Intracompartmental Pressure Monitoring Research Articles

Continuous Compartment Pressure Monitoring—Better Than Clinical Assessment?

Although the pathophysiologic concept of compartment syndrome as progressive myoneural ischemia caused by elevated intracompartment pressure is well accepted, it is not an entity that is easily diagnosed. The difficulty in diagnosing compartment syndrome is problematic because the consequences of missed compartment syndrome can be profound (rhabdomyolysis, muscle fibrosis and contracture, and permanent neurologic deficit), and the only effective prophylactic or therapeutic option of surgical fasciotomy has its own morbidity, expense, and potential complications. Thus, “getting it right” is both extremely important and extremely difficult. Currently, clinical examination findings and use of intracompartmental pressure monitoring are both most useful in telling us who does not need fasciotomy rather than who does. We can be confident that most patients without concerning physical findings and all patients who have a perfusion pressure (diastolic blood pressure minus intracompartmental pressure) of >30 mm Hg can be safely observed. What we do not know is what we should do with patients who have positive clinical findings or perfusion pressure of <30 mm Hg. Such patients often undergo fasciotomy, but once fasciotomy is done, it is unknown whether compartment syndrome was really present (unless there was necrotic muscle), and therefore whether the fasciotomy was prophylactic, therapeutic, or completely …

Systematic Review and Recommendations for Intracompartmental Pressure Monitoring in Diagnosing Chronic Exertional Compartment Syndrome of the Leg

Although all intracompartmental pressure (ICP) measurement, magnetic resonance imaging, and near-infrared spectroscopy seem to be useful in confirming the diagnosis of chronic exertional compartment syndrome (CECS), no standard diagnostic procedure is currently universally accepted. We reviewed systematically the relevant published evidence on diagnostic criteria commonly in use for CECS to address 3 main questions: (1) Is there a standard diagnostic method available? (2) What ICP threshold criteria should be used for diagnosing CECS? (3) What are the criteria and options for surgical management? Finally, we made statements on the strength of each diagnostic criterion of ICP based on a rigorous standardized process. We searched for studies that investigated ICP measurements in diagnosing CECS in the leg of human subjects, using PubMed, Score, PEDRO, Cochrane, Scopus, SportDiscus, Web of Knowledge, and Google Scholar. Initial searches were performed using the phrase, "chronic exertional compartment syndrome." The phrase "compartment syndrome" was then combined, using Boolean connectors ("OR" and "AND") with the words "diagnosis," "parameters," "levels," "localisation," or "measurement." Data extracted from each study included study design, number of subjects, number of controls, ICP instrument used, compartments measured, limb position during measurements, catheter position, exercise protocol, timing of measurements, mean resting compartment pressures, mean maximal compartment pressures, mean postexercise compartment pressures, diagnostic criteria used, and whether a reference diagnostic standard was used. The quality of studies was assessed based on the approach used by the American Academy of Orthopaedic Surgeons in judging the quality of diagnostic studies, and recommendations were made regarding each ICP diagnostic criteria in the literature by taking into account the quality and quantity of the available studies proposing each criterion. In the review, 32 studies were included. The studies varied in the ICP measurement techniques used; the most commonly measured compartment was the anterior muscle compartment, and the exercise protocol varied between running, walking, and ankle plantarflexion and dorsiflexion exercises. Preexercise, mean values ranged from 7.4 to 50.8 mm Hg for CECS patients, and 5.7 to 12 mm Hg in controls; measurements during exercise showed mean pressure readings ranging from 42 to 150 mm Hg in patients and 28 to 141 mm Hg in controls. No overlap between subjects and controls in mean ICP measurements was found at the 1-minute postexercise timing interval only showing values ranging from 34 to 55.4 mm Hg and 9 to 19 mm Hg in CECS patients and controls, respectively. The quality of the studies was generally not high, and we found the evidence for commonly used ICP criteria in diagnosing CECS to be weak. Studies in which an independent, blinded comparison is made with a valid reference standard among consecutive patients are yet to be undertaken. There should also be an agreed ICP test protocol for diagnosing CECS because the variability here contributes to the large differences in ICP measurements and hence diagnostic thresholds between studies. Current ICP pressure criteria for CECS diagnosis are therefore unreliable, and emphasis should remain on good history. However, clinicians may consider measurements taken at 1 minute after exercise because mean levels at this timing interval only did not overlap between subjects and controls in the studies we analyzed. Levels above the highest reported value for controls here (27.5 mm Hg) along with a good history, should be regarded as highly suggestive of CECS. It is evident that to achieve an objective recommendation for ICP threshold there is a need to set up a multi-center study group to reach an agreed testing protocol and modify the preliminary recommendations we have made.

