PubMed · 14856963
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M O CANTOR. 1951. Swallowed intestinal decompression tubes.. https://doi.org/10.1007/bf02891990
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Lumbal spinal stenosis is gaining more and more clinical relevance because of changing population structure and increasing demand on lifequality in the elderly. Current treatment recommendations are based on clinical experience, expert opinions and single studies rather than on proven evidence. The radiologic degree of stenosis does not correlate with the patients' clinical situation. It is not the main factor indicating surgery but rather the typical history and spinal claudication. Symptomatic patients with light to moderate complaints should undergo multimodal conservative treatment. Epidural injections, delordosating physiotherapy and medication are useful. In patients with severe symptomatic stenosis surgery is indicated after a conservative treatment of 3 months. Relevant pareses or a cauda equina syndrome are absolute indications for surgery. The general aim is to decompress sufficiently while maintaining or restoring segmental stability. A laminectomy is not necessarily required. In patients with accompanying degenerative Meyerding grade I-II spondylolisthesis or instability in functional radiographs, fusion or dynamic stabilisation are recommended in addition to decompression, depending on the patient's age and activity level.
INTRODUCTION: Divers use decompression schedules to reduce the probability of occurrence of decompression sickness when returning to the surface at the end of a dive. The probability of decompression sickness resulting from these schedules varies across different dives and the models used to generate them. Usually the diver is unaware of this variance in risk. This paper describes an investigation into the feasibility of producing optimized iso-probabilistic decompression schedules that minimize the time it takes for a diver to reach the surface. METHODS: The decompression schedules were optimized using the sequential quadratic programming method (SQP), which minimizes the ascent time for a given probability of decompression sickness. The U.S. linear-exponential multi-gas model was used to calculate an estimate of the probability of decompression sickness for a given dive. In particular 1.3-bar oxygen in helium rebreather bounce dives to between 18 m and 81 m were considered and compared against the UK Navy QinetiQ 90 tables for a similar estimate of probability of decompression sickness. RESULTS: The SQP method reliably produced schedules with fast and stable convergence to an optimized solution. Comparison of the optimized decompression schedules with the QinetiQ 90 schedules showed similar stop times for shallow dives to 18 m. For dives with a maximum depth of 39 m to 81 m, optimizing the decompression resulted in savings in decompression time of up to 30 min. CONCLUSIONS: This paper has shown that it is feasible to produce optimized iso-probabilistic decompression tables given a reliable risk model for decompression sickness and appropriate dive trials.
We report the case of a glossopharyngeal neuralgia that was successfully treated using microvascular decompression (MVD). A 61-year-old female reported intermittent piercing pain from tongue to pinna on the left side. Although she had been prescribed carbamazepine and has undergone attempted nerve block on several occasions, no pain relief has been achieved. MVD was thus attempted using a lateral suboccipital approach. The offending vessel, which was PICA, had adhered to the glossopharyngeal nerve and was repositioned laterally away from the nerve by interposition of a felt cushion. Pain disappeared immediately after surgery and has not recurred. In the literature, MVD for glossopharyngeal neuralgia has been performed using a transcondylar approach to achieve minimally invasive surgery. However, the sensory distributions for the floor of the oral cavity and tongue involve 4 overlapping nerves: the trigeminal nerve, sensory components of the facial and vagal nerves, and the glossopharyngeal nerve. In typical cases, it seems that the transcondylar fossa approach is appropriate for glossopharyngeal neuralgia. If the pain occurs in the place involving an overlapping nerve, the lateral suboccipital approach might be necessary.