The surgical treatment of painful traumatic neuromas

1993 ◽  
Vol 78 (5) ◽  
pp. 714-719 ◽  
Author(s):  
Kim J. Burchiel ◽  
Timothy J. Johans ◽  
Jose Ochoa
Keyword(s):  
Pain Relief ◽  
Nerve Blocks ◽  
Content Type ◽  
Traumatic Neuroma ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
External Neurolysis ◽  
Fine Print ◽  
Group 1

✓ Pain following suspected nerve injury was comprehensively evaluated with detailed examination including history', neurological evaluation, electrodiagnostic studies, quantitative sensory testing, thermography, anesthetic agents, and sympathetic nerve blocks. Forty-two surgically treated patients fell into four discrete groups: Group 1 patients had distal sensory neuromas treated by excision of the neuroma and reimplantation of the proximal nerve into muscle or bone marrow; Group 2 patients had suspected distal sensory neuromas in which the involved nerve was sectioned proximal to the injury site and reimplanted; Group 3 patients had proximal in-continuity neuromas of major sensorimotor nerves treated by external neurolysis; and Group 4 patients had proximal major sensorimotor nerve injuries at points of anatomical entrapment treated by external neurolysis and transposition, if possible. Patient follow-up monitoring from 2 to 32 months (average 11 months) was possible in 40 (95%) of 42 patients. Surgical success was defined as 50% or greater improvement in pain using the Visual Analog Scale or pain relief subjectively rated as either good or excellent, without postoperative narcotic usage. Overall, 16 (40%) of 40 patients met those criteria. Success rates varied as follows: 44% in 18 Group 1 patients, 40% in 10 Group 2 patients, 0% in five Group 3 patients, and 57% in seven Group 4 patients. Twelve (30%) of 40 patients were employed both pre- and postoperatively. It is concluded that: 1) neuroma excision, neurectomy, and nerve release for injury-related pain of peripheral nerve origin yield substantial subjective improvement in a minority of patients; 2) external neurolysis of proximal mixed nerves is ineffective in relieving pain; 3) surgically proving the existence of a neuroma with confirmed excision may be preferable; 4) traumatic neuroma pain is only partly due to a peripheral source; 5) demographic and neurological variables do not predict success; 6) the presence of a discrete nerve syndrome and mechanical hyperalgesia modestly predict pain relief; 7) ongoing litigation is the strongest predictor of failure; and 8) change in work status is not a likely outcome.

Clinical experience with radiofrequency and laser DREZ lesions

1990 ◽  
Vol 72 (5) ◽  
pp. 715-720 ◽  
Author(s):  
Ronald F. Young
Keyword(s):  
Stainless Steel ◽  
Pain Relief ◽  
Stainless Steel Electrode ◽  
Electrode Temperature ◽  
Steel Electrode ◽  
Content Type ◽  
Group 3 ◽  
Group 2 ◽  
Fine Print ◽  
Group 1

✓ Dorsal root entry zone (DREZ) lesions were used to treat intractable pain due to deafferentation in 78 patients managed between 1981 and 1988. Etiology of pain included avulsion of brachial or lumbosacral plexuses (27 cases), spinal cord injury (20 cases), amputation (nine cases), post-herpetic neuralgia (16 cases), and cauda equina injury (six cases). Three different lesioning techniques were employed: a radiofrequency (rf) method using a 0.5 × 2-mm stainless steel electrode with control of electric current and duration (Group 1: 21 cases); the CO2 laser (Group 2: 20 cases); and an rf method, using a 0.25 × 2-mm stainless steel electrode with control of electrode temperature and duration (Group 3: 37 cases). Overall, 48 (61.5%) of 78 patients received satisfactory pain relief, defined as a 50% or greater reduction in pain intensity, cessation of narcotic analgesic usage, and improvement in functional capacity. Fourteen (67%) of the 21 Group 1 patients obtained effective pain relief, compared to nine (45%) of the 20 Group 2 patients and 25 (68%) of the 37 Group 3 patients. Neurological complications including mainly ipsilateral leg weakness or loss of proprioception occurred in 52.3% of the patients in Group 1, 15% of the Group 2 patients, and 8.1% of the Group 3 patients. These results support the view that DREZ lesions may be made most effectively and safely with the rf lesioning technique associated with control of electrode temperature and duration.