Acute compartment syndrome: obtaining diagnosis, providing treatment, and minimizing medicolegal risk

Acute compartment syndrome (ACS) is a surgical emergency. Diagnosis depends on a high clinical suspicion and an understanding of risk factors, pathophysiology and subtle physical exam findings. The typical high risk scenario for ACS is a male patient younger than 35years of age, involved in a high energy sport or roadway collision, resulting in a tibial shaft fracture. He will go on to develop acute compartment syndrome of the leg in less than 10 hours and require emergent fasciotomy. Diagnosis of ACS in this patient is primarily a clinical one but can be confirmed with invasive intracompartmental pressure monitoring or non-invasive near infrared spectroscopy (NIRS). Delaying the diagnosis will likely result in some degree of permanent disability and places the surgeon at high risk for litigation. This article reviews the salient features of acute compartment syndrome that should be understood by all orthopaedic residents and surgeons.

The Use of Near-Infrared Spectrometry for the Diagnosis of Lower-Extremity Compartment Syndrome

While intracompartmental pressure monitoring is a widely used diagnostic tool to measure intracompartmental pressures in the setting of compartment syndrome, its invasive nature has prompted the development of noninvasive techniques, such as near-infrared spectrometry. We prospectively assessed the association between tissue oxygen saturation measured by near-infrared spectrometry and compartment pressure measured by intracompartmental pressure monitoring in a cohort of patients with compartment syndrome of the lower extremity. We hypothesized that tissue oxygen saturation measured by near-infrared spectrometry would negatively correlate with intracompartmental pressures. Tissue oxygen saturation was determined for all 4 compartments of the lower extremity in 7 patients using near-infrared spectrometry. All patients subsequently underwent lower-extremity fasciotomies. Mechanism of injury, compartment pressures, blood pressure, near-infrared spectrometry measurement of tissue oxygen saturation, and characteristics of the muscle at the time of fasciotomy were recorded. The strength of the correlations between tissue oxygen saturation and absolute and relative compartment pressures was estimated based on mixed linear (growth) models with repeated observations nested within patients. Our analyses demonstrated no significant relationship between tissue oxygen saturation measured by near-infrared spectrometry and the absolute or relative compartment pressures. This suggests that compartment tissue oxygen saturation measurements by near-infrared spectrometry do not correlate with the diagnosis of compartment syndrome, and that near-infrared spectrometry would not serve as a reliable diagnostic tool.

Experimental study into forearm compartmental pressures

IntroductionChronic compartment syndrome is well recognised, although rare in the forearm. In our chronic compartment syndrome clinic, we successfully identified and treated four cases. This prompted a literature review searching...

The Effect of HyProCure ® Sinus Tarsi Stent on Tarsal Tunnel Compartment Pressures in Hyperpronating Feet

