PubMed Health⌕ Search

Biomedical subjects

S Zygmunt

Publications and source records attributed to S Zygmunt.

At least 19 recordsLinked to original sources
PubMed1999

Cervical laminectomy without fusion in patients with rheumatoid arthritis.

OBJECT: The authors performed a prospective study to determine whether cervical laminectomy without simultaneous fusion results in spinal instability. METHODS: Because of clinical and radiographic signs of cord compression, 15 patients with rheumatoid arthritis (including one with Bechterew's disease) and severe involvement of the cervical spine underwent decompressive laminectomy without fusion performed on one or more levels. Preoperative flexion-extension radiographs demonstrated dislocation but no signs of instability at the level of cord compression. Clinical and radiological reexamination were performed twice at a median of 15 months (6-24 months) and 43 months (28-72 months) postoperatively. One patient developed severe vertical translocation 28 months after undergoing a C-1 laminectomy, which led to sudden tetraplegia. She required reoperation in which posterior fusion was performed. No signs of additional instability at the operated levels were found in the remaining 14 patients. In three patients increased but stable dislocation was demonstrated. The results of clinical examination were favorable in most patients, with improvement of neurological symptoms and less pain. CONCLUSIONS: The authors conclude that decompressive laminectomy in which the facet joints are preserved can be performed in the rheumatoid arthritis-affected cervical spine in selected patients in whom signs of cord compression are demonstrated, but in whom radiographic and preoperative signs of instability are not. Performing a simultaneous fusion procedure does not always appear necessary. Vertical translocation must be detected early, and if present, a C-1 laminectomy should be followed by occipitocervical fusion.

Adolescent↗
PubMed1996

Overall management outcome of ruptured posterior fossa aneurysms.

A study of the overall management of ruptured posterior fossa aneurysms was conducted over a 1-year period (1993) in five neurosurgical centers in Sweden, serving a population of 6.93 million people. Forty-nine cases were identified and treated. One-third of the patients were in the seventh or eighth decade of life. Good overall management outcomes at 6 months were achieved in 30 cases (61%). The overall mortality rate was 27%. Patients with Hunt and Hess Grades I and II had a good overall recovery rate of 87%. On admission, 69% of the patients were assigned Hunt and Hess Grades III to V. The impact on patient outcomes of the intraoperative difficulties encountered, especially in the basilar tip area, is stressed. The authors found that delayed operation is not warranted in most cases. Frequent devastating rebleeding was observed among patients not offered early aneurysm clipping and the operative results were not at significant variance between the early and late surgical groups. Only 50% of the patients scheduled for delayed surgery ultimately made a good recovery, whereas 72% of patients scheduled for early operation did so. The data demonstrate that overall management results with posterior fossa aneurysms, comparable to achievements with supratentorial lesions, are within the reach of modern strategies, even in centers not specializing in these problems.

Adult↗
PubMed1996

Warning leak and management outcome in aneurysmal subarachnoid hemorrhage.

The impact of warning leaks on management results in patients with aneurysmal subarachnoid hemorrhage (SAH) was evaluated in this prospective study. In a consecutive series of 422 patients with aneurysmal SAH, 84 patients (19.9%) had an episode suggesting a warning leak; 34 (40.5%) of these patients were seen by a physician without the condition being recognized. The warning leak occurred less than 2 weeks before a major SAH in 75% of the patients. A good outcome was experienced by 53.6% of patients who had a warning leak versus 63.3% of those who had no warning leak. In a subgroup of patients who had an interval of 3 days or less from warning leak to SAH, only 36.4% had a good outcome. The proportion of patients in good neurological condition (Hunt and Hess Grades I and II) who had a good outcome was 88.1% in the group with no warning leak versus 53.6% in the group whose SAH was preceded by a warning leak. A difference of 35% between these two groups reflects the impact of an undiagnosed warning leak on patient outcome, based on the assumption that patients with a warning leak had clinical conditions no worse than Hunt and Hess Grade II at the time of the episode. In the subgroup of patients with the short interval between warning leak and SAH, the difference was almost 52%. The difference in outcome also reflects the potential improvement in outcome that can be achieved by a correct diagnosis of the warning leak. If the correct diagnosis is made in patients seeking medical attention due to a warning leak, favorable outcomes in the overall management of aneurysmal SAH are estimated to increase by 2.8%. An active diagnostic attitude toward patients experiencing a sudden and severe headache is warranted as it offers a means of improving overall outcome in patients with SAH.

