ANATOMICAL AND FUNCTIONAL RESULTS OF PUBOVAGINAL SLING PROCEDURE USING POLYPROPYLENE MESH FOR THE TREATMENT OF STRESS URINARY INCONTINENCE

PURPOSE: The anatomical and functional results of pubovaginal sling procedure using polypropylene mesh were investigated. MATERIALS AND METHODS: A total of 50 women with stress urinary incontinence, including 26 with type 2, 7 with mixed type 2/3 and 17 with type 3 disease, underwent the pubovaginal sling procedure using polypropylene mesh. A self-fashioned 2 cm. polypropylene mesh sling was used in all cases. The slings were fixed without tension at each side of the bladder neck. The sling was further suspended to elevate the bladder neck in patients with type 2 disease and those with a hypermobile bladder base, while it was placed without further tension in those with type 3 disease and those with a nonmobile bladder base. After the operation video urodynamics and transrectal sonography were done to evaluate functional and anatomical results. RESULTS: At a median followup of 24 months 42 women were cured, 6 had improvement and treatment had failed in 2. Although the maximum flow rate increased, no changes were noted in detrusor pressure, post-void residual urine or cystometric capacity at month 3. Transrectal sonography revealed that mean sling width plus or minus standard deviation had decreased to 13.5 +/- 3.3 mm. at 3 months. The endopelvic fascia was thicker in women with type 2 than in those with types 2/3 or 3 disease (mean 5.3 +/- 1.5 versus 3.5 +/- 1.3 mm., p = 0.001). The position of bladder neck on video urodynamics was elevated a mean of 2.01 +/- 2.01 and 3.07 +/- 2.07 cm. compared to baseline elevation during resting and straining, respectively (p = 0). No hypermobility was noted while the patients coughed and no kinking of the urethra was observed while they performed the Valsalva maneuver. Detrusor instability resolved in 6 of 8 women (75%) and new onset detrusor instability was noted in 7 (14%). In 2 women with persistent stress urinary incontinence a repeat sling procedure was necessary to treat type 3 disease and cure incontinence. The overall success rate was 96%. One patient with sling erosion into the vaginal wall was treated with simple revision. CONCLUSIONS: Fixation of a polypropylene mesh sling at the bladder neck and adequate suspension may effectively achieve a hammock effect without creating bladder outlet obstruction in patients with types 2 and 2/3 stress urinary incontinence. The anatomical and functional results of this study show that a well suspended bladder neck did not create bladder outlet obstruction after a pubovaginal sling procedure using polypropylene mesh.     

The highly specific platelet glycoprotein (GP) VI agonist trowaglerix impaired collagen-induced platelet aggregation ex vivo through matrix metalloproteinase-dependent GPVI shedding

Summary.  Background:  C-type lectin proteins (CLPs) have diverse targets including platelet GPIb, GPVI and integrin α₂β₁, and affect platelet function in a various way. In this study, we characterized a huge, heterodimeric venom protein, trowaglerix, which belongs to the CLP family. Methods:  We purified a potent platelet-aggregation inducer, trowaglerix, from the crude venom of Tropidolaemus wagleri . Biotinylated trowaglerix was used for binding assays, and immunoblotting was used to investigate the signal transduction involved. Results:  Two distinct subunits of trowaglerix with similar masses of around 16 kDa were eluted by high-performance liquid chromatography after reduction and alkylation. Trowaglerix induced platelet aggregation of washed human platelets and platelet-rich plasma (PRP) in a concentration-dependent manner. Biotinylated trowaglerix specifically bound to platelet membrane GPVI, but not to GPIb or α₂ integrin. Treatment with trowaglerix induced GPVI loss in human platelets in vitro and impaired the platelet aggregation of mouse PRP ex vivo in response to collagen but not in response to adenosine diphosphate (ADP). However, GM6001, a matrix metalloproteinase (MMP) inhibitor, inhibited trowaglerix-induced GPVI cleavage and restored the platelet responsiveness of PRP to collagen. Conclusions:  Trowaglerix activates platelets through specific binding to GPVI, leading to kinases-dependent exposure of functional α_IIbβ₃ and platelet aggregation, and also induces MMP-dependent GPVI shedding from platelets.     

