Long-term functional results after unilateral mid-urethral sling transection for voiding dysfunction.

OBJECTIVE: To investigate the long-term outcomes of unilateral mid-urethral sling transection to treat voiding dysfunction after synthetic mid-urethral sling placement for stress urinary incontinence. STUDY DESIGN: Twenty-three patients who underwent an unilateral sling transection were analyzed retrospectively. Patient records were analyzed for subjective outcome, and pre- and postoperative flow patterns were used as objective outcome parameters. RESULTS: At the first postoperative follow-up, 77.3% of the patients remained dry. After a mean follow-up of 42 months, 73.9% of patients were continent. The flow pattern after lateral sling transection was significantly better than pre-operatively, with higher maximum flow rate (24.2ml/s, p=0.001), higher mean flow rate (10.4ml/s, p=0.001), higher voided volume (308.5ml, p=0.002) and lower residual volume (28.7ml, p=0.003). At final postoperative follow-up, eight patients (34.8%) reported urgency and six patients (26.1%) were incontinent; four of these patients (17.4%) mainly had urge incontinence. CONCLUSIONS: Unilateral mid-urethral sling transection is a safe, effective technique to treat voiding symptoms with good preservation of continence. The technique repairs the obstructive flow effectively. Urgency and urge incontinence after mid-urethral sling placement are difficult to treat with transection alone.

Regional variation of bone matrix components in osteoarthrotic and normal femoral heads.

Three regios of cancellous bone, two subchondral and one central, from the femoral heads of five normal and ten osteoarthrotic individuals were analysed for their content of collagen, sialoprotein, proteoglycan and carbohydrate. Confirming previous findings in osteoarthrotic bone this study shows that there are significant quantitative changes in matrix composition consisting of a decrease in collagen content and increase in noncollagenous proteins in osteoarthrosis. Since these matrix alterations were present in all areas of the femoral head, also at areas distal from the subchondral area, it is unlikely that these changes are secondary to bone remodeling near the joint destruction. Difference in matrix composition according to the area of the femoral head was also found in the controls, indicating that bone matrix proteins are related to mechanic properties of the bone. The more stress the bone has to withstand, the lower the collagen/noncollagenous protein ratio in its matrix. These observations suggest that in osteoarthrosis, the bone is stiffer and can therefore absorb less well impact loading and by transmitting it back to the cartilage provokes cartilage dysfunction.

[Cystic formations of the mesentery. Apropos a case report of a pseudocyst of the lesser omentum]. / Les formations kystiques du mésentère. A propos d'une observation d'un pseudo-kyste du petit épiploon.

Mesenteric cysts are rare intraabdominal tumors in surgical pathology. Their etiology has been subject to much discussion. Symptoms are variable and depend on specific complications. Localisation in the gastro-hepatic mesentery is uncommon and has been reported only in two previous issues. We describe a new case with literature review.

[Gastric schwannoma. Observations apropos of a case report of an schwannosarcoma with lymph node metastasis]. / Les schwannomes gastriques. Réflexions à propos d'une observation d'une schwannosarcome avec métastase ganglionnaire.

Schwannomas as neurofibromas are neurogenic mesenchymal tumors of the stomach. They arise from the Schwann cells of nerves of th gastric wall and are usually benign. The incidence of malignant schwannomas is uncertain because of the variable pathologic criteria used. Immunohistochemistry is a diagnostic tool used to distinguish between schwannomas and leiomyomas both constituted by spindle-cells. In this issue we report a case of malignant schwannoma with lymph node involvement. The clinical and histological features of gastric schwannomas are discussed with evaluation of their diagnostic and therapeutic modalities.

[Delayed perforation of the sigmoid colon following closed abdominal trauma. Apropos of a case report]. / Perforation retardée du côlon sigmoïde après traumatisme fermé de l'abdomen. A propos d'une observation.

Blunt abdominal trauma and delayed colon perforations are not common and usually occur in patients sustaining other injuries, but also as isolated event. We report a case of delayed perforation of sigmoid colon, three days after a blunt abdominal trauma in a male adult. It was caused by disinsertion of sigmoid colon mesentery for about ten centimeters. This condition is discussed with literature review.

[Benign retroperitoneal pelvic schwannoma. Apropos of 2 cases]. / Les schwannomes bénins rétropéritonéaux pelviens. A propos de 2 observations.

Authors have described 2 cases of benign schwannomas of pelvian origin and with abdominal extension. The diagnosis is often late because of the absence of early clinical signs and of specific investigations. The reliability of the diagnosis is based on the mobid anatomy of the surgical pieces, the hypervascularization. Schwannomes with bone adherences complicate the surgical treatment. These tumors very seldom degenerate. The pronostic is related to the risk seldom degenerate. The pronostic is related to the risk of recurrence if their ablation is incomplete.

[Conversion laparatomies during cholecystectomies under laparoscopy. Apropos of 285 consecutive cholecystectomies]. / Les laparotomies de conversions au cours des cholécystectomies par laparoscopie. A propos de 285 cholécystectomies consécutives.

Retrospective analysis of a consecutive series of 285 cholecystectomies carried out by laparoscopy showed that 47 patients (17.5%) required conversion laparotomy. In 55% of these cases the conversion was due to difficulty in dissecting the gallbladder or cystic duct. Peri-operative cholangiography should be performed routinely, not only to verify the vacuity of the common bile duct (13% of the conversions) but, more particularly, to ensure the integrity of the principal biliary pathway during the dissection (8.5% of the conversions). Cholecystectomy under celioscopy is a proven and safe technique, on the condition that all stages of classical surgery can be carried out under good conditions.

MR imaging of a diverticulum in a female urethra.

The case of a 44-year-old woman with urethral diverticulum is described. The lesion was initially detected by ultrasonography. MRI proved to be very sensitive in localising and delineating the urethral diverticulum and could differentiate it from lesions arising from the vagina or bladder.

Urethral advancement for distal hypospadias repair, indications, techniques and results.

Urethral advancement is a less well known technique for the repair of distal hypospadias. We treated 37 patients with a median age of 3 years for coronal and subcoronal hypospadias, with excellent results.