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At least 145 records · Page 8Linked to original sources
PubMed1999

Long-term results of the use of silicone sheets after diskectomy in the temporomandibular joint: clinical, radiographic and histopathologic findings.

The aim of the present study was to evaluate the long-term results of a group of patients who had the disk of the temporomandibular joint (TMJ) removed and permanently replaced by a silicone sheet. The study group comprised 48 patients, treated in the period from 1983 to 1993. In eight patients, the implants had to be removed after an average interval of 5.6 years and they were submitted for histopathological examination. Twenty-five of the 40 patients with silastic implants in place, and five of the 8 patients who had their implants removed, were available for long-term follow-up (mean interval of 7.0 years, SD 2.8 years). Clinical function was rated according to the Helkimo Dysfunction Index and compared to the preoperative findings. Results showed decreased tenderness of muscles and joints to palpation and increased mouth opening, but no statistically significant improvement in joint function. In 4 patients, a decrease in condylar width was found, while another 4 patients presented with thickening of the condyle by appositional bone formation. Histopathology of the failed implants showed scattered fragments of silastic material and dacron fibers with accumulation of histiocytes in immediate contact with the silicone particles and phagocytozed intracellular material. T-lymphocytes were also present in the vicinity of the silicone particles.

Adult↗
PubMed1992

[The use of propofol during diskectomy in neurosurgery].

The intravenous anaesthetic agent propofol has become more and more popular not only for induction but also for the maintenance of anaesthesia in all fields of surgery. For this purpose, different infusion rates and also combinations of propofol with opioids, nitrous oxide and volatile anaesthetic agents have been described. The present study was designed to find the best dosage regimen for short operations and rapid changes. The necessity for the frequently recommended standardized combination of propofol with opioids should be checked with respect to the cardiovascular effects. METHODS. A series of 60 patients (ASA I and II, age range 22-79 years) selected for discectomy were prospectively randomized to three groups. Half an hour before operation all patient received 0.5 mg atropine, 50 mg promethazine and 50 mg pethidine as i.m. premedication. In all groups anaesthesia was induced with propofol in a bolus dose of 2.5 mg/kg body weight over a period of approximately 45 s. After 5 mg atracurium the patients were intubated under 100 mg succinylcholine and normoventilated with 70% nitrous oxide and 30% oxygen. For relaxation 25 mg of atracurium were given. In group I propofol was administered in a dosage of 15 mg/kg body weight per hour for 10 min after induction. After this time the propofol infusion was reduced to 6 mg/kg body weight per hour. Group II received 0.1 mg fentanyl before induction. The dosage of propofol was similar to group I. In group III 0.1 mg of fentanyl was administered before induction and propofol was given with an infusion rate of 6 mg/kg body weight from the beginning. The following parameters were controlled and documented: systolic and diastolic blood pressure (SAP and DAP), heart rate (HF), end-expiratory carbon dioxide (eeCO2), inspiratory oxygen concentration (FiO2) and peripheral oxygen saturation (sO2). Recovery time was determined as the time from the end of the propofol infusion until eye-opening on command. RESULTS. In all groups anaesthesia could be induced and maintained without complications. There was a slight increase in SAP in group I after intubation, while in the groups with fentanyl a pronounced decrease of SAP was found simultaneously with induction of anaesthesia (Fig. 1). In group I HF showed significantly higher values after intubation and for the next 15 min than in group II and group III. A rapid and pronounced increase of end-tidal carbon dioxide occurred in the fentanyl groups with the beginning of spontaneous ventilation at the end of anaesthesia. There was a significantly longer recovery time in group II with fentanyl and initial higher propofol infusion rate. A correlation between dosage of propofol and recovery time could not be found. DISCUSSION. The results of this study demonstrate that a routine combination of propofol with opioids is not necessary even for painful surgical procedures if the propofol dosage is initially increased. There are differences in cardiovascular reactions between group I without and groups II and III with fentanyl, but in our patients these changes were of no clinical importance. An additional administration of fentanyl can prevent hypertensive reactions or tachycardia with intubation, but on the other hand fentanyl can also increase the cardial depression of propofol with a dangerous decrease in blood pressure and heart rate. Therefore in combination with opioids lower doses of propofol should be used for induction and maintenance of anaesthesia. If opioids are administered, signs of a residual postoperative respiratory depression have to be taken seriously.

Adult↗
PubMed1991

[Directed photonucleolysis of the intervertebral disk and its herniation. Preparation for percutaneous laser diskectomy].

Under model conditions it proved possible, using a whole-body stereotactic apparatus, to focus on a human intervertebral disc and its prolapses and eliminate them by photocoagulation, using a laser. The suitable cannulae have a 3 mm diameter and an output of 6 to 12 W. The necessary lesion is reached in a fractionated manner within 1 minute. Thus the conditions were created for the new technique of percutaneous disectomy which has been done hitherto by means of chemical substances or mechanically by incision and suction.

Humans↗
PubMed1990

[Clinical experience with automated percutaneous diskectomy].

Percutaneous automated aspiration discectomy (Nucleotome, Surgical Dynamics) is a new procedure for treating herniated lumbar discs. In a series of 35 patients, followed-up after 6 months, the overall success rate was 74%. 19 patients resumed work 4 weeks after surgery. In 6 patients the interventions were judged as failures and required reoperation (laminectomies). All the patients obtained complete relief. Meticulous selection of patients for percutaneous lumbar discectomy is the key to success. No intra-operative or post-operative complications occurred.

Adult↗
PubMed1990

[Comparison of the results of therapy with vinblastine iontophoresis in post-diskectomy syndromes and other painful conditions].

The authors tested in 36 patients treatment of chronic intractable pain by percutaneous iontophoretic administration of an inhibitor of microtubular transport, Vinblastine inj. (G. Richter, Hungary). The groups comprised: (1) 16 patients with severe radicular pain after one or several operations of prolapsed lumbar intervertebral discs, (2) 20 patients with severe pain in the area of radicular dermal zones or dermal innervation areas of peripheral nerves. In every patient a minimum of 15 procedures were tried. Evaluation of the therapeutic effect was based on subjective data of the patient on the mitigation of pain in per cent, on the intensity of the current pain and the interference of the intensity of pain with daily activities. According to all criteria improvement was achieved in 31 subjects, i.e. in 86%. A favourable effect of treatment was observed after the 8th-10th administration. In the first group of patients clinically significant mitigation of algic symptoms was achieved in 69% of the treated subjects. In the second group a therapeutic effect was achieved in 90% of the patients. A marked difference between the two groups was found with respect to mitigation of the intensity of pain on completion of treatment. The mean mitigation of pain intensity in the first group was 24.1%, in the second group 47.7%. This difference is highly significant. With the exception of one female patient always a positive effect at the site of administration (beneath the anode) was observed.

Adult↗
PubMed1989

[Magnetic resonance tomography using gadolinium-DTPA in the diskectomy syndrome--a reliable method of identifying a recurrent prolapse in scar tissue].

The non invasive diagnostic possibilities of MR have resulted in better diagnosis of degenerative spinal diseases. Twenty-one patients with failed back surgery syndrome (postdiscectomy syndrome) were studied to evaluate the possibility of 1-Tesla magnetic resonance (MR) imaging with gadolinium diethylene triamine pentaacetic acid (Gd-DTPA) in differentiating post operative scar tissue from recurrent disc herniation. The enhanced MR studies correctly depicted the character of abnormal epidural tissue in all patients. We conclude that MR with GD-DTPA might be the method of choice to differentiate reliably postoperative epidural fibrosis from recurrent disc prolapse.

Adult↗