A Standardized Protocol for Post-Partum Salpingectomy with Suture Ligation: A Prospective Feasibility Study

Our objective is to define a standard protocol for post-partum salpingectomy and provide a prospective assessment of safety and feasibility of such a procedure. Thus, a protocol for performing post-partum salpingectomy in limited-resource environments was created based on contemporary practices for tubal ligation. Gravidae presenting for post-partum tubal ligation following vaginal delivery or at time of cesarean were prospectively approached and, if consent was obtained, enrolled. Outcomes were compared to a historical cohort of gravidae who underwent standard post-partum tubal ligation following vaginal birth or at the time of cesarean as per institutional standard of care. The primary outcome was operative time. One hundred and fifty-seven subjects underwent post-partum salpingectomy following cesarean or vaginal delivery (on post-partum days 0–2). Post-partum salpingectomy performed after vaginal delivery (n = 97) resulted in slightly longer operative times (39.1 ± 11.8 vs. 34.3 ± 13.1 min, p = 0.003) and slightly greater blood loss (21.0 ± 22.0 vs. 13.4 ± 17.3 mL, p = 0.001) than modified Pomeroy tubal ligation (n = 200). Post-partum salpingectomy at cesarean resulted in no difference in estimated blood loss, but slightly longer operative times compared to Parkland tubal ligations (99.5 ± 47.3 vs. 86.5 ± 33.9 min, p = 0.048). Surgical complications for post-partum salpingectomy were similar to controls, regardless of when the procedure was performed. In conclusion, a standardized protocol created for post-partum salpingectomy using suture ligation is feasible and safe

Populations structure analysis.

<p><b>(A)</b> goeBURST analysis of 1643 STs present in the PubMLST database. Each dot represents the single ST. Groups are formed by linking the STs that are double locus variants (DLV) and called as clonal complex (CC). The largest clonal complex 300 has the other STs leaving 1634, 1632, 1636, 1639 as singletons (<b>B</b>) Snapshot of the clonal complex 300.</p

Details of the study isolates identifiers and corresponding year of isolation, type of infection, geographical location, and the sequence type information.

<p>Details of the study isolates identifiers and corresponding year of isolation, type of infection, geographical location, and the sequence type information.</p

Comparison between the nucleotide diversity of MLST housekeeping genes of the study isolates.

<p>Comparison between the nucleotide diversity of MLST housekeeping genes of the study isolates.</p

Epidemiological year of isolation of the STs identified in the study isolates from different South Asian countries.

<p>Epidemiological year of isolation of the STs identified in the study isolates from different South Asian countries.</p

Distribution and association of the study ST’s with the ST’s from Southeast Asian region retrieved from the PubMLST database (10).

<p>Light Green–ST1364 (Kerala & Sri Lanka); Dark Green ST375 (Tamilnadu & Thailand); Black—ST1552 (Tamilnadu and Pondicherry); Red—ST51 (Tamilnadu, Singapore, China, Thailand, Malaysia and Burma); Purple—ST228 (West Bengal, Thailand &Vietnam); Blue–ST1099 (Jharkhand & China); Brown–ST56 (West Bengal Bangladesh, Cambodia & Vietnam); Orange—ST300 (West Bengal and Thailand); Yellow–ST99 (Bangladesh, Philippines, Thailand and Malaysia). The figure was recreated using open source-<a href="https://commons.wikimedia.org/wiki/Atlas_of_the_world" target="_blank">https://commons.wikimedia.org/wiki/Atlas_of_the_world</a>.</p

The UK experience of a treatment strategy for pediatric metastatic medulloblastoma comprising intensive induction chemotherapy, hyperfractionated accelerated radiotherapy and response directed high dose myeloablative chemotherapy or maintenance chemotherapy (Milan Strategy)

BACKGROUND: Historically, the 5-year overall survival (OS) for metastatic medulloblastoma (MMB) was less than 40%. The strategy of post-operative induction chemotherapy (IC) followed by hyperfractionated accelerated radiotherapy (HART) and response directed high dose chemotherapy (HDC) was reported in a single center study to improve 5-year OS to 73%. We report outcomes of this strategy in UK. METHODS: Questionnaires were sent to all 20 UK pediatric oncology primary treatment centers to collect retrospective data on delivered treatment, toxicity and survival with this strategy in children aged 3-19 years with MMB. RESULTS: Between February 2009 and October 2011, 34 patients fulfilled the entry criteria of the original study. The median age was 7 years (range 3-15). Median interval from surgery to HART was 109 versus 85 days in the original series. The incidence of grade 3 or 4 hematological toxicities with IC and HDC was 83-100%. All 16 patients who achieved complete response by the end of the regimen remain in remission but only three of 18 patients with lesser responses are still alive (P < 0.0001). With a median follow-up of 45 months for survivors, the estimated 3-year OS is 56% (95% CI 38, 71). This result is outside the 95% CI of the original study results and encompasses the historical survival result of 40%. CONCLUSION: Within the limits of statistical significance, we did not replicate the improved survival results reported in the original series. The reasons include differences in patient sub-groups and protocol administration. International randomized phase III studies are needed