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At least 55 records · Page 3Linked to original sources

[Cubital tunnel syndrome--simple nerve decompression or decompression with subcutaneous anterior transposition?].

The purpose of this prospective, randomised and controlled study was to evaluate which kind of operative technique for treatment of cubital tunnel syndrome is favourable: subcutaneous anterior transposition or nerve decompression without transposition. This study included 66 patients suffering from pain and/either neurological deficits with clinically and electrographically proven cubital tunnel syndrome. 32 patients underwent nerve decompression without transposition, whereas 34 underwent subcutaneous transposition of the nerve. Follow-up examinations evaluating pain, motor and sensory deficits as well as motor nerve conduction velocities were performed three, nine and 24 months postoperatively. Irrespectively of operative procedures (simple decompression vs. subcutaneous anterior transposition) there were no significant differences between the outcomes of the two groups at either postoperative follow-up examination (p > 0.05).

Aged↗

Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone.

One hundred twenty-four patients with degenerative lumbar stenosis underwent decompression with fusion (32 patients) and without fusion (92 patients) during a 30-month period between 1986 and 1988. Patient-reported satisfaction at a mean follow-up period of 5.8 years (range 4.6-6.8 years) revealed a 79% good or fair outcome and a 21% poor outcome (26 patients). Seven patients (6%) developed lumbar instability, three patients (2%) developed new stenosis at an adjacent unoperated level, and three patients (2%) developed a new disc herniation between 2 and 5 years after surgery. Progressive postoperative spondylolisthesis occurred in 31% of patients with normal preoperative alignment (mean 7.8 mm, range 2-20 mm) and in 73% of patients with preoperative subluxation (mean 5.1 mm, range 2-13 mm) in whom fusion was not attained. Radiological progression did not correlate well with patient-reported outcome. The major conclusions from this study are the following: 1) the majority of patients respond well to this surgery, but complication (22%) and late deterioration (10%) rates are not insignificant; 2) radiological instability is common after decompression for degenerative lumbar spinal stenosis, but this correlates poorly with clinical outcome; 3) there are no definitive clinical or radiological factors that preoperatively predict patients at risk for a poor outcome; 4) post-operative radiological instability is more likely to occur when the following criteria are present: preoperative spondy-degenerated L-4 or a markedly degenerated L-3 disc; and when a radical and extensive decompression greater than one level is planned; and 5) the group at greatest risk for a poor outcome consists of those patients with normal preoperative alignment who do not suffer slippage following surgery.

Adult↗

[Comparative study of decompression-induced formation of gas bubbles using ultrasonic equipment and the development of altitude-decompression disorders].

442 altitude experiments on 40 volunteers were performed. Gas bubbles in venous blood were detected using an ultrasonic Doppler system functioning in a continuous mode at a frequency of 5 MHz. The threshold of bubble formation was identified in 31 test subjects and that of emergency of altitude-decompression disorders, in 28 test subjects. Individual resistance to decompression-induced bubbles was revealed. It was shown that the thresholds may vary with time, in the head-down position and in the head-down position combined with exercises. A correlation was established between the rate of intravascular bubble formation and the frequency of altitude-decompression disorders.

Adult↗

Does microsurgical vascular decompression for trigeminal neuralgia work through a neo-compressive mechanism? Anatomical-surgical evidence for a decompressive effect.

The positive effect of Microsurgical Vascular Decompression (MVD) on idiopathic trigeminal neuralgia still remains controversial between a decompressive mechanism and a "neo-compressive" one. This paper is a summary of a comparative study of the results on pain obtained with two technical modifications of the MVD procedure. The first consisted of interposition of a foreign material between the nerve and the transposed artery after dissection of the trigeminal nerve, whilst in the second the offending vessel(s) was dislodged without using any material touching the nerve. The two series of 60 patients in each were similar concerning the clinical features. Evaluation of results on neuralgia - with one year follow-up-in both series, shows that the technique used in the second group was not followed by a higher rate of recurrence than the technique used in the first group. On the contrary; 4.5% in the 2nd group compared to 10% in the first. This indicates that MVD would not act as a result of "neo-compression" of the nerve, but rather through a real decompressive mechanism.

