RESUMEN
Treatment of patients suffering from severe head injury is so far restricted to general procedures, whereas specific pharmacological agents of neuroprotection including hypothermia have not been found to improve the outcome in clinical trials. Albeit effective, symptomatic measures of the preclinical rescue of patients (i.e. stabilization or reestablishment of the circulatory and respiratory system) or of the early clinical care (e.g. prompt diagnosis and treatment of an intracranial space occupying mass, maintenance of a competent circulatory and respiratory system, and others) by and large constitute the current treatment based on considerable organizational and logistical efforts. These and other components of the head injury treatment are certainly worthwhile of a systematic analysis as to their efficacy or remaining deficiencies, respectively. Deficits could be associated with delays of providing preclinical rescue procedures (e.g. until intubation of the patient or administration of fluid). Delays could also be associated in the hospital with the diagnostic establishment of intracranial lesions requiring prompt neurosurgical intervention. By support of the Federal Ministry of Education and Research and under the auspices of the Forschungsverbund Neurotraumatology, University of Munich, a prospective system analysis was carried out on major aspects of the pre- and early clinical management at a population based level in patients with traumatic brain injury. Documentation of pertinent data was made from August 1998 to July 1999 covering a catchment area of Southern Bavaria (5.6 mio inhabitants). Altogether 528 cases identified to suffer from severe head injury (GCS < or = 8 or deteriorating to that level within 48 hrs) were enrolled following admission to the hospital and establishment of the diagnosis. Further, patients dying on the scene or during transport to the hospital were also documented, particularly as to the frequency of severe head injury as underlying cause of mortality. The analysis included also cases with additional peripheral trauma (polytrauma). The efficacy of the logistics and organization of the management was studied by documentation of prognosis-relevant time intervals, as for example until arrival of the rescue squad at the scene of an accident, until intubation and administration of fluid, or upon hospital admission until establishment of the CT-diagnosis and commencement of surgery or transfer to the intensive care unit, respectively. The severity of cases studied in the present analysis is evident from a mortality of far above 40% of cases admitted to the hospital, which was increased by about 20% when including prehospital mortality. The outcome data notwithstanding, the emerging results demonstrate a high efficacy of the pre- and early clinical management, as indicated by a prompt arrival of the rescue squad at the scene, a competent prehospital and early clinical management and care, indicative of a low rate of avoidable complications. It is tentatively concluded on the basis of these findings that the patient prognosis is increasingly determined by the manifestations of primary brain damage vs. the development of secondary complications.
Asunto(s)
Traumatismos Craneocerebrales/mortalidad , Traumatismos Craneocerebrales/terapia , Servicios Médicos de Urgencia/estadística & datos numéricos , Sistemas de Registros Médicos Computarizados/estadística & datos numéricos , Manejo de Atención al Paciente/métodos , Manejo de Atención al Paciente/estadística & datos numéricos , Documentación , Alemania/epidemiología , Humanos , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND AND OBJECTIVE: In patients with obstructive sleep apnea syndrome (OSAS) there is an increased comorbidity of internal diseases such as hypertension, coronary heart disease, chronic obstructive pulmonary disease and endocrine diseases. We analyzed prospectively frequency and consequences of pathological results in routine examinations of internal medicine in sleep laboratory. METHODS: 250 patients with OSAS underwent routine bodyplethysmography, blood- gas analysis, electrocardiogram and laboratory studies after anamnesis and clinical examination. Prior to this we indicated, whether we based on history and physical examination deemed any of these examinations necessary. Frequency and kind of pathological results as well as the consequences were analyzed. RESULTS: 129 results of bodyplethysmography and blood-gas analysis were pathological (51.6 % of all investigations), most frequently hypoxemia (22 %) and obstructive pattern (16.4 %). Further steps were necessary in 19 patients (7.6 %); the indication was seen before in 13 patients, therefore 6 results with consequences (2.4 %) were not expected. Laboratory studies were abnormal in 133 patients (53.2 % of all investigations), most of them hyperglycaemia (26.8 %) and elevated liver enzymes (20.4 %). 29 results (11.6 %) had consequences, of which 16 (6.4 %) were not expected. 82 electrocardiograms were pathological (32.8 % of all investigations), presenting most frequently as coronary heart disease (21.2 %). Further steps were necessary in 5 patients (2 %), while that was not expected in 3 patients (1.2 %). CONCLUSIONS: Routine examinations of internal medicine in patients with OSAS frequently present pathological results, which seldom have further consequences. As most of the important results can be predicted by history and clinical investigation, pathological by chance diagnoses are rare. With the exception of blood sugar tests routine examinations for patients with OSAS should be considered critically.
