Our goal was to report the preliminary results of a transvaginal mesh repair of genital prolapse using the Prolift™ system. This retrospective multicentric study includes 110 patients. All patients ...had a stage 3 (at the hymen) or stage 4 (beyond the hymen) prolapse. Total mesh was used in 59 patients (53.6%), an isolated anterior mesh in 22 patients (20%) and an isolated posterior mesh in 29 patients (26.4%). We report one bladder injury sutured at surgery and two haematomas requiring secondary surgical management. At 3 months, 106 patients were available for follow-up. Mesh exposure occurred in five patients (4.7%), two of them requiring a surgical management. Granuloma without exposure occurred in three patients (2.8%). Failure rate (recurrent prolapse even asymptomatic or low grade symptomatic prolapse) was 4.7%. According to the perioperative and immediate post-operative results, Prolift™ repair seems to be a safe technique to correct pelvic organ prolapse. Anatomical and functional results must be assessed with a long-term follow-up to confirm the effectiveness and safety of the procedure.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
L'hystérectomie reste un geste habituel lors de la cure du prolapsus génital, notamment par voie vaginale. Pourtant il peut sembler illogique, au vu de notre meilleure connaissance de l'anatomie ...pathologique pelvipérinéale, de débuter une réparation de la statique pelvienne par un geste d'exérèse. La question de la conservation utérine au cours de la chirurgie du prolapsus est donc plus que jamais d'actualité. Même si quelques auteurs ont tenté d'apporter des arguments à la discussion, nous ne disposons pas aujourd'hui de travaux rigoureux, prospectifs et randomisés, susceptibles de prouver la supériorité de l'hystérectomie ou de la conservation utérine sur les résultats anatomiques à long terme de nos interventions quelque soit la voie d'abord choisie. Néanmoins l'hystérectomie expose, en cas de chirurgie avec renforts prothétiques, à un risque majoré d'exposition de prothèse. Elle majore aussi les pertes sanguines peropératoires et allonge la durée de l'intervention et du séjour d'hospitalisation. A contrario, la conservation utérine impose un suivi gynécologique constant
: l'hystérectomie secondaire en cas de pathologies utérines bénignes ou malignes est alors souvent rendue difficile par les gestes de pexie utérine préalables. L'hystérectomie subtotale qui prévient tout risque endométrial est une alternative possible mais aucune étude n'a démontré un éventuel rôle du col utérin dans la statique pelvienne. Les résultats fonctionnels sont encore plus difficiles à analyser, influencés par la nature et le nombre de gestes associés. L'impact sexuel de l'hystérectomie a fait l'objet de nombreuses publications de qualité scientifique inégale. Chez une patiente informée et correctement évaluée avant l'intervention, l'hystérectomie ne semble pas avoir de répercussions négatives sur la sexualité qu'elle peut même, dans certaines circonstances, améliorer
; néanmoins on peut admettre que la conservation cervicale, chez certaines femmes, puisse avoir un rôle en termes de plaisir davantage pour des raisons «
balistiques
» et «
fantasmatiques
» qu'organophysiologiques. En l'absence de travaux rigoureux et spécifiquement orientés sur le sujet, il paraît légitime aujourd'hui de plaider pour la mise en route d'études prospectives et randomisées, de déconseiller les attitudes systématiques, de privilégier la conservation utérine chez la femme jeune et en cas de chirurgie prothétique, de réaliser un bilan gynécologique complet avant toute décision de conservation, et enfin, d'informer loyalement la patiente et de respecter ses préférences.
