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PubMed2004

Neurological recovery and its influencing factors in thoracic and lumbar spine fractures after surgical decompression and stabilization.

Surgical decompression and internal fixation of the injured spine have become standard procedures in the management of thoracic and lumbar spine fractures, but their effectiveness on neurological recovery remains controversial. We report on 169 consecutive patients with thoracic and lumbar spine fractures who were treated by reduction, fusion, and internal fixation using transpedicular screw-rod systems. Open decompression was carried out in 67 (39.6%) of them, including all 42 patients (25%) who presented with initial neurological deficits. At least 8 months following surgery, 30 (71%) had neurologically improved by one to three grades on the Frankel scale. Thirteen (59%) out of 22 patients whose initial deficits had been classified as "motor useless" (Frankel grades A to C) could walk, at least with support. Thirteen out of 20 patients with posttraumatic deficit Frankel D ("motor useful") improved to full recovery (Frankel E). In six (3.6%) patients (all from the group of the 127 patients without initial neurological deficits), permanent slight postoperative neurological impairment of one Frankel grade (E to D) was seen, among them two (1.2%) with new minor motor deficit. Neurological outcome was significantly better (p<0.01) in patients operated upon within the first 24 h after injury than in those who underwent surgery later. Severity of injury also had a negative influence (p<0.001) on neurological recovery. Analysis suggests that there may be significant neurological improvement in patients treated surgically very early.

Adolescent↗
PubMed2007

Intraoperative management to prevent cerebrospinal fluid leakage after microvascular decompression: dural closure with a "plugging muscle" method.

Our objective is to present surgical techniques used for the prevention of cerebrospinal fluid leakage after microvascular decompression (MVD). From January 1996 to February 2006, microvascular decompression for hemifacial spasm or trigeminal neuralgia was performed in 678 consecutive patients. In order to achieve watertight dural closure, several pieces of muscle were interposed between the dura when the dura was sutured; the dura was stitched with the addition of muscle pieces to plug the dural defect. In cases where the mastoid air cell system was opened, bone wax was used to seal the opened surface of the cavity, and a muscle patch was applied for the secondary sealing. The cranioplasty was performed using polymethylmethacrylate (PMMA) bone cement. Only 2 (0.29%) of 678 patients, who underwent MVD followed by dural closure using several muscle pieces to plug the potential dural defect, suffered from CSF leaks. Both were treated with lumbar subarachnoid drainage; neither patient required a lumbar peritoneal shunt or a revision operation. A watertight dural closure with the addition of muscle pieces in a "plugging" fashion, along with sealing the opened surface of the mastoid cavity using bone wax and cranioplasty using bone cement, provides a simple and effective technique for the prevention of CSF leakage after MVD.

Adolescent↗
PubMed2004

Delayed ischemic cecal perforation despite optimal decompression after placement of a self-expanding metal stent: report of a case.

Endoscopic deployment of self-expanding metal stents offers an alternative to surgical intervention in rectocolonic obstructions. Reported clinical failures in the literature are all related to the site of stent placement. We report a case of serious intra-abdominal disease after technically and clinically successful stent deployment: a potentially dangerous situation of which the surgeon should be aware. A previously healthy 72-year-old female was referred to our department with symptoms of an obstructing colorectal tumor. Successful stent placement resulted in resolution of the obstructive condition. Three days after stent deployment, x-ray examinations revealed a small-bowel obstruction and emergency surgery was performed. Intraoperative findings demonstrated a segment of ileum fixated to the tumor in the small pelvis, resulting in the obstructive condition. Furthermore, a cecal perforation, probably caused by ischemic conditions developed before stent-decompression of the colon was revealed during the operation. The patient died in the postoperative course. We discuss the observation of patients treated with self-expanding metal stents based on the selection-strategy used to allocate patients to this specific treatment. We conclude that although a patient is eligible for treatment with self-expanding metal stents, large-bowel obstruction can be too "old" for stent-decompression, causing ischemic perforation of the colon. Furthermore, we underline the need to focus on the possibility of obstructions other than those being treated.

Aged↗
PubMed2005

Temporary decompression of the right ventricle to assess the right ventricle-dependent coronary circulation in pulmonary atresia with intact ventricular septum.