Asunto(s)
Examen Físico , Apnea Obstructiva del Sueño/diagnóstico , Apnea Obstructiva del Sueño/fisiopatología , Análisis de los Gases de la Sangre , Índice de Masa Corporal , Comorbilidad , Pruebas Diagnósticas de Rutina , Femenino , Humanos , Hipoxia/epidemiología , Masculino , Persona de Mediana Edad , Pletismografía , Apnea Obstructiva del Sueño/complicacionesRESUMEN
Basal cell carcinomas (BCC) are the most common cutaneous malignant neoplasms affecting fair-skinned human beings. They may progressively enlarge and spread by peripheral extension. Intracranial invasion is very rare. A case of a giant BCC of the scalp invading directly into the left hemisphere through the frontal and parietal lobe and meninges is presented. Brain invasion along Virchow-Robin's spaces is demonstrated histopathologically. A review of literature failed to disclose a previous report of similar extensive and fatal cerebral invasion from a basal cell carcinoma of the scalp.
Asunto(s)
Neoplasias Encefálicas/patología , Carcinoma Basocelular/patología , Neoplasias de Cabeza y Cuello/patología , Cuero Cabelludo , Neoplasias Cutáneas/patología , Neoplasias Craneales/patología , Neoplasias Encefálicas/terapia , Carcinoma Basocelular/terapia , Resultado Fatal , Femenino , Neoplasias de Cabeza y Cuello/terapia , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias Cutáneas/terapia , Neoplasias Craneales/terapiaRESUMEN
Up to now changes of intracranial pressure can only be objectively assessed by invasive measurement tools e.g. epidural transducers or intraventricular or intraparenchymatous catheters. Changes of intracranial pressure (ICP) are known to influence the inner ear since the subarachnoid space is linked to the perilymphatic space of the inner ear via the cochlear aquaeduct. A new method for assessing cochlear disorders is based on otoacoustic emissions (OAE) which are generated by the outer hair cells (OHCs) of the inner ear. The aim of the present study was to find out whether changes of intracranial pressure can be monitored by spontaneous otoacoustic emissions (SOAEs), transient evoked otoacoustic emissions (TEOAEs) and distortionproduct otoacoustic emissions (DPOAEs). SOAEs, TEOAEs and DPOAEs were measured in 12 young normally hearing subjects (volunteer group) in different body postures (horizontal, -30 degrees and +30 degrees supine position). In 5 patients undergoing continuous intraventricular pressure monitoring for the assessment of normal pressure hydrocephalus (NPH), DPOAEs were measured simultaneously in different body postures as well (patient group). At an increase of ICP the SOAE-level of the volunteer group decreased by -3.3 dB SPL (sound pressure level) and the TEOAE-level by -2.1 dB SPL. The DPOAEs showed a frequency dependent reduction of its level with maximal changes at the lowest frequency tested (f2 = 1 kHz; -7.9 dB SPL). In the patient group the ICP amounted to 19.2 cm H(2)0 and the DPOAE-level also decreased particularly at lower frequencies (-2.0 dB SPL). In conclusion otoacoustic emissions, particularly DPOAEs, may provide a new clinical tool for non-invasive monitoring of ICP.
Asunto(s)
Monitoreo del Ambiente/métodos , Presión Intracraneal/fisiología , Emisiones Otoacústicas Espontáneas/fisiología , Células Ciliadas Auditivas Externas/fisiología , Humanos , Postura , Valores de ReferenciaRESUMEN
Most frequently the ependymomas of the central nervous system affect the Conus medullaris and Filum terminale. Ependymomas of the thoracic spine with association of a tumor-caused syringomyelia are extremely rare. The reported 50 years old patient with a thoracic ependymoma realized first symptoms as a shoulder-arm pain caused by the tumor-syrinx. The case report indicates that MRI is the superior imaging modality for primary tumors of the central nervous system. All relevant diagnostic and therapeutic informations derived from the MRI. The article describes the clinical manifestations, the diagnostic way and therapeutic procedure in the problem region thoracic spine.
