RESUMO
AIMS: This work evaluated the post-implant biomechanical properties of light-weight (LW) and heavy-weight (HW) monofilament polypropylene (PP) meshes with different knitting patterns in an animal model in vivo. METHODS: Forty-five adult female Wistar rats were divided into three groups and randomly implanted with 32 × 32 mm HW-PP (62 gm-2 ) orLW-PP (16 gm-2 ) in the lower abdomen. LW-PPwas tested orthogonally (called LWL and LWT) to reproduce the longitudinal and transverse planes of the vaginal wall, respectively. Abdominal walls were removed at 7, 30, and 60 days, and then tested for tensile load (maximum load until avulsion from the tissue), deflection, and stiffness to maximum load. Explants were compared over time and between groups. RESULTS: LW-PP meshes implanted in the LWT fashion (vaginal transverse plane) showed comparable maximum load and stiffness to HW-PP meshes, and LW-PP meshes implanted in the LWL fashion (vaginal longitudinal plane) presented lower maximum load and stiffness than the HW-PP meshes. There were no significant differences in the values of deflection at maximum load between the studied meshes as a function of time. CONCLUSIONS: The final mechanical behavior of PP mesh can be changed by its weight and knitting pattern. These properties may be useful in making more biocompatible prostheses for pelvic organ prolapse (POP) with less foreign material to maintain longitudinal vaginal elasticity and minimize sexual symptoms while maintaining transverse resistance (i.e., between vaginal fornixes) to prevent POP recurrence. Neurourol. Urodynam. 36:73-79, 2017. © 2015 Wiley Periodicals, Inc.
Assuntos
Polipropilenos , Telas Cirúrgicas , Animais , Anisotropia , Fenômenos Biomecânicos , Elasticidade , Feminino , Ratos , Ratos Wistar , Resistência à Tração , Vagina/cirurgiaRESUMO
Los sarcomas primitivos de mama son tumores infrecuentes que representan entre el 0,2% y 1,0% de las neoplasias mamarias y dentro de éstos, los leiomiosarcomas, de presentación excepcional, representan del 5% al 10% de los sarcomas mamarios. Hasta la fecha se han documentado aproximadamente 50 casos en la bibliografía. Debido a la baja incidencia de esta patología, varios aspectos importantes del diagnóstico y tratamiento se basan en datos escasos, todavía no hay consenso sobre el abordaje terapéutico óptimo de estas pacientes con relación al tratamiento primario y complementario. Se presentan 2 pacientes con nódulos mamarios, uno de crecimiento acelerado en meses y otra de crecimiento lento en años, se describen las dificultades diagnósticas que ocasionan este tipo de tumores con las imágenes, debido a su similitud con nódulos benignos; dificultades para el patólogo aun con la inmunohistoquímica, en la biopsia histológica con aguja gruesa y los inconvenientes del estudio intraoperatorio. Se efectuó mastectomía simple como tratamiento primario, con diagnóstico definitivo de leiomiosarcomas primitivos de mama, si bien es discutida la utilidad del tratamiento complementario, una paciente efectuó radioterapia y la otra no, ambas con supervivencia libre de enfermedad hasta la fecha. Se realiza una revisión de la bibliografía, se plantea y discute el manejo de estos casos.
