Rate of Vaginal Cuff Dehiscence When Using Vicryl (Poliglactyn 910) Compared to PDS (Polydioxanone) for Vaginal Cuff Closure in Laparoscopic Hysterectomy.

Objective: To compare the vaginal cuff dehiscence (VCD) rates using Vicryl (Poliglactyn 910) and Polydioxanone (PDS) in patients who underwent laparoscopic hysterectomy. Materials and methods: A retrospective, monocentric study was conducted, including all patients undergoing laparoscopic hysterectomy at the Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, Catania, between January 2014 and December 2021. Patients underwent hysterectomy for benign gynecologic pathologies (endometriosis, leiomyomas, or benign pelvic pathologies) or malignant gynecologic pathologies (endometrium cancer, complex endometrial hyperplasia, ovarian cancer, cervix cancer, or uterine carcinosarcoma). The Z-score calculation was performed to find eventual statistically significant differences between the two populations regarding VCD rates. Results: Laparoscopic vaginal cuff closure was performed, with Vicryl sutures in 202 patients and PDS sutures in 184 women. Demographic and baseline characteristics were not significantly different in the two groups. VCD occurred in three patients in the Vicryl group and did not occur in the PDS group. The three cases of VCD were precipitated by intercourses that occurred within 90 days of surgery. However, there was not a significant statistical difference between the two groups regarding VCD (p = 0.09). Conclusions: Vicryl and PDS sutures seem to be similar for vaginal cuff closure in laparoscopic hysterectomy. The VCD rate was low, and the observed differences between the Vicryl and PDS groups did not reach statistical significance. Further research through prospective studies is essential.

Bioactive Suture with Added Innate Defense Functionality for the Reduction of Bacterial Infection and Inflammation.

Surgical site infections (SSI) are a clinical and economic burden. Suture-associated SSI may develop when bacteria colonize the suture surface and form biofilms that are resistant to antibiotics. Thrombin-derived C-terminal peptide (TCP)-25 is a host defense peptide with a unique dual mode of action that can target both bacteria and the excessive inflammation induced by bacterial products. The peptide demonstrates therapeutic potential in preclinical in vivo wound infection models. In this study, the authors set out to explore whether TCP-25 can provide a new bioactive innate immune feature to hydrophilic polyglactin sutures (Vicryl). Using a combination of biochemical, biophysical, antibacterial, biofilm, and anti-inflammatory assays in vitro, in silico molecular modeling studies, along with experimental infection and inflammation models in mice, a proof-of-concept that TCP-25 can provide Vicryl sutures with a previously undisclosed host defense capacity, that enables targeting of bacteria, biofilms, and the accompanying inflammatory response, is shown.

Efficacy of mesh coverage in surgical bullectomy for primary spontaneous pneumothorax: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Thoracic surgeons are now adopting a new method of using a mesh covering to reduce recurrence in surgical pleurodesis for pneumothorax. We aimed to review the literature and compare the outcomes of using mesh covering as an additional procedure during surgical pleurodesis. METHODS: A comprehensive search was performed from inception to October 2022 on PubMed, Embase, Cochrane and Scopus. Randomised controlled trials (RCTs) and observational cohort studies (OCSs) comparing the use of mesh coverage, and different materials were included. Data were extracted to compare recurrence and other outcomes using a random effect model. RESULTS: 23 studies consisting of 2 RCTs and 21 OCSs totalling 5092 patients were included. Patients with a mesh had a significantly lower recurrence (OR = 0.22, 95% CI 0.12-0.42, p < 0.0001) and a shorter duration of chest tube drainage (SMD = -0.74 days, 95% CI -0.28 to -1.20, p < 0.0001) but no significant difference in the length of operation. The use of polyglycolic acid (PGA) and vicryl mesh was associated with a significantly shorter duration of chest tube drainage [(PGA, SMD = 0.83 days, 95% CI 0.14-1.52, p < 0.0001), (vicryl, SMD = 1.06 days, 95% CI 0.71-2.82, p = 0.0005)]. They also had a shorter post-operative length of stay than oxidized regenerative cellulose (ORC) but this was not statistically significant. CONCLUSION: The use of a mesh material reduced the incidence of post-operative air leaks in the short term and the recurrence rate in the long term. Some mesh materials such as PGA and vicryl performed better than other materials.

