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At least 1,333 records · Page 74Linked to original sources
PubMed1993

Enteral nutrition with simultaneous gastric decompression in critically ill patients.

OBJECTIVE: Early enteral nutrition is an important adjunct in the care of critically ill patients. A double-lumen gastrostomy tube with a duodenal extension has been reported to enable early enteral feeding with simultaneous gastroduodenal decompression. We tested the ability of this device to achieve these goals in critically ill patients. DESIGN: Noncomparative, descriptive case series. SETTING: Surgical intensive care unit in a university hospital. PATIENTS: Fifteen consecutive critically ill patients, who, at the time of laparotomy, were assessed likely to need long-term nutritional support and gastric decompression, underwent tube placement. Mean age was 47 +/- 21 yrs. Mean Acute Physiology and Chronic Health Evaluation (APACHE II) and Therapeutic Intervention Scores were 15 +/- 7.3 (SD) and 29 +/- 10.2, respectively, and the mean Injury Severity Score of 11 trauma patients in the group was 27 +/- 7.4. INTERVENTIONS: Correct tube positioning was verified by radiograph or endoscopy. METHODS: Caloric and protein requirements, nutritional parameters, and problems encountered with the device were recorded. The correlation between the volume of feeding port input and suction port output was noted, and this correlation was considered significant if r2 was > or = .5. RESULTS: Only three (20%) of 15 patients reached full enteral nutritional support via the enteral route. None of these patients achieved this level of nutritional support within the first postoperative week. In 67% of the patients, large quantities of enteral feeding solution appeared in the gastroduodenal suction port effluent. When feeding port input was plotted against effluent volume, a correlation coefficient of > .71 (r2 = > or = .5) was found in 40% of the patients. Other complications included: a) excessive gastroduodenal drainage requiring fluid/electrolyte replacement in eight (53.3%) patients; and b) skin ulceration at the tube entrance site in seven (46.7%) patients. CONCLUSIONS: These data do not support the use of this device for early enteral feeding and simultaneous gastric decompression in critically ill patients.

Adolescent↗
PubMed2000

Efficacy of interposed abdominal compression-cardiopulmonary resuscitation (CPR), active compression and decompression-CPR and Lifestick CPR: basic physiology in a spreadsheet model.

This study was undertaken to understand and predict results of experimental cardiopulmonary resuscitation (CPR) techniques involving compression and decompression of either the chest or the abdomen. Simple mathematical models of the adult human circulation were used. Assumptions of the models are limited to normal human anatomy and physiology, the definition of compliance (volume change/pressure change), and Ohm's law (flow = pressure/resistance). Interposed abdominal compression-CPR, active compression and decompression of the chest, and Lifestick CPR, which combines interposed abdominal compression and active compression and decompression, produce, respectively, 1.9-, 1.2-, and 2.4-fold greater blood flow than standard CPR and systemic perfusion pressures of 45, 30, and 58 mm Hg, respectively. These positive effects are explained by improved pump priming and are consequences of fundamental principles of cardiovascular physiology.

Abdomen↗
PubMedDate not supplied

Bone marrow edema of the hip: MR findings after core decompression.

Magnetic resonance imaging is an extremely sensitive technique for evaluation of bone marrow changes at an early stage of avascular necrosis (AVN) of the hip. We therefore examined 11 painful hips whose clinical symptoms led us to suspect idiopathic AVN. The radiographs of all of these either were normal or demonstrated a minimal decrease in radiodensity. Magnetic resonance demonstrated diffuse signal loss of the bone marrow at short TR/TE images of the femoral head in all hips, with various extensions in the head, neck, and intertrochanteric area. These regions turned iso- to hyperintense on long TR/TE images compatible with bone marrow edema (BME). Focal abnormalities characteristic for AVN were not seen in any of the cases. Radionuclide studies performed in six cases were positive. All patients underwent core decompression treatment. Hydrostatic bone marrow pressure measurement and intraosseous venography were positive in five cases when measured. Histology available in eight cases confirmed the presence of BME. Furthermore, the bone changes corresponded to those of early AVN. Follow-up examinations after core decompression with MR showed normal signal intensity in all cases. Magnetic resonance represents a viable diagnostic tool for BME and can monitor the therapeutic success of core decompression. Whether BME of the femoral head constitutes a distinct transient syndrome or represents an early form of AVN is controversial at present. Our findings support those who believe that BME may represent an initial stage of idiopathic AVN.

Adult↗
PubMed1991

Spinal canal decompression in traumatic thoracolumbar burst fractures: posterior distraction rods versus transpedicular screw fixation.