Tarsal tunnel syndrome is characterized by increased pressure in the tarsal tunnel. In hyperpronation, there is excessive abnormal pronation resulting from partial displacement of the talus on the calcaneus. In this study, we hypothesized that hyperpronation caused by talotarsal instability will lead to increased pressure in the tarsal tunnel and porta pedis. We also hypothesized that the pressure in these compartments will decrease following an extra-osseous talotarsal stabilization procedure using HyProCure ®. Pressures in the tarsal tunnel and porta pedis were measured in 9 fresh-frozen cadaver specimens using an intracompartmental pressure monitor system. Pressures were measured with the foot in neutral and hyperpronated position, before and after stabilization using HyProCure. For the tarsal tunnel, pressure in the neutral position with and without HyProCure was 3 ± 3 mm Hg and 4 ± 3 mm Hg, respectively ( P = .159). However, for the hyperpronating foot, the pressure decreased from 32 ± 16 mm Hg to 21 ± 10 mm Hg ( P < .001) following the placement of HyProCure. In the porta pedis, pressure in the neutral position with and without HyProCure was 2 ± 2 mm Hg and 2 ± 2 mm Hg, respectively ( P = .168). However, for the hyperpronating foot, the pressure decreased from 29 ± 15 mm Hg to 18 ± 11 mm Hg ( P < .001) following the placement of HyProCure. The pain caused by compression of the posterior tibial nerve in the tarsal tunnel and its branches in the porta pedis, owing to hyperpronation, may be alleviated by implantation of HyProCure.

The effect of haematoma aspiration on intra-articular pressure and pain relief following Mason I radial head fractures

Background The aspiration of the accompanying haematoma by Mason type I radial head fractures is advocated by several authors to achieve an analgesic effect. The purpose of this study was to investigate the effect of haematoma aspiration on intra-articular pressure and on pain relief after Mason I radial head fractures. Materials and methods A total of 16 patients (10 men and six women, age 23–47 years) with an isolated Mason I radial head fracture were subjected to haematoma paracentesis. Initially, intra-articular pressure was measured by using the Stryker Intra-Compartmental Pressure Monitor System. After haematoma aspiration, a new pressure measurement without moving the needle was performed. Pain before and after haematoma aspiration was evaluated by using an analogue 10-point pain scale. Results Intra-articular elbow pressure prior to haematoma aspiration varied from 49 to 120 mmHg (median, 76.5 mmHg), while following aspiration, it ranged from 9 to 25 mmHg (median, 17 mmHg). The median quantity of the aspired blood was 2.75 ml (range, 0.5–8.5 ml). Patients reported a decrease in the visual analogue score (VAS) for pain from 5.5 (4–8) before to 2.5 (1–4) after aspiration. Decrease for both pressure and pain was statistically significant ( p = 0.005). Conclusion The formation of an intra-articular haematoma in the elbow joint following an undisplaced Mason I radial head fracture leads to a pronounced increase of the intra-articular pressure accompanied by intense pain for the patient. The aspiration of the haematoma results in an acute pressure decrease and an immediate patient relief.

Experimental Study of Forearm Compartmental Pressures

Chronic compartment syndrome is well recognized, although it is rare in the forearm. Diagnosis is based on history, clinical examination, and compartment pressure readings. Existing normal pressure ranges for the forearm are based on lower limb measurements. This study aimed to establish normal pre- and post-exercise forearm compartment pressures. Using a Stryker intracompartmental pressure monitor (Stryker, Kalamazoo, MI), 41 volunteers had pressure measurements of the extensor and flexor forearm compartments before and after exercise. Normal ranges were established for pre-exercise extensor compartment (2-27 mm Hg; upper confidence interval [CI] 18.8-25.2 mm Hg), post-exercise extensor compartment (2-24 mm Hg; upper CI 16.8-22.8 mm Hg), pre-exercise flexor compartment (1-19 mm Hg; upper CI 13.3-17.4 mm Hg), and post-exercise flexor compartment (0-19 mm Hg; upper CI 16-21.4 mm Hg) pressures. No significant difference was found between pressures before and after exercise. There was no correlation between whether pressures increased or decreased following exercise. There was a significant gender difference. Normal ranges were 0 to 25.2 mm Hg for the extensor compartment and 0 to 21.4 mm Hg for the flexor compartment. This study has shown a significant difference in normal forearm compartment pressures between genders. A normal reference range of flexor and extensor forearm compartment pressures to aid diagnosis of chronic compartment syndrome has been determined. This might also prove useful in aiding the diagnosis of acute forearm compartment syndrome.

