Transforaminal endoscopic lumbar discectomy (TELD) is increasingly used as an effective alternative to open discectomy or microdiscectomy, supported by comparable outcomes in the literature. Advances in techniques and instrumentation now permit selective endoscopic decompression of diverse disc pathologies, including complex stenosis cases. However, the rising number of procedures has been accompanied by a corresponding increase in complications, which has been exacerbated by heterogeneous reporting standards in literature. Standardized systems for defining, classifying, and scoring TELD complications are lacking, but would be essential for quality assurance, comparative studies, research, and outcome assessment. Therefore, we systematically reviewed the literature to identify studies focusing on TELD complications and propose a consensus classification system. PubMed, Scopus, and Science Direct were searched to identify studies primarily addressing complications, or their classification, in patients with lumbar disc herniation or lumbar canal stenosis undergoing TELD. The exclusion criteria encompassed studies involving other pathologies, such as infections or tumors, and studies with patients undergoing revision surgery. Initial database searches yielded 887 articles, with 560 unique articles after duplicate removal. Title and abstract screening excluded 313 articles, leaving 247 articles for full-text assessment. Ultimately, 95 articles met the inclusion criteria. The narrative synthesis focused on compiling complications associated with TELD, which helped propose a structured classification system. Complications in TELD can match or exceed those of traditional surgical procedures, influenced by a steep learning curve and longer initial operation times. Expanded indications introduce the potential for encountering previously unreported complications even among experienced surgeons. Effective documentation, rating, and follow-up of complications are crucial for informed treatment decisions, enhancing patient consent processes, and improving overall outcomes.

Background: and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2–5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT. Methods: This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke. Results: Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0–3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18–4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07–4.41; P=0.04). Conclusion In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS.

Methods: The study comprised 62 subjects. Of this number, 32 subjects (group A) were unskilled laborers from the construction industry; the other 30 subjects (group B) were in the control group and had never previously carried heavy weights on their heads. Cervical spine radiographs were taken for all the 62 subjects. Subjects in group A were asked to carry a load (approximately 35 kg) on their heads and walk for about 65 m, with their cervical spine radiographs taken afterward. Results: The mean ages of patients in groups A and B were 27.17 and 25.75 years, respectively. The mean cervical lordosis observed in group A (18.96°) was dramatically less compared with group B (25.40°), showing a further decrease in head loading (3.35°). Five subjects had a reversal of lordosis (−5.61°). A statistically significant reduction in disc height and listhesis was observed when the load was carried on the head with a further decrease after walking with the load. Accelerated degenerative changes, particularly affecting the upper cervical spine, were observed in head loaders. Conclusions Carrying a load on the head leads to accelerated degenerative changes, which involve the upper cervical spine more than the lower cervical spine and predisposes it to injury at a lower threshold. Thus, alternative methods of carrying loads should be proposed.

INTRODUCTIONWe aim to study and elucidate the safety profile of the antiepileptic doses of gabapentin during pregnancy, and to evaluate gabapentin-induced murine fetotoxicity at different dose levels.

METHODSA total of 60 pregnant mice, divided into 12 groups of five mice each, were exposed to gabapentin in four different doses of 0 (control), 113, 226, or 452 mg/kg body weight per day, at three different gestational stages including early gestation (1-6 days), mid-gestation (7-12 days), and late gestation (13-17 days). The pregnant mice were euthanized on day 18 of gestation, and foetuses were examined for teratogenic manifestations. Their brains were dissected and examined for gross changes, malformations, histological changes, and quantitative protein estimation.

RESULTSFoetal resorptions were observed in all treated groups with gabapentin administration at early gestation (1-6 days), and mid-gestation (7-12 days). On the other hand, growth retardation along with stunting in size of live foetuses were observed in all the mid-gestation (7-12 days), and late gestation (13-17 days) treated groups. Various gross malformations were observed with all the three doses (113, 226, and 452 mg/kg body weight per day) when gabapentin was administered at mid-gestation (7-12 days). The same trends were confirmed by gross and microscopic examination of brains along with quantitative protein estimation.

CONCLUSIONGabapentin should not be prescribed during pregnancy, as no therapeutic dose of gabapentin is safe during this period as far as the foetal well-being is concerned.

