A Pathology of Mesh and Time: Dysejaculation, Sexual Pain, and Orchialgia Resulting From Polypropylene Mesh Erosion Into the Spermatic Cord.

OBJECTIVE: The ubiquitous use of polypropylene mesh in hernia surgery has spawned a new clinical syndrome: chronic post-herniorrhaphy neuralgia. A subset of that clinical picture is dysejaculation, sexual pain, and orchialgia. We propose to identify the processes that lead to that pain. SUMMARY OF BACKGROUND DATA: Specimens of vas adherent to polypropylene mesh, explanted in an attempt to control severe, life-changing inguinodynia are extremely difficult to obtain. This scarcity may be due to ingrained attitudes in our society about removal of vas and/or testicles for whatever reason. Attempts at preserving such damaged structures may paradoxically contribute to the chronicity and severity of such pain. METHODS: The medical files of patients who had mesh specimens explanted because of severe chronic post-herniorrhaphy pain were reviewed to identify cases with recorded evidence, at the time of surgery, of involvement of spermatic cord/vas deferens with mesh. These criteria were met in 13 cases and the specimens were analyzed histologically. RESULTS: The vas deferens was resected in 83% (5 of 6) of the patients with a history of sexual pain and/or dysejaculation (vs 14% of those without a history of sexual pain, P = 0.03). Histology demonstrated unequivocal mesh invasion of the spermatic cord, where the initial damage occurred to nerves (autonomic, somatic), then to the smooth muscle of the vas while the lumen remained patent. In 50% (3 of 6), the vas and other cord structures appeared to be completely invaded by the mesh and replaced by scar tissue. CONCLUSIONS: Irreversible damage of the nerves and vas musculature due to mesh migration is one of the mechanisms for sexual pain and dysejaculation. Attempts at all cost to preserve elements of the spermatic cord may not be justified in cases of severe pain, especially sexual pain (and/or dysejaculation) and intraoperative finding of cord involvement by the mesh. Vasectomy with mesh removal may well be indicated and be considered not a radical procedure but a conservative measure given the severity of the pain!

33 W continuous output power semiconductor disk laser emitting at 1275 nm.

We demonstrate a semiconductor disk laser emitting at 1275nm, employing a wafer fused AlInGaAs/InP-AlAs/GaAs gain mirror. A built-in Au-reflector was used to reflect the pump light not absorbed in a single pass through the gain chip active region. The laser exhibited an output power of 33 W for a pump spot with a diameter of 0.86 mm, an output coupler of 2.5%, and a heat-sink temperature of -5°C. When the temperature of the heat-sink was increased to 15 °C, the maximum output power reached a value of ~24 W. The study reveals that the wafer fused gain mirrors have a high optical quality and good uniformity enabling scaling of the maximum emitted power with the diameter of the pump spot, i.e. at least up to the 1 mm diameter.

750 nm 1.5 W frequency-doubled semiconductor disk laser with a 44 nm tuning range.

We demonstrate 1.5 W of output power at the wavelength of 750 nm by intracavity frequency doubling a wafer-fused semiconductor disk laser diode-pumped at 980 nm. An optical-to-optical efficiency of 8.3% was achieved using a bismuth borate crystal. The wavelength of the doubled emission could be tuned from 720 to 764 nm with an intracavity birefringent plate. The beam quality parameter M2 of the laser output was measured to be below 1.5 at all pump powers. The laser is a promising tool for biomedical applications that can take advantage of the large penetration depth of light in tissue in the 700-800 nm spectral range.

High performance wafer-fused semiconductor disk lasers emitting in the 1300 nm waveband.

We report for the first time on the performance of 1300 nm waveband semiconductor disc lasers (SDLs) with wafer fused gain mirrors that implement intracavity diamond and flip-chip heat dissipation schemes based on the same gain material. With a new type of gain mirror structure, maximum output power values reach 7.1 W with intracavity diamond gain mirrors and 5.6 W with flip-chip gain mirrors, using a pump spot diameter of 300 µm, exhibiting a beam quality factor M(2)< 1.25 in the full operation range. These results confirm previously published theoretical modeling of these types of SDLs.

High-power flip-chip semiconductor disk laser in the 1.3 µm wavelength band.

