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PubMed1981

Ménière's disease: endolymphatic sac decompression compared with sham (placebo) decompression.

The placebo effect in surgery for Ménière's disease was investigated in a double-blind, controlled surgery by comparing the effect of a regular endolymphatic shunt with the effect of a purely placebo operation (regular mastoidectomy). Thirty patients with typical Ménière's disease participated in the study. They were selected for surgery because of unsuccessful medical treatment and were chosen randomly for each treatment group. The patients filled in daily dizziness questionnaires for 3 months before and 12 months after surgery, registering nausea, vomiting, vertigo, tinnitus, hearing impairment, and pressure in the ears. The patients were operated on in two university ENT departments. Those operated on in one department were controlled each month at the other department, and vice versa. At the termination of the trial, the investigators as well as the patients gave their overall opinion of the efficacy of the operation. Minor differences could be demonstrated between the active and the placebo group, but the greatest difference in symptoms was found when comparing pre- and postoperative scores, in which both groups improved significantly.

Adult↗
PubMed2000

Effect of prior orbital decompression on outcome of strabismus surgery in patients with thyroid ophthalmopathy.

PURPOSE: To compare strabismus surgery outcomes of patients who have had prior orbital decompression for thyroid ophthalmopathy with those of patients who have not had decompression. METHODS: The records of all patients operated on by the author for strabismus related to thyroid ophthalmopathy were retrospectively reviewed. RESULTS: Fifty patients were included in this study. Seventeen patients had previously undergone orbital decompression, and 33 patients had not. Seventy-six percent of patients who had had orbital decompression had a good or excellent outcome compared with 91% of those who had not had orbital decompression. Patients in the orbital decompression group had an average of 1.4 operations compared with 1.2 in the no-decompression group. The average numbers of muscles operated on were 3.1 in the decompression group and 1.9 in the no-decompression group. Patients who had been decompressed were more than 4 times as likely to require surgery for both a horizontal and vertical deviation than patients who had not been decompressed. CONCLUSIONS: Patients with thyroid ophthalmopathy who have had orbital decompression have a lower success rate of surgery for strabismus, more frequently need correction for both horizontal and vertical deviations, and have more muscles operated on than patients who have not had orbital decompression. The need for orbital decompression in patients with Graves' disease is reflective of a worse degree of orbitopathy. In addition, ocular changes from decompression surgery may interfere with a successful result from strabismus surgery.

Decompression, Surgical↗
PubMed1997

Early time-dependent decompression for spinal cord injury: vascular mechanisms of recovery.

Although surgical decompression is often advocated for acute spinal cord injury, the timing and efficacy of early treatment have not been clinically proven. Our objectives were to determine the importance of early spinal cord decompression on recovery of evoked potential conduction under precision loading conditions and to determine if regional vascular mechanisms could be linked to electrophysiologic recovery. Twenty-one mature beagles were anesthetized and mechanically ventilated to maintain normal respiratory and acid-base balance. Somatosensory-evoked potentials from the upper and lower extremities were measured at regular intervals. The spinal cord at T-13 was loaded dorsally under precision loading conditions until evoked potential amplitudes had been reduced by 50%. At this functional endpoint, spinal cord displacement was maintained for either 30 (n = 7), 60 (n = 8), or 180 min (n = 6). Spinal cord decompression was followed by a 3-h monitoring period. Regional spinal cord blood flow was measured with fluorescent microspheres at baseline (following laminectomy) immediately after stopping dynamic cord compression, 5, 15, and 180 min after decompression. Within 5 min after stopping dynamic compression, evoked potential signals were absent in all dogs. We observed somatosensory-evoked potential recovery in 6 of 7 dogs in the 30-min compression group, 5 of 8 dogs in the 60-min compression group, and 0 of 6 dogs in the 180-min compression group. Recovery in the 30- and 60-min groups varied significantly from the 180-min group (p < 0.05). Regional spinal cord blood flow at baseline, 21.4+/-2.2 ml/100/g/min (combined group mean +/- SE) decreased to 4.1+/-0.7 ml/100 g/min after stopping dynamic compression. Reperfusion flows after decompression were inversely related to duration of compression. Of the 7 dogs in the 30 min compression group, 5 min after decompression the blood flow was 49.1+/-3.1 ml/100 g/min, which was greater than two times baseline. In the 180-min compression group early post-decompression blood flow, 19.8+/-6.2 ml/100 g/min, was not significantly different than baseline. Of the 8 dogs in the 60-min compression group, 5 who recovered evoked potential conduction revealed a lower spinal cord blood flow sampled immediately after stopping dynamic compression, 2.1+/-0.4 ml/100 g/min, compared to the 3 who did not recover where blood flow was 8.4+/-2.1 ml/100 g/min (p < 0.05). Reperfusion flows measured as the interval change in blood flow between the time dynamic compression was stopped to 5, 15, or 180 min after decompression, were significantly greater in those dogs that recovered evoked potential function (p < 0.05). Three hours after decompression, spinal cord blood flow in the 3 dogs in the 60-min compression group with no recovery, 11.1+/-2.1 ml/100 g/min, was significantly less than the spinal cord blood flow of the recovered group (n = 5), 20.5+/-2.2 ml/100 g/min. These data illustrate the importance of early time-dependent events following precision dynamic spinal cord loading and sustained compression conditions. Spinal cord decompression performed within 1 h of evoked potential loss resulted in significant electrophysiologic recovery after 3 h of monitoring. This study showed that the degree of early reperfusion hyperemia after decompression was inversely proportional to the duration of spinal cord compression and proportional to electrophysiologic recovery. Residual blood flow during the sustained compression period was significantly higher in those dogs that did not recover evoked potential function after decompression suggesting a reperfusion injury. These results indicate that, after precise dynamic spinal cord loading to a point of functional conduction deficit (50% decline in evoked potential amplitude), a critical time period exists where intervention in the form of early spinal cord decompression can lead to effective recovery of electrophysiologic function in the 1- to 3-h post-decompression p

