ABSTRACT
The authors proposed to evaluate the quantity of anatomical intracranial reserve according to morphometric measurements in axial projection by means of helical computer tomography data of bitemporal distance, width of the tentorial opening, diameter of the foramen magnum and mutual correlation of these parameters in points. This method showed a high accuracy (92%) and predictive value (85%) in determination of terms and volume of complex treatment of 140 victims with craniocerebral injury, 120 patients with primary tumors of the brain and 110 patients with acute disorder of cerebral circulation.
Subject(s)
Brain Diseases/surgery , Brain Injuries/surgery , Brain/diagnostic imaging , Tomography, Spiral Computed/methods , Adult , Brain Diseases/diagnosis , Brain Injuries/diagnosis , Female , Follow-Up Studies , Humans , Male , Middle Aged , Reproducibility of ResultsABSTRACT
The article presents the results of examination and surgery of 185 patients with degenerative diseases as well as with a cervical spine trauma. The circulatory disturbance of the vertebral artery took place in all patients. A different degree of changes was observed in color duplex scanning. There were minor circulatory disturbances, course deformations (angular, C, S, V-shaped twists) and dissection of the vertebral artery. Color duplex scanning allowed estimating of local and system hemodynamic significance of extravasal influences. The strategy of treatment and volume of surgical interference were defined by the degree of circulatory disturbance in the vertebral artery.
Subject(s)
Cervical Vertebrae , Neurodegenerative Diseases , Neurosurgical Procedures/methods , Spinal Cord Injuries , Vertebrobasilar Insufficiency , Adult , Cervical Vertebrae/injuries , Cervical Vertebrae/pathology , Decompression, Surgical/methods , Disease Management , Female , Hemodynamics , Humans , Male , Middle Aged , Neurodegenerative Diseases/complications , Neurodegenerative Diseases/diagnosis , Neurodegenerative Diseases/physiopathology , Neurodegenerative Diseases/surgery , Neurologic Examination , Spinal Cord Injuries/complications , Spinal Cord Injuries/diagnosis , Spinal Cord Injuries/physiopathology , Spinal Cord Injuries/surgery , Treatment Outcome , Ultrasonography, Doppler, Color , Vertebral Artery/diagnostic imaging , Vertebrobasilar Insufficiency/diagnosis , Vertebrobasilar Insufficiency/etiology , Vertebrobasilar Insufficiency/physiopathology , Vertebrobasilar Insufficiency/therapyABSTRACT
An analysis of 658 medical records of inpatient treatment from 15 hospitals of St.Petersburg was made using a computer-aided technology of the assessment of medical care quality. It was revealed that a proper quality of medical care in craniocerebral trauma was only in 52.9% cases. Different defects of medical care were noted in the rest of observations. It influenced on the condition of the patients (1.0%), the delivery and assessment of health care (40% and 38%, respectively), health resources (18%), social resources (1.0%). Defects of medical records were indicated in 38% patients. It caused a reduction of medical care. Risks of occurrence of medical care defects are low in children hospitals in the case of combined craniocerebral trauma.
Subject(s)
Craniocerebral Trauma , Hospitalization/statistics & numerical data , Medical Records , Quality of Health Care , Adult , Child , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/therapy , Health Care Surveys , Humans , Medical Records/standards , Medical Records/statistics & numerical data , Needs Assessment , Outcome Assessment, Health Care/methods , Outcome Assessment, Health Care/statistics & numerical data , Quality of Health Care/standards , Quality of Health Care/statistics & numerical data , RussiaABSTRACT
A retrospective analysis of diagnostics and surgical treatment was made in 440 patients with polytrauma, who were on the treatment in hospitals in Saint-Petersburg, Syktyvkar and Omsk during 2009-2012. The neurotrauma was the dominating damage. The patients were divided into two groups: the main and the control group, using the equal quantitative ratio according to the sex, age, circumstances of trauma and type of damages. The strategy of programmed multistage surgical treatment ("damage control surgery") was used in the main group (220 patients, average age 31.7 +/- 5.2 years). The traditional strategy of treatment was applied in the control group (220 patients, average age 30.7 +/- 5.4 years). The damage control surgery allows the reduction of lethality in neurotrauma by 15.0% and improvement of social adaptation of patients by 12.7%.
