One, if not the only effective way of treating pain due to preganglionic avulsion of the brachial plexus is the Dorsal Root Entry Zone (DREZ) lesion procedure. In 1985 the author began to use ultrasound as a lesion-maker for operations in the DREZ. Since then, 127 (3 patients were operated on twice) DREZ-Operations have been carried out on 124 patients suffering from chronic pain due to brachial plexus avulsion. Different technical lesioning modalities were employed: ultrasonic discontinuous DREZ lesions in 20 cases and a new modality: ultrasonic DREZ-sulcomyelotomy in 107 cases. Analysis of the results after ultrasonic DREZ-operations revealed that ultrasonic DREZ-sulcomyelotomy was the most effective technical modality. Immediately after operation good pain relief was obtained in 103 (96%) out of the 107 patients operated on with the ultrasonic DREZ-sulcomyelotomy method, and in 15 (75%) out of the 20 patients with ultrasonic discontinuous DREZ-lesions. The total follow-up study (47.5 months on average) revealed 87% good results overall.
Pain and restriction of movements in the hip joint due to coxarthrosis are common causes of patients'' visits to their doctors. During the past few years, endoprosthetic surgery has been the most common surgical method for the treatment of this disease. Endoprosthetic operation is contraindicated for some patients in view of their excessive body weight or the presence of concurrent somatic diseases. In order to eliminate pain due to coxarthrosis, we have developed a new operation -percutaneous radiofrequency destruction of the obturator nerve - carried out at the point of its exit from the small pelvis through the obturator canal.
Objective: Compare rehabilitation after spinal cord lesions (SCL) in different countries. Design: Multicenter comparative study. Setting: Four spinal rehabilitation units, in Denmark, Russia, Lithuania and Israel. Subjects: 199 SCL patients. Interventions: Information was collected about unit properties, rehabilitation objectives, American Spinal Injury Association (ASIA) scale and spinal cord independence measure (SCIM) assessments, and patient data. w 2 -test, t-test, ANOVA and ANCOVA were used for statistical analysis. Main outcome measures: Time from lesion onset to admission for rehabilitation (TAR), length of stay in rehabilitation (LOS), SCIM and spinal cord ability realization measurement index (SCI-ARMI) scores, SCIM gain, SCI-ARMI gain and rehabilitation efficiency (RE). Results: Differences were found between the units in rehabilitation objectives, facilities and special equipment for rehabilitation. Staff/bed ratio was 1.7 in Lithuania and Denmark, 1.1 in Israel and 0.9 in Russia. Russian patients were the youngest and had the most severe lesions among participating units. Admission SCIM and SCI-ARMI were the lowest in Israel: 25.1 ± 17.2 and 34.3 ± 17.3. TAR was highest in Russia (12.4 month) and lowest in Israel (2 weeks; Po0.01). LOS was longest in Denmark (176.9 days; Po0.001). SCIM score at the end of rehabilitation was highest in Denmark (67.3 ± 23). SCIM gain and SCI ARMI gain were highest in Israel (36.9±18.3 and 38.5±19.4, respectively) and lowest in Russia (Po0.001). RE was highest in Lithuania and lowest in Denmark (Po0.001). Conclusions: In the participating units, SCL rehabilitation outcomes depend on SCL severity and unitspecific properties. A moderately delayed rehabilitation with long LOS achieved high functioning, and early or slightly delayed rehabilitation combined with shorter LOS achieved high functional gain or efficiency.
This work focuses on the use of an ultrasound neurosurgical unit which includes frequency generator and acoustic converter with different types of surgical attachments according to the surgical peculiarity. These attachments were designed to be used for ultrasonic resection, ultrasonic aspiration, ultrasonic disintegration and other applications. High cutting ability, possibility of local disintegration, specific hemostatic effects and other benefits of ultrasonic surgical tools (in the experimental level) were behind the efforts to create the ultrasound microneurosurgical unit with different attachments of cutting, disintegration, aspiration and separation tools. We used the ultrasound microneurosurgical unit during 299 operations involving meningiomas; acoustic neurinomas; gliomas; hordomas; pituitary adenomas; craniopharyngiomas; tuberculoma; paroxysmal pain in the patients with brachial plexus injuries, facial pain, phantom limb pain, intercostal neuralgia, post-mastectomy syndrome, syringomyelia and tumors of nerve trunks. The experience of using the surgical instruments based on ultrasound oscillation of the working edge showed their high efficiency and good perspective in experimental research as well as in practical application in different ramifications of surgery.
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