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PubMed2002

Thoracoscopic approaches to the thoracic spine: experience with 241 surgical procedures.

INTRODUCTION: Microsurgical thoracoscopic approaches to the thoracic spine allow access to the spinal cord, spinal nerves, disc spaces, vertebral bodies, paravertebral soft tissues, and sympathetic chain with minimal invasiveness. METHODS: Between January 1994 and January 2000, 241 thoracoscopic procedures were performed: 164 thoracic sympathectomies, 60 discectomies, 5 neurogenic tumor resections, 8 corpectomies and spinal reconstructions, 2 anterior releases, and 2 biopsies. Cases were reviewed to evaluate the efficacy, surgical results, and complications of the thoracoscopic procedures. RESULTS: An adequate sympathectomy was achieved in all 164 sympathectomies. There was 100% relief of palmar and 95% relief of axillary hyperhidrosis. Reflex sympathetic dystrophy responded poorly to sympathectomy with recurrent pain. Thoracoscopic discectomy achieved complete decompression in 98% of patients. Gross total tumor resection was achieved in all five paraspinal neurogenic tumors. There was no operative mortality. Morbidity compared favorably with open surgical approaches to the thoracic spine. CONCLUSION: Thoracoscopic spinal surgery is an effective technique that provides full, direct access to the ventral thoracic spine. Its morbidity rate appears to be lower than that associated with open thoracotomy. It improves patient comfort and cosmetic results and shortens recovery. This technique has become the authors' surgical approach of choice for removing benign intrathoracic paraspinal neurogenic tumors and central herniated thoracic discs and for performing biopsies and thoracic sympathectomies. The senior author still prefers open surgical approaches for most thoracic corpectomies and spinal reconstruction procedures.

Adult↗
PubMed2003

[Results of the Ilizarov method in the treatment of pseudoarthrosis of the lower extremities].

OBJECTIVES: We evaluated the results of the Ilizarov method in the treatment of pseudoarthrosis of the lower extremities. METHODS: Forty-six patients (34 men, 12 women; mean age 38.6 years; range 28 to 69 years) were treated by the Ilizarov method for femoral (n=8, 17%) and tibial (n=38, 83%) pseudoarthrosis. The mean duration of the disease was 1.6 years (range 6 months to 4.8 years). Pseudoarthrosis was hypertrophic in seven patients (16%) and atrophic in 39 patients (84%). The mean number of previous operations was 1.4 (range 0 to 4); the mean bone loss was 7.4 cm (range 3 to 12 cm); the mean shortening was 6.8 cm (range 0 to 12 cm); the mean size of the defect was 5.2 cm (range 3 to 12 cm). Applications were monofocal in 30 patients (66%) and bifocal in 16 patients (34%). The mean follow-up was 22.6 months (range 9 to 54 months). RESULTS: Union occurred in all patients (92%) but four (2 monofocal, 2 bifocal). The fixator was applied for a mean of 208 days (range 93 to 750 days), which was 162 days (range 98 to 296 days) for monofocal, and 286 days (range 140 to 496 days) for bifocal applications. According to the Paley's criteria, the results for bone healing and function were excellent in 26 and 25 patients, good in 12 and 14 patients, fair in four and three patients, and poor in four patients, respectively. Pin tract infections developed in 28 patients, and reflex sympathetic dystrophy in three patients. Refracture occurred after the removal of the frame in three patients who received bifocal treatment. One patient developed transient peroneal nerve palsy with drop foot. Equinus rigidity of the ankle was seen in four patients. Cancellous bone grafting was performed in four patients (25%) in whom delayed healing was observed at the target site following segmental bone transport. Three patients had union with a residual deformity of more than 7 degrees. In the monofocal group, none of the patients had a residual shortening of more than 1 cm. Following bifocal applications, no bone defects were observed; the mean residual length discrepancy was 1. 5 cm (range 0 to 4 cm), and the healing index was 52 days/cm. CONCLUSION: The Ilizarov technique may simultaneously be successful in the treatment of joint contractures, angular, rotational, and translational deformities, shortening, and bone defects.

Adult↗
PubMed2003

[Short-term results of external fixation of unstable distal radial fractures].