Asunto(s)
Ependimoma/diagnóstico , Dolor de Cuello/etiología , Dolor de Hombro/etiología , Neoplasias de la Columna Vertebral/diagnóstico , Vértebras Torácicas , Diagnóstico Diferencial , Diagnóstico por Imagen , Ependimoma/patología , Ependimoma/cirugía , Femenino , Humanos , Persona de Mediana Edad , Médula Espinal/patología , Médula Espinal/cirugía , Neoplasias de la Columna Vertebral/patología , Neoplasias de la Columna Vertebral/cirugía , Siringomielia/diagnóstico , Siringomielia/patología , Siringomielia/cirugía , Vértebras Torácicas/patología , Vértebras Torácicas/cirugíaRESUMEN
Thoracic disc herniations rarely occur; they vary with respect to the clinical symptomatic and do not always lead to neurological deficit. A patient is being reported on with first symptoms of unspecific back pain. The patient has been frequently treated within 12 months (at regular intervals) exclusively by chiropractic manipulation without a considerable success. It is the objective of this case report that in persistent and therapy resistant back pain without obvious neurological deficite beside native radiographs further diagnostic investigation (MRI) is indicated. Concerning chiropractic manipulations (mobilisation techniques with impulse) this paper recommends testing maneuvers, the consideration of contraindications (structural lesions, neurological deficite) and emphasizes the use of atraumatic manipulation techniques.
Asunto(s)
Quiropráctica , Desplazamiento del Disco Intervertebral/diagnóstico , Imagen por Resonancia Magnética , Vértebras Torácicas , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Desplazamiento del Disco Intervertebral/terapia , Manipulación Espinal , Vértebras Torácicas/patologíaRESUMEN
OBJECTIVE: In order to be able to assess the contrast medium enhancement of vessels and regions with disturbed blood-brain barrier, the neurosurgeon must mentally perform a subtraction of the corresponding native and contrast-enhanced scans of the CT or MRI. The principle disadvantages of this comparison are the amount of time required and the potential errors which may result from false interpretation. METHODS: The process presented here combines corresponding scans without and with contrast medium offline on a PC. In this process each couple of the black and white scans is assigned to the colour channels of the RGB system (red, green, blue) and transformed to one colour picture of the RGB colour space (additive colour mixture). RESULTS: We demonstrate that contrast medium-dependent changes can be represented in a colour contrast of complementary colours in one single picture. Additionally, the unchanged structures remain in the black and white contrast as they were before. CONCLUSION: Thanks to the optimized visualization of contrast medium dependent differences there are besides saving in time further advantages such as the reduced amount of pictures and an objective representation.
Asunto(s)
Encéfalo/diagnóstico por imagen , Encéfalo/patología , Sensibilidad de Contraste , Imagen por Resonancia Magnética , Intensificación de Imagen Radiográfica , Tomografía Computarizada por Rayos X , Adulto , Colorantes , Medios de Contraste , Humanos , Interpretación de Imagen Asistida por Computador , Masculino , Persona de Mediana Edad , Técnica de SustracciónRESUMEN
Extradural spinal lipomas are rare tumorous lesions. "True adult lipomas" have to be histologically differentiated from angiolipomas. The authors describe a case of segmental dorsal lipomas in the lower lumbar spine which led to a clinical apparent spinal claudication. Having reviewed the literature this case is the first ever described. In this case MRI was the diagnostic tool of choice. The tumor could be removed completely via interarcual laminotomy and flavectomy. The clinical outcome was excellent. In differential diagnosis of a spinal claudication this rare cause should be kept in mind when typical osseous changes are absent.