NDAT Targets PI3K-Mediated PD-L1 Upregulation to Reduce Proliferation in Gefitinib-Resistant Colorectal Cancer.

The property of drug-resistance may attenuate clinical therapy in cancer cells, such as chemoresistance to gefitinib in colon cancer cells. In previous studies, overexpression of PD-L1 causes proliferation and metastasis in cancer cells; therefore, the PD-L1 pathway allows tumor cells to exert an adaptive resistance mechanism in vivo. Nano-diamino-tetrac (NDAT) has been shown to enhance the anti-proliferative effect induced by first-line chemotherapy in various types of cancer, including colorectal cancer (CRC). In this work, we attempted to explore whether NDAT could enhance the anti-proliferative effect of gefitinib in CRC and clarified the mechanism of their interaction. The MTT assay was utilized to detect a reduction in cell proliferation in four primary culture tumor cells treated with gefitinib or NDAT. The gene expression of PD-L1 and other tumor growth-related molecules were quantified by quantitative polymerase chain reaction (qPCR). Furthermore, the identification of PI3K and PD-L1 in treated CRC cells were detected by western blotting analysis. PD-L1 presentation in HCT116 xenograft tumors was characterized by specialized immunohistochemistry (IHC) and the hematoxylin and eosin stain (H&E stain). The correlations between the change in PD-L1 expression and tumorigenic characteristics were also analyzed. (3) The PD-L1 was highly expressed in Colo_160224 rather than in the other three primary CRC cells and HCT-116 cells. Moreover, the PD-L1 expression was decreased by gefitinib (1 µM and 10 µM) in two cells (Colo_150624 and 160426), but 10 µM gefitinib stimulated PD-L1 expression in gefitinib-resistant primary CRC Colo_160224 cells. Inactivated PI3K reduced PD-L1 expression and proliferation in CRC Colo_160224 cells. Gefitinib didn't inhibit PD-L1 expression and PI3K activation in gefitinib-resistant Colo_160224 cells. However, NDAT inhibited PI3K activation as well as PD-L1 accumulation in gefitinib-resistant Colo_160224 cells. The combined treatment of NDAT and gefitinib inhibited pPI3K and PD-L1 expression and cell proliferation. Additionally, NDAT reduced PD-L1 accumulation and tumor growth in the HCT116 (K-RAS mutant) xenograft experiment. (4) Gefitinib might suppress PD-L1 expression but did not inhibit proliferation through PI3K in gefitinib-resistant primary CRC cells. However, NDAT not only down-regulated PD-L1 expression via blocking PI3K activation but also inhibited cell proliferation in gefitinib-resistant CRCs.

Comparison of non-absorbable silk and absorbable polyglactin sutures for external ptosis repair.

Purpose: The authors compare the outcomes and revision rates for external levator aponeurotic advancement for the treatment of involutional ptosis using non-absorbable silk and absorbable polyglactin sutures.Methods: An IRB-approved retrospective chart review identified 121 patients who underwent external levator advancement for involutional ptosis between 2015 and 2016 by the senior author (JBH).  All patients underwent ptosis repair using either 5-0 polyglactin 910 on a S-14 spatulated needle or 6-0 silk on a G-1 reverse cutting needle for the aponeurotic advancement. Ptosis etiologies other than involutional ptosis were excluded. Patients with >0.5 mm of upper lid height asymmetry post-operatively underwent surgical adjustment. Demographics, clinical findings and revision rates were collected and analyzed from follow-up visits.Results: 116 patients (190 eyelids) met inclusion criteria. Fewer ptosis repairs performed using silk sutures necessitated adjustment when compared to those using polyglactin (1/73 [1.4%] vs. 14/117 [12.0%], p = 0.010). Silk direct connection sutures had no better stability than polyglactin direct connection sutures (p = 0.16), but silk hang-back sutures were significantly superior to polyglactin hang-back sutures (p = 0.035).  Thirteen out of fifteen (86.7%) revisions were advancements to raise the eyelid, while two (13.3%) were recessions.Conclusion: Non-absorbable silk suture may be superior to absorbable polyglactin, necessitating fewer surgical revisions. Silk demonstrated superiority to polyglactin when a hang-back suture was employed. Since the need to place direct or hang-back sutures cannot be made pre-operatively, the authors modified their technique to utilize silk sutures for external aponeurotic ptosis repair.

