Ovarian fibrothecoma is a relatively new term that is used to describe an ovarian sex cord stromal tumour that has mixed features of both fibroma and thecoma. The prevalence of ovarian fibrothecoma tumours is very rare and is reported to be about 1.2% of all ovarian tumours. We report a case of a 32-year-old woman who presented with acute menorrhagia with no previous medical, surgical or gynecological history. She was amenorrhic for four years after the insertion of a levonorgestrelreleasing intrauterine system (LNG-IUS) for contraception. The efficacy and location of LNG-IUS was reflected due to the sudden onset of menorrhagia. On pelvic examination and ultrasound the LNG-IUS could not be visualized and a uterine fibroid was noted. A diagnostic laparoscopy was done to identify the LNG-IUS, which revealed an incidental large ovarian mass on the left ovary. CA-125 level was elevated to 45 kU/L (Normal range <35 kU/L). Total abdominal hysterectomy, left salpingo-oopherectomy and cystectomy were performed. On histopathology, the mass was proven to be an ovarian fibrothecoma. No signs of malignancy were noted on peritoneal fluid cytology. The LNG-IUS was found inside the uterus. Our case is reported on the basis of the rare incidence of ovarian fibrothecoma and the possible effect it may have on the efficacy of LNG-IUS causing menorrhagia.
Menorrhagia ; Fibroma ; Thecoma ; Ovarian Neoplasms

A 60-year-old female developed a right parotid swelling six months after surgery for intra-oral squamous cell carcinoma. Fine needle aspiration (FNA) cytological smears showed dissociated large and small pleomorphic tumour cells with abundant mitoses and oncocytic features. A cytological diagnosis of parotid acinic cell carcinoma (ACC) was made. Histological study of the subtotal parotidectomy specimen showed a papillary cystic variety of acinic cell carcinoma (ACC-PCV). FNA cytological features in this case of ACC-PCV differs from the two previously reported cases in that it showed prominent oncocytic and high grade features and absence of papillary pattern in the cytological smears. ACC-PCV is an uncommon tumour and knowledge of its varied FNA cytological features is important for the diagnosis of this neoplasm.
Fine needle biopsy, NOS ; Cells ; Carcinoma ; Grade ; Packed cell volume

Late vascular complications involving aorta are rare but devastating adversities following anterior thoracic spine operations are present.The current article describes our experience with one such patient who had an iatrogenic pseudoaneurysm of the thoracic aorta,mimicking infection.The patient was treated successfully following concomitant efforts by multidisciplinary experts with shunting.We wish to highlight upon the significance of recognizing the possible sinister consequences of a dangerously prominent spinal implant and the role of a suspicious surgeon in identifying these menacing complications at the right time.

BACKGROUND: The pelvic bone is the most common site of bone metastases following the axial skeleton. Surgery on the pelvic bone is a demanding procedure. Few studies have been published on the surgical outcomes of metastasis to the pelvic bone with only small numbers of patients involved. This study sought to analyze the complications, local progression and survival after surgery for metastasis to the pelvic bone on a larger cohort of patients. METHODS: We analyzed 83 patients who underwent surgery for metastases to the pelvic bone between the years 2000 and 2015. There were 41 men and 42 women with a mean age of 55 years. Possible factors that might be associated with complications, local progression and survival were investigated with regard to patient demographics and disease-related and treatment-related variables. RESULTS: The overall complication rate was 16% (13/83). Advanced age (> 55 years, p = 0.034) and low preoperative serum albumin levels (≤ 39 g/L, p = 0.001) were associated with increased complication rates. In patients with periacetabular disease, the complication rate was higher in those who underwent total hip replacement arthroplasty (THR) than those who did not (p = 0.030). Local progression rate was 46% (37/83). The overall median time to local progression was 26 ± 14.3 months. The median time from local progression to death was 13 months (range, 0 to 81 months). The local progression-free survival was 52.6% ± 6.4% at 2 years and 36.4%± 7.6% at 5 years, respectively. Presence of skip lesions (p = 0.017) and presence of visceral metastasis (p = 0.027) were found to be significantly associated with local progression. The median survival of all patients was 24 months. The 2-year and 3-year survival rates were 52.5% ± 5.9% and 35.6% ± 6%, respectively. Metastasis from the kidney, breast, or thyroid or of hematolymphoid origin (p = 0.014), absence of visceral metastasis (p = 0.017) and higher preoperative serum albumin levels (p = 0.009) were associated with a prolonged survival. CONCLUSIONS: Advanced age and low serum albumin levels were associated with high complication rates. Local progression after surgery for metastases to the pelvic bone was affected by the presence of skip lesions, not by surgical margins. Primary cancer type, serum albumin level and visceral metastasis influenced survival.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Bone Neoplasms ; Breast ; Cohort Studies ; Demography ; Disease Progression ; Disease-Free Survival ; Female ; Humans ; Kidney ; Male ; Neoplasm Metastasis* ; Pelvic Bones* ; Serum Albumin ; Skeleton ; Survival Rate ; Thyroid Gland