Subject(s)
Multiple Trauma/surgery , Neurosurgical Procedures/methods , Practice Guidelines as Topic , Trauma, Nervous System/surgery , Adult , Female , Humans , Male , Neurosurgical Procedures/standards , Retrospective Studies , Russia , Trauma Severity Indices , Trauma, Nervous System/diagnosis , Treatment OutcomeABSTRACT
A retrospective analysis of diagnostics and surgery in 240 patients was made. The vertebral spinal trauma took place in 168 patients (average age 31 +/- 5 years), degenerative dystrophic diseases of spine were in 72 patients (average age 52 +/- 7 years). The clinicodiagnostic complex included survey and functional radiography of the spine, magnetic resonance image and helical computer tomography of the spine with spondylometric measurements and color duplex scanning of the vertebral artery. Stabilization of the spine was performed in 137 (57%) cases. The variants were determined on the basis of predominate injury of 1 out of 3 supporting complexes. The rigid and dynamic methods and their combination were used for fixation of the spine. More favorable results were registered using dynamic fixation and the arthroplasty of intervertebral disks with nitinol constructions. An algorithm of radiodiagnostics and surgery methods were proposed.
Subject(s)
Arthrometry, Articular/methods , Cervical Vertebrae , Intervertebral Disc Degeneration , Orthopedic Procedures/methods , Spinal Injuries , Adult , Algorithms , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/physiopathology , Cervical Vertebrae/surgery , Female , Humans , Intervertebral Disc Degeneration/diagnosis , Intervertebral Disc Degeneration/physiopathology , Intervertebral Disc Degeneration/surgery , Magnetic Resonance Imaging/methods , Male , Middle Aged , Orthopedic Procedures/classification , Orthopedic Procedures/statistics & numerical data , Outcome and Process Assessment, Health Care , Spinal Injuries/diagnosis , Spinal Injuries/physiopathology , Spinal Injuries/surgery , Tomography, Spiral Computed/methods , Ultrasonography, Doppler, Color/methodsABSTRACT
The retrospective analysis of surgical and rehabilitation treatment of 172 patients with neurotrauma was made. The patients were treated in Russian Polenov Neurosurgical Institute and Municipal hospital of St. Elizabeth in the period since 2009 till 2012. Rehabilitation of different types of neurotrauma presented the system of surgical and recovery methods of treatment, which should be used in a short term after damage. Means of internal cerebral decompression, including drainage of ecephalocoel and cerebral basal cistern and the tentoriotomy, should be used in acute period of craniocerebral trauma according to morphometric data of beam inspection. Management of wound by means of laser or LED radiation, SHWF-therapy, magnetic and electrostimulation were the effective methods of neurorehabilitation. It is noted, that 73 (43,4%) patients returned to a former employment rate among 172 victims, though 26 patients had a moderate invalidization. An average figures of Glasgow scale outcomes were 1,9+/-0,2.
Subject(s)
Neurosurgical Procedures/rehabilitation , Rehabilitation , Trauma, Nervous System/surgery , Adult , Disability Evaluation , Early Medical Intervention , Female , Humans , Male , Middle Aged , Neurosurgical Procedures/adverse effects , Neurosurgical Procedures/methods , Postoperative Period , Recovery of Function , Rehabilitation/classification , Rehabilitation/methods , Rehabilitation/statistics & numerical data , Retrospective Studies , Time-to-Treatment , Treatment OutcomeABSTRACT
The radiation diagnosis made before and after operation was analyzed in 231 case histories of patients with brain tumors treated in hospitals of St.Petersburg in 2009. Most typical errors of administration and interpretation of radiation diagnostic methods were established. MRI was not performed in 54% of cases, in 32% operative intervention was performed without SCT findings. Contrast enhancement was used but in 68% of observations, angiographic methods--in 8%. Not a single radiation examination was performed in 61% of patients, in 33% SCT was made, in 6%--MRI, only in a third of patients contrast enhancement was used. In 52% of cases control radiation examination was not prescribed in dynamics. The estimation of the data obtained helped to obtain more exact criteria of using radiation methods in patients with tumors of the brain before and after operation.
Subject(s)
Brain Neoplasms/diagnosis , Magnetic Resonance Imaging/methods , Neurosurgical Procedures , Tomography, X-Ray Computed/methods , Brain Neoplasms/surgery , Female , Follow-Up Studies , Humans , Middle Aged , Postoperative Period , Preoperative Period , Reproducibility of Results , Retrospective StudiesABSTRACT
A retrospective analysis of 231 case histories of patients with cerebral tumors treated at different hospitals of St. Petersburg in 2009 and expert assessment of the quality of medical care were made. Most frequent defects of medical care were established which were systematized in 3 main groups depending on their influence on the state and results of treatment of the patient: significant, minimally significant and not significant. They were: different errors in pre- and postoperative examinations, medical and surgical strategy as well as making up medical documentation. Significant defects were revealed in 75%, minimally significant--in 47% and not significant--in 83% of observations. In most cases there was a combination of defects of different groups (79-90%). Assessment of the quality of medical care on the basis of the groups established allows the aimed clinical-organizational liquidation of them.
