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At least 307 records · Page 17Linked to original sources
PubMed2002

Fasciotomy for chronic compartment syndrome in the lower limb.

BACKGROUND: The aim of this study was to determine the success of fasciotomy of lower limb compartments with elevated intra-compartment pressure. METHODS: The present report is a retrospective cohort study at No. 3 Combat Support Hospital involving a survey and case note review of patients who had undergone fasciotomy for compartment syndrome at least 6 months earlier (December 1997-December 2000). RESULTS: Fourteen patients met the inclusion criteria. Eleven reported success with complete resolution of symptoms and return to military fitness levels. Two reported no change and significant residual symptoms. One reported worse symptoms and one required re-operation with a successful result. CONCLUSION: Surgical decompression is the accepted treatment of compartment syndrome as proven by pressure manometry, after failure of conservative treatment.

Adult↗
PubMed2003

Outcome following surgery for thoracic outlet syndrome.

INTRODUCTION: the diagnosis of thoracic outlet syndrome (TOS) relies heavily on subjective rather than objective assessment criteria. Subsequently, published results after surgical decompression vary considerably. This study aimed to use a symptom-based patient-directed questionnaire to assess the outcome after decompression for TOS. METHODS: sixty patients who underwent decompression procedures were identified from a prospectively maintained vascular database. Patient records were analysed for details regarding initial presentation, investigation, type of procedure used for decompression and management. Outcome questionnaires were sent to all identified patients to give a patient-based outcome measure. RESULTS: eighty-four per cent of patients responded. In 90% of these patients there was an improvement in symptoms post-surgery with a median follow up of 43 months. The results were not influenced by the procedure or approach used. CONCLUSION: surgery remains an effective tool in the management of TOS. A simple patient-directed questionnaire as used in this study could assist in the standardisation of outcome assessment.

Adolescent↗
PubMed2001

Entrapment of the lateral antebrachial cutaneous nerve exiting through the forearm fascia.

Isolated lateral antebrachial cutaneous nerve entrapment syndromes are uncommon. This report describes the compression of the lateral antebrachial cutaneous nerve of the forearm at the level of its passage through the superficial antebrachial fascia, distal to the elbow crease. Numbness and a painful dysesthesia over the radial aspect of the volar forearm were documented. Failure of conservative treatment necessitated surgical decompression.

Adult↗
PubMed2000

Vascular tracheobronchial compression syndromes-- experience in surgical treatment and literature review.

Between January 1988 and December 1997 a total of 22 patients (age: 8 days-46 years) were operated for vascular airway compression syndromes with respiratory insufficiency. Vascular anomalies in tracheal compression were double aortic arch in 7 patients, (2 previously operated elsewhere), right aortic arch + left ligamentum arteriosum in 1, and pulmonary artery sling in 3. Three of these patients had secondary long-segment tracheomalacia. Compression of trachea and a main bronchus existed in 2 patients with right aortic arch + left ligamentum. Isolated main bronchus obstruction was present in 9 patients (abnormal insertion of ligamentum arteriosum in 1, status post (s.p.) previous operation for PDA in 4, s. p. surgery for coarctation in 1, right aortic arch + left ligamentum arteriosum in 2, and right lung aplasia + left ligamentum in 1). 3 of these cases had secondary long-segment bronchomalacia. All patients had a complex respiratory anamnesis [long-term intubation in 7, s.p. tracheostomy in 2 (over 3 months - 3 years), and progressive respiratory insufficiency in 13). In tracheal compression, surgical correction included transsection of the underlying ring or sling components (with additional anterior aortic arch translocation in 5 patients resection-reimplantation of left pulmonary artery in 3, segmental tracheal resection in 1, and external tracheal suspension in 2). In the 2 cases with compression of the trachea and a main bronchus, aortic "extension" by a prosthetic tube was necessary. In isolated main bronchus obstruction, surgical decompression basically consisted of transsection of the ligamentum arteriosum or resection of its scarry remnant forming the "corner point" of a compression between aorta and pulmonary artery. In 3 patients with secondary long-segment malacia, additional external bronchus suspension was performed. Effective decompression and re-expansion of the airway segment concerned was achieved, and was demonstrated by intraoperative endoscopy in all patients. There were 3 postoperative deaths (sepsis 2; massive, irreversible edema of the tracheal mucosa 1). Of the 19 surviving patients 16 could be extubated between the 1st and 17th (mean = 7.5) postoperative day. In 1 case the preoperative long-term tracheostomy had to be left in place for inoperable additional laryngeal stricture. 2 patients had to be reoperated (segmental cervical tracheal resection after 5 months for primary long-term intubation-related subglottic stenosis in 1, esophageal decompression for residual dysphagia after 57 months related to a traction phenomenon at the right descending aorta in the other), both with gratifying results. In all other patients clinical, endoscopic, and radiographic examinations (follow-up = 2 months - 6 years) demonstrate good results.

