Post-epilepsy surgery psychogenic nonepileptic seizures.

OBJECTIVES: We investigated the prevalence of post-epilepsy surgery psychogenic nonepileptic seizures (PNES) in patients with drug-resistant epilepsy and the possible influence of risk factors on these seizures. METHODS: In this retrospective study, we examined data from all patients with a clinical diagnosis of drug-resistant epilepsy who underwent epilepsy surgery at Graduate Hospital and the Jefferson Comprehensive Epilepsy Center between 1986 and 2016. Postsurgical outcome was identified for up to 15 years after surgery. Diagnosis of PNES was verified in the epilepsy monitoring unit with video-electroencephalography (EEG) ictal recording. Potential associated factors were assessed by comparing patients with or without postoperative PNES. RESULTS: A total of 1,105 patients were studied; 697 patients had postoperative seizures, and, of these, 27 patients (3.9%) had documented PNES after surgery. A full-scale intelligence quotient (IQ) <80 was significantly associated with post-epilepsy surgery PNES (odds ratio [OR] 2.89, p = 0.007, 95% confidence interval [CI] 1.33-6.29). A history of a preoperative psychiatric diagnosis was also significantly associated with post-epilepsy surgery PNES (OR 4.67, p = 0.0001, 95% CI 2.01-10.82). Other factors were not significantly associated with post-epilepsy surgery PNES. SIGNIFICANCE: Post-epilepsy surgery PNES should be considered when patients report recurrent seizures after epilepsy surgery. Although these seizures probably occur relatively infrequently, attention to factors such as appearance of new ictal behaviors, a preoperative history of a psychiatric disorder, and a low full-scale IQ should raise suspicion and lead to appropriate diagnostic measures.

Hysterical conversion paralysis in an adolescent boy with lumbar spondylolysis.

We describe a case of recurrent hysterical paralysis triggered by low back pain because of lumbar spondylolysis. A 16-year-old male soccer player was referred to our institution with five previous episodes of acute paralysis triggered by severe low back pain. We performed direct surgical repair of the terminal-stage bilateral spondylolysis at L4 using a hook-rod system. His chronic low back pain was completely resolved, and no further episodes of hysterical paralysis have occurred after surgery. Spine surgeons should be aware of possible hysterical conversion paralysis when there is discrepancy between radiological and neurological findings.

Effect of deep brain subthalamic stimulation on camptocormia and postural abnormalities in idiopathic Parkinson's disease.

Camptocormia has been described in patients with idiopathic Parkinson's disease (PD). We present a patient with young-onset PD in whom the disease progressed over 25 years to a crippling state with severe camptocormia and bent knees. The camptocormia along with other parkinsonian symptoms improved dramatically after bilateral subthalamic deep brain stimulation.

Colecistectomía Laparoscópica: resultados de seis años en el Hospital "Sor Juana Inés de la Cruz", Mérida / Laparoscopic cholecystectomy: results of six years in the Hospital \"Sor Juana Inés de la Cruz\", Mérida

Informar los resultados de un estudio de 262 pacientes de colecistectomía por video-laparoscópica. El presente trabajo expone los resultados de la experiencia de la colecistectomía laparoscópica durante siete años. Se realizó un estudio retrospectivo de las historias médicas de todos aquellos pacientes sometidos a colecistectomía laparoscópica a partir del 1 de Mayo de 1996 hasta el 31 de diciembre de 2002. Se realizó un total de 262 colecistectomías, con un predominio de pacientes del sexo femenino con un (80.92 por ciento), la edad promedio fue de 42 años. Las indicaciones quirurgicas fueron: colecistitis crónica litiásica (93.13 por ciento), colecistitis aguda (3.44 por ciento), colecistopatía alitiásica sintomática (0.76 por ciento) y pólipos vesiculares (2.67 por ciento). Hubo 33 casos de conversión a cirugía abierta para un (12.59 por ciento) y 2 casos de lesión de vía biliar extrahepática para un (0.76 por ciento). Las principales causas de conversión fueron: dificultad en la disección, anomalías anatómicas, sangrado transoperatorio y lesión de vía biliar. Se presentaron 33 complicaciones (12.59 por ciento), de las cuales 18 son transoperatorias y 15 postoperatorias. El promedio de estancia hospitalaria fue 58.78 por ciento, con menos de 48 horas siguientes al procedimiento quirúrgico. El tiempo quirúrgico promedio fue de 75 minutos. Hospital Sor Juana Inés de la Cruz en Mérida-Venezuela. La colecistectomía laparoscópica es un procedimiento seguro, confiable en manos experimentadas, que puede realizarse con seguridad en colecistopatía litiásica, sin embargo, dicho procedimiento no está exento de complicaciones, lo cual requiera convertir el procedimiento a cirugía abierta. Es importante que el cirujano este capacitado para resolver estas complicaciones, e igualmente en el momento oportuno decidir a conversión. Colecistectomía laparoscópica, litiasis vasicular, complicaciones quirúrgicas.