AIm: Supplementing anterior cervical diskectomy and fusion (ACDF) with plates enhances stabilization, increases fusion and reduces failure rates. Zero-P implant for stand-alone anterior interbody fusion procedures of the cervical spine was recently developed to avoid complications associated with anterior cervical plates. We evaluate the outcome of its use in our patients undergoing ACDF. mATeRIAL and meTHods: 84 patients were selected to undergo ACDF with Zero-P implant of whom 75 (52 male and 23 female) were followed up for 12 to 16 months (mean 14.2 months) with a total of 94 operated levels (54 single, 21 double level). Patients underwent pre-and postoperative clinical evaluation with full neurological examination, visual analogue scale (VAS), Neck Pain and Disability Scale (NPAD) and Bazaz-Yoo dysphagia index for postoperative dysphagia. Postoperative plain X-ray evaluation of fusion and implant-associated complications was done.ResuLTs: All patients had significant reduction in arm and neck pain and NPAD maintained over 12 months, no implant-associated complications during follow-up, and radiological fusion by 3 months. None had dysphagia after 3 months postoperatively. CoNCLusIoN:The Zero-P implant is a valid alternative to anterior cervical plating after ACDF with a very low incidence of postoperative dysphagia and no implant-related complications.KeywoRds: Anterior, Cervical, Diskectomy, Zero-profile, Plate, Dysphagia ÖZ AmAÇ: Anterior servikal diskektomi ve füzyonu (ACDF) plakalarla desteklemek stabilizasyonu güçlendirir, füzyonu arttırır ve başarısızlık oranını azaltır. Anterior servikal plakalarla ilişkili komplikasyonlardan kaçınmak üzere yakın zamanda servikal omurganın tek başına anterior interbody füzyon işlemleri için Zero-P implantı geliştirilmiştir. ACDF yapılan hastalarımızda bu implantın kullanılmasının sonuçlarını değerlendirdik. BuLGuLAR: Tüm hastalarda 12 ay boyunca devam edecek şekilde kol ve boyun ağrısı ve NPAD bakımından önemli azalma oldu, takip boyunca implantla ilişkili komplikasyon görülmedi ve 3 ay içinde radyolojik füzyon gerçekleşti. Ameliyattan 3 ay sonra hiçbirinde disfaji yoktu.soNuÇ: Zero-P implantı ACDF sonrasında servikal plakalama için geçerli bir alternatiftir ve postoperatif disfaji insidansı çok düşük olup implantla ilişkili bir komplikasyon görülmemiştir.

BackgroundBelly dancer’s dyskinesia is an extremely rare condition. It manifests as semicontinuous, slow, writhing, sinuous abdominal wall movements that are bothersome to the patient. Management of this condition is extremely difficult and challenging.MethodsWe describe four patients with belly dancer’s dyskinesia who were treated with Botulinum Toxin A (BTX) injections under ultrasound guidance.ResultsAll patients underwent the same BTX injection procedure using an aseptic technique under ultrasound guidance. The patients responded well to the BTX injections after an unsatisfactory course of medical treatment. The patients reported complete abolishment of abnormal abdominal movements with no side effects.ConclusionsWe report a cohort of patients with belly dancer dyskinesia treated successfully with BTX injections. Ultrasound guidance for injections increases the accuracy and reduces the risk of the complications. BTX injection under ultrasound guidance is a safe and effective treatment modality that should be employed as a first-line in the management of patients with belly dancer’s dyskinesia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-016-0746-5) contains supplementary material, which is available to authorized users.

Triplet and higher-order multiple pregnancies can carry increased fetal and maternal complications. Reports of triplet pregnancies after kidney transplant are scarce and have been associated with perinatal complications. Presence of diabetes in such cases worsens both fetal and maternal outcomes. Here, we present a triplet pregnancy in a kidney transplant recipient with diabetes. We also reviewed the literature for causes, prevalence, and outcomes in association with chronic kidney disease, kidney transplant, and diabetes mellitus. The patient, a 31-year-female who received a living-donor kidney transplant, had a firsttime pregnancy 6 years after transplant. Pregnancy was complicated by gestational diabetes, preeclampsia, and miscarriage. She continued to have postpartumimpaired glucose tolerance. She became pregnant again after 6 months but required insulin therapy during her third trimester. Pregnancy was terminated by cesarean section for a viable small boy. Two years later, she had triplet pregnancy after ovulation induction with clomiphene. Glycemic control was maintained using intensive insulin therapy guided by frequent home blood glucose monitoring (HbA1c was 5.8% at 22 wk). Both gynecologic care and nephrologic care were carried out through outpatient follow-up. Pregnancy was complicated by hypertension and mild renal dysfunction without proteinuria and ended in elective premature cesarean section at 32 weeks of gestation. She had 3 male babies with low birth weights (1320, 1380, 1275 g), with the largest baby developing sepsis and requiring an intensive care unit stay and then incubator for 49 days. The other 2 required incubators for 36 days. Their weights after 22 months were 9, 16, and 11 kg. The mother is now normotensive with normal renal function and impaired glucose tolerance. Care of diabetic kidney recipients with triplet pregnancy constitutes a special challenge requiring a multispecialty skilled team to ensure the best outcome.

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