Testing the radiosurgery-based arteriovenous malformation score and the modified Spetzler—Martin grading system to predict radiosurgical outcome

2005 ◽  
Vol 103 (4) ◽  
pp. 642-648 ◽  
Author(s):  
Yuri M. Andrade-Souza ◽  
Gelareh Zadeh ◽  
Meera Ramani ◽  
Daryl Scora ◽  
May N. Tsao ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Grading System ◽  
Chi Square ◽  
Content Type ◽  
Group 4 ◽  
Chi Square Test ◽  
Group 3 ◽  
Group 2 ◽  
Fine Print ◽  
Group 1

Object. The aim of this study was to validate the radiosurgery-based arteriovenous malformation (AVM) score and the modified Spetzler—Martin grading system to predict radiosurgical outcome. Methods. One hundred thirty-six patients with brain AVMs were randomly selected. These patients had undergone a linear accelerator radiosurgical procedure at a single center between 1989 and 2000. Patients were divided into four groups according to an AVM score, which was calculated from the lesion volume, lesion location, and patient age (Group 1, AVM score < 1; Group 2, AVM score 1–1.49; Group 3, AVM score 1.5–2; and Group 4, AVM score > 2). Patients with a Spetzler—Martin Grade III AVM were divided into Grades IIIA (lesion > 3 cm) and IIIB (lesion < 3 cm). Sixty-two female (45.6%) and 74 male (54.4%) patients with a median age of 37.5 years (mean 37.5 years, range 5–77 years) were followed up for a median of 40 months. The median tumor margin dose was 15 Gy (mean 17.23 Gy, range 15–25 Gy). The proportions of excellent outcomes according to the AVM score were as follows: 91.7% for Group 1, 74.1% for Group 2, 60% for Group 3, and 33.3% for Group 4 (chi-square test, degrees of freedom (df) = 3, p < 0.001). Based on the modified Spetzler—Martin system, Grade I lesions had 88.9% excellent results; Grade II, 69.6%; Grade IIIB, 61.5%; and Grades IIIA and IV, 44.8% (chi-square test, df = 3, p = 0.047). Conclusions. The radiosurgery-based AVM score can be used accurately to predict excellent results following a single radiosurgical treatment for AVM. The modified Spetzler—Martin system can also predict radiosurgical results for AVMs, thus making it possible to use this system while deciding between surgery and radiosurgery.

Prognostic significance of magnetic resonance imaging in the acute phase of cervical spine injury

1992 ◽  
Vol 76 (2) ◽  
pp. 218-223 ◽  
Author(s):  
Dale M. Schaefer ◽  
Adam E. Flanders ◽  
Jewell L. Osterholm ◽  
Bruce E. Northrup
Keyword(s):  
Cervical Spine ◽  
Mr Imaging ◽  
Prognostic Significance ◽  
Spinal Segment ◽  
Content Type ◽  
Group 3 ◽  
Group 2 ◽  
Fine Print ◽  
Group 1

✓ Fifty-seven patients with acute cervical spine injuries and associated major neurological deficit were examined within 2 weeks of injury by magnetic resonance (MR) imaging. All patients had abnormal scans, indicating intramedullary lesions. This study was undertaken to determine if the early MR imaging pattern had a prognostic relationship to the eventual neurological outcome. Three different MR imaging patterns were observed in these patients: 21 patients had patterns characteristic of intramedullary hematoma (Group 1); 17 had intramedullary edema over more than one spinal segment, but no hemorrhage (Group 2); and 19 had restricted zones of intramedullary edema involving one spinal segment or less (Group 3). The neurological state was determined using standard motor index scores at admission and at follow-up examination. Characteristically, the patients in Group 1 had admission motor scores significantly lower than the other two groups. At follow-up examination, the median percent motor recovery was 9% for Group 1, 41% for Group 2, and 72% for Group 3. These studies suggest that the MR imaging pattern observed in the acutely injured human spinal cord has a prognostic significance in the final outcome of the motor system. It is only when an accurate prognosis can be given at the outset that useful treatment data might be collected for homogeneous injury groups, and accurately based long-term planning made for the best patient care.

