Abdominal colposuspension with the use of tension-free tape at the lateral abdominal wall: a novel technique.

INTRODUCTION: The aim of this study was to present a novel technique for the female pelvic organ prolapsed, an abdominal colpopexy at the lateral abdominal wall (ACLAW) using a tension-free tape and to compare it with the gold standard, the abdominal sacrocolpopexy (ASC). MATERIALS AND METHODS: A retrospective comparative study was conducted consisting of 38 patients who underwent ACLAW and 40 patients who underwent ASC during the period 2007-2009. POP-Q data as well as PISQ-12 and POPDI-6 score values were recorded during a mean follow-up of 26.71 and 23.52 months for ACLAW and ASC groups, respectively. Parameters like operative time, blood loss and hospital stay time were evaluated as well. RESULTS: Except the 6-month point, anatomical outcome in terms of C point values and total vaginal length was comparable. Both score analyses did not demonstrate statistically significant differences between the groups. The novel technique was proved very much shorter (30 ± 10.2 vs. 125.93 ± 15.42 min, p < 0.001) and less hemorrhagic (1.68 ± 0.79 vs. 2.22 ± 1.08 g/dl reduction in hemoglobin level, postoperatively) than the traditional sacrocolpopexy. Hospital stay time did not demonstrate significant difference. CONCLUSIONS: Based on the study results, ACLAW, a technique much easier and shorter than the traditional abdominal colpopexy results in comparable outcomes.

A prospective randomized study for evaluation of wound retractors in the prevention of incision site infections after cesarean section.

Surgical site infections (SSIs) after cesarean section appear to be more common than generally believed. We prospectively evaluated 231 consecutive pregnant women who underwent elective or emergency cesarean section, and were assigned to have either the Alexis wound retractor (study group) or a conventional Doyen retractor (control group) during the operation. There was no evidence of SSI, defined as wound dehiscence, pain or tenderness in the lower abdomen, localized swelling, redness, heat or purulent discharge from the wound in any woman in the study group. Moreover, no endometritis occurred in this patient collective. There were three SSI in the control group, but no endometritis. Our preliminary data show excellent protection of wound infections with an additive protective effect to that given by antibiotic cover. After a short learning curve, the handling of the Alexis device became easier and the median insertion time was 18 sec.

Steroid receptor expression in human endometrium during the follicular phase of stimulated cycles.

BACKGROUND: No data are currently available regarding kinetics of human endometrial steroid receptors in stimulated cycles. METHODS: In 31 patients (age <39 years) stimulated with gonadotrophins and GnRH antagonists for intrauterine insemination (IUI) an endometrial biopsy was performed on the first day after the end of menstruation and a second biopsy was performed two (Group 0 + 2, n = 10) or four (Group 0 + 4, n = 11) days after the first biopsy, or on the day of hCG administration (Group 0 + hCG, n = 10). Expression of progesterone (PR) and estrogen (ER) receptor was investigated by immunohistochemistry using monoclonal antibodies. RESULTS: PR and ER levels were significantly increased in the second versus the first biopsy, in all groups analyzed (P = 0.01), in both stromal and glandular cells. Between the three groups compared, a significant increase in PR expression was observed for glandular cells (P = 0.03), with the highest value observed in Group 0 + 4. Moreover, the increase in PR expression in stromal cells differed between groups (P = 0.01), with the highest value observed in the Group 0 + hCG. CONCLUSIONS: In stimulated cycles for IUI, ER expression in both glandular and stromal endometrial cells, after an initial increase, does not appear to change significantly during the follicular phase. On the contrary, during the same period of time, following an initial rise, PR expression in glandular and stromal cells continues to increase.

Prenatal management and postnatal separation of omphalopagus and craniopagus conjoined twins.

Two cases of prenatally diagnosed conjoined twins are presented: a set of omphalopagus twins sharing a common liver, and a set of craniopagus with involvement limited to the skull. In both cases, prenatal diagnosis allowed accurate planning of pre- and postnatal management. Prenatal management involved serial imaging and counseling with participation of different specialists according to imaging findings. In the rare case of conjoined twins, an interdisciplinary approach is required, with feto-maternal specialists playing a pivotal role in co-ordinating teamwork and planning successive stages of management.