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PubMed2000

Laparoscopic decompression of abdominal compartment syndrome after blunt hepatic trauma.

Abdominal compartment syndrome (ACS) can occur in a variety of surgical conditions, particularly those with major life-threatening hemorrhage, massive volume resuscitation, prolonged operation times, and coagulopathy. In severely traumatized patients, the incidence of ACS is reported to be as high as 14% to 15% after damage control laparotomies. Although favorable results have been achieved with nonsurgical management of adult blunt hepatic trauma, the failure rates still range from 0% to 19%. Exploratory laparotomy is considered the intervention of choice in patients with blunt hepatic trauma who fail nonsurgical treatment. Expedient abdominal decompression currently is the treatment of choice after ACS. Oliguria, tachypnea, and tachycardia developed in two blunt hepatic trauma patients with grade IV and V injuries while they were receiving nonsurgical treatment. The intra-abdominal pressures measured more than 35 and 25 cm H 2O, respectively. Two patients with grade II and III ACS received laparoscopic examination instead of laparotomy. Their ACS was decompressed effectively via laparoscopy without any adverse effects. Therefore, we suggest that laparoscopy can be used as a safe alternative for the decompression of ACS.

Abdominal Injuries↗

PubMed1991

The effect of the menstrual cycle and of decompression stress on arachidonic acid-induced platelet aggregation and on intrinsic platelet thromboxane production in women compared with men.

Menstrual cycle variations in platelet aggregation and thromboxane production in association with sex steroids have been reported. External stimuli such as decompression sickness have been associated with clotting activity changes, specifically, increased platelet aggregation. Differences in response of platelets from women and men, when subjected to such a stress, have been observed. This study evaluated the ability of washed platelets from women in the proliferative and secretory phases of the menstrual cycle to aggregate in response to arachidonic acid and the aggregation difference between washed platelets from women and men in response to decompression stress and arachidonic acid. Additionally, platelet thromboxane production differences between the assessed platelet populations were compared. Our results indicate no difference in platelet aggregability between phases of the menstrual cycle. A significant aggregation difference between platelets from women and men was noted. Platelets from women were more sensitive to arachidonic acid aggregation. These differences were not affected by decompression stress. No difference in thromboxane B2 production was noted between the platelet populations evaluated.

Adult↗

PubMed1980

Hepatic pathology as a determinant of prognosis after portal decompression.

The status of 124 patients who had liver biopsies and underwent portal decompression was analyzed and correlated with certain clinical features and hepatic histologic findings. Child risk class, the urgency of operation, the presence of many Mallory bodies, the presence of cirrhosis and the cause of portal hypertension as determined histologically were found to correlate with prognosis. The estimate of hepatic reserve by Child risk class system and the presence of many Mallory bodies were found to have an independent predictive value. The observed differences in prognosis determined by other factors may be accounted for by variations in hepatic reserve. The presence of few or many Mallory bodies appears to be a contraindication to urgent operative portal decompression because of an exceedingly high mortality rate. In addition, the presence of many Mallory bodies regardless of Child class appears to correlate with a poor diagnosis. Since Mallory bodies may occur in all Child risk classes, preoperative liver biopsy is recommended whenever feasible to better define the actual operative risk of any portal decompressive procedure.

Biopsy↗

PubMed1981

Preoperative percutaneous transhepatic biliary decompression lowers operative morbidity in patients with obstructive jaundice.

Percutaneous transhepatic biliary decompression is a safe and potentially helpful procedure. If done correctly, it will accomplish adequate decompression of the biliary tree and permit hepatic function to return to a more normal state preoperatively. The time gained while waiting for the bilirubin level to decrease can be used for adequate preoperative preparation of the patient. Use of this technique may make it possible for operative treatment of obstructive jaundice to return to a two-stage procedure, the first stage being percutaneous transhepatic biliary decompression.

Adult↗

PubMed1984

Effect of biliary decompression on morbidity and mortality of pancreatoduodenectomy.

To evaluate the effect of levels of serum bilirubin on morbidity and mortality after pancreatoduodenectomy, a prospective study was designed to compare patients who underwent preoperative biliary decompression to those who did not. Preoperative biliary decompression decreased the mean serum bilirubin level from 15.8 to 5.8 mg/dl in one group of 10 patients (Group A). The only statistical differences between this group and the two other groups of patients (Groups B and C) who were not treated with preoperative biliary decompression was the level of serum bilirubin before pancreatoduodenectomy (5.8, 22, and 1.3 mg/dl in Groups A, B, and C, respectively). Only one death occurred in each group of patients. The numbers of nonfatal complications were comparable. These results suggest that there is no decrease in morbidity or mortality after pancreatoduodenectomy when the serum bilirubin level is decreased by preoperative biliary drainage.

