Isolated seizures in rats do not cause neuronal injury.

BACKGROUND: Previous studies have shown that status epilepticus can lead to neuronal injury. However, the effect of a small number of isolated seizures is uncertain. METHODS: We used structural MRI and neuropathology to study the effects of isolated seizures induced by kainic acid (KA), (RS)-2-amino-3-(3-hydroxy-5-tert-butylisoxazole-4-yl)propanoic acid (ATPA), and α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate in rats. A group of animals received normal saline. After seizure induction, animals were followed for 12 weeks. RESULTS: ATPA and KA led to small but significant increases in ADC. There were no changes in T2 signal intensity or hippocampal volume. Blinded pathological examination showed no differences between animals receiving saline or glutamatergic agents. CONCLUSION: Our study suggests that isolated seizures cause minimal neuronal injury in rats.

Technical Feasibility, Outcomes, and Patient Satisfaction After Needlescopic and Laparoscopic Bariatric Surgery: a Randomized Study.

BACKGROUND: Needlescopic instruments create a 3-mm incision and may result in less pain and superior cosmesis. There is limited understanding of the effectiveness of needlescopic instruments in patients with a body mass index (BMI) > 35 kg/m2. We report perioperative outcomes and perception of body image with use of needlescopic instruments after bariatric surgery. METHODS: Laparoscopic bariatric procedures were performed on 30 adults at a single academic medical center from January to December 2017. Patients were randomized to conventional laparoscopy (LAP) or needlescopic (NEED) surgery. The Multidimensional Body-Self Relations Questionnaire (MBSRQ) and Patient Scar Assessment Questionnaire (PSAQ) were completed at 6 months and 1 year. Univariate analysis was performed on perioperative outcomes and survey scores. RESULTS: Surgery was completed on patients in the LAP group (N = 13) and compared to the NEED group (N = 17). The mean BMI was 41.4 kg/m2 LAP and 41.1 kg/m2 NEED. The most common procedure was Roux-en-Y gastric bypass (RYGB), with 13 RYGB in LAP and 12 RYGB in NEED (P = 0.76).The operative time was not significantly different between the LAP and the NEED group (209.5 ± 66.1 vs 181.9 ± 58.1 min, P = 0.48). There was no leak or mortality in the 30-day follow-up period. Within MBSRQ, the patient's appearance self-evaluation score was similar between LAP and NEED (2.5 ± 0.6 vs 2.4 ± 0.6, P = 0.61). Within PSAQ, the mean satisfaction score for incision appearance was also similar between LAP and NEED (16.1± 2.9 vs 15.4 ± 4.6, P = 0.85). Incision-related perceptions remained consistent at 6 months and 1 year after bariatric surgery. CONCLUSIONS: Needlescopic instruments are safe and a viable alternative to use during bariatric surgery. Appearance and perception of scar were similar between groups. Further studies with needlescopic instruments should include patients with a BMI > 35 kg/m2 and compare additional factors associated with body image.

Robotic Assisted Prostatectomy with Magnetic Retraction.

INTRODUCTION: In prostate surgery retraction of the prostate is essential to ensure appropriate visualization of the surgical field. In the past improvement in exposure would require the dedicated use of a port or an additional incision. Magnetic retraction provides a novel solution by allowing shaftless retraction during robotic assisted prostatectomy that does not require a dedicated port or extra incision. METHODS: We conducted a retrospective review of consecutive patients who underwent robotic assisted prostatectomy using magnetic retraction at a single center (Duke Regional Hospital) between April 2017 and November 2018. RESULTS: The 39 cases were all robotic assisted total prostatectomies for adenocarcinoma. All cases were successfully completed without conversion to open. Mean age was 63 years (range 44-75) and preoperative body mass index was 30.4 kg/m2 (range 20.1-43.9). Mean operative time was 184 minutes (range 129-304). Four patients experienced minor 30-day complications that were not directly attributed to the device and did not require further interventions. One patient suffered a myocardial infarction 5 days after surgery and recovered without major sequelae. There were no 30-day mortalities. Surgeons described subjective overall surgical exposure as adequate and device use as technically simple. CONCLUSIONS: Magnetic assisted retraction is a novel approach that allows a safe and reproducible technique for unconstrained tissue retraction, and manipulation does not require another port. The device successfully permitted optimal prostate retraction during robotic assisted prostate surgery, enhancing surgical exposure while not requiring additional abdominal incisions.