Although the benefit of spinal canal decompression of traumatic thoracolumbar burst fractures is controversial, it remains a desirable procedure, as many reports describe improved neurologic outcome with spinal canal reconstruction. The optimal type of posterior instrumentation for reconstructing the spinal canal is unclear. This study focused on the efficacy of posterior distraction rods versus transpedicular screw fixation implants in decompressing the spinal canal and on the relationship between the amount of canal decompression and subsequent neurologic recovery. A medical records review was conducted to identify all patients surgically treated for traumatic burst fractures of the thoracolumbar spine from January 1, 1987 to June 30, 1989. Sixty-seven patients were selected by this review, and, of these, 30 had had both preoperative and postoperative CT scans. We could find no bias among patients who received both preoperative and postoperative CT scans as compared to those who did not, therefore the 30 patients were considered to be a random sample of the total population of 67. A retrospective study was then conducted on the 30 patients with surgically treated burst fractures--15 treated with posterior distraction rods and 15 treated with AO Fixator Interne transpedicular screw fixation implants. Preoperative and postoperative spinal canal cross-sectional areas were measured directly from the scaled CT scans. The area of most severe compromise was compared with an internal standard defined as the next, caudal, uncompromised spinal level, and the percentage of preoperative and postoperative canal compromise was calculated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Delayed hearing loss after neurovascular decompression.

We report two unusual cases of delayed hearing loss after neurovascular decompression of structures within the cerebellopontine angle. In the first case, the patient noted a unilateral hearing loss 3 weeks after undergoing vascular decompression of the trigeminal nerve for tic douloureux. This gradually improved over an 18-month period. In the second case, the patient awoke on the 4th day after vascular decompression of the facial nerve for hemifacial spasm with a bilateral hearing loss that has remained unchanged after the onset. These are examples of delayed acoustic dysfunction occurring with a shift in surgically freed vessels and may have been induced by newly directed neurovascular compression or distortion.

Adult↗
PubMed1997

Anterior decompression and fusion using bone grafts obtained from cervical vertebral bodies for ossification of the posterior longitudinal ligament of the cervical spine: technical note.

OBJECTIVE: To describe a surgical technique of anterior decompression and fusion using bone grafts obtained from cervical vertebral bodies with ossification of the posterior longitudinal ligament of the cervical spine. This technique seeks to avoid complications associated with an anterior approach of decompression and bone fusion, which widely uses autogenous bone from the iliac crest. METHODS: Forty patients with cervical myelopathy were studied. The ossified ligament was localized to one, two, three, four, five, six, and seven vertebral bodies in 10, 18, 5, 4, 1, 1, and 1 patients, respectively. The ossified area of all posterior longitudinal ligament was completely removed using microsurgical techniques, and 11 patients were operated on at one level, 21 at two levels, and 8 at three levels. RESULTS: The symptoms of all patients improved after the operation. Postoperative x-ray films showed solid bone fusion in all patients at a mean follow-up time of 3 years (range, 1-5.25 yr). Anterior angulation was found in one of eight patients (13%) who underwent three-level fusion. CONCLUSION: Two major advantages were as follows: 1) no complications related to the iliac donor site occurred, and 2) early mobilization of patients was possible with a soft cervical collar. Anterior decompression and fusion should be used for cases with ossification of up to three consecutive vertebrae needing either one- or two-level fusions.

Adult↗
PubMed1998

Syringomyelia persistence after Chiari decompression as a result of pseudomeningocele formation: implications for syrinx pathogenesis: report of three cases.

OBJECTIVE AND IMPORTANCE: We present the cases of three patients in whom pseudomeningocele (PSM) formations after posterior fossa decompression of hindbrain herniations (Chiari I malformations) were associated with persistence of syringomyelia. The physiological importance of correcting this complication has not been previously described. CLINICAL PRESENTATION: We identified three patients who developed suboccipital PSMs after undergoing posterior fossa decompression for hindbrain herniations and syringomyelia. All three patients experienced persistence of their symptoms and their syringomyelia, despite adequate posterior fossa decompression. TECHNIQUE: Subsequent exploration revealed cerebrospinal fluid leaking either from the dural suture line (one patient) or from perforations found within the bed of a polyglactin mesh dural graft (two patients). Correction of the PSM resulted in resolution of both the syringomyelia and the symptoms in all three patients. DISCUSSION: The persistence of syringomyelia in the presence of a PSM may be the result of dissipation of the cerebrospinal fluid systolic pressure wave into the distensible PSM cavity. This phenomenon suggests that the cerebrospinal fluid pressure exerted on the spinal cord surface favors resolution of the syrinx cavity.

