Pain Management During Office Hysteroscopy: A Survey of Hysteroscopists.

OBJECTIVE: Outpatient hysteroscopy can be a painful procedure for some patients and there is still no consensus regarding analgesia use. We evaluated which types and modalities of analgesia are most commonly used in a select group of hysteroscopists. STUDY DESIGN: A 15-item questionnaire was created to assess the use of routine analgesia during office hysteroscopy. The SurveyMonkey portal (https://www.surveymonkey.com/) was used to administer the questionnaire. Of the 400 hysteroscopists who were approached, 229 replied. RESULTS: Routine pre-procedural or intra-procedural analgesia was used by 34% of hysteroscopists (67% of these reported using NSAIDs, 12% paracetamol, 7% opioids 13.5% other). Among hysteroscopists who routinely used intra-procedural analgesia, 46.1% reported using a paracervical block, 15.4% used an intracervical blockage, 15.4% had the patient listen to music during the procedure, 3.8% used local anesthetics, as in a spray or gel on the surface of the cervix, and 19.2% used some other method. Regarding misoprostol use, 75% of hysteroscopists reported not using it routinely. CONCLUSION: Our results are consistent with poor evidence from published studies that there is a low prevalence of routine analgesia use during outpatient hysteroscopy.

In vivo biomechanical properties of heavy versus light weight monofilament polypropylene meshes. Does the knitting pattern matter?

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.

Primary fixation of mini slings: a comparative biomechanical study in vivo.

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 7°, 14° and 30° days. The impact of this feature in the clinical setting needs to be verified.

Primary fixation of mini slings: a comparative biomechanical study in vivo

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.

Linfoma primitivo de mama / Primary lymphoma of the breast

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.