Upper limb compartment syndrome after an adder bite: a case report

Abstract Compartment syndrome after an adder bite is extremely rare, whose effects are only secondary to the cytotoxic and hemorrhagic effects of venom. Here we reported a case of compartment syndrome in the upper limb following an adder bite in the thenar eminence. Elevated compartment pressure was documented and immediate surgical fasciotomy was practiced. The patient achieved complete recovery with a good functional result. We discussed the controversies on fasciotomy and non-invasive measures in such a situation, and recommended intracompartmental pressure monitoring during the management of compartment syndrome following adder bites.

A New Method for Estimating Arterial Occlusion Pressure in Optimizing Pneumatic Tourniquet Inflation Pressure

To reduce pressure-related injuries resulting from pneumatic tourniquet use, the lowest possible inflation pressure is recommended. Arterial occlusion pressure (AOP) is a measure of the cuff pressure required to maintain a bloodless surgical field. However, its determination method is time consuming, requires operator skill, and is therefore seldom used in current practice. An AOP estimation can be made by knowing the pressure transmitted to the underlying soft tissues. We measured upper and lower extremity tissue pressures under the tourniquet cuff at 100, 200, and 300 mm Hg of tourniquet inflation pressures in 30 anesthetized living adult patients. All patients received general anesthesia with neuromuscular relaxation. A Stryker intra-compartmental pressure monitor was used to measure tissue pressures under the tourniquet cuff. In all patients, the soft tissue pressures were consistently lower than the applied tourniquet inflation pressures. Our results revealed tissue padding coefficients for extremities 20 to 75 cm in circumferences. An estimation method of AOP was developed [AOP = (systolic blood pressure + 10)/Tissue padding coefficient]. The new AOP estimation method may be a simple, rapid, and clinically practical alternative to the AOP determination method.

Accuracy in the Measurement of Compartment Pressures: A Comparison of Three Commonly Used Devices

In situations in which accurate physical diagnosis is inconclusive, an objective method for measuring compartment pressure can aid in the diagnosis of compartment syndrome. Previous studies have compared measurement devices with each other but not with an accurately determined gold standard. The purpose of the present study was to devise a reproducible in vitro model of compartment pressure and to compare commonly used measurement devices in order to determine their accuracy. With a graduated cylinder being used to generate a known pressure, freshly harvested ovine muscle was placed into a chamber for testing. The cylinder was incrementally filled with saline solution (in fifty-five steps), and measurements of tissue pressure were obtained with use of the Stryker Intracompartmental Pressure Monitor System, an arterial line manometer, and the Whitesides apparatus. Each device was tested with a straight needle, a side-port needle, and a slit catheter, for a total of nine setups in all. Five trials were done with each setup. Control pressures were calculated on the basis of the height of the saline solution column (test range, 0.13 to 10.80 kPa). Multiple regression analysis was used to compare measured tissue pressures with calculated control pressures. Most methods demonstrated excellent correlation (R2> 0.95) between calculated and measured pressures. The arterial line manometer with the slit catheter showed the best correlation (R2= 0.9978), and the Whitesides apparatus with the side-port needle showed the worst (R2= 0.9115). Furthermore, the Stryker system with the side-port needle demonstrated the least constant bias (+0.06 kPa). Straight needles tended to overestimate pressure. Two of the three needle configurations involving the Whitesides apparatus overestimated pressure. The data for the Whitesides methods had the highest standard errors, showing clinically unacceptable scatter. Side-port needles and slit catheters are more accurate than straight needles are. The arterial line manometer is the most accurate device. The Stryker device is also very accurate. The Whitesides manometer apparatus lacks the precision needed for clinical use.