Hysterectomy remains a usual procedure in vaginal reconstructive pelvic surgery. However, it may seem illogical, given our improved knowledge of the pathologic pelvic anatomy, to begin pelvic repair by a removal procedure. The question about uterine preservation during vaginal reconstructive surgery is crucial. Although some authors have proposed some arguments on this topic, we don't have, at present, any rigorous prospective and randomized studies able to prove the superiority of hysterectomy or uterine preservation, on long-term anatomic results. Nevertheless, in reconstructive surgery with synthetic mesh, hysterectomy exposes to an increased risk of mesh exposure. Consequently, it increases blood lost, surgical duration and hospitalisation stay. On the other hand, uterine preservation imposes constant gynaecologic follow-up. Subsequently, if a hysterectomy is needed for benign or malignant diseases, the surgery is often difficult because of prior uterine fixation. Subtotal hysterectomy which prevents endometrial cancer can be a possible alternative but, at the moment, no study was able to demonstrate that uterine cervix has a role in pelvic static. Functional results, influenced by biological individual characteristics and by the number of associated procedures, are even more difficult to analyse. Sexual life after hysterectomy has been the subject of numerous publications of unequal scientific quality. Among correctly evaluated and informed patients, hysterectomy do not seem to produce negative consequences on sexuality; it can even improve, in some circumstances, the sexual life. We can admit that cervical conservation in some women may have a role in terms of pleasure, more from sexual fantasies and ballistic reasons than in relation with organic and physiologic reasons. Since no rigorous and specifically oriented works on that topic have been published until now, it seems justified today to promote prospective and randomized studies, advice against systematic attitudes, favour uterine conservation in young women and when doing surgery with mesh, realize a complete gynaecologic work-up before all uterine conservation decisions, correctly inform the patient and respect her preference.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Urethral erosion (UE) is an uncommon but potentially severe complication after suburethral synthetic slings. We aimed to identify the risk factors and diagnostic modalities of UE and also functional ...outcome after UE surgical management. We retrospectively analyzed eight cases of UE managed in our department between 1997 and 2007. The main presumptive risk factors of UE were excessive sling tensioning (six of eight) and postoperative urethral dilation (four of eight). The most frequent symptoms included voiding difficulties (five of eight), storage symptoms (three of eight), pain (three of eight), and recurrent stress incontinence (three of eight). UE diagnosis was accessible to introital ultrasound (five of five) and confirmed by urethroscopy (eight of eight). Surgical management was performed in seven cases and included transvaginal sling removal with urethral repair (two of seven), endoscopic transurethral sling resection (four of seven), and combined approach (one of seven). All the approaches provided good functional outcomes. Transurethral endoscopy is a mini-invasive treatment of UE and should be tried first in selected cases.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Radiolysis of mixed AuIII/AgI solutions at different dose rates is examined. The progressive evolution with dose of the UV−visible absorption spectra of radiation-induced metal clusters is discussed ...and compared with those calculated by Mie theory. The clusters have been also observed by transmission electron microscopy and analyzed by X-ray microanalysis and diffraction. At low dose rate, reduced silver atoms transfer an electron to gold ions (either free or at the surface of aggregates). Then, when AuIII ions are totally reduced, reduction of the silver ions occurs in a second step at the surface of gold clusters, and silver-coated gold aggregates are obtained. At high dose rate, the shape of the absorption spectrum does not change with an increase in the absorbed dose and X-ray microdiffraction confirms that bimetallic alloyed Ag/Au clusters are synthesized. These results imply the preponderant influence of kinetics in the competition between the reduction−coalescence processes and intermetallic electron transfer. The segregation or the alloying of the metals is controlled by the reduction rate; a fast total reduction of both types of metal ions prevents the redox equilibrium through electron transfer from being established. A perfectly ordered nanocrystal, as observed by electron microdiffraction, also implies an intimate association of metal atoms from the early steps of reduction and aggregation.
