Brachial monomelic amyotrophy as an initial manifestation of stiff person syndrome.

Stiff person syndrome (SPS) is characterized by rigidity of truncal and proximal muscles. The presence of abdominal and paraspinal rigidity is a defining clinical feature of SPS. It is rarely associated with the lower motor neuron (LMN) features. We report a patient with SPS whose initial clinical presentation was that of brachial monomelic amyotrophy (BMA). A 24-year-old gentleman presented with a history of the left upper limb wasting and weakness. In addition, he reported stiffness of the lower limbs and abdomen while walking. On examination, patient had left upper limb monomelic amyotrophy and hypertonia, exaggerated deep tendon reflexes in all four limbs. He also had abdominal and paraspinal rigidity. Serum was strongly positive for GAD 65 antibodies suggestive of SPS. Patient showed dramatic improvement to immunomodulation. Patient presented with features of BMA. Symptoms related to SPS were mild. Abdominal rigidity was the clue to the diagnosis. LMN features have been reported previously in stiff person plus syndrome with an atypical course and progressive encephalomyelitis with myoclonus and rigidity, but not in classical SPS.

Colorectal cancer surgery: by Cambridge Medical Robotics Versius Surgical Robot System-a single-institution study. Our experience.

With the previous experiences in performing laparoscopic for over a period of 15 years and da Vinci colorectal surgeries from 2010 to 2013, we started operating using the Cambridge Medical Robotics (CMR) Versius Surgical Robot System. The aim of the study is a prospective analysis and evaluation of short-term results of consecutive patients to study the technical feasibility and oncological outcome of robot-assisted low anterior resection (LAR) and ultralow anterior resection (ULAR), using the CMR Versius Surgical Robot System. This study was conducted at single minimal access surgery institute. 31 patients with colorectal adenocarcinoma underwent robot-assisted LAR and ULAR between August 2019 and March 2020. Patient characteristics, perioperative parameters and complications were evaluated. Surgical and pathological outcomes such as quality of Total Mesorectal Excision (TME), free circumferential resection margins and number of lymph nodes dissected were also evaluated. Of 31 patients, 23 were men and 8 women, with mean age of 55.6 years. The mean robotic operative time was 51 min and the mean blood loss was 55 ml. The mean robot docking and undocking time was 17 min and 5 min, respectively. The mean hospital stay was 7 days. The longitudinal and circumferential resection margins were negative in all patients. Histopathological reports of 27 among 31 patients showed complete TME. Splenic flexure of colon mobilization was done laparoscopically. We feel that Versius robot has the qualities in terms of dexterity, vision and intuitive movements, and to translate this technical ability into oncological safety.

Endovascular treatment for acute ischemic stroke using solitaire stent: temporary endovascular bypass, a novel technique.

Early restoration of flow to perfuse salvageable brain tissue has been shown to significantly reduce the morbidity and mortality of ischemic stroke. Several mechanical devices have shown promising results in patients with large vessel occlusive stroke. Solitaire revascularization device (ev3, Inc., Irvine, California) is a recoverable self-expanding thrombectomy device that can also be used as a temporary endovascular bypass. We report a patient in whom solitaire aneurysm bridging stent was used as a temporary bypass procedure to recanalize carotid T occlusion patient with good functional outcome.

Feasibility of robotic radical hysterectomy (RRH) with a new robotic system. Experience at Galaxy Care Laparoscopy Institute.

The main objective of this study was to assess in a series of 30 patients, the feasibility, oncological safety and efficacy of radical hysterectomy by a new robotic system. Prospective study design. Galaxy Care Laparoscopy Institute and Multispeciality Hospital. We performed Robotic Radical Hysterectomy in patients from August 2019 through February 2020. All the surgeries were performed by a single surgeon (Puntambekar S). Since August 2019, 30 patients with early cervical cancer/endometrial cancer were selected for radical hysterectomy. All patients were in good general condition with controlled medical comorbidities. The mean operative time was 104 min, with mean total lymph node yield of 24.7. The average blood loss was 60 ml and the hospital stay was 2.1 days, and majority of the patients were catheter free by 1 week. Two patients developed uretero-vaginal fistula on the 8th day of surgery. One was managed with Double J stenting and in the other we did laparoscopic ureteroneocystostomy. Our study has demonstrated the feasibility, safety and efficacy of RRH by the Versius robotic systems.

Clobazam monotherapy in drug naïve adult patients with epilepsy.

PURPOSE: Evaluation of the efficacy and side effects profile of Clobazam in a 24-week open-labelled trial involving 26 cases of drug naïve adult patients with epilepsy. METHODS: The study was an open labelled unicentre trial in which only drug naïve cases with epilepsy were included. A total of 26 cases were recruited. One case was dropped because he did not complete the desired follow up. Seizure type and frequency were recorded and follow up was done at 4, 8, 12, 18 and 24 weeks after initiation of therapy. The change in seizure severity, the dose of Clobazam required and development of side effects were recorded. RESULTS: The seizure types included GTCS (n=16), complex partial seizures (n=4), focal motor seizures with secondary generalisation (n=3) and juvenile myoclonic epilepsy (n=2). Out of 25 patients, 16 (64%) became seizure free, while five (20%) had >50% reduction in their seizure frequency. Thus, these 21 patients (84%) were considered to be well controlled. The commonest side effect seen was sedation, which was noted in 4 of the 25 patients (16%). However, in none of these four patients sedation was significant enough to warrant stoppage of therapy. Weight gain, gait ataxia, loss of short-term memory and breakthrough seizures were noted in one patient each. CONCLUSIONS: The efficacy of Clobazam coupled with the lack of significant side effects noted in our study makes it merit consideration as monotherapy in adult patients with epilepsy.