Aged↗

PubMed1993

Early ductal decompression prevents the progression of biliary pancreatitis: an experimental study in the opossum.

BACKGROUND: The value of early endoscopic or surgical interventions to remove bile duct stones and decompress the biliopancreatic ductal system in gallstone pancreatitis is controversial. METHODS: To evaluate this issue, acute hemorrhagic necrotizing pancreatitis was induced in opossums by obstructing the biliopancreatic ductal system with a balloon catheter for 1, 3, or 5 days. RESULTS: A progressive increase in the severity of pancreatitis, as manifested by inflammation, fat necrosis, hemorrhage, acinar cell vacuolization, in vitro lactate dehydrogenase release, and acinar cell necrosis, was noted in these obstructed animals. In contrast, decompression of the obstructed ductal system by removal of the balloon catheter after 1 or 3 days prevented the increase in severity of these parameters of pancreatic injury. CONCLUSIONS: We concluded that the severity of biliary pancreatitis in this model is dependent upon the duration of ductal obstruction and that decompression of the ductal system can prevent progression of the disease. These observations support the practice of early attempts to remove obstructing stones in clinical gallstone pancreatitis.

Animals↗

PubMed1986

Blink reflex in patients with hemifacial spasm. Observations during microvascular decompression operations.

The blink reflex cannot normally be elicited during surgical anesthesia using inhalation anesthetics. However, in patients with hemifacial spasm (HFS) the early component of the reflex response (R1) can be elicited on the affected side but not on the unaffected side during such anesthesia. The electromyographic (EMG) response from the mentalis muscle to stimulation of the supraorbital nerve was recorded during microvascular decompression (MVD) of the facial nerve to relieve HFS and compared to the response from the same muscle to stimulation of the zygomatic branch of the facial nerve in four patients. During the operation before the facial nerve was decompressed, contractions in both the orbicularis oculi and the mentalis muscles could be elicited by stimulation of the supraorbital nerve (mean latencies 12.2 +/- 1.9 and 12.9 +/- 2.0 ms, respectively). When the facial nerve had been decompressed the blink reflex could no longer be elicited, and there was no response from the mentalis muscle to stimulation of the zygomatic branch of the facial nerve. Compound action potentials (CAP) recorded from the 7th cranial nerve in response to stimulation of the supraorbital nerve had latencies of 7.5 ms +/- 1.4 ms to the negative peak.

Anesthesia, General↗

PubMed1992

Simple decompression of the ulnar nerve: an alternative to anterior transposition.

Anterior transposition and/or medial epicondylectomy are often considered procedures of choice for ulnar neuropathy at the elbow. Much experience suggests simple decompression to be a comparably effective alternative which involves less trauma, morbidity, and rehabilitation time. The post-operative clinical and electrophysiological results of 52 cases of simple decompression (41 patients) are summarized. Excellent or good clinical results were found in 75% of the nerves. Mean ulnar motor conduction velocities were significantly improved post-operatively, although nerve conduction parameters did not consistently correlate with clinical outcome. The average return-to-work time was 5.1 weeks. The advantages of simple decompression make it the procedure of choice for most cases of ulnar neuropathy.

Adult↗

PubMed1996

Active compression-decompression cardiopulmonary resuscitation--instructor and student manual for teaching and training. Part I: The workshop.

In an attempt to standardize the teaching and training of active compression-decompression cardiopulmonary resuscitation (ACD-CPR), a group of leading emergency physicians, cardiologists, anesthesiologists, paramedics and nurses with practical, theoretical, educational, and scientific experience in the subject met in June 1995. The group was called The International Working Group of Teaching and Training Active Compression-Decompression CPR. The group was 'born' as a result of the first International Conference of Active Compression-Decompression CPR held in Copenhagen in March 1995. The following paper describes the background, development and text of and ACD-CPR course manual for both students and instructors.

Cardiopulmonary Resuscitation↗

PubMed1994

Intraneural ulnar nerve pressure changes related to operative techniques for cubital tunnel decompression.

To evaluate the effect of critical anatomic structures on the ulnar nerve after cubital tunnel decompression, we determined the intraneural ulnar nerve pressure in 50 fresh cadavers after the following surgical procedures: simple decompression, medial epicondylectomy, subcutaneous transposition, and submuscular transposition by the Learmonth and by the musculofascial lengthening technique. Intraneural pressure was measured in 0 degrees, 30 degrees, 60 degrees, and 90 degrees elbow flexion at locations that were proximal, within, and distal to the cubital tunnel. Statistical analysis compared the mean change in intraneural pressure between the "postoperative" and the baseline "preoperative" pressure measurements for the different surgical strategies. While both the simple decompression and the medial epicondylectomy had significantly lower intraneural pressures than the Learmonth or the subcutaneous transposition, each of these four techniques resulted in elevated intraneural pressures. The musculofascial lengthening technique for submuscular transposition was the only surgical strategy that reduced intraneural ulnar pressure at each site of measurement and for all degrees of elbow flexion, this reduction of pressure being significant in comparison with the other surgical techniques.