Asunto(s)
Neoplasias Epidurales/complicaciones , Claudicación Intermitente/etiología , Lipoma/complicaciones , Compresión de la Médula Espinal/complicaciones , Adulto , Anciano , Neoplasias Epidurales/diagnóstico , Neoplasias Epidurales/cirugía , Espacio Epidural/patología , Humanos , Claudicación Intermitente/cirugía , Laminectomía , Ligamento Amarillo/cirugía , Lipoma/diagnóstico , Lipoma/cirugía , Imagen por Resonancia Magnética , Masculino , Médula Espinal/patología , Compresión de la Médula Espinal/diagnóstico , Compresión de la Médula Espinal/cirugíaAsunto(s)
Traumatismos Craneocerebrales/terapia , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/organización & administración , Alemania , Escala de Coma de Glasgow , Humanos , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Proyectos de Investigación , Factores de Tiempo , Salud UrbanaRESUMEN
Postoperative lumbar spondylodiscitis can cause a failed back syndrome. With 0.1 to 3% according to the literature it belongs to the rarer complications following lumbar disc surgery. We present the characteristic clinical picture and typical findings (ESR, plain X-rays, MR) with suspected spondylodiscitis on 19 patients (= 0.2% of 9492 operative interventions for lumbar disc prolapse from 1980 to 1990) and show MR tomography to be the most sensitive investigation. Principles of therapy consist of lumbar immobilisation with a light cast orthesis for an average of 12 weeks and additional antibiotic therapy up to two weeks beyond normalisation of ESR. Finally results of therapy are presented with a satisfying outcome in 84.2% of cases.
Asunto(s)
Discitis/diagnóstico , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Complicaciones Posoperatorias/diagnóstico , Adulto , Discitis/terapia , Femenino , Estudios de Seguimiento , Humanos , Inmovilización , Desplazamiento del Disco Intervertebral/diagnóstico , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/terapiaRESUMEN
Dysfunction of sacroiliac joint and tendinosis of erector trunci muscle may cause severe pain after lumbar discectomy. In this paper we discuss pathophysiology, clinical appearance as well as specific diagnostic procedures and therapy. We want to point out that sacroiliac joint dysfunction must be taken into consideration if persistent pain occurs after discectomy.
Asunto(s)
Desplazamiento del Disco Intervertebral/cirugía , Dolor de la Región Lumbar/etiología , Vértebras Lumbares/cirugía , Complicaciones Posoperatorias/etiología , Articulación Sacroiliaca , Tendinopatía/diagnóstico , Diagnóstico Diferencial , Diagnóstico por Imagen , Discectomía , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico , Dolor de la Región Lumbar/diagnóstico , Examen Neurológico , Dolor Postoperatorio/etiología , Complicaciones Posoperatorias/diagnóstico , RecurrenciaRESUMEN
Persisting low back pain after lumbar discectomy may have many reasons. Reoperation is likely to be successful if a recurrent disc prolapse is found. The sensitivity and validity of diagnostic tools used cannot as yet be considered to be optimal. For this reason in our study 130 patients who were supposed to have a recurrent disc herniation underwent MRI with and without application of Gadolinium DTPA. In all patients we saw enhancement in the spinal canal. Sensitivity of MRI as verified by reoperation was > 90%. Hence, we can recommend this diagnostic tool for the diagnosis of recurrent disc herniation.
Asunto(s)
Desplazamiento del Disco Intervertebral/cirugía , Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética , Complicaciones Posoperatorias/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Cicatriz/diagnóstico , Cicatriz/cirugía , Medios de Contraste , Femenino , Gadolinio DTPA , Humanos , Disco Intervertebral/patología , Desplazamiento del Disco Intervertebral/diagnóstico , Vértebras Lumbares/patología , Masculino , Persona de Mediana Edad , Compuestos Organometálicos , Ácido Pentético/análogos & derivados , Complicaciones Posoperatorias/cirugía , Recurrencia , ReoperaciónRESUMEN
MRT was performed, using a 0.5 and 1.5 Tesla magnet, on 150 patients with FBSS between three days and 23 years following lumbar disc surgery. T1-weighted spin echo sequences were obtained before and after the application of gadolinium (0.15 mmol/kg). In 67 patients the MRT findings were compared with surgical observations. MRT had a sensitivity of 94% in diagnosing recurrent prolapse, a specificity of 100% and accuracy of 94%. The ventral epidural scar tissue, the disc and the neighbouring vertebral bodies showed increased contrast uptake over a prolonged post-operative period.