OBJECTIVES: We assessed the effectiveness of external fixation in the treatment of unstable distal radial fractures. METHODS: Twenty-five patients (19 males, 6 females; mean age 39 years; range 20 to 71 years) with unstable distal radius fractures were treated by external fixation. Three patients had open fractures. According to the AO classification, the fractures were B1 (1 fracture), B2 (2), C1 (8), C2 (10), and C3 (4). External fixator was combined with K-wires or volar plates in 17 fractures. The fixator was used for a mean of 6.6 weeks, and the mean follow-up was 13.5 months. The earliest radiologic-anatomic and functional evaluations were based on the findings obtained at the end of six months. A modified Sarmiento scoring system was used for radiologic-anatomic assessment. For functional assessment, the scoring system proposed by Sarmiento et al. was used, which was based on the Gartland and Werley's system. RESULTS: Radiologic measurements indicated that anatomical results were excellent in 16 patients (64%), good in eight patients (32%), and fair in one patient (4%). Functional results were excellent in four patients (16%), good in seven patients (28%), fair in 11 patients (44%), and poor in three patients (12%). The complications encountered were pin tract infections in four patients, breakage of the fixator pin holder in one patient, and the development of reflex sympathetic dystrophy in five patients. CONCLUSION: Our data suggest that high success rates in anatomic results do not closely reflect satisfactory functional results. The protocol to be implemented after the application of the external fixator has to be determined according to the type of the fracture.

Adult↗
PubMed1992

Human centrifugation machine a physiological stimulator of endogenous prostaglandin synthesis.

A new model of human centrifugation machine with clinical purposes which makes possible to stimulate endogenous prostaglandin synthesis by a mechanical stimulus over the vessel walls is presented. The different therapeutical applications of this machine were demonstrated in lymphedema, peripheral obstructive arteriopathies, reflex sympathetic dystrophy syndrome, diabetic background retinopathy and coronary artery disease.

Centrifugation↗
PubMed1954

Lumbar sympathectomy by electrocoagulation; its use in the management of certain vascular and visceral disorders.

Although normally the sympathetic nerves aid vascular dilatation during effort, in certain diseases of the vascular system they have a reverse effect. Abolition of sympathetic vasoconstrictive impulses by sympathectomy is the most effective treatment in some chronic peripheral vascular conditions. The authors have used electrocoagulation for a number of years and found it quick, effective and more likely to prevent regeneration of the affected nerves. Improvement was obtained by sympathectomy in arteriosclerotic vascular insufficiency, thromboangiitis obliterans, Raynaud's disease, reflex sympathetic dystrophy following thrombophlebitis or trauma, scleroderma, spinal sympathetic dystrophy and acquired megacolon. A case of causalgia was aggravated by the operation. Abstention from the use of tobacco appears to be sufficient for control of symptoms in many cases. Since vasospasm is manifested in many conditions long before a thrombotic catastrophe occurs, not only relief of symptoms but prevention of irreversible changes may be achieved by early operation.

Causalgia↗
PubMed1992

Complications of patellofemoral joint surgery.

The goal of patellofemoral surgery, as is true in any surgical procedure, is the maximum benefit with the least morbidity. It is imperative that the surgeon be aware of the potential complications of operating on the patellofemoral joint. It was with this goal in mind that this review was undertaken. Complications specific to surgical therapy for LPCS, malalignment, degenerative arthritis, and trauma were covered. Procedure-specific complications were discussed, as well as IPCS and reflex sympathetic dystrophy. Recommendations on how to avoid these complications were made. Specific treatment recommendations, where appropriate, were also put forth.

Femur↗
PubMed1992

[Anomalous course and anomalous division of the median nerve in the distal forearm].

An anatomic variation of the median nerve is demonstrated in a female patient suffering from carpal tunnel syndrome subsequent to a distal radius fracture with malalignment and reflex sympathetic dystrophy. The median nerve coursed anterior to the superficial flexor tendons from proximal ulnar toward the distal radial region of the distal forearm, giving off an ulnar branch just 2.5 cm proximal to the flexor retinaculum. This case proves that in the distal forearm, branches of the median nerve can be found both radial and ulnar to the midline.

Carpal Tunnel Syndrome↗
PubMed1992

[Bone marrow edema in MRT].

Like other vascularized organs, bone can react with increasing interstitial fluid to disturbances in permeability caused by various noxae. Signs of bone marrow edema recognizable in magnetic resonance imaging are described for conditions such as trauma, stress, reflex sympathetic dystrophy, ischemia, and infection. A bone marrow edema may be an early or the only sign of a disease entity visible solely on MR images. We made a retrospective study of musculoskeletal MR examinations conducted over a period of 3 months to estimate the incidence of bone marrow edema.

Bone Marrow Diseases↗
PubMed2003

Dystonic tremor.

