Do we really need three-dimensional convex inguinal hernia meshes?

PURPOSE: The aim of our study was to assess the anatomical variability in the curvature of the muscles in inguinal region and to determine the necessity of using three-dimensional convex-shape hernia meshes in spite of typical flat ones. METHODS: The group analyzed consisted of 180 patients with no abnormalities in inguinal region: 30 males and 30 females for every subgroup, with decreased, normal, and increased BMI. For every patient a 3D software model of muscles in the inguinal region was built, based on the segmentation of pelvic CT images and its outer surface determining the shape of the hernia mesh was created. Correlation was tested between the diameter of sphere describing the shape, the height of mesh top, and BMI. The optimal number and diameter of prefabricated hernia mesh set was obtained. RESULTS: Only a moderate correlation (r = - 0.32) was found between the diameter of sphere and BMI in females and between the height of the mesh top and BMI in females (r = 0.43) and in the whole group of patients (r = 0.33). Accepting fitting error < 5 mm for 62 from 180 cases there was no need to use a convex-shape hernia mesh, for the other cases one of 3 prefabricated hernia meshes with diameters: 854 mm, 434 mm, 298 mm was sufficient. CONCLUSIONS: For about one-third of patients a commonly used flat hernia mesh is adequate, for the rest of the cases one of 3 convex-shape meshes is sufficient.

[The first names of Tissot (1728-1797)]. / Au sujet des prénoms de Tissot (1728-1797).

In different registers, dictionaries and publications the first names of the famous doctor Tissot are "David", "Auguste" or, absolutely wrong "Simon-André". After the baptismal Register of the village of Grancy, his birth place, his correct first names are Samuel, Auguste, André, David or--shortened--Samuel Auguste.

The old and the new camptocormia.

A forced posture with a forward-bent trunk was termed camptocormia by the French neurologist Souques in 1915. In his case history, which consisted of young soldiers, the condition occurred acutely, was usually psychogenic, lasted for months, and could be cured quickly and durably by a "persuasive" electrotherapy. Numerous similar cases were observed during the World War I and II and immediately thereafter. In the last 10 years, the same term has been used to describe kyphotic postural anomalies resulting from a primary or neurogenic affection of the paravertebral muscles. This condition mainly occurs in older women, takes a chronically progressive course, and responds well to corticosteroid therapy. To avoid misunderstandings of nomenclature, this somatic disease should not be designated as camptocormia, but rather as thoracolumbar kyphosis in old age.

EEG findings during basilar migraine attacks in children.

We present clinical and EEG findings in 4 children with basilar migraine (BM) (three female and one male, age 11 to 13.5 years). All patients had an EEG during the acute attack and a follow-up EEG within 4 to 18 days. In two patients the EEG, done within 4 h of the onset of symptoms (initial stage), showed diffuse polymorphic subdelta-delta activity. In two other children the EEG, performed 16 h after the onset of symptoms, showed delta-theta activity predominant over the occipital regions. Resolution of these abnormalities during follow-up was observed in all patients. We wish to stress the danger of misinterpretation of the slow wave activity in the EEG of patients with BM attacks. Together with the clinical findings and their evolution, EEG results should not be interpreted as a sign of a structural brain-stem lesion, such as infarction or inflammation.

[Samuel-Auguste Tissot 1728-1797): on the 200th anniversary of his death]. / Samuel-Auguste Tissot (1728-1797): Zum 200. Todestag.

Samuel-Auguste Tissot (1728-1797), general practitioner in the Swiss city of Lausanne, was one of the great physicians of the eighteenth century (the Age of Enlightenment), one of the founders of rational medicine and a firm foe of quackery. He was renowned for his popular book "Avis au peuple sur sa santé" (published in 1761), which furthered the understanding of sanitary principles, dietetics and prevention among ordinary people and gave advice on self-treatment for inhabitants of remote areas. His most significant scientific book was the "Traité de l'épilepsie", published in 1770. There, Tissot describes the symptomatology of nearly every form of epileptic seizures and expresses his views on the pathogenesis, course and prognosis of epilepsy. The book remains one of the cornerstones of modern epileptology.

[The controversy about so-called "active euthanasia"]. / Zur Kontroverse über die sogenannte "aktive Sterbehilfe".

