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At least 1,783 records · Page 99Linked to original sources
PubMed2003

[Traumatic dissection of the internal carotid artery: malignant supratentorial infarction and decompressive treatment].

We present a case report of a thirty-six-year-old right-handed female. She suffered with a malignant space-occupying supratentorial ischemic stroke caused by a traumatic cervical internal carotid artery dissection. She had a car accident and, initially, presented with a normal examination. In two days, she became comatose (Glasgow Coma Scale score was 5) with complete left hemiplegia, right mydriasis and required respiratory assistance despite the medical treatment. It was decided to perform a large right frontotemporoparietal bone flap with large dural plasty. Eighteen months later, with intensive rehabilitation, the results of neuropsychological testing were normal, and the Barthel Index score was 90. The indications for decompressive surgery in malignant space-occupying supratentorial ischemic stroke remains controversial. The age, general condition, neurological examination (consciousness, pupils, deficit), extent of parenchymal hypodensity and attenuated corticomedullary contrast on the brain CT, degree of midline shift, presence of uncal hernation, disparition of the visibility of the mesencephalic cisterns and third ventricle, high level of the intracranial pressure, and perhaps the results of the perfusion-and diffusion-weighted MRI, are the elements to decide (or not decide) decompressive surgery.

Accidents, Traffic↗
PubMed2003

[Surgical decompression in space-occupying cerebral infarct; notification of a randomized trial].

Patients with a hemispheric infarct and massive space-occupying brain oedema have a poor prognosis. Despite intensive conservative treatment, the case fatality rate may be as high as 80%, and most survivors are left severely disabled. Non-randomised studies suggest that decompressive surgery substantially reduces mortality and improves the functional outcome of survivors. The 'Hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial' (HAMLET) is a newly-conceived randomised multi-centre clinical trial that compares the efficacy of decompressive surgery to improve functional outcome with that of conservative treatment in patients with space-occupying supratentorial infarction.

Brain↗
PubMed2003

Change of occurance of type 1 and type 2 decompression sickness of divers treated at the Croatian Naval Medical Institute in the period from 1967 to 2000.

A significant change of occurrence (p=0.0343) of type 1 and type 2 decompression sickness (DCS) of divers in Croatia was observed in the period from 1991 to 2002 (type 1: n=26, 37.68% and type 2: n=43, 62.32%) compared with the period from 1967 to 1990 (type 1: n=93, 52.84% and type 2: n=83, 47.16%). The change was attributed to the extensive usage of diving computers and artificial gas mixtures which enable extended bottom times and deeper dives, thus putting divers at an increased decompression risk. The importance of the results of this report is in the fact that permanent neurological deficit occurs only after type 2 DCS. Injured divers with permanent loss after type 2 DCS are not fit for diving and require a long term medical care, thus becoming a significant public health problem.

Croatia↗
PubMed2004

Detection of leukocyte activation in pigs with neurologic decompression sickness.

BACKGROUND: In a porcine model of neurological decompression sickness (DCS), perivascular leukocyte activation was a consistent finding in biopsies of associated cutaneous DCS. This prompted examination of other organs for similar changes; multifocal leukocyte activation was found in the lungs (pneumonitis) and liver (hepatitis). HYPOTHESIS: DCS in pigs induces leukocyte aggregation and activation in the liver and lungs. METHODS: Male Yorkshire swine, trained to run on a modified treadmill, were compressed to 200 ft of seawater (fsw) in a dry, air-filled compression chamber. Decompression varied according to the profile under study. RESULTS: In 106 pigs, evidence for association of leukocyte aggregation and activation with the clinical diagnosis of neurologic DCS was sought. The incidence of pneumonitis (20/68, 29% with DCS; 4/38, 10% without DCS) and hepatitis (23/68, 33% with DCS; 4/38, 10% without DCS) were strongly correlated with the incidence of neurologic DCS via Pearson Chi-squared analysis (p = 0.026 pneumonitis and p = 0.008 hepatitis). Additionally, Kruskal-Wallis rank analysis for numbers of organs involved and incidence of neurologic DCS showed a strong correlation between the increasing occurrence of neurologic DCS and the involvement of both the liver and lungs (p = 0.004). CONCLUSIONS: The results imply that, at least in pigs, DCS induces leukocyte aggregation and activation in the liver and lungs. These organs are not normally considered targets of DCS. Leukocyte aggregation in these organs may be related to their roles as highly perfused organs. Leukocyte aggregation may be a marker for DCS, providing further evidence for wider, systemic effects of DCS.