Subject(s)
Brain Neoplasms/therapy , Delivery of Health Care/standards , Quality Assurance, Health Care/methods , Quality of Health Care , Humans , Retrospective Studies , RussiaABSTRACT
A retrospective analysis of clinical-radial examination was made in 1946 patients with polytrauma. In 82% of them severe cranio-cerebral traumas and extracranial injuries were revealed. The diagnosis of fractures of the skull bones on the basis of survey radiography was possible but in 2% of the patients. Cranio-cerebral and craniofacial traumas appeared much more often than injuries of other anatomical areas, reaching 79.4%. Spiral computed tomography was the main method of early diagnosing polytrauma which allowed detecting the character, localization and volume of traumatic injuries of the skull bones, facial skeleton and brain in shorter terms. The information value of the method was 97%.
Subject(s)
Craniocerebral Trauma , Magnetic Resonance Imaging/methods , Multiple Trauma , Radiography/methods , Tomography, Spiral Computed/methods , Adult , Brain/diagnostic imaging , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/etiology , Female , Humans , Male , Multiple Trauma/complications , Multiple Trauma/diagnosis , Process Assessment, Health Care , Skull/diagnostic imaging , Skull/injuries , Trauma Severity Indices , UltrasonographyABSTRACT
Clinico-radial data were compared in 583 patients with trauma and degenerative diseases of the spine. The clinico-diagnostic complex included radiography of the spine (round-up and functional), magnetic resonance imaging, computerized helical tomography of the spine with spondylometric measurements. Indices of the measurements of the cross-section area of the vertebral artery canal at the level of C3-C6 vertebrae and the volume of the intervertebral canal at different levels in health among men and women are presented. An algorithm of radiation diagnostics in pathology of the spine is proposed.
Subject(s)
Magnetic Resonance Imaging , Spinal Diseases/diagnosis , Spinal Injuries/diagnosis , Spine/diagnostic imaging , Tomography, Spiral Computed , Vertebral Artery/diagnostic imaging , Adult , Aged , Algorithms , Female , Humans , Magnetic Resonance Imaging/methods , Magnetic Resonance Imaging/standards , Male , Middle Aged , Reference Standards , Reference Values , Spine/blood supply , Tomography, Spiral Computed/methods , Tomography, Spiral Computed/standardsABSTRACT
Retrospective clinico-radial data obtained in 163 patients were compared with traumas and degenerative diseases of the vertebral column of those who were treated by decompressive and decompressive-stabilizing interventions. Characteristic alterations were determined such as considerably decreased area of the spinal canal (in 44.2% of the patients), intervertebral foramen (in 57.7%) and the volume of intervertebral canal (in 66.3%), which allowed specification of the character and volume of the operative interventions and objective assessment of adequacy of surgical correction.
Subject(s)
Decompression, Surgical/methods , Spinal Fractures/surgery , Spondylolysis/surgery , Adult , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Spinal Fractures/diagnosis , Spinal Fractures/physiopathology , Spondylolysis/diagnosis , Spondylolysis/physiopathology , Tomography, X-Ray Computed , Treatment Outcome , Young AdultABSTRACT
The method of duplex scanning was used in examination of 210 patients with degenerative-dystrophic diseases of the cervical part of the spine. It allows quantitative and qualitative assessment of the local and systemic hemodynamic value of extravasal compression of vertebral arteries. Local hemodynamic shifts in the area of extravasal influences on the artery were detected in 72.9% of the patients: decreased indices of blood flow and increased indices of peripheral resistance proximal to the compression zone, growing blood velocity in the area of the artery course deformity, in the place of its lumen constriction, decreased blood flow indices and indices of peripheral resistance distally to the compression zone. The assessment of blood flow in the vertebral arteries allows determination of the strategy of treatment of patients with degenerative-dystrophic diseases of the cervical part of the spine.
Subject(s)
Cervical Vertebrae/blood supply , Cervical Vertebrae/diagnostic imaging , Spinal Diseases/complications , Vertebral Artery/diagnostic imaging , Vertebrobasilar Insufficiency/diagnostic imaging , Vertebrobasilar Insufficiency/etiology , Female , Hemodynamics , Humans , Male , Middle Aged , Ultrasonography, Doppler, Duplex , Vertebral Artery/pathology , Vertebrobasilar Insufficiency/pathologyABSTRACT
The results of treatment of 42 patients after eradication of hernias of intervertebral discs of the lumbosacral area of the spine with a recurrent pain syndrome were analyzed within the period from 2 months to 3 years after surgery. Almost all the patients were found to have a combination of two or more factors, responsible for the development of pain syndrome. Lumbostenosis and spondiloarthrosis were noted more often. Complex and specially directed medical actions allow getting regress of the pain syndrome and stable remission in 69% of the patients.