scholarly journals Comparison of Four Different Pain Relief Methods during Hysterosalpingography: A Randomized Controlled Study

2015 ◽  
Vol 20 (2) ◽  
pp. 107-111 ◽  
Author(s):  
Bekir Serdar Unlu ◽  
Mehmet Yilmazer ◽  
Gulengul Koken ◽  
Dagistan Tolga Arioz ◽  
Ebru Unlu ◽  
...  
Keyword(s):  
Pain Relief ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Cervix Uteri ◽  
Controlled Study ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

BACKGROUND: Hysterosalpingography (HSG) is the most commonly used method for evaluating the anatomy and patency of the uterine cavity and fallopian tubes, and is an important tool in the evaluation of infertility. The most frequent side effect is the pain associated with the procedure.OBJECTIVES: To evaluate four analgesic methods to determine the most useful method for reducing discomfort associated with HSG.METHODS: In the present prospective study, 75 patients undergoing HSG for evaluation of infertility were randomly assigned to four groups: 550 mg of a nonsteroidal anti-inflammatory drug (NSAID) (group 1); 550 mg NSAID + paracervical block (group 2); 550 mg NSAID + paracervical analgesic cream (group 3); or 550 mg NSAID + intrauterine analgesic instillation (group 4). A visual analogue scale was used to assess the pain perception at five predefined steps.RESULTS: Instillation of the liquids used for HSG was found to be the most painful step of HSG, and this step was where the only significant difference among groups was observed. When comparing visual analogue scale scores, group 2 and group 3 reported significantly less pain than the other groups. Group 1 reported significantly higher mean ( ± SD) scores (7.2 ± 1.6) compared with groups 2 and 3 (4.7 ± 2.5 and 3.8 ± 2.4, respectively) (P<0.001). In addition, group 2 reported significantly less pain than group 4 (4.7 ± 2.5 versus 6.7 ± 1.8, respectively) (P<0.02).CONCLUSIONS: For effective pain relief during HSG, in addition to 550 mg NSAID, local application of lidocaine cream to the posterior fornix of the cervix uteri and paracervical lidocaine injection into the cervix uteri appear to be the most effective methods.

Results of trimethoprim-sulfamethoxazole prophylaxis in ventriculostomy and shunting procedures

1985 ◽  
Vol 62 (5) ◽  
pp. 694-697 ◽  
Author(s):  
Göran C. Blomstedt
Keyword(s):  
Placebo Group ◽  
Infection Rates ◽  
Group 14 ◽  
Content Type ◽  
Group 4 ◽  
Antibiotic Group ◽  
Group 3 ◽  
Group 2 ◽  
To Receive ◽  
Group 1

✓ The author reports the results of a study to assess the effectiveness of a trimethoprim-sulfamethoxazole combination as prophylaxis in ventriculostomy or shunting operations. Between 1980 and 1983, 122 patients undergoing shunting procedures were randomly assigned to receive trimethoprim-sulfamethoxazole (Group 1, 62 cases) or a placebo (Group 2, 60 cases). The same regimen was followed at each operation, and the patients were followed for a minimum of 6 months. There was a higher infection rate in the placebo group (14 of 60 patients compared with 4 of 62 patients in the antibiotic group, p < 0.01). The antibiotic protected against early infections (nine of the 60 patients in Group 2 against none of the patients in Group 1), but not against late infections (four of the 62 in Group 1 compared with five of the 60 in Group 2). During the same period, 52 patients undergoing ventriculostomy only were also randomly assigned to receive trimethoprim-sulfamethoxazole (Group 3) or placebo (Group 4). There were no differences in the infection rates between these groups (one of 25 in Group 3 as against one of 27 in Group 4).