Animals↗
PubMed2000

Strabismus after balanced medial plus lateral wall versus lateral wall only orbital decompression for dysthyroid orbitopathy.

PURPOSE: This study aimed to determine the relative incidence and time course of new-onset strabismus after balanced medial plus lateral wall orbital decompression versus decompression of the lateral wall alone for dysthyroid orbitopathy. METHODS: The study design was a retrospective nonrandomized comparative case series. Thirty-two consecutive patients underwent balanced medial plus lateral wall orbital decompression or lateral wall orbital decompression for dysthyroid orbitopathy. The incidence, duration, and treatment of postoperative strabismus was recorded for each patient. RESULTS: Significant preoperative strabismus was present in 31% (4/13 patients) of the balanced decompression group and in 26% (5/19 patients) of the lateral wall decompression group. Only 25% (1/4) of cases of preexisting strabismus in the balanced decompression group resolved postoperatively without muscle surgery, whereas 60% (3/5) of cases in the lateral wall decompression group resolved postoperatively without surgery. Preoperative strabismus was absent in 69% (9/13) of patients in the balanced decompression group and in 74% (14/19) of patients in the lateral wall decompression group. New-onset, persistent postoperative strabismus developed in 33% (3/9) of patients in the balanced decompression group and in 7% (1/14) of patients in the lateral wall decompression group. CONCLUSION: Lateral wall orbital decompression may produce less new-onset, persistent postoperative strabismus than balanced medial plus lateral wall orbital decompression for dysthyroid orbitopathy.

Adult↗
PubMedDate not supplied

Comparison of clinical and radiographic outcome in instrumented anterior cervical discectomy and fusion with or without direct uncovertebral joint decompression.

BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) is an established procedure for the operative treatment of cervical disc disease in patients with radiculopathy resulting from impingement from uncovertebral joint osteophytes. Studies demonstrate that direct decompression of the lesion provides good result. However, known complications include vertebral artery injury, dural tears, nerve root injury, loss of biomechanical stability and increased operative time. Other studies suggest that disc space distraction may play an important role by indirectly decompressing neural elements. Therefore, if equivalent functional outcomes can be achieved without sacrificing the uncovertebral joint, then potential morbidity and mortality could be decreased. PURPOSE: To assess and compare clinical and radiographic outcomes of patients with neck pain and cervical radiculopathy who underwent instrumented ACDF with or without direct uncovertebral joint decompression. STUDY DESIGN/SETTING: Retrospective clinical chart and radiographic review to assess clinical outcome and graft fusion in 109 patients who underwent one- or two-level ACDF with rigid anterior plate fixation. PATIENT SAMPLE: Radiographs and clinical charts for 109 patients (mean, 46 years; range, 27 to 83) who underwent ACDF with rigid anterior plate fixation were retrospectively reviewed at a single institution. Patients with radiculopathy resulting from herniated disc, spondylosis or a combination of both refractory to conservative treatment underwent surgery using a standard Smith-Robinson left-sided approach. Seventy-one patients who received direct uncovertebral joint decompression (Group 1) were compared with 38 patients without direct decompression but indirect decompression by disc space distraction (Group 2). In Group 1, 37 one-level and 34 two-level ACDFs were performed. In Group 2, 11 and 27 were one-level and two-level ACDFs, respectively. Smoking and work-related injuries involved 26.7% and 38.0% of Group 1 and 28.9% and 28.9% of Group 2, respectively. Autologous iliac crest grafts were used in 51 patients, whereas 58 patients received allograft. OUTCOME MEASURES: Independent blinded analyses of plain lateral neutral, flexion and extension radiographs were conducted to assess fusion, evaluate graft and plate and screw integrity (mean, 12 months). Clinical outcomes were reported as excellent, good, fair or poor (mean, 23 months) based on Odom's criteria. METHODS: Postoperative clinical outcome and radiographic studies of graft and instrument integrity were assessed in 71 patients undergoing ACDF with uncovertebral joint decompression and 38 patients without uncovertebral joint decompression, but with indirect decompression through disc space distraction. RESULTS: Fusion occurred in 95.8% of Group 1 and 100% of Group 2. In Group 1, 26.8% of the patients reported excellent results, 57.7% reported good results, 12.7% reported fair results and 2.8% reported poor results. In Group 2, 23.7% of the patients reported excellent results, 60.5% reported good results and 15.8% reported fair results. All nonunions reported good outcomes. Postoperative respiratory distress developed in one patient and dysphagia developed in another both from Group 1. No other complications were noted. The presence or absence of direct uncovertebral joint decompression and clinical outcome was not statistically significant (p>.05). The use of graft-type, operative level, presence of smoking and work-related injury in relation to clinical outcome was not found to be significant (p>.05). CONCLUSION: Good to excellent results were obtained in 84.5% and 84.2% of patients for Groups 1 and 2, respectively. Indirect foraminal decompression through distraction remains somewhat controversial during ACDF. However, sacrificing the uncovertebral joint can increase operative time and potentially increase complication rates. This study demonstrates that ACDF with or without direct uncovertebral joint decompression can provide good clinical results for neck pain with cervical radiculopathy. Therefore, routine direct uncovertebral joint decompression should not be undertaken during ACDF.

Cervical Vertebrae↗
PubMed1993

Active compression-decompression resuscitation: analysis of transmitral flow and left ventricular volume by transesophageal echocardiography in humans. Cardiopulmonary Resuscitation Working Group.

OBJECTIVES: This study was designed to test the hypothesis that active compression-decompression cardiopulmonary resuscitation increases transmitral flow and end-decompression left ventricular volume over levels achieved with standard manual cardiopulmonary resuscitation. BACKGROUND: Recently, cardiopulmonary resuscitation incorporating active compression and decompression of the chest has been demonstrated to improve hemodynamic status in a canine model and in humans after cardiac arrest. METHODS: The active compression-decompression device was applied midsternum in five consecutive patients and results compared sequentially (in random order) with those of standard manual cardiopulmonary resuscitation. Both techniques were performed at 80 compressions/min with a 1.5- to 2-in. (3.8 to 5.1 cm) compression depth and a 50% duty cycle. Transesophageal echocardiographic data obtained in each patient included the velocity-time integral of transmitral pulsed Doppler recordings and two-dimensional images of the left ventricle in the long-axis view. Planimetric volume measurements of the left ventricle were obtained at both end-compression and end-decompression. RESULTS: No difference was observed in end-compression volume between the two techniques (p = 0.81). Increased end-decompression volume (active compression-decompression technique 81.3 +/- 12.5 vs. standard technique 69.4 +/- 10.8, p < 0.05), stroke volume (active compression-decompression technique 32.6 +/- 6.8 vs. standard technique 17.6 +/- 5.2, p < 0.05) and velocity-time integral of transmitral flow (active compression-decompression technique 15.8 +/- 4.3 vs. standard technique 7.8 +/- 2.3, p < 0.05) were found in the active compression-decompression group. The transmitral velocity-time integral was highly correlated with left ventricular stroke volume (r = 0.90). CONCLUSIONS: Improved transmitral flow, end-decompression left ventricular volume and stroke volume are seen with active compression-decompression resuscitation, suggesting a biphasic cardiothoracic cycle of flow. Active decompression of the chest appears to be a beneficial adjunct to standard cardiopulmonary resuscitation.

Aged↗
PubMed2005

[Core decompression of the femoral head for avascular necrosis].

