Background and Objectives: Intraoperative evaluation of the uterus has been reported to predict risk of lymph node spread in endometrial cancer. Four criteria have been prospectively validated by the Mayo Clinic; histopathology, grade, tumor size, and depth of myometrial invasion. The objective of this study is to assess the accuracy of intraoperative evaluation in a university-affiliated teaching setting. Methods: This study was a retrospective chart review of 105 cases of endometrial cancer who underwent roboticassisted staging from January 2016 through December 2017. Results: Seventy-five cases were included. The mean age was 65 y and mean body mass index was 33 kg/m 2. Fifty-eight patients (80.6%) had no change between intraoperative and postoperative grade. This yielded a 19.4% discordance rate with a significant disagreement (P ϭ .003, Cohen's ϭ 0.705). Fifty-eight patients (82.9%) had no change in depth of invasion. This yielded a 17.1% discordance rate with a significant disagreement (P ϭ .0498, Cohen's kappa of 0.69 [95% confidence interval, 0.53-0.85]). Average tumor diameter was 3.4 cm. Seven patients (11.7%) were upsized from the low-risk (Յ2 cm) to the high-risk category (Ͼ2 cm). This led to an 11.7% discordance rate, with a significant disagreement (P ϭ .008, Cohen's kappa of 0.69 [95% confidence interval, 0.48-0.89]). In 15 of 75 cases (20%), intraoperative evaluation of the size of the tumor was not possible and deferred to the final pathology report. Conclusion: We conclude the Mayo Clinic Criteria cannot be universally adopted until all four criteria can be validated through a prospective study that includes institutions that have variable resources.

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INTRODUCTION: Bacterial meningitis is a rare, life-threatening disease with an incidence in the general population of 2.6–6 cases per 100,000 adults, and is even rarer in pregnancy. A study suggests that bacterial meningitis has an estimated mortality rate of >20% in adults. METHODS: A 27-year-old G1 at 28 weeks gestation presented with complaints of headache, fever, and difficulty speaking. Patient was reporting symptoms of otitis infection. On admission, patient's mental status declined, requiring intubation and sedation. Patient was febrile and had a leukocytosis. Lumbar puncture and blood cultures grew Streptococcus pneumonia. On admission, patient was started on broad spectrum antibiotics, which were switched to meropenem based on sensitivities. Secondary to CT evidence of increased intracranial pressure, an intracranial pressure catheter was placed. Fetal status was reassuring throughout hospitalization. Patient was intubated for 9 days before self-extubating. Patient showed clinical improvement and was discharged home after 16 days of inpatient treatment. Patient went on to deliver a full-term liveborn male neonate via normal spontaneous vaginal delivery. CONCLUSION: An observational study, showed that bacterial meningitis in pregnancy does not typically present with the typical clinical triad of fever, neck stiffness, and headache, but rather with headache (87%), altered mental status (73%), fever (60%), and signs of otitis infection (60%) [PMID 22925078]. These symptoms tend to be vague and difficult to decipher, but prompt diagnosis and treatment is crucial in maternal survival. This case report supports the most commonly associated symptoms found in patients with bacterial meningitis in pregnancy.

Background: The use of routine cystoscopy after hysterectomy is controversial.Objective: To evaluate the role of routine cystoscopy in the detection of urinary tract injuries in robotic total laparoscopic hysterectomies performed for endometrial cancer staging. Study design: This was a retrospective chart review of patients undergoing robotic-assisted laparoscopic hysterectomy for endometrial cancer staging by a single gynecologic oncologist between January 2012 and December 2015. Routine cystoscopy was performed in all cases. Results: A total of 157 cases met inclusion criteria and among those, five cases of urinary tract injury were identified (3.2%). Among the patients with urinary tract injury, average age was 66 [range 47, 90] years old, the average BMI was 34 [range 25, 34], and all patients had Stage I of endometrial cancer. Three patient injuries were detected intraoperatively, and 2 injuries were diagnosed postoperatively. Two of the intraoperative injuries were caused by dissection of the bladder from the lower uterine segment and detected prior to performing the cystoscopy. Another intraoperative injury was detected immediately after performing a mini-laparotomy to extract a larger uterus. The 2 urinary tract injury cases detected postoperatively were both ureteral injuries. The visual detection rate of the urinary tract injuries was 60% (3/5), while the cystoscopy detection rate was 0%. There were no significant differences detected in risk factors between the injury cases and the whole cohort. Conclusion: In this study, the incidence of urinary tract injury in robotic hysterectomy performed for endometrial cancer staging was 3.2%. Performing routine cystoscopy did not improve detection of urinary tract injuries in these cases.

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