Cadaver↗

PubMed1991

Arthroscopic subacromial decompression in the treatment of full-thickness rotator cuff tears.

Arthroscopic subacromial decompression has become an accepted treatment for patients with impingement syndrome; however, its use for full-thickness rotator cuff tears is controversial. We observed 25 patients with full-thickness rotator cuff tears treated by arthroscopic subacromial decompression and cuff debridement alone with a minimum of 1 year follow-up observation. Based on the University of California at Los Angeles shoulder rating, 84% of the cases were rated as excellent or good. There was significant improvement in pain, function, motion, and strength. Eighty-eight percent of the patients were satisfied with the procedure. Although all tear sizes improved significantly, smaller tears fared better than larger tears. The preliminary results of arthroscopic subacromial decompression with cuff debridement compare favorably to open techniques of rotator cuff repair with or without acromioplasty and should be considered in selected patients with full-thickness rotator cuff tears.

Acromion↗

PubMed1992

Arthroscopic subacromial decompression: a clinical review.

Arthroscopic subacromial decompression has become a popular technique supplanting the open Neer acromioplasty in many instances of chronic rotator cuff disease. A review of 61 consecutive decompressions with a minimum follow-up of 12 months was undertaken to evaluate preoperative criteria and surgical outcomes. Of the 61 patients, 53 patients with an average follow-up of 23 months were available for review. Thirty-four men and 19 women with an average age of 47 years comprised the study group. Eleven (21%) had full-thickness tears, 35 (66%) had partial-thickness injuries, and 7 (13%) had normal-appearing rotator cuffs at the time of arthroscopy. The UCLA shoulder rating system was used to evaluate outcome. Eighty-one percent of the patients had an excellent (32%) or good (49%) result whereas 19% (15% fair and 4% poor) were considered unsatisfactory. Those with early impingement findings and partial rotator cuff tears were likely to experience a satisfactory outcome. Patients with full-thickness rotator cuff tears were less likely to experience a successful result (55%). Workmen's compensation cases had a satisfactory outcome in 74%, with a predominance of good over excellent results. Excluding those with full-thickness tears and work-related injuries, a satisfactory outcome was achieved in 90%. Arthroscopic subacromial decompression for mechanical impingement of the rotator cuff is a technically demanding procedure requiring appropriate skills as well as careful preoperative treatment and evaluation. For individuals in whom conservative measures fail and who meet stringent criteria, namely, a largely intact rotator cuff and a non-work-related injury, a highly reliable and satisfying outcome can be anticipated by both patient and surgeon.

Acromion↗

PubMed1992

Subacromial impingement: open versus arthroscopic decompression.

An analysis of the follow-up results of 53 patients treated by an arthroscopic decompression (AD) and 53 patients treated by an open decompression (OD) is presented. Patients were evaluated pre- and postoperatively with the UCLA Shoulder Rating Scale, which includes an assessment of pain, function, range of motion, strength, and patient satisfaction. After an average of 20.1 months for the AD group and 27.3 months for the OD group, good or excellent results were found in 83.1% in the AD group and in 81.1% in the OD group. Patient satisfaction was 88.3% (AD) compared with 94.3% (OD). Results of decompression in both groups were not influenced by associated pathologies (acromioclavicular degeneration, frozen shoulder, calcified tendinitis, rotator cuff lesions).

Acromion↗

PubMedDate not supplied

Mechanical properties of regenerated coracoacromial ligament after subacromial decompression.

Recent publications suggest that the coracoacromial ligament regenerates after it has been partially excised during subacromial decompression or acromioplasty. This observation may aid the understanding of the successes and failures of this very commonly performed surgical procedure. This study determines the mechanical properties of the apparently regenerated ligament. Eight regenerated coracoacromial ligaments were excised during revision surgery after subacromial decompression and were taken for mechanical testing. It appears that the ligament does have the ability to re-form relatively quickly after subacromial decompression or acromioplasty but takes time to regain strength. The results indicate that the ligament may possibly regain normal mechanical properties after regeneration times in excess of 3 years.

Acromioclavicular Joint↗

PubMed2004

Evaluation of an impedance threshold device in patients receiving active compression-decompression cardiopulmonary resuscitation for out of hospital cardiac arrest.