Abnormalities, Drug-Induced ; Amines ; adverse effects ; Animals ; Anticonvulsants ; adverse effects ; Body Weight ; Congenital Abnormalities ; prevention & control ; Cyclohexanecarboxylic Acids ; adverse effects ; Dose-Response Relationship, Drug ; Female ; Mice ; Mice, Inbred ICR ; Models, Chemical ; Pregnancy ; Pregnancy, Animal ; drug effects ; Teratogens ; gamma-Aminobutyric Acid ; adverse effects

INTRODUCTIONThe aim of this study was to analyse the feasibility, safety and benefits of laparoscopic appendicectomy (LA) in comparison with open appendicectomy (OA) for perforated appendicitis (PA) in children.

MATERIALS AND METHODSA retrospective analysis of all consecutive cases of PA who underwent OA or LA between July 2001 and April 2004 was done. The patient demographics, duration of symptoms and operative findings were noted and the feasibility, safety and benefits of LA were analysed with respect to postoperative recovery and complications.

RESULTSOne hundred and thirty-seven consecutive patients with PA underwent either OA (n = 46) or LA (n = 91). Both groups were comparable with respect to patient demographics, duration of symptoms and operative findings. The mean operative time was 106.5 min (95% CI, 100.2 - 112.8) in the LA group and 92.8 min (95% CI, 82.9-102.7) in the OA group (P = 0.02). The return to afebrile status after surgery was significantly faster in the LA group [mean, 45.4 hours (95% CI, 36.8-54)] than the OA group [mean, 77 hours (95% CI 56.7-97.3)] (P = 0.007). The mean duration for postoperative opioid analgesia was 2.5 days (95% CI, 2.2-2.7) for LA and 3.2 days (95% CI, 2.9- 3.6) for OA (P = 0.001). The resumption of oral feeds after surgery was at 3.1 days (95% CI, 2.8-3.3) for LA and 3.7 days (3.4-4.1) for OA (P = 0.005). The length of the hospital stay was shorter in the LA group [mean, 6.5 days (95% CI, 6.1-6.8)] as compared to that of the OA group [mean, 8.2 days (95% CI, 7.1-9.3)] (P = 0.006). Postoperative complications included wound infection, adhesive intestinal obstruction and pelvic abscess formation. The incidence of these complications was 5.6% in the LA group and 19.6% in the OA group (P = 0.01). Nine patients (9.8%) needed conversion to open surgery in the LA group. None of the LA patients had wound infection.

CONCLUSIONLA is feasible, safe and beneficial in children with PA.

Age Factors ; Appendectomy ; methods ; Appendicitis ; surgery ; Child ; Feasibility Studies ; Female ; Humans ; Laparoscopy ; adverse effects ; methods ; Male ; Outcome and Process Assessment (Health Care) ; Pilot Projects ; Retrospective Studies ; Safety ; Time Factors ; Treatment Outcome

The use of antiepileptic drugs in pregnancy always presents challenges to doctors and their patients as it may have deleterious effects on the developing embryo. Lamotrigine is most commonly-prescribed drug among the newer antiepileptic drugs; hence, it has been selected for the present review. A number of studies pertaining to the safety of lamotrigine use during pregnancy have been reported, with differing results. Contradictory results have been reported in animals regarding lamotrigine teratogenicity, and human studies have also proven inconclusive. In many countries, human pregnancy registries are maintained to establish the safety of antiepileptic drugs during pregnancy, as all the different suggestions favour some over others, with specific antiepileptic combinations still being questioned. It is our hope that the present work may integrate the available disparate relevant facts into a directed effort towards minimising the risk of foetal compromise.
Abnormalities, Drug-Induced ; Animals ; Anticonvulsants ; adverse effects ; therapeutic use ; Epilepsy ; drug therapy ; Female ; Folic Acid Deficiency ; chemically induced ; Humans ; Pregnancy ; Teratogens ; pharmacokinetics ; pharmacology ; Triazines ; adverse effects ; therapeutic use

In most of the medical colleges in India, unclaimed bodies from various mortuaries reach the dissection hall; and here, the body donors club has yet to gain the desired dimensions. In spite of all the adverse circumstances, the cadaver and the dissection both have survived the most rigorous test of pedagological fitness--the test of time. Today, many of the Western countries have long donor waiting lists where cadavers are acquired as anatomical gifts or through body donor programmes. Thailand's approach to body donors offers a role model for resolving the present situation. The spirit of volunteerism reflects the drastic shift in public perception and a global change in approach is needed in the present time.
Anatomy ; education ; Cadaver ; Dissection ; Education, Medical, Undergraduate ; Humans ; India ; Tissue Donors