Polypropylene as a reinforcement in pelvic surgery is not inert: comparative analysis of 100 explants.

INTRODUCTION AND HYPOTHESIS: Currently, most implants used for reinforcement in surgical treatment of pelvic floor disorders are knitted monofilament polypropylene (PP). While previously recognized