Assuntos
Mama , LeiomiossarcomaRESUMO
Los sarcomas primitivos de mama son tumores infrecuentes que representan entre el 0,2% y 1,0% de las neoplasias mamarias y dentro de éstos, los leiomiosarcomas, de presentación excepcional, representan del 5% al 10% de los sarcomas mamarios. Hasta la fecha se han documentado aproximadamente 50 casos en la bibliografía. Debido a la baja incidencia de esta patología, varios aspectos importantes del diagnóstico y tratamiento se basan en datos escasos, todavía no hay consenso sobre el abordaje terapéutico óptimo de estas pacientes con relación al tratamiento primario y complementario. Se presentan 2 pacientes con nódulos mamarios, uno de crecimiento acelerado en meses y otra de crecimiento lento en años, se describen las dificultades diagnósticas que ocasionan este tipo de tumores con las imágenes, debido a su similitud con nódulos benignos; dificultades para el patólogo aun con la inmunohistoquímica, en la biopsia histológica con aguja gruesa y los inconvenientes del estudio intraoperatorio. Se efectuó mastectomía simple como tratamiento primario, con diagnóstico definitivo de leiomiosarcomas primitivos de mama, si bien es discutida la utilidad del tratamiento complementario, una paciente efectuó radioterapia y la otra no, ambas con supervivencia libre de enfermedad hasta la fecha. Se realiza una revisión de la bibliografía, se plantea y discute el manejo de estos casos.(AU)
Assuntos
Leiomiossarcoma , MamaRESUMO
INTRODUCTION AND OBJECTIVES: The mini sling concept for stress urinary incontinence is an anatomical approach that involves placing a midurethral low-tension tape anchored to the obturator internus muscles bilaterally. They overcome the blind passage of long needles and all the related complications. There are many different devices available and because these are outpatient procedures, primary fixation plays an important role in the outcome. The objective is to evaluate the primary fixation of the various devices of attachment of the commercially available mini-slings through biomechanical tests. MATERIALS AND METHODS: A total of 45 Wistar rats were divided in 3 groups of 15 rats each. They underwent 5 subcutaneous implantation of different mini slings and one polipropilene mesh (control), as follows: TVT-Secur® (Gynecare, USA), Type 1 polypropylene mesh (control); Ophira Mini Sling System ® (Promedon, Argentina), Tissue Fixation System ® (TFS PTY, Australia), Zipper Sling ® and â³T deviceâ³ (Prosurg, USA). The abdominal wall was removed on bloc at different times after implant for biomechanical evaluation, which consisted in application of unidirectional force to the extremity of the fixation system or mesh, until it was completely removed from the tissue using a tension meter (Nexygen 3.0 Universal Testing Machine-LLOYD Instruments). The force was measured in Newtons (N). RESULTS: There was significant difference in the resistance to extraction among the different fixation systems. At 7 days the Ophira Mini Sling System ® presented the best fixation and â³T dispositiveâ³ the worst. CONCLUSION: Ophira mini sling System ® presented the best primary fixation at 7°, 14° and 30° days. The impact of this feature in the clinical setting needs to be verified.
Assuntos
Slings Suburetrais , Uretra/cirurgia , Incontinência Urinária por Estresse/cirurgia , Análise de Variância , Animais , Fenômenos Biomecânicos , Teste de Materiais , Polipropilenos , Implantação de Prótese/métodos , Ratos , Ratos Wistar , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
INTRODUCTION AND OBJECTIVES: The mini sling concept for stress urinary incontinence is an anatomical approach that involves placing a midurethral low-tension tape anchored to the obturator internus muscles bilaterally. They overcome the blind passage of long needles and all the related complications. There are many different devices available and because these are outpatient procedures, primary fixation plays an important role in the outcome. The objective is to evaluate the primary fixation of the various devices of attachment of the commercially available mini-slings through biomechanical tests. MATERIALS AND METHODS: A total of 45 Wistar rats were divided in 3 groups of 15 rats each. They underwent 5 subcutaneous implantation of different mini slings and one polipropilene mesh (control), as follows: TVT-Secur® (Gynecare, USA), Type 1 polypropylene mesh (control); Ophira Mini Sling System® (Promedon, Argentina), Tissue Fixation System® (TFS PTY, Australia), Zipper Sling® and "T device" (Prosurg, USA). The abdominal wall was removed on bloc at different times after implant for biomechanical evaluation, which consisted in application of unidirectional force to the extremity of the fixation system or mesh, until it was completely removed from the tissue using a tension meter (Nexygen 3.0 Universal Testing Machine - LLOYD Instruments). The force was measured in Newtons (N). RESULTS: There was significant difference in the resistance to extraction among the different fixation systems. At 7 days the Ophira Mini Sling System® presented the best fixation and "T dispositive" the worst. CONCLUSION: Ophira mini sling System® presented the best primary fixation at 7º, 14º and 30º days. The impact of this feature in the clinical setting needs to be verified.