Absorbable Polyglactin vs. Non-Cross-linked Porcine Biological Mesh for the Surgical Treatment of Infected Incisional Hernia.

BACKGROUND: The use of absorbable meshes during contaminated or infected incisional hernia (IH) repair is associated with high morbidity and recurrence rates. Biological meshes might be more appropriate but have been described in highly heterogeneous series. This study aimed at comparing the efficacy of absorbable vs. biological meshes for the treatment of contaminated or infected IH in a homogeneous series with a standardized technique. METHODS: Data of all patients operated on between 2008 and 2015 for contaminated or infected IH, using an absorbable (A) Vicryl® or a biological (B) Strattice® mesh, were reviewed. Patient characteristics, infectious complication rates, and recurrence-free outcome (RFO) were compared between the two groups. A propensity score methodology was applied to a Cox regression model to deal with unbalanced characteristics between groups. RESULTS: Patient demographics in A (n = 57) and in B (n = 24) were similar except that B patients had larger parietal defects (p < 0.001) and higher Center for Disease Control (CDC) wound class (p = 0.034). Patients in A had statistically significantly more postoperative early (61.4% vs. 33.3%, p = 0.03) and late (31.2% vs. 8.3%, p = 0.046) infectious complications. Six-, 12-, and 36-month RFO rates were 77%, 47%, and 24%, and 96%, 87%, and 82% in A and B, respectively, p < 0.001. Raw multivariable Cox regression analysis found that B (HR = 0.1, 95% CI [0.03-0.34], p < 0.001) was independently associated with prolonged RFO (HR = 0.091, 95% CI [0.045-0.180], p < 0.001). CONCLUSION: Biological meshes seem to be superior to absorbable meshes in patients with contaminated or infected incisional hernia. These results need to be confirmed by prospective randomized trials.

A Retrospective Review of Vaginal Cuff Dehiscence: Comparing Absorbable and Nonabsorbable Sutures.

STUDY OBJECTIVE: To compare the rate of spontaneous and complete vaginal cuff dehiscence (VCD) using absorbable versus nonabsorbable sutures for vaginal cuff closure. DESIGN: Retrospective comparative cohort design. SETTING: Freestanding ambulatory surgery center in suburban Maryland. PATIENTS: Women age >18 years old who underwent hysterectomy for benign conditions between October 2013 and April 2018. INTERVENTION: Laparoscopic retroperitoneal hysterectomy was performed by 2 gynecologic surgical specialists. Transvaginal cuff closure was performed using either absorbable Vicryl (polyglactin 910) sutures (n = 881) or nonabsorbable Ethibond (polyester) sutures (n = 574). The nonabsorbable sutures were surgically removed after 90 days. MEASUREMENTS AND MAIN RESULTS: No statistically significant differences in age, race, weight, body mass index, parity, uterine weight, or number of comorbidities were noted between the nonabsorbable and absorbable suture groups. Spontaneous vaginal cuff dehiscence (VCD) occurred in 3 patients (0.52%) in the nonabsorbable group and in 12 patients (1.4%) in the absorbable group (p = .183). Eleven of the 12 cases of VCD in the absorbable group were precipitated by intercourse and occurred within 90 days of surgery. CONCLUSION: Our data suggest that use of a nonabsorbable suture may be an effective approach to prevent spontaneous VCD, but the benefits should be weighed against the inherent risk associated with a second procedure to remove sutures.

Effect of Using Triclosan-Impregnated Polyglactin Suture to Prevent Infection of Saphenectomy Wounds in CABG: A Prospective, Double-Blind, Randomized Clinical Trial.