We repaired a case of pulmonary atresia with intact ventricular septum in which the blood supply to the left anterior descending coronary artery depended on the right ventricle. At the time of a bidirectional Glenn operation, total cardiopulmonary bypass with venous drainage from the right atrium was performed in order to evaluate the safety of right ventricular decompression required for a planned Fontan operation. We confirmed the dependence of the coronary perfusion on the right ventricle by demonstrating transient depression of the ST segment in the epicardial electrocardiogram during temporary decompression of the right ventricle. To prevent ischemic myocardial damage, we then performed an extracardiac Fontan operation with a temporary venous shunt and without cardiopulmonary bypass.

Cardiopulmonary Bypass↗
PubMed1989

Equivalent multi-tissue and thermodynamic decompression algorithms.

Multi-tissue and thermodynamic decompression algorithms are described and a computational equivalence is established between the two approaches. Eigenvalues and weighted eigenfunctions of the Fick-Fourier equation effectively define response functions from which Haldane half-lives can be extracted from arbitrary exposures, operationally bridging the two approaches. Decompression criteria for the algorithms are also described and coupled. Comparisons of similarities and differences of approaches are given from both theoretical and applied viewpoints. A seven-parameter set, spanning both models, forms the basis of analysis. We find that representative thermodynamic parameters in a perfusion-diffusion model effectively recover Haldane half-lives in a bootstrap and that critical parameters overlap, though ranges differ in the two cases.

Algorithms↗
PubMed1983

Maternal blood flow and PO2 changes during abdominal decompression treatment of poor intrauterine fetal growth.

Maternal blood flow and tcPO2 were measured together with fetal heart rate during decompression treatment of four cases of poor intrauterine fetal growth. Increase in maternal blood flow was recorded when decompression was applied. Maternal tcPO2 and the fetal heart rate were not significantly changed during the treatment sessions. The results indicate that the mechanism of action for better intrauterine growth after treatment is related to increased placental blood flow. The treatment does not exert changes of maternal haemodynamics leading to possible damage for the fetus.

Decompression↗
PubMed1977

Spectral analysis of Doppler ultrasonic decompression data.

Several aspects of spectral analysis of bubble transients in Doppler ultrasonic decompression data are discussed. The computation of energy density spectra, using fast Fourier transform techniques for analyzing bubble transients, is described. Spectral analysis of data from probes implanted within animals, using a conventional Fourier analyzer, provided good visual indications of bubble events and interesting changes in spectral structure. A new transient spectral analysis technique that is suitable for quantitative real-time monitoring of small decompression bubbles is described. In a feasibility study using data from an implanted probe, an increase of 900% in bubble signal/noise ratio was observed.

Animals↗
PubMed1986

Inhibitors of ex vivo aggregation of human platelets induced by decompression, during reduced barometric pressure.

It has been shown experimentally ex vivo that human platelet aggregation is induced by decompression (reduced pressure) produced by various means, i.e., reduced barometric pressure, reduced hydrostatic pressure, and reduced hydrodynamic pressure due to Bernoulli's principle. We report here that the spontaneous platelet aggregation induced by reduced barometric pressure (253 torr for three hours) is inhibited by 1:10(7) diluted Japanese herbal plant oil (JHP) and also by two of its major constituents, menthone and menthol with the median inhibitory concentration (IC50) in the millimolar range. These drugs gave essentially similar results when collagen and ADP were used as aggregating agents. Inhibitor concentrations were determined by microscopic examination of platelets in wet preparations when the aggregating stimulus was reduced pressure and by optical aggregometry when collagen and ADP were the aggregating agents. Potential usefulness of these compounds in the prevention of decompression syndrome (DCS) and acute mountain sickness (AMS) are discussed.

Atmospheric Pressure↗
PubMedDate not supplied

Efficacy of Doppler ultrasound [correction of utrasound] for screening symptoms of decompression sickness during simulated extravehicular activities.

