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PubMed1988

Tube decompression of the dilated colon.

With the technique described herein, decompression of a massively dilated colon is effectively accomplished, allowing resection to proceed safely. This method of decompression has allowed us to perform colonic resection in all patients with toxic megacolon seen in recent years. It is desirable to remove the infected and inflamed colon in such a circumstance. We have not resorted to blowhole colostomies in cases of toxic megacolon, as this leaves the colon, which is the septic source, within the abdominal cavity. This technique has also been used successfully to expedite subtotal colectomy and ileosigmoid anastomosis in patients with obstructing lesions of the left side. It allows colonic decompression and on-table bowel preparation by irrigation with antiseptics such as povidone-iodine (Betadine).

Humans↗

PubMed1979

Distal spleno-renal shunt for portal decompression in childhood.

Successful portal decompression presents a unique challenge in children. The meso-caval shunt, utilizing the large caliber iliac vein in constructing the anastomosis, has been accepted as the standard operative procedure for treating these patients. Technical and anatomic difficulties, however, often prevent the successful performance of this shunt. The proximal spleno-renal shunt, advocated by many as an alternative in children, incurs the penalty of splenectomy. Furthermore, in both techniques, portal venous blood is preferentially shunted from the liver, posing a potential for subsequent development of hepatic encephalopathy as the patients mature. The distal spleno-renal shunt avoids these problems by selectively decompressing the esophageal venous plexus through the spleen. With this procedure, the majority of portal venous blood flow is maintained and the spleen is preserved. The present report describes three children in whom the distal spleno-renal shunt has been successfully employed for portal decompression. The youngest of these patients was 2 1/2 yr of age at the time of operation and has a patent portal-systemic shunt 18 mo postoperatively. This experience confirms the effectiveness of the distal spleno-renal shunt as an alternative to the meso-caval shunt, especially in children with inflammatory involvement of the superior mesenteric vein.

Child↗

PubMed1997

Management of urinary retention: rapid versus gradual decompression and risk of complications.

The literature was reviewed to quantify the risk of complications related to the relief of obstruction in urinary retention. We also sought to determine whether the risk of complications is higher with rapid or gradual decompression (or "clamping") of the obstructed urinary bladder. The medical literature was identified by a search of the MEDLINE database and a manual review of the bibliographies of the identified articles. Studies show that, after quick, complete relief of obstruction, hematuria occurs in 2 to 16% of patients; however, clinically significant hematuria is rare. After relief of obstruction, blood pressure often decreases, but it usually normalizes and does not progress to clinically significant hypotension. Postobstructive diuresis occurs after relief of obstruction in 0.5 to 52% of patients; however, it is easily managed and rarely of clinical significance. We were unable to identify any randomized controlled studies that directly compared quick, complete emptying with gradual emptying of the obstructed bladder. Moreover, we identified no studies supporting the practice of gradual emptying of the obstructed bladder. The available published studies support quick, complete emptying for relief of the obstructed urinary bladder. We conclude that hematuria, hypotension, and postobstructive diuresis may occur after decompression of the obstructed urinary bladder, but these complications are rarely clinically significant. Quick, complete emptying of the obstructed bladder is safe, simple, and effective and is recommended as the optimal method for decompressing the obstructed urinary bladder. Prudent, supportive care is needed for all patients, with special attention to elderly patients and those with hypovolemia.

Acute Disease↗

PubMed1982

Recurrence of lumbar canal stenosis a decade after decompressive laminectomy.

Lumbar canal stenosis is treated by decompressive laminectomy with a high rate of success, but patients may experience late recurrence of pain. We report on 3 patients with return of symptoms years after their original decompression. CT scanning showed reformation by bone; their symptoms were relieved by decompression. While scarring is probably a more common cause of the return of pain, this reformation of bone can be more easily treated than scar formation and its presence should be sought by CT scanning.

Constriction, Pathologic↗

PubMed1991

Modified optic nerve decompression in patients with functioning lumboperitoneal shunts and progressive visual loss.

Chronic papilledema from pseudotumor cerebri can cause progressive visual loss despite functioning lumboperitoneal shunts. The authors performed modified optic nerve sheath decompression in 12 patients (16 operations) with functioning lumboperitoneal shunts and progressive visual loss. All of the patients demonstrated improvement in visual function. Optic nerve sheath decompression allows release of localized cerebrospinal fluid (CSF) pressure. By performing optic nerve sheath decompression, progressive visual loss secondary to chronic papilledema can be halted and reversed.

Adult↗

PubMed1991

Long-term efficacy of orbital decompression for compressive optic neuropathy of Graves' eye disease.

