RESUMEN
The results after percutaneous lumbar discectomy were evaluated in 52 patients with low back pain corresponding to the L5 or S1 root. All patients were examined with a median follow-up time of 14 weeks. The patients were divided in two groups. Group 1: patients with an obvious indication for surgery (29 patients) and group 2: patients with a relative indication for surgery (23 patients). The follow-up results for patients in group 1 were comparable with the results after conventional discectomy. The results concerning follow-up low back pain in groups 1 and 2 were good or excellent in 69% and 43% of the patients respectively. The corresponding results for sciatica were 69% and 65% respectively. It is concluded that percutaneous lumbar discectomy is a possible alternative to conventional discectomy in selected patients.
Asunto(s)
Discectomía Percutánea , Desplazamiento del Disco Intervertebral/cirugía , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/cirugía , Adolescente , Adulto , Discectomía Percutánea/métodos , Estudios de Evaluación como Asunto , Femenino , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico , Dolor de la Región Lumbar/diagnóstico , Masculino , Persona de Mediana EdadRESUMEN
In a prospective study including 16 patients with multiple trauma and head injury and 14 patients with isolated head injury we measured plasma levels of prothrombin fragment 1 and 2 (F1 + 2) and thrombin/antithrombin III complex (TAT) on admission and on days 1, 2, 3, and 7 after the incident. On admission, all patients had values of F1 + 2 and TAT above the reference range. Admission levels of both F1 + 2 and TAT were significantly higher compared with levels on the following days. Admission levels of F1 + 2 was significantly correlated to the Injury Severity Score. TAT was higher in patients with multiple trauma than in patients with isolated head injury and were significantly correlated to the Injury Severity Score on admission and on day 3. Levels of F1 + 2 were significantly lower on day 1 in four patients with post-traumatic pulmonary dysfunction compared with patients without pulmonary dysfunction. With respect to levels of TAT, no differences were detected between patients with and without pulmonary dysfunction.
Asunto(s)
Antitrombina III/análisis , Traumatismos Craneocerebrales/sangre , Traumatismo Múltiple/sangre , Fragmentos de Péptidos/análisis , Péptido Hidrolasas/análisis , Protrombina/análisis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Traumatismos Craneocerebrales/complicaciones , Coagulación Intravascular Diseminada/etiología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Enfermedades Pulmonares/etiología , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
In a prospective study including 30 traumatized patients, levels of fibrinogen, fibrinopeptide A (FpA), fibrin monomers (FM) and fibrin degradation products (FbDP) were measured on admission and on days 1, 2, 3 and 7 after the incident. High levels of FpA, FM and FbDP were observed immediately after the trauma. Fibrinogen levels increased during the first 7 posttraumatic days whereas FpA and FM decreased. FbDP was significantly higher on day 7 than on day 3. All variables were to some extent correlated to the injury severity score. FbDP were significantly lower on the day after admission in 4 patients who developed pulmonary dysfunction compared with patients without this complication.
Asunto(s)
Traumatismos Craneocerebrales/sangre , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Fibrina/análisis , Fibrinógeno/análisis , Fibrinopéptido A/análisis , Traumatismo Múltiple/sangre , Edema Pulmonar/etiología , Adolescente , Adulto , Traumatismos Craneocerebrales/complicaciones , Femenino , Fibrinólisis , Hemostasis , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/complicaciones , Estudios Prospectivos , Edema Pulmonar/fisiopatología , Índice de Severidad de la EnfermedadRESUMEN
A new scale for assessment of overall responsiveness, the Reaction Level Scale (RLS 85), which has been shown to have better reliability than the Glasgow Coma Scale (GCS), has been tested in four neurosurgical departments regarding inter-observer agreement and coverage i.e. the proportion of patients that could be assessed by the scale. In a carefully designed study 51 observers pairwise performed 164 tests on 88 patients. Reliability was studied by the Kappa method, which is defined as inter-observer agreement corrected for agreement by chance. The inter-observer agreement measured as overall Kappa was good (K = 0.69 +/- 0.05) and there were no significant differences between the departments, professional categories or aetiologies. Regarding the separate RLS 85 levels the Kappa values were above 0.65, except for withdrawing (K = 0.51) and flexor responses (K = 0.55). There was good inter-observer agreement on coma (K = 0.71). In conclusion, the RLS 85 proved to be easily learnt, it showed full coverage without pseudoscoring, and it was used in a consistent way by doctors, nurses and assistant nurses of four different neurosurgical departments in two Scandinavian countries.
Asunto(s)
Nivel de Alerta/fisiología , Encefalopatías/fisiopatología , Coma/fisiopatología , Pruebas Neuropsicológicas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Encéfalo/fisiopatología , Encefalopatías/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
A case is presented of a 'top of the basilar' stroke followed by a well circumscribed midbrain lesion mainly involving the parenchyma around both third nerve nuclear complexes. Prominent clinical features were: third nerve paralysis including huge pupils unresponsive to light, transient unconsciousness, and slight cerebellar dyscoordination.
Asunto(s)
Trastornos Cerebrovasculares/fisiopatología , Pupila , Adulto , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/etiología , Trastornos Cerebrovasculares/complicaciones , Femenino , Humanos , Oftalmoplejía/etiología , Tegmento Mesencefálico/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Material from 100 consecutive operations on herniated discs has been investigated for amyloid. Various degrees of amyloid degeneration were found in disc tissue from 41 patients. Material from patients over 50 years old showed significantly more amyloid than that from younger patients; there was no sex difference. Eighteen patients had previously been operated on for herniated discs; seven of these (39%) had pyrophosphate deposits in their disc tissue, often in close topographical relation to amyloid. 26% of the patients had calcium phosphate deposits and 29% had slight inflammation--both without relation to amyloid. No pathogenetic correlation between amyloid degeneration and herniation of intervertebral disc tissue could be shown.
Asunto(s)
Amiloide/análisis , Desplazamiento del Disco Intervertebral/metabolismo , Disco Intervertebral/análisis , Adulto , Factores de Edad , Anciano , Femenino , Humanos , Disco Intervertebral/patología , Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/patología , Desplazamiento del Disco Intervertebral/cirugía , Masculino , Persona de Mediana EdadAsunto(s)
Vértebras Cervicales/lesiones , Fracturas Óseas/cirugía , Luxaciones Articulares/cirugía , Accidentes de Tránsito , Adolescente , Adulto , Anciano , Vértebras Cervicales/diagnóstico por imagen , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neurocirugia , RadiografíaRESUMEN
Five patients suffering from suprascapular nerve compression syndrome were treated by surgical decompression of the nerve. The syndrome is described and the surgical treatment is outlined. The diagnostic necessity for electromyography is stressed as is the intraoperative evaluation of the conductive obstacle by use of electrostimulation.