The Transorbital Approach: A Comprehensive Review of Targets, Surgical Techniques, and Multiportal Variants

The transorbital approach (TOA) is gaining popularity in skull base surgery scenarios. This approach represents a valuable surgical corridor to access various compartments and safely address several intracranial pathologies, both intradurally and extradurally, including tumors of the olfactory groove in the anterior cranial fossa (ACF), cavernous sinus in the middle cranial fossa (MCF), and the cerebellopontine angle in the posterior cranial fossa (PCF). The TOA exists in many variants, both from the point of view of invasiveness and from that of the entry point to the orbit, corresponding to the four orbital quadrants: the superior eyelid crease (SLC), the precaruncular (PC), the lateral retrocanthal (LRC), and the preseptal lower eyelid (PS). Moreover, multiportal variants, consisting of the combination of the transorbital approach with others, exist and are relevant to reach peculiar surgical territories. The significance of the TOA in neurosurgery, coupled with the dearth of thorough studies assessing its various applications and adaptations, underscores the necessity for this research. This extensive review delineates the multitude of target lesions reachable through the transorbital route, categorizing them based on surgical complexity. Furthermore, it provides an overview of the different transorbital variations, both standalone and in conjunction with other techniques. By offering a comprehensive understanding, this study aims to enhance awareness and knowledge regarding the current utility of the transorbital approach in neurosurgery. Additionally, it aims to steer future investigations toward deeper exploration, refinement, and exploration of additional perspectives concerning this surgical method.

Bilateral or unilateral tubo-ovarian abscess: exploring its clinical significance

OBJECTIVES

To assess the characteristics of patients with unilateral and bilateral tubo-ovarian abscess (TOA).

METHODS

Women diagnosed with TOA during 2003-2017 were included in this retrospective cohort study. TOA was diagnosed using sonography or computerized tomography and clinical criteria, or by surgical diagnosis. Demographics, sonographic data, clinical treatment, surgical treatment, and post-operative information were retrieved.

RESULTS

The study cohort included 144 women who met the inclusion criteria, of whom 78 (54.2%) had unilateral TOA and 66 (45.8%) had bilateral TOA. Baseline characteristics were not different between the groups. There was a statistical trend that women with fewer events of previous PID were less likely to have with bilateral TOA (75.3% vs. 64.1%, respectively; p = 0.074). Women diagnosed with bilateral TOA were more likely to undergo surgical treratment for bilateral salpingo-oophorectomy compared to unilateral TOA (61.5% vs. 42.3%, respectively; p = 0.04). There was no difference in maximum TOA size between groups.

CONCLUSIONS

This study detected a trend toward increased need for surgical treatment in women diagnosed with bilateral TOA. These findings may contribute to determining the optimal medical or surgical treatment, potentially leading to a decrease in the duration of hospitalization, antibiotic exposure, and resistance. However, it is important to acknowledge that the results of the current study are limited, and further research is warranted to validate these potential outcomes.

The role of systemic immune inflammation index in predicting treatment success in tuboovarian abscesses

PURPOSE

The aim of this study was to determine the predictability of the systemic immune inflammation index (SII) on the response to medical treatment in tubo-ovarian abscess (TOA).

METHODS

296 patients with TOA in a tertiary center were enrolled in the study. Patients were divided into two groups: Group1 (n  =  165) included patients in whom medical treatment was successful, and Group2 (n  =  131) included patients in whom surgery was required. Demographic, sonographic and laboratory findings were compared between groups. SII was calculated using peripheral blood parameters [SII  =  (platelets ∗ neutrophils)/lymphocytes].

RESULTS

Age, BMI, gravida, parity, smoking and menopausal status, CRP levels of patients were similar in both groups (p  >  0.05). Mass size (4.398 ± 0.306 vs 7.683 ± 0.689, p  <  0.001), white blood cell (WBC) (8685.08 ± 3981.98 vs 9994.35 ± 4468.024, p = 0.008), Hb (12.18 ± 1.65 vs 11.68 ± 1.65, p = 0.010), platelet to lymphocyte ratio (PLR) (151.26 ± 74.83 vs 230.77 ± 140.25, p < 0.001), neutrophil to lymphocyte ratio (NLR) (4.21 ± 3.27 vs 6.07 ± 6.6, p  =  0.003), monocyte to lymphocyte ratio (MLR) (0.300 ± 0.177 vs 0.346 ± 0.203, p = 0.041) and SII (1014.18 ± 781.71 vs 2094.088 ± 2117.58, p < 0.001) were statistically higher in group 2. ROC Analysis was used to determine the predictability of the variables and PLR (AUC = 0.718, p  <  0.001), NLR (AUC = 0.593, p  =  0.593), MLR (AUC = 0.576, p  =  0.024), SII (AUC  =  0.723, p  <  0.001) and size of mass (AUC = 0.670, p  <  0.001) were found to be significant. The SII, size of mass and bilateral involvement of adnexa were found to be the strongest prognostic factors for surgical intervention (OR:1.004 (1.002-1.005), OR:1.018 (1.010-1.027), OR:3.397 (1.338-8.627); p  <  0.001, p  <  0.001, p  =  0.010 resspectively).

