The multifilament polypropylene tape erosion trouble: tape structure vs surgical technique. Which one is the cause?

This study was designed to clarify whether the structure of multifilament tape or the surgical technique is associated with vaginal erosions. Patients were randomized into two groups: in group 1, formed from the patients who were operated with the technique “setting the tape loosely leaving a scissor tip gap between the tape and the urethra,” and in group 2, formed from the patients who were operated with the technique “setting the tape actually touched the urethra and covering the tape by the adjacent pubocervicovaginal fascia with the aid of a suture.” After 4-year follow-up, it was found that the erosion rate was very high in group 1 (13.6%). We conclude that the high erosion rate seen in multifilament tapes is associated with the surgical technique that is used, not the structure of the multifilament tape.     

MIB-1 index, S-phase fraction, mitotic figure count, and SBR histologic grading in invasive breast carcinoma: a comparative study

Abstract: Proliferative activity has been proven to be of prognostic significance in breast carcinoma. This study was performed to compare the different proliferative fractions in the Egyptian population and to define the most suitable one for daily routine use in our surgical pathology laboratories. The proliferative activity of 63 invasive ductal carcinomas was evaluated by immunohistochemical staining of paraffin-embedded tissue sections with MIB-1 rabbit polyclonal antibody and the heat-induced epitope retrieval method, flow cytometric determination of the S-phase fraction (SPF) on frozen tissues, and estimation of the Scarff–Bloom–Richardson (SBR) grading and mitotic figure count (MFC) on hematoxylin and eosin-stained tissue sections. Fifty-two percent of invasive ductal carcinoma were aneuploid. The mean values of MIB-1 index, SPF, and MFC were 17.7 ± 12.3, 4.9 ± 3.8, and 5.2 ± 4.5, respectively, for diploid tumors; while for aneuploid tumors, they were 58.6 ± 31.9, 19.9 ± 12.2, and 23.1 ± 16.9, respectively. These values were significantly higher in aneuploid versus diploid tumors (p < 0.0001). A close correlation was found between MIB-1 index, SPF, MFC, and SBR grading (p < 0.0001). In conclusion, in surgical pathology laboratories that cannot afford the costs of flow cytometry and/or immunostaining, proper SBR grading and MFC can provide an estimation of the proliferation fraction similar to the flow cytometric SPF and MIB-1 immunostaining.     

Hidden female urinary incontinence in urology and obstetrics and gynecology outpatient clinics in Turkey: what are the determinants of bothersome urinary incontinence and help-seeking behavior?

The purpose of this study was to assess the prevalence of female urinary incontinence (UI) and risk factors of bothersomeness and help-seeking behavior of hidden female UI in urology and obstetrics and gynecology outpatient clinics. This multicentric and cross-sectional study was conducted as a part of the Turkish Overactive Bladder Study. Female patients (n = 5,565) who were referred with complaints other than UI and overactive bladder symptoms were surveyed using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) with supplementation of five more questions. The crude prevalence of UI was found to be 35.7%. The prevalence of frequent and severe incontinence was 8.2 and 6.8%, respectively. The mean age of incontinent patients was significantly higher (p < 0.001). The prevalence of stress, urge, and mixed UI was 39.8, 24.8, and 28.9%, respectively. More than half (53%) of incontinent patients were not bothered by UI, and only 12% of incontinent patients had previously sought medical help for their problem. Frequency, severity, and type of UI were independent factors for predicting bothersome UI, while only bothersomeness increased help-seeking behavior. The ICIQ-SF score of 8 has been found to be the best cutoff value to delineate the bothersome UI. Although the crude prevalence of female UI was found to be high, bothersome UI was not so common. The majority of incontinent female patients did not seek medical help. Frequency, severity, and mixed type of UI were found to be the determinants of bothersome UI for which the ICIQ-SF cutoff score of 8 was obtained.     

Identification of intervertebral disc regeneration with magnetic resonance imaging after a long-term follow-up in patients treated with percutaneous diode laser nucleoplasty: a retrospective clinical and radiological analysis of 14 patients

Purpose

The aim of this study was to demonstrate regeneration of intervertebral discs undergoing laser therapy with sagittal relaxation time (T2) mapping after a long-term follow-up.

Materials and methods

Fourteen patients (9 men, 5 women; age range 20–57 years; mean age 36.5 years) treated with percutaneous 908-nm wave-length diode laser nucleoplasty for lumbar disc prolapsus at our clinic between January 2006 and June 2009 were studied. For the application of laser nucleoplasty in the past, patients who did not have central canal stenosis and/or lateral stenosis, sequestered disc fragment, operation scars and bleeding disorders were selected. The intervertebral disc levels undergoing laser therapy were L3–L4 (n = 2) or L4–L5 (n = 12). Patients were called for follow-up visits after a maximum 6-years (n = 2) or a minimum 3 years (n = 3) with a mean of 4.4 years. The patients’ clinical status for leg pain was evaluated according to the visual analog scale (VAS) and subsequently, a lumbar magnetic resonance imaging was performed. Sagittal T2 mapping was performed for the intervertebral discs undergoing laser nucleoplasty. We analyzed the relationship between T2 in the regions of interest (ROIs), which is known to correlate with changes in the composition of intervertebral discs, and the degree of degeneration determined using the Pfirrmann grading system and VAS of patients.