Neuroendoscopic approach to tectal tumors: a consecutive series

1999 ◽  
Vol 91 (6) ◽  
pp. 964-970 ◽  
Author(s):  
Kazunari Oka ◽  
Yoshiaki Kin ◽  
Yoshinori Go ◽  
Yushi Ueno ◽  
Katsuyuki Hirakawa ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Signal Intensity ◽  
Obstructive Hydrocephalus ◽  
Consecutive Series ◽  
Content Type ◽  
Group 3 ◽  
Group 2 ◽  
Operative Notes ◽  
Fine Print ◽  
Group 1

Object. The authors report a consecutive series of 10 patients who presented with signs and symptoms caused by tectal tumors. Clinical findings, radiographic features, neuroendoscopic management strategies, and histological findings are reported and discussed.Methods. Since January 1990, 11 neuroendoscopic procedures were performed in 10 patients who harbored tectal tumors. The patients were followed for an average of 5 years (range 2 months-11 years), and a retrospective study was conducted in which case notes, radiological findings, operative notes, and histopathological findings were assessed. Magnetic resonance (MR) imaging was performed, and the images were used to classify patients into three groups: those with hypertrophy of the tectum in whom isointensity appeared on T1-weighted images (Group 1); those with a tectal tumor occupying the cerebral aqueduct in whom decreased signal intensity appeared on T1-weighted images, as well as no enhancement after gadolinium administration (Group 2); and those with a tectal tumor in whom mixed signal intensity and conspicuous evidence of contrast enhancement appeared on T1-weighted images (Group 3). The results of histological examination were consistent with MR imaging features: in Group 1, glial tissue or gliosis; in Group 2, benign astrocytoma; and in Group 3, malignant astrocytoma. Cerebrospinal fluid diversion was the only surgical treatment that provided relief from obstructive hydrocephalus. One patient in Group 3 underwent radiotherapy and subsequent partial tumor removal under neuroendoscopic guidance. Thereafter, the tumor remained in decline. All patients had normal intellectual status after undergoing surgery in which a neuroendoscope was used.Conclusions. Neuroendoscopic procedures can provide histological diagnosis, define the tumor—midbrain interrelationship, and be highly effective in treating obstructive hydrocephalus and in removing tectal tumors. This procedure may receive clinical application as a new management strategy for tectal glioma.

Surgical alternatives in the treatment of cavernous sinus aneurysms

1989 ◽  
Vol 71 (6) ◽  
pp. 846-853 ◽  
Author(s):  
Fernando G. Diaz ◽  
Sam Ohaegbulam ◽  
Manuel Dujovny ◽  
James I. Ausman
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Visual Loss ◽  
Internal Carotid ◽  
Content Type ◽  
Group 3 ◽  
Group 2 ◽  
Fine Print ◽  
Group 1

✓ Direct surgery on aneurysms in the cavernous sinus is a formidable technical procedure. The intimate relationship of the intracavernous carotid artery to the venous structures and to the cranial nerves make surgical access difficult at best. Thirty-two of 356 aneurysm patients presented with symptomatic aneurysms originating from the intracavernous internal carotid artery. Twenty-one patients had aneurysms contained entirely within the cavernous sinus, and in 11 others the aneurysms arose within the cavernous sinus and extended into the subarachnoid space. Of the purely intracavernous aneurysms there were five small aneurysms (< 25 mm) and 16 giant (≥ 25 mm) aneurysms. Fifteen patients with purely intracavernous lesions had a superior orbital fissure syndrome, and six had a variety of other symptoms. Of 11 patients with subarachnoid extension, five had a subarachnoid hemorrhage (Grade I or II), five had ipsilateral visual loss, and one had periorbital pain. The aneurysms were treated as follows: Group 1 received progressive ligation of the internal carotid artery in the neck with a Selverstone clamp and a surface superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis (purely intracavernous in nine, and with subarachnoid extension in one); Group 2 underwent trapping of the internal carotid artery and a deep STA-MCA anastomosis (purely intracavernous in seven); and Group 3 had direct clipping of the aneurysm (purely intracavernous in five, and with subarachnoid extension in 10). The cavernous sinus was entered directly through its roof by a pterional craniotomy with radical removal of the optic canal, lesser sphenoid wing, and lateral and superior orbital walls. Proximal control of the internal carotid artery was obtained through a cervical incision. Two patients in Group 1 developed transient neurological deficits, which resolved. Two patients in Group 2 developed a cerebral infarction, one of whom died; in both of these patients, the anastomosis was completed after the internal carotid artery occlusion. Two patients in Group 3 progressed from marked visual loss to blindness of the same side, and one developed an intraventricular hemorrhage during induction of anesthesia and died without surgery. It is proposed that a direct approach to symptomatic aneurysms in the cavernous sinus is the best initial alternative. When this approach is not feasible, a trapping procedure preceded by a high-flow extracranial-intracranial anastomosis may be considered. Although the authors have been able to clip aneurysms of various sizes, this has not been possible in all patients. Further work is needed in this area.