Validation of Direct Intraabdominal Pressure Measurement Using a Continuous Indwelling Compartment Pressure Monitor

According to recommendations, intraabdominal pressure should be monitored every 8 hours for patients at high risk of abdominal compartment syndrome. Continuous intraabdominal pressure monitoring may be valuable for these patients. For 15 patients undergoing laparoscopic surgery, a pressure monitor was introduced after formation of pneumoperitoneum. During the procedure, the laparoscopic insufflator pressure was varied. The pressure monitor values and the time to equilibrium were recorded. Altogether, 152 pressure recordings were taken for the patients studied. The measurements from the insufflator and pressure monitor were compared using a Bland-Altman plot. The mean difference between the techniques was 0.04 +/- 3.8, and 95% of the points from the pressure monitor were within two standard deviations of the mean difference. Pressure changes were essentially "real time." The intracompartmental pressure monitor provides accurate, rapid, and direct measurement of intraabdominal pressure, and may be a useful tool for continuous intraabdominal pressure measurement among patients at risk of abdominal compartment syndrome.

How much pressure does a pressure dressing press? quantifying the effects of a pressure dressing on the post-cesarean section incision

EFFECTS OF A PRESSURE DRESSING ON THE POST-CESAREAN SECTION INCISION ANJALI KAIMAL, JAMES PHILLIP, JAMES GREENBERG, Brigham and Women’ s Hospital, Department of Obstetrics and Gynecology, Boston, Massachusetts, Brigham and Women’s Hospital, Department of Anesthesia, Boston, Massachusetts, Brigham and Women’s Hospital, Department of Obstetrics and Gynecology, Boston, Massachusetts OBJECTIVE: Application of a pressure dressing is intended to compress dead space and prevent hematoma and seroma formation, leading to decreased wound disruption, a complication that causes significant morbidity and cost. Theoretically, the pressure dressing improves hemostasis by preventing venous capillary blood loss and exudate. Conversely, pressure dressings may cause increased patient discomfort and their removal can be associated with skin trauma. Given the paucity of data supporting the benefit of a pressure dressing for an abdominal incision and the potentially deleterious effects, this pilot study seeks to determine the increase in pressure exerted by a pressure dressing after a primary cesarean section. STUDY DESIGN: After undergoing routine cesarean section via a Pfannenstiel skin incision, the wound pressures in five subjects were measured in three different states. Using a Stryker Intra-Compartmental Pressure Monitor System, subcutaneous tissue pressures were measured immediately after wound closure, after application of a simple Telfa dressing, and after application of a pressure dressing. A t-test was used to compare the measurements. RESULTS: Mean baseline pressure in the subcutaneous tissue in an undressed wound was 1.4 mmHg. After application of a Telfa dressing, the mean pressure was 1.8 mm Hg. After application of a pressure dressing, the mean pressure was 6.6 mm Hg. Application of a pressure dressing resulted in an average increase in pressure in the subcutaneous tissue of 4.8 mm Hg (P ! .005) as compared with a Telfa dressing alone. CONCLUSION: Application of a pressure dressing significantly increases the pressure in the subcutaneous tissue of a cesarean section incision. However, the increase in pressure demonstrated by this study may not be sufficient to overcome capillary venous pressure; therefore, the pressure dressing may not be able to decrease hematoma and seroma formation. Until there is data that a dressing can impact the pathophysiology of wound disruption, surgeons may want to reconsider the use of a pressure dressing in this setting. 221 LABOR INDUCTION AND AUGMENTATION: INDEPENDENT RISK FACTORS FOR UTERINE RUPTURE? GEORGE MACONES, DAVID STAMILIO, EMMANUELLE PARE, JEFFREY PEIPERT, ANTHONY SCISCIONE, HARISH SEHDEV, SARAH RATCLIFFE, MARY SAMMEL, University of Pennsylvania, Obstetrics and Gynecology, Philadelphia, Pennsylvania, Brown University, Obstetrics & Gynecology, Providence, Rhode Island, Drexel University, Obstetrics and Gynecology, Philadelphia, Pennsylvania, Pennsylvania Hospital, Obstetrics & Gynecology, Philadelphia, Pennsylvania, University of Pennsylvania, Biostatistics, Philadelphia, Pennsylvania OBJECTIVE: To determine whether induction and augmentation of labor with specific agents independently increases the risk of uterine rupture in women attempting VBAC. STUDY DESIGN: A case-control study, nested within a cohort study of 13,706 women who attempted VBAC at 17 participating institutions (community and tertiary), was performed. Cases of uterine rupture were compared to randomly selected controls for a variety of obstetrical, historical, and intrapartum factors. Information was collected from the inpatient medical record by trained research nurses. We used both bivariate and multivariate techniques to determine whether induction/augmentation and the use of specific agents increased the risk of uterine rupture. RESULTS: We identified 133 cases of uterine rupture (incidence = 0.98%) and compared them to 665 randomly selected controls. After adjustment for confounding factors, neither labor induction (adjusted OR= 1.0, 95% CI 0.42.3) nor labor augmentation (adjusted OR= 1.7, 95% CI 0.8-3.6) were independently associated with uterine rupture. The use of prostaglandins alone was not associated with an increased risk of uterine rupture (adjusted OR= 1.4, 95% CI 0.2-8.2). The use of sequential prostaglandin and pitocin was, however, associated with a 3 fold increase in the risk of rupture (adjusted OR= 3.1, 95% CI 1.0-9.8). CONCLUSION: In contrast to a prior report and ACOG’s recent opinion, prostaglandins alone do not appear to be associated with uterine rupture. The need for sequential prostaglandins and pitocin, signifying a more difficult induction, appears modestly associated with rupture.