Adolescent↗
PubMed1995

Does a routine operation for intracranial aneurysm incur brain damage?

A biochemical marker of brain cell damage, the BB-isozyme of the intracellular enzyme Creatine Kinase (CK), was used to evaluate any possible injury to the brain, caused by an operation for a ruptured intracranial aneurysm (SAH). CSF-CK BB was assessed before and at intervals after operation in a series of 60 patients, aged 29-71 (mean 51 years) operated on for intracranial aneurysms, all but one after SAH. The m/f ratio was 18/42. 35 of the 60 patients were operated on acutely, i.e. within 72 hours after the SAH. CK BB was determined as CKB-activity after immunological inactivation of CKM. Normally there should be almost no detectable enzyme activity in the CSF. The pre-operative CK BB-activity was 0.01+ -0.01 mikrokatal in the patients in Hunt & Hess grade I who were operated on > 7 days after their SAH, and 0.05+ -0.04 in those operated on acutely, probably still reflecting the effects of the SAH on the brain. The mean per-operative CK BB increase was 0.11+ -0.17 for patients who had an uneventful postoperative course, compared to 0.39+ -0.49 for those showing some degree of immediate postoperative deterioration. This difference is significant at the 1% level. 52 of the 60 patients showed a rise of CK BB after operation. The mean increase for those patients operated upon in a good state and without any complication or postoperative deterioration was 0.02+ -0.03 mikrokatal, which could therefore be considered as a "normal" or acceptable elevation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Effect of intraventricular haemorrhage and rebleeding following subarachnoid haemorrhage on CSF eicosanoids.

CSF eicosanoid levels are raised following subarachnoid haemorrhage but not sufficiently to be vasoactive per se within the cerebral circulation. Rebleeding and intraventricular haemorrhage are two factors associated with a worse outcome after aneurysmal SAH. We have examined the effects of these two factors on the CSF levels of TXB2 (TXA2 metabolite), PG6-keto F1 alpha (prostacyclin metabolite), PGF2 alpha and PGE2 in 44 patients following subarachnoid haemorrhage. In 15 patients who had received no non-steroidal anti-inflammatory agent or dexamethasone, intraventricular haemorrhage increased the median levels of all four eicosanoids in ventricular CSF by 2.1-5.1-fold. In 4 patients who rebled, the CSF median levels of all four eicosanoids were raised up to 250-fold over the normal range. These concentrations are just sufficient to have cerebrovascular and neuromodulatory effects.

6-Ketoprostaglandin F1 alpha↗
PubMed1994

Bovine bone grafting in occipito-cervical fusion for atlanto-axial instability in rheumatoid arthritis.

Bovine bone chips (Surgibone) were used in occipito-cervical fusion in nine patients with atlanto-axial instability due to rheumatoid arthritis. The patients were examined with CT 12-15 months after surgery. Graft resorbtion was observed in one patient. The other 8 patients showed preserved grafts, in most cases the grafts appeared to be in contact with the underlying bone. One patient was revised, and at the grafted site a bony bridge was found. In conclusion, the use of bovine chips in posterior occipito-cervical fusion will not lead to predictable bone union. However, there seem to be exceptions to that rule.

Adult↗
PubMed1993

Characterization and functional assessment of patients subjected to occipito-cervical fusion for rheumatoid atlanto-axial dislocation.

20 patients with rheumatoid arthritis and atlanto-axial dislocation subjected to occipito-cervical fusion were studied. The patients were evaluated by a rheumatologist before surgery and 6-12 months after the fusion procedure. Joint tenderness was assessed by Ritchie's Index while the functional capacity was evaluated using a health assessment questionnaire and according to the classification by Steinbrocker. Localization and character of the symptoms from the head-neck region were registered. The neck pain was measured on a visual analogue scale. Radiographs of hands and wrists were obtained before surgery and joint destruction was classified according to the Larsen Dale Index. Reduction of pain and neurological symptoms was observed in the majority. There was, however, little evidence of improved functional capacity.

Adult↗
PubMed1992

Hyperthermia during occipito-cervical fusion with acrylic cement. Epidural thermometry in 23 cases.

In 22 patients, 23 posterior occipito-cervical fusions using acrylic cement were studied; 18 had seropositive rheumatoid arthritis and 4 traumatic atlanto-axial instability. The mean age was 60 (39-75) years. During the curing of the cement, epidural temperature measurements were performed over the cerebellum and between the foramen magnum and C1. Temperatures up to 69 degrees C were recorded. Cooling with profuse surface irrigation using normal saline solution or precooled 8 degrees C fluid did not influence the maximal temperatures recorded under the cement. Even though no gross neurological damage was noted, the epidural temperatures in occipito-cervical fusion with acrylic cement can be of sufficient degree to be hazardous; surface irrigation does not seem to be an effective way to reduce this risk.