In a retrospective evaluation of the long-term effect of transantral-ethmoidal decompression for compressive optic neuropathy, the authors evaluated visual acuity, visual fields, color vision, and motility in 30 patients (52 orbits) for a median follow-up period of 2.5 years (range, 0.6 to 6.5 years). Patients with preoperative visual acuity of 20/40 or better uniformly remained in this category and demonstrated an earlier stabilization of vision than those with poorer preoperative visual acuity. Of the ten patients whose preoperative visual acuity was 20/50 to 20/100, 80% attained acuity of 20/40 or better. In patients whose visual acuity was 20/200 or less (n = 7), 57% attained an acuity of 20/40 or better. The most common visual field defect was generalized constriction, which was noted in 43 of the 52 eyes (83%). After decompression, the preoperative visual field defect had improved or completely resolved in all but one case. Dyschromatopsia, noted in 20 eyes preoperatively, cleared in 17 (85%) postoperatively. Although the study showed that surgical decompression is beneficial, some patients may require additional modalities of treatment.

Adult↗

PubMed1992

Miniplate reconstruction of the lateral orbital rim after orbital decompression for Graves disease.

BACKGROUND: Removal of lateral orbital bone with or without simultaneous removal of the lateral orbital rim is an accepted method of orbital decompression for Graves disease. Once removed, the bone is no longer available for reconstruction and secondary complications such as rounding of the canthal angle, canthal dystopia, and globe dystopia may result. METHODS: The authors replaced the excised bone with a titanium miniplate to protect the globe and fixate the lateral canthal tendon in 18 patients (33 orbits). The orbital rim and lateral orbital wall were completely removed, and the inner aspect of the orbit was enlarged with a cutting burr. A standard titanium miniplate was then anchored to remaining bone, and soft tissue was secured to the miniplate to reconstruct the lateral canthus. RESULTS: The results, as manifest by appearance of the lateral canthus and position of the eyelid in apposition to the globe, were graded as excellent in all patients and orbits. There were no early or late complications. CONCLUSION: Miniplate reconstruction of the lateral orbital rim after decompression for Graves disease allows the beneficial affect of lateral decompression and preserves the functional aspect of the lateral orbital wall.

Adult↗

PubMed1994

Optic canal decompression in indirect optic nerve trauma.

BACKGROUND: The proper management of neurogenic visual loss after blunt head trauma is controversial. Non-treatment, corticosteroids, and surgical decompression of the optic canal are all currently considered to be reasonable alternatives. The goal of this study was to identify factors affecting improvement in patients treated with canal decompression. METHODS: A retrospective analysis of 31 cases in which transethmoidal decompression of the optic canal had been performed for neurogenic visual loss after closed head trauma was conducted. Each patient was alert and free of injury to the globe when evaluated before surgery. Surgery was performed within 6 days of injury, and all were given perioperative steroids. RESULTS: Visual acuity improved in 22 (71%) patients, with 6 (19%) regaining visual acuity of 20/40 or better. The mean improvement from preoperative visual deficit was 42.0% +/- 6.6%, with a median improvement of 45.2%. Both univariate and multivariate analysis suggested that vision improved more in patients who were younger than 40 years of age than in patients who were 40 years of age or older. Interval between injury and surgery, preoperative visual acuity, and the presence of optic canal fracture did not affect outcome. CONCLUSION: Any future randomized trials of therapy should stratify patients based on age. Enrollment of patients with no light perception or who experienced delay between injury and treatment may be reasonably considered.

Adolescent↗

PubMed1992

Decompressive procedures. Indications and techniques.

Hemilaminectomy and dorsal laminectomy are the surgical techniques most suited for decompression of the thoracic, thoracolumbar, lumbar, and lumbosacral spine. Hemilaminectomy is preferred for decompressing the spinal cord before applying fixation devices for fractures/luxations. Dorsal laminectomy is the method of choice for exploration of the spinal canal and for decompression of the lumbosacral region. Either method is applicable to removal of herniated intervertebral disc material and fenestration of other disc spaces.

Animals↗

PubMed1995

Outcome study of ulnar nerve compression at the elbow treated with simple decompression and an early programme of physical therapy.

Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper limb. This paper presents the experience of treating cubital tunnel syndrome with simple decompression in 131 patients (164 ulnar nerves) over the past 12 years. 85% of these patients had mild or moderate ulnar nerve disease. In 146/164 ulnar nerves (89%), simple decompression resulted in good or excellent immediate post-operative relief of symptoms. After an average follow-up of 4.3 years (range, 0.8-12.0 years), 130/164 (79%) still reported good or excellent relief. The independent predictors of a better long-term outcome were absence of post-operative subluxation, greater body weight, normal pre-operative two-point discrimination (2-PD), and a more recent date of operation. A physical therapy rehabilitation program generally began on the day after surgery. Active participation in this predicted a rapid return to work or activities of daily living. The average time to return to work with simple decompression was 20 workdays.