OBJECTIVE: To evaluate the efficacy of triclosan-coated suture for the reduction of infection in saphenectomy wounds of patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: A total of 508 patients who underwent saphenectomy in CABG surgery were included in a prospective, randomized, double-blind trial from February/2011 to June/2014. Patients were randomized into the triclosan-coated suture group (n= 251) and the conventional non-antibiotic suture group (n=257). Demographic (gender and age), clinical (body mass index, diabetes, and use of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp times) variables and those related to the saphenectomy wound (pain, dehiscence, erythema, infection, necrosis, and hyperthermia) were measured and analyzed. RESULTS: Of the 508 patients who underwent saphenectomy, 69.9% were males and 40.2% were diabetic. Thirty-three (6.5%) patients presented infection: 13 (5.3%) with triclosan and 20 (7.9%) with conventional suture (P=0.281). Among diabetic patients (n=204), triclosan suture was used in 45.1% with four cases of infection; conventional suture was used in 54.9% of them, with 11 cases of infection. Most patients (94.3%) underwent on-pump CABG. Wound pain was observed in 9.9% of patients with triclosan-coated suture and in 17.9% with conventional suture (P=0.011). Wound hyperthermia was found in 1.6% of patients with triclosan-coated suture and in 5.4% of those with conventional suture (P=0.028). CONCLUSION: Triclosan-coated suture shows lower infection rate in saphenectomy of patients undergoing CABG, although the differences were not statistically significant. Pain and wound hyperthermia were less frequent in patients with triclosan-coated sutures compared with conventional sutures.

Bone Formation of Titanium Implant Surfaces Treated with Submicron Poly(lactide-co-glycolide)/Recombinant Human Transforming Growth Factor- ß2 Particles by the Electrospray Method: An In Vivo Study.

PURPOSE: This study evaluated the effect of anodized titanium implants coated with submicron-sized poly(lactide-co-glycolide) (PLGA)/recombinant human transforming growth factor- ß2 (rhTGF- ß2) particles via electrospray on osseointegration in an in vivo model. MATERIALS AND METHODS: An experimental group of anodized titanium implants coated with submicron PLGA/rhTGF-ß2 particles by electrospray was compared topographically and histomorphometrically to noncoated anodized implants. Forty-eight anodized titanium implants were inserted into the tibias of 12 New Zealand rabbits. The histomorphometric specimens were prepared after sacrificing at 3 and 6 weeks after implant placement. Bone-to-implant contact percentage (BIC%) and bone area percentage (BA%) were calculated. The surface roughness and histomorphometric values were statistically analyzed, with a P value < .05 defined as statistically significant. RESULTS: The implant surfaces showed a uniform submicron-sized coating of PLGA/rhTGF-ß2 particles. There was no significant difference in surface roughness between the groups. Both BIC% and BA% of the three best consecutive threads in the experimental group (3 weeks postplacement) were significantly higher than those of the control group (P = .045 and P = .048, respectively), whereas only the BIC% of the three best consecutive threads of the experimental group (6 weeks postplacement) was higher than that of the control group (P = .033). None of the groups tested showed any statistically significant differences in these metrics along the total length of the implant. CONCLUSION: Within the limitations of this study, coating rhTGF-ß2 on implants with the help of PLGA carriers by electrospray may have enhanced osseointegration during the early stage of implant healing period in in-vivo rabbit tibia model.

Effect of using triclosan-impregnated polyglactin suture to prevent infection of saphenectomy wounds in cabg: a prospective, double-blind, randomized clinical trial

Abstract Objective: To evaluate the efficacy of triclosan-coated suture for the reduction of infection in saphenectomy wounds of patients undergoing coronary artery bypass graft (CABG) surgery. Methods: A total of 508 patients who underwent saphenectomy in CABG surgery were included in a prospective, randomized, double-blind trial from February/2011 to June/2014. Patients were randomized into the triclosan-coated suture group (n= 251) and the conventional non-antibiotic suture group (n=257). Demographic (gender and age), clinical (body mass index, diabetes, and use of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp times) variables and those related to the saphenectomy wound (pain, dehiscence, erythema, infection, necrosis, and hyperthermia) were measured and analyzed. Results: Of the 508 patients who underwent saphenectomy, 69.9% were males and 40.2% were diabetic. Thirty-three (6.5%) patients presented infection: 13 (5.3%) with triclosan and 20 (7.9%) with conventional suture (P=0.281). Among diabetic patients (n=204), triclosan suture was used in 45.1% with four cases of infection; conventional suture was used in 54.9% of them, with 11 cases of infection. Most patients (94.3%) underwent on-pump CABG. Wound pain was observed in 9.9% of patients with triclosan-coated suture and in 17.9% with conventional suture (P=0.011). Wound hyperthermia was found in 1.6% of patients with triclosan-coated suture and in 5.4% of those with conventional suture (P=0.028). Conclusion: Triclosan-coated suture shows lower infection rate in saphenectomy of patients undergoing CABG, although the differences were not statistically significant. Pain and wound hyperthermia were less frequent in patients with triclosan-coated sutures compared with conventional sutures.