Results

On the basis of the evaluation of the results of intervertebral discs in all patients, there was a significant increase in T2 in the anterior NP (ROI 2, +10.3 ms; p < 0.05). A significant increase was noted in T2 in the middle NP (ROI 3, +24.6 ms; p < 0.001). The most significant increase was recorded for the posterior NP (ROI 4, +28.6 ms; p < 0.001). No significant decrease was found in T2 in the anterior and posterior AF (ROI 1, ?1.5 ms; p = 0.925; ROI 5, ?0.1 ms; p = 0.683). According to the Pfirrmann grading system, disc degeneration grades before laser therapy were recorded as grade III (n = 6) and grade IV (n = 8) whereas disc degeneration grades after laser therapy were found to be grade I (n = 6) and II (n = 8). A significant decrease was noted in Pfirrmann grades of disc degeneration after laser therapy (p < 0.0005).

Conclusions

In this study, there was a prolongation of T2 indicating regeneration in the nucleus pulposus after laser therapy and these results were found to be consistent with VAS measurements after a long-term follow-up. This study, which demonstrates the quantitative efficacy of laser therapy, indicates that MRG can be more effectively used in the future.     

Dissected Aorta Repair Through Stent Implantation trial: Canadian results

Objectives

We describe the Canadian results of the Ascyrus Medical Dissection Stent (AMDS), a novel partially uncovered aortic arch hybrid graft implanted antegrade during hypothermic circulatory arrest to promote true lumen expansion and enhance aortic remodeling.

The Effect of Perioperative Iron Therapy in Acute Major Non-cardiac Surgery on Allogenic Blood Transfusion and Postoperative Haemoglobin Levels: A Systematic Review and Meta-analysis

Background

Perioperative anaemia in relation to surgery is associated with adverse clinical outcomes. In an elective surgical setting, it is possible to optimize patients prior to surgery, often by iron supplementation with correction of anaemia. Possibilities for optimization prior to and during acute surgical procedures are limited. This review investigates whether iron treatment initiated perioperatively improves outcomes in patients undergoing major acute non-cardiac surgery.

Method

This systematic review was performed using PubMed, EMBASE (Ovid) and Scopus to identify current evidence on iron supplementation in acute surgery. Primary outcomes were allogenic blood transfusion (ABT) rate and changes in haemoglobin. Secondary outcomes were postoperative mortality, length of stay (LOS), and postoperative complications. Iron was administered at latest within 24 h after end of surgery.

Results

Of the 5413 studies screened, four randomized controlled trials and nine observational cohort studies were included. Ten studies included patients with hip fractures. A meta-analysis of seven studies showed a risk reduction of transfusion (OR = 0.35 CI 95% (0.20–0.63), p = 0.0004, I² = 66%). No influence on plasma haemoglobin was found. Postoperative mortality was reduced in the iron therapy group in a meta-analysis of four observational studies (OR 0.50 (CI 95% 0.26–0.96) p = 0.04). No effect was found on LOS, but a reduction in postoperative infection was seen in four studies.

Conclusions

This review examined perioperative iron therapy in acute major non-cardiac surgery. IV iron showed a lower 30-day mortality, a reduction in postoperative infections and a reduction in ABT largely due to the observational studies. The review primarily consisted of small observational studies and does not have the power to formally recommend this practice.

     

The electrovesicogram in the overactive bladder: role in determining pathogenesis and diagnostic significance

We investigated the hypothesis that the abnormal contractility of the smooth musculature of the overactive bladder (OAB) may be due to derangement of its electrical activity. Percutaneous electrovesicography was performed in 22 patients (mean age 46.3 years, 12 men, ten women) with OAB and 14 healthy volunteers (mean age 45.6 years, eight men, six women). Recording was performed with the bladder full and empty. Three electrodes were applied suprapubically and one reference electrode was applied to a lower limb. Reproducible regular triphasic slow waves (SWs) were recorded in the volunteers. The pattern of the full and empty bladder were similar except for the higher amplitude of the waves in the former (P<0.05). The OAB patients showed a dysrhythmic pattern with irregular frequency, amplitude and conduction velocity in both the empty and full bladders. We obtained tachyrhythmic, bradyrhythmic and arrhythmic areas in the same recording. The OAB exhibited a dysrhythmic electrical pattern with areas of different electrical activity in the same recording. The tachyrhythmic, bradyrhythmic and arrhythmic areas are suggested to explain the abnormal vesical contractions and clinical manifestations of OAB. Further studies are required to investigate the cause of the dysrhythmic pattern and the electrovesicogram is suggested as an investigative tool in OAB diagnosis.