Adult↗

PubMed1998

Improved haemodynamics with increased compression-decompression rates during ACD-CPR in pigs.

The haemodynamic effects of variations in the compression-decompression frequency, 60, 90 and 120 min(-1) during ACD-CPR, were tested in a randomized cross-over design during ventricular fibrillation (VF) in 12 anaesthetized pigs (17-22 kg) using an automatic hydraulic chest compression-decompression device. There were significant increases with increasing frequency for mean (+/- S.D.) carotid blood flow (17 +/- 5, 25 +/- 9 and 36 +/- 12 ml min(-1), transit time flow probe), cerebral blood flow (17 +/- 7, 30 +/- 17 and 40 +/- 13 ml min(-1) 100 g(-1), radionuclide microspheres) and mean aortic pressure (34 +/- 8, 37 +/- 10 and 43 +/- 7 mmHg), respectively. Myocardial blood flow (radionuclide microspheres) and diastolic coronary perfusion pressure, CPP, increased significantly from 60 to 90 min(-1) with no further significant increase to 120 min(-1) (28 +/- 13, 46 +/- 23 and 49 +/- 19 ml min(-1) 100 g(-1) and 25 +/- 8, 31 +/- 11 and 32 +/- 9 mmHg, respectively). Renal and hepatic blood flow also increased with increasing rate. No significant differences in the expired CO2 levels were observed. In conclusion increasing the compression-decompression frequency from 60 to 90 and 120 min(-1) improved the haemodynamics during ACD-CPR in a pig model with VF.

Analysis of Variance↗

PubMed1999

Chest injuries after active compression-decompression cardiopulmonary resuscitation (ACD-CPR) in cadavers.

In a prospective study of 38 cadavers of patients older than 18 without previous chest injury or cardiopulmonary resuscitation (CPR), active compression-decompression (ACD) resuscitation manoeuvres were performed to determine possible factors influencing sternal and/or rib fractures. ACD was performed for 60 s, with compression and decompression forces being continuously recorded. A stepwise logistic regression analysis was applied. Factors analyzed were age, gender, use of a compression cushion beneath the piston of the ACD device (Ambu CardioPump), and maximal compression and decompression forces. After ACD, the cadavers were autopsied and thoracic injuries were assessed. There was a significant correlation between sternal fractures and gender (P = 0.008), and between rib fractures and age (P = 0.008). Women were found to have a higher risk for sternal fractures, whereas older patients had a higher risk for rib fractures. Maximal compression force was another factor in sternal and/or rib fracture (P = 0.048). Even though a significantly higher incidence of sternal fractures was observed when the compression cushion was used (P = 0.045), inclusion of this variable in the regression analysis only marginally improved the prediction for correct classification of sternal fractures. In conclusion, when well controlled ACD-CPR is performed in cadavers, age is the most important factor determining the incidence of rib fracture. Sternal fractures were more common in female cadavers.

Age Factors↗

PubMed1998

Pudendal canal syndrome as a cause of vulvodynia and its treatment by pudendal nerve decompression.

Notwithstanding many established causes of vulvodynia there still remains an idiopathic group with unknown etiology and variable results of treatment. We present 11 women with idiopathic vulvodynia in whom the etiology could be defined and who were successfully treated. Age varied from 28-53 years. The vulvar pain was associated with stress urinary incontinence in 6/11 patients and all had constipation. Perineal and vulvar hypoesthesia occurred in 6, weak anal reflex in 7 and diminished EMG activity of the external anal sphincter in 3, of the external urethral sphincter in 6 and of the levator ani muscle in 11. There was significant increase (P<0.05) of the pudendal nerve terminal motor latency (PNTML) in all. The motor and sensory change as well as the increased PNTML point to pudendal canal syndrome. Pudendal nerve block, as a diagnostic and therapeutic test, effected temporary pain relief. Pudendal nerve decompression was performed. The inferior rectal nerve was exposed through a para-anal incision, and followed to the pudendal nerve in the pudendal canal. Pudendal canal fasciotomy was done to release the pudendal nerve in the ischiorectal fossa. Vulvar pain disappeared in 9/11 women and stress urinary incontinence in 4/6. Anal reflex was normalized in 5/7 women, and vulvar and perineal hypoesthesia in 4/6. The EMG activity of the external urethral sphincter improved in 4/6, of the external anal sphincter in 2/3 and of the levator ani in 9/11 women. The PNTML was normalized in 9/11 women. In conclusion, pudendal nerve decompression effected relief and improvement in the sensory and motor manifestations of the pudendal nerve in 9/11 women. Two women did not improve due probably to an irreversible damage of the pudendal nerve, or to incomplete pudendal nerve decompression.