Dystonic tremor is a new and still poorly defined clinical entity. It seems to be generally accepted that tremor in the setting of obvious dystonia should be classified in this category. It may occur in generalized, segmental, and focal dystonias as well as in primary and secondary dystonias. In primary dystonia dystonic tremor may precede the occurrence of clear signs of dystonia which hence causes uncertainty about the classification of this condition. Secondary criteria like persistently focal tremor in one extremity, jerky and irregular tremors, gestes antagonistes, or selective responsiveness to antidystonic therapeutic agents may be helpful to distinguish this entity. The occurrence of dystonic tremor in symptomatic cases is often seen following thalamic lesions, peripheral injuries or in dystonia associated with sympathetic reflex dystrophy. The pathophysiology is unknown. Reciprocal inhibition and other inhibitory reflex pathways at various levels seem to be reduced at least in some cases with dystonic tremors.

Dystonia↗
PubMed2003

Complex regional pain syndrome.

A previously well fifty-five year-old female household helper developed complex regional pain syndrome Type II (reflex sympathetic dystrophy) following a minor injury to her left hand. She had marked hyperaesthesia and allodynia and was unable to perform her household work and to participate in the required physiotherapy. Following a series of stellate ganglion block, neurostimulation as well as physical therapy, there was a dramatic improvement in her condition and she was able to return to normal function.

Causalgia↗
PubMedDate not supplied

Pulmonary granulomatous vasculitis induced by insoluble particulates: a case report.

The authors report a case of a 39-year-old woman who sustained an injury to her left knee requiring arthroscopic surgical medial menisectomy and ganglionic block for reflex sympathetic dystrophy syndrome. Approximately 1 year after injury, the patient presented with an elevated white blood cell count and fever and was diagnosed to have a psoas muscle abscess, which was treated with antibiotics. She was also taking 4 different oral medications that contained microcrystalline cellulose as a filter. Approximately 1 month after being diagnosed with the psoas muscle abscess, the patient developed shortness of breath, marked weakness, diaphoresis, and intermittent emesis. She became hypotensive and tachyneic and expired. Postmortem examination showed granulomatous vasculitis with extensive occlusions of pulmonary arteries by birefringent crystalline material identified to be cellulose histochemically and by analytical electron microscopy evaluation. This case report describes the ultrastructural and chemical features of various medicinal tablet fillers and compares them to pure samples. This report also demonstrates the usefulness of analytical electron microscopy in accurately identifying birefringent material in lung tissue.

Adult↗
PubMed1992

[Interpleural anesthesia].

In 1986, Reiestad and Strömskag introduced interpleural postoperative analgesia with local anaesthetic solutions. The aim of this review was to describe the physiological mechanisms, indications and limits of this new mechanisms, indications and limits of this new technic. Interpleural analgesia has been successfully used for pain relief after cholecystectomy by subcostal incision. Nevertheless, the potential side-effects of this technic and the reduction of the postoperative pain with the use of coelioscopic approach discard interpleural analgesia. After thoracotomy, if this technic seemed to be simple by visual placement of the catheter tips by the surgeon, most of the studies failed to demonstrate reduction of postoperative pain. Finally, interpleural analgesia has recently been shown to be effective in the management in various chronic pain syndromes of the upper abdomen (pancreatitis...) and thorax (postherpetic neuralgia, upper extremity reflex sympathetic dystrophy). The efficacy of this technic for long-term chronic pain involves the blockade of the sympathetic chain of the injected side.

Analgesics↗
PubMed1992

Comminuted intra-articular fracture of the distal radius--results of early open reduction and internal fixation.

Comminuted intra-articular fracture of the distal radius remains a challenging problem. This article reviews the results of 15 consecutive cases which were treated with open reduction and internal fixation with T-plate after failing to achieve articular congruency with closed reduction. The follow-up ranges from 20 months to 28 months. In thirteen cases, articular congruency was restored. However, 4 of these 13 cases later lost some of the articular congruency. This suggests the need for supplementary bone grafting. Reduction of the extra-articular portion of distal radius was generally well maintained. There was an average of 2.4 mm loss in styloid height, an increase of 1.2 mm in ulnar variance and loss of 12.5 degrees of volar tilt. Seven patients (46%) were completely pain-free, with the remaining 8 patients (53%) experiencing mild pain associated with forceful activities involving the wrist. All patients achieved a functional range of motion. Grip strength averaged 81% of the uninjured side. Of the 12 patients who were engaged in active employment, 10 returned to their previous job within 4 months of injury (average 8.5 weeks). The only complication in this series was the development of reflex sympathetic dystrophy in a 68-year-old housewife. We recommend open reduction and internal fixation if closed reduction fails to achieve articular congruency in comminuted distal radius fractures.

Adult↗
PubMed2004

[Early functional results of arthroscopic surgery for ankle lesions].

