Acute viral infection encephalopathy linked to organic personality disorder

Introduction: Encephalopathy is a structural and/or functional disorder of the brain with multiple causes, one of them being acute viral infection. It is clinically presented with a variety of neurologi­cal and psychiatric symptoms - muscle weakness, poor concentration, seizures, changes in personal­ity, as well as lethargy or psychosis.Materials and methods: A 12-year-old patient is being presented, hospitalized in the past due to viral encephalitis. Symptoms included fever, nausea, drowsiness, apathy and confusion. A lumbar punc­ture was performed at the time with no pathogens found in the cerebrospinal fluid. After a psychi­atric assessment through an interview the patient was diagnosed with organic personality disorder. Therapy was conducted and after the full resolution of the patient`s condition he was discharged. An year and a half later a relapse of previous symptomatology occurred. The boy was hospitalized again in a psychosis-like state after an interview with a psychiatrist.Results: Beginning with fever the second episode included visual hallucinations, photophobia and disorientation, psychosis-like beliefs - believing his mother is not real (Capgras syndrome). Although fully managing the first episode a therapy with Aripiprazole and Finlepsin only lead to a partial im­provement and fluctuation of the condition during the relapse. A follow up and additional examina­tions were commissioned.Conclusion: Even though long term complications are rare the condition should be treated with care. Neuropsychiatric symptoms are common in the acute phase of viral encephalitis. In rare cas­es they may also reappear after recovery, especially in children. Symptoms may present as psychosis (35%), catatonia (33%), psychotic depression (16%), and mania (11%). Post-infectious structural and functional changes in the brain may lead to personality shifts, e.g. detachment from reality and dis­inhibited behaviour resulting in long-term disability and social isolation of the patient. Psychiatric consultation and follow-up should be requested for patients at risk without hesitation

Advantages of laparoscopic surgery in inguinal hernia repair

Introduction: Inguinal hernia has been one of the most common surgical conditions for the last few decades. Risk factors for hernia are excessive physical activity in adults or athletes and birth defects in collagen production. Over the years hernia repair has evolved as a simple, rapid and safe operation with the lowest complication rate. In the last decades laparoscopic hernia repair has replaced the clas­sic open method. The two most popular laparoscopic approaches are totally extraperitoneal repair (TEP) and transabdominal preperitoneal repair (TAPP).Materials and methods: The goal is to do an analysis based on scientific studies. A literature review using PubMed, Google Scholar was conducted. Keywords like inguinal hernia, laparoscopic and open surgery were used. The aim was to compare the laparoscopic versus open hernia surgery for length of hospital stay, postoperative pain, complication rate and return to normal activity.Results: Based on the conducted literature review, laparoscopic surgery was observed to be less pain­ful and the complication rate is lower. Furthermore the length of hospital stay and time until the re­turn to normal activity are shorter. Laparoscopic operations provide the ability to view the abdomi­nal cavity for other pathologies. The efficacy of the repair depends on the experience of the surgeon.Conclusion: In the last decades laparoscopic hernia repair has evolved. It has imposed itself as a gold­en standard in most countries, except for the patients with severe comorbidities. In conclusion, TAPP and TEP are preferred from the patients and replace the different types of open hernia repair, due to their numerable advantages