Ann Acad Med Singap
-
Ann Acad Med Singap · May 1993
Case ReportsPedicle fixation: an adjuvant for the treatment of thoracolumbar metastases.
For a long time, radiotherapy was considered as the best treatment for spinal metastases. However, radiotherapy alone could not resolve the problem of pathological fracture which is an important complication of spinal metastases. ⋯ The operation time was short and none of the patients required a blood transfusion. Tissue diagnosis was possible through this approach.
-
Ann Acad Med Singap · May 1993
Influence of basal cisterns, midline shift and pathology on outcome in head injury.
The relationship of outcome to the basal cisterns, midline shift and pathology as seen on initial CT scan was assessed in 107 moderate and severe head injured patients. The mortality rates were 82 cases (76%) and 29 cases (27%) among those with obliterated and normal basal cisterns, and 74 cases (69%) and 42 cases (39%) when the midline shift was present and absent, respectively. ⋯ The state of the above two parameters when correlated with GCS score, showed that they were important for those with higher GCS scores. This indicates that the status of the cisterns and midline shift is correlated with the type of pathology and GCS score rather than these parameters taken alone in prediction.
-
Ann Acad Med Singap · May 1993
ReviewCritical care medicine--a review of the outcome prediction in critical care.
Predicting the outcome of critically ill patients has undergone considerable evolution over the last two decades. Economic constraints require the channelling of resources and efforts to patients with reasonable chances of survival. ⋯ The issues surrounding the use of the APACHE score from the literature are discussed. Estimation of specific individual mortality risks have not been as successful as that for large groups of critical care patients in general using the available prognostic scores and until better systems are available, clinical decisions on any individual outcome should not be based on any prognostic score alone.
-
Several basic and fundamental principles remain prime considerations in lumbar spine surgery, so a review of these is appropriate in view of the current headlong rush into the use of new and developing technology for lumbar spine surgery. Eighteen hundred and sixty-one laminectomy procedures are reviewed, the majority of these for simple lumbar disc protrusion and spinal canal stenosis but also 204 cases where patients required a surgical procedure for failed back surgery syndrome. Surgical technique and technology will fail when an inappropriate patient is selected for surgical intervention; failure also occurs particularly in lumbar disc protrusion if lateral recess stenosis is undiagnosed and untreated at the time of surgery. The patient's motivation status also has a significant effect on surgical outcome and the optimum patient to submit to surgery for failed back surgery syndrome has sciatica, more severe than backache, a recurrent or residual disc protrusion associated with the stenosis and excellent motivation which is not affected by workers' compensation or other insurance claims or benefit.