CONCLUSION

SII, size of mass and bilaterality can be used to predict medical treatment success in patients with TOA.

Underwater Wireless Sensor Networks with RSSI-Based Advanced Efficiency-Driven Localization and Unprecedented Accuracy

Deep-sea object localization by underwater acoustic sensor networks is a current research topic in the field of underwater communication and navigation. To find a deep-sea object using underwater wireless sensor networks (UWSNs), the sensors must first detect the signals sent by the object. The sensor readings are then used to approximate the object's position. A lot of parameters influence localization accuracy, including the number and location of sensors, the quality of received signals, and the algorithm used for localization. To determine position, the angle of arrival (AOA), time difference of arrival (TDoA), and received signal strength indicator (RSSI) are used. The UWSN requires precise and efficient localization algorithms because of the changing underwater environment. Time and position are required for sensor data, especially if the sensor is aware of its surroundings. This study describes a critical localization strategy for accomplishing this goal. Using beacon nodes, arrival distance validates sensor localization. We account for the fact that sensor nodes are not in perfect temporal sync and that sound speed changes based on the medium (water, air, etc.) in this section. Our simulations show that our system can achieve high localization accuracy by accounting for temporal synchronisation, measuring mean localization errors, and forecasting their variation. The suggested system localization has a lower mean estimation error (MEE) while using RSSI. This suggests that measurements based on RSSI provide more precision and accuracy during localization.

Liquid-liquid extraction of No-carrier-added 129Cs with various extractants

Two different iodide targets, BiI₃ and KI were irradiated by α-particles to produce ¹²⁹Cs via ¹²⁷I(α, 2n)¹²⁹Cs reaction. ¹²⁹Cs was separated from bulk Bi (when BiI₃ was used as target) by anion exchanger TOA dissolved in cyclohexane. Irradiation of KI with alpha particle produced ¹²⁹Cs along with minute amount ^44mSc. ^44mSc was successfully separated from ¹²⁹Cs using 18-crown 6 ether dissolved in nitrobenzene.

Ovarian Clear Cell Carcinoma and Rectal Adenocarcinoma Detected by Tubo-Ovarian Abscess: A Case Report

Most cases of tubo-ovarian abscess (TOA) are due to transvaginal infection, while other internal diseases may also be associated with TOAs. We experienced a case of ovarian clear cell carcinoma and rectal carcinoma that was discovered to be a result of TOA. A 46-year-old woman was diagnosed with TOA and referred to our hospital. Laparoscopic abscess drainage was performed, and pathological findings confirmed the presence of ovarian clear cell carcinoma inside the abscess. The tumor marker carcinoembryonic antigen (CEA) was elevated, and rectal cancer was diagnosed by a gastrointestinal endoscopy. Abdominal computed tomography (CT) showed a left adnexal abscess with an air image inside, and penetration of the abscess wall and rectal cancer were observed. Histopathologically, there was an accumulation of neutrophils around the rectal tumor cells. We concluded that the rectal cancer had penetrated the existing ovarian tumor and formed TOA. Non-gynecological diseases may be associated with TOA. It is necessary to consider the possibility that other clinical diseases may be associated with the trigger of TOA.

Late Occurrence of the Tubo-Ovarian Abscess after Appendectomy for Perforated Appendicitis in a Virginal Adolescent Girl

BACKGROUND

Tubo-ovarian abscess (TOA) is generally seen in sexually active women. It is rarely reported in virginal adolescent girls.

CASE

A 12-year-old virginal girl was referred to us for repeated fever and right lower abdominal pain. She had undergone an appendectomy for a perforated appendix with abscess 5 years previously. Laparoscopic surgery revealed pelvic adhesions associated with TOA in the right pelvis. At 2 months after laparoscopic drainage, she underwent resection of the affected tube with wedge resection of the ipsilateral ovary due to the recurrence of TOA.

SUMMARY AND CONCLUSION

Late occurrence of TOA should be considered in the differential diagnosis of repeated abdominal pain and fever in virginal adolescent girls with a history of appendectomy for complicated appendicitis, even if the history is remote.

A case-report on diverticulitis misdiagnosed as tubo-ovarian abscess

Introduction and importance

Tubo-ovarian abscesses (TOA) is presented with multiple clinical manifestations including gastrointestinal findings.

Case presentation

Herein, we present a case of complicated diverticulitis that was misdiagnosed as TOA, owing to overlapping genital involvement.