Monitoring antebrachial compartmental pressure in displaced supracondylar elbow fractures in children

Our aim was to measure antebrachial volar compartment pressure in displaced supracondylar elbow fractures in children. We conducted a prospective, observational study of 42 fractures. The mean age was 5.2 years. There was type II displacement in nine cases (21.4%) and type III in 33 (78.6%). A wick catheter (1.5 mm in diameter) was placed perioperatively and compartmental pressure was monitored on a intra-compartmental pressure monitor system (STIC monitor) with a +/- 1 mmHg margin of error. Compartmental, systolic and diastolic pressures were measured every day for the first three postoperative days and then for a 2-week follow-up period. Descriptive statistics, t-test and correlation with a P < 0.05 significance were studied. Mean compartmental pressure before reduction was 8.3 mmHg and 6.7, 4, 2.4, 1.7 and 1 mmHg during the first 3 days and at 1 and 2 weeks post-reduction, respectively. Pressure decreased 40% (P = 0.0005) from the first to the second day and 75% (P = 0.0005) from the first day to the first week. There was no correlation between compartmental pressure and systolic and diastolic pressure. The compartmental pressure decreased significantly by the third postoperative day (P = 0.02). Compartmental pressure decreased 60% the first 3 days. In displaced supracondylar fractures with clinical risk factors, it is advisable to monitor compartmental pressure during the first 24-48 h.

Reduced perception of pain in schizophrenia: its relevance to the clinical diagnosis of compartment syndrome

An atypical presentation of compartment syndrome is reported in a chronic schizophrenic patient with a closed upper tibial fracture. The features of this case and a review of the literature pertaining to pain perception in this group of patients are presented to raise clinical awareness of this combination of disorders, which may lead to delayed treatment of a surgical emergency, consequent on lack of development of classic symptoms in these patients. We suggest continuous intracompartmental pressure monitoring, even in awake schizophrenic patients with injuries at risk of compartment syndrome.

THE CHRONIC PROSTATITIS-CHRONIC PELVIC PAIN SYNDROME CAN BE CHARACTERIZED BY PROSTATIC TISSUE PRESSURE MEASUREMENTS

Purpose: We performed a prospective study to confirm early results implying that intraprostatic tissue pressure is elevated in men with the chronic prostatitis-chronic pelvic pain syndrome. We planned to determine further whether this technique would detect a significant difference in inflammatory and noninflammatory categories IIIA and IIIB.Materials and Methods: A total of 48 patients with the chronic prostatitis-chronic pelvic pain syndrome, including 18 with inflammatory category IIIA and 30 with noninflammatory category IIIB disease, and 12 asymptomatic controls completed a Finnish version of the National Institutes of Health-Chronic Prostatitis Symptom Index. In addition, culture and microscopy of lower urinary tract segmented specimens, serum prostate specific antigen determination, transrectal ultrasound, uroflowmetry and ultrasound post-void residual urine measurement were done. All patients and controls also underwent independent intraprostatic right and left lobe tissue pressure measurement usi...