scholarly journals Impact of the Use of β-Lactam Antimicrobials on the Emergence of Escherichia coli Isolates Resistant to Cephalosporins under Standard Pig-Rearing Conditions

2014 ◽  
Vol 81 (5) ◽  
pp. 1782-1787 ◽  
Author(s):  
Karla Cameron-Veas ◽  
Marc Solà-Ginés ◽  
Miguel A. Moreno ◽  
Lorenzo Fraile ◽  
Lourdes Migura-Garcia
Keyword(s):  
Macconkey Agar ◽  
Content Type ◽  
E Coli ◽  
Group 4 ◽  
Rearing Conditions ◽  
Cephalosporin Resistance ◽  
Pig Farm ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

ABSTRACTThe aim of this study was to evaluate if the treatments with ceftiofur and amoxicillin are risk factors for the emergence of cephalosporin resistant (CR)E. coliin a pig farm during the rearing period. One hundred 7-day-old piglets were divided into two groups, a control (n= 50) group and a group parenterally treated with ceftiofur (n= 50). During the fattening period, both groups were subdivided in two. A second treatment with amoxicillin was administered in feed to two of the four groups, as follows: group 1 (untreated,n= 20), group 2 (treated with amoxicillin,n= 26), group 3 (treated with ceftiofur,n= 20), and group 4 (treated with ceftiofur and amoxicillin,n= 26). During treatment with ceftiofur, fecal samples were collected before treatment (day 0) and at days 2, 7, 14, 21, and 42 posttreatment, whereas with amoxicillin, the sampling was extended 73 days posttreatment. CRE. colibacteria were selected on MacConkey agar with ceftriaxone (1 mg/liter). Pulsed-field gel electrophoresis (PFGE), MICs of 14 antimicrobials, the presence of cephalosporin resistance genes, and replicon typing of plasmids were analyzed. Both treatments generated an increase in the prevalence of CRE. coli, which was statistically significant in the treated groups. Resistance diminished after treatment. A total of 47 CRE. coliisolates were recovered during the study period; of these, 15 containedblaCTX-M-1, 10 containedblaCTX-M-14, 4 containedblaCTX-M-9, 2 containedblaCTX-M-15, and 5 containedblaSHV-12. The treatment with ceftiofur and amoxicillin was associated with the emergence of CRE. coliduring the course of the treatment. However, by the time of finishing, CRE. colibacteria were not recovered from the animals.