In vitro evaluation of the knot-holding capacity and security, weight, and volume of forwarder knots tied with size-3 polyglactin 910 suture exposed to air, balanced electrolyte solution, or equine abdominal fat.

OBJECTIVE: To evaluate the effect of exposure to a balanced electrolyte solution (BES), or equine abdominal fat on the knot-holding capacity (KHC), relative knot security (RKS), weight, and volume of forwarder knots versus surgeon's knots. SAMPLE: 315 knots tied and tested in vitro. PROCEDURES: United States Pharmacopeia size-3 polyglactin 910 suture exposed to air (dry [control]), equine abdominal fat (fat-exposed), or BES (BES-exposed) was used to tie forwarder knots with 2, 3, and 4 throws and surgeon's knots with 5, 6, 7, and 8 throws. A universal materials testing machine was used to test the tensile strength of suture and knots to failure, and the KHC, RKS, weight, and volume of knots were determined. RESULTS: Forwarder knots had significantly higher KHC and RKS and lower volume, compared with surgeons' knots. Forwarder knots tied with fat-exposed suture had greater weight, but not volume, than did forwarder knots tied with dry or BES-exposed suture with the same number of throws. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that forwarder knots were superior to surgeon's knots when configured as start knots intended for continuous lines of suture. Exposure to media did not negatively affect mechanical or physical properties of forwarder knots and may improve specific biomechanical functions, including KHC and RKS.

Retroperitoneal exploration with Vicryl mesh and fibrin tissue sealant for refractory chylous ascites.

BACKGROUND: Congenital chylous ascites poses a significant challenge in neonatal care, and often results in prolonged, complex hospital stays and increased mortality. Few effective options exist in refractory cases. METHODS: Patients aged 0 to 12 months with refractory chylous ascites underwent retroperitoneal exploration after medical treatment and minimally invasive therapies were unsuccessful. The retroperitoneum was completely exposed via left and right medial visceral rotation and opening the lesser sac. Visible leaks were ligated, and alternating layers of fibrin glue and Vicryl mesh were used to cover the entire retroperitoneum. RESULTS: All 4 patients had resolution of their chylous ascites. None required reoperation or reintervention for chyle leaks. All achieved goal enteral feeds at a median of 29 days postoperatively and were discharged from hospital at a median of 42 days postoperatively. CONCLUSIONS: Management of chylous ascites is extremely challenging in refractory cases. Complete retroperitoneal exposure with fibrin glue and Vicryl mesh application offers a definitive, reliable therapy for achieving cessation of lymphatic leakage and ultimate recovery for patients who fail all nonoperative approaches. STUDY TYPE: Therapeutic. LEVEL OF EVIDENCE: IV.

Nano-Diamino-Tetrac (NDAT) Enhances Resveratrol-Induced Antiproliferation by Action on the RRM2 Pathway in Colorectal Cancers.

Cancer resistance to chemotherapeutic agents is a major issue in the management of cancer patients. Overexpression of the ribonucleotide reductase regulatory subunit M2 (RRM2) has been associated with aggressive cancer behavior and chemoresistance. Nano-diamino-tetrac (NDAT) is a nanoparticulate derivative of tetraiodothyroacetic acid (tetrac), which exerts anticancer properties via several mechanisms and downregulates RRM2 gene expression in cancer cells. Resveratrol is a stilbenoid phytoalexin which binds to a specific site on the cell surface integrin αvß3 to trigger cancer cell death via nuclear translocation of COX-2. Here we report that resveratrol paradoxically activates RRM2 gene expression and protein translation in colon cancer cells. This unanticipated effect inhibits resveratrol-induced COX-2 nuclear accumulation. RRM2 downregulation, whether achieved by RNA interference or treatment with NDAT, enhanced resveratrol-induced COX-2 gene expression and nuclear uptake which is essential to integrin αvß3-mediated-resveratrol-induced antiproliferation in cancer cells. Elsewhere, NDAT downregulated resveratrol-induced RRM2 expression in vivo but potentiated the anticancer effect of the stilbene. These findings suggest that RRM2 appears as a cancer cell defense mechanism which can hinder the anticancer effect of the stilbene via the integrin αvß3 axis. Furthermore, the antagonistic effect of RRM2 against resveratrol is counteracted by the administration of NDAT.

