Neural Complication Research Articles

Sentiment Analysis of Consumer Reviews: Unveiling Perspectives and Building a Machine Learning Model for Product Evaluation

The goal of this paper is to classify the unusual and dreadful critiques of the clients over one-of-a-kind products and put up a control analysis version to polarize big amounts of analysis. Our dataset comprises consumer reviews and ratings, which are information we have obtained through user evaluations of Amazon goods. We took the skills from our dataset and developed a large supervised version entirely based on them. These modes not great consist of conventional algorithms mutually with naive bays, linear helping vector machines, and k-nearest fellow resident, but also deep studying metrics which encompass frequent Neural Networks and complication neural networks. We evaluated the correctness of those fashions and got a higher know-how of the inverse attitude earlier to the produce. The initial objective is to describe the situation from the client's perspective and assess the intensity of the emotion. The goal of the second assignment is to build and train a machine learning system that can be used to divide customer evaluations into two categories: excellent and terrible. Regardless of the information that Amazon does now not have an API like Twitter to download evaluation with, it does have links for every assessment on every item for consumption, to theoretically traverse the web page through product IDs. We used Perl script written by way of Andrea Eula to get hold of the evaluation for the stimulation and some poles apart products. The most important script downloads the entire HTML page for the product, and the second searches the record for data about the appraisal, such as the product ID, rating, assessment date, and estimate passage. This study shows that the model had a classification accuracy of 78% and a precision similar to the sympathy and genuine score, but the Kappa do curve was rather low. In the future, more work can be done by improving the key parameters.

Thiamethoxam evoked neural oxido-inflammatory stress in male rats through modulation of Nrf2/NF-kB/iNOS signaling and inflammatory cytokines: Neuroprotective effect of Silymarin

Thiamethoxam (TMX), a neonicotinoid insecticide, is a widely used insecticide with neurotoxic potential. Silymarin (SM), a milk thistle-derived flavonoid, is known with its promising biological activities. This study explored the neuroprotective effects of SM against TMX-triggered cortical injury in male rats. Animals were divided into four groups and treated daily either with SM (150 mg/kg), TMX (78.15 mg/kg), or both at the aforementioned doses for 28 days. Our results revealed marked declines in cortical SOD and CAT activities with elevations in MDA, IL-1b and TNF-α levels in TMX-treated rats. Further, TMX induced down-regulation in the gene expressions of Sod, Cat, Gpx, and Nrf-2, with up-regulation in the gene expressions of IL-1b, IL-6, iNOS, TNF-α and NF-kB. Interestingly, pre-treatment with SM provided a notable neuroprotective action against TMX-mediated cortical damage that indicates its promising antioxidant and anti-inflammatory activities. This effect may be mediated by Nrf2/NF-kB/iNOS signalling and suppression of excess free radicals and production of inflammatory cytokines. In brief, SM could be a promising therapeutic agent against TMX-mediated neural complication via its antioxidant and anti-inflammatory properties. Practical applicationsThe using of neonicotinoids as thiamethoxam is recently increased and is associated with brain damage. TMX induced excessive oxidative and inflammatory damage. Therefore, new therapeutic approaches are needed to counteract its adverse effects on the nervous system. SM, a flavonoid, is extracted from the seeds and fruits of milk thistle. Due to its potent antioxidative activity, SM have been applied to mitigate the oxidative stress as well as inflammatory disorders. Herein, we examined the potential therapeutic role of SM against TMX-induced brain oxidative stress and inflammation in rats through evaluating oxidative markers, inflammatory response, and histopathological changes in the brain cortical tissue.