Analysis of Variance↗
PubMed2004

Microvascular decompression of cranial nerves using sheets of a dural substitute--technical note.

Several types of prosthesis are used for microvascular decompression (MVD) surgery for neurovascular compression syndrome. However, most prostheses adhere to the surrounding neuronal structures and occasionally cause granulomas. The present study evaluated a dural substitute made of expanded polytetrafluoroethylene, the Gore-Tex EPTFE patch, as a prosthesis for MVD. Twelve patients with trigeminal neuralgia, 19 patients with hemifacial spasm (HFS), and two patients with glossopharyngeal neuralgia underwent MVD using the dural substitute. In most cases, one or two sheets of the dural substitute were inserted between the offending artery and the compression site covering the cranial nerve and the brainstem. Thirty of the 33 patients experienced complete relief of the symptoms that lasted for at least 10-75 months after the surgery. HFS recurred one month post-surgery in a patient who underwent MVD using two small sheets. Varied grades of hearing disturbance were observed in three patients with HFS. MVD using dural substitute is an easy and efficient method because it is not necessary to move the offending arteries away from the compression site. Large sheets should be positioned over the compression site for sufficient decompression. However, this technique needs to be improved so that the prosthesis does not affect cranial nerve VIII, as three of 19 patients with HFS showed hearing disturbances despite intraoperative monitoring of the auditory brainstem response.

Adult↗
PubMed2003

[Decompressive craniectomy in a patient with herpetic encephalitis associated to refractory intracranial hypertension].

Herpetic encephalitis is the most common cause of viral encephalitis in our country. Pathological studies show progressive necrosis and edema in specific territories of the brain. The mortality of herpetic encephalitis was reduced from 70% to 20% with the use of intravenous aciclovir in the first three days of illness. However, almost 50% of patients develop a neurological deficit. One of the most important causes of death in herpetic encephalitis is the refractory intracranial hypertension. There are anecdotal reports of patients with refractory intracranial hypertension due to herpetic encephalitis that were treated with decompressive craniectomy with good results. We report a 21 years old female patient with herpetic encephalitis and refractory intracranial hypertension that was successfully treated with a decompressive craniectomy.

Adult↗
PubMed2003

[Direct and late outcome in trigeminal neuralgia treated by means of microvascular decompression in cerebellopontine angle].

BACKGROUND: Microvascular decompression (MVD) is a method of choice in the surgical treatment of trigeminal neuralgia (TN). OBJECTIVE: To evaluate direct and long-term results of MVD in TN. MATERIAL AND METHODS: The authors analyzed 20 patients (9 women and 11 men, mean age 62.2 years) with TN who had been treated surgically at the Department of Neurosurgery of the University Hospital in Cracow between October 1998 and September 2002. MVD was performed using Janetta technique via suboccipital retro-sigmoid craniectomy. All patients underwent additional neurolysis. Indentations in portio major of the trigeminal nerve were present in 5 cases. Short- and long-term pain relief was assessed according to Slettebo-Eide scale. RESULTS: Complete short-term pain relief was observed in 15 patients (75%), in 3 patients (15%) significant pain control was achieved. Very good and good long-term result was reported by 70% of patients. Pre-operative invasive treatment of neuralgia did not affect the long-term outcome. MVD of the trigeminal nerve indented by compression of the adjacent vessels yielded very good and good long-term result in 80% of patients compared with 66% in the group of patients with no trigeminal nerve indentation. In all of the 6 octogenarians very good or good pain control was observed. Duration of the history of trigeminal neuralgia did not influence the outcome. Severe postoperative complication (hemorrhagic cerebellar infarction) was observed in one case. CONCLUSION: Microvascular decompression is safe and effective method in the treatment of trigeminal neuralgia. MVD yields beneficial results in elderly patients.

Adult↗
PubMed2004

Treatment of decompression sickness in swine with intravenous perfluorocarbon emulsion.