Feasibility study on mouse live imaging after spinal cord injury and poly(lactide-co-glycolide) bridge implantation.

Spinal cord injury (SCI) causes permanent paralysis below the damaged area. SCI is linked to neuronal death, demyelination, and limited ability of neuronal fibers to regenerate. Regeneration capacity is limited by the presence of many inhibitory factors in the spinal cord environment. The use of poly(lactide-co-glycolide) (PLG) bridges has demonstrated the ability to sustain long-term regeneration after SCI in a cervical hemisection mouse model. Critically, imaging of regenerating fibers and the myelination status of these neuronal filaments is a severe limitation to progress in SCI research. We used a transgenic mouse model that selectively expresses fluorescent reporters (eGFP) in the neuronal fibers of the spinal cord. We implanted a PLG bridge at C5 vertebra after hemisection and evaluated in live animals' neuronal fibers at the bridge interface and within the bridge 8 weeks postimplant. These in vivo observations were correlated with in situ evaluation 12 weeks postimplantation. We sectioned the spinal cords and performed fluorescent bioimaging on the sections to observe neuronal fibers going through the bridge. In parallel, to visualize myelination of regenerated axons, we exploited the characteristics of the third-harmonic generation arising from the myelin structure in these fixed sections.

Conjugation of Transforming Growth Factor Beta to Antigen-Loaded Poly(lactide- co-glycolide) Nanoparticles Enhances Efficiency of Antigen-Specific Tolerance.

Current strategies for treating autoimmunity involve the administration of broad-acting immunosuppressive agents that impair healthy immunity. Intravenous (i.v.) administration of poly(lactide- co-glycolide) nanoparticles (NPs) containing disease-relevant antigens (Ag-NPs) have demonstrated antigen (Ag)-specific immune tolerance in models of autoimmunity. However, subcutaneous (s.c.) delivery of Ag-NPs has not been effective. This investigation tested the hypothesis that codelivery of the immunomodulatory cytokine, transforming growth factor beta 1 (TGF-ß), on Ag-NPs would modulate the immune response to Ag-NPs and improve the efficiency of tolerance induction. TGF-ß was coupled to the surface of Ag-NPs such that the loadings of Ag and TGF-ß were independently tunable. The particles demonstrated bioactive delivery of Ag and TGF-ß in vitro by reducing the inflammatory phenotype of bone marrow-derived dendritic cells and inducing regulatory T cells in a coculture system. Using an in vivo mouse model for multiple sclerosis, experimental autoimmune encephalomyelitis, TGF-ß codelivery on Ag-NPs resulted in improved efficacy at lower doses by i.v. administration and significantly reduced disease severity by s.c. administration. This study demonstrates that the codelivery of immunomodulatory cytokines on Ag-NPs may enhance the efficacy of Ag-specific tolerance therapies by programming Ag presenting cells for more efficient tolerance induction.

Nylon, fibrin glue and Vicryl®- the graft fixation techniques in the conjunctival autotransplant for the treatment of primary pterygium / Nylon, cola de fibrina e Vicryl® - Avaliação da fixação do enxerto no autotransplante conjuntival para tratamento do pterígio primário