Full Endoscopic Lumbar Foraminoplasty with Periendoscopic Visualized Trephine Technique for Lumbar Disc Herniation with Migration and/or Foraminal or Lateral Recess Stenosis

To introduce a newly designed periendoscopic visualized trephine system for foraminoplasty in treating lumbar disc herniation with migration and/or foraminal or lateral recess stenosis, and report early clinical outcomes evaluated by the Patient-Reported Outcomes Measurement Information System (PROMIS). A total of 25 patients who underwent transforaminal endoscopic lumbar discectomy with foraminoplasty using a periendoscopic visualized trephine from June 2019 to January 2020 were retrospectively reviewed. PROMIS pain interference and physical function were selected as outcome measures. The average age of the 25 patients (16 males, 9 females) was 32.0 ± 7.5 years (20-48 years). All patients were successfully followed up with the mean time of 10.1 ± 2.8 months (6-12 months). PROMIS pain interference scores decreased significantly from mean 67.0 ± 3.4 preoperatively to 37.5 ± 5.4 at the final follow-up (P < 0.01), and PROMIS physical function scores improved significantly from mean 29.2 ± 5.5 preoperatively to 59.3 ± 3.7 at the final follow-up (P < 0.01). No neural or vascular complication occurred. Full endoscopic lumbar foraminoplasty with a periendoscopic visualized trephine technique is safe and effective for treating lumbar disc herniation with migration and/or lateral recess or foraminal stenosis, with improved flexibility and convenience and decreased radiation exposure.

Survivals of the Intraoperative Motor-evoked Potentials Response in Pediatric Patients Undergoing Spinal Deformity Correction Surgery: What Are the Neurologic Outcomes of Surgery?

This is a retrospective cases study from a prospective patient register. To clarify the clinical implication regard to the survivals of motor-evoked potential (MEP) response. Intraoperative neurophysiological monitoring has become an essential component for decreasing the incidence of neurological deficits during spine surgeries. Significant motor-evoked potential (MEP) loss but does not vanish completely is common especially in some high-risk and complicated pediatric spine deformity surgeries. A total of 1820 young patients (mean age = 12.2 years) underwent spinal deformity correction were mainly analyzed. Intraoperative monitoring (somatosensory-evoked potential, MEP, free-run electromyography, free-run electromyography) and postoperative neurologic outcomes were mainly analyzed in this study. All patients with monitoring alerts were divided into two groups: group 1, intraoperative MEP recovery group; and group 2, no obvious MEP recovery group. Moreover, the patients would be followed up strictly if he/she showed IOM alerting. The surviving MEP response was identified as significant monitoring alerts (80%-95% MEP Amp. loss) associated with high-risk surgical maneuvers. The results showed that there were 32 pediatric patients (group 1, 21 cases and group 2, 11 cases) presenting significant MEP monitoring alerts (80%-95% loss) relative to baseline. The patients in group 1 presented the partial/entire signal recovery from MEP alerts and they did not show spinal cord deficits postoperation. The patients in group 2 without obvious intraoperative MEP recovery showed different levels of new spinal deficits, no patient showed postoperative complete paraplegia or permanent spinal cord/nerve root deficits. When the intraoperative MEP changes significant and persistent but without totally disappeared, the rate of postoperative neural complication is relatively low. The chance of recovery of these neurological deficits is very high. Therefore, this phenomenon may be used to predictive of nonpermanent paraplegia. 3.

Spinal myoclonus following neuraxial anesthesia: a literature review.

Spinal myoclonus (SM) is a rare neurologic movement disorder following neuraxial anesthesia (NA). SM following NA (SM-NA) has insufficient clinical information and its pathogenesis remains to be elucidated. The aim of this review article was to summarize the past cases and consider SM-NA pathophysiology. Based on our PubMed search, it was revealed that SM-NA develops within several hours after neuraxial local anesthetic (LA) administration and resolves in a day without leaving neurologic compilations. It occurs primarily in the lower extremities, but can sometimes spread upward and affect the upper extremities and trunk. Although statistical adjustments are indispensable, analysis of the previous cases provided important facts that seem to be related with the mechanism of SM-NA. The frequently used LAs for spinal anesthesia were hyperbaric. SM-NA occurrence was more frequent in women. After initiation of spinal anesthesia, intrathecal hyperbaric LA distributes cephalad. In the LA elimination process, the large concentration differences in intrathecal LA may induce the partially functioning spinal neurons, resulting in myoclonus generation. The morphological features of the lumbar spine in women can predispose to a higher LA concentration difference. SM-NA is an unpredictable and rare neural complication following NA and should be confirmed by basic experiments and large-scale researches.

