ABSTRACT
Hemiation of the thoracic intervertebral disk is a rare pathology causing a severe neurological deficit. Of all the disk hernias, thoracic ones account for less than 1%. Thirty-five patients have been operated on for 12 years, by using the following methods: posterior approach (laminectomy) (n = 2), lateral extrapleural approach (n = 8), anterior (transthoracic) approach (n = 25). Out of the 35 patients operated on, there were 2 patients who felt worse after surgery via posterior approach, 6 patients had no changes, and positive changes were observed in 26 cases. For resection of hernias of the thoracic intervertebral disk, it is necessary to apply either transpleural (for Th(VI)-Th(XII) hernias) or lateral extrapleural (Th(I)-Th(VI)) approaches. Laminectomy is inadmissible.
Subject(s)
Decompression/methods , Intervertebral Disc Displacement/surgery , Adult , Female , Herniorrhaphy , Humans , Male , Middle Aged , Thoracic Vertebrae/surgeryABSTRACT
The paper summaries authors' experience with lifetime and postmortem pulmonary changes in 223 victims with severe craniocerebral injury, as well as the data available in literature on this point. The investigations have shown that microcirculatory disorders make a great contribution to the development of pulmonary complications and revealed specific feature of the natural history of the shock lung in patients with severe craniocerebral injury. The paper provides strong evidence for the neurotrophic pattern of pulmonary complications and proposes a scheme of their development in this injury.
Subject(s)
Brain Injuries/complications , Lung Diseases/etiology , Acute Disease , Adolescent , Adult , Aged , Brain Concussion/complications , Brain Concussion/physiopathology , Brain Injuries/physiopathology , Child , Female , Humans , Lung Diseases/physiopathology , Male , Middle Aged , Pneumonia/etiology , Pneumonia/physiopathology , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/physiopathology , Time FactorsABSTRACT
The symptomatology and results of treatment of 26 patients with traumatic hematomas of the posterior cranial fossa (PCF) are analysed. The hematomas were verified on operation in 19 patients and on postmortem examination in the other patients. It is concluded that the diagnosis of PCF hematomas is based on a combination of signs: cervico-occipital mechanism of the trauma, fracture of the occipital bone, cerebello-stem symptomatology, and acute hydrocephalus. The formation of trephination openings on the line of the fracture of the occipital bone is considered expedient in the presence of the above listed signs of affection of the PCF structures and the absence of computer tomography. Tests for induced stem potentials must also be included in the diagnostic complex. Total lethality was 53.8%, surgical lethality--25%.
Subject(s)
Cerebral Hemorrhage/diagnosis , Hematoma/diagnosis , Occipital Bone/injuries , Skull Fractures/diagnosis , Adult , Cerebellar Diseases/diagnosis , Cerebellar Diseases/etiology , Cerebellar Diseases/surgery , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/surgery , Cranial Fossa, Posterior , Female , Hematoma/etiology , Hematoma/surgery , Hematoma, Epidural, Cranial/diagnosis , Hematoma, Epidural, Cranial/etiology , Hematoma, Epidural, Cranial/surgery , Hematoma, Subdural/diagnosis , Hematoma, Subdural/etiology , Hematoma, Subdural/surgery , Humans , Male , Middle Aged , Skull Fractures/complications , TrephiningABSTRACT
Changes of the bronchial tree revealed during sanative fiber bronchoscopy in the first 24 hours of the acute period of severe craniocerebral trauma were studied in 57 patients. Analysis of the results made it possible to identify the components of the obstructive syndrome, its dependence on the side and level of injury to the brain, to determine the terms of disappearance of the bronchial obstruction and the number of sanative endoscopies. Comparison with the results of treatment of 75 similar patients without bronchoscopy showed the role of the obstructive syndrome in the development of pneumonia in severe craniocerebral trauma.
Subject(s)
Brain Injuries/complications , Bronchi/physiopathology , Pneumonia/etiology , Acute Disease , Blood Gas Analysis , Brain Injuries/blood , Brain Injuries/physiopathology , Brain Injuries/therapy , Bronchoscopy , Fiber Optic Technology , Humans , Partial Pressure , Pneumonia/blood , Pneumonia/physiopathology , Pneumonia/therapy , Therapeutic Irrigation , TracheostomyABSTRACT
The results of endoscopic studies of the bronchial tree have been assessed in 150 patients during the acute period of craniocerebral trauma. A correlation has been established between the side and degree of the brain stem damage and the onset of asymmetrical bronchomalacia. The development and signs of the obstructive syndrome within a 2-week post-traumatic period have been demonstrated. The incidence of destructive pneumonia has reduced four-fold. It is concluded that endoscopy of the bronchial tree is highly effective for the prevention of pneumonia in the acute period of severe craniocerebral trauma.
Subject(s)
Brain Injuries/complications , Pneumonia/etiology , Humans , Pneumonia/prevention & controlABSTRACT
Anterior compression of the spinal cord at the level of the thoracic vertebrae cannot be corrected adequately through a posterior approach (laminectomy). This widely encountered form of spinal cord compression calls for a differentiated use of the anterolateral or lateral approach to the vertebral canal, i.e. combination of osteotransversectomy with hemilaminectomy. A lateral access to the vertebral canal is indicated in most cases.
