[ANCHORLESS VAGINAL IMPLANT FOR THE TREATMENT OF ADVANCED PELVIC ORGAN PROLAPSE].

INTRODUCTION: The use of vaginal mesh in pelvic surgery has previously demonstrated anatomical advantage combined with surgical complications that have called its effectiveness into question. OBJECTIVES: To evaluate the safety and efficacy of an anchorless implant for the repair of pelvic organ prolapse (POP) in women with risk factors for recurrence. METHODS: Retrospective evaluation of the self-retaining support (SRS) implant in women with a ≥2 degree vaginal anterior and apical prolapse with an increased risk of prolapse recurrence. Demographic and clinical data were collected, and women suspected of recurrence, based on a telephone questionnaire, were re-examined. RESULTS: Sixty women were evaluated. Four (6.6%) underwent reoperation due to prolapse recurrence of the posterior and vaginal apex. No intra-operative complications were documented; 4 (6.6%) women had surgical field hematoma treated conservatively. No chronic pelvic pain or dyspareunia were documented. Six (10%) women who reported bulging sensation in the telephone questionnaire were examined and found to have prolapse of the posterior compartment and not of the anterior or apical compartment treated by the SRS. CONCLUSIONS: Use of the SRS demonstrated 93.3% success rate at a mean follow-up of 14 months postoperatively without intra-operative complications and mild post-op complications at follow-up. DISCUSSION: Short term data on the use of the SRS demonstrate that anchorless mesh technique may preserve the benefits of vaginal mesh while eliminating surgical complications. The SRS is a safe and effective surgical alternative for the repair of anterior and apical vaginal prolapse in women with advanced pelvic organ prolapse and risk factors for relapse.

[GASTRIC CANCER IN PREGNANCY].

INTRODUCTION: Gastric carcinoma in pregnancy is rare and occurs in only 0.025% to 0.1% of all pregnancies. Due to it's symptoms of abdominal discomfort and nausea, which are common during pregnancy, the diagnosis is usually made in an advanced stage. We present a case of a 37 years old woman who presented at 18 weeks of gestation with abdominal pain, nausea and vomiting accompanied with severe maternal ascites. Her workup included an MRI scan, abdominal and obstetrical ultrasound scans, sampling of the peritoneal fluid, gastroscopy and diagnostic laparoscopy. She was diagnosed with a stage four gastric carcinoma. As seen in this case and in the current literature, diagnosis of gastric carcinoma in pregnancy is difficult. It often tends to be made in stage three or four and usually carries a very poor prognosis. In this paper, we describe our experience with this patient and review the literature.

Several siblings with Cystic Fibrosis as a risk factor for poor outcome.

BACKGROUND: Occurrence of Cystic Fibrosis (CF) in more than one member in a family is not uncommon. The aim of our study was to assess the influence of multiple siblings with CF on disease expression and outcome. METHODS: Study group consisted of 2-siblings (2-sibs, n = 42) or 3/4 siblings (3/4-sibs, n = 22) with CF in one family. Each sibling was matched by age, mutation, and gender to a single CF patient. RESULTS: 3/4-sibs subgroup compared to singles showed a lower mean FEV1 with a faster decline rate (58.4 ± 27.5 vs. 72.7 ± 25.4 and -5 ± 6.4 vs. -1.7 ± 2.8 %predicted decline/year respectively, p < .05), more airway colonization by Pseudomonas aeruginosa and Mycobacterium abscessus (15 (68%) vs. 8 (36%) and 7 (32%) vs. 4 (18%), respectively, p < .05) and more lung transplants (5 (23%) vs. 2 (9%), respectively, p < .02). Last mean FEV1 within 3/4-sibs was significantly lower for the youngest sib (p < .05). CONCLUSIONS: Three or more CF patients in one family may be a risk factor for more severe disease and poor prognosis. In our view this reflects the burden of disease on the patients and families.

[Who will take care of the caretaker? Lifestyle recommendations for physicians].

A healthy lifestyle is the mainstay of preventive medicine. HeaLthcare personnel might disregard keeping a healthy diet and exercise habits, perhaps due to feeling protected by their own knowledge. Physicians might under-diagnose their own overweight status, and have been shown in some studies to display lower rates of healthy behaviors compared with the general population. This review presents the availabLe data on physicians' own lifestyle habits, and discusses the importance of these for both their own health, and for the benefit of their patients. We supply several healthy lifestyle recommendations based on national and international guidelines, and adapt them to the clinic and hospital settings. Eating a healthy diet, and performing at least 150 minutes of aerobic exercise a week, with additional resistance exercises 2-3 times a week, will benefit all caretakers--both personally and professionally.