1012P - A multi-institutional dose-finding and efficacy confirmation trial of superselective intra-arterial infusion of cisplatin and concomitant radiotherapy for patients with locally advanced maxillary sinus cancer (JCOG1212, RADPLAT-MSC): Results of dose-finding phase

Superselective intra-arterial infusion of high-dose cisplatin with concomitant radiotherapy (RADPLAT) has been performed for the patients with locally advanced maxillary sinus squamous cell carcinomas (LA-MSSCCs) in several institutions and has been reported to result in a favorable survival. This multi-institutional prospective trial was aimed to confirm the adequate dose and efficacy of RADPLAT for the patients with LA-MSSCCs. The dose-finding phase was performed to evaluate the incidence of dose-limiting toxicity (DLT) and to determine the recommended cycle of intra-arterial infusion of cisplatin. Eighteen patients were registered from 7 institutions for this study. In this dose-finding study, 100 mg/m2 of cisplatin was administered intra-arterially weekly for 7 weeks with concomitant radiotherapy (total 70 Gy). Cisplatin was skipped in the case of adverse events that met the skipping rule defined by the protocol. The recommended number of cycles was determined according to the distribution of the number of cycles of administered cisplatin and the incidence of DLT. The median age of all participants was 64 years old (range, 40-75 years old). Sixteen patients were diagnosed as T4aN0M0, and two patients as T4bN0M0. All patients achieved full dose of radiotherapy. The number of cycles of administered cisplatin was 7 in 13 patients and 6 in 5. DLT was observed in 5 patients; Gr 3 liver dysfunction (1), Gr 4 thrombocytopenia (1), Ccr < 40 (1), Gr 3 retinopathy (1), and Gr 3 retinal detachment (1). There was not either treatment-related death or neural complication. RADPLAT appears to be safe and well-tolerated at 7 cycles of cisplatin at a dose of 100 mg/m2 each cycle, which were determined to be the recommended number of cycles for LA-MSSCC.

Lamina Fenestration Technique for Treatment of Thoracic Ossified Ligamentum Flavum: 2-Year Follow-Up Result.

Background The incidence of thoracic ossification of ligamentum flavum (OLF) is increasing, and the available surgical techniques were invasive. Study Aims To evaluate the surgical outcome and prognostic factors in relation to clinicoradiologic variables with a novel minimally invasive lamina fenestration technique in patients with thoracic OLF. Patients and Methods Between July 2005 and November 2010, 27 levels with 50 lesions in 17 patients were treated with the lamina fenestration technique for the decompression of thoracic OLF. This technique creates a keyhole in the lamina, preserving lower lamina bone, facet joint, and ligamentum flavum. Patient outcome was analyzed using the Japanese Orthopaedic Association (JOA) score and progression of kyphosis on simple X-ray. Results All patients were successfully treated with the laminar fenestration technique. There was one dural tear but no neural complication or injury. Mean length of follow-up was 49 months. Mean JOA score improved from 4.88 to 7 (p = 0.000). Six patients had an excellent surgical outcome; 10 had a good surgical outcome according to JOA scoring. Conclusion The lamina fenestration technique for the treatment of thoracic OLF had a successful outcome with few complications. This technique can be a minimally invasive surgical option for the treatment of thoracic OLF.

Percutaneous Ethanol Injection vs Reoperation for Locally Recurrent Papillary Thyroid Cancer