Asunto(s)
Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Complicaciones Posoperatorias/diagnóstico , Adulto , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , RecurrenciaRESUMEN
Between 1986 and 1988 100 patients in whom MRI had been used to diagnose prolapses of lumbar intervertebral discs were admitted to the neurosurgical department of the Munich Technical University. MRI proved to be a valuable diagnostic technique, even if one has to concede certain limitations to the usefulness of the results when compared to conventional methods, particularly in such cases where clinical symptoms are not clear. Typical findings are illustrated and compared with those seen in MRI, whose relative importance is discussed.
Asunto(s)
Desplazamiento del Disco Intervertebral/diagnóstico , Vértebras Lumbares/patología , Humanos , Imagen por Resonancia Magnética , Valor Predictivo de las PruebasRESUMEN
The intravenous anaesthetic agent propofol has become more and more popular not only for induction but also for the maintenance of anaesthesia in all fields of surgery. For this purpose, different infusion rates and also combinations of propofol with opioids, nitrous oxide and volatile anaesthetic agents have been described. The present study was designed to find the best dosage regimen for short operations and rapid changes. The necessity for the frequently recommended standardized combination of propofol with opioids should be checked with respect to the cardiovascular effects. METHODS. A series of 60 patients (ASA I and II, age range 22-79 years) selected for discectomy were prospectively randomized to three groups. Half an hour before operation all patient received 0.5 mg atropine, 50 mg promethazine and 50 mg pethidine as i.m. premedication. In all groups anaesthesia was induced with propofol in a bolus dose of 2.5 mg/kg body weight over a period of approximately 45 s. After 5 mg atracurium the patients were intubated under 100 mg succinylcholine and normoventilated with 70% nitrous oxide and 30% oxygen. For relaxation 25 mg of atracurium were given. In group I propofol was administered in a dosage of 15 mg/kg body weight per hour for 10 min after induction. After this time the propofol infusion was reduced to 6 mg/kg body weight per hour. Group II received 0.1 mg fentanyl before induction. The dosage of propofol was similar to group I. In group III 0.1 mg of fentanyl was administered before induction and propofol was given with an infusion rate of 6 mg/kg body weight from the beginning. The following parameters were controlled and documented: systolic and diastolic blood pressure (SAP and DAP), heart rate (HF), end-expiratory carbon dioxide (eeCO2), inspiratory oxygen concentration (FiO2) and peripheral oxygen saturation (sO2). Recovery time was determined as the time from the end of the propofol infusion until eye-opening on command. RESULTS. In all groups anaesthesia could be induced and maintained without complications. There was a slight increase in SAP in group I after intubation, while in the groups with fentanyl a pronounced decrease of SAP was found simultaneously with induction of anaesthesia (Fig. 1). In group I HF showed significantly higher values after intubation and for the next 15 min than in group II and group III. A rapid and pronounced increase of end-tidal carbon dioxide occurred in the fentanyl groups with the beginning of spontaneous ventilation at the end of anaesthesia. There was a significantly longer recovery time in group II with fentanyl and initial higher propofol infusion rate. A correlation between dosage of propofol and recovery time could not be found. DISCUSSION. The results of this study demonstrate that a routine combination of propofol with opioids is not necessary even for painful surgical procedures if the propofol dosage is initially increased. There are differences in cardiovascular reactions between group I without and groups II and III with fentanyl, but in our patients these changes were of no clinical importance. An additional administration of fentanyl can prevent hypertensive reactions or tachycardia with intubation, but on the other hand fentanyl can also increase the cardial depression of propofol with a dangerous decrease in blood pressure and heart rate. Therefore in combination with opioids lower doses of propofol should be used for induction and maintenance of anaesthesia. If opioids are administered, signs of a residual postoperative respiratory depression have to be taken seriously.
Asunto(s)
Anestesia Intravenosa , Disco Intervertebral/cirugía , Propofol/administración & dosificación , Adulto , Anciano , Femenino , Fentanilo/administración & dosificación , Hemodinámica/efectos de los fármacos , Hemodinámica/fisiología , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
This study reports about 10 patients, with low back pain and sciatica caused by conjoined nerve roots. The described nerve root anomaly could produce sciatica even without the presence of a disc prolaps or another impingement. On computed tomography it is difficult to distinguish conjoined nerve roots from a disc prolaps. Two of these patients have been operated, eight of them have had conservative treatment. Our experiences show that the best results could be achieved with conservative treatment, especially with stabilising gymnastics and with transcutaneous nerve stimulation.
