Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery

The use of vacuum assisted closure (V.A.C.) therapy in postoperative infections after dorsal spinal surgery was studied retrospectively. Successful treatment was defined as a stable healed wound that showed no signs of acute or chronic infection. The treatment of the infected back wounds consisted of repeated debridement, irrigation and open wound treatment with temporary closure by V.A.C. The instrumentation was exchanged or removed if necessary. Fifteen patients with deep subfascial infections after posterior spinal surgery were treated. The implants were exchanged in seven cases, removed completely in five cases and left without changing in one case. In two cases spinal surgery consisted of laminectomy without instrumentation. In two cases only the wound defects were closed by muscle flap, the remaining ones were closed by delayed suturing. Antibiotic treatment was necessary in all cases. Follow up was possible in 14 patients. One patient showed a new infection after treatment. The study illustrates the usefulness of V.A.C. therapy as a new alternative management for wound conditioning of complex back wounds after deep subfascial infection.     

“Skull punch” for craniotomy in neonates and infants

We have designed a new instrument that we have called a skull punch, which is useful and safe for making a burr hole for a purely osteoplastic craniotomy in neonates and infants. The instrument is described in detail.     

A NEW METHOD FOR DETECTING EYE MOVEMENT IN SLEEP

A new method of detecting eye movements (EMs) during sleep is described. The method consists of an electromechanical measurement using micro-miniaturized silver cup electrodes. These electrodes, when placed on the eyelid, produce electro-oculographic (EOG) recordings similar to the usual electrical method. The eyelid method offers the advantage of a relatively “clean” recording showing only EMs and movement artifact, with no intermingling of EEG and EOG. Furthermore, the method is at least one and one half times as sensitive as the usual EOG technique. In addition to these two special advantages, it also offers the features of conventional methods, convenience of DC coupling, independence from signal converters, ease of analyzing EM directionality, and durability despite the small size of the electrodes. Fabrication of the electrodes, recording configurations, and simultaneous comparisons to both the usual EOG technique and to a strain gauge method are described.     

First clinical experience with an endoscopic retroperitoneal approach for anterior fusion of lumbar spine fractures from levels T12 to L5

Background: Recent experience indicates that unstable spine fractures should be stabilized dorsoventrally. To avoid the high morbidity associated with the common anterior approach—i.e., thoraco-phreno-lumbotomy—we developed a technique that allows the anterior fusion of lumbar spine fractures using an endoscopic retroperitoneal (lumboscopic) approach. Methods: Lumboscopic anterior fusion was performed a few days after the initial dorsal stabilization. The retroperitoneal space was accessed endoscopically via a suprailic incision and enlarged using a ballon spacer and CO₂ insufflation. The peritoneum and the kidney were gently pushed ventrally. Mobilization of the psoas muscle dorsally then allowed exposure of the fractured spine bodies. Via two additional trocars placed opposite the fractured level, the damaged disc and bone were removed, and anterior spondylodesis was performed with an iliac crest bone block and a titanium plate. Results: The technique was applied successfully in 12 patients with fractures of L1 (n= 6), L2 (n= 4), L3 (n= 1), and L4 (n= 1) as a mono- or bisegmental fusion, requiring instrumentation from T12 to L5. No major complications (including neurological problems) were encountered. Blood loss was minimal. None of the patients required conversion to open surgery. Patients were mobilized early, starting regularly at the second postoperative day. Conclusions: Lumboscopic instrumentation of the lumbar spine is a safe, minimally invasive method for the treatment of spine fractures. The patients benefit from reduced pain, low morbidity, and excellent cosmetic results. Received: 30 April 1999/Accepted: 2 July 1999     

Japanese standard for clinical stabilometry assessment: Current status and future directions

Stabilometry is a useful tool for examining patients with functional disorders of the vestibular system. However, measurement techniques and devices vary by country. Therefore, international standardization of stabilometry is mandatory to validate the exchange of important findings. This was advocated at the 1983 Posturography Meeting in Kyoto but has not been adopted worldwide, and each country has continued to use unique regional measurement methods. In Japan, stabilometry has widespread application in medical practice in conjunction with research into its applications. With a goal of international standardization, we present details of stabilometry measurement methods and their application in Japan, together with a brief history and potential future directions of stabilometry.     

Fracture resistance of teeth instrumented by the Self-Adjusting File,ProTaper NEXT and WaveOne

AimThe present in-vitro study aimed to compare the fracture resistance of mandibular premolars, obturated after instrumentation by Self-Adjusting File (SAF), ProTaper NEXT (PTN) and WaveOne (WO).MethodSixty extracted mandibular premolars were decoronated to obtain the root length of 15 mm. The samples were divided into 4 experimental groups: Group 1 without instrumentation (control), Group 2 instrumented with SAF, Group 3 with PTN (X1 and X2) and Group 4 with WO (primary). Following instrumentation, the samples were obturated by cold lateral compaction technique using gutta-percha and AH Plus sealer. A week later, after the sealer was completely set, a vertical load was applied to the specimen's canal until fracture. Statistical analysis was performed.ResultsThe mean fracture load exhibited significant difference (p < 0.01) (One-way ANAOVA) between the groups. The Multiple Tukey post hoc tests revealed, the fracture resistance by group 1 showed no statistical difference when compared to group 2 and group 3 (p > 0.05), but a significant difference with group 4 (p < 0.01). Group 2 (SAF) presented a significantly higher fracture resistance when individually compared to group 3 and 4 (PTN and WO) (p < 0.01).ConclusionTeeth instrumented by SAF exhibited a better fracture resistance.