Surg Neurol
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Cranioplasty is among the oldest surgical procedures. Trauma, infections, tumors and compression caused by brain edema are some of the reasons for the removal of bone. ⋯ However, there are many theories suggesting that an underlying physiological alteration may occur which may require the correction of the bone defect; many patients improve after surgery. We discuss the physiopathological basis of the "syndrome of the trephined" and try to achieve a better understanding of the present status of cranioplasty and its possible therapeutic role.
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Cervical spine fractures in the elderly are relatively common. The management of such injuries may be complicated by underlying medical debility and osteopenia as well as reduced tolerance to halo immobilization. ⋯ Although external immobilization with a halo device is our treatment of choice for most C1 and C2 fractures in elderly patients, a Philadelphia collar is useful in select cases when halo immobilization or early surgical fusion is contraindicated. Posterior cervical fusion can be safely and effectively performed in elderly patients and should be strongly considered for initial therapy in the elderly with fracture types unlikely to progress to osseous union with external immobilization alone.
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The surgical technique for transthoracic endoscopic sympathectomy varies from one to three skin incisions, room air to carbon dioxide pneumothorax, and destruction of the second (T2), third (T3), and fourth sympathetic ganglia to destruction of the T2 ganglion only. A knowledge of the surgical anatomy of the apex may help the surgeon to safely use this technique. ⋯ Transthoracic video endoscopic electrocautery of the T2 and T3 ganglia for patients with palmar hyperhidrosis may yield excellent results if the first rib can be properly identified.
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Randomized Controlled Trial Clinical Trial
Local wound infiltration with bupivacaine in lumbar laminectomy.
Parenteral administration of narcotics has been the mainstay for postoperative pain relief in patients undergoing lumbar laminectomy. However, this may lead to respiratory depression and nausea, which may be hazardous in these patients. ⋯ Local wound infiltration with bupivacaine is a safe and effective method for providing postoperative pain relief and reducing narcotic use in patients undergoing lumbar laminectomy.