Decompression of multiple pneumatoceles in a premature infant by percutaneous catheter placement.
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Pneumatoceles due to acquired localized overinflation as a form of pulmonary interstitial emphysema are complications of advanced bronchopulmonary dysplasia. Different ventilation modes, selective bronchial intubation, balloon obstruction of the affected bronchus and steroids have been reported with success. Lobectomy has also been used. We present a premature infant with multiple large pneumatoceles causing respiratory compromise. In our case percutaneous decompression under fluoroscopy guidance resulted in a permanent cure. (+info)
Retroperitoneal hematoma associated with femoral neuropathy: a complication under antiplatelets therapy.
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We report a case of retroperitoneal hematoma presenting as femoral nerve pulsy on antiplatelet therapy. The patient, a 78-year-old man who had undergone antiplatelet treatment using ticlopidine, was admitted to our hospital with complaints of sudden-onset low abdominal and back pain. Computed tomography showed an iso-density mass in the right retroperitoneum within the psoas muscle. We made a diagnosis of retroperitoneal hematoma compressing the femoral nerve and performed an operation to remove the hematoma in order to decompress the femoral neuropathy. Postoperatively, the patient rapidly recovered from the femoral neuropathy. In the particular case in which no antagonist against the ticlopidine is available, surgical decompression could produce a good outcome. (+info)
Anterior retropharyngeal approach to the cervical spine.
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The anterior retropharyngeal approach (ARPA) accesses anteriorly situated lesions from the clivus to C3, in patients with a short neck, Klippel Feil anomaly or those in whom the C2-3 and C3-4 disc spaces are situated higher in relation to the hyoid bone and the angle of mandible where it is difficult to approach this region using the conventional anterior approach, due to the superomedial obliquity of the trajectory. The ARPA avoids the potentially contaminated oropharyngeal cavity providing for a simultaneous arthrodesis and instrumentation during the primary surgical procedure. Experience of five patients with high cervical extradural compression, who underwent surgery using this approach between 1994 and 1999, is presented. The surgical procedures included excision of ossified posterior longitudinal ligament (n=2); excision of prolapsed disc and osteophytes (n=2); and excision of a vertebral body neoplasm (n=1). Following the procedure, vertebral arthrodesis was achieved using an iliac graft in all the patients. Only one patient with vertebral body neoplasm required an additional anterior cervical plating procedure for stabilisation the construct. The complications included transient respiratory insufficiency and neurological deterioration in two patients; and, pharyngeal fistula and donor site infection in one patient. (+info)
Massive aneurysmal bone cyst of the anterior cranial fossa floor--case report.
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A 19-year-old male patient presented with a midline facial, nose, and forehead hard and bony swelling associated with hypertelorism. Neuroimaging revealed a massive tumor involving the anterior cranial fossa floor, which had occupied and enlarged all paranasal air sinuses, and displaced the orbits outwards and the frontal lobes of the brain superiorly. A basal transcranial route was used for radical resection of the massive and vascular tumor. Histological examination confirmed an aneurysmal bone cyst. Such tumors only rarely involve the cranial bones or paranasal air sinuses. (+info)
Surgical treatment modalities of thyroid ophthalmopathy.
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This report presents the use of various surgical treatment modalities in patients who were diagnosed as having thyroid ophthalmopathy. The records of 53 patients who received surgery because of thyroid ophthalmopathy at the Department of Ophthalmology, Yonsei University College of Medicine between Sept. 1996 and Jan. 2000 were retrospectively evaluated. Among the 53 patients, there were 30 females and 23 males. The mean ages of the patients were 40.8 +/- 17.1 years. Orbital wall decompression (52.8%) was the most frequently performed surgery followed by lid surgery (49.1%) and strabismus surgery (26.4%). Only one type of surgery was performed on 86.8% of the patients while 13.2% received more than one type of surgery. Among the many different types of surgeries possible in patients that have thyroid ophthalmopathy, orbital wall decompression, lid surgery, and strabismus surgery are the most commonly used surgical methods for treatment. (+info)
Rectus extraocular muscle paths and decompression surgery for Graves orbitopathy: mechanism of motility disturbances.
