High uterosacral vault suspension vs Sacrocolpopexy for treating apical defects: a randomized controlled trial with twelve months follow-up.

INTRODUCTION AND HYPOTHESIS: The high uterosacral vault suspension (HUVS) is a vaginal approach for treating apical prolapse that provides shorter operative and recovery times and is associated with lower morbidity rates. Success rates reported for this technique are comparable with the abdominal sacrocolpopexy (SCP); however, to date, there are no prospective randomized studies comparing HUVS to SCP. The aim of the study was to compare the anatomical objective cure rates for the apical compartment in patients undergoing either HUVS or SCP at 12 months' follow-up. METHODS: We performed a single-center parallel randomized controlled trial in patients with severe apical defect defined as Pelvic Organ Prolapse Quantification (POP-Q) point C ≥ stage 3. Based on the center's previous experience, a sample size of 124 patients was required to show a 20% cure rate difference between both techniques with 80% power and using a two-tailed 5% level of significance. One hundred and ten patients were available for analysis; 54 were allocated to abdominal SCP and 56 to HUVS. The primary outcome was to evaluate surgical objective success defined as POP-Q point C stage<2. The Pelvic Floor Distress Inventory (PFDI-20), the Perceived Quality of Life Scale (P-QOL), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) questionnaires were used for subjective assessment. RESULTS: The objective success rate for apical suspension at 12 months' follow-up was 100% for abdominal SCP and 82.5% for HUVS (log-rank p 0.033). Both techniques showed a significant improvement with regards to prolapse symptoms, quality of life (QOL), and sexual function. The significant improvement in postoperative questionnaires was comparable between both surgeries at 12 months' follow-up. CONCLUSIONS: Abdominal SCP has statistically significant better anatomical results when compared with HUVS for correcting apical defects at 12 months.

Avian toxoplasmosis: experimental infection of chicken and pigeon.

Two groups of 13 new-laying hens each were infected by crop-route with 5000 and 50,000 infective oocysts of T. gondii. Four groups of 5 pigeons each were inoculated by crop-route with 50, 500, 1000 and 5000 infective oocysts. To each group of infected birds suitable controls were added. Hens from the experiment with 5000 infective oocysts were apparently resistant to the infection and they had no clinical signs in the succeeding 40 days p.i. Hens from the experiment with 50,000 infective oocysts showed an egg-drop and mortality in embryonated eggs, especially during the first 2 weeks p.i. Isolation of the parasite was unsuccessfully attempted from 720 embryonated eggs, produced by infected groups, and tested on various days p.i. and at different stages of infection. The parasite was isolated from the brain, heart, liver, spleen and lung of infected birds 7 and 15 days p.i.; 40 days p.i. it was evident only in brain and heart. IgG onset and mean course were monitored by ELISA and high titers were reached by both groups. Pigeons from groups 500, 1000 and 5000 developed rapidly progressive clinical signs as diarrhea, trembling, incoordination, torticollis and death. They had enlargement of liver and spleen and focal necrosis, nodular features in the crop. Pigeons from expt 50 had no clinical signs in spite of the presence of the parasite in their organs for over 45 days p.i. Parasite was isolated from brain, heart, liver, spleen, lung, kidney, crop and muscles from all infected groups. Histopathological and ultrastructural features revealed the presence of multiplying tachizoites even within cells of the crop. Seroconversion, as monitored by ELISA, was recorded in all infected groups although high ELISA-titres were never reached. One of the negative controls from expt 5000 developed specific antibodies but the parasite was not isolated from its organs.

Detection of tet(M) gene from raw milk by rapid DNA extraction followed by a two-step PCR with nested primers.

The likelihood that milk and milk products may act as a vehicle for antibiotic-resistant bacterial genes has become a concern to the food industry and a public health issue, and the demand for rapid tests has increased. The purity of DNA extracted from food samples is a key issue in the sensitivity and usefulness of biological analyses, such as PCR for pathogens and nonpathogens. A rapid, phenol-chloroform free method based on a modification of a sodium iodide DNA extraction, followed by a two-step PCR was developed for direct detection of the tet(M) gene in milk samples within a single working day. This study compares the proposed method with a traditional phenol solvent extraction method and with a commercial kit (QIAamp DNA blood mini kit, Qiagen). The three DNA extraction methods were used to ensure access to the tet(M) gene from 1 ml of raw milk, inoculated with a strain of Enterococcus faecalis, which carries the tet(M) gene. The proposed method, followed by a two-step PCR with nested primers specific for the tet(M) gene, was able to reach a detection limit below 10 CFU/ml in less than 4 h, including the two amplification cycles, thus outperforming in sensitivity and rapidity both the traditional and the commercial method.

[Serous peritoneal papillary tumor of low malignancy potential. Report of a case]. / Tumor papilar peritoneal seroso de bajo potencial maligno. Comunicación de un caso.

Papillary serous carcinoma with low malignant potential, similar to those described in the ovary, can also originate in the peritoneum. Characteristically they show peritoneal spread without involvement of the ovary and, if present, it corresponds to a superficial implant similar to those seen in the rest of the peritoneal cavity. Histologically they correspond to a low malignant potential tumor; they are slow growing and have good prognosis. They are common in young women, usually they present few symptoms and are frequently discovered during other surgical procedures. The treatment is surgical and it can be conservative in cases of women who want to preserve their fertility, without coadjuvant therapy. We report a 34 years old woman with a primary peritoneal serous carcinoma with low malignant potential and discuss its management.

[Congenital defects of antithrombin III and proteins C and S during pregnancy]. / Defectos congénitos de antitrombina III y proteínas S y C durante el embarazo.

We report 10 patients with congenital deficiencies of the natural anticoagulant proteins S, C and antithrombin III. Thirteen of a total of 30 pregnancies were managed at the perinatal branch of our department. We discuss the mechanism of action of these proteins and their role in thrombotic events. We analyze the most frequent thrombotic complications and we discuss the general guidelines for the investigation of a patient with a suspected congenital thrombophilia with special regard to its management during pregnancy, delivery and perinatal outcome.