Sacrocolpopexy: Surgical Technique,Outcomes, and Complications

Purpose of Review

Pelvic organ prolapse is a non-life-threatening condition that has a wide variety of symptoms. Sacrocolpopexy has been the “gold standard” for management of apical pelvic organ prolapse with reported high success rates for anatomic correction. Herein, we review the surgical procedure, anatomic, and functional outcomes, as well as the intraoperative and postoperative complications.

Recent Findings

Findings suggest that the ASC has an acceptably low overall complication rate comparable between open and minimally invasive approach. Mesh extrusion and anatomic failure have been shown to increase over time.

Summary

Patient education and counseling are important preoperatively. It is important to discuss with the patient risks of the surgical procedure, specifically mesh-related extrusion, longer term anatomic recurrence rates, rates of functional improvement, or worsening of bladder and bowel symptoms, as well as rates of dyspareunia.

     

A 22-nucleotide spliced leader sequence in the human parasitic nematode Brugia malayi is identical to the trans-spliced leader exon in Caenorhabditis elegans.

The mRNAs encoding a 63-kDa antigen in the human parasitic nematode Brugia Malayi contain a spliced leader sequence of 22 nucleotides (nt) that is identical to the trans-spliced leader found on certain actin mRNAs in the distantly related nematode Caenorhabditis elegans. The 22-nt sequence does not appear to be encoded near the 63-kDa genes but is present in multiple copies in several locations within the parasite genome, including the 5S rRNA gene repeat. The 5S-linked copies of the 22-nt sequence are transcribed to yield a 109-nt nonpolyadenylated RNA with the 22-nt leader sequence at its 5' end. We suggest that the 22-nt leader is acquired by 63-kDa antigen mRNAs through trans-splicing. These results indicate that trans-splicing is widespread in nematodes and argue for the functional significance of the 22-nt spliced leader exon in nematode mRNA metabolism.     

Cellular proliferation in female pelvic organ prolapse: a pilot study

Purpose  

To assess cell proliferation in pelvic organ prolapse (POP).     

Morphological plasticity of dendrites in adult brain

Deafferentation of certain brain regions in adult animals results in (1) the disappearance of degenerating axon terminals and (2) in the temporary persistence of vacant postsynaptic sites. These postsynaptic sites were shown to be re-supplied by sprouted axon terminals of intact axons. It is described in this paper, that in brain regions (e.g. cerebellar cortex, lateral geniculate nucleus) where axonal sprouting of local elements or of persisting afferent axons is negligible or absent, synaptic reorganization occurs via the active participation of postsynaptic dendritic and somatic elements of surviving local nerve cells. The dendrites may develop two types of reaction upon deafferentation (1) formation of presynaptic specializations along their otherwise "classical" postsynaptic membrane, resulting in the formation of new, dendro-dendritic synapses and (2) the "adaptive" (structural) reduction in size of denervated nerve cell dendritic arbor, leading to a relative increase in density of the surviving (though non-sprouting) afferent axon terminals. A partial functional recovery in both cases is also demonstrated.     

HLA-DR and H-2E transgenes differentially mediate TCR-specific positive selection

The use of HLA transgenic mice in models of immunity and diseaseassumes that human MHC molecules are able to contribute towardthe positive selection of the mouse TCR repertoire. As an initialstep towards analysis of this we have compared the relativeability of DR/Eß or E/Eß complexes to induceT cell receptor (TCR) positive selection in H-2Ea and HLA-DRAtransgenic mice lacking endogenous E. The results show that,like E/Eß, the hybrid DR/ß complexes arecapable of mediating positive selection of V_ß2⁺;,V_ß6⁺, and V_ß10⁺ cells. However, differenceswere found between the effects of the two transgenes. Thus,while V_ß6⁺ cells were efficiently selected in bothH-2Ea and DRA transgenic mice, positive selection of V_ß10⁺cells was less apparent in the DRA transgenic mice. Variationbetween Ea and DRA transgenic mice is consistent with the notionthat this process is dependent on differential binding of endogenouspeptides to the E/Eß and DR/Eß complexes.Furthermore, contrary to expectations, in neither set of micewas positive selection limited solely to the CD4⁺ subset. Thus,examples were found in which V_ß-specific positiveselection was confined to either the CD4⁺ or CD8⁺ subsets, andothers in which both subpopulations were concomltantly increased.In the case of V_ß2 positive selection, H-2Ea transgenicmice showed expansion of these cells in both the CD4⁺ and CD8⁺subpopulations whlle in DRA transgenic mice this occurred predominantlyin the CD8⁺ subpopulatlon.     

Nitrate-induced coronary vasodilation by stress-magnetic resonance imaging: a novel noninvasive test of coronary vasomotion

PURPOSE: To evaluate the feasibility of assessing coronary vasodilation following exogenous nitrates, using magnetic resonance angiography (MRA). The assessment of coronary response to exogenous nitrovasodilators may have a diagnostic and prognostic impact in patients with coronary artery disease. To date, stress imaging of coronary artery vasomotion has been confined to the catheterization laboratory. MRA is emerging as a noninvasive tool for coronary artery imaging. MATERIALS AND METHODS: Coronary MRA was performed in 20 healthy volunteers (12 males, age = 33 +/- 8). We used spiral spoiled gradient echo (SSGE) sequences for imaging of coronary artery lumen. After the baseline short-axis view of the coronary artery was obtained, sublingual nitroglycerin (NTG) (0.3 mg) was administered. In all subjects, short-axis views of the coronary artery were acquired repetitively (8-10 times) from 1 up to 10 minutes after NTG administration. Measurements were obtained by two independent investigators. RESULTS: Interpretable short-axis view of left anterior descending artery (LAD) was obtained in 15 subjects (75%); in the remaining five subjects the right coronary artery (RCA) was examined. The interobserver variability was 15%, and the intraobserver variability 4%. The NTG-induced maximal vasodilation was 43 +/- 22%. The vasodilator response over time after NTG was maximal on average at 279 +/- 112 seconds, but with substantial heterogeneity. CONCLUSION: Entity and time course of nitrate-induced coronary vasodilation in the left anterior descending and/or RCA can be assessed using MRA with high feasibility and reproducibility. Coronary MRA has potential for dynamic imaging of coronary vasomotion.     

The p150,95 molecule is a marker of human mononuclear phagocytes: comparison with expression of class II molecules

A new monoclonal antibody (mAb), named 3.9, is described that is specific for the p150,95 molecule, a member of the LFA-1, CR3, p150,95 family of human leukocyte differentiation antigens. The LFA-1 molecule participates in a variety of T cell interactions and the CR3 molecule is the receptor for the complement component iC3b, but little is known about the p150,95 molecule. Here we show that the expression of p150,95 is confined to myeloid cells. mAb 3.9 reacts variably with neutrophils, more strongly with monocytes and is most strongly expressed on tissue macrophages. Using this mAb and others, we have examined the heterogeneity of tissue macrophages. Cells such as Langerhans' cells, dendritic reticulum cells and osteoclasts failed to react with these mAb and thus, probably do not belong to the mononuclear phagocyte lineage. Using a new double-labeling technique, we investigated lymphoid tissue for dendritic cells bearing class II molecules which might function in interactions with T cells. In T cell areas macrophages expressing class II markers were seen but there was no evidence for other types of dendritic or interdigitating cells which expressed class II molecules but not macrophage epitopes. The conclusion from this survey was that the most prominent cell with dendritic morphology found in the T cell areas of lymphoid tissue was a macrophage.