Articles: surgery.
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Objective. Treatment of pain associated with failed back surgery syndrome was evaluated in a pilot clinical study of a new dual lead spinal cord stimulation (SCS) system. Methods. ⋯ While external hardware problems occurred, 65% of dual lead SCS patients were willing to repeat the SCS implant procedure. Conclusions. Dual lead stimulation proved beneficial for patients with low back and leg pain associated with failed back surgery syndrome.
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Objective. This study examines, in a retrospective fashion, the effects of intraspinal infusion therapy, primarily using opioids, in the treatment of recalcitrant noncancer pain in a sample of 29 consecutive patients. Patients were, on average, 58 years of age having had one surgery, with a pain duration of 221 months. ⋯ Side effects remain fairly common and require continued attention. Their presence, however, did not appear to deter from the patient's overall sense of satisfaction. Acquiring information from significant others and clinic staff may be a useful adjunct in interpreting the overall outcome.
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Objective. Follow-up of 80 patients using multiple program spinal cord stimulation (SCS). Methods. ⋯ Conclusions. In spinal cord stimulation the use of multiple electrodes and multiple stimulation programs, together with advanced programmability, increases paresthesia overlap, reduces pain scores, and may improve patient satisfaction with SCS therapy. This study indicates a significant patient preference for multiple program SCS, if patients are given the option to choose between a single program SCS system or a multiple program SCS system.
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Plast. Reconstr. Surg. · Nov 1999
Factor XI deficiency: implications for management of patients undergoing aesthetic surgery.
We report our experience in patients with an abnormal partial thromboplastin time elevation due to factor XI deficiency (Rosenthal syndrome) who presented for aesthetic surgery consideration. Preoperative evaluation included a thorough history, physical examination, coagulation profile, and hematological consultation. Nine of 10 patients underwent 12 elective aesthetic procedures without undue intraoperative or postoperative bleeding. ⋯ High-risk patients were those with factor XI levels less than 15 percent, history of bleeding either spontaneously or with surgery, and a family history of bleeding diathesis from factor XI deficiency. Low-risk patients had fresh frozen plasma available for the procedure, whereas high-risk patients received fresh frozen plasma 2 hours before surgery. We conclude that (1) in these patients with abnormally high partial thromboplastin time values and no prior known bleeding disorder, we have identified factor XI deficiency as the prevalent coagulopathy; (2) partial thromboplastin time does not necessarily correlate with factor XI levels; (3) patients can be classified as high or low risk for elective surgery based on factor XI levels and prior surgical or family history; (4) recommendations for perioperative management can be made based on this risk profile; and (5) aesthetic surgery can be performed successfully and safely on patients with factor XI deficiency on a case-by-case basis when appropriate guidelines are enforced.