Adult↗
PubMedDate not supplied

Somatosensory evoked potentials during decompression and stabilization of the spine. Methods and findings.

As part of a study to determine if decompressive surgery benefits patients who have incomplete lesions of the spinal cord, the somatosensory evoked potential (SEP) has been employed as an intraoperative spinal cord monitor. This procedure was used to see if decompression results in any rapid changes in spinal cord conductivity and to correlate these findings with the patient's subsequent clinical course. In addition to trauma, however, other factors also affect the SEP, and these must be recognized if intraoperative monitoring is to be successful. Frequency of stimulation, wakefulness, and anesthetic agents alter the wave-form and amplitude of the SEP. Using nitrous oxide, oxygen, meperidine (or morphine), and a muscle relaxant for anesthesia, and stimulating at frequencies of 1 or 2 per second, 11 patients with cervical or upper thoracic lesions have been monitored. There was no loss or diminution of an SEP and no patient was neurologically poorer afterwards. In 4 patients, the SEP "improved" soon after decompression. Clinical outcome, however, was not related to whether the SEP changed or remained the same. In total, 8 patients subsequently improved functionally and 3 did not.

Anesthesia↗
PubMed1985

Confirmation of the posterolateral technique to decompress and fuse thoracolumbar spine burst fractures.

A posterolateral technique to decompress retropulsed bone from the spinal canal has been employed in nine patients, confirmed with intraoperative canal inspection and pre- and postoperative computed axial tomographic (CAT) evaluation. This technique has allowed reduction of retropulsed bony elements from the spinal canal, assessment of canal decompression and reestablishment of vertebral body alignment. The approach permits posterior fusion at the same operation. If the postoperative CAT scan continues to show spinal cord embarrassment from anterior bony elements, an anterior approach can be performed for additional decompression and fusion. The posterolateral approach does not necessarily improve neurologic function. However, when compared with posterior instrumentation alone, it does help ensure canal reduction and alignment, which may aid recovery and hasten rehabilitation.

Adolescent↗
PubMed1990

Delayed anterior decompression in patients with spinal cord and cauda equina injuries of the thoracolumbar spine.

Forty-nine patients with complete and incomplete injuries of the spinal cord or cauda equina who had undergone anterior decompression at a minimum of 3 months after injury were examined. Follow-up was from 12 months to 19 years. Postoperative neurologic improvement occurred in 46.5% of patients with incomplete injuries. If the surgery was performed less than 2 years after injury, neurologic improvement occurred in 68% with an improvement in Frankel grade of 32%. Bladder function improved in 27% of patients and if operated on less than 2 years after injury improvement occurred in 43%. Conus medullaris decompression resulted in a 50% improvement. There was an 83% improvement in the pattern of pain after decompression. Of 23 patients with preoperative spasticity, 10 improved but 6 were worse after surgery.

Adult↗
PubMed1992

Posterior decompression and stabilization for multiple metastatic tumors of the spine.

Although the value of surgical decompression and stabilization for solitary spinal metastasis is well documented, indication for surgery for advanced multiple metastatic tumors of the spine is controversial. In this study, the clinical effect of posterior decompression and stabilization was investigated in 11 patients with advanced multiple spinal metastases with unfavorable conditions. Mean blood loss during surgery was 3000 g. Disseminated intravascular coagulation occurred in three patients. Neurologic improvement was observed in nine patients. There was no neurologic deterioration due to surgery in any patients. A measure of pain relief was obtained in all patients. However, the postoperative longevity was short and the patients died 2.5 months (on average) after operation, except in cases of breast cancer. The effect of the posterior surgery on multiple spinal metastases depended on primary diseases. In cases of short life expectancy, the effect of the surgery was limited only to the short duration of neurologic improvement, pain relief, and ease of nursing care while confronted with grave surgical morbidity. In cases of long life expectancy with tumors like breast cancer, however, posterior decompression and stabilization were expected to exert long-term therapeutic effect. Therefore, the posterior surgery for multiple spinal metastases is cautiously indicated considering the nature of the primary tumor.

Adult↗
PubMed1995

A complication of spinal decompression. A case report.