Simultaneous occurrence of papulonecrotic tuberculide and erythema induratum and the identification of Mycobacterium tuberculosis DNA by polymerase chain reaction

The simultaneous occurrence of two tuberculides in one patient is rare. We report the case of a 32-year-old man presenting with both papulonecrotic tuberculide and erythema induratum. Mycobacterial DNA was identified from both skin lesions by polymerase chain reaction using formalin-fixed and paraffin-embedded tissues, suggesting that tuberculides are related to tuberculosis. New skin lesions developed after the patient discontinued his medication on his own initiative, 2 months after triple antituberculous therapy had been started. It is important to continue therapy for a prolonged period.     

Mycoplasma pneumonia: Clinical and radiographic features in 39 children

BACKGROUND: The purpose of the present paper was to evaluate the clinical and chest radiographic features of pediatric patients with serologically proven Mycoplasma pneumoniae pneumonia (mycoplasma pneumonia). METHODS: The clinical records and chest radiographs of 39 consecutive patients (19 male, 20 female; age 3-13 years) with serologically positive IgG and IgM mycoplasma pneumonia were reviewed. RESULTS: More than 90% of patients presented with fever and cough and 48% of patients had leukocyte count >10,000/mm(3). A C-reactive protein (CRP) level >0.375 mg/dL was noted in 28 patients (72%). Chest radiographs displayed four different patterns: (i) peribronchial and perivascular interstitial infiltrates (n= 19, 49%); (ii) airspace consolidations (n= 15, 38%); (iii) reticulonodular opacification (n= 3, 8%); and (iv) nodular or mass-like opacification (n= 2, 5%). Bilateral peribronchial perivascular interstitial infiltrations in central and middle lung zones were frequently seen (n= 19, 49%). Other radiological features were bilateral lesions in 51% of patients, pleural effusion in 23%, and hilar lymphadenopathy in 13%. Means of duration for treatment response and hospitalization were 2.5 and 5 days, respectively. CONCLUSION: There are various radiological features of mycoplasma pneumonia in children. Bilateral peribronchial and perivascular interstitial infiltrates were most frequently seen in the present patients.     

哺乳类动物心室肌细胞的Luo-Rudy模型及计算机仿真研究的进展

在实验数据的基础上基于Hodgkin-Huxley方程建立的哺乳类动物心室肌细胞的Luo-Rudy模型及计算机仿真研究使得对心脏的认识从定性转入定量.本文简述了Luo-Rudy模型的发展过程及其应用研究,并给出了LR91模型的计算机仿真结果.心肌细胞模型在心脏电生理研究中起着重要的作用,随着对心肌细胞模型的进一步研究将在分子水平上揭开心源性猝死的原因.     

The Vanishing Defibrillator Syndrome: Incidence, Mechanism, and Clinical Relevance

Intraperitoneal migration of an abdominally implanted cardioverter defibrillator is a complication not yet fully described. In a consecutive series of 195 patients, migration occurred between I and 20 months in 5 (8%) of the 63 patients in whom a subrectus abdomini placement of the generator was chosen. It was unrelated to the patients'clinical characteristics or the defibrillator model. Dysuria and inability to interrogate the device were present in every subject, and the diagnosis was confirmed by the characteristic abdominal x-ray appearance and the findings at the time of surgery. Adhesions involving the omentum, and in one case, the small bowels, were present in three patients and seem to be related to the length of intraabdominal permanence of the generator. Because this complication may be due to specific anatomical characteristics of the aponeurosis of the abdominal muscles, it is likely that its incidence will be unchanged by the use of smaller devices. A close follow-up of the generators implanted deep to the rectus fascia is therefore advisable.     

Postchemotherapy retroperitoneal residual mass in infantile yolk sac tumor

BACKGROUND: Persistent postchemotherapy retroperitoneal residual mass with normalization of alpha-fetoprotein (AFP) in infantile yolk sac tumor is rare. METHODS/RESULTS: A 38-month-old boy with recurrent yolk sac tumor was treated with cisplatin-based combination chemotherapy. After chemotherapy, the retroperitoneal lymph node metastasis, 7 x 6 cm in size, decreased to 2 x 2 cm. Serum AFP levels returned to normal. The retroperitoneal residual mass was resected and histologically showed complete necrosis without viable cancer cells. CONCLUSION: The patient has remained free of disease for 36 months after operation.