Asunto(s)
Dolor de Espalda/etiología , Ciática/etiología , Raíces Nerviosas Espinales/anomalías , Adulto , Dolor de Espalda/diagnóstico por imagen , Dolor de Espalda/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/cirugía , Masculino , Persona de Mediana Edad , Mielografía , Síndromes de Compresión Nerviosa/diagnóstico por imagen , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Recurrencia , Ciática/diagnóstico por imagen , Ciática/cirugía , Raíces Nerviosas Espinales/diagnóstico por imagen , Raíces Nerviosas Espinales/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Spondylodiscitis is a well-known as well unavoidable complication of lumbar disc surgery. For diagnosis typical clinical symptoms and diagnostic procedures such as x-ray and scintigram are important but MRI proved to be the most sensitive and reliable. However, meaningful results can only be obtained with MRI if the measurement parameters are carefully considered, where by the field strength of the magnet plays a subordinate role. Therapy of spondylodiscitis using a light cast corset is described and it's advantages over other methods are shown.
Asunto(s)
Discitis/diagnóstico , Imagen por Resonancia Magnética , Complicaciones Posoperatorias/diagnóstico , Antibacterianos/uso terapéutico , Sedimentación Sanguínea , Moldes Quirúrgicos , Terapia Combinada , Discitis/etiología , Discitis/terapia , Estudios de Evaluación como Asunto , Humanos , Vértebras Lumbares/patología , Vértebras Lumbares/cirugía , Complicaciones Posoperatorias/terapiaRESUMEN
Apart from disc prolapse, there is a range of other disorders associated with low back pain, for which, when all conservative efforts have failed, surgical treatment should be offered. It must be emphasized, however, that the indication for surgery needs to be rigorously applied, since the most common cause of failure of surgical therapy is an erroneous surgical indication. Here, the clarification of the cause of the pain and not the diagnosis per se is decisive. In particular in degenerative disorders of the lumbar spine in the elderly, the diagnoses established often have little pathological value. Unfortunately, in many cases the real cause of low back pain still cannot be clarified with certainty. Our experience to date, however, in particular with the use of modern implants, shows that, in cases of lumbar spinal stenosis especially, tumors and pronounced segmental instability, excellent results can be achieved with surgery.
Asunto(s)
Dolor de Espalda/cirugía , Vértebras Lumbares/cirugía , Enfermedades de la Columna Vertebral/cirugía , Dolor de Espalda/etiología , Humanos , Desplazamiento del Disco Intervertebral/cirugíaRESUMEN
We report on a 81-year old patient who showed clinical signs of a shunt infection eight months after implantation of a ventriculo-atrial shunt system Heyer-Schulte. The reason was identified to be a massive infection with staphylococcus albus. Elimination of the infection was achieved by intravenous administration of fosfomycine and local instillation of gentamycin into the valve. The follow-up was uneventful for more than two years until the death of the patient in January 1987.
Asunto(s)
Derivaciones del Líquido Cefalorraquídeo , Fosfomicina/administración & dosificación , Gentamicinas/administración & dosificación , Hidrocefalia/cirugía , Infecciones Estafilocócicas/tratamiento farmacológico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Anciano , Neoplasias Encefálicas/complicaciones , Quimioterapia Combinada/administración & dosificación , Femenino , Humanos , Inyecciones IntraventricularesRESUMEN
Spondylodiscitis after lumbar disc surgery is a well-known complication with a frequency of 0.1 to 3%. According to the authors, the etiological factors are: combination of operated segment instability, damage to the lower and upper plates due to disc space curettage and transmission of germs. After treatment of 100 selected cases, all with increased risk of postoperative spondylodiscitis, distinct possibilities for prevention have been discovered. Basic treatment consisted of 3 x 80 mg perioperative doses of Gentamicin i.m. In addition a collagen sponge (Sulmycin Implant) containing 50 mg Gentamycin was inserted in the cleared disc spaces of 50 patients. Complications in this procedure were not observed. The following is recommended for prevention of postoperative spondylodiscitis: a careful operating technique, perioperative antibiotics, and in particularly endangered patients, insertion of Sulmycin Implant in the disc-spaces.