OBJECTIVES: We evaluated early functional results of arthroscopic surgery in the treatment of ankle pathologies. METHODS: A total of 32 patients (17 males, 15 females; mean age 35 years; range 17 to 54 years) underwent arthroscopic surgery for ankle lesions, which included osteochondritis dissecans (n=21), synovitis (n=6), impingement syndrome (n=4), and synovial chondromatosis. Arthroscopic surgery was performed in the left ankle in 15 patients, and in the right ankle in 17 patients. Osteochondral lesions were assessed by the Berndt-Harty, arthroscopic views by the Ferkel-Cheng classification systems. Preoperative and postoperative functional evaluations were made using the Freiburg ankle scoring system. The mean follow-up was 42 months (range 11 to 84 months). RESULTS: There was no improvement in Freiburg scores within nine weeks in patients with osteochondritis dissecans, whose preoperative mean score was 66. However, at the end of 3.5 months, the Freiburg scores manifested a marked increase to a mean of 88. Functional scores increased from 72 to 90, and from 80 to 95 in patients with synovitis and impingement syndrome, respectively, at the end of nine weeks. The patient with synovial chondromatosis became symptom-free after two months. Complications included breakage of a drill in one patient and development of reflex sympathetic dystrophy in another. CONCLUSION: Arthroscopic surgery for ankle lesions decreases surgical morbidity and promotes functional improvement, especially in patients with osteochondritis dissecans, synovitis, and impingement syndrome.

Adolescent↗
PubMed1992

Autonomic involvement in systemic diseases.

It is now well recognized that autonomic dysfunction may occur in disorders affecting the various body systems. Over the past year important observations have been reported in congestive cardiac failure, reflex sympathetic dystrophy (RSD), acquired immune deficiency syndrome (AIDS) and diabetes mellitus.

Autonomic Nervous System↗
PubMed2004

Minifragment plating for fractures of the distal radius.

Twelve patients with fracture of the distal radius were treated by open reduction and internal fixation with titanium minifragment plates. There were 8 women and 3 men, with a mean age of 42 years. The mean follow-up was 18 months. According to the score of Gartland and Werley, 11 patients had an excellent result and one patient had a good result. All patients reported no pain in their activities of daily living and were satisfied with the result. All workers returned to work. One patient developed reflex sympathetic dystrophy which resolved with treatment. No patients needed plate removal because of irritation of the tendons. The results obtained with this technique appear promising, although more cases are needed to achieve a definitive conclusion.

Adolescent↗
PubMed2004

[Treatment results of pseudarthrosis of the humeral shaft by open reduction and internal fixation with dynamic compression plating].

OBJECTIVES: We evaluated the results of open reduction and internal fixation with the use of dynamic compression plating in patients with pseudarthrosis of the humeral shaft. METHODS: Eighteen patients (12 males, 6 females; mean age 41 years; range 22 to 68 years) with aseptic pseudarthrosis of the humeral shaft were treated by open reduction and internal fixation with the use of a dynamic compression plate following unsuccessful treatment with conservative (n=7) or surgical (n=11) methods. The mean interval between the initial and final treatments was 12.2 months (range 5 t 46 months). Exploration of the radial nerve and autogenous corticocancellous grafting were simultaneously performed in all the cases. Functional results were evaluated according to the Stewart-Hundley's criteria. The mean follow-up was 38.8 months (range 12 to 78 months). RESULTS: Union was achieved in all (94.4%) but one patient within a mean duration of 5.5 months (range 3 to 8 months). Functional results were good in fourteen patients (77.8%), fair in three patients (16.7%), and poor in one patient (5.6%). Radial nerve palsy that occurred in two patients during the early postoperative period underwent spontaneous recovery within three and five months, respectively. Mild reflex sympathetic dystrophy developed in two patients. CONCLUSION: In selected patients with pseudarthrosis of the humeral shaft, the results of open reduction and internal fixation with the use of dynamic compression plating are excellent, provided that an appropriate surgical technique is employed.

Adult↗
PubMedDate not supplied

Sexual rehabilitation after radical retropubic prostatectomy: new technique using ilio-inguinal nerve graft.

Sural nerve grafts have been used to repair the cavernous nerves and allow sexual potency recovery after radical prostatectomy. In order to overcome the drawbacks related to the harvesting of the sural nerve, the authors developed an original technique using ilio-inguinal nerve grafts to repair the cavernous innervation during radical prostatectomy. This technique used in a group of new patients proved its feasibility and absence of intra- and postoperative complications. Compared to sural nerve the use of ilio-inguinal graft has some advantages: 1)- Greater familiarity for urologists to harvest the ilio-inguinal nerve; 2)- Less time to acquire the graft; 3)- Greater postoperative comfort, avoiding inferior limb pain and edema, that delay patients' mobilization and recovery; 4)- Absence of anesthesia or paresthesia in the calcaneal area; 5)- Absence of sympathetic reflex dystrophy in inferior limbs.

Journal Article↗