Adult↗
PubMed1989

[Favourable surgery of cervical neck instability in rheumatism].

A team project commenced 20 years ago can now present results of 150 surgical stabilising procedures for cervical neck instability in rheumatoid arthritis. The favourable results indicate widened indications. MR examination demonstrated regression of soft tissue swelling ("pannus") after surgery, which possibly contributed to the good results.

Aged↗
PubMed1989

Pre- and postoperative MR imaging of the craniocervical junction in rheumatoid arthritis.

Ten patients with severe chronic rheumatoid arthritis with atlantoaxial subluxation were examined with conventional radiography and MR imaging of the cervical spine before and at an average of 6 months after posterior occipitocervical fusion. Periodontoid pannus formation was revealed by MR preoperatively in nine patients, all with mobile horizontal atlantoaxial subluxation. Compression of the medulla and/or upper cervical cord, due to subluxation and periodontoid pannus bulging into the spinal canal, was seen in seven patients. After the stabilizing surgery the periodontoid pannus had decreased in size in all patients with preoperative pannus. This reduction in the pannus seems to be the result of the atlantoaxial immobility achieved by the posterior fusion. Postoperatively, three patients had some remaining compression of the medulla and/or cord secondary to immobile subluxation, while the pannus posterior to the odontoid process had disappeared. Artifacts from the surgical stainless steel fixation material were confined to the posterior part of the neck on short TR/short TE MR images and did not interfere with the evaluation of the periodontoid region and the anterior part of the medulla/cervical cord. We found that flexion and extension lateral radiographs, combined with sagittal short TR/short TE MR images in the neutral position, enable preoperative evaluation of patients with rheumatoid arthritis in the cervical spine. Postoperative MR should be performed only if there are residual or new symptoms.

Aged↗
PubMed1988

The natural history of subarachnoid haemorrhage with negative angiography: a prospective study and 3-year follow-up.

One hundred and forty-eight patients with negative cerebral angiography after subarachnoid haemorrhage are reported. Good grade, normotension and normal CT are associated with a favourable outcome. In 89 patients with negative four-vessel angiography the overall annual risks of rebleeding and fatal rebleeding were 1.5% and 0.4% respectively. In 52 patients undergoing appropriate limited angiography corresponding risks were 2.5% and 1.9%. No fatal rebleeds occurred after 6 months. Initial CT scanning in 104 patients was abnormal in 34. Of these, 14 had SAH alone, in whom no episodes of rebleeding occurred, although SAH on CT was associated with an increased chance of a poor outcome. Twenty had other abnormalities, three of whom rebled, two (both with ICH on CT) being fatal. The annual risks of rebleeding and fatal rebleeding in patients with these CT abnormalities were 5.0% and 3.33% respectively. Fifty-two patients were hypertensive, of whom six rebled, four fatally. Two of the 89 normotensive patients rebled, neither fatally.

Female↗
PubMed1988

Reduction of rheumatoid periodontoid pannus following posterior occipito-cervical fusion visualised by magnetic resonance imaging.

Nine patients (four females and five males) with chronic rheumatoid arthritis (RA) and atlanto-axial (AA) instability subjected to occipito-cervical fusion were evaluated clinically and radiologically. All of them had soft tissue formation (pannus) around the odontoid peg. The age ranged from 50 to 79 years (mean: 66). The duration of the RA disease was 3-48 years (mean: 18.5). All patients were seropositive. Both conventional radiography and magnetic resonance imaging (MR) were performed pre- and postoperatively. All fusions except one were stable. One patient was re-fused after 2 months because of wire break. With regard to pain all patients had improved and eight were pain free. Six patients who experienced signs of myelopathy prior to the fusion had improved at follow up. MR revealed reduction of pannus in all nine cases. This was obvious in one patient within 6 weeks postoperatively. The MR findings of a reduction or even disappearance of pannus following posterior fusion should decrease the need for transoral surgery.

Aged↗
PubMed1987

Management of ruptured intracranial aneurysm: a review.