Abstract Objective: to compare nylon, fibrin glue and Vicryl® in the conjunctival autograft for treatment of primary pterygium. Methods: Prospective study approved by the Ethics Committee following the Declaration of Helsinki. 89 eyes were underwent pterygium excision and conjunctival autograft. They were grouped according to the technique: fibrin glue, nylon 10-0 and 8-0 Vicryl® and followed up for 3 months. Surgical Time, intra and postoperative symptoms, biomicroscopic signs, ocular discomfort ( by Visual Analogue Scale), aesthetic appearance and recurrences (day 21, 90 and 3 years) were evaluated. Results: The operative time was shorter with the fibrin glue (p<0.001). As to intraoperative symptomatology, burning sensation predominated with Vicryl® (p=0,012). The postoperative symptoms and signs: on day 1- secretion with fibrin glue (p=0.02), foreign body sensation (p=0.017) and subconjunctival hemorrhage (p=0.022) with Vycril®; on day 7- chemosis (p=0.035), hyperemia (p<0.001) and eyelid edema (p=0.011) with Vicryl®; on day 21-foreign body sensation (p=0.001) and conjunctival hyperemia (p<0.001) with nylon; on day 90- dry eye (p=0.005) with Vicryl®. Ocular discomfort was greater with Vycril® (p=0.015) on day 7. Final aesthetic appearance was superior with fibrin glue (p=0.003). The recurrences was greater on day 90: 20,7%(nylon), 10%(fibrin glue) and 19%(Vicryl®) (p=0.496) and after 3 years: 4.8% in NG, 0% in FGG, and 5.3% in VG (p=0.536). Conclusion: Fibrin glue showed efficacy, rapidity, less postoperative discomfort and better final aesthetic appearance. Vicryl® showed significant intraoperative and early postoperative symptoms and obvious signs of inflammation, beside ocular discomfort on day 7. Nylon caused more foreign body sensation and conjunctival hyperemia until its removal. The signs of recurrence were similar among the groups.

Resumo Objetivo: comparar o nylon, a cola de fibrina e o Vicryl® no autotransplante conjuntival para o tratamento do pterígio primário. Métodos: estudo prospectivo aprovado pelo Comitê de Ética seguindo a Declaração de Helsinque. 89 olhos foram submetidos à excisão de pterígio e autotransplante conjuntival, agrupados conforme as técnicas: nylon 10-0, cola de fibrina, e Vicryl® 8-0, acompanhados por 3 meses. Tempo cirúrgico, sintomas intra e pós-operatórios, sinais biomicroscópicos, desconforto ocular (Escala Analógica Visual), aspecto estético, recorrências no 21º e 90º dia pós-operatório e aos 3 anos. Resultados: O tempo operatório foi menor com a cola de fibrina e maior com Vicryl® (p<0,001). Sintomatologia intra-operatória: a ardência predominou com Vicryl® (p=0,012). Sintomas e sinais pós-operatórios significativos: no 1º dia, secreção com cola de fibrina (p=0,02), sensação de corpo estranho (p=0,017) e hemorragia subconjuntival (p=0,022) com Vycril®; No 7º dia - quemose (p=0,035), hiperemia (p<0,001) e edema da pálpebra (p=0,011) com Vicryl®; No 21º dia - sensação de corpo estranho (p=0,001) e hiperemia conjuntival (p<0,001) com nylon; No 90º dia - olho seco (p=0,005) com Vicryl®. Desconforto ocular: maior com Vycril® (p=0,015) no 7º dia. Aparência estética final: melhor com a cola (p=0,003). Sinais de recidiva: maior no 90º dia: 20,7%(nylon), 10%(cola) e 19%(Vicryl®) e após 3 anos: 4,8%(nylon), 0%(cola) e 5.3%(Vicryl®) (p=0,536). Conclusão: A cola de fibrina mostrou eficácia, rapidez, menor desconforto pós-operatório e melhor aspecto estético; o Vicryl®, maiores sintomas intraoperatórios, pós-operatórios iniciais e sinais evidentes de inflamação, aliados ao desconforto ocular no 7º dia; o nylon, mais sensação de corpo estranho e hiperemia conjuntival até sua remoção. Os sinais de recidiva foram semelhantes entre os grupos.

Urethrovaginal fistula following vaginal prolapse of a pedunculated uterine myoma: a case report.

BACKGROUND: Urethrovaginal fistulas are usually secondary to a foreign body in the vagina or to vaginal gynecologic surgeries. We present a case of an urethrovaginal fistula secondary to vaginal prolapse of a huge pedunculated submucosal uterine myoma. CASE PRESENTATION: A 25-year-old black African woman with a past history of huge uterine fibroids and an uncomplicated vaginal delivery 5 weeks prior to presentation consulted for a difficult micturition that occurred 2 days earlier. A vaginally prolapsed huge uterine myoma was diagnosed. The fibroid was easily twisted off per vagina. Around 9 days after prolapse of the fibroid or 5 days after its removal, she complained of a vaginal leaking of urine during micturition. An urethrovaginal fistula was diagnosed using a blue dye test. The fistula was successfully repaired with polyglactin and she was discharged on day 15. CONCLUSIONS: To the best of our knowledge, this is the first case of urethrovaginal fistula secondary to delivered uterine myoma. We recommend close postpartum follow-up of women carrying huge uterine fibroid and urgent management of a vaginally prolapsed uterine fibroid to reduce the risk of urethrovaginal fistula.