In the past few years, the discussion about the right to kill severely ill patients for humanitarian reasons--once called euthanasia and after World War II in the German speaking countries as euphemism called 'aktive Sterbehilfe' (active help to die)--has become more intensive. Actually, only the Netherlands do officially practice euthanasia. But the variant that consists in putting a pharmaceutical at the patient's disposal in order to kill himself is very well known in other countries, e.g. in Switzerland, where the pressure on the legislator to also legalize euthanasia grows. Taking into account medico-ethical reasons, historical experiences, alarming euthanasia ideas in bioethics and social philosophy, the danger due to the impossibility to control the development in this field, and the insidious extension of euthanasia indications, the author rejects firmly the idea of legalized euthanasia. These problems are related to those that occur in fixing the moment of death of potential organ donors. A lack of organs in transplantation medicine should not lead physicians to explant organs from donors in a dying condition. For physicians who take care of potential organ donors and who have to look after their interests towards transplantation teams, it is often too difficult to cope with this task. Local ethical commissions should support them.

[Electroencephalography and epileptology in the 20th century]. / Elektroenzephalographie und Epileptologie im 20. Jahrhundert.

In 1875, Caton was already able to detect cerebral electric currents during experimental studies in animals. In 1914, Cybulski and Jelenska-Macieszyna reported on the increase of current-intensity during a focal motor epileptic seizure. In 1929 in Jena, Berger revolutionized the study of epilepsy with his paper on the human electroencephalogram 'Uber das Elektrenkephalogramm des Menschen'. His discovery and further publications as well as later works of numerous researchers, especially F. and E. Gibbs, Lennox, Penfield and Jasper, made it possible to distinguish different forms of 'little' epileptic seizures and to separate them from nonepileptic paroxysmal disorders. New epileptic syndromes could be singled out, as e.g. the symptomatic epilepsy of childhood with variable clinical manifestations of seizures and slow spike-wave complexes in the EEG (Lennox-Gastaut syndrome) or the benign partial epilepsy of childhood with centrotemporal EEG spikes. In these fields, as well as for the epileptic seizures in newborns and babies and for the differentiation between epileptic and nonepileptic twilight states in later stages of life, the EEG remains an indispensable tool in the CT and MRI era. It also contributes largely to the diagnosis of nonepileptic cerebral illness such as herpes simplex encephalitis, subacute sclerosing panencephalitis van Bogaert and Creutzfeldt-Jakob disease. Since the introduction of phenobarbital by Hauptmann in 1912, the palet of effective drugs against epilepsy, such as phenytoin, carbamazepine, valproate and benzodiazepines used for status-epilepticus treatment, became essentially larger. The value of newer substances (vigabatrin, progabide, gabapentin, lamotrigin) can't be estimated actually.(ABSTRACT TRUNCATED AT 250 WORDS)

[The heyday of epileptology]. / Die Sternstunden der Epileptologie.

The clinical symptoms of most types of epileptic seizures were already described in 1770 by Tissot. During the first half of the 19th century, his teaching was further developed and the nomenclature of epilepsy enriched. Rolando's description of the cortical convolutions as well as Bouchet's and Cazauvielh's observation of anatomical changes in the Ammon's horn of epileptic patients with psychical disturbances have prepared the way for the discovery of the role of local brain pathology as the cause of partial seizures. During the second half of the 19th century, Fritsch, Hitzig and Ferrier, by means of animal experiments, and Jackson, by means of clinical observation, discovered the motor function of the precentral cortex and that its irritation results in contralateral seizures. Independent of each other, Jackson and Sommer recognized that the initiation of what we nowadays call psychomotor or complex partial seizures lies within the limbic system. Caton's method of investigation brain currents in animal experiments, described in 1875, make possible in the 20th century to confirm Jackson's theory of epileptic seizures as sudden excessive discharges of the grey matter of the brain. Further advances of 19th century epileptology include: the etiological reclassification of epilepsies by Delasiauve, the first effective pharmacological (Bromide) and surgical therapies for epilepsy, the publication of classic textbooks on epilepsy by Gowers and Herpin as well as the setting up of specialized treatment centres for epilepsy.

[The dedication of the "inaugural lecture" (1766) of Samuel-Auguste Tissot]. / Sur la dédicace du "Sermo inauguralis" (1766) de Samuel-Auguste Tissot.

Samuel-Auguste Tissot (1728-1797) has been appointed professor of medicine at the Academy of Lausanne. He gave his inaugural lecture on "De Morbis Litteratorum" on April the 9th 1766 and published it 15 days later under the title "Sermo inauguralis de valetudine litteratorum". The affirmations, made by some of his recognized biographers, that this publication was dedicated to the King of Poland (Stanislaw August Poniatowski) are erroneous. In reality, this dedication starts with the inscription: "Inclytae Reipublicae Bernensis Consulibus (...)". The dedication itself and the following "Epistola" are both entirely consecrated to the excellencies and senators of the Republic of Berne.