We present 6.1 W of output power from a flip-chip semiconductor disk laser (SDL) emitting in the 1.3 µm wavelength region. This is the first demonstration of a flip-chip SDL in this wavelength range with output powers that are comparable to those obtained with intracavity diamond heat spreaders. The flip-chip configuration circumvents the optical distortions and losses that the intracavity diamond heat spreaders can introduce into the laser cavity. This is essential for several key applications of SDLs.

Transverse mode discrimination in long-wavelength wafer-fused vertical-cavity surface-emitting lasers by intra-cavity patterning.

Transverse mode discrimination is demonstrated in long-wavelength wafer-fused vertical-cavity surface-emitting lasers using ring-shaped air gap patterns at the fused interface between the cavity and the top distributed Bragg reflector. A significant number of devices with varying pattern dimensions was investigated by on-wafer mapping, allowing in particular the identification of a design that reproducibly increases the maximal single-mode emitted power by about 30 %. Numerical simulations support these observations and allow specifying optimized ring dimensions for which higher-order transverse modes are localized out of the optical aperture. These simulations predict further enhancement of the single-mode properties of the devices with negligible penalty on threshold current and emitted power.

Microvascular density as an independent predictor of clinical outcome in renal cell carcinoma: an automated image analysis study.

Tumor microvascular density (MVD) has been shown to correlate with the aggressiveness of several cancers. With the introduction of targeted anti-angiogenic therapy, assessment of MVD has the potential not only as a prognostic but also as a therapeutic marker. The significance of tumor vascularity in clear cell renal cell carcinoma (ccRCC) has been debated, with studies showing contradictory results. Previous studies were limited by manual quantification of MVD within a small area of tumor. Since then, the validity of this method has been questioned. To avoid the inaccuracies of manual quantification, we employed a computerized image analysis, which allowed assessment of large areas of tumor and adjacent normal tissue. The latter was used as an internal reference for normalization. MVD and vascular endothelial growth factor (VEGF) were assessed in 57 cases of ccRCC. Sections were immunostained for CD34 and VEGF. Areas of ccRCC and normal kidney medulla were analyzed within scanned images using software that counted CD34-positive vessels and measured the intensity of VEGF staining. We obtained unadjusted values from tumoral areas and calculated adjusted values as tumor/normal ratios. Unadjusted MVD had no association with clinical outcome. However, similarly to tumor stage, higher adjusted MVD was associated with shorter disease-free survival (log-rank P=0.037, Cox P=0.02). This was significant in univariate and multivariate analyses. MVD did not correlate with tumor stage, pointing to its independent prognostic value. As expected due to the known molecular abnormalities in ccRCC, most tumors showed higher VEGF expression than normal tissue. Higher adjusted VEGF was associated with high tumor grade (P=0.049). The finding of increased MVD as an independent marker of tumor aggressiveness may prove useful in the development of new tests for prognostic and therapeutic guidance. Digital techniques can provide more accurate assessment of immunomarkers and may reveal less obvious associations.

8 mW fundamental mode output of wafer-fused VCSELs emitting in the 1550-nm band.

We report record-high fundamental mode output power of 8 mW at 0 °C and 1.5 mW at 100°C achieved with wafer-fused InAlGaAs-InP/AlGaAs-GaAs 1550 nm VCSELs incorporating a re-grown tunnel junction and un-doped AlGaAs/GaAs distributed Bragg reflectors. A broad wavelength tuning range of 15 nm by current variation and wavelength setting in a spectral range of 40 nm on the same VCSEL wafer are demonstrated as well. This performance positions wafer-fused VCSELs as prime candidates for many applications in low power consumption, "green" photonics.

Intra-cavity patterning for mode control in 1.3 µm coupled VCSEL arrays.

We report coupled VCSEL arrays, emitting at 1.3 µm wavelength, in which both the optical gain/loss and refractive index distributions were defined on different vertical layers. The arrays were electrically pumped through a patterned tunnel junction, whereas the array pixels were realized by intra-cavity patterning using sub-wavelength air gaps. Stable oscillations in coupled modes were evidenced for 2x2 array structures, from threshold current up to thermal roll-over, using spectrally resolved field pattern analysis.