Adolescent↗
PubMed2001

Idiopathic fibrosing pancreatitis presenting with obstructive jaundice in a child.

Idiopathic fibrosing pancreatitis (IFP) is a rare cause of obstructive jaundice in children. The obstruction is caused by circumferential compression of the intrapancreatic portion of the common bile duct (CBD). Various forms of biliary decompression, including surgical sphincteroplasty, choledochoduodenostomy, and Roux-en-Y choledochojejunostomy are employed as a treatment. We report a 14-year-old boy with IFP who was successfully treated by a temporary drainage of compressed CBD with the help of a stent placed by endoscopic retrograde cholangiopancreatography (ERCP). The diagnosis of IFP was confirmed histologically after open surgery. The patient remains well after 3.5 years of follow-up with no evidence of pancreatic insufficiency. This report offers an additional case of IFP causing obstructive jaundice treated by temporary internal drainage of CBD, which is safer and less invasive than biliodigestive surgical decompression.

Adolescent↗
PubMed2004

[Traumatic optic neuropathy--the present state].

Direct or indirect trauma may damage the optic nerve and result in permanent visual loss. The diagnosis of traumatic optic neuropathy is not always straightforward and is complicated by unfavourable circumstances for the examination. The diagnosis should only by established if it can be based on a clear objective finding, a relative afferent pupillary defect or a pathological flash-evoked visual response. Concerning therapy, surgical decompression (even without direct injury to the nerve) or megadose steroids or both in combination have been recommended. But even spontaneous improvement may occur. A large multicentre study could not demonstrate a significant advantage for any of the measures recommended, not even against the spontaneous course. However, the study was not randomised. In animal experiments steroids have shown an unfavourable effect. Currently, therapeutic decisions have to be made on an individual basis, in the absence of any evidence-based recommendations.

Animals↗
PubMed2005

[Bilateral carpal tunnel syndrome with familial accumulation].

We report on a six-year-old girl with bilateral carpal tunnel syndrome with familial accumulation. Parents and one grandmother had positive history for CTS, treated by surgical decompression. Following neurologic and radiologic evaluation and after failed conservative treatment in a plaster cast, open carpal tunnel release was performed in a two-stage procedure. Postoperatively symptoms diminished and now six months after surgery, all complaints disappeared completely.

Carpal Tunnel Syndrome↗
PubMedDate not supplied

[Intermediate-term follow-up of surgically managed tendinosis calcarea (calcifying subacromion syndrome--SAS) of the shoulder joint].

PURPOSE: Investigation of clinical und ultrasonographical results after operatively treated calcifying tendinitis. METHODS: 131 patients with calcifying tendinitis were treated by surgical decompression and, if necessary and possible, calcific deposit removal. 93% of these patients were clinically and ultrasonographically examined after an average time of 4 years and 5 months. RESULTS: Pain rating on a visual analogue scale 0-no pain to 10-maximum pain was 8.7 before surgery and 1.4 at follow-up. 88% of the patients rated the operation excellent or good. The Constant Score results corresponded to the average results of a normal population (100.3). At the time of examination in 16.4% of the cases new calcific deposits could be discovered. CONCLUSION: According to the clinical results operative treatment shows good and excellent results in a high degree even after unsuccessful non-operative therapy.

Acromion↗
PubMed2000

Edematous swelling of the facial nerve in Bell's palsy.

Surgical decompression of the intratemporal facial nerve from the geniculate ganglion to the stylomastoid foramen was carried out in 91 patients with Bell's palsy. All of the patients had denervation exceeding 95%, and a suprastapedial lesion. Edematous swelling of the nerve was assessed using the following three grades: + +, nerve swells beyond the bony facial canal; +, nerve swells beyond the nerve sheath, but within the bony canal, and -, no notable swelling observed. Varying degrees of swelling of the nerve were noted in all of the patients from onset to the end of the ninth week. The incidence of + + swelling was highest within 3 weeks of onset and then declined. + + swelling was most often noted in the vicinity of the geniculate ganglion, and was thought to be a manifestation of inflammation due to herpes simplex virus infection. There was a clear time dependency of the swelling in the horizontal and pyramidal segments, but not in the mastoid segment. After the ninth week, the incidence of swelling decreased sharply and no swelling of the nerve was observed in about one-third of the patients. Considering the etiology and the analysis of edematous swelling, we propose that the course of Bell's palsy be differentiated into an acute phase (the first 3 weeks after onset), a subacute phase (from the fourth to ninth weeks) and a chronic phase (after the tenth week).

Adolescent↗
PubMed2006

In-vivo measurement of brain relaxation after lobectomies.

