Primary fixation of mini slings: a comparative biomechanical study in vivo

INTRODUCTION AND OBJECTIVES: The mini sling concept for stress urinary incontinence is an anatomical approach that involves placing a midurethral low-tension tape anchored to the obturator internus muscles bilaterally. They overcome the blind passage of long needles and all the related complications. There are many different devices available and because these are outpatient procedures, primary fixation plays an important role in the outcome. The objective is to evaluate the primary fixation of the various devices of attachment of the commercially available mini-slings through biomechanical tests. MATERIALS AND METHODS: A total of 45 Wistar rats were divided in 3 groups of 15 rats each. They underwent 5 subcutaneous implantation of different mini slings and one polipropilene mesh (control), as follows: TVT-Secur® (Gynecare, USA), Type 1 polypropylene mesh (control); Ophira Mini Sling System® (Promedon, Argentina), Tissue Fixation System® (TFS PTY, Australia), Zipper Sling® and "T device" (Prosurg, USA). The abdominal wall was removed on bloc at different times after implant for biomechanical evaluation, which consisted in application of unidirectional force to the extremity of the fixation system or mesh, until it was completely removed from the tissue using a tension meter (Nexygen 3.0 Universal Testing Machine - LLOYD Instruments). The force was measured in Newtons (N). RESULTS: There was significant difference in the resistance to extraction among the different fixation systems. At 7 days the Ophira Mini Sling System® presented the best fixation and "T dispositive" the worst. CONCLUSION: Ophira mini sling System® presented the best primary fixation at 7º, 14º and 30º days. The impact of this feature in the clinical setting needs to be verified.

Linfoma primitivo de mama / Primary lymphoma of the breast

Se presenta un caso de linfoma maligno primitivo de la mama en una paciente de 71 años, cuyo hallazgo fue casual, durante un autoexamen. La punción aspiración resultó negativa, la mamografía demostró un tumor de 3 cm de diámetro, de contornos irregulares y sin microcalcificaciones. Ecográficamente apareció con características sólidas, heterogéneo y multilobulado. La biopsia por congelación informó cáncer ductal infiltrante, por lo que se realizó, en el acto quirúrgico, tumerectomía amplia más linfadenectomía. La biopsia diferida informó linfoma centroblástico difuso, por lo que se completó el estudio con técnicas inmunohistoquímicas, determinando que la estirpe celular predominante era B. En estudios posteriores no se encontraron lesiones linfomatosas en otra parte de la economía. Se completó el tratamiento con 3 ciclos de quimioterapia. Este trabajo incluye también una amplia revisión en la literatura mundial y nacional, acerca de los casos de linfomas primitivos de la mama.