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PURPOSE: To study possible causes of motility disturbances that may result from orbital decompression surgery in patients with Graves orbitopathy and especially the role of rectus extraocular muscle paths. METHODS: Sixteen patients with Graves orbitopathy were studied before and 3 to 6 months after translid (6 patients) and coronal (10 patients) orbital decompression surgery for disfiguring proptosis. Ocular motility changes were measured by comparing maximum ductions and severity of diplopia, and the positions and the displacements of the anterior rectus muscle paths were objectively measured using cine magnetic resonance imaging (MRI). RESULTS: Averaged preoperative rectus muscle path positions were not different from those in normal subjects. Averaged postoperative muscle path positions were generally the same as preoperative paths. The only significant exceptions were centrifugal (outward from the orbital axis) displacements of the inferior rectus (IR) muscle path after translid surgery, and of the medial rectus (MR) muscle path after coronal surgery. The amount of IR path displacement with translid surgery was directly correlated with range of depression and with severity of vertical diplopia. The amount of MR path displacement with coronal surgery was inversely correlated with range of abduction and directly correlated with severity of horizontal diplopia. CONCLUSIONS: The anterior orbital connective tissue seems to form a "functional skeleton" that is usually (except as noted for IR and MR) capable of keeping the rectus muscle paths aligned after decompression surgery and preserving the normal functions of rectus muscle pulleys. The centrifugal displacement of the IR and MR may increase the elastic component of the muscle force, leading to the specific patterns of motility disturbance that may occur in some patients after translid and coronal surgery. These findings suggest that standard surgical management of Graves orbitopathy should be supplemented. (+info)
Effects of body position on intracranial pressure and cerebral perfusion in patients with large hemispheric stroke.
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BACKGROUND AND PURPOSE: The purpose of this study was to prospectively evaluate the effects of body position in patients with large supratentorial stroke. METHODS: We performed 43 monitoring sessions in 18 patients with acute complete or subtotal middle cerebral artery (MCA) territory stroke. Intracranial pressure (ICP) was monitored with a parenchymal probe. Mean arterial blood pressure, ICP, and MCA peak mean flow velocity (VmMCA) were continuously recorded. Patients with acute ICP crises were excluded. After baseline values at a 0 degree supine position were attained, the backrest was elevated in 2 steps of 5 minutes each to 15 degrees and 30 degrees and then returned to 0 degree. RESULTS: Baseline mean arterial pressure was 90.0+/-1.6 mm Hg and fell to 82.7+/-1.7 mm Hg at 15 degrees and 76.1+/-1.6 mm Hg at 30 degrees backrest elevation (P<0.0001). ICP decreased from 13.0+/-0.9 to 12.0+/-0.9 mm Hg at 15 degrees and 11.4+/-0.9 mm Hg at 30 degrees backrest elevation (P<0.0001). As a result, cerebral perfusion pressure decreased from a baseline value of 77.0+/-1.8 to 70.0+/-1.8 mm Hg at 15 degrees and 64.7+/-1.7 mm Hg at 30 degrees backrest elevation (P<0.0001). VmMCA was already higher on the affected side during baseline measurements. VmMCA decreased from 72.8+/-11.3 cm/s at 0 degree to 67.2+/-9.7 cm/s at 15 degrees and 61.2+/-8.9 cm/s at 30 degrees on the affected and from 49.9+/-3.7 cm/s at 0 degree to 47.7+/-3.6 cm/s at 15 degrees and 46.2+/-2.2 cm/s at 30 degrees on the contralateral side (P<0.0001). CONCLUSIONS: In patients with large hemispheric stroke without an acute ICP crisis, cerebral perfusion pressure was maximal in the horizontal position although ICP was usually at its highest point. If adequate cerebral perfusion pressure is considered more desirable than the absolute level of ICP, the horizontal position is optimal for these patients. (+info)
What is effective in malignant middle cerebral artery infarction: reperfusion, craniectomy, or both? An experimental study in rats.
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BACKGROUND AND PURPOSE: We sought to evaluate the effects of reperfusion and craniectomy treatment at different time points after middle cerebral artery (MCA) occlusion on infarct volume and neurological outcome in MCA infarction in rats. METHODS: We used an endovascular technique to obtain MCA occlusion in 182 rats. Thirteen groups with 14 animals each were investigated: control group 1 with no treatment; groups 2 to 7 with only reperfusion or craniectomy at 1, 4, or 12 hours, respectively; and groups 8 to 13 with reperfusion at 1 or 4 hours combined with craniectomy at 1, 4, or 12 hours, respectively. We used infarct volume and neurological performance as study end points in all animals at day 7. RESULTS: Neurological score and infarct volume in animals undergoing early reperfusion at 1 hour were significantly smaller (1.8/79+/-59 mm3) than those in control animals (3.8/225+/-26 mm3) (P<0.01). Reperfusion at 4 hours (2.8/182+/-62 mm3) and 12 hours (3.7/231+/-69 mm3) did not result in significant improvement. Animals undergoing craniectomy at 1, 4, and 12 hours demonstrated significantly better outcome and significantly reduced infarct volume (1.6/96+/-30 mm3, 1.9/109+/-39 mm3, and 2.6/150+/-34 mm3, respectively) (P<0.05). Compared with 1 treatment at a time, combined reperfusion and craniectomy did not result in a significant additional benefit. CONCLUSIONS: Early reperfusion and craniectomy at 1 hour are both effective in large MCA infarction. While reperfusion later than 1 hour was not beneficial, late craniectomy at 4 and 12 hours still resulted in significant improvement of neurological score and reduction of infarction size. Combined treatment at different time points yields no significant additional benefit compared with 1 treatment at a time. (+info)