Prolene mesh migration into the rectum after sacral colpopexy presented with frozen pelvis

INTRODUCTIONPelvic organ prolapse (POP) is a common gynecological problem. Repair with synthetic materials such as prolene mesh has become a popular approach in prolapsus surgery. Migration of synthetic materials can cause serious complications.PRESENTATION OF CASEA 69-year-old woman was admitted to the hospital with a complaint of sensation of fullness and a feeling of a foreign material protruding during defecation. The patient underwent exploratory laparotomy. Prolene mesh was detected in sacral region but resection of the mesh could not be conducted because of dense adhesions causing frozen pelvis. The migrated prolene mesh was resected transanally.DISCUSSIONGenital prolapse or genital hernia is described as the protrusion of pelvic organs along the vagina. It is one of the common gynecological conditions that affect the quality of life in women. Mesh migration is a well-known clinical pathology.CONCLUSIONMesh migration is a serious complication after sacral colpopexy. Surgical resection of migrated mesh can be difficult due to dense adhesions.     

Acute and long-term outcomes of catheter ablation using remote magnetic navigation in patients with congenital heart disease

The aim of the present study was to assess the feasibility, safety, and long-term results of remote magnetic navigation in arrhythmias associated with complex congenital heart disease (CHD). The improved outcomes for CHD resulted in an increased number of complex arrhythmias requiring distinctive ablation techniques. Thirty-six patients with CHD (age 35 ± 19 years, 21 male) were divided into 3 complexity groups and underwent 43 radiofrequency catheter ablation procedures using the magnetic navigation system (including 7 redo ablations) in combination with the CARTO RMT system. A total of 59 tachyarrhythmias were identified. Most patients had surgical scar-related tachycardia (25 focal, including 4 microreentrant atrial tachycardia, and 27 macroreentrant atrial tachycardia). Four accessory pathways and three ventricular tachycardias were diagnosed and treated. In 31 patients, ablation was successful, with an end point of noninducibility (86%). The success rate for CHD complexity of type I, II, and III was 50%, 88%, and 89%, respectively. The mean procedure and fluoroscopy time was 216 ± 101 minutes and 40 ± 34 minutes, respectively. The number of radiofrequency applications was 42 ± 47. No major complications related to the procedures occurred. Of the patients, 67% remained free of recurrence during a mean follow-up of 26 ± 4 months. Recurrence developed in 0%, 16%, and 45% of patients with CHD type I, II, and III, respectively. In conclusion, the magnetic navigation system is feasible to treat arrhythmias with reasonable success rates and good long-term outcomes in adult patients with CHD. The use of the magnetic navigation system offers advantages in complex anatomic situations.     

Prevalence of sacrococcygeal pilonidal sinus as a silent disease

Purpose

The aim of this research was to determine the prevalence of sacrococcygeal pilonidal sinus disease (SPSD) based on clinical examination and histopathological evaluation.

Methods

Between January 1, 2010 and December 30, 2010, 432 corpses were evaluated in the Istanbul Central Office of Forensic Medicine Institute of the Turkish Ministry of Health.

Results

41 of the 432 cases (9.4 %) had SPSD-related findings. 20 (4.6 %) had at least one sinus tract (clinical SPSD) and all of them had at least three positive histopathologic parameters. 16 of 41 cases (3.7 %) were clinically normal but had at least three positive histopathologic parameters (silent SPSD).

Conclusion

Prevalence of SPSD with clinical examination is 4.6 %. These data are according to the literature. But with inclusion of the silent cases, the prevalence rate increases to 8.3 %. We conclude that inflammatory process does not result in SPSD in nearly half of the cases.     

Safety and efficacy of the remote magnetic navigation for ablation of ventricular tachycardias—a systematic review

Objective

Remote magnetic navigation (RMN) is considered to be a solution for mapping and ablation of several arrhythmias. In this systematic review we aimed to assess the safety and efficacy of RMN in ablation of ventricular tachycardia (VT).

Methods

The National Library of Medicine??s PubMed database was searched for articles containing any of a predetermined set of search terms that were published prior to November 1, 2011. Quality of evidence was rated using the GRADE system.

