No abstract

Epstein-Barr Virus (EBV) encephalitis is a rare (<1%) and generally self-limited disease with few sequelae. This neurological complication has been reported almost exclusively in the course of acute primary infection and in paediatric patients. We describe a case of a young adult immunocompetent man who developed an acute fatal necrotizing haemorrhagic encephalitis as the only manifestation of an acute EBV infection. EBV-DNA was tested positive in several CSF samples by qualitative and quantitative PCR. Serological profile showed: absence of IgM against Viral Capsid Antigen (VCA) in three different consecutive samples, presence of IgG against VCA and IgG seroconversion for Epstein Barr Nuclear Antigen (EBNA). EBV-DNA was detected by qualitative PCR in autoptic brain material. Clinical course was not influenced by antiviral therapy with acyclovir. In conclusion to our knowledge, this is the only case of acute necrotizing haemorrhagic EBV encephalitis with a fatal outcome, in an adult immunocompetent man.

Information is lacking from prospective studies on the incidence and risk factors for postoperative nerve injury after routine gynecologic surgery. In 2 retrospective studies, the reported risk of nerve injury from major gynecologic oncologic procedures was estimated to be between 1.1% and 1.9%. This prospective cohort study evaluated the overall incidence and time course of pelvic nerve injury in a population of 616 female patients undergoing elective gynecologic surgery for benign and malignant conditions. The study was conducted between 2007 and 2008 at a single academic medical center.Before surgery, neurologic evaluation found preexisting lower extremity neuropathies in 12 (1.9%) participants. After surgery, 14 new peripheral nerve injuries were observed in 11 patients; the overall incidence of postoperative neuropathy was 1.8% (11/616), with a 95% confidence interval of (1.0-3.2). The neuropathies detected included 1 ilioinguinal/ iliohypogastric, 1 saphenous, 1 genitofemoral, 1 common fibular, 5 lateral femoral cutaneous, and 5 femoral. There was a complete resolution of neuropathic symptoms in 91% (10/11) of the patients at a median time of 31.5 days (range: 1 day to 6 months).These findings are consistent with other studies suggesting a low risk of new onset neurologic injury after gynecologic surgery. GYNECOLOGYVolume 65, Number 2 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT Hypoestrogenism in postmenopausal women results in skin atrophy with a decrease in both elasticity and skin thickness. The fragility of the skin in aging women may be responsible for the reported 50% or more increase in major laparoscopic complications during the initial entry into the female abdomen. Several first-entry techniques in laparoscopy have been investigated to minimize entry-related complications. The Veress needle approach is the standard method used by most gynecologists. A promising new method is the direct optical access (DOA) which uses optically-guided trocars to provide visual guidance during entry. These 2 techniques have not been compared.The aim of this prospective randomized study was to evaluate the efficacy and safety of these 2 methods in postmenopausal women. The study was conducted at multiple European gynecology centers between 2004 and 2008. A total of 186 postmenopausal women scheduled to undergo laparoscopy for simple, persistent postmenopausal ovarian cysts were randomized to 2 groups: group I (n ϭ 89) was assigned to surgical entry using DOA, and group 2 (n ϭ 97) was assigned to entry using the Veress needle method. The 2 procedures were compared for the following parameters: the time needed for achieve adequate abdominal access, the occurrence of major and minor vascular and bowel injuries, and blood loss during laparoscopic access. Operative Gynecology 91 92Obstetrical and Gynecological Survey ABSTRACTMajor risk factors in the general surgical population for morbidity and mortality have been identified using a number of risk scoring systems. Such risk factors include older age, length of surgery,...