Reoperation for recurrent papillary thyroid cancer (PTC) can be associated with a high rate of complications and failure to provide lasting remission. Percutaneous ethanol injection (PEI) may be an effective nonsurgical management option for locally recurrent PTC. This systematic analysis of the current literature compares the efficacy and complications related to PEI vs reoperative surgical intervention for treatment of locally recurrent PTC. Original studies were identified using the keywords "thyroid/ethanol" and "recurrent thyroid cancer/repeat surgery." Studies evaluating reoperation or PEI for lymph node metastases in patients with primary surgery of total thyroidectomy with appropriate lymph node dissection where indicated were included in the analysis for both reoperation and PEI. Animal studies, single case reports, and studies with fewer than 10 lesions were excluded. Outcomes included interval to detection of recurrence, success and failure rates, recurrence rates, complication rates, and follow-up duration. Between-group outcome differences were calculated using random-effects models, and pooled data cross-tabulation and logistic regression analysis were used. In all, 945 publications were identified, and 27 studies met the inclusion criteria. There were no studies that directly compared the 2 treatment techniques. A total of 1617 patients were included in this analysis; 168 (11.4%) were treated with PEI, and 1449 (88.6%) were treated with reoperation. Reoperation was successful in 94.8% of cases compared with an 87.5% success rate for PEI (odds ratio [OR], 2.58; 95% CI, 1.55-4.31; P < .001). The recurrence rates for PEI and reoperation at the site of the treated lesion or elsewhere in the neck were also similar (OR, 1.07; 95% CI, 0.65-1.77; P = .78). Reoperation was associated with a 3.5% pooled risk of complications, while PEI incurred a pooled risk of 1.2% (OR, 2.9; 95% CI, 0.72-12.3; P = .08). However, most studies did not report routine preoperative and postoperative laryngoscopies, an evaluation needed for accurate neural complication analysis associated with each procedure. High-quality, well-designed studies are needed to evaluate the feasibility of incorporating PEI into the treatment protocol of PTC. Although presently inferior to reoperation, PEI has the potential to be a widely accepted and effective nonsurgical treatment option for limited recurrent PTC in poor surgical candidates or patients seeking to avoid multiple reoperations.

MIS lateral spine surgery: a systematic literature review of complications, outcomes, and economics.

Over the past decade, the minimally disruptive lateral transpsoas approach for lumbar interbody fusion (MI-LIF) is increasingly being used as an alternative to conventional surgical approaches. The purpose of this review was to evaluate four primary questions as they relate to MI-LIF: (1) Is there an anatomical justification for MI-LIF at L4-5? (2) What are the complication and outcome profiles of MI-LIF and are they acceptable with respect to conventional approaches? (3) Given technical and neuromonitoring differences between various MI-LIF procedures, are there any published clinical differences? And, (4) are modern minimally disruptive procedures (e.g., MI-LIF) economically viable? Through a MEDLINE and Google Scholar search, a total of 237 articles that discussed MI-LIF were identified. Of those, topical areas included anatomy (22), biomechanics/testing (17), technical descriptions (11), case reports (40), complications (30), clinical and radiographic outcomes (43), deformity (23), trauma or thoracic applications (10), and review articles (41). In answer to the questions posed, (1) there is a high strength of evidence showing MI-LIF to be anatomically justified at all levels of the lumbar spine from L1-2 to L4-5. The evidence also supports the use of advanced neuromonitoring modalities. (2) There is moderate strength evidence in support of reproducible and reasonable complication, side effect, and outcome profiles following MI-LIF which may be technique dependent. (3) There is low-strength evidence that shows elevated neural complication rates in non-traditional (e.g., shallow-docking approaches and/or those without specialized neuromonitoring) MI-LIF, and (4) there is low- to moderate-strength evidence that modern minimally disruptive surgical approaches are cost-effective. There is considerable published evidence to support MI-LIF in spinal fusion and advanced applications, though the results of some reports, especially concerning complications, vary greatly depending on technique and instrumentation used. Additional cost-effectiveness analyses would assist in fully understanding the long-term implications of MI-LIF.

Electromyographic Monitoring and Its Anatomical Implications in Minimally Invasive Spine Surgery

Literature review. The objective of this article is to examine current intraoperative electromyography (EMG) neurophysiologic monitoring methods and their application in minimally invasive techniques. We will also discuss the recent application of EMG and its anatomic implications to the minimally invasive lateral transpsoas approach to the spine. Minimally invasive techniques require that the same goals of surgery be achieved, with the hope of decreased morbidity to the patient. Unlike standard open procedures, direct visualization of the anatomy is decreased. To increase the safety of minimally invasive spine surgery, neurophysiological monitoring techniques have been developed. Review of the literature was performed using the National Center for Biotechnology Information databases using PUBMED/MEDLINE. All articles in the English language discussing the use of intraoperative EMG monitoring and minimally invasive spine surgery were reviewed. The role of EMG monitoring in special reference to the minimally invasive lateral transpsoas approach is also described. In total, 76 articles were identified that discussed the role of neuromonitoring in spine surgery. The majority of articles on EMG and spine surgery discuss the use of intraoperative neurophysiological monitoring (IOM) for safe and accurate pedicle screw placement. In general, there is a paucity of literature that pertains to intraoperative EMG neuromonitoring and minimally invasive spine surgery. Recently, EMG has been used during minimally invasive lateral transpsoas approach to the lumbar spine for interbody fusion. The addition of EMG to the lateral approach has contributed to decrease the complication rate from 30% to less than 1%. In minimally invasive approaches to the spine, the use of EMG IOM might provide additional safety, such as percutaneous pedicle screw placement, where visualization is limited compared with conventional open procedures. In addition to knowledge of the anatomy and image guidance, directional EMG IOM is crucial for safe passage through the psoas muscle during the minimally invasive lateral retroperitoneal approach.

