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Biomedical subjects

J S Tompkins

Publications and source records attributed to J S Tompkins.

6 recordsLinked to original sources
PubMed1993

Toward the elimination of homologous blood use in elective lumbar spine surgery.

Two hundred twenty-four consecutive patients underwent elective posterior lumbar spinal surgery over a 3 1/2-year span at the University of Miami/Jackson Memorial Medical Center. Patients ranged in age from 17 to 87 years, and 58% were male. Fifty-eight patients underwent revision surgery, and 65 patients required fusions, including 35 necessitating internal fixation. One hundred seventy-four patients (78%) were requested to participate in a preoperatively donated autologous blood (PDAB) program. Six of these patients were excluded from participation, and 168 patients banked 425 U of autologous blood. Eighty percent of the patients participating in the PDAB program received some or all of their donated blood. Intraoperative blood salvage was used in 37% of cases. Seven patients received homologous blood: four in addition to salvaged and donated blood, two that were unable to donate blood due to positive hepatitis B serology, and one erroneously. The combined use of PDAB and intraoperative salvage program allowed autologous blood replacement to meet the total transfusion requirements of 96% of the patients who predeposited blood, including 94% of those undergoing spinal fusions. Autologous blood comprised 99% of the total blood replacement used in this series, and 95% of the patients requiring blood transfusions received only autologous blood. Establishment of a protocol judiciously using PDAB in conjunction with intraoperative blood salvage can result in virtual elimination of the need for homologous blood transfusion in elective lumbar spine surgery.

Adolescent↗
PubMed1989

Pain response post-chemonucleolysis or disc excision.

Eighty-five patients with proven lumbar disc displacement who had failed at least 3 months of conservative care were enrolled in this prospective study. The patients were self-selected into one of three treatment groups: collagenase, chymopapain, or surgery, based on information provided regarding the nature benefits and risks of each. Pain levels were self-recorded by patients in the post-treatment period, and follow-up physical examinations were performed and data were collected regarding hospital stay and return to activities for 3 months post-treatment. Patient's pain perception post-treatment was statistically lowest in the surgically treated group. The enzyme-injected patients reported higher levels of pain perception throughout the follow-up period, with collagenase-treated patients reporting more pain than chymopapain patients. Surgical patients had the most satisfactory outcome of treatment at 3 months. An explanation regarding the differences in pain response to the two enzymes is offered based on in vitro studies of the effects of the enzymes on the two major structural macromolecules of the connective tissue matrix.

Chymopapain↗
PubMed1988

Epidural anesthesia for lumbar spine surgery.

A retrospective review of the hospital records of 80 patients undergoing elective lumbar spine surgery was performed, in order to determine the effect of anesthetic technique on various clinical parameters. Forty patients receiving epidural bupivacaine anesthesia were matched with 40 patients receiving general endotracheal anesthesia; these two groups were homogeneous based on age, sex, type of operative procedure, and number of spinal levels operated upon. Significant results included lower injectable narcotic requirements (p less than 0.001), lower incidence of postoperative urinary retention (p less than 0.01), and lower operative blood loss (p less than 0.1) for patients receiving epidural anesthesia. Epidural bupivacaine provided satisfactory anesthesia, and allowed intraoperative testing of lower extremity motor function. In a follow-up surgery, 38 of 40 patients who received epidural anesthesia were satisfied with the technique. For patients undergoing decompressive lumbar spine surgery, epidural bupivacaine anesthesia is an effective, well tolerated technique with several potential advantages, and an acceptable incidence of complications, as compared with general endotracheal anesthesia.

Anesthesia, Epidural↗
PubMed1986

Chemonucleolysis (discolysis) with collagenase.

Fifty-four patients with proven lumbar disc displacement were treated by intradiscal injection of collagenase (Nucleolysin) between April 1981 and January 1984. Follow-up by history and physical examination, phone survey, and/or mail survey shows 72% success rate (excellent, good, and fair) and 28% poor or unsuccessful results. No patient was made worse by the treatment. Success rate was greater in patients older than the age of 50 years, male patients, and patients with pain complaints of longer than 4 months' duration. The presence of a list and/or crossed straight leg raising and/or straight leg raising positive less than 30 degrees was associated with a poor prognosis. Discography prior to collagenase injection did not compromise the outcome of treatment. Postinjection changes in the CT scan correlated with a satisfactory outcome of treatment. Findings at surgery in patients who failed to obtain relief following collagenase injection did not show a specific deleterious effect of the enzyme, nor were the expected results from surgery compromised by a previous unsuccessful intradiscal collagenase injection.

Adult↗