Combined surgical and physical treatment in traumatic painful syndromes of the cervical spine

Clinical observations suggest the need for changing therapeutic management to a more active one in cases of cervical spine injury with damage to the spinal cord and nerve roots or brachial plexus. In 248 patients with these injuries treated initially conservatively the incidence of cervicobrachial pain was analysed. Neuralgic pains were present in 31.5% of cases, causalgic pains in 2.4% and sympathalgic pains in 2%. Conservative treatment conducted in these patients (89 cases) during many months after trauma had no effect on return of mobility. Long-term application of physioterapy prevented only temporarily the development of trophic changes and only partially relieved pains. Only surgical decompression of the spinal cord or spinal nerves with stabilization of damaged vertebrae caused disappearance of painful syndromes and improvement in the motor activity of the extremities. These observations show that early surgical intervention for decompression of the spinal cord, roots or brachial plexus should be advocated in these cases.     

The specifics of diagnosis and surgical treatment of traumatic pneumocephalus

Traumatic pneumocefalus (TPC)--complication of severe craniocerebral injury--occurs, as a rule, in fractures, line of which is coming across the air-containing sinuses of the skull base. Depending on the air localization subarachnoidal, subdural, epidural, ventricular, clinically asymptomatic and strained forms of TPC are discerned. TPC diagnosis is based on taking into account the clinico-neurological and radiological examination peculiarities. In the acute craniocerebral injury period surgical treatment for parabasal injuries is directed on the skull cavity hermetization and for TPC--the valve mechanism abolition, liquorous fistula closure, the air tumor emptying and intracranial space hermetization. Presence of strained progressing TPC constitutes the life perilous indication for surgical intervention.     

Diagnosis and surgical treatment of traumatic heart defects

The authors suggest a method of aldosterone determination in the urine. Aldosterone is extracted from the sample and purified with the aid of columnar and thin-layer chromatography on silicagel. Aldosterone is distinctly identified in ultraviolet light on the chromatogram by its green fluorescence developing after sprinkling the plate with phosphoric acid and its subsequent heating. Quantitative determination is carried out by the measurement of the intensity of aldosterone fluorescence in sulfuric acid.     

Results of surgical treatment of acute traumatic aortic rupture

Between 1967 and 1994 48 patients have been treated at our institution for acute rupture. Two patients died before operation, in two cases the operative attempt had to be abandoned with irreversible cardiopulmonary arrest, and in 44 patients surgical correction could be performed, The rupture was complete in 14 cases and incomplete in 30. In 25 patients surgery consisted of direct suture, in one patient an aortoplasty was performed, and in 18 patients a dacron tube interposition was necessary. In 7 cases the clamp and repair technique was applied, and in 37 cases extracorporeal circulation was installed. The hospital mortality amounted to 18% and was mainly contributable to the concomitant injuries. Two patients presented with paraplegia at admission, both died; postoperative paraplegia occurred in two instances, once after 48 hours. The late results were in the majority of the cases influenced by orthopedic or neurological sequelae, only one patient had to be reoperated for a false aneurysm. Our results and the review of the literature lead to the following conclusions: In spite of an optimized emergency care system, many patients with aortic rupture die before any surgical intervention. The installation of extracorporeal circulation can decrease the incidence of postoperative paraplegia; in our experience the administration of heparin does not increase the risk of bleeding from concomitant injuries. Direct suture represents the correction of choice. The long-term results are excellent.     

Efficacy of surgical treatment in traumatic central cord syndrome

BACKGROUND: Controversy surrounds the treatment of traumatic central cord syndrome (TCCS), as there are strong advocates for nonsurgical treatment for most patients. However, conservative treatment has been shown to yield a longer period of discomfort from pain and weakness in certain cases. METHODS: In a retrospective review of 114 patients presenting with acute or chronic TCCS from 1988-94, four different age groups were separately observed under different treatments. Motor and sensory recovery were assessed. RESULTS: Better results were achieved in younger patients, with or without radiographic abnormalities, and in patients with clinically correlated encroaching cord lesions who received early surgical decompression. CONCLUSIONS: Surgical intervention for TCCS must be addressed with careful clinical and radiographic survey. Removal of offending lesions in the subacute period results in significant motor and sensory improvement in short-term and long-term follow-up.     

The conservative and surgical therapy of traumatic humeral shaft fractures

Sixty-three patients with humeral shaft fractures were evaluated clinically and radiographically 18 months after injury; 27 patients were treated surgically (group A) and 36 patients conservatively (group B). Analysis of the results according to a score by Kwasny revealed 6.2 points in group A and 2.2 points in group B (P < 0.0001; F = 46.9). The results of these two comparable groups suggest that conservative treatment of humeral shaft fractures is superior regarding mobility of the shoulder and elbow, strength, the incidence of neurological complications, pain, subjective rating and cosmesis. There were no differences on roentgenograms between the two groups (P = 0.48).     

The surgical treatment of hyperhidrosis

The diagnosis of primary hyperhidrosis is one of exclusion, but it is not a difficult one to make. It is a common, embarrassing and even disabling condition. If it does not respond to simple conservative therapy, the practitioner should not hesitate to advise sympathectomy for hyperhidrosis of the upper or lower limbs, or some simple local operation on the affected skin area for localized excessive axillary sweating.     

The surgical treatment of traumatic rupture of the aortic valve: report of a case after blunt chest trauma

An elderly patient with traumatic aortic valvular insufficiency was treated surgically with valve replacement, the preferred method of treatment, since prognosis is poor without timely surgical therapy. Further emphasis should be given to early diagnosis of this lesion.     

