Measurement of extraction forces of non-absorbable suture and different anchoring systems used for pelvic organ prolapse surgery using soft-embalmed cadavers: A feasibility study.

OBJECTIVE: Success of pelvic organ prolapse (POP) mesh procedures also depends on reliable anchoring systems (AS). Our primary aim was to assess the use of soft-embalmed cadavers in testing of different AS and our secondary aim was to compare extraction forces (EF) of different AS and non-absorbable suture (NAS). STUDY DESIGN: IRB approval was obtained. NAS (Ti-cron®) and different AS were attached to force-measuring instrument (Dynamometer SS25LA) and anchored to anterior longitudinal (ALL) and pectineal ligament (PL) (Protack®, Uplift®, NAS), and sacrospinous ligament (SSL) (Surelift®, Elevate PC®, NAS) of Thiel soft-embalmed cadavers. EF were measured 2-4 times in each cadaver. Data were compared using non-parametric tests. Statistical significance was set at p < 0.05. RESULTS: Three female cadavers (age 59, 77 and 87) were used. NAS EF were significantly higher than AS EF for ALL and SSL, but not PL. Thiel soft-embalmed cadavers proved to be useful in testing of different AS. CONCLUSIONS: Use of soft-embalmed cadavers in testing of different AS is feasible. According to our results, the NAS provides most reliable intra-corporeal fixation. However, significant inter- and intra-subject variability indicates that results may also be dependent on the tissue properties and anchoring procedure. Further testing using soft-embalmed cadavers could help optimise mesh procedures and establish a threshold EF necessary for reliable fixation.

Modern stem cell therapy: approach to disease.

Various types of stem cells exist, each with their own advantages and disadvantages. Considering the current available evidence, important preclinical and clinical studies regarding the therapeutic potential of stem cells, stem cell therapy might be the important strategy for tissue repair. The development of stem cell therapy for tissue repair has primarily relied on stem cells, especially mesenchymal stem cells. Multilineage differentiation into all of the described cells are considered as important candidates for a range of diseases like neurological diseases, cardiovascular diseases, gastrointestinal cancer and genetic defects, as well as for acute and chronic wounds healing and pharmaceutical treatment. We review the properties and multipotency of stem cells and their differentiation potential, once cultured under specific growth conditions, for use in cell-based therapies and functional tissue replacement.

Biological pathways involved in the development of inflammatory bowel disease.

Apoptosis, autophagy and necrosis are three distinct functional types of the mammalian cell death network. All of them are characterized by a number of cell's morphological changes. The inappropriate induction of cell death is involved in the pathogenesis of a number of diseases.Pathogenesis of inflammatory bowel diseases (ulcerative colitis, Crohn's disease) includes an abnormal immunological response to disturbed intestinal microflora. One of the most important reason in pathogenesis of chronic inflammatory disease and subsequent multiple organ pathology is a barrier function of the gut, regulating cellular viability. Recent findings have begun to explain the mechanisms by which intestinal epithelial cells are able to survive in such an environment and how loss of normal regulatory processes may lead to inflammatory bowel disease (IBD).This review focuses on the regulation of biological pathways in development and homeostasis in IBD. Better understanding of the physiological functions of biological pathways and their influence on inflammation, immunity, and barrier function will simplify our expertice of homeostasis in the gastrointestinal tract and in upgrading diagnosis and treatment.

Complete mapping of lateral and medial sural artery perforators: anatomical study with Duplex-Doppler ultrasound correlation.

INTRODUCTION: The precise vascular anatomy of posterior lower leg skin is not well understood. Despite being a potential donor site for sural artery perforator flaps, this region is rarely used and underestimated. The aim of this study was to provide exact preoperative planning for medial and lateral sural artery perforator flap harvest. METHODS: An anatomical study on 16 cadaveric lower legs was performed to determine the number and location of all medial and lateral sural artery perforators in relation to five fixed points (medial and lateral maleolus, calcaneus, medial and lateral condyle). A Duplex study on 32 lower legs determined the number and location of dominant medial and lateral sural artery perforators in relation to same anatomical points. Results of the two studies were correlated. RESULTS: A total of 234 perforators were found in the anatomical (134) and Duplex studies (100). A dominant lateral sural artery perforator was found in 9.4% of all lateral perforators in 31% of dissected legs. A dominant medial sural artery perforator was found in 37% of all medial perforators in 94% of legs. The difference in the number of dominant medial and lateral perforators was significant (p < 0.001) in the anatomical study, while no significant difference was found in the Duplex study (p = 0.920). CONCLUSION: The anatomical study showed relative unreliability of sural region regarding number of dominant perforators. Therefore, harvest of medial and particularly lateral sural artery perforator flap is unsafe without preoperative perforator mapping. No significant difference in location of dominant perforators was found between Duplex and anatomical studies. Duplex proved reliable for planning of sural artery perforator flaps due to high precision in detecting location of dominant perforators.