AIMS: The purpose of this multicentre clinical randomized controlled blinded prospective trial was to determine whether an inspiratory impedance threshold device (ITD), when used in combination with active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), would improve survival rates in patients with out-of-hospital cardiac arrest. METHODS AND RESULTS: Patients were randomized to receive either a sham (n = 200) or an active impedance threshold device (n = 200) during advanced cardiac life support performed with active compression-decompression cardiopulmonary resuscitation. The primary endpoint of this study was 24 h survival. The 24 h survival rates were 44/200 (22%) with the sham valve and 64/200 (32%) with the active valve (P = 0.02). The number of patients who had a return of spontaneous circulation (ROSC), intensive care unit (ICU) admission, and hospital discharge rates was 77 (39%), 57 (29%), and 8 (4%) in the sham valve group versus 96 (48%) (P = 0.05), 79 (40%) (P = 0.02), and 10 (5%) (P = 0.6) in the active valve group. Six out of ten survivors in the active valve group and 1/8 survivors in the sham group had normal neurological function at hospital discharge (P = 0.1). CONCLUSION: The use of an impedance valve in patients receiving active compression-decompression cardiopulmonary resuscitation for out-of-hospital cardiac arrest significantly improved 24 h survival rates.

Cardiopulmonary Resuscitation↗

PubMed2004

Continuous intratracheal insufflation of oxygen improves the efficacy of mechanical chest compression-active decompression CPR.

The aim of the present study was to compare the efficacy of intratracheal continuous insufflation of oxygen (CIO) with intermittent positive pressure ventilation (IPPV) regarding gas exchange and haemodynamics during mechanical chest compression-active decompression cardiopulmonary resuscitation (mCPR) provided by the LUCAS device. Ventricular fibrillation (VF) was induced electrically and ventilation was discontinued in 16 pigs, mean body weight 23 kg (range 22-27 kg). They were randomized into two groups (CIO versus IPPV). After 8 min of VF, mCPR was started and run for 30 min in normothermia, after which defibrillation was attempted during on-going mCPR. Return of spontaneous circulation was obtained in eight of eight CIO pigs and in four of eight IPPV pigs. Arterial oxygen tension (P < 0.05) and coronary perfusion pressure (P < 0.01) were significantly higher in the CIO pigs. Arterial CO(2)-tension was subnormal in both groups and significantly (P < 0.05) lower in the IPPV-pigs (around 4.5 versus 3.0 kPa). The intratracheal pressure differed significantly (P < 0.001) between the two groups. It was negative in each decompression phase in the IPPV pigs in spite of 6 mmHg of PEEP. The CIO pigs had a positive intratracheal pressure during the whole cycle of mCPR, with a minimum pressure of 8 mmHg during each decompression phase. To conclude, mCPR combined with CIO gave adequate ventilation and significantly better oxygenation and coronary perfusion pressure than mCPR combined with IPPV.

Animals↗

PubMed2004

Inferior mesenteric venous left renal vein shunting for decompression of excessive portal hypertension in adult living related liver transplantation.

In the present study, we investigated the effect of decompression of excessive portal hypertension by inferior mesenteric venous (IMV) left renal vein shunting in 7 cirrhotic patients with esophago-gastric varices and 2 patients who underwent adult living related donor liver transplantation (ALRDLT). The portal pressure remarkably decreased after shunting in all patients with esophago-gastric varices (388 +/- 42 mm H2O vs. 247 +/- 57 mm H2O; P < .05). It also decreased after a shunt operation in patients who had undergone liver transplantation. We report that the excessive shear stress by portal hypertension after small-for-size LRDLT induces a liver injury and the decompression of portal hypertension by splenic arterial ligation or splenectomy prevents postoperative liver injury following massive hepatectomy and small-for-size LRDLT. Our present studies suggested that IMV left renal vein shunting might prevent postoperative liver injury by partial decompression of excessive portal hypertension following small-for-size LRDLT.

Angiography↗

PubMed1983

Increase in orbital volume obtained by decompression in dried skulls.

We totally or partially removed the medial wall, floor, lateral wall, or a combination of the three, in four orbits and measured the increased orbital volume that results from the more common orbital decompression techniques. Removal of medial wall alone added 6 cc of volume to the orbit. Removing the floor of the orbit while preserving bone lateral to the infraorbital groove added 7 cc of volume. Removing the lateral floor added 1 cc and removing the lateral wall added 2 cc. Effective lateral decompression, therefore, requires creation of space within the temporal fossa. Removing the wall and the medial floor together added 13 and 14 cc of volume in two separate skulls. The largest volume gained by orbital decompression was 15 cc. This occurred when the entire orbital floor and medial wall were removed. Little volume is lost, however, when the lateral floor is preserved.

Cadaver↗