Arteries↗

Incomplete chest wall decompression: a clinical evaluation of CPR performance by trained laypersons and an assessment of alternative manual chest compression-decompression techniques.

BACKGROUND: Complete chest wall recoil improves hemodynamics during CPR by generating relatively negative intrathoracic pressure, which draws venous blood back to the heart, providing cardiac preload prior to the next chest compression. OBJECTIVE: This study was designed to assess the quality of CPR delivered by trained laypersons and to determine if a change in CPR technique or hand position would improve complete chest wall recoil, while maintaining adequate duty cycle, compression depth, and proper hand position placement. Standard manual CPR and three alternative manual CPR approaches were assessed. METHODS: This randomized prospective trial was performed on an electronic test manikin. Thirty laypersons (mean age of 40.6 years (range 28-55)), who were trained in CPR within the last 24 months, signed an informed consent and participated in the trial. Subjects performed 3 min of CPR on a Laerdal Skill Reportertrade mark CPR manikin using the Standard Hand Position followed by 3 min of CPR (in random order) using three alternative CPR techniques: (1) Two-Finger Fulcrum Technique - lifting the heel of the hand slightly but completely off the chest during the decompression phase of CPR using the thumb and little finger as a fulcrum; (2) Five-Finger Fulcrum Technique - lifting the heel of the hand slightly but completely off the chest during the decompression phase of CPR using all five fingers as a fulcrum; (3) Hands-Off Technique - lifting the heel and all fingers of the hand slightly but completely off the chest during the decompression phase of CPR. The participants did not know the purpose of the study prior to, or during this investigation. RESULTS: Adequate compression depth was poor for all hand positions tested and ranged only from 18.6 to 35.7% of all compressions. When compared with the Standard Hand Position, the Hands-Off Technique decreased the mean compression duty cycle from 39.0 +/- 1.0 to 33.5 +/- 1.0%, (P < 0.0001) but achieved the highest rate of complete chest wall recoil (92.5% versus 24.1%, P < 0.0001) and was 46.3 times more likely to provide complete chest wall recoil (OR: 46.3; CI: 16.4-130.3). There were no significant differences in accuracy of hand placement, adequate depth of compression, or perceived discomfort with its use compared with the Standard Hand Position. CONCLUSIONS: The Hands-Off Technique decreased compression duty cycle but was 46.3 times more likely to provide complete chest wall recoil (OR: 46.3; CI: 16.4-130.3) compared to the Standard Hand Position without differences in accuracy of hand placement, adequate depth of compression, or perceived discomfort with its use. All forms of manual CPR tested (including the Standard Hand Position) in trained laypersons produced an inadequate depth of compression for two-thirds of the time. These data support development and testing of more effective layperson CPR training programmes and more effective means to deliver manual as well as mechanical CPR.

Adult↗

Medical decompression of toxic megacolon by "rolling". A new technique of decompression with favorable long-term follow-up.

We treated 19 consecutive patients with toxic megacolon complicating inflammatory bowel disease with the usual intensive medical regimen, but also added a new technique, namely, the frequent rolling of the patient to the prone position in order to redistribute colonic gas and thereby promote decompression. In all 19 patients (100%) the colon was decompressed within 1-13 days (mean 4.9 days). Two patients (10.5%) died. In long-term follow-up (mean 6.5 years), only 4 of the 17 survivors (21%) ultimately required colectomy; the remaining 13 (68%) were either completely well or only minimally symptomatic and did not require steroids. Most reports on the management of toxic megacolon stress the need for early surgical intervention, but our success in decompression with the addition of the "rolling technique" suggests an improvement in the nonoperative management of toxic megacolon.

Adult↗

[Evaluation of the risk of decompression disease during hypobaric decompression from the standpoint of the probability theory].

Author's probabilistic theory of decompression sickness (DS) asserts that DS risk for human subjects during a single-stage reduction of pressure will be rated by distribution of estimated nucleation efficiency in the "worst" body tissues and its critical value as a function of initial nitrogen pressure, end-pressure, and bubble growth dynamics. The method was tested in the analysis of literature on the DS risk during altitude exposures with preliminary denitrogenation of varying length. Results of the analysis suggest that washing out half of nitrogen from the "worst" tissues will take minimum 480 minutes instead of 360 minutes. Calculated parameters of nucleation in tissues were used to plot DS risk due to hypobaric decompression against the final pressure. Influence of physical activity on nucleation parameters and DS risk curves is discussed.