Very little data exists on the visco-elastic properties of the living human brain tissue and collection of such data is vital for mechanical modelling. The purpose of this study was to measure the rate of relaxation of brain that has been compressed by tumour after surgical decompression. Seven patients who underwent a lobectomy for an intracranial space occupying lesion were included in the study. All underwent two CT scans within the first 24 h after the surgery. Volumes of the residual void on the serial CT scan were calculated using tools in the image acquisition software. There was a rapid expansion of the brain to fill up the void space in the first 24 h after surgery. The average rate of relaxation of the compressed brain is 2.25(0.76 - 6.64) ml/h. The graphs plotted for the volume of the void space against the time after surgery when the CT scans were done can be used to further explore the dynamics of brain relaxation. The rate of brain relaxation in the first 24 h after removal of a mass lesion averages 2.25(0.76 - 6.64) ml/h in this study. Further studies using more frequent data collection would allow for more accurate definition of the rate of relaxation.

Aged↗
PubMed1998

Rehabilitation outcome of individuals with nontraumatic myelopathy resulting from spinal stenosis.

A study was undertaken of 46 patients (19 cervical and 27 lumbar) admitted to an inpatient rehabilitation unit following surgical decompression for myelopathy or cauda equina syndrome resulting from spinal stenosis (SS). Individuals with SS represented 16 percent of all spinal cord injury (SCI) admissions. When compared to patients with traumatic SCI, patients with SS were significantly (t-test, p < .01) older (mean age 68 versus 39 years), more frequently retired/unemployed (89 percent versus 43 percent), more often married (57 percent versus 36 percent) and less often male (54 percent versus 82 percent) but with similar ethnicity. Significant (p < .01) Functional Independence Measurement (FIM) changes for the SS patients were noted after rehabilitation in the categories of self-care, sphincter control and mobility/locomotion. Additionally, outcome comparisons with a group of traumatic SCI patients who had similar motor function revealed similar lengths of stay, discharge FIM scores and discharge-to-community rates. This study suggests that individuals with weakness secondary to SS represent a significant proportion of individuals with SCI, make significant functional gains following inpatient rehabilitation and can achieve functional outcomes similar to those of traumatic SCI individuals.

Activities of Daily Living↗
PubMed2004

Blepharoptosis caused from compression of levator muscle by fractured orbital roof fragment.

The authors report two cases of blepharoptosis caused by compression of the levator muscle by fractured orbital roof fragment; both were improved by surgical treatments. In one case, because neurosurgeons were concerned with the contusional hemorrhage of the right frontal lobe during the early admission period, they missed the orbital roof fracture. The patient underwent surgery on the 18th post-trauma day. In the other case, the early diagnosis was made, and the surgical treatment were performed on the 10th post-trauma day. The authors think if the blepharoptosis is not improved in several days and the fractured fragment is suspected to compress the levator in computed tomography scan, surgical decompression is necessary and should be performed as soon as possible.

Adult↗
PubMed1999

Early versus delayed surgery for acute cervical spinal cord injury.

The optimal timing of surgical intervention in cervical spinal cord injuries has not been defined. The goals of the study were to investigate changes in neurologic status, length of hospitalization, and acute complications associated with surgery within 3 days of injury versus surgery more than 3 days after the injury. All patients undergoing surgical treatment for an acute cervical spinal injury with neurologic deficit at two institutions between March 1989 and May 1991 were reviewed retrospectively. Forty-three patients initially were evaluated. At one institution, patients with neurologic spinal injuries had surgical intervention within 72 hours of injury. At the other institution, patients underwent immediate closed reduction with subsequent observation of neurologic status for 10 to 14 days before undergoing surgical stabilization. This study indicates that patients who sustain acute traumatic injuries of the cervical spine with associated neurologic deficit may benefit from surgical decompression and stabilization within 72 hours of injury. Surgery within 72 hours of injury in patients sustaining acute cervical spinal injuries with neurologic involvement is not associated with a higher complication rate. Early surgery may improve neurologic recovery and decrease hospitalization time in patients with cervical spinal cord injuries.

Adolescent↗
PubMed2002

Treatment of tuberculosis of the spine with neurologic complications.

Neurologic complications are the most dreaded complication of spinal tuberculosis. The patients who have paraplegia develop in the active stage of tuberculosis of the spine require active treatment for spinal tuberculosis and have a better prognosis than the patients who have paraplegia develop many years after the initial disease has healed. Neurologic dysfunctions in association with active tuberculosis of the spine can be prevented by early diagnosis and prompt treatment. Prompt treatment can reverse paralysis and minimize the potential disability resulting from Pott's paraplegia. When needed, a combination of conservative therapy and surgical decompression yields successful results in most patients with tuberculosis of the spine who have neurologic complications. The vertebral body primarily is affected in tuberculosis; therefore, decompression has to be anterior. Laminectomy is advocated in patients with posterior complex disease and spinal tumor syndrome. Late onset paraplegia is best avoided by prevention of the development of severe kyphosis. Patients with tuberculosis of the spine who are likely to have severe kyphosis develop (< 60 degrees) on completion of treatment should have surgery in the active stage of disease to improve kyphus.