The discouraging history associated with management of aneurysmal subarachnoid haemorrhage (SAH) is reviewed along with improvements in outlook attributable to progress made within the past decade. Among the new developments is the introduction of microsurgical techniques that allow elective surgery in the acute stage thereby preventing repeat haemorrhages. Early operation also offers the possibility of a more aggressive pharmacological anti-ischaemic treatment. Notwithstanding the improved results of acute elective surgery and the fact that delayed ischaemic deterioration (symptomatic cerebral vasospasm) now may be almost eliminated, the overall outcome remains gloomy. Despite recent advances not more than one out of three individuals, who are struck by the rupture of an intracranial aneurysm, may be expected to make a good neurological and functional recovery. Hope for further improvements may depend on the development of techniques that can identify intracranial aneurysms before they rupture and increased knowledge of the aetiology of such arterial wall lesions.

History, 18th Century↗
PubMed1986

Outcome evaluation following subarachnoid hemorrhage.

Seventy-eight individuals among a population of 1.46 million suffered aneurysmal subarachnoid hemorrhage (SAH) during 1983. Within 24 hours after the bleed, 32 of the 78 patients were in Hunt and Hess neurological Grades I to II, 13 were in Grade III, 21 were in Grades IV to V, and 12 were dead on admission to a hospital or forensic department. When the amount of blood visualized on computerized tomography (CT) scanning was integrated with the Hunt and Hess neurological classification in order to improve prediction of prognosis, only 16 patients were considered to have a good prognosis (CT-modified Grades I to II), 21 had a less favorable prognosis (CT-modified Grade III), and 29 had a poor prognosis (CT-modified Grades IV to V). Assessment at 1 year revealed that only 32 patients (41%) had a good physical recovery. The physical morbidity rate was 22%, and the overall mortality rate was 37%. Twenty-six individuals with a good neurological outcome and five with a fair outcome also underwent reexamination 1 year or more post-SAH, which included a comprehensive evaluation of the quality of life, assessment of cognitive dysfunction, and determination of general adjustment. Five of the patients with a good neurological outcome and all five with a fair outcome (four of whom had had a poor prognosis in the acute stage) showed severe psychosocial and cognitive incapacitation. When functional morbidity, based upon persistent severe cognitive and psychosocial impairment, was included in the outcome assessment, only 33% of the total series was considered to have a favorable outcome. Approximately 60% of the initially good-risk patients (Grades I and II) showed a good physical outcome without concomitant indications of severe cognitive dysfunction and/or psychosocial impairment. Among the good-risk patients with a CT-modified grade, the figure was 70%. It is suggested that in any outcome grading system, persistent cognitive and psychosocial disturbances be taken into account.

Cognition Disorders↗
PubMed1985

Early operation and overall outcome in aneurysmal subarachnoid hemorrhage.

Over a 3-year period, 251 individuals in a population of 1.46 million were known to have suffered an aneurysmal subarachnoid hemorrhage (SAH). Forty-three individuals (17%) were either found dead or were dead on arrival at a hospital or forensic department. Forty-nine patients (20%) were at no stage in their clinical course considered to be surgical candidates. Six patients (2% of the total series) were initially in good condition, but subsequently deteriorated during the acute phase and were not treated surgically. Nineteen poor-risk patients (8% of the total series) underwent emergency surgery because of a life-threatening intracerebral hematoma; 105 patients (42% of the total series or 69% of the surgically treated patients) were operated on at the acute stage, and 29 patients (11% of the total series or 19% of the surgically treated patients) underwent late surgery. Of the total series, 107 patients (42%) recovered without neurological deficits; the overall morbidity rate was 19%, and the mortality rate was 39%. Of 99 Grade I to III patients who were operated on at the acute stage, 76% recovered without neurological deficits, and 4% died. It is concluded that the overall outcome in aneurysmal SAH remains poor, mainly because of the large group of patients who are permanently devastated by their initial bleed.

Adult↗
PubMed1984

Total hip replacement with spongious bone graft for acetabular protrusion in patients with rheumatoid arthritis.

Total hip replacement (THR) with the use of autogenous spongious bone graft reinforcement to the medial acetabular wall proved a successful surgical procedure in patients with rheumatoid arthritis and acetabular protrusion. In 25/26 THR followed for an average of 2 (1-4) years, the bone grafts healed in place radiographically and no further protrusion occurred. A non-progressive radiolucent zone of 3 mm at the bone-cement interface occurred around one acetabular cup. Recurrent dislocations occurred in one hip, which eventually turned out to have a loose acetabular cup. One hip with a firmly seated cup was converted to a resection arthroplasty 4 months after the primary operation because of deep infection.

Acetabulum↗