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[Angle secure dish pertaining to strategy to deficit bone injuries of the pelvis (non-surgical rear locked retention dish) : Online video article].
BACKGROUND Patients with isolated occipital condyle lesions concerning for metastases rarely undergo surgical biopsies and are more commonly treated with empirical radiation with or without chemotherapy. This is likely related to the morbidity associated with open condylar approaches and the importance of surrounding structures. We present a minimally invasive technique to approach the occipital condyle using a tubular dilating retractor system. CASE DESCRIPTION A 38-year-old woman with medical history of breast cancer presented with a 2-month history of headache localizing to the right occipital area and right tongue deviation. Magnetic resonance imaging revealed a heterogeneously enhancing mass within the right occipital condyle. The patient was brought into the operating room and placed in prone position. A 2-cm paramedian incision was made on the right approximately 2.5 cm off midline at the level of C1. Sequential dilation using a tubular retractor system was performed under fluoroscopic guidance. Once the condylar cortex was identified and entered, the tumor was immediately visualized and resected. Operative time was 65 minutes and estimated blood loss was 5 mL. The patient was discharged to home on postoperative day 1. CONCLUSIONS This report, to our knowledge, presents the first case of a minimally invasive tubular retractor system-based approach for biopsy and resection of an occipital condylar metastasis causing occipital condyle syndrome. This approach allows for tissue diagnosis to precisely dictate medical management and minimizes the morbidity associated with traditional open surgical approaches. OBJECTIVE To compare the value of ultrasonography (USG) score, cancer antigen 125 (CA 125), human epididymis protein 4 (HE 4) and risk of malignancy algorithm (ROMA) in differential diagnosis ovarian masses. METHODS This prospective study was conducted between May 2012 and September 2013 in a single center. Eighty-four women who had an ovarian mass on imaging and underwent surgery were included. The diagnostic performances of CA 125, HE 4, ROMA score and USG score for ovarian cancer were analyzed. RESULTS There were 65 (77.3 %) women with benign ovarian tumors and 19 (22.7 %) women with malignant ovarian tumors. According to receiver operating characteristic (ROC) analysis; area under curve (AUC) was 0.874 for the USG score (p less then 0.001), 0.794 for the CA 125 (p less then 0.001), 0.9 for the HE 4 (p less then 0.001), and 0.893 for the ROMA (p less then 0.001). The USG score ≥ 3 had a sensitivity of 68.4 % and specificity of 90.7 %.The CA 125 ≥ 35 IU/l, had a sensitivity of 84.2 %, specificity of 49.2 %, the HE 4 ≥ 150 pM, had a sensitivity of 84.2 %, specificity of 98.4 % and the ROMA score had a sensitivity of 84.2 %, specificity of 75.3 % CONCLUSION The HE 4 had higher accuracy than ROMA score, USG score and CA 125, in predicting ovarian cancer. Besides, the USG score was a simple and achievable method with acceptable performance. OBJECTIVES The purpose of this study was to estimate our center-specific CVS-related miscarriage rate. METHODS This is an observational retrospective study of women submitted to a CVS in our hospital, between January 1st, 2007 and December 31st, 2016. Maternal and pregnancy characteristics, procedure details, genetic results and pregnancy outcomes of all patients were collected. The FMF miscarriage risk algorithm was used to estimate our population expected risk of miscarriage. To establish the procedure-related risk of miscarriage, we compared the observed with the expected miscarriage rate. RESULTS We had a total number of 1523 women with a singleton pregnancy who did a CVS over the 10-year period. The mean maternal age was 34 years old; the majority of the women was Caucasian, multiparous and had a spontaneous pregnancy. The most common indication for CVS was a high-risk result in the 1st trimester combined screening test. The karyotype was normal in 72,7% of cases, 11,1% were T21 and 7,2% were T13 or T18. In the study group, 33 women were diagnosed with a fetal demise, 435 had a TOP and there were 4 intrauterine deaths and 34 miscarriages. The rate of miscarriage in our population was 3,2% and the expected patient specific risk for miscarriage was 3,0%. There was no statistical significance between the two miscarriage rates p = 0,705. CONCLUSION In our study the risk of miscarriage in the CVS group was not significantly different from that the expected patient specific risk (3.2 % vs 3%, p = 0.7). The procedure-related risk of miscarriage was 0,2%, similar to the rates describe in the literature. An accurate risk of pregnancy loss should be used when counseling women for CVS to allow an informed decision. This review aimed to provide an updated scenario of the Group A Streptococcus (GAS) epidemiology in the Middle Eastern and North African (MENA) region with a special spotlight on the most prevalent emm types and macrolide resistance profiles. While the burden of invasive GAS infections is elusive to assess in the MENA region, the GAS prevalence ranged from 2.5% to up 42.4% in pharyngitis patients and from 2.4% to up 35.4% in healthy carriers. emm1, emm12, emm89, emm4, emm28, and emm3 were responsible for the major GAS burden in the MENA region. The coverage rate of the new M-protein based vaccine candidate (30-valent) varied from 42% to 100% according to the countries. The rate of erythromycin resistance differed substantially between countries where values differed from low, moderate, to high. Our data add more shreds of evidence on the neglected GAS burden in the MENA region. Systematic surveillance of invasive GAS infections along with a molecular characterization of GAS isolates are strongly recommended to track the trends of circulating clones and evaluate the potential coverage of the vaccine candidates. OBJECTIVE The aim of this study was to clarify the genetic and epidemiological properties of multidrug-resistant Acinetobacter baumannii in medical settings in Myanmar. METHODS A total of 45 A. baumannii clinical isolates were obtained in medical settings in Myanmar. The whole genomes were sequenced by a next generation sequencer, and the phylogenetic tree was constructed from single nucleotide polymorphism concatemers. Multilocus sequence types were deduced and drug resistance genes were identified. JAK pathway RESULTS Thirty-eight MDR Acinetobacter baumannii isolates were obtained from seven hospitals in Myanmar. The majority of MDR A. baumannii isolates belonged to ST2. Of the 38 isolates, 5 harbored blaNDM-1, and 28 did armA or armA2 CONCLUSIONS A. baumannii ST2 producing 16S rRNA methylase ArmA has been spreading in medical settings in Myanmar.
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