Application of Stryker dynamic joint distractor II in elbow arthrolysis

Objective To discuss clinical results of Stryker dynamic joint distractor (DJD Ⅱ) hinged external fixators in elbow arthrolysis for patients with elbow stiffness. Methods From January to December in 2009, 43 cases of stiff elbow were treated by the same operative team. Forty-one patients, 23 males and 18 females, obtained full follow-up. Their average age was (37.3 ± 11.3) years old. There were 22 left and 19 right sides, and 20 dominant and 22 non-dominant sides. In group A, 13 cases were treated only with arthrolysis;in group B, 26 cases were treated with arthrolysis and hinged external fixators;in group C, 2 cases were treated with inter-positional arthroplasty and hinged external fixators. Results The average follow-up lasted 8.0 months (4 to 15 months) . The mean time for external fixation was 6.4 weeks (5 to 8 weeks) . The mean ROM of extension and flexion in Group A was improved by (63.85 ± 45. 01 )°, from (38.46 ± 31.05) ° before operation to ( 1 02. 31 ± 29. 20) ° after operation. In Group B, it was improved by (90.77 ± 21.53) °, from (29. 23 ± 22. 61 ) ° before operation to ( 120. 00 ± 17.89) ° after operation. There was a significant difference ( P ＜ 0. 05 ) in the improvement between the 2 groups. Of the patients treated with external fixators, 3 had mild infection in the pin holes, one had rotation limitation because of the insufficient incision, one experienced breakage of the external fixator, one suffered early skin abrasion due to the swollen elbow. There was no report of neural complication or pin loosening. Conclusions Application of the Stryker DJD Ⅱ hinged external fixator after arthrolysis for treatment of the stiff elbow can achieve good outcomes, especially in improvement of the ROM of extension and flexion. However, improper manipulation may give rise to limitation of ROM. Key words: Elbow joint; External fixator; Arthrolysis

Lipopolysaccharide treatment and inoculation of influenza A virus results in influenza virus–associated encephalopathy–like changes in neonatal mice

Influenza virus-associated encephalopathy (IAE) is a highly mortal neural complication of influenza A virus (IAV) infection, mostly affecting children younger than 5 years old, and the brain pathology of IAE is characterized by peracute brain edema with evidence of an impaired blood-brain barrier. The pathogenesis of IAE is unknown, but hypercytokinemia of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and IL-6 is suspected of playing a central role in the development of IAE. Because the brain pathology of IAE is similar to that of septic encephalopathy due to endotoxemia, the effect of combined treatment of IAV and lipopolysaccharide (LPS) was tested using suckling mice. The results show that pulmonary infection with non-neurotropic IAV enhanced the neuropathogenicity of LPS and induced encephalopathy that was similar to IAE with respect to the occurrence of central nervous system (CNS) histopathology and the absence of direct infection of IAV in the brain. Influenza A virus also increased blood-brain barrier (BBB) permeability and induced inflammatory cytokines in the blood. These results suggested that the mice treated with IAV+LPS are possible animal models of IAE, and that hypercytokinemia and/or the involvement of endotoxemia in IAV infection are possible causes of IAE.