The surgical treatment of Graves'' disease

The in vitro adherence of Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli to five commercially available prosthetic vascular graft materials was compared. The influence of precoating the segments with human plasma for 2 h was also studied. S35-methionine was used to radiolabel bacteria. The segments were exposed to bacterial suspensions of approximately 10(7) CFU/ml at 37 degrees C for 0.5-18h. Following repeated washing in phosphate buffered saline (PBS), radioactivity associated with the segments was measured. The adherence of the three clinically relevant bacterial species was higher to untreated Dacron than to gelatin or collagen impregnated/coated Dacron or to PTFE. Furthermore, precoating of grafts with human plasma reduced bacterial adherence to woven Dacron, had a little effect on gelatin coated Dacron, but increased the adherence to collagen treated Dacron and, in particular, to PTFE.     

The surgical treatment of distal hypospadias

Distal hypospadias is one of the most common conditions encountered by the pediatric urologist. For many years it was considered to be a non-surgical pathology, since attempts to correct this condition was cosmetically unsatisfactory and more problems were caused rather than resolved. Over the last 15 years, early in the 80's, John Duckett rekindled the interest in this pathology whose treatment had advanced very little since the era of Mathieu. This article is a posthumous tribute to my mentor, John W. Duckett, who contributed considerably to the advancement of surgical treatment of hypospadias.     

The surgical treatment of normotensive glaucoma

The efficacy of surgical treatment of low (normal)-pressure glaucoma is validated on the basis of analysis of the disease progress risk factors. The risk factors are inadequate intraocular pressure (IOP) and insufficient blood supply to the optic nerve and retina. For stabilizing the glaucomatous process, IOP is to be reduced below 14 mm Hg. After antiglaucoma surgery, IOP decreases by 35% on average (to 13.9 mm Hg), and visual field is retained in remote period in 81.2% patients. Antiglaucoma operation with simultaneous decompression of the optic nerve results in a greater increase of visual field due to improvement of blood supply to the optic nerve and retina; visual functions are stabilized for a long time in 77.8% cases at a higher IOP (16.14 mm Hg) in patients with worse initial status. Functional results of surgery for normotensive glaucoma depend on ophthalmic tone and optic nerve and retinal hemodynamics.     

The surgical treatment of thoracolumbar metastases

Intrathecal implants of adrenal chromaffin cells are known to release analgesic substances such as catecholamines and opioid peptides. In the present study, bovine chromaffin cells were encapsulated in a permselective polymer membrane which protects the cells from the host immune system and allows grafting of xenogeneic cells without immunosuppression. The effects of such implants were evaluated on the pain behavior resulting from a chronic constrictive injury (CCI) of the rat sciatic nerve. Sprague-Dawley rats with a unilateral lesion were implanted in the lumbar subarachnoid space and tested for mechanical/thermal allodynia and hyperalgesia. A significant reduction in pain was observed after mechanical non-nociceptive stimulation in animals implanted with chromaffin cells. Furthermore, these animals showed decreased signs of spontaneous pain. However, response to thermal non-noxious stimuli or to painful mechanical stimuli was not significantly decreased. Abundant clusters of viable chromaffin cells intensely labeled with the anti-tyrosine hydroxylase antibodies were observed in the retrieved implants. These results establish the analgesic efficacy of intrathecal encapsulated chromaffin cells in a chronic pain model of nerve injury. Immunoprotected allo- or xenogeneic chromaffin cells acting as 'mini pumps' continuously delivering neuroactive substances could be a useful therapy for patients suffering from neuropathic pain.     

Our experience in diagnosing and surgical treatment of traumatic intracranial hematomas. Analysis of 610 patients

610 patients with traumatic intracranial hematomas treated in the Clinic of Neurosurgery in Plovdiv University of Medicine from 1975 to 1990 were studied. The study aimed at analyzing the most common clinical symptoms and paraclinical indicators leading to correct diagnosis and showing the possibilities of approximate determination of the hematoma location in accordance with the shift of the brain midline and the trauma biomechanics. It also recommends the most effective surgical method which yields the least number of hematoma recurrences. In the study the most common clinical symptom is shown to be the lucid interval. The most common paraclinical indicator is the shift of the brain midline caused by the pathological process. Visualization of the brain midline used in conjunction with the data from the biomechanics of the injury could guide the surgeons for the first burr hole in the exploratory trephination of the skull. It is recommended that, if possible, osteoplastic trephination of the skull on a four-burr-hole bone flap should be applied in the acute period of the craniocerebral trauma. This surgical method assures achievement of the best hemostasis, complete evacuation of the hematoma and the least percentage of recurrences of hematoma after surgery.     

The painful bipartite patella

Two skeletally immature patients with bipartite patella, a lesion normally classified as a developmental variation, proved to have a symptomatic lesion with a traumatic etiology. In both patients, appropriate treatment resulted in complete subsidence of symptoms; one patient was treated with cast immobilization, while the other eventually required surgical resection. In addition, normal and bipartite patellar specimens from skeletally immature cadavers were histologically and morphologically assessed. These clinical and anatomic studies suggest that in some cases a bipartite patella may be a traumatically induced, chondroosseous disruption of the superolateral pole of the incompletely ossified patella, analogous to Sinding-Larsen-Johansson disease at the inferior patellar pole or Osgood-Schlatter disease in the tibial tuberosity. The possibility of bipartite patella being such a chronic stress fracture in a symptomatic patient should be considered in order to render appropriate treatment.