STUDY DESIGN: Biomechanical study. PURPOSE: To determine the effect of density, insertion angle and reinsertion on pull-out strength of pedicle screw in single and two screw-rod configurations. OVERVIEW OF LITERATURE: Pedicle screw pull-out studies have involved single screw construct, whereas two screws and rod constructs are always used in spine fusions. Extrapolation of results using the single screw construct may lead to using expensive implants or increasing the fusion levels specifically in osteoporotic bones. METHODS: Single screw and two screw pull-out strength tests were carried out according to American Society for Testing and Materials F 543-07 on foam models to test the effect of density, insertion angle and reinsertion using poly axial pedicle screws. RESULTS: Bone density was the most significant factor deciding the pull-out strength in both single and two screw constructs. The difference in pull-out strength between single screw and two screw configurations in extremely osteoporotic bone model (80 kg/m3) was 78%, whereas in the normal bone model it was 48%. Axial pull-out value was highest for the single screw configuration; in the two screw configuration the highest pull-out strength was at 10°-15°. There was an 18% reduction in pull-out strength due to reinsertion in single screw configuration. The reinsertion effect was insignificant in the two screw configuration. CONCLUSIONS: A significant difference in response of various factors on holding power of pedicle screw between single and two-screw configurations is evident. The percentage increase in pull-out strength between single and two screw constructs is higher for osteoporotic bone when compared to normal bone. Reinsertion has no significant effect on pull-out strength in the two screw rod configuration.
Bone Density ; Osteoporosis ; Pedicle Screws* ; Spine

STUDY DESIGN: Biomechanical study. PURPOSE: To determine the effect of density, insertion angle and reinsertion on pull-out strength of pedicle screw in single and two screw-rod configurations. OVERVIEW OF LITERATURE: Pedicle screw pull-out studies have involved single screw construct, whereas two screws and rod constructs are always used in spine fusions. Extrapolation of results using the single screw construct may lead to using expensive implants or increasing the fusion levels specifically in osteoporotic bones. METHODS: Single screw and two screw pull-out strength tests were carried out according to American Society for Testing and Materials F 543-07 on foam models to test the effect of density, insertion angle and reinsertion using poly axial pedicle screws. RESULTS: Bone density was the most significant factor deciding the pull-out strength in both single and two screw constructs. The difference in pull-out strength between single screw and two screw configurations in extremely osteoporotic bone model (80 kg/m3) was 78%, whereas in the normal bone model it was 48%. Axial pull-out value was highest for the single screw configuration; in the two screw configuration the highest pull-out strength was at 10°-15°. There was an 18% reduction in pull-out strength due to reinsertion in single screw configuration. The reinsertion effect was insignificant in the two screw configuration. CONCLUSIONS: A significant difference in response of various factors on holding power of pedicle screw between single and two-screw configurations is evident. The percentage increase in pull-out strength between single and two screw constructs is higher for osteoporotic bone when compared to normal bone. Reinsertion has no significant effect on pull-out strength in the two screw rod configuration.
Bone Density ; Osteoporosis ; Pedicle Screws* ; Spine