Surgical management of severe rigid tuberculous kyphosis of dorsolumbar spine

To assess the effectiveness of deformity correction and safety of the two major corrective spinal surgical procedures, 35 patients, aged 14-47years, were placed into two groups according to procedures performed. Sixteen patients (group A) had four-stage procedures including initial halo-pelvic distraction after anterior release and a subsequent three procedural steps plus brace. Nineteen patients (group B) had one-set two-stage procedures: wire segmental stabilisation in eight cases and rod/hook and/or pedicle screw stabilisation in 11 cases. Average preoperative kyphosis in group A was 88° and postoperative at zero, three, six, and 18months were 29˚, 33˚, 35˚ and 35˚, respectively, while those of group B were 86˚ preoperative and postoperative 27˚, 31˚, 33˚, and 33˚, respectively. Neural complication developed in five cases: one in group A and four in group B. It was concluded that the one-set two-stage procedure is more efficient, time-saving, and cost-effective, though it is highly challenging with relatively high rates of neural complication.

Treatment of Zucker diabetic fatty rats with AVE7688 improves vascular and neural dysfunction.

Vasopeptidase inhibitors are drugs that inhibit angiotensin-converting enzyme and neutral endopeptidase (NEP). The latter is a protease that degrades vasoactive peptides and is increased in diabetes. We have previously shown that treating streptozotocin-induced diabetic rats, an animal model of type 1 diabetes, with AVE7688, a vasopeptidase inhibitor, improves neurovascular and neural function. In this study, we determined the effect of treating Zucker diabetic fatty (ZDF) rats, an animal model of type 2 diabetes, with AVE7688 on vascular and neural function. ZDF rats at 12 weeks of age were treated for 12 weeks with AVE7688 (500 mg/kg diet). Afterwards, vascular reactivity of epineurial arterioles of the sciatic nerve and nerve conduction velocity and blood flow was determined. Vascular and neural function was significantly impaired in ZDF rats compared with age-matched lean (control) rats. Treating ZDF rats with AVE7688 improved vascular relaxation to acetylcholine and calcitonin gene-related peptide in epineurial arterioles. Motor and sensory nerve conduction velocity, endoneurial blood flow and thermal nociception end-points were also improved by treatment compared with untreated ZDF rats. Superoxide and expression of NEP were increased in epineurial arterioles from ZDF rats and attenuated by treatment with AVE7688. AVE7688 is an effective treatment for microvascular and neural disease in ZDF rats. Thus, vasopeptidase inhibitors may be an effective treatment for diabetic microvascular and neural complication in type 2 diabetes.

Neural Complications in the Surgical Treatment of Adolescent Idiopathic Scoliosis

Multicenter, prospective, consecutive clinical series. To report on neural complications in a prospective cohort study of 1301 children undergoing spinal fusion and instrumentation for adolescent idiopathic scoliosis (AIS). The incidence of neural complications for spinal deformity surgery has been reported to be 0.26% to 17%. However, most studies have relied on retrospective voluntary reporting of nonconsecutive cases. A review of 1301 consecutive surgical cases was conducted using the Prospective Pediatric Scoliosis Study database, which is maintained by the Spinal Deformity Study Group. There were 9 neural complications. There were 3 thecal penetrations, none of which required repair, and none of which demonstrated intraoperative neural monitoring changes or postoperative clinical sequelae. There were 2 nerve root injuries. In 1 nerve root injury, a positional compression femoral neurapraxia resolved over 6 months. The other was an L4 neurapraxia despite lowest instrumented vertebra L1, and resolved spontaneously by 3 months' follow-up. There were 4 spinal cord injuries. One required removal of implants and fusion in situ, 1 required relaxation of correction and in situ fusion with instrumentation, while the other 2 were observed after fusion and instrumentation with reduction. All resolved spontaneously within 3 months after operation. The neural complication rate was 0.69%. Two thecal penetrations were due to medial placement of pedicle screws, and 1 was due to dissection during spine exposure. If these are eliminated, as they imply intraspinal entry but not direct neural injury, together with 1 positional neurapraxia, which is remote from the surgical field, our complication rate is 0.38%. This is consistent with other studies in the North American Literature, including multiple reports from the Scoliosis Research Society. Common themes are significant curve correction producing neural stretch and the use of sublaminar wires. None of the neural injuries was permanent. These results reaffirm that surgical treatment of adolescent idiopathic scoliosis has a low but real neural complication rate.