Clinical discussion

Imaging could be misleading in these patients as a result of severe inflammation of intestines and surrounding organs.

Conclusion

Patients who do not respond to antibiotic treatment should be suspected of other gastrointestinal pathologies such as diverticulitis and should be evaluated accordingly.

•

Concomitant presentation of diverticulitis and Tubo-ovarian abscesses (TOA) has been rarely reported.

•

Diverticulitis can also be complicated, indicated by the involvement of other organs such as ovaries and fallopian tube.

•

In such cases, pathological evaluation, following the surgical intervention can indicate the exact disease.

Separation of 206Po from alpha particle irradiated lead bismuth eutectic target

Lead bismuth eutectic (LBE) target was bombarded with 46 MeV α-particle. Possibility of separation of no-carrier-added (NCA) polonium radioisotopes from the bulk lead-bismuth eutectic target was explored. Differential precipitation showed presence of Po with bulk Bi, leaving behind bulk Pb in aqueous medium. NCA ²⁰⁶Po radioisotope was then separated from bulk Bi using trioctylamine (TOA) as the extractant. At best condition of 0.01 M TOA+0.1 M HCl, highest separation factor (>500) was achieved between NCA Po and bulk Bi.

The effect of intrauterine device presence and other factors in medical treatment success of tuboovarian abscess

BACKGROUND

To identify the epidemiologic and clinical risk factors associated with failed response to medical treatment in tuboovarian abscess (TOA) patients and whether there is a relationship between the presence of intrauterine device (IUD), duration of use and medical treatment success or not.

METHODS

For this study, the medical records of patients diagnosed with TOA and hospitalized in an 8-year period were analyzed retrospectively. The presence of TOA and IUD was confirmed ultrasonographically in all patients. Parenteral antibiotic treatment was initiated as the first step. Patients who did not improve with this medical treatment underwent surgery. Patients who recovered with medical treatment were defined as the successful group, while those who underwent surgery after medical treatment failure were recorded as the failed group.

RESULTS

There were 37 patients in successful group and 87 patients in failed group. The mean age, parity, white blood count, TOA size, duration of IUD use, rate of multigravida and multiparity were higher in the failed group. Logistic regression analysis revealed that presence of multiparity, TOA size and the duration of IUD use were significant independent factors in predicting medical treatment success of TOA. The best cut-off value for TOA size was 4.5 cm and for duration of IUD use was 5.5 years in the Receiver Operating Characteristic curve analysis.

CONCLUSION

The presence of long-term IUD use, increased TOA size, and multiparity were found to be risk factors related to the failure of medical treatment in TOA cases.

Clinical and demographic characteristics of adenomatoid odontogenic tumors: analysis of 116 new cases from a single center

Introduction

The adenomatoid odontogenic tumor is a relatively uncommon odontogenic neoplasm representing about 4.7% of all odontogenic tumors.

Objective

The aim of this study was to determine the demographic and clinical profile of the adenomatoid odontogenic tumors in a Sri Lankan population.

Methods

Data gathered from the cases received for a period of 38 years from the Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya. Request forms, biopsy reports and electronic data base of the department were used to obtain relevant information. Demographic data including age, gender and location of the tumor were included in the analysis.

Results

Out of 116 cases of adenomatoid odontogenic tumor, the mean age was 21.02 ± 11.24. It occurs more fre quently in the second decade of life, more prevalent in females, most often associated with the maxilla, predominantly affecting anterior jaw bones and presenting mostly in the right side of the jaw bone. The results from the present study showed the statistically significant relationship with site of occurrence (maxilla/mandible) and age (p < 0.005). Further, depending on whether it occurs in anterior/mid/posterior site also showed a significant relationship with age (p ≤ 0.001). However, side of occurrence, left or right or site of occurrence, showed no statistically significance with age (p > 0.05).

Conclusion

Adenomatoid odontogenic tumor occurs more frequently in the second decade of life with a significant female predominance and the commonest site is anterior maxilla. This study revealed few differences on demographic and clinical presentations of adenomatoid odontogenic tumor from some regions of the world.

Mobile Synchronization Recovery for Ultrasonic Indoor Positioning

The growing interest for indoor position-based applications and services, as well as ubiquitous computing and location aware information, have led to increasing efforts toward the development of positioning techniques. Many applications require accurate positioning or tracking of people and assets inside buildings, and some market sectors are waiting for such technologies for starting a fast growth. Ultrasonic systems have already been shown to possess the desired positioning accuracy and refresh rate. However, they still require accurate synchronization between ultrasound emitters and receivers to work properly. Usually, synchronization is carried out through radio frequency (RF) signals, adding system complexity and raising the cost. In this work, this limit is overcome by introducing a novel self-synchronizing indoor positioning technique. Ultrasonic signals travel from emitters placed at fixed reference positions to any number of mobile devices (MD). The travelled distance is computed from the time of flight (TOF), which requires in turn synchronism between emitter and receiver. It is shown that this synchronism can be indirectly estimated from the time difference of arrival (TDOA) of the ultrasonic signals. The obtained positioning information is private, in the sense that the positioning infrastructure is not aware of the number or identity of the MDs that use it. Computer simulations and experimental results obtained in a typical office room are provided.

