Neurosurgical analysis of logging accidents: An observational study

Objective: Forestry is one of the most dangerous occupations with record high rates of accidents and mortality relative to other occupations. In the past, related studies have been conducted within the scope of occupational safety, occupational health, and public health. Clinical studies on this subject are extremely rare and not within the scope of neurosurgery. We intended to facilitate the management of logging accidents for physicians by conducting a clinical study on logging accidents. This first-of-its-kind study also aimed to comprehend the injury mechanisms in order to contribute to the efforts made to prevent injuries and to facilitate the management of these cases. Methods: The hospital records of patients who presented at the Karabük University EAH Emergency Department owing to logging accidents between 1/1/2019 and 5/1/2020 in the Karabük province were retrospectively analyzed. The information about patient profile, demographic information, mechanism of the logging injury, and the patterns of spinal and cranial injuries as well as other body area injuries (if any) were retrieved from the hospital records. The spinal and cranial injury patterns were analyzed from the imaging records (MRI or CT). Results: A total of 19 subjects were included in this analysis, of which 5 had cranial injury (26.3%), 2 had spinal injury (10.5%), 1 (5.2%) had both cranial and spinal injuries (this subject died in the intensive care unit at follow-up). A total of 9 (47%) subjects died. Three subjects were followed up for observation (15.7%), while 5 (26.3%) were referred to the department of orthopedics. The cranial and spinal injuries were accompanied by additional injuries such as rib fracture, hemothorax, fibula fracture, and pneumothorax. These injuries occurred in pathological conditions such as cardiac arrhythmia, facial paralysis, and epilepsy. One subject developed spinal cord damage (5.2%) that progressed to neurological shock and crash syndrome. Overall, 19 injuries occurred mainly due to 5 different mechanisms. Conclusions: The patterns of resultant spinal and cranial injuries and the related demographic information would facilitate efficient patient management. Understanding the injury mechanisms would facilitate both the management and diagnosis of such cases and the prevention of logging accidents through combined efforts of occupational safety and public health specialists

Posterior Auricular Muscle Response: Observations in Brainstem Lesions

Objective: Posterior auricular muscle response (PAMR) is a myogenic potential recorded over PAM after auditory stimulation. Its circuit is formed by cochlear and facial nerves with the generator in the brainstem. Here, we investigated whether the addition of a PAMR examination would add additional use in determining or localizing isolated brainstem lesions given that the importance of blink reflex (BR) in determining or localizing brainstem lesions is known. Our hypothesis was that examination of both reflexes would increase clinical utility. Materials and Methods: We included 34 patients with isolated brainstem lesions (multiple sclerosis, ischemic stroke and cerebellopontine angle schwannoma) and 41 healthy subjects. PAMRs were recorded over the PAM after auditory stimulation. BR was elicited by the electrical stimulation of the supraorbital nerve. Results: PAMR was present in 82.9% of healthy subjects, whereas the presence was quite low in the patient group (38.2%, p=0.001). The mean latency of PAMR was delayed in patients compared with healthy subjects (p=0.001). BR was obtained in all healthy subjects, whereas prolonged latencies or absence of BR was observed in the patient group. There were no differences according to the different etiologies or localization. Conclusion: Although the presence of PAMR is quite high, its absence does not always indicate a pathology. However, prolonged latencies almost always suggest an involvement of the PAMR pathway. Likewise, absent PAMR with an abnormal BR provides information for the involvement of brainstem facial nucleus or the proximal part of the facial nerve

The effect of lateral pectoral nerve sparing technique and radiotherapy on the pectoralis major muscle applied with modified radical mastectomy

Summary: Background/Objective: The aim of this study was to evaluate with electromyography (EMG) the effect of lateral pectoral nerve sparing technique (LPNST) and radiotherapy (RT) on the lateral pectoral nerve (LPN) in patients applied with modified radical mastectomy (MRM). Methods: The study included 66 patients who underwent MRM surgery. The patients were separated into 2 groups as those applied with LPNST and those who underwent standard surgery (Control group). Within these 2 groups, patients were again separated as those who received or did not receive RT. The EMG evaluations were made by a neurology specialist blinded to the patient groups. Results: The mean age of the patients was 53.3 ± 10.6 years. Standard surgery was applied to 33 (50%) patients and LPNST to 33 (50%) patients, RT was applied to 32 (48.5%) patients and not to 34 (51.5%) patients. In the EMG evaluation, latency was 2.1 ms (1.4–3.2) in the LPNST and 3.7 ms (1.9–12.4) in the control (p 0.05). Conclusion: The results of this study demonstrated that electromyographically the latency and amplitude values were better protected in the LPNST group. It was also seen that RT increased the formation of nerve damage in both groups. Keywords: Modified radical mastectomy, Radiotherapy, Electromyography, Lateral pectoral nerve, Pectoralis major muscl