PURPOSE OF THE STUDY: Core decompression of the femoral head is a conservative surgical treatment with controversial efficacy. We studied retrospectively a series of 32 cases of femoral head osteonecrosis treated by core decompression between 1988 and 2000 in 25 patients. We examined the epidemiological and clinical features as well as the laboratory findings, comparing cases requiring secondary hip replacement and those who had a favorable outcome. We search for prognostic factors. MATERIAL AND METHODS: The series included 32 hips, one case was lost to follow-up. Mean age at decompression was 41.3 years (22-55). In eight hips, osteonecrosis was favored by corticosteroid treatment, in three by chronic alcoholism, and in one by hypertriglyceridemia. No favoring factors were present for 20 hips. According to the ARCO classification there were 15 stage I hips, 13 stage II, 3 stage III, and one stage IV. Core decompression was centered in 24 hips and mean time to decompression was 6.4 months (14 days to 40 months). We reviewed hips without a total prosthesis using the Postel-Merle-d'Aubigne function score and for the radiological assessment the ARCO stage and the Koo index. RESULTS: Favorable outcome was noted in 12 hips. Total hip arthroplasty was required for 19, one hip was lost to follow-up. Mean follow-up in the success group was 82 months (26-176) and mean "time of participation" in the failure group was 11 months (1-38). Mean survival after core decompression was 14 months. Time between onset of symptoms and decompression did not influence outcome. Lesions which remained asymptomatic before decompression remained stable. The stage I hips did not have more favorable outcome than the stage II hips (p < 0.05). Stage III or IV hips had unfavorable outcome. Hips with a Koo index > 40 had a poor outcome (p < 0.05). DISCUSSION: Epidemiological factors which can worsen outcome after core decompression for osteonecrosis are controversial in the literature. Early stage disease (I or II) is considered as an ideal indication for decompression, but is insufficient alone to guarantee success. As other authors, we consider that ARCO stage III and IV and a Koo index > 40 are contraindications for decompression. Improved outcome after core decompression can only be achieved by limiting indications.

Adrenal Cortex Hormones↗
PubMed1998

The incidence of diplopia following coronal and translid orbital decompression in Graves' orbitopathy.

PURPOSE: Firstly, to assess the incidence of induced diplopia following orbital decompression in patients with Graves' orbitopathy. Secondly, to assess patient satisfaction after orbital decompression. Thirdly, to determine the factors that contribute to the variable reported incidence of diplopia complicating decompression surgery. METHODS: We present a retrospective analysis of the alterations of ocular motility in a consecutive series of 81 patients with Graves' orbitopathy who underwent orbital decompression by either a coronal or a translid approach. We assessed patient satisfaction by a telephone survey, and we reviewed the literature. RESULTS: Eleven patients underwent decompressive surgery for dysthyroid optic neuropathy (DON); 5 of them had a three-wall coronal decompression, the other 6 had a two-wall translid decompression. One of the 5 (20%) coronal versus 2 of the 6 (33%) traslid patients experienced worsening of their existing diplopia. Seventy patients underwent surgery for disfiguring proptosis; 41 of them had a coronal decompression and 29 had a translid decompression. Eight of the 41 coronal patients (20%) and 4 of the 29 translid patients (14%) experienced aggravation of their motility impairment. There was no statistically significant difference between these percentages (chi-squared, p > 0.05). Three of 26 coronal patients (12%) without pre-operative motility impairment developed diplopia in all directions. Twenty-five per cent needed strabismus surgery (9% multiple times). High satisfaction scores were noted after both types of orbital decompression. Through a review of the literature, several factors that may add to heterogeneous results were identified, including definition of diplopia, inclusion criteria and type of surgery. CONCLUSIONS: Induced diplopia is seen after any type of orbital decompression (19% overall), and its incidence is determined by various factors. To facilitate comparative studies between decompression techniques, a standardised protocol for orthoptic evaluation should be developed.

Adult↗
PubMed2006

Effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine: usefulness of the ossification-kyphosis angle on MRI.