Doppler ultrasound is frequently used for monitoring circulating microbubbles during decompression to assess the symptoms of Decompression Sickness (DCS). This analysis was carried out to evaluate its effectiveness for screening symptoms of DCS during simulated extravehicular activities (EVA). The information from various hypobaric chamber studies carried out at the NASA Johnson Space Center, Houston, TX was used in this analysis (n=516). The circulating microbubbles were detected in the precordial area in 42% (218/516), and symptoms were reported in 16% (81/516) of these exposures. The accuracy of Doppler-detectable bubbles (Spencer grades) on all symptoms of DCS was examined by calculating measures of sensitivity and specificity. The efficacy of Doppler as a screening device was examined by calculating their positive predictive value (PPV) and negative predictive value (NPV). The results of these analyses indicated that the sensitivity of Doppler decreased, and the PPV increased with higher Spencer grades. However, the likelihood of detecting true negative cases (NPV) was consistently higher with all bubble grades. Due to the high false-positive rate and low prior probabilities of the risk of DCS, Doppler was found to be more useful to identify those who did not develop DCS, than to detect positive cases of DCS in the simulated EVA exposures.

Decompression Sickness↗
PubMed1985

Swimming movements initiate bubble formation in fish decompressed from elevated gas pressures.

Young specimens of trout, catfish, sculpin and salamanders were equilibrated with elevated gas pressures, then rapidly decompressed to ambient pressure. The newly hatched forms tolerated extremely high gas supersaturations; equilibration pressures of 80-120 atm argon or 150-250 atm helium were required for in vivo bubble formation. During subsequent larval development, the equilibration pressures required decreased to just 5-10 atm and bubbles originated in the fins. Anesthetising older fish before decompression prevented bubble formation in the fins; this suggests that swimming movements mechanically initiate bubbles, possibly by a tribonucleation mechanism.

Ambystoma↗
PubMed1994

Assessment of spinal cord trauma using evoked potentials in a rat model of decompression sickness.

A rapid quantitative technique for assessing spinal cord trauma in a rat model of decompression sickness is described. Evoked potentials are measured from the lower limbs of rats before and after dives with compressed air in a hyperbaric chamber. Under chloral hydrate anesthesia, the sciatic nerve is stimulated at the sciatic notch with needle electrodes and platinum/iridium electrodes are used to record the action potentials from the plantar muscles. Analysis showed that the sensory reflex response was markedly depressed in the rats soon after diving and did not recover for up to 5 days. The motor response was similarly affected although to a lesser degree. The latency of the reflex response also became prolonged after 3 days. The significant and complex pattern of neurological dysfunction shown by this electrophysiologic technique validates the use of the rat model for the study of spinal cord decompression sickness. This technique should aid studies aimed at testing new therapies for this disease.

Action Potentials↗
PubMed1996

A prospective randomized study of abdominal aortic surgery without postoperative nasogastric decompression.

Nasogastric decompression following abdominal aortic aneurysmectomy or bypass, for 3-4 days, is a routine part of postoperative care in many centers. A prospective randomized study of 80 patients undergoing abdominal aortic surgery was performed in order to determine the necessity of prolonged nasogastric decompression. Patients were divided evenly between removal of the nasogastric tube upon tracheal extubation and retention of the tube until the passage of flatus. Preoperative risk factors, aortic cross-clamp time, estimated blood loss, length of procedure, length of intensive care unit stay, numbers of days with nasogastric tube, number of days until clear liquid and regular diets commenced, and the length of hospital stay were recorded for all patients. There were no significant differences in any of the measured variables between the two groups. The length of hospital stay was similar in both groups and three patients in each group required a nasogastric tube or reinsertion of one. In conclusion, the routine postoperative use of nasogastric tubes for abdominal aortic procedures is unnecessary.

Aged↗
PubMed2004

Identification of professional scuba divers with patent foramen ovale at risk for decompression illness.

Functional and anatomic characteristics of patent foramen ovale (PFO) were investigated in 66 professional scuba divers (41 with and 25 without decompression illness) using transthoracic and transesophageal echocardiography. PFO with right-to-left shunting at rest is associated with decompression illness, particularly the neurologic type. A wider patency diameter together with a higher membrane mobility are associated with the risk of developing the disease in divers with PFO.

Adult↗
PubMed2005

Endoscopic decompression of the optic nerve in pseudotumor cerebri.

Pseudotumor cerebri is a neurological condition in which patients develop headaches and visual loss that may not be successfully treated with medication. In these cases surgery is indicated, and decompression of the optic nerve is the preferred surgical procedure. We report a case of decompression of the optic nerve performed through an endonasal endoscopic approach in a patient with pseudotumor cerebri where enhancement of visual acuity was successful. To our knowledge, no previous investigators have reported this approach to treat pseudotumor cerebri.