Management of elderly patients with aneurysmal subarachnoid hemorrhage

1988 ◽  
Vol 69 (3) ◽  
pp. 332-339 ◽  
Author(s):  
Tetsuji Inagawa ◽  
Mitsuo Yamamoto ◽  
Kazuko Kamiya ◽  
Hidenori Ogasawara
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Age Groups ◽  
Content Type ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Fine Print ◽  
Group 1

✓ A total of 299 patients with aneurysmal subarachnoid hemorrhage (SAH) were classified into three age groups, that is, those aged 59 years or younger (Group 1: 159 patients, 53%), those aged 60 to 69 years (Group 2: 85 patients, 28%), and those aged 70 years or older (Group 3: 55 patients, 18%). A comparison was made of the surgical indications and their overall management outcome in these age groups. The overall outcome at 1 year after SAH of Group 3 was significantly poorer than that of Group 1 (p < 0.01) or Group 2 (p < 0.01), but no significant difference could be demonstrated between Groups 1 and 2. Overall, 104 of the 299 patients died, for a mortality rate of 35%. The mortality rate by age group was 29% for Group 1, 33% for Group 2, and 55% for Group 3. Surgery was performed on 122 patients (77%) in Group 1, 56 (66%) in Group 2, and 25 (45%) in Group 3. The overall operative outcome at 1 year after SAH in Group 3 was significantly poorer than that of Group 1 (p < 0.01), but no significant difference was observed in this regard between Groups 1 and 2. The operative mortality rate of the patients in Groups 1 , 2, and 3 who were preoperatively in Hunt and Hess Grades I and II was 1%, 7%, and 22%, respectively (no significant difference). By life-table analysis the 5-year survival probability was 65% for Group 1, 60% for Group 2, and 37% for Group 3. The rate of patients surviving in good condition or in a disabled but independent condition at 1 year after SAH was 93% and no statistically significant difference in survival probability was observed among the three age groups.

Endovascular treatment of intracranial aneurysms: comparative evaluation in a terminal bifurcation aneurysm model in dogs

2004 ◽  
Vol 101 (6) ◽  
pp. 996-1003 ◽  
Author(s):  
Yoshikazu Yoshino ◽  
Yasunari Niimi ◽  
Joon K. Song ◽  
Michael Silane ◽  
Alejandro Berenstein
Keyword(s):  
Side Wall ◽  
Parent Artery ◽  
Content Type ◽  
Aneurysm Neck ◽  
Bifurcation Aneurysm ◽  
Group 3 ◽  
Group 2 ◽  
Aneurysm Model ◽  
Fine Print ◽  
Group 1

Object. The authors investigated whether HydroCoils decreased coil compaction and aneurysm recanalization in a canine model of a large, wide-necked, high-flow bifurcation aneurysm. Methods. Eleven experimental aneurysms were created. Two aneurysms were untreated (Group 1); three were treated with standard platinum coils (Guglielmi Detachable Coils; Group 2); and six were treated with platinum framing coils and filling HydroCoils (Group 3). Comparative angiographic and histopathological data were analyzed at 2 weeks and again at 3 months. At 3 months, the Group 1 aneurysms remained patent without spontaneous thrombosis. After coil placement the percentage of aneurysm filling by volume ranged from 59 to 90% (mean 75.4%) for Group 3 (HydroCoil-treated) and 34.3 to 48.9% (mean 39.6%) for Group 2 (GDC-treated) (p < 0.05). At 14 days, two of the three Group 2 aneurysms exhibited coil compaction and aneurysm recanalization at the neck; in both cases the condition worsened at 3 months. At 14 days and 3 months, five of the six Group 3 aneurysms were 100%, and one of six was 90% occluded and remained stable. At 3 months, the neointima of the aneurysm neck was significantly thicker in the Group 3 lesions, which had been treated by HydroCoils (0.329 ± 0.191 mm), than in Group 2 lesions, which had been treated with GDCs (0.026 ± 0.018 mm) (p , 0.001). No thrombus formation occurred in Group 2; however, in two of the six aneurysms in Group 3, thrombus formed at the coil—neck interface. Conclusions. The experimental canine bifurcation aneurysm model overcomes the limitations of side-wall aneurysm models. In this model, HydroCoils resulted in significantly denser coil packing, less follow-up coil compaction, and thicker neointimal tissue at the neck of the lesion. HydroCoils also appeared more thrombogenic at the aneurysm neck—parent artery interface.

Sign in / Sign up

Export Citation Format

Share Document