Biomedical subjects

Ralph J Mobbs

Publications and source records attributed to Ralph J Mobbs.

6 recordsLinked to original sources

PubMed2003

Entrapment neuropathy of the ulnar nerve by a constriction band: the role of MRI.

The diagnosis of ulnar nerve entrapment at the elbow has relied primarily on clinical and electrodiagnostic findings. Magnetic resonance imaging (MRI) has been used in the evaluation of peripheral nerve entrapment disorders to document signal and configurational changes in nerves. In this case report we review the MRI and operative findings of a rare constriction band causing ulnar nerve compression at the elbow. We review the sensitivity and specificity in diagnosing ulnar nerve entrapment at the elbow as defined by MRI findings.

Elbow Joint↗

PubMed2003

Mesh electrode for peripheral nerve stimulation.

The implanted peripheral nerve stimulator has a role for pain relief in well-selected patients with pain in a peripheral nerve distribution. We describe an electrode to help simplify the surgical implantation of a peripheral nerve stimulator and also to reduce the possibility of electrode migration following implantation. Design details of the electrode are discussed, as are notes on surgical technique.

Electric Stimulation↗

PubMed2003

Death after late failure of endoscopic third ventriculostomy: a potential solution.

OBJECTIVE: Late failure after successful third ventriculostomy is rare, and death caused by failure of a previously successful third ventriculostomy has been reported on four occasions. We describe a simple innovation that adds little morbidity and has the potential to reduce the advent of death after late failure of endoscopic third ventriculostomy. METHODS: After endoscopic fenestration of the floor of the third ventricle, a ventricular catheter and subcutaneous reservoir are placed via the endoscope path. With acute blockage and neurological deterioration, cerebrospinal fluid can be removed via needle puncture of the reservoir until consultation with a neurosurgeon. RESULTS: From 1979 to 2003, more than 240 endoscopic third ventriculostomies have been performed at our institution, with one death after late failure. The revised technique was devised after this death and has been performed on 21 patients to date. CONCLUSION: The addition of a reservoir adds little time and morbidity to the procedure and offers the potential to sample cerebrospinal fluid, measure intracranial pressure, and reduce mortality associated with late failure of endoscopic third ventriculostomy.

Death↗

PubMed2002

Effect of cervical hard collar on intracranial pressure after head injury.

BACKGROUND: Patients suffering head trauma are at high risk of having a concomitant cervical spine injury. A rigid cervical collar is usually applied to each patient until spinal stability is confirmed. Hard collars potentially cause venous outflow obstruction and are a nociceptive stimulus, which might elevate intracranial pressure (ICP). This study tested the hypothesis that application of a hard collar is associated with an increase in ICP. METHODS: A prospective series of 10 head-injured patients with a postresuscitation Glasgow coma scale score of nine or less had ICP measurements before and after cervical hard collar application. RESULTS: Nine out of 10 patients had a rise in ICP following application of the collar. The difference in pre- and postapplication ICP was statistically significant (P < 0.05). CONCLUSIONS: Early assessment of the cervical spine in head-injured patients is recommended to minimize the risk of intracranial hypertension related to prolonged cervical spine immobilization with a hard collar.

Adolescent↗

PubMed2002

Endoscopic assisted posterior decompression for spinal neoplasms.

The authors describe a technique for anterior thoracic decompression via a posterolateral approach for spinal metastatic disease followed by anterior and posterior column stabilization. We discuss the benefits of decompression via a posterolateral approach including minimization of cord retraction, avoidance of thoracotomy, early mobilization and shorter hospital stay. Technical details are reviewed and difficulties of the approach discussed.

Decompression, Surgical↗

PubMed2002

The dangers of diagnostic laparoscopy in the head injured patient.

Pneumoperitoneum during laparoscopy has been known to result in a rise in intracranial pressure (ICP) in experimental studies. There are no reports of the effect of pneumoperitoneum during diagnostic laparoscopy in patients suffering closed head injuries. We present the case of a 39 year old male with a closed head injury. Diagnostic laparoscopy was performed while intracranial pressure was monitored. ICP increased from 9 mmHg to over 60 mmHg within 10 min of pneumoperitoneum. Laparoscopy was terminated and the ICP returned to normal levels within 35 min. The authors recommend that pneumoperitoneum laparoscopy should not be used in the trauma setting where head injury is suspected.

Accidents, Traffic↗