Anatomical peculiarities of the cavo-tricuspid isthmus in the human heart.

The cavo-tricuspid isthmus is the term for the part of the right atrium between the ostium of the inferior vena cava and its border--the Eustachian ridge on one side and the tricuspid valve on the other side. In this area lie the coronary sinus ostium with its Thebesian valve, the fibers of Chiari (10%), and ostia of the deep cardiac veins--the Thebesian veins in close relation to the coronary sinus ostium (35%). Pacing of the coronary sinus is very often used during the treatment of cardiac arrhythmias; radiofrequency catheter ablation in cases of permanent atrial tachycardia is successfully performed through the coronary sinus; during certain cardiosurgical procedures, cardioplegia is performed by retrograde perfusion of the myocardium through the coronary sinus. Knowing and recognizing certain anatomical peculiarities of the structures in this part of the right atrium may be interesting for clinical practice.

An anatomical variation of the origin of the human right inferior thyroid and bronchial arteries.

During routine anatomical dissection we found an unusual case of origin of the right bronchial artery from a common stem with the inferior thyroid artery, which arose from the internal thoracic artery. Anatomical variations of the origin of bronchial arteries are very frequent and numerous, and their recognition may be helpful in certain surgical and diagnostic procedures.

The anatomic variability of the coronary vasculature of the human heart--part II: some anatomical peculiarities of arteriovenous relations.

The arteriovenous relations in human heart are, in some instances, different from arteriovenous relations in other parts of the body. The specific relations between cardiac arteries and veins may enable diffusible substances carried through the system of juxta-arterial cardiac veins to influence the regulation of the lumen of the coronary arteries. Arteriovenous anastomoses (6% of our 150 cases) permit direct communication between the arteries and veins bypassing the capillary circulation; it is assumed that these anastomoses prevent coagulation of blood in small veins. In cases of arterial occlusion, the myocardium is supplied by veins that allow retrograde vascularization of the myocardium. In 33% of our cases the posterior atrial branches (0.5-1.0 mm in diameter) of the coronary arteries ran through the wall of the coronary venous sinus on their way from the parent vessel, which lay in the coronary sulcus, to the left atrium. In 11% of the cases, the arterial branch that ran through the distal portion of the wall of the coronary sinus was the interatrial branch. The blood flow through the parietal arteries of the venous coronary sinus probably depends on the condition of the muscular layer of the sinus during the phases of cardiac action, and this might be important in the course of certain cardiosurgical procedures.

The anatomic variability of the coronary vasculature of the human heart--part I: functional vascular zones--a morphological view.

The myocardium may be divided into distinct zones which act as functional units of the coronary vascular network. The basic principle of this functional systematization of cardiac blood vessels is a constant relationship between the "distributing" and the "delivering" vessels. Six arterial zones of the myocardium are identified under this scheme: anterior right ventricular, lateral left ventricular, posterior left ventricular, interventricular septal, posterior right ventricular, and atrial. The distributing vessels of functional myocardial zones are most frequently both arterial and venous. However, between the lateral and posterior left ventricular zones there is sometimes only the left marginal vein (24%) or left marginal artery (20%). Between the atrial and posterior right ventricular zones there is sometimes only the right coronary artery (52%), or only the small cardiac vein (14%) as a distributing vessel. Between the left and the right posterior ventricular zones there is sometimes an arterial and sometimes a venous distributing vessel (10%). Between the posterior and anterior right ventricular zones there is either the artery (21%) or the right marginal vein (8%) as a distributing vessel. The permanence of the six functional myocardial zones is determined not only by the arterial but also by the venous distributing vessels, and in some cases the venous vessels are the only distributing vessels between certain zones.