STUDY DESIGN: This case study is designed to report the previously unreported specific complication of acute cauda equina compression after decompression surgery for spinal stenosis. OBJECTIVES: To inform others of the possibility of such a complication; to suggest a possible mechanism for this situation, namely hourglass constriction of the cauda causing ischemia to distal nerve roots; and to suggest a management plan--immediate magnetic resonance imaging to identify the problem and return to the operating room for further decompression--which was successful in this case. SUMMARY OF BACKGROUND DATA: Previous reports of causes of paraparesis or paraplegia after surgery are listed, and previous theories on the etiology of acute cauda compression are discussed. METHODS: The clinical findings of spinal stenosis in a 32-year-old man are presented, and subsequent details of the surgery, complications after surgery, investigation, and future surgery, including magnetic resonance imaging scans before and after surgery, are provided. RESULTS: The result in this case was a patient free of symptoms. CONCLUSIONS: Incomplete decompression in surgery for spinal stenosis can result in acute cauda equina compression. In these circumstances, magnetic resonance imaging can reveal the cause, and in this case, immediate surgery was successful in relieving the symptoms and signs.

Acute Disease↗
PubMed1996

Tortuosity of the vertebral artery in patients with cervical spondylotic myelopathy. Risk factor for the vertebral artery injury during anterior cervical decompression.

STUDY DESIGN: The case report presented herein shows tortuosity of the vertebral artery in a patient with cervical myelopathy. This case led the authors to evaluate 22 other patients who also had undergone anterior cervical fusion. They were studied before operation by either magnetic resonance imaging angiography or selective vertebral angiography. OBJECTIVES: To analyze the radiographs, computed tomography, magnetic resonance imaging, and angiography findings to detect any tortuosity of the vertebral artery in patients with cervical myelopathy to show the risk factors of vertebral artery injury during anterior decompression. SUMMARY OF BACKGROUND DATA: Complications of vertebral artery laceration during cervical anterior decompression are rare, so this injury and abnormality in the course of vertebral artery in patients with cervical myelopathy receive little attention. METHODS: The tortuosity of the vertebral artery was assessed by angiography, magnetic resonance imaging, and computed tomography. RESULTS: Mild vertebral artery tortuosity was observed in 10 patients and loop formation in three associated with cervical spondylotic changes. CONCLUSIONS: This study suggests that vertebral artery loop formation is developed associated with cervical spondylotic changes. During the anterior decompression of cervical spondylotic myelopathy or radiculopathy, the looped vertebral artery could be injured by an excessive wide rejection of the bone or disc material. In the case of vertebral artery migration, the looped vertebral artery can even be injured by routine procedures.

Adolescent↗
PubMed1997

Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis.

STUDY DESIGN: This is a retrospective study analyzing 76 patients treated by decompression, pedicle screw instrumentation, and fusion for spondylolytic spondyiolisthesis with symptomatic spinal stenosis. OBJECTIVES: To verify the advantages of adding posterior lumbar interbody fusion to the usual posterolateral fusion with pedicle screw instrumentation. SUMMARY OF BACKGROUND DATA: Stabilization after decompression of spondylolytic spondylolisthesis is difficult because of a lack of fusional bone bases, gap between the transverse process bases, and incompetent anterior disc support. Posterior lumbar interbody fusion offers anterior support, reduction, and a broad fusion base. METHODS: Forty patients were treated with posterolateral fusion, and 36 were treated with additional posterior lumbar interbody fusion. They were compared for union, reduction of the deformity, and clinical results. RESULTS: The patients were followed up for more than 2 years. Nonunion was observed in three patients who underwent posterolateral fusion (7.5%), and no cases of nonunion was found in patients who underwent posterior lumbar interbody fusion. Reduction of slippage was 28.3% in those who underwent posterolateral fusion and 41.6% in those who had posterior lumbar interbody fusion (P = 0.05). In the posterolateral fusion group, eight patients (20%) had recurrence of deformity, with loss of reduction more than 50%. Hardware failures occurred in two patients who had posterolateral fusion. There was no major neurologic complications in both groups. Both groups had satisfactory results in more than 90% of patients, with marked improvement of claudication. However, subjective improvement of back pain by Kirkaldy-Willis criteria revealed differences in the excellent results. An excellent result was reported by 45% in the posterolateral fusion group and by 75% in posterior lumbar interbody fusion group. CONCLUSIONS: The addition of posterior lumbar interbody fusion to posterolateral fusion after a complete decompression and pedicle screw fixation is a recommended procedure for the treatment of spondylolytic spondylolishesis with spinal stenosis.

Adult↗
PubMed2000

Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases.