Results

The database search resulted in 11 relevant articles evaluating the usefulness of RMN. Three groups of VTs were studied: VT in patients with ischemic cardiomyopathy (ICMP), non-ischemic cardiomyopathy (NICMP) and structurally normal hearts (SNH). The use of RMN in patients with ICMP has been associated with success rates ranging from 71 to 80%. RMN has been shown to be a feasible and effective method for ablation of VT in NICMP and SNH patients. Success rates between 50% and 100% have been reported in NICMP populations. Rates ranging from 86% to 100% have been reported for SNH patients. The lowest rates of arrhythmia recurrence are reported for SNH patients (0?C17%). In ICMP and NICMP, recurrence rates of 0?C30% and 14?C50%, respectively, have been reported. One patient experienced total heart block, and one patient experienced a thromboembolic event after RMN catheter ablation procedures.

Conclusions

RMN has been shown to be an effective and safe method for ablation of VT in various patient populations with low recurrence and complication rates. However, more comparative and randomized studies are necessary, and therefore the true value of RMN for VT ablation remains still unknown.     

What is new in peripartum hysterectomy? A seventeen year experience in a tertiary hospital

ObjectiveTo identify changing trends in peripartum hysterectomy (PH), both elective.cesarean hysterectomy and emergency cesarean hysterectomy, at a single training and research hospital over the last 17 years in Istanbul, Turkey.Materials and methodsA retrospective cohort study was performed between January 2001 and September 2017. The records of all patients who had PH at Kanuni Sultan Süleyman Training and Research Hospital were analyzed.ResultsThere were 243 cases of PH during the study period. A total of 266,386 births occurred, of which 60.1% were vaginal deliveries and 39.8% were cesarean sections. The incidence of PH increased from 0.67 per 1000 deliveries to 1.14 per 1000 deliveries during 2001–2008 and 2009–2017, respectively, with an overall incidence of 0.91 per 1000 deliveries during the 17 years. The main indication for PH changed significantly during this time from uterine atony (57.1%) to placenta accreta spectrum (85%). About 37% of women who underwent PH had at least one previous cesarean delivery during 2001–2008, whereas that percentage increased to 95.4% during 2009–2017.ConclusionPlacenta accreta spectrum was the leading cause of PH and was associated with significant maternal morbidity and mortality.     

Bone strains around apically free versus grafted implants in the posterior maxilla of human cadavers

The objective of this study was to compare the bone strains of apically free versus grafted implants in the posterior maxilla. The experiments were undertaken in four edentulous maxillary posterior regions of fresh human cadavers, having a minimum bone height of 8 mm. In each bone fragment, two Ø 4.1 mm × 12 mm Straumann^® implants were placed, and insertion torque values (ITV) and implant stability quotients (ISQ) of the implants were quantified to determine implant anchorage. Two splinted crowns were fabricated for each experimental model. Strain gauges were bonded on the buccal and sinus floor cortical bones around apically free and grafted implants. Microstrains were recorded by a data acquisiton system and corresponding software at a sample rate of 10 KHz under central and buccally oriented lateral–axial static loads of 100 and 150 N in separate cases. The data were compared by independent T test at a significance level set at P < 0.05. Bone tissue strains on the buccal cortical areas adjacent to apically free implants were higher than those of apically grafted implants (P < 0.05). The differences ranged between 10 and 48 με under central and lateral axial loads of 100 and 150 N. The shift in load application from central to buccally oriented lateral axial mode increased strains between 60 and 201 με on buccal cortical bone around apically free and grafted implants (P < 0.05). Bone strains around anterior implants were higher than those of posterior implants. Microstrains in the sinus floor cortical bone in apically grafted models were slightly higher than apically free models. Bone tissue strains on the buccal cortical areas adjacent to apicallyfree implants are higher than those of apically grafted implants. Sinus lifting, resulting in an enhanced apical support, slightly increases strains at the sinus floor region, but leads to a decrease in bone strains around the collar of supporting implants.     

Mycotic innominate artery aneurysm repair using a bovine pericardial bifurcation prosthesis

We report the use of a bovine pericardial bifurcation prosthesis to repair a mycotic innominate artery aneurysm.