Short-term outcomes of a multicentre prospective study using a "visible" polyvinylidene fluoride onlay mesh for the prevention of midline incisional hernia.

INTRODUCTION: Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under magnetic resonance imaging (MRI). METHOD: This is a prospective multicentre observational cohort study. Preliminary results from the first 3 months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. Multivariate logistic regression was used. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position. MRIs were performed 6 weeks after treatment. RESULTS: Between July 2016 and June 2022, 185 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with the requirement of stoma being the only significant risk factor (OR = 7.59, p = 0.03). The formation of a seroma at 6 weeks detected by MRI, was associated with body mass index (OR = 1.13, p = 0.02). CONCLUSIONS: The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to detect asymptomatic seromas during the early process of integration. STUDY REGISTRATION:  This protocol was registered at ClinicalTrials.gov (NCT03105895).

MR imaging-based assessment of the female pelvic floor.

Pelvic floor weakness is a functional condition that affects the anatomic structures supporting the pelvic organs: fasciae, ligaments, and muscles. It is a prevalent disorder among people older than 50 years, especially women, and may substantially diminish their quality of life. Many complex causes of pelvic floor weakness have been described, but the greatest risk factors are aging and female sex. Pelvic floor weakness can provoke a wide range of symptoms, including pain, urinary and fecal incontinence, constipation, difficulty in voiding, a sense of pressure, and sexual dysfunction. When the condition is diagnosed solely on the basis of physical and clinical examination, the compartments involved and the site of prolapse are frequently misidentified. Such errors contribute to a high number of failed interventions. Magnetic resonance (MR) imaging, which allows visualization of all three compartments, has proved a reliable technique for accurate diagnosis, especially when involvement of multiple compartments is suspected. MR imaging allows precise evaluation of ligaments, muscles, and pelvic organs and provides accurate information for appropriate surgical treatment. Moreover, dynamic MR imaging with steady-state sequences enables the evaluation of functional disorders of the pelvic floor. The authors review the pelvic floor anatomy, describe the MR imaging protocol used in their institutions, survey common MR imaging findings in the presence of pelvic floor weakness, and highlight key details that radiologists should provide surgeons to ensure effective treatment and improved outcomes.

Cribado radiológico de cáncer de mama en mujeres con alto riesgo / Radiological screening of breast cancer in women at high risk

Se han identificado numerosos factores de riesgo relacionados con el desarrollo del cáncer de mama. Las mujeres con alto riesgo deben someterse a un estudio intensificado para la detección precoz de lesiones sospechosas. Sin embargo, la definición de población de alto riesgo ha sufrido modificaciones durante las últimas décadas, apuntando actualmente a los antecedentes personales y familiares, basados en modelos predictivos, y a la herencia, valorada a través de un estudio genético, como los principales factores a tener en cuenta a la hora de seleccionar a las mujeres con mayor riesgo para efectuar el cribado. Así mismo, los protocolos en cuanto al tipo de estudios de imagen y la periodicidad de estos a la hora de realizar el cribado se están homogenizando, implementando el examen de resonancia magnética anual a partir de los 30 años en la mayoría de las recomendaciones. Esta actualización intenta resumir las recomendaciones de las principales sociedades científicas a nivel internacional, en cuanto a la selección de las mujeres con alto riesgo y las exploraciones radiológicas que deben realizarse para efectuar un seguimiento individualizado. (AU)

Numerous risk factors have been identified for the development of breast cancer. High-risk women should participate in an intensified study for the early detection of suspicious lesions. However, the definition of the high-risk population has changed in recent decades. Currently, the main factors to consider in the selection of women at highest risk of developing breast cancer are personal and family history, based on predictive models, and inheritance, evaluated through genetic study. Similarly, protocols for the imaging technique and their timing are being standardised, with the most widely made recommendation being the use of annual magnetic resonance imaging from the age of 30 years. This update attempts to summarise the recommendations of the main international scientific societies for the selection of high-risk women and the radiological examinations that should be performed to establish an individualised follow-up. (AU)