Algorithms↗
PubMed2003

Spinal cord injuries from gunshot wounds to the spine.

Although vehicular trauma traditionally has accounted for the majority of spinal cord injuries, gunshot wounds are the second most common cause. Furthermore, the proportion of spinal cord injuries caused by gunshot wounds are increasing although the proportion of injuries caused by high-speed vehicular trauma is decreasing. Gunshot wounds to the spine commonly are thought to be stable injuries. There is, however, a potential for instability if the bullet passes transversely through the spinal canal and fractures pedicles and facets. Injuries to the thoracic region of the spine are the most common, followed by the thoracolumbar area and the cervical spine. Completeness of injury is related to the anatomic region. Patients with incomplete injuries and patients with injuries in the thoracolumbar region have the greatest improvement in motor function. Approximately (1/4) of individuals are able to ambulate 1 year after injury. Surgical decompression of bullets from the spinal canal has been shown to improve neurologic recovery below the T12 level. Improvement of neurologic recovery after bullet removal has not been shown in other regions of the spine. Rare instances of late neurologic decline because of retained bullet fragments have been documented.

Decompression, Surgical↗
PubMed1997

Idiopathic spinal epidural lipomatosis.

OBJECTIVE: Spinal epidural lipomatosis (SEDL) is a rare disorder often associated with the administration of exogenous steroids or the elevation of endogenous steroids. Spinal epidural lipomatosis develops in some patients in the absence of elevated steroid levels. The limited information known about idiopathic SEDL comes predominantly from isolated case reports. We proposed to study our experience with idiopathic SEDL and to review the literature. METHODS: We identified eight symptomatic patients with idiopathic SEDL treated at our institution, which is the largest series reported. All patients were male and obese by body mass index (> 27.5 kg/m2). The mean age of the patients was 35.4 years. Idiopathic SEDL was equally distributed between the thoracic and lumbar spine. Six patients underwent laminectomy and fat debulking with good postoperative results; two patients were treated with a weight loss diet, which resulted in the relief of symptoms after losing > 15 kg each. RESULTS AND CONCLUSION: A review of our patients in conjunction with other reported cases reveals the following: 1) idiopathic SEDL occurs almost exclusively in the obese population; 2) idiopathic SEDL seems to occur with equal frequency between the thoracic and lumber spine; 3) a strong male predominance exists; 4) thoracic SEDL presents at an earlier age compared with lumbar SEDL; 5) surgical decompression remains the treatment of choice for the immediate relief of symptoms. Our experience suggests that idiopathic epidural lipomatosis may be a pathological entity that has been underdiagnosed.

Adolescent↗
PubMed2002

Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes.

OBJECTIVE: This study was performed to evaluate the clinical manifestations and prognostic factors for outcomes among patients with nontuberculous spinal epidural abscesses. METHODS: The records and magnetic resonance imaging/computed tomographic results for patients treated between 1994 and 2000 were retrospectively evaluated. Outcomes were assessed after 11 months, using scores ranging from 0 (dead) to 4 (no neurological deficits). RESULTS: All 25 patients (mean age, 62 yr) underwent surgery and subsequently received antibiotics. Back/neck pain (72% of patients), leukocytosis (64%), fever (60%), and motor deficits (56%) were the most common symptoms at admission. Outcomes were assessed as poor for 40% of the patients and as good (no deficit or independently ambulatory) for 60%. Low leg muscle strength grades (r = 0.68, P < 0.001) and high white blood cell (WBC) counts (r = -0.56, P = 0.006) at admission were significantly correlated with low outcome scores. From the time of admission until 14 days after surgery, the poor-outcome group exhibited significantly (P < 0.005) higher WBC counts, compared with the good-outcome group. The same was true for C-reactive protein levels, with the exception that no differences between groups were observed until 8 days after surgery. Factors such as cervicothoracic abscess locations (P = 0.041), lower limb motor deficits (P = 0.005), complete paralysis (P = 0.005), and WBC counts of more than 14,000 cells/microl (P = 0.049) at admission were observed to be prognostic for poor outcomes. CONCLUSION: Surgical decompression combined with antimicrobial therapy remains the recommended treatment. In addition to abscess locations and motor deficits, inflammatory markers such as WBC counts and C-reactive protein levels are prognostic for outcomes.

Adult↗