Adolescent↗
PubMed2004

Arthroscopically assisted core decompression of the proximal humerus for avascular necrosis.

Abstract Core decompression has been described as an effective treatment for early stage avascular necrosis of the humeral head. This article describes the technique for arthroscopically assisted core decompression of the humeral head using a transtibial anterior cruciate ligament guide. This technique provides an advantage over the open procedure by avoiding soft-tissue stripping or damaging the biceps tendon or ascending branch of the anterior humeral circumflex artery, as well as providing accurate and safe placement of the core biopsy tract and the ability to address other intra-articular pathology.

Arthroscopy↗
PubMed2005

Arthroscopic subacromial decompression performed under local anesthesia.

Shoulder arthroscopy is usually performed under general anesthesia or interscalene block. General anesthesia may be contraindicated and interscalene block sometimes fails. We had 8 patients who were at high-risk and, therefore, shoulder arthroscopy and decompression were performed under local anesthesia in the beach-chair position. We used 50 mL of 1% lidocaine; 30 mL were infiltrated into the skin and underlying tissues and into the glenohumeral joint, and the rest was infiltrated into the subacromial joint. Before the infiltration, all patients were given 5 mg midazolam and 0.1 mg fentanyl intravenously. All 8 patients were satisfied with the analgesia provided by the anesthesia. We conclude that arthroscopy and subacromial decompression can be readily performed under local anesthesia in combination with efficient sedation.

Anesthesia, Local↗
PubMed2006

Transient bone marrow edema syndrome of the knee: clinical and magnetic resonance imaging results at 5 years after core decompression.

PURPOSE: We report on 24 cases of transient bone marrow edema syndrome in 18 patients who underwent core decompression of the knee. METHODS: Diagnosis was made with the use of radiographs, magnetic resonance imaging (MRI), and core biopsy testing. Arthroscopic surgery and core decompression were carried out in all patients, and MRI was performed again, 5 years after surgery was performed. RESULTS: Medial and lateral femoral condyles were affected in 15 and 7 knees, respectively. In all, 6 patients presented with bilateral involvement of the knees (migrating transient bone marrow edema syndrome). Two of these patients had affections of the medial and lateral compartments within the same knee at different times, consistent with intra-articular regional bone marrow edema syndrome. Core biopsy specimens showed areas of bone marrow edema and vital trabeculae covered by osteoblasts and osteoid seams. Resolution of symptoms and normalization of MRI findings occurred in all patients within 12 weeks after surgery. CONCLUSIONS: Migrating bone marrow edema was found in a high percentage (33%) of patients at 5-year follow-up; however, all patients were clinically asymptomatic, and signal alterations on MRI had resolved completely. The high incidence of migrating bone marrow edema, the lack of osteonecrotic regions in our specimens, and the fact that none of these cases progressed to spontaneous osteonecrosis seem to further support the contention that bone marrow edema syndrome of the knee is a distinct entity. LEVEL OF EVIDENCE: Level II, diagnostic study; development of diagnostic criteria on the basis of consecutive patients and with universally applied reference gold standard.

Adult↗
PubMedDate not supplied

Percutaneous nucleotomy: preliminary communication on a decompression probe (Dekompressor) in percutaneous discectomy. Ten case reports.

For the past years, new therapeutic options have been proposed secondary to the progress in the interventional imaging. The purpose of this article is to report a preliminary study on the use of the 1.5 mm "Dekompressor probe" (Stryker, Kalamazoo, MI, USA) in the percutaneous discectomy by decompression. We have conducted, from September 2003 to March 2004, a retrospective review on 10 patients (mean age of 49.8), chosen at random, presenting a nonextruded herniated disc resisting all medical treatments. The procedure is CT guided or performed under fluorosocopy, a discography is performed by introducing the probe at the level of the protruded disc. After local anesthesia, an incision of a few millimeters is performed, allowing the introduction of a coxial trocar to the level of the disc. The decompression probe is then introduced. No technical failure occurred. The results in our series show, in eight patients, a satisfactory result with a decrease of the initial VAS of more than 70% and a complete elimination of the medical therapy. Our preliminary results are encouraging but should also be confirmed by a multicentric based on a large series, and the criteria of inclusion or exclusion must be strictly respected to obtain satisfactory clinical results.

Decompression, Surgical↗