Long-Term Recurrence and Nerve Injury After Total and Partial Stripping of the Great Saphenous Vein by External Phleboextractor

The objective of this study was to assess the efficacy of an external phleboextractor (EP) in improving the results of total and short stripping of the great saphenous vein (GSV) with particular reference to saphenous nerve injury occurring during the operations. Two hundred fifty-seven consecutive patients affected by varicose veins in the lower limbs (of which 22 had bilateral diseases) underwent total (Group A) or partial (Group B) saphenectomies by means of the Corcos' EP. The interventions were selected on the basis of type of reflux diagnosed by clinical and Doppler ultrasound examinations. The results were assessed 6 months and 3 years after operation. One hundred four limbs were evaluated in Group A and 160 limbs in Group B. After 3 years, 101 limbs in Group A (97.1%) and 155 in Group B (96.8%) had excellent-to-good results in terms of recurrent varices. Neurological examinations were comparable between Group A (11 saphenous nerve injuries = 10.6%) and Group B (10 nerve injuries = 6.3%). This study shows that total or short stripping of the GSV reduced varicose vein recurrence and neural compli cation using the EP.

Femoral neuropathy after pelvic operation

A case of bilateral femoral neuropathy after vaginal hysterectomy is reported. In femoral neuropathy, weakness and atrophy of the quadriceps group of muscles, loss of extension of leg, and absent patellar reflex are common. The gynecologic surgeon should be alert to the possibilities of trauma given occasion by: (1) thin body build, (2) self-retaining retractors, (3) Pfannenstiel incisions, (4) predisposing factors, such as diabetes, (5) duration of operation, and finally (6) lithotomy position. During the abdominal procedure, careful placement of the retractor blades to avoid pressure on the psoas muscle is desired; pulsation of the external iliac artery distal to the lateral retractor blades indicates lack of excessive pressure on the adjacent femoral nerve. During the vaginal procedure, avoiding extremes of hip flexion and abduction in lithotomy positioning is recommended. When this neural complication is recognized, a favorable prognosis can be predicted, thus allaying anxiety for both patient and physician.

FEMORAL NEUROPATHY—A NEUROLOGICAL COMPLICATION OF HYSTERECTOMY

A study of the clinical findings of ten patients in whom femoral neuropathy developed following hysterectomy and 36 cases reported in the literature, along with an anatomical reinvestigation of 14 cadavers, has led to the realization that the pathogenesis of the neuropathy is continuous pressure exerted by retractor blades on the greater psoas muscle. This produces ischemia of the femoral nerve. Self-retaining retractors are most often to blame. A preventive measure would be palpation of the femoral artery after pelvic retractor is in place. Repositioning of retractor blades should be performed until pulsations are perceived in this artery. This neural complication need create little concern, for it is almost always fully reversible.

Femoral Neuropathy—A Neurological Complication of Hysterectomy

A study of the clinical findings of ten patients in whom femoral neuropathy developed following hysterectomy and 36 cases reported in the literature, along with an anatomical reinvestigation of 14 cadavers, has led to the realization that the pathogenesis of the neuropathy is continuous pressure exerted by retractor blades on the greater psoas muscle. This produces ischemia of the femoral nerve. Self-retaining retractors are most often to blame. A preventive measure would be palpation of the femoral artery after pelvic retractor is in place. Repositioning of retractor blades should be performed until pulsations are perceived in this artery. This neural complication need create little concern, for it is almost always fully reversible.

ACUTE ENCEPHALOMYELITIS FOLLOWING GERMAN MEASLES

Complications in the central nervous system following vaccination and the acute febrile diseases of childhood have become clinically prominent during the past twenty years. The most common neural complication of the acute exanthemas, infectious parotitis, antirabic and other vaccinations and influenza has been disseminated encephalomyelitis. Least common have been the nervous disorders following German measles. Prior to the severe and widespread epidemic of rubella in 1935, the medical literature contained but two clinical reports (Benard1and Brock2) describing this complication. Because of the relatively infrequent appearance of neural complications following rubella, this exanthem was considered relatively benign. While some observers were aware of no severe complications, believing the course to be mild and favorable, others referred to any complication as a coincidence. During the outbreak of the disease in 1935 there was a sudden and marked increase in the incidence of encephalomyelitis complicating rubella. From scattered areas eight