Late vascular complications involving aorta are rare but devastating adversities following anterior thoracic spine operations are present. The current article describes our experience with one such patient who had an iatrogenic pseudoaneurysm of the thoracic aorta, mimicking infection. The patient was treated successfully following concomitant efforts by multidisciplinary experts with shunting. We wish to highlight upon the significance of recognizing the possible sinister consequences of a dangerously prominent spinal implant and the role of a suspicious surgeon in identifying these menacing complications at the right time.
Aneurysm, False ; Aorta, Thoracic ; surgery ; Humans ; Iatrogenic Disease ; Thoracic Vertebrae ; surgery ; Tomography, X-Ray Computed

Since December 2019, a novel coronavirus disease (COVID-19) creates a global threat. Medical students are more susceptible to be infected by the virus. This study aimed to assess COVID-19 related knowledge, attitude towards COVID-19, and preventive behaviours against COVID-19 among medical students within the first month of the onset of the outbreak in Malaysia. We collect data from medical students using an online Google survey form. Out of 696 students, 467 responded to the questionnaire. The analysis revealed that the mean percentage of knowledge was (85.04), attitude (84.12), and preventive practice (77.75) respectively. Hierarchical multiple linear regression analysis revealed that living with family (p<0.01) and knowledge of COVID-19 (p<0.001) appeared to be important predictors of attitude toward COVID-19. However, gender (p<0.001), living status (p<0.001), frequency of travel during movement control order (p<0.01), attitude towards COVID-19 (p<0.001) have appeared significant predictors for preventive practice against COVID-19. But knowledge of COVID-19 had no impact on preventive practice against COVID-19 (p>0.05). We found a high level of COVID-19 related knowledge, attitude, and preventive practice against COVID-19 among medical students. A sustained knowledge, attitude, and preventive behavioural strategy could play an ingredient in upholding the student’s learning and practice against any disease like COVID-19.

Results: Pullout strength decreased by 36% when the size of the revision screw was increased by 1 mm, while it increased by 35% when the size of the revision screw was increased by 2 mm compared to the index screw value. While the morphologies of the load paths were similar in all cases, they differ between the two groups: the larger screw responded with generally elevated stiffer path than the smaller screw, suggesting that revision surgery using a larger screw has more purchase along the inserted body-pedicle axis. Conclusions A larger screw enhances strength and increases biomechanical stability in revision surgeries, although the final surgical decision is made by the clinician, which includes the patient’s anatomy and associated characteristics.

OBJECTIVETo report a case series of six neglected cervical spine dislocations without neurological deficit, which were managed operatively.

METHODSThe study was conducted from August 2010 to December 2011 and cases were selected from the out-patient department of Postgraduate Institute of Medical Education and Research, India. The patients were in the age group of 30 to 50 years. All patients were operated via both anterior and posterior approaches.

RESULTSDuring the immediate postoperative period, five (83.33%) patients had normal neurological status. One (16.67%) patient who had C5-C6 subluxation developed neurological deficit with sensory loss below C6 level and motor power of 2/5 in the lower limb and 3/5 in the upper limb below C6 level.

CONCLUSIONThere is no role of skull traction in neglected distractive flexion injuries to cervical spine delayed for more than 3 weeks. Posterior followed by anterior approach saves much time. If both approaches are to be done in the same sitting, there is no need for instrumentation posteriorly. But if staged procedure is planed, posterior stabilization is recommended, as there is a risk of deterioration in neurological status.

Adult ; Cervical Vertebrae ; injuries ; Female ; Humans ; India ; Joint Dislocations ; physiopathology ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Spinal Injuries ; physiopathology ; surgery ; Treatment Outcome