Wireless localization for mmWave networks in urban environments

Millimeter wave (mmWave) technology is expected to be a major component of 5G wireless networks. Ultra-wide bandwidths of mmWave signals and the possibility of utilizing large number of antennas at the transmitter and the receiver allow accurate identification of multipath components in temporal and angular domains, making mmWave systems advantageous for localization applications. In this paper, we analyze the performance of a two-step mmWave localization approach that can utilize time-of-arrival, angle-of-arrival, and angle-of-departure from multiple nodes in an urban environment with both line-of-sight (LOS) and non-LOS (NLOS) links. Networks with/without radio-environmental mapping (REM) are considered, where a network with REM is able to localize nearby scatterers. Estimation of a UE location is challenging due to large numbers of local optima in the likelihood function. To address this problem, a gradient-assisted particle filter (GAPF) estimator is proposed to accurately estimate a user equipment (UE) location as well as the locations of nearby scatterers. Monte-Carlo simulations show that the GAPF estimator performance matches the Cramer-Rao bound (CRB). The estimator is also used to create a REM. It is seen that significant localization gains can be achieved by increasing beam directionality or by utilizing REM.

Entropy-Based TOA Estimation and SVM-Based Ranging Error Mitigation in UWB Ranging Systems

The major challenges for Ultra-wide Band (UWB) indoor ranging systems are the dense multipath and non-line-of-sight (NLOS) problems of the indoor environment. To precisely estimate the time of arrival (TOA) of the first path (FP) in such a poor environment, a novel approach of entropy-based TOA estimation and support vector machine (SVM) regression-based ranging error mitigation is proposed in this paper. The proposed method can estimate the TOA precisely by measuring the randomness of the received signals and mitigate the ranging error without the recognition of the channel conditions. The entropy is used to measure the randomness of the received signals and the FP can be determined by the decision of the sample which is followed by a great entropy decrease. The SVM regression is employed to perform the ranging-error mitigation by the modeling of the regressor between the characteristics of received signals and the ranging error. The presented numerical simulation results show that the proposed approach achieves significant performance improvements in the CM1 to CM4 channels of the IEEE 802.15.4a standard, as compared to conventional approaches.

A hybrid TOA-fingerprinting based localization of mobile nodes using UWB signaling for Non-line-of-sight conditions

Recently, Impulse Radio Ultra Wideband (IR-UWB) signaling has become popular for providing precise location accuracy for mobile and wireless sensor node localization in the indoor environment due to its large bandwidth and high time resolution while providing ultra-high transmission capacity. However, the Non-line-of-sight (NLOS) error mitigation has considerable importance in localization of wireless nodes. In order to mitigate NLOS errors in indoor localization this paper proposes and investigates a novel approach which creates a hybrid combination of channel impulse response (CIR)-based fingerprinting (FP) positioning and an iterative Time of Arrival (TOA) real time positioning method using Ultra Wideband (UWB) signaling. Besides, to reduce the calculation complexities in FP method, this paper also introduces a unique idea for the arrangement of reference nodes (or tags) to create a fingerprinting database. The simulation results confirm that the proposed hybrid method yields better positioning accuracies and is much more robust in NLOS error mitigation than TOA only and FP only and a conventional iterative positioning method.

Using ASTER Imagery in Land Use/cover Classification of Eastern Mediterranean Landscapes According to CORINE Land Cover Project

The satellite imagery has been effectively utilized for classifying land cover types and detecting land cover conditions. The Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) sensor imagery has been widely used in classification process of land cover. However, atmospheric corrections have to be made by preprocessing satellite sensor imagery since the electromagnetic radiation signals received by the satellite sensors can be scattered and absorbed by the atmospheric gases and aerosols. In this study, an ASTER sensor imagery, which was converted into top-of-atmosphere reflectance (TOA), was used to classify the land use/cover types, according to COoRdination of INformation on the Environment (CORINE) land cover nomenclature, for an area representing the heterogonous characteristics of eastern Mediterranean regions in Kahramanmaras, Turkey. The results indicated that using the surface reflectance data of ASTER sensor imagery can provide accurate (i.e. overall accuracy and kappa values of 83.2% and 0.79, respectively) and low-cost cover mapping as a part of inventory for CORINE Land Cover Project.