Assuntos
Animais , Ratos , Slings Suburetrais , Uretra/cirurgia , Incontinência Urinária por Estresse/cirurgia , Análise de Variância , Fenômenos Biomecânicos , Teste de Materiais , Polipropilenos , Implantação de Prótese/métodos , Ratos Wistar , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
OBJECTIVE: The creation of neo utero-sacral neoligaments, decribed by Petros, evolved into a new procedure allowing for the anatomical reconstruction of the three levels proposed by DeLancey. The aim of this study is evaluate the anatomical and functional outcomes of this minimally invasive procedure. PATIENTS AND METHOD: From December 2004 to March 2007, a total of 34 patients with posterior defect grade III or higher underwent this procedure. The minimum follow up was 13 months Mean age was 63 years. The site of fixation was the Sacrospinous ligament. SURGICAL TECHNIQUE: The ischiorectal fossa is dissected. Next two small skin incisions are made 3 cm lateral and inferior to the center of the anus. A proper needle is introduced, vertically towards the sacrospinal ligament at the level of the ischial spine, guided by the surgeon index finger, 2 cm medially avoiding the Alcok canal. The armpit of the mesh is connected to the tip of the needle and brought to the perineal region. No site specific correction is made. RESULTS: The cure rate was 94,7% and recurrence rate was 5,3%. No visceral, nerurovascular injuries were observed. The mesh exposure rate (less than 1 cm2) was (14.7%) and all patients were treated conservatively with no impact on the outcome. There were transient dyspareunia in 2 (11.8%) of the 17 sexually active patient and persistent in 1 case (5.9%). CONCLUSIONS: This procedure is an attractive minimally invasive alternative for the anatomical and functional reconstruction of the posterior and apical defects.
Assuntos
Polipropilenos , Próteses e Implantes , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Desenho de PróteseRESUMO
UNLABELLED: The aim of this study was to evaluate the efficacy of the Posterior Tibial Nerve stimulation in women with overactivity bladder symptoms and the impact in the quality of life using the Overactivity Bladder Questionnaire (OABq). METHODS: thirty seven women from female urology outpatient clinic of the Hospital das Clinicas de Campinas (HC/UNICAMP) were enrolled in this prospective, controlled and randomized clinical trial. The patients were randomly placed in one of two groups: TREATMENT GROUP: patients were submitted to tibial posterior nerve electrical stimulation (n=21) and Sham group: patients had electrodes placed without electricity (n = 16). After informed consent the patients underwent a physiotherapeutic evaluation, that included voiding diary and the overactivity bladder questionnaire (OABq). The treatment schedule included eight sessions of electrical stimulation in the posterior tibial nerve, twice a week. RESULTS: there were significant changes in symptoms such as frequency and nocturia (p=0,003 and p=0,001). The urgency and quality of life was improved in both group after treatment. CONCLUSION: The posterior tibial nerve electrical stimulation is an effective treatment in overactive bladder.
Assuntos
Terapia por Estimulação Elétrica , Bexiga Urinária Hiperativa/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Nervo TibialRESUMO
Se presenta un caso de linfoma maligno primitivo de la mama en una paciente de 71 años, cuyo hallazgo fue casual, durante un autoexamen. La punción aspiración resultó negativa, la mamografía demostró un tumor de 3 cm de diámetro, de contornos irregulares y sin microcalcificaciones. Ecográficamente apareció con características sólidas, heterogéneo y multilobulado. La biopsia por congelación informó cáncer ductal infiltrante, por lo que se realizó, en el acto quirúrgico, tumerectomía amplia más linfadenectomía. La biopsia diferida informó linfoma centroblástico difuso, por lo que se completó el estudio con técnicas inmunohistoquímicas, determinando que la estirpe celular predominante era B. En estudios posteriores no se encontraron lesiones linfomatosas en otra parte de la economía. Se completó el tratamiento con 3 ciclos de quimioterapia. Este trabajo incluye también una amplia revisión en la literatura mundial y nacional, acerca de los casos de linfomas primitivos de la mama.
Assuntos
Humanos , Feminino , Idoso , Biópsia , Neoplasias da Mama/diagnóstico , Autoexame de Mama , Mama/anormalidades , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/cirurgia , Excisão de Linfonodo , Linfoma não Hodgkin , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/cirurgia , Mamografia , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Prednisona/uso terapêutico , Vincristina/uso terapêuticoRESUMO
Se presenta un caso de linfoma maligno primitivo de la mama en una paciente de 71 años, cuyo hallazgo fue casual, durante un autoexamen. La punción aspiración resultó negativa, la mamografía demostró un tumor de 3 cm de diámetro, de contornos irregulares y sin microcalcificaciones. Ecográficamente apareció con características sólidas, heterogéneo y multilobulado. La biopsia por congelación informó cáncer ductal infiltrante, por lo que se realizó, en el acto quirúrgico, tumerectomía amplia más linfadenectomía. La biopsia diferida informó linfoma centroblástico difuso, por lo que se completó el estudio con técnicas inmunohistoquímicas, determinando que la estirpe celular predominante era B. En estudios posteriores no se encontraron lesiones linfomatosas en otra parte de la economía. Se completó el tratamiento con 3 ciclos de quimioterapia. Este trabajo incluye también una amplia revisión en la literatura mundial y nacional, acerca de los casos de linfomas primitivos de la mama. (AU)