Y. Kaufman

Long-term sleep disturbances in adolescents after minor head injury

It has been demonstrated that patients in the acute phase after minor head injury (MHI) complain of sleep disturbances. The purpose of the present study was to characterize the long-term effects of MHI on sleep in adolescents. Nineteen adolescents who had suffered MHI 3 years before the study and had complained of sleep disturbances completed a sleep questionnaire and were investigated in the sleep laboratory by whole-night polysomnographic recordings and were actigraphically monitored for 5 days at home. Questionnaire results revealed severe complaints regarding sleep behavior. Polysomnographic recordings revealed that in comparison with controls, MHI was associated with lower sleep efficiency (79.8 +/- [9.8]% vs 87.7 +/- [6.8]%; P < 0.005), with more wake time (10.6 +/- [9.0]% vs 3.4 +/- [4.4]%; P < 0.005), and with more awakenings lasting more than 3 minutes (2.1 +/- [1.5] vs 0.6 +/- [0.8]; P < 0.005). These findings were confirmed by actigraphic monitoring that revealed lower sleep efficiency (90 +/- [5]% vs 94 +/- [3]%; P < 0.05), more minutes of wake time (49 +/- [21] min vs 28 +/- [15] min; P < 0.05), and a trend toward more awakenings longer than 5 minutes (1.8 +/- [0.8] vs 1.2 +/- [0.8]; P = 0.063). Our data demonstrated that 3 years after MHI without any discernible clinical sequel, adolescents still complain of sleep disturbances that could be confirmed by both polysomnographic and actigraphic monitoring.

Prevalence and risk of sleep disturbances in adolescents after minor head injury.

Sleep disturbances were reported in patients during the acute stage after minor head injury, and for some of these patients, the disturbances may become chronic. The purpose of the present study was to assess the prevalence and risk factors of the long-term sleep disturbances in adolescents after minor head injury. Unselected adolescents (98) who had experienced a minor head injury 0.5-6 years before the institution of the study and 80 matched control subjects were interviewed and completed a detailed questionnaire. The prevalence of sleep disturbances was significantly larger among adolescents who experienced minor head injury compared with the control subjects (28% versus 11%, P < 0.05). Within the study group, those who developed long-term sleep disturbances manifested a greater body mass index (20.8 +/- 4.0 vs 18.4 +/- 2.8 kg/m(2), P = 0.005) and poorer parental education (fathers 11.0 +/- 4.0 vs 13.4 +/- 3.0 years, mothers 11.8 +/- 3.3 vs 13.2 +/- 2.9 years, P < 0.05 for both), compared with those who did not develop sleep disturbances. Our data indicate that subjective sleep disturbances may be evident in a fairly high percentage of adolescents after minor head injury, up to 28%, suggesting that minor head injury may not be as benign as previously estimated. Risk factors include heavier body mass and poorer parental education.

The Pelvic Uterus-like Mass—A Primary or Secondary Müllerian System Anomaly?

The pelvic uterus-like mass is a rare phenomenon in which an extrauterine mass, comprised of smooth muscle and a central cavity lined by endometrium, is found within the pelvis. The mass is associated with endometriosis and in some of the cases with congenital Müllerian malformations. There is an ongoing debate whether the finding is a result of smooth muscle metaplasia or a remnant of a Müllerian system defect. We present 2 distinct cases of a uterus-like mass.

Cystoscopy after total or subtotal laparoscopic hysterectomy: the value of a routine procedure

Ureteral injury during hysterectomy is one of the most troubling complications gynecologists need to be aware of. In various studies, such injury occurred in laparotomy, laparoscopy, and vaginal hysterectomy. The objective of our study was to assess the necessity, efficiency, and cost-effectiveness of cystoscopy at the end of total or subtotal laparoscopic hysterectomy (TLH/STLH). This is a retrospective analysis of 7 years’ experience in a university-affiliated hospital. All hysterectomies were performed on an overnight basis by experienced surgeons. Out of 338 patients, 106 patients underwent TLH, and 232 underwent STLH. Four cases (1.18%) of ureter injury were noted (one after TLH and three after STLH). Diagnosis was clinically made by postoperative vaginal sonography and was confirmed by intravenous pyelography. A cystoscopy was performed after intravenous indigo carmine injection. The study period consisted of two phases. In the first phase, we used bipolar cautery to occlude the uterine artery; consequently, a nearby thermal injury could be misdiagnosed. In the second phase we clipped the uterine artery with a new hemoclip called Hem-o-lok (Weck Closure Systems, USA), which forced an exact uterine artery closure. As a result, in the second phase no cases of ureteral injury were noted. In view of the fact that the equipment for cystoscopy is used during surgery for TLH/STLH and is sterile and available, the only additional cost of the cystoscopy is an ampule of indigo carmine. Therefore, we conclude that cystoscopy at the end of surgery for TLH/STLH is an important evaluation and provides the following significant advantages: In patients presenting with postoperative flank pain, cystoscopy may prevent the need for further evaluation and expensive testing, and cystoscopy increases the surgeon’s and the patient’s confidence in the integrity of the urinary tract during the recovery period.

The three-dimensional “insect eye” laparoscopic imaging system-a prospective randomized study

The VS-1 “insect eye” technology is a new three-dimensional (3D) imaging system used for laparoscopic surgery. It is based on a microscopic array of hundreds of thousands of lenses that form a single apparatus, providing streaming 3D imaging without the side effects of previous 3D systems. This study analyzed the VS-1 system in terms of operative results and surgeon satisfaction compared with the standard two-dimensional (2D) imaging system. Eighty-eight patients undergoing laparoscopic surgery of different difficulty levels, performed by three different surgeons, graded as novice or experienced, were randomly assigned for the VS-1 3D or the standard 2D imaging systems, 44 patients in each group. Results showed that, when using the 3D VS-1 system, surgery duration was reduced for both novice and experienced surgeons. Surgeons reported having good depth perception, anatomic understanding and procedure efficiency, as well as physician confidence and efficiency during complicated maneuvers. No user side effects were reported. The VS-1 “insect eye” 3D imaging system provided improved operative results when compared with the 2D imaging system, with a decrease in surgery duration, along with good surgeon confidence and satisfaction, and without user side effects.