hemifacial spasm, trigeminal and glossopharyngeal neuralgia, paroxysmal vertigo and tinnitus: I. Surgical technique and results.

Intracranial microvascular decompression was performed in 21 out of 24 patients with hyperactive dysfunction of cranial nerves: 8 cases of hemifacial spasm, 12 of trigeminal neuralgia, 3 of glossopharyngeal neuralgia and 1 case of paroxysmal vertigo and tinnitus. In 21 cases an abnormal vascular loop was found to impinge on the root entry zone of the nerve in the brainstem. Dissection of this loop with decompression of the nerve resulted in long-lasting relief of symptoms in all but two patients who presented early recurrence; in one of these a second procedure was eventually successful. In two patients with trigeminal neuralgia a benign tumor of the cerebellopontine angle that had escaped preoperative diagnosis was present. Finally, in one case no compressive lesions were found. From the data of the literature and from our present experience microvascular decompression can be considered a safe as well as an effective procedure, affording a high success rate in conditions often or usually resistant to medical treatment and erroneously considered "idiopathic".

Adult↗
PubMed2003

[Microsurgery of acquired degenerative lumbar spinal stenosis. Bilateral over-the-top decompression through unilateral approach].

Degenerative lumbar spinal stenosis is diagnosed with an increasing incidence. Clinical and radiological signs of progression often result in a significant decrease in the patient's quality of life. The indication for surgical treatment follows the spectrum of clinical symptoms. In cases with "structural" spinal stenosis and predominant "leg symptoms" such as neurogenic claudication and/or radicular symptoms, decompressive types of surgery are indicated. However, due to the multimorbidity of the mostly elderly patients, the surgical risk should be as low as possible whereas the surgical efficacy should be as high as possible. We describe a microsurgical technique, which can achieve a bilateral decompression of the central and lateral lumbar spinal canal through a unilateral surgical approach. In a consecutive series of 275 patients, a significant increase in standing time and walking distance could be attained. The surgical complication rate was low. A complete decompression of the spinal canal with preservation of the "tension band" of the posterior spinal column could be achieved. Although this type of surgery is adequate for patients with "predominantly leg symptoms" only, low back pain improved as well in nearly 50% of the patients. However, in cases with dynamic spinal stenosis and/or disturbed curvature with predominant low back pain, a combination of the described procedure with stabilizing surgery (spinal fusion, dynamic fixation etc.) is recommended.

Adult↗
PubMed2006

Response times seen as decompression times in Boolean concept use.

This paper reports a study of a multi-agent model of working memory (WM) in the context of Boolean concept learning. The model aims to assess the compressibility of information processed in WM. Concept complexity is described as a function of communication resources (i.e., the number of agents and the structure of communication between agents) required in WM to learn a target concept. This model has been successfully applied in measuring learning times for three-dimensional (3D) concepts (Mathy and Bradmetz in Curr Psychol Cognit 22(1):41-82, 2004). In this previous study, learning time was found to be a function of compression time. To assess the effect of decompression time, this paper presents an extended intra-conceptual study of response times for two- and 3D concepts. Response times are measured in recognition phases. The model explains why the time required to compress a sample of examples into a rule is directly linked to the time to decompress this rule when categorizing examples. Three experiments were conducted with 65, 49, and 84 undergraduate students who were given Boolean concept learning tasks in two and three dimensions (also called rule-based classification tasks). The results corroborate the metric of decompression given by the multi-agent model, especially when the model is parameterized following static serial processing of information. Also, this static serial model better fits the patterns of response times than an exemplar-based model.

Adolescent↗