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Biomedical subjects

W A Stening

Publications and source records attributed to W A Stening.

9 recordsLinked to original sources
PubMed1991

Results of ulnar neuropathy at the elbow treated by decompression or anterior transposition.

A retrospective study was conducted on 148 patients with ulnar neuropathy at the elbow, who underwent surgical treatment between 1981 and 1989. Of the 178 nerves operated on, 105 underwent subcutaneous anterior transposition, and 73 were decompressed without transposition. We compared the surgical results of these two groups, and factors influencing prognosis. Overall, 92% of patients improved postoperatively. Pre-operatively, electrophysiological assessment corresponded well to clinical findings, and to macroscopic findings at operation in 95% of cases. The severity of pre-operative clinical findings, advancing age, duration of symptoms and the presence of intraneural fibrosis did not predict an adverse outcome. A satisfactory outcome in 72% of those decompressed compared with 60% of those who were transposed was not statistically significant. However, there was a lower percentage of those with unsatisfactory results in the decompressed series. Thus, we advise that, except where there is persistent deformity or a mass lesion in the region of the ulnar groove, decompression is the operation of choice.

Adult↗
PubMed1990

Endoscopic third ventriculostomy.

Long-term extracranial shunting for hydrocephalus has numerous drawbacks related to shunt malfunction and infection. In some cases outcome has been very disappointing. We successfully managed 5 patients with acquired aqueductal stenoses with no significant morbidity by the use of an intracranial cerebrospinal fluid diversion, namely a third ventriculostomy. First advocated by Dandy, ventriculostomy was largely passed over in favor of extracranial procedures. With improved surgical techniques, however, ventriculostomy is now considered to be a viable alternative in selected cases. In a further 19 patients, we subsequently broadened our patient selection to include those with Arnold-Chiari malformations, congenital noncommunicating hydrocephalus, and tumors. Two thirds of these children remain without shunts and apart from 1 child developing hemiplegia postoperatively, there has been no significant morbidity. Although the best results have been seen in the late onset groups, even early onset, noncommunicating hydrocephalus has been successfully managed. Even in patients in whom third ventriculostomy has failed and who have subsequently required ventriculoperitoneal shunts, we anticipate that they will remain less dependent on shunts because their hydrocephalus is now communicating, which tends not to have such a rapid onset or extreme levels of raised intracranial pressure.

Adolescent↗
PubMed1986

Preventable causes of death and disability from neurotrauma.

Preventable causes of death and disability have been studied retrospectively in a series of 1161 cases of neurotrauma occurring in New South Wales in 1977-78, and prospectively in 153 cases of neurotrauma occurring in country districts in South Australia in 1981-82. In the first study, it was found that at least 80 deaths could be attributed to preventable causes; chiefly, transfer to an inappropriate hospital and/or delay in instituting treatment. Apparent failures in initial management of shock and airway obstruction were evident in this study and also in the South Australian study, which identified major deficiencies in cardiorespiratory management in 7% of cases transferred from country areas. These studies confirm that there is a need for better training, at all levels, in the management of neurotrauma. They also provide powerful arguments for the concept of an integrated regional trauma service.

Australia↗
PubMed1986

Experience with multiple intracranial haematomas in New South Wales.

A retrospective survey of head injuries in NSW in 1977 and 1978 was conducted by the Trauma Subcommittee of the Neurosurgical Society of Australasia. This paper describes the findings for 129 patients who had more than one significant intracranial haematoma. Overall, the case fatality rate for these patients was 85%. The presence of low or fluctuating blood pressure was associated with a significantly higher mortality than in the rest of the group. Bilateral reacting pupils or an improvement in level of consciousness following decompressive surgery carried a more favourable prognosis. There was 100% fatality if surgery was not carried out or if the bleeding was not found at operation. A subset of patients who died was selected on the basis of a calculated prognostic variable, and compared with a similar subset of survivors. A higher proportion of patients who died had a delay in the provision of definitive treatment and failure to correct shock. This comparison was made on two criteria. Using the first accepted optimal treatment in 1984, nearly all cases were treated suboptimally, as might be expected. Using the second, acceptable treatment in 1977-78, it was calculated that between nine and 12 patients died with MIH in NSW in the 2 years of the survey, whose deaths might have been prevented.

Accidents, Traffic↗
PubMed1986

Experience with acute subdural haematomas in New South Wales.

A retrospective survey of head injuries in NSW in 1977 and 1978 was conducted by the Trauma Subcommittee of the Neurosurgical Society of Australasia. Two hundred and ninety patients, who were found to have acute or subacute subdural haematomas, were considered. The mortality rate was 76%, with 19% making a satisfactory recovery. Several factors were found to produce significant improvement in outcome. The availability of neurosurgical facilities at the time of admission made a significant difference. Those patients who had decompressive operations also fared better. No patient survived without operation. Shock, defined as a systolic blood pressure lower than 90 mmHg for more than 60 min was associated with significantly increased mortality. The chance of developing a significant hypotensive episode was greater if two or more other parts of the body were injured. If three other areas were injured, the mortality was 100%. A case control study suggested that some 35 (16%) of all deaths could have resulted from preventable causes, notably delay in instituting definitive treatment and/or inadequate treatment of shock.

Acute Disease↗
PubMed1986

Epidemiology and clinical outcomes of neurotrauma in New South Wales.

This study of 1161 neurotrauma patients in New South Wales hospitals was designed to examine the role of preventable causes of death and disability in cases of spinal injury, extradural, subdural and multiple intracranial haematomas in order to make recommendations for improvements in accident, emergency, ambulance and hospital services. Methods have been developed for standardizing diagnosis in different classes of hospital for the assessment of severity in terms of the patient's age, sex, physical signs, head and spine injuries and other injuries. Estimates have been made of the number of preventable deaths by a case control study of each category of neurotrauma under study.

Adolescent↗
PubMed1979

Experimental neurogenic disorders of the bladder after section of cauda equina.

Changes in the cystometric pattern and urethral pressure profile after surgical section of the cauda equina have been studied in a group of 20 monkeys (Macaca nemestrinal). The experimental autonomous bladder was characterised by tonic response to filling and with variable urethral dribbling incontinence but without co-ordinated detrusor activity. This pattern developed despite previous urinary diversion to prevent inadvertent overstretch of the bladder. Deliberate "overstretch" of the autonomous bladder was not followed by loss of tonus but was associated with the development of high amplitude regular detrusor contractions which were superimposed upon a steep rising filling cystometrogram. With urinary diversion the resting urethral pressure profiles were preserved after division of the cauda equina but were lower in amplitude after overstretch of the autonomous bladder.

Animals↗