Whole genome shotgun sequencing of Indian strains of Streptococcus agalactiae.

Group B streptococcus is known as a leading cause of neonatal infections in developing countries. The present study describes the whole genome shotgun sequences of four Group B Streptococcus (GBS) isolates. Molecular data on clonality is lacking for GBS in India. The present genome report will add important information on the scarce genome data of GBS and will help in deriving comparative genome studies of GBS isolates at global level. This Whole Genome Shotgun project has been deposited at DDBJ/ENA/GenBank under the accession numbers NHPL00000000 - NHPO00000000.

Radioguided Parathyroidectomy is Successful in 98.7% of Selected Patients.

OBJECTIVE: To examine an individualized approach to patients with primary hyperparathyroidism (PHPT) in an effort to identify factors that would differentiate patients who can be treated with radioguided parathyroidectomy (RP) from those that require more extensive parathyroid exploration (PE) using intraoperative parathyroid hormone (IOPTH) measurement and to compare rates of recurrent and persistent hypercalcemia. METHODS: A total of 100 patients were retrospectively studied. Patients with positive single photon emission computed tomography (SPECT) scans underwent surgeon-performed sonography (SPS) followed by RP. Patients with negative or equivocal SPECT scans underwent PE utilizing SPS as a guide and IOPTH. The success rate, recurrence and persistence rates, and rate of bilateral exploration were compared. RESULTS: Seventy-five percent of patients with PHPT had a positive SPECT scan and underwent RP, whereas 25% of patients had a negative SPECT scan and underwent PE with IOPTH utilizing SPS as a guide. Persistent hypercalcemia was noted in 1 patient (1.3%) and recurrent hypercalcemia in 2 patients (2.6%) in the RP group, whereas no persistent hypercalcemia was noted in the group undergoing PE utilizing SPS and IOPTH. Overall, 89% of patients were cured with unilateral surgery. CONCLUSION: Patients with positive SPECT scans may undergo RP with an expected cure rate of 98.7%. Patients with negative SPECT scans should undergo SPS followed by PE using IOPTH and can expect a cure rate near 100%. Properly selected patients may undergo RP, with low rates of persistent (1.3%) and recurrent (2.6%) hypercalcemia.

Surgeon-performed ultrasonography as an adjunct to minimally invasive radio-guided parathyroidectomy in 100 consecutive patients with primary hyperparathyroidism.

OBJECTIVE: To examine whether surgeon-performed ultrasonography (SPU) in patients with primary hyperparathyroidism and negative preoperative sestamibi scans improves adenoma localization, increases the directed unilateral exploration rate, and reduces operative time and length of hospital stay. METHODS: We retrospectively analyzed 100 consecutive patients with primary hyperparathyroidism encountered between January 1, 2005, and March 31, 2007. Patients underwent preoperative sestamibi scanning and SPU. Minimally invasive radio-guided parathyroidectomy (MIRP) was performed on patients with positive sestamibi scans. In sestamibi scan-negative patients, unilateral exploration was performed with removal of the adenoma, which was submitted for frozen section. Accuracy, operative time, hospital length of stay, mortality, and morbidity were assessed. RESULTS: Of 100 patients, 79 had positive sestamibi scans and underwent MIRP. Twenty-one had negative sestamibi scans, 18 of whom underwent SPU. Parathyroid adenoma was localized in 17 (94%) of the 18 patients. Operative time and length of hospital stay were not significantly different between sestamibi scan-negative patients who underwent SPU with directed unilateral exploration and sestamibi scan-positive patients who underwent MIRP (operative time: 46 minutes vs 38 minutes, respectively; length of hospital stay: 17.8 hours vs 16.1 hours, respectively). Operative time and length of hospital stay were significantly shorter in sestamibi scan-negative patients who underwent SPU with directed unilateral exploration and in patients who underwent MIRP than in historical controls who underwent 4-gland exploration (P<.01 for both outcomes). No morbidity or mortality was documented. CONCLUSION: SPU localizes 94% of adenomas in sestamibi scan-negative patients, which allows for directed unilateral exploration and results in operative time and length of hospital stay not significantly different from patients undergoing MIRP.

Minimally invasive radio-guided parathyroidectomy in 152 consecutive patients with primary hyperparathyroidism.

OBJECTIVE: To examine the results of minimally invasive radio-guided parathyroidectomy (MIRP) in the treatment of patients with primary hyperparathyroidism, including factors associated with negative technetium-labeled sestamibi scanning. METHODS: We retrospectively analyzed the findings in a group of 152 consecutive patients encountered during the period 2001 through 2004. The overall accuracy of preoperative sestamibi scanning was assessed, and the success of MIRP was determined on the basis of operative time, duration of hospital stay, and rate of complications. RESULTS: All 152 patients underwent preoperative sestamibi scanning; 118 (78%) had positive scans and were treated with MIRP, whereas 34 (22%) had negative scans and underwent traditional neck explorations. Patients with negative sestamibi scans had 5 times the incidence of concomitant thyroid disease in comparison with those who had positive sestamibi scans (P<0.01), and they had higher rates of parathyroid hyperplasia (26% versus 0%; P<0.01). In comparison with traditional neck dissection, MIRP-treated patients had shorter operative times (38 minutes versus 86 minutes; P<0.01) and shorter hospital stays (0.67 day versus 1.09 days; P<0.01). Among the MIRP-treated patients, 67% were discharged the same day as performance of the outpatient surgical procedure. Correction of hypercalcemia was accomplished in 116 of 118 patients (98%) who underwent MIRP. Complications in the MIRP group were low, including 1 postoperative hemorrhage. No cases of recurrent laryngeal nerve injury occurred. There were 2 false-positive sestamibi scans (1.3%). CONCLUSION: Parathyroid hyperplasia and concomitant thyroid pathologic conditions are associated with negative preoperative sestamibi scans. MIRP is applicable in 78% of patients with primary hyperparathyroidism and is a safe, effective operation that results in shorter surgical time, reduced hospital stay, and minimal complications.