Ultrasound-induced mild hyperthermia improves the anticancer efficacy of both Taxol® and paclitaxel-loaded nanocapsules.

We study the influence of ultrasound on paclitaxel-loaded nanocapsules in vitro and in vivo. These nanocapsules possess a shell of poly(dl-lactide-co-glycolide)-poly(ethylene glycol) (PLGA-PEG) and a liquid core of perfluorooctyl bromide (PFOB). In vitro experiments show that mechanical effects such as cavitation are negligible for nanocapsules due to their small size and thick and rigid shell. As the mechanical effects were unable to increase paclitaxel delivery, we focused on the thermal effects of ultrasound in the in vivo studies. A focused ultrasound sequence was therefore optimized in vivo under magnetic resonance imaging guidance to obtain localized mild hyperthermia with high acoustic pressure. Ultrasound-induced mild hyperthermia (41-43°C) was then tested in vivo in a subcutaneous CT-26 colon cancer murine model. As hyperthermia is applied, an inhibition of tumor growth for both paclitaxel-loaded nanocapsules and the commercial formulation of paclitaxel, namely Taxol® have been observed (p<0.05). Ultrasound-induced mild hyperthermia at high acoustic pressure appears as an interesting strategy to enhance cytotoxic efficacy locally.

Cirugía conservadora en el cáncer de mama. Reconstrucción con malla reabsorbible de poliglactina 910 / Conservative surgery in breast cancer. Polyglactin 910 absorbable mesh reconstruction

Objetivo. Evaluar los resultados obtenidos en la realización de cirugía conservadora del cáncer de mama mediante el uso de malla reabsorbible de poliglactina 910. Pacientes y método. Estudio prospectivo de serie de casos de pacientes intervenidas de cirugía conservadora de cáncer de mama utilizando malla de poliglactina 910 en aquellas en las que la amplitud de la resección hacía prever un resultado estético desfavorable. El estudio se llevó a cabo en un hospital de tercer nivel en el período 2010-2015. Resultados. Se intervino mediante esta técnica un total de 46 mujeres, con una media de edad de 57 años. Dos pacientes (4,3%) presentaron morbilidad postoperatoria por infección del sitio quirúrgico, requiriendo extracción de la malla en una de ellas y resolviéndose con antibioticoterapia intravenosa el otro caso. En 3 casos (6,5%) se indicó mastectomía por contacto de bordes en estudio anatomopatológico diferido. No se apreciaron dificultades en el seguimiento radiológico, ni recidivas radiológicas en el parénquima mamario, aunque sí se detectó una recidiva cutánea a nivel de la cicatriz de la tumorectomía. El resultado estético obtenido fue favorable en la valoración de las pacientes. Conclusiones. La reconstrucción mediante malla de Vicryl™ en casos seleccionados se presenta como una técnica fácil, resolutiva, rápida y con buenos resultados valorados por el médico y el paciente (AU)

Purpose. To evaluate the results of breast-conserving surgery for breast cancer by using polyglactin 910 absorbable mesh. Patients and method. Prospective case series of patients undergoing conservative breast surgery using polyglactin 910 mesh. Patients were included if the size of resection made a favourable aesthetic result unlikely. The study was conducted in a tertiary hospital during the period 2010-2015. Results. A total of 46 women underwent this technique. The mean age of the patients was 57 years. Postoperative morbidity occurred in two patients (4.3%) due to surgical site infection, which required mesh removal in one and was resolved with intravenous antibiotics in the other. In three patients (6.5%), total mastectomy was performed because delayed pathological analysis revealed margin involvement. There were no difficulties in the radiological follow-up, or radiological recurrences in the breast parenchyma, although a cutaneous recurrence was detected at the lumpectomy scar. Patient assessment of the aesthetic result was favourabe. Conclusions. Reconstruction using polyglactin 910 mesh in selected patients is an easy, decisive, and rapid technique. Patient and physician assessment was favourable (AU)