Adult↗

PubMed1993

Arthroscopic decompression of shoulder impingement secondary to Os acromiale.

Os acromiale is the result of failure of one of the outer ossification centers of the acromion to unite with the more medial portion. This creates an additional motion segment which may itself contribute to impingement syndrome of the shoulder or which may create hypertrophy or spurs which directly impinge on the cuff. Three cases of impingement syndrome of the shoulder with associated os acromiale are presented. All three were initially relieved with arthroscopic subacromial decompression of either the entire os acromiale or simply of the impinging spur. After 1 year, however, all three had recurrent or continued complaints of pain and/or impingement. Therefore, it would appear that arthroscopic subacromial decompression is not a solution to impingement syndrome secondary to os acromiale. Careful preoperative radiographic evaluation to rule out all causes of impingement syndrome including os acromiale is essential so that the surgeon may better choose an approach to decompression.

Acromion↗

PubMed1996

Arthroscopic decompression of a ganglion cyst causing suprascapular nerve compression.

Ganglion cysts causing suprascapular nerve compression are an uncommon cause of suprascapular nerve compression. The advent of magnetic resonance imaging (MRI) and its application in patients with shoulder pain has improved the ability to diagnose cystic lesions causing extrinsic compression of the suprascapular nerve. Traditionally, treatment of suprascapular nerve compression by a ganglion cyst has required open cyst excision through either a deltoid and infraspinatus muscle takedown or a muscle splitting approach. We present three cases of suprascapular nerve compression by a ganglion cyst in which the cyst was decompressed arthroscopically. In each case the patient's symptoms resolved after arthroscopic cyst decompression, and a postoperative MRI does not demonstrate reaccumulation of the cyst fluid. Arthroscopic ganglion cyst decompression is a well-tolerated approach to this problem that avoids the morbidity of an open surgical procedure. The absence of recurrent cyst formation combined with resolution of the symptoms attests to the success of this method.

Adult↗

PubMed2003

Hydrostatic pressure and cellular respiration: are the values observed post-decompression representative of the reality under pressure?

The goal of this article was to assess whether a pressure change can constitute a bias of interpretation of pressure effects on pressure-acclimatized fishes. This work consisted first in a study of the recompression effects of mitochondrial extracts from eels pressure-acclimatized; and then in a study of red muscle fibre compression/decompression. The first experimental series shows a decrease of mitochondrial performances after recompression when compared with the decompressed group. It is concluded that recompression does not allow to get rid of decompression effects. This is confirmed by the second experimental series which show that a decompression induces a stronger reduction of MO2 than the previous compression.

Journal Article↗

PubMed1995

The use of a CT scan to predict the feasibility of decompression of the first segment of the facial nerve via the transattical approach.

Total surgical decompression of the facial nerve can be offered to patients severely affected by Bell's palsy whether via the transattical or middle fossa approach. We prefer, when feasible, the transattical approach because it does not violate the cranial vault. The purpose of this study was to find the anatomical parameter of the temporal bone, measured by means of computed tomography (CT scan) and to decide which of these approaches should be offered. Sixty temporal bones were studied by CT scan, and then dissected in order to perform total facial nerve decompression via the transattical approach. Correlation between the two studies was established. Results suggest that measurement by CT scan of the attical area in the axial plane (AAA) may determine those patients for whom the transattical approach to facial nerve decompression should be undertaken.

Facial Nerve↗

PubMed1995

Anterior decompressive surgery for cervical ossified posterior longitudinal ligament causing myeloradiculopathy.

This paper reviews 88 patients (74 males and 14 females) who underwent anterior decompression and fusion for symptomatic ossified posterior longitudinal ligament of the cervical spine. Follow up averaged 8.5 years. Eighteen patients underwent one-vertebra, 59 two-vertebra, and 11 three-vertebra decompression with interbody fusion. The preoperative severity of symptoms significantly affected neurological recovery. Patients with three-vertebra spondylectomy showed significantly little neurological improvement. The return of patients to their previous activities as monitored at follow up was related to their preoperative neurological status. MRI findings appeared to be relevant to neurological recovery. Our findings suggest that anterior decompression is to be recommended for patients with less advanced preoperative symptoms and the involvement of one or two vertebrae.

Activities of Daily Living↗