STUDY DESIGN: A reliability study was conducted. OBJECTIVE: To report the utility of the ossification- kyphosis angle of a decompression site in the sagittal view of MRI in the preoperative evaluation of the effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine. SUMMARY OF BACKGROUND DATA: In patients with ossification of the posterior longitudinal ligament, in the thoracic spine, posterior decompression may not always be effective for those with physiologic kyphosis; however, posterior decompression is sometimes useful for patients with multilevel lesions or with ossification of the ligamentum flavum. Therefore, it is necessary to evaluate the indications or limitations of posterior decompression before surgery. METHODS: The indications or limitations of posterior decompression for this disease were reviewed from the findings of intraoperative ultrasonography and various parameters on preoperative imaging in 22 patients with thoracic myelopathy. RESULTS: Thirteen patients had echo-free space and 9 patients had no echo-free space in intraoperative ultrasonography after posterior decompression. In the kyphosis angle of the decompression site and the configuration of the maximal prominent OPLL, there was no significant difference between the group with echo-free space and the group without echo-free space (P = 0.49, P = 0.55). On the other hand, the ossification-kyphosis angle of the decompression site was more than 23 degrees in all patients with no echo-free space (23 degrees -34 degrees , 28.2 degrees +/- 3.6 degrees ), and it was less than 23 degrees in all patients with echo-free space (10 degrees -23 degrees , 17.4 degrees +/- 4.1 degrees ). There was also significant difference between the groups statistically (P < 0.01, P = 1.50789E-06). In addition, in the occupation rate of the greatest prominence of the OPLL, there was statistically significant difference between the groups (P = 0.032). CONCLUSION: The ossification-kyphosis angle in the sagittal view of MRI has potential as an indicator of the effectiveness of posterior decompression in this disease. It is thought that there is a critical point of posterior decompression at nearly 23 degrees of the ossification-kyphosis angle of the decompression site. When the ossification-kyphosis angle is more than 20 degrees , the presence of echo free space should be carefully confirmed in intraoperative ultrasonography.

Adult↗
PubMed1980

The detection of gas bubbles in guinea-pigs after decompression from air saturation dives using ultrasonic imaging.

1. Bubble formation in the hind limb of anaesthetized guinea-pigs, after decompression from two different saturation exposures to air, 0.69 and 0.83 MPa gauge, has been studied using an ultrasonic pulse--echo imaging technique. 2. A qualitative analysis of the bubble formation, observed over a 30 min period after decompression, showed that profuse, largely stationary bubble formation occurred within 3 min of the decompression from 0.83 MPa gauge but that extensive stationary bubble formation was not observed until 17 min after decompression from 0.69 MPa gauge. Electrocardiogram changes appeared coincidently with the appearance of major bubble formation after the 0.83 MPa decompression but after the 0.69 MPa decompression changes were not observed until the end of the 30 min surveillance period, considerably later than the occurrence of a large number of bubbles. 3. A quantitative analysis of the echo patterns recorded during the 60 sec decompression and for 60 sec after the decompression demonstrated that the increase in severity of the decompression corresponded to an increase of 152% in the number of bubbles observed. The echoes observed during this period have been identified as either transient or persistent and their distribution of size, location and times of appearance and duration have been described. 4. From the quantitative analysis approximate estimates of the contribution by mobile, intravascular gas bubbles to the elimination of the excess gas have been made. These estimates range from 0.01 to 0.9% after the 0.69 MPa decompression and from 0.06 to 6% after the 0.83 MPa decompression. 5. It is concluded that the pulse--echo ultrasonic imaging technique provides a powerful means of analysing the distributions of bubble formation, both qualitatively and quantitatively, after decompression; it has the important attribute of being able to monitor both moving and stationary bubbles simultaneously in a variety of tissue types.

Animals↗
PubMed2006

Decompressive laparotomy for abdominal compartment syndrome--a critical analysis.

INTRODUCTION: Abdominal compartment syndrome (ACS) is increasingly recognized in critically ill patients, and the deleterious effects of increased intraabdominal pressure (IAP) are well documented. Surgical decompression through a midline laparotomy or decompressive laparotomy remains the sole definite therapy for ACS, but the effect of decompressive laparotomy has not been studied in large patient series. METHODS: We reviewed English literature from 1972 to 2004 for studies reporting the effects of decompressive laparotomy in patients with ACS. The effect of decompressive laparotomy on IAP, patient outcome and physiology were analysed. RESULTS: Eighteen studies including 250 patients who underwent decompressive laparotomy could be included in the analysis. IAP was significantly lower after decompression (15.5 mmHg versus 34.6 mmHg before, p < 0.001), but intraabdominal hypertension persisted in the majority of the patients. Mortality in the whole group was 49.2% (123/250). The effect of decompressive laparotomy on organ function was not uniform, and in some studies no effect on organ function was found. Increased PaO2/FIO2 ratio (PaO2 = partial pressure of oxygen in arterial blood, FiO2 = fraction of inspired oxygen) and urinary output were the most pronounced effects of decompressive laparotomy. CONCLUSION: The effects of decompressive laparotomy have been poorly investigated, and only a small number of studies report its effect on parameters of organ function. Although IAP is consistently lower after decompression, mortality remains considerable. Recuperation of organ dysfunction after decompressive laparotomy for ACS is variable.

Abdomen↗