Subject(s)
Intervertebral Disc Displacement/surgery , Lumbosacral Region/surgery , Pain, Postoperative/diagnosis , Pain, Postoperative/therapy , Adult , Female , Humans , Male , Middle Aged , Pain, Postoperative/etiology , SyndromeABSTRACT
Results of minimally invasive surgical treatment were studied in 978 patients with degenerative diseases of the spine. Paracentetic interventions were made on different structures of the spinal-motor segment after complex clinico-radial examinations. Catamnestic investigations during 3 years allowed detection of sufficiently stable positive effect of fenestration and decompression of the intervertebral disk (71%), dereception of different structures (64.1%), high-frequency electrodestruction (67.1%) and laser influence on them (78.4%).
Subject(s)
Cervical Vertebrae , Decompression, Surgical/methods , Lumbar Vertebrae , Minimally Invasive Surgical Procedures/methods , Spinal Fusion/methods , Spinal Osteochondrosis/surgery , Thoracic Vertebrae , Adult , Follow-Up Studies , Humans , Severity of Illness Index , Spinal Osteochondrosis/diagnosis , Time Factors , Treatment OutcomeABSTRACT
The results of surgical treatment of 185 patients with osteochondrosis of the vertebral column were studied during 12 months who, after complex clinico-radial examination, were treated by puncture laser nucleoplasty of intervertebral disks using a diode laser. Stable positive effect was obtained in 84.3% of cases using minimally invasive manipulations.
Subject(s)
Intervertebral Disc Degeneration/surgery , Intervertebral Disc/surgery , Laser Therapy/instrumentation , Lasers, Semiconductor/therapeutic use , Orthopedic Procedures/methods , Spinal Osteochondrosis/surgery , Adult , Cervical Vertebrae , Humans , Intervertebral Disc/diagnostic imaging , Intervertebral Disc/pathology , Intervertebral Disc Degeneration/diagnosis , Intervertebral Disc Degeneration/etiology , Lumbar Vertebrae , Magnetic Resonance Imaging , Spinal Osteochondrosis/complications , Spinal Osteochondrosis/diagnosis , Thoracic Vertebrae , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Under study there were the nearest and long-term results of surgical treatment of 618 patients with neuralgia of trigeminus who were subjected to different methods of impact on its peripheral branches after complex clinical-radial examination. Of substantial significance in examination of the patients proved to be spiral computed tomography of the facial skeleton. Laser destruction of the trigeminus peripheral branches was not practically accompanied by a local reaction and provided longer remission. However, spirit-procaine blockades as an emergency care for rapid relief of strong painful syndrome still remain to be of great importance.
Subject(s)
Catheter Ablation/methods , Laser Coagulation/methods , Nerve Block/methods , Sclerotherapy/methods , Trigeminal Neuralgia/therapy , Anesthetics, Local/administration & dosage , Ethanol/administration & dosage , Follow-Up Studies , Humans , Injections , Pain Measurement , Phenol/administration & dosage , Procaine/administration & dosage , Retrospective Studies , Sclerosing Solutions/administration & dosage , Time Factors , Tomography, Spiral Computed , Treatment Outcome , Trigeminal Neuralgia/diagnostic imagingABSTRACT
An investigation of the clinical picture of 4671 patients with associated cranio-cerebral traumas treated at the hospitals of Saint Petersburg in 2004 has shown that the clinical picture of associated traumas unlike that of isolated cranio-cerebral traumas have an atypical character with the development of pseudo-syndromes of injury of the brain. Extracranial injuries also have atypical manifestations with little symptoms. The diagnosis of associated cranio-cerebral trauma must include radial and little-invasive methods of examination.
Subject(s)
Craniocerebral Trauma/diagnosis , Electroencephalography/methods , Multiple Trauma/diagnosis , Ultrasonography, Doppler, Transcranial/methods , Adolescent , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Trauma Severity Indices , Young AdultABSTRACT
Clinico-statistical characterization of 661 subjects who died from combined cerebro-cranial traumas in hospitals of St. Petersburg in 2004 is presented with an analysis of the quality of medical care rendered to them. Most of those subjects had severe combined injuries with dominating or markedly seen signs of combined cerebro-cranial traumas. The main cause of death was most frequently a severe combined trauma of the body (52%) and different complications of trauma disease (36.3%). In the process of complex expert assessment of the quality of medical care each case was referred to one of three categories of outcomes: avoidable, conventionally avoidable and unavoidable. The groups of subjects with avoidable and conventionally avoidable outcomes (53.6%) are considered to be a substantial reserve for improvement of the results of treatment of combined cerebro-cranial traumas.
Subject(s)
Brain Injuries/epidemiology , Brain Injuries/therapy , Hospital Mortality/trends , Multiple Trauma/epidemiology , Multiple Trauma/therapy , Quality of Health Care , Urban Population , Adolescent , Adult , Female , Humans , Male , Retrospective Studies , Russia/epidemiology , Trauma Severity IndicesABSTRACT
Discusses the application of content analysis of medical periodicals as exemplified by neurosurgery. Content analysis is an obligatory element of modern research in public health organization.