Decompression↗

[Viral infection, the mask of decompression sickness and decompression sickness diagnosed as viral infection].

Two cases of diving persons: a soldier from the military centre of divers training and a student amateur diver, have been presented in the study. On the basis of similar symptoms--among others: muscular pain, discomfort, subfebrile body temperature, extremely different, incorrect diagnoses were given and improper treatment was introduced. In the case of the soldier suffering from a viral infection decompression sickness was diagnosed only because he served in a divers unit. Whereas, in the second case a physician did not take into consideration all available history data and diagnosed influenza despite evident symptoms of decompression sickness. In the discussion the factors which should have guided the physician in both cases to proper diagnosis and proper therapeutic management have been indicated.

Adult↗

[New surgical technique of anterior decompression for cervical disc disease: vertebral column autograft with the intervertebral disc after anterior cervical decompression].

The authors describe the surgical technique of vertebral column autograft with the intervertebral disc after anterior decompression for cervical disc disease. This series consisted of 41 patients with cervical disc disease suffering from cervical spondylotic radiculomyelopathy. There were 27 men and 14 women, ranging in age from 27 to 72 years (mean age 49 years). 33 patients were operated on at one level and 8 patients at two levels. The average postoperative follow-up period was one year 10 months and ranged from 6 months to 3 years 3 months. The patients were generally allowed out of bed wearing a soft collar within 1 day postoperatively. The collar was used for 2 months after surgery. The postoperative course of all patients was uneventful and neurological symptoms improved. Postoperative X-ray films showed some movement in the operated disc level in all patients. The authors think that this surgical procedure may be suitable for preserving mobility of the spine.

Adult↗

[Decompression of the ulnar wrist joint compartment by decompression osteotomy of the head of the ulna].

Both post-traumatic shortening of the radius and positive ulnar variance can lead to a compression syndrome in the ulnar compartment of the wrist. The indication for a decompression osteotomy of the ulnar head after a distal radius fracture is limited to only those cases in which there is a slight shortening without a deviation of the axis of the distal radius. In order to enlarge the space between the ulnar head and proximal row of the carpal bones, a 2 to 3 mm slice is taken from the ulnar head by means of two oblique, parallel osteotomies and fragment retention with two screws. 47 patients were re-examined after an average period of 3 1/2 (1 to 8) years. In 23 cases the results were very good and in 17 cases good. In five cases the results were poor. In two cases, the bone did not heal and the Kapandji-Sauvé procedure was performed.

Adult↗

Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis.

Fifty patients who had spinal stenosis associated with degenerative lumbar spondylolisthesis were prospectively studied clinically and radiographically to determine if concomitant intertransverse-process arthrodesis provided better results than decompressive laminectomy alone. There were thirty-six women and fourteen men. The mean age of the twenty-five patients who had had an arthrodesis was 63.5 years and that of the twenty-five patients who had not had an arthrodesis, sixty-five years. The level of the operation was between the fourth and fifth lumbar vertebrae in forty-one patients and between the third and fourth lumbar vertebrae in nine patients. The patients were followed for a mean of three years (range, 2.4 to four years). In the patients who had had a concomitant arthrodesis, the results were significantly better with respect to relief of pain in the back and lower limbs.

Aged↗

Surgical management of Meniere's disease with endolymphatic sac decompression by wide bony decompression of the posterior fossa dura: technique and results.

The results of wide bony decompression of the posterior fossa in 49 consecutive individuals with idiopathic unilateral Meniere's disease are reported. These results are similar to many previously published series, 71% of individuals are free of vertigo and 86% have unchanged or improved hearing. Utilizing the classification proposed by the American Academy of Ophthalmology and Otolaryngology, 73% fell into Class A, B, or C with relief of vertigo. These results together with the low complication rate encourages us to consider surgery at an earlier date, hoping to stabilize hearing at a more useful level and to relieve vertigo.

Adolescent↗