THE CHRONIC PROSTATITIS-CHRONIC PELVIC PAIN SYNDROME CAN BE CHARACTERIZED BY PROSTATIC TISSUE PRESSURE MEASUREMENTS

We performed a prospective study to confirm early results implying that intraprostatic tissue pressure is elevated in men with the chronic prostatitis-chronic pelvic pain syndrome. We planned to determine further whether this technique would detect a significant difference in inflammatory and noninflammatory categories IIIA and IIIB. A total of 48 patients with the chronic prostatitis-chronic pelvic pain syndrome, including 18 with inflammatory category IIIA and 30 with noninflammatory category IIIB disease, and 12 asymptomatic controls completed a Finnish version of the National Institutes of Health-Chronic Prostatitis Symptom Index. In addition, culture and microscopy of lower urinary tract segmented specimens, serum prostate specific antigen determination, transrectal ultrasound, uroflowmetry and ultrasound post-void residual urine measurement were done. All patients and controls also underwent independent intraprostatic right and left lobe tissue pressure measurement using a standard intracompartmental tissue pressure monitor system. Pressure was measured via an intraprostatic needle placed percutaneously in the perineum at baseline, and 10, 60 and 120 seconds after standard saline injection. All patients with the chronic prostatitis-chronic pelvic pain syndrome had significantly higher pressure at all measurement points compared with controls (p <0.001). Mean intraprostatic tissue pressure was significantly higher (p <0.01) in category IIIA with greater than 10 leukocytes per high power field in prostate specific specimens compared with category IIIB with less than 10. Our study supports the suggestion that patients with the chronic prostatitis-chronic pelvic pain syndrome have significantly higher prostate tissue pressure than controls. Findings also validated the previous clinical assumption that there is a rationale for differentiating chronic prostatitis-chronic pelvic pain syndrome cases into inflammatory and noninflammatory categories.

Prostatic tissue pressure measurement as a possible diagnostic procedure in patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome.

Forty-two patients with chronic nonbacterial prostatitis (CNP) and twelve men without any urological complaints or history underwent intraprostatic tissue pressure measurement with a Stryker intracompartmental pressure monitor device. The pressures were measured under spinal anesthesia in connection with various surgical procedures. Tissue pressure was monitored at 10, 60 and 120 s after an injection of 1 ml saline. Significantly (P < 0.001) higher intraprostatic pressure values were registered at all the three time points in the patients with CNP compared to the controls. Our study shows that patients with CNP have elevated intraprostatic tissue pressures, probably reflecting increased tissue resistance and a poor tissue microcirculation status. It seems that this method can be used as a diagnostic tool to differentiate between various causes of chronic pelvic pain in the male. The aim is to develop further this method so that it is also suitable for outpatient use.

Chronic compartment syndrome affecting the lower limb: MIBI perfusion imaging as an alternative to pressure monitoring: two case reports.

Intracompartmental pressure monitoring remains the primary method of diagnosing chronic compartment syndrome. MIBI perfusion imaging is widely available and offers a radionuclear imaging technique for diagnosing this condition. Although the...

コンパートメント症候群の臨床的検討

We present 15 cases of compartment syndromes. All cases were male and their age range was 7 to 72 years. Three cases were compartment syndrome of the forearm, one case was the hand, two cases were the thigh, 7 cases were the lower leg, and three cases were the foot. The diagnosis was determined by clinical symptoms, such as increasing pain, passive stretch test, tenseness, neurological symptoms, and circulation disturbance. Tissue pressure measurement was done inpatients with lumbar anesthesia. All 15 patients had fasciotomies, and showed good results.In conscious and alert patients, acute compartment syndromes are usually easy to diagnosis clinically; however, in unconscious patients, a diagnostic aid such as the intracompartmental pressure monitor is useful.