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.

Quadriparesis and nuclear oculomotor palsy with total bilateral ptosis mimicking coma: a mesencephalic 'locked-in syndrome"?

Upper lid and vertical eye movements are usually preserved in patients with the "locked-in" syndrome, a condition manifested by anarthria, spastic quadriparesis, and intact mental function, and caused by lesions in the ventral portion of the pons. We describe a presumed mesencephalic "locked-in" syndrome in a patient who had total bilateral ptosis at the onset of his disease and later on experienced complete bilateral oculomotor nerve paralysis.

Samuel Auguste Tissot (1728-1797). His research on migraine.

The famous Swiss physician of the eighteenth century, Samuel Auguste André David Tissot, devoted an 83-page chapter to migraine in his Traité des nerfs et de leurs maladies (Treatise on the nerves and nervous disorders). From his own personal observations and an exhaustive critical review of the medical literature, he described in clear terms the signs and symptoms and the clinical course of the disease, made known his findings to contemporary physicians and created a basis for research for future generations of doctors. In so doing, he fully deserves his high reputation as the classical authority on migraine.

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.

[Periodic EEG discharges of stereotyped morphology]. / Okresowe wyladowania EEG o stereotypowej morfologii

Clinical course of disease and results of EEG examinations of 6 patients with severe brain disturbances of various aetiology provided grounds for discussion on the phenomenon of periodic stereotyped EEG discharges (PSD) which is of considerable diagnostic value in some cases. The variability in appearance of these discharges, in their form and duration of intervals between them are stressed--the last parameter varied in own material from 0.5 to 8 sec. The appearance of PSD may indicate increased convulsive excitability of the cortical and subcortical structures of the gray matter. The prognostic value of PSD was not always the same and it could be established only basing upon a comparison of EEG findings during successive examinations.

[Rudimentary psychomotor seizures and their differential diagnosis]. / Rudimentäre psychomotorische Anfälle und ihre Differentialdiagnose.

Clinically it is often very difficult to distinguish rudimentary psychomotor seizures from absence seizures and sudden nonepileptic disturbances, especially from transitory cerebral ischaemia. In contrast to absence seizures during which bifrontally accentuated spike-wave activity is registered in the EEG, absence like psychomotor seizures usually present with unilateral temporal or frontotemporal EEG discharges. Syncopal and psychomotor attacks may overlap in the following context: falls resembling syncope during psychomotor seizures, the so-called "temporal fainting spells"; cardiac arrhythmias during psychomotor attacks; psychomotor symptoms such as automatisms and/or "dreamy states" that occur during syncopal attacks with transient dysfunction of the limbic system; alternating psychomotor and syncopal attacks in the same patient Symptoms of intermittent vertebrobasilar insufficiency: non-systematic vertigo, brief blurring of consciousness and blackouts may all be misinterpreted as rudimentary psychomotor seizures. The further differential diagnosis includes psychogenic attacks as well as states of confusion due to a variety of diseases in internal medicine.

[Epileptic impaired consciousness in adults]. / Epileptische Dämmerzustände bei Erwachsenen.

Alterations of consciousness with impaired perception and drive persisting over hours to days can be due to a nonconvulsive status epilepticus. This possibility has to be considered not only in patients with already known epilepsy, but also in those with a negative history for seizure disorders. The immediately recorded electroencephalogram (EEG) provides decisive clues. In the case of petit mal status most frequently appear tiredness, reduced vigilance and lack of drive. The EEG shows a generalized spike-wave activity. In status psychomotoricus, the clinical symptomatology varies from case to case. It can be characterized by anxiety, dreamy states or productive-psychotic states with agitation, automatisms and hallucinations. In the EEG a temporal or temporally-accentuated epileptic activity will be recorded. Transitional and mixed forms of petit mal status and status psychomotoricus can also be found. I.v. injections of benzodiazepines (clonazepam, diazepam) are an appropriate therapy for any type of nonconvulsive status epilepticus. Phenytoin is indicated in status psychomotoricus, but contra-indicated in the case of petit mal status.

[Variability in seizure phenomenology in the same epileptic patient]. / Variabilität der Anfallsphänomenologie beim gleichen Epilepsiekranken.

There are many different causes for an alternate outbreak of different seizure manifestations in the same patient. According to Herpin's 'law of identity', this is more a question of differing degrees of intensity of the same seizure type. Subsequently, minor or partial seizures are to be interpreted as rudimentary forms of 'major' seizures. This may be true for some, but not for all cases. It would be daring to maintain that a typical absence is a rudimentary form of a 'grand mal' seizure. Their mutual pathogenetic relations are unknown. A series of other cases would likewise go beyond the scope of Herpin's law. A patient can show, even during a cerebral condition of the same etiology, several different localized epileptogenic foci which 'flame up' alternately and initiate different types of seizures. Progressive cerebral illnesses can lead to a change in the original seizure symptoms and can also trigger off additional seizure forms. This can occasionally occur during medication. Finally, it is necessary to consider the possibility of an alternate outbreak of epileptic and nonepileptic seizures in the same patient.

[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 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 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.