STUDY DESIGN: Retrospective review of prospectively maintained institutional spine database. OBJECTIVES: To assess the pain, neurologic, and functional outcome of patients with metastatic spinal cord compression using a posterolateral transpedicular approach with circumferential fusion. SUMMARY OF BACKGROUND DATA: Patients with spinal metastases often have patterns of disease requiring both an anterior and posterior surgical decompression and spinal fusion. For patients whose concurrent illness or previous surgery makes an anterior approach difficult, a posterior transpedicular approach was used to resect the involved vertebral bodies, posterior elements, and epidural tumor. This approach provides exposure sufficient to decompress and instrument the anterior and posterior columns. METHODS: During the past 15 months, 25 patients were operated on using a posterolateral transpedicular approach. The primary indications for surgery were back pain (15 patients) and neurologic progression (10 patients). All patients had vertebral body disease, and 21 patients had high-grade spinal cord compression from epidural disease as assessed by magnetic resonance imaging. Seven patients underwent preoperative embolization for vascular tumors. In each patient, the anterior column was reconstructed with polymethyl methacrylate and Steinmann pins and the posterior column with long segmental fixation. RESULTS: All patients achieved immediate stability. Pain relief was significant in all 23 patients who had had moderate or severe pain. Neurologic symptoms were stable or improved in 23 patients. One patient with an acutely evolving myelopathy was immediately worse after surgery, and one patient had a delayed neurologic worsening, progressing to paraplegia. CONCLUSIONS: The posterolateral transpedicular approach provides a wide surgical exposure to decompress and instrument the anterior and posterior spine. This technique avoids the morbidity associated with anterior approaches and provides immediate stability. Vascular tumors may be removed safely after embolization. Patients can be mobilized early after surgery.

Adult↗
PubMed2004

Decompressive craniectomy in head injury.

PURPOSE OF REVIEW: To examine the evidence for the role of decompressive craniectomy in the management of traumatic brain injury. RECENT FINDINGS: This review highlights the importance of brain swelling and raised intra-cranial pressure (ICP) as of the one fundamental pathophysiological processes following traumatic brain injury. The role of protocol driven therapy in controlling raised intra-cranial pressure is discussed, with the staged application of medical interventions (including hypothermia and barbiturates). If these measures fail to control ICP, a surgical option - removal of the skull (decompressive craniectomy) can be considered. The evidence for this operation is reviewed in terms of data published in peer-reviewed journals since 1997. This evidence consists pre-dominantly of case series with no definitive Class I evidence and demonstrates a wide range of outcomes with no clear consensus regarding the indications for the operation. SUMMARY: Decompressive craniectomy is currently being applied in the management of traumatic brain injury with a wide range of outcomes reported in the literature. Current opinion on the role of this operation is therefore divided and it is now appropriate to proceed to prospective randomised studies.

Clinical Trials as Topic↗
PubMed2003

Radius decompression for treatment of kienböck disease.

The authors present a new concept in the treatment of Kienböck disease. They believe that the favorable outcome obtained with these different procedures (ie, either shortening of the radius or lengthening of the ulna) is due to the surgical decompression on the distal forearm. The procedure presented is called metaphyseal core decompression and it consists of curettage of the distal radius and ulna (the ulna has been excluded for the past 12 years) through a small cortical window. From 1976 to 2000, 48 patients were operated and retrospectively reviewed. Thirty-five were men and 13 were women, with an average age of 39 years (range, 18-64 years). The dominant limb was involved in 35 patients. All patients complained of pain and had decreased motion of the involved wrist. On radiographic examination, 4 had Lichtman stage 1, 17 had stage 2, and 25 had stage 3A. Patients who had stages 3B or 4 were excluded. Two patients had normal radiographic but MRI diagnostic for Kienböck disease, and were classified as stage 0. There were no postoperative complications reported and no patient had any additional procedure. The long-term follow-up reveals that metaphyseal core decompression produces results at least as good as other surgical procedures, with no postoperative complications.

Journal Article↗
PubMed2004

Operative technique of a new decompression procedure for Kienböck disease: partial capitate shortening.

A new decompression procedure for Kienböck disease, namely "partial capitate shortening," was developed. Patients in Lichtman stages 2 and 3A, independent of the ulnar variance, are candidates for this procedure. This procedure can dramatically reduce compressive forces on the lunate almost as much as a traditional decompression procedure of the capitate (capitate shortening combined with capitate-hamate fusion) and much more than the decompression procedure of the forearm bone such as radial shortening. We surmise that our procedure will allow better lunate revascularization. Although the scaphoid progressively adopts an abnormal palmarflexed position after capitate shortening combined with capitate-hamate fusion, partial capitate shortening can maintain normal carpal alignment, resulting in better joint congruency around the scaphoid and range of motion of the wrist. Moreover, partial capitate shortening allows minimal invasion and is an easy technique without bone grafting. Both operating and immobilizing time are shortened, and there are no secondary problems in the distal radioulnar and/or ulnocarpal joint often seen after radial osteotomy procedures.

Journal Article↗