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IJS, KILJ, NUK, PNG, UL, UM
The codeposition behaviour of nickel–iron alloys has been studied in acid sulphate electrolytes in the presence of a magnetic field superimposed parallel to the surface. The magneto-induced ...modifications in the Ni–Fe film composition and morphology were attributed to an increase of the surface concentration of inhibiting species (i.e. FeII) by magnetohydrodynamic effects. In addition, the X-ray mapping demonstrates a high homogeneity of the distribution of nickel and iron atoms throughout the surface under the magnetic convection, except in the vicinity of hydrogen bubbles, where can be observed a disturbance of the distribution of nickel and iron atoms. It was also demonstrated that the magnetic field slightly affects the surface magnetic properties. The results of the electrochemical investigation reveal the same inhibition phenomenon that leads to reduce the current density and increase the adsorption-loop amplitude of the Nyquist electrochemical impedance diagrams.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK
Abstract Objectives Prospective evaluation of outcome and complications over a 5-year period post-treatment of urinary stress incontinence by TVT, and comparison of our results with the reference ...studies. Materials and methods About 94 patients were treated for urinary stress incontinence only by one TVT procedure (single surgical procedure), between April 1997 and December 1998; 68% of patients presented pure urinary stress incontinence and 32% mixed incontinence. We found also a 25.5% rate of sphincter deficiency (UCP < 20 cm H2 O) in this cohort. Patients were evaluated after 5 years: 52 complete evaluations (clinical, flow measurement with measurement of post-mictional residue, 24 h PAD-test, quality of life questionnaire), 30 complete telephone interviews, 12 lost to follow-up (2 patients deceased). Results About 87% of the patients had a 5-year follow-up. The success rate was 79.2% overall (84.5% for the pure urinary stress incontinence and 67% for the mixed incontinence cases), and 72.2% for the cases of associated sphincter deficiency. We had only a 13% rate of patients lost to follow-up. More than half of the urinary urgency cases were treated successfully, however with a less satisfactory outcome in cases of bladder instability. The urodynamic exploration appeared to reveal that TVT caused dysuria: 52% of patients had a maximum flowrate below 15 ml/s, but the quality of life was improved, with a 95% rate of satisfaction without functional problems. We observed no late complications such as vaginal erosion or rejection of the prolene; the de novo syndrome was rare, with 8.5% of urinary frequency, 6% of urinary urgency and only 5.7% of invalidating dysuria. We saw no cases of pelvic floor disease after TVT treatment. Discussion Our casuistry results are comparable with the reference studies by Scandinavian authors, Rezapour and Ulmsten, confirming the long-term success of the TVT procedure. Concerning the apparently elevated rates of post-TVT dysuria found by urodynamic exploration, a distinction has to be drawn between post-TVT urinary problems (frequent but oligosymptomatic), and true, severe dysuria (rare). However, “dysuria” in the broad sense did not affect the patients’ quality of life, and is a reminder of the absolute necessity of meticulous compliance with the correct surgical techniques. Conclusion Treatment of urinary incontinence by TVT is a reliable, mini-invasive, reproducible technique, almost suitable for outpatients, with no serious complications; it is inexpensive and very successful, including in complicated cases such as sphincter deficiency. All the recent data confirms, with this 5-year follow-up, that the TVT procedure is comparable to the previously gold standard, the Burch colposuspension.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK
A magnetic field perpendicular to the surface of a plane electrode creates convective effects that are analyzed through stationary and dynamic investigations. These effects are enhanced when the ...species involved is paramagnetic. The magnetic force that acts on the gradient of the electroactive species is highlighted. The diffusion limiting current can be expressed as a function of the induced velocity gradient. By modulation of the magnetic field, a magnetohydrodynamic transfer function can be obtained that allows the diffusion limiting current dependence on both the gradient concentration species and the magnetic field amplitude to be confirmed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK
From the end of 1994 to the beginning of 1995, 49 patients with hemorrhagic symptoms were hospitalized in the Makokou General Hospital in northeastern Gabon. Yellow fever (YF) virus was first ...diagnosed in serum by use of polymerase chain reaction followed by blotting, and a vaccination campaign was immediately instituted. The epidemic, known as the fall 1994 epidemic, ended 6 weeks later. However, some aspects of this epidemic were atypical of YF infection, so a retrospective check for other etiologic agents was undertaken. Ebola (EBO) virus was found to be present concomitantly with YF virus in the epidemic. Two other epidemics (spring and fall 1996) occurred in the same province. GP and L genes of EBO virus isolates from all three epidemics were partially sequenced, which showed a difference of <0.1% in the base pairs. Sequencing also showed that all isolates were very similar to subtype Zaire EBO virus isolates from the Democratic Republic of the Congo.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
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