Labetalol is better tolerated than methyldopa, gives more efficient control of blood pressure and may have a ripening effect on the uterine cervix.

We report a 27-year-old XY female who presented with abdominal pain due to hemoperitoneum from a ruptured abdominal mass. Gonadoblastoma overgrown by endodermal sinus tumor and dysgerminoma was detected. The risk of neoplasia in such cases is discussed.

Purpose We aimed to assess the efficacy and safety of flow-diverter stents (FDs) in the management of posterior circulation cerebral aneurysms and compare FD efficacy between anterior and posterior circulation aneurysms. Methods We searched the PubMed, Scopus, Cochrane, and Web of Science databases for relevant studies through March 2020. Studies assessing FDs for posterior circulation aneurysms that included ≥20 treated aneurysms were included. Moreover, the studies compared FD efficacy between anterior and posterior circulation aneurysms were included. Data regarding angiographic aneurysmal occlusion, procedural complications, mortality, and morbidity were extracted and pooled in a random-effects meta-analysis model. Results Fourteen studies with a total of 659 patients and 676 posterior circulation aneurysms were included. The pooled rate of aneurysmal occlusion at long-term angiographic follow-up was 78% [95% confidence interval (CI), 71–85]. The pooled rates of intraparenchymal hemorrhage, ischemia, and procedure-related mortality and neurological morbidity were 2%, 8%, 7%, and 6%, respectively. Complete occlusion occurred in 82.4% of the posterior circulation aneurysm subgroup and 77.5% of the anterior circulation aneurysm subgroup. The difference was not significant (relative risk 1.01; 95% CI, 0.86–1.19; p = 0.91). Regression analysis showed that elderly patients and females had higher morbidity. Conclusion Posterior circulation aneurysms can be effectively treated with FDs with comparable occlusion rates to those in anterior circulation aneurysms. However, periprocedural complications are not negligible.

Objective: To evaluate the association of gene polymorphisms of the SNP of TNF-α gene -238G>A and IL-18 gene-607C>A with the development of hepatocellular carcinoma among Egyptian patients. Methods: One hundred and fifty patients were allocated to this study; eighty patients with hepatocellular carcinoma (Group A), seventy cancer-free HCV age, and sex-matched patients (Group B). We analyzed two Single nucleotide polymorphisms (SNPs) (TNF-α-238G>A and IL-18-607C>A) by real-time polymerase chain reaction using sequence-specific primers (PCR-SSP). Results: Significant higher risk of HCC was associated with genotype IL-18-607AA (P<0.001), OR: 5(2.188-11.47), allele IL-18 -607⁄A (P=0.001), OR: 2.1(1.32-3.3). A significant association was found between the size of HFL in the HCC group and different genotypes of IL18 genes (P=0.013) where 62.5% of patients with tumor size >5 cm carried the risky (AA) genotype on the other hand the SNP of TNF-α gene -238G>A showed no statistically significant association between the two groups. Conclusion: The SNP -607C>A in the IL18 gene was associated with increased HCC risk in Egyptian patients suggesting its use as a potential diagnostic non-invasive tool that allows to identify a new group of HCC patients at an earlier stage.

Background: Meningomyelocele reconstruction is a lifesaving procedure. A freestyle propeller perforator flap is an ideal option for moderate to large soft tissue meningomyelocele reconstruction. Previous studies that focused on the reliability of perforator flaps for meningomyelocele reconstruction recommended preserving a cuff of soft tissue around the perforators to avoid vasospasm. This method is a very conservative approach in comparison to the recently well-established principles of pedicled perforator flap dissection. In this study, we used a dissection ladder approach. In this method, the pedicle is freed by just islanding the pedicle, skeletonization of the perforator, or further dissection of the perforators beyond the muscles, based on intraoperatively monitoring of the flap. Materials and Methods: Thirty-six infants with a mean age of 2.1 ± 1.1 months underwent surgery for dorsolumbar meningomyelocele at Assuit University Hospital for 3 years. During surgery, the freestyle perforator flap followed a dissection ladder for perforating vessels and intraoperative flap monitoring. Flap viability, seroma, hematoma, and cerebrospinal fluid leakage were evaluated. Results: Nine cases required perforator skeletonization, 4 cases required dissection beyond the muscle, and 23 cases required islanding the flap on the perforators. The average operative time was 43.37 ± 7.87 minutes. Partial tip ischemia was detected in 2 cases. These cases exhibited partial dehiscence and healed by secondary intention. Complete flap loss did not occur in any cases. Conclusions: A conservative approach for perforator flap elevation in infants did not provide optimal results in all cases of thoracolumbar meningomyelocele reconstructions. Well-established principles of perforator dissection, including skeletonization and dissection beyond the muscle, are safe, prevent vasospasms, and improve flap viability.