New onset epilepsy following unintentional durotomy in a patient on anti-psychiatric medication

We would like to present a rare case report describing a case in which new-onset tonic-clonic seizures occurred following an unintentional durotomy during lumbar discectomy and decompression. Unintentional durotomy is a frequent complication of spinal surgical procedures, with a rate as high as 17%. To our knowledge a case of new onset epilepsy has never been reported in the literature. Although dural tears during surgery and CSF hypovolaemia are thought to be the main contributing factors, one postulates on the effects of anti-psychiatric medication with epileptogenic properties. Amisulpride and Olanzapine can lower seizure threshold and should be used with caution in patients previously diagnosed with epilepsy. However manufacturers do not state that in cases where the seizure threshold is already lowered by CSF hypotension, new onset epilepsy might be commoner. Finally, strong caution and aggressive post-operative monitoring is advised for patients with CSF hypotension in combination with possible epileptogenic medication

Comparative evaluation of lichtenstein tension free hernia repair vs laparoscopic tep repair of inguinal hernia

Introduction: During the last several decades numerous innovative and creative techniques have been introduced in an effort to manage patients with inguinal hernia. Despite the development of many newer technologies including that of optics, the treatment of inguinal hernia by laparoscopic method has still eluded many of our patients. Aim: The study was undertaken to compare efficacy, safety and patient satisfaction between these two procedures. Materials and methods: This prospective analytical study conducted in 100 consecutive cases of inguinal hernia were included. All patients underwent either Lichtenstein tension free hernia repair or laparoscopic TEP repair. The age/sex incidence, types of hernia, postoperative complications, post operative pain, hospital stay, and time to return to normal activities and recurrence were all evaluated .Results: The incidence of post operative complications was18% and 4% between the open and laparoscopic group respectively. The incidence of severe post operative pain was 5 in open group and 1 in the laparoscopic group. The overall incidence of post operative pain was significantly less in the laparoscopic group. The mean duration of hospital stay was found to be 3.84 days for the Lichtenstein Tension Free Hernia Repair group compared to the Laparoscopic TEP repair of Inguinal Hernia group which was around 3.44 days. Mean duration of time to return to normal activities was found to be 9.74 days for the Lichtenstein Tension Free Hernia Repair group compared to the Laparoscopic TEP Repair of Inguinal Hernia group which was around 8.22 days. There were no recurrences in either group. Conclusion: The laparoscopic TEP repair of inguinal hernia is a safe and acceptable procedure for repair of inguinal hernias