BACKGROUND: We examined an adjunctive treatment for severe decompression sickness (DCS) to be used when hyperbaric treatment is delayed or unavailable. HYPOTHESIS: It has been hypothesized that intravenous perfluorocarbon (PFC) emulsion combined with 100% inspired O2 would improve the outcome in severe DCS. METHODS: Swine (n = 45) were compressed to 4.9 ATA on air for 22 h and brought directly to 1 ATA at 0.9 ATA min(-1). The animals were then randomized to three groups. The first group breathed ambient air, the second group breathed 100% O2, and a third group received 6 ml x kg(-1) of perflubron emulsion (Oxygent) intravenously and breathed 100% O2. Outcomes of neurological and cardiopulmonary DCS and death were recorded. RESULTS: Animals that received PFC emulsion sustained less DCS (p < 0.01) than the other groups (53% vs. 93%). No animals in the PFC group sustained neurological DCS, which was present in 69% of the subjects in the other two groups. CONCLUSION: O2 breathing postdive did not significantly reduce morbidity or mortality in this model. Postdive treatment with PFC emulsion and 100% O2 decreased the incidence of DCS after nonstop decompression from saturation.

Animals↗
PubMedDate not supplied

Adjuvant surgical decompression gastrostomy: audit of a procedure coming of age.

BACKGROUND/AIMS: Adjunctive decompression gastrostomy has been a popular alternative to nasogastric suction in the care for general surgical patients suffering from postoperative ileus--avoiding discomfort and adverse sequelae of nasogastric tubes. Patient benefit thus correlates with procedural safety and ileus duration. These baseline data of decision-making were scrutinized in a general surgical patient population. METHODOLOGY: Retrospective analysis of a prospective data set. Two hundred and fifty-nine patients undergoing emergency (n=208) or elective procedures (n=51) received decompression gastrostomy when prolonged ileus or noncompliance with nasogastric suction were anticipated. Procedural complications, incidence of postoperative pneumonia and duration of postoperative ileus assessed by daily oral fluid intake vs. gastric drainage volumes were prospectively documented. RESULTS: Gastrostomy complications comprised 0.4% with minor morbidity only. The incidence of pneumonia was 4.5%. Postoperative ileus was nil in 17%, 1-3 days in 48%, 4-5 days in 16%, 6-8 days in 12% and 9-23 days in 7%. CONCLUSIONS: Adjuvant Stamm-Kader gastrostomy is a safe procedure. The incidence of pneumonia was comparatively low and a pertinent prophylactic effectivity appears plausible but remains unproven due to study design. Postoperative ileus exceeding 3 days affects 35%, exceeding 5 days 19% and exceeding 8 days only 7% of pertinent patients, and ileus duration cannot be predicted at the time of surgery. Thus, a substantial number of patients may be overtreated by prophylactic adjuvant surgical gastrostomy. The procedure improves patient's comfort and avoids complications of nasogastric suction. Prophylactic surgical gastrostomy remains a timely adjunct to general surgery but the indication should be individualized.

Adult↗
PubMed2004

Consensus factors used by experts in the diagnosis of decompression illness.

INTRODUCTION: The diagnosis of decompression illness (DCI) is entirely based on clinical findings and DCI experts are rare. Of all the chambers reporting to Diver's Alert Network (DAN), 86% see less than 10 cases per year. Simulated diving injury cases (vignettes) were used to identify diagnostic factors important to 11 international experts attending the 2003 Undersea and Hyperbaric Medical Society symposium on DCI diagnosis. METHODS: There were 200 vignettes evaluated for the probability of DCS and/or arterial gas embolism (AGE). Vignettes were constructed from 141 factors that modeled information from DAN's emergency call system. Factor probability mirrored DAN's 2001 Report on Decompression Illness and Diving Fatalities. Factors included: diver characteristics, exposure characteristics, signs, symptoms, treatment, and response. Multiple linear regression with stepwise elimination identified and ordered the significant factors in terms of their importance to the experts. Results were confirmed with logistic regression. RESULTS: For DCS, the top five factors in order of importance were: 1) a neurological symptom as the primary presenting symptom; 2) onset time of symptoms; 3) joint pain as a presenting symptom; 4) any relief after recompression treatment; and 5) the maximum depth of the last dive. For AGE, the top five factors were: 1) onset time of symptoms; 2) altered consciousness; 3) any neurological symptoms as a presenting symptom; 4) motor weakness; and 5) seizure as the primary presenting symptom. Age, gender, or physical characteristics were not statistically important. CONCLUSIONS: The vignette concept may be useful in the development of consensus standards for DCI diagnosis.

Decompression Sickness↗
PubMed1992

Decompression sickness: an increasing risk for the private pilot.

Decompression sickness is not an appreciated hazard among the private pilot community. This is of growing concern with the increasing number of nonpressurized aircraft capable of flying to altitudes in excess of 5,468 m (18,000 ft). A case report is presented of a 42-year-old pilot who apparently experienced decompression sickness at flight level 250 which went unrecognized until several months after the incident.

Adult↗
PubMed2005

Optic nerve decompression via mid-facial translocation approach.

Optic neuropathy is a disease complex with a broad range of etiologies that have a common end point if left untreated: blindness. Treatment varies from expectant management, medical therapy, to surgical treatment. We present a new technique for optic nerve decompression using a midfacial translocation approach. We present a case where this technique was used twice to decompress the optic nerve from an encroaching fibrous dysplasia in the same eye. Patient's vision had deteriorated to near blindness each time and it improved to its preoperative level after each surgery. This technique is especially useful in cases where the local anatomy and relevant landmarks have been distorted by the pathologic process and the surgeon requires a good exposure with minimal morbidity.

Adolescent↗
PubMed2004

Computerized expert system for evaluation of automated visual fields from the Ischemic Optic Neuropathy Decompression Trial: methods, baseline fields, and six-month longitudinal follow-up.

PURPOSE: To validate a computerized expert system evaluating visual fields in a prospective clinical trial, the Ischemic Optic Neuropathy Decompression Trial (IONDT). To identify the pattern and within-pattern severity of field defects for study eyes at baseline and 6-month follow-up. DESIGN: Humphrey visual field (HVF) change was used as the outcome measure for a prospective, randomized, multicenter trial to test the null hypothesis that optic nerve sheath decompression was ineffective in treating nonarteritic anterior ischemic optic neuropathy and to ascertain the natural history of the disease. METHODS: An expert panel established criteria for the type and severity of visual field defects. Using these criteria, a rule-based computerized expert system interpreted HVF from baseline and 6-month visits for patients randomized to surgery or careful follow-up and for patients who were not randomized. RESULTS: A computerized expert system was devised and validated. The system was then used to analyze HVFs. The pattern of defects found at baseline for patients randomized to surgery did not differ from that of patients randomized to careful follow-up. The most common pattern of defect was a superior and inferior arcuate with central scotoma for randomized eyes (19.2%) and a superior and inferior arcuate for nonrandomized eyes (30.6%). Field patterns at 6 months and baseline were not different. For randomized study eyes, the superior altitudinal defects improved (P = .03), as did the inferior altitudinal defects (P = .01). For nonrandomized study eyes, only the inferior altitudinal defects improved (P = .02). No treatment effect was noted. CONCLUSIONS: A novel rule-based expert system successfully interpreted visual field defects at baseline of eyes enrolled in the IONDT.

Aged↗
PubMed2005

[Clinical study of vecuronium maintenance speed in trigeminal microvascular decompression surgery].

BACKGROUND: Patients receiving chronic carbamazepine therapy may be resistant to vecuronium. The purpose of this study was to determine maintenance speed of vecuronium in trigeminal microvascular decompression surgery. METHODS: The vecuronium maintenance speed of the patient for microvascular decompression diagnosed as trigeminal neuralgia (group T: n=18) or hemi-facial spasm (group C: n=18) was examined retrospectively. Anesthesia was induced with propofol, ketamine, midazolam and buprenorphine. Vecuronium was given to facilitate tracheal intubation. The patients received balanced anesthesia with infusion of propofol, ketamine, buprenorphine and vecuronium (60-80 microg x kg(-1) x h(-1)), with nitrous oxide. In both groups the scheduled vecuronium maintenance speed was increased if needed, using the TOF-Watch, at the time of body movement or with more than four TOF count. RESULTS: All patients of group T were medicated with carbamazepine before operation. None of C received carbamazepine. With C, vecuronium maintenance speed was as scheduled. With T, however, scheduled vecuronium speed increased in most of the cases. Actual vecuronium speed was significantly faster with T, compared with C. Although actual speed divided by scheduled speed was 1 in group C, it was 1.4 in T. CONCLUSIONS: Vecuronium maintenance speed is 1.4 times of scheduled speed in patients medicated with carbamazepine.

Aged↗
PubMed1992

Lidocaine as an adjunct to hyperbaric therapy in decompression illness: a case report.

A recreational scuba diver with nervous system decompression illness had a poor response to hyperbaric therapy. On the basis of available and supportive in vivo data, he was then given a continuous infusion of lidocaine (serum levels, low therapeutic range: 6.4-9.1 mumol/liter). Within 24 h of the start of this infusion he experienced a full resolution of his neurologic deficits. His symptoms recurred 3 days later, but again completely resolved after further hyperbaric therapy and concurrent administration of lidocaine (serum levels: 6.9-9.1 mumol/liter). This observation supports the need to conduct trials of lidocaine as an adjunct to hyperbaric therapy in decompression illness.

Adult↗
PubMed2005

Microvascular decompression in patients with hemifacial spasm: report of 1200 cases.

BACKGROUND: Microvascular Decompression (MVD) operation is the most reliable treatment for hemifacial spasm (HFS), but it causes many complications. The aim of this retrospective study was to investigate the factors relavent to the effects and postoperative complications of microvascular decompression on hemifacial spasm. METHODS: A total of 1200 HFS patients treated with MVD were studied retrospectively. The root exit zone (REZ) of the facial nerve was exposed through the infraflocculus approach, the offending vessels were identified and separated from the REZ, and a Teflon graft was interposed between the offending vessels and the brain stem. Brain stem auditory evoked potential (AEP) was monitored intraoperatively. RESULTS: The offending vessels can be identified in all patients. The anteroinferior cerebellar artery was the main offending vessel (42.6%). Patients with vertebral artery compression had a multiple vascular compression fashion. Follow-up for 2 - 10 years (mean 4.2 years) showed that 88.7% patients were cured and 5.6% relieved, with an effective rate of 94.3%. Recurrence rate was 3.2%, and the ineffective rate was 2.6%. The most frequent complication was hearing dysfunction (2.8%). CONCLUSIONS: MVD is the most definitive treatment method of HFS. The key procedures of this operation include adequate exposure of the REZ, identification of the offending vessels, and proper positioning of Teflon grafts. Complications can be reduced effectively by utilizing a real-time AEP monitoring during the operation.

Adult↗
PubMed2005

Aerobic exercise 2 hours before a dive to 30 msw decreases bubble formation after decompression.

BACKGROUND: A single bout of aerobic exercise 24 h before a dive significantly reduces the formation of circulating venous gas emboli (VGE) on decompression. The purpose of this investigation was to determine the effect of aerobic exercise 2 h before a dive. METHODS: There were 16 trained military divers who were compressed to 30 msw (400 kPa) for 30 min breathing air in a dry hyperbaric chamber at rest, then decompressed at a rate of 10 m x min(-1) with a 9-min stop at 3 msw. Each diver performed two dives 3 d apart, one with and one without exercise that consisted of running for 45 min at 60-80% of maximum heart rate (estimated as 220 - age). VGE were graded according to the Spencer scale using a pulsed Doppler detector on the precordium at 30 min (T30) and 60 min (T60) after surfacing. RESULTS: Mean bubble grades at T60 were 1.25 for control dives and 0.44 for dives preceded by exercise, the difference being highly significant. None of the divers showed an increase in venous bubble grade after exercise. CONCLUSION: Like exercise 24 h ahead, 45 min of running 2 h before a dive decreases bubble formation after diving, suggesting a protective effect of aerobic exercise against DCS. The threshold of exercise intensity and duration necessary to change venous circulating bubbles is unknown. Mechanisms underlying the protective effect of exercise remain unclear. Rather than altering the nitrogen elimination rate, exercise may affect the population of gaseous nuclei from which bubbles form.

Adult↗
PubMed2005

Significant scoliosis regression following syringomyelia decompression: case report.

We present the case of a 5-year-old boy presenting with a 54-degree scoliosis secondary to a Chiari I malformation with a holocord syringomyelia extending from C1 to T10. Neurosurgical treatment involved posterior fossa craniectomy with decompression, and partial C1 laminectomy. At follow-up 7 years later, at age 12, radiographs revealed only a 4-degree scoliosis, and follow-up MRI revealed a deflated syrinx. We report this case to reveal the most significant scoliosis regression seen in our experience that may occur in younger patients after neurosurgical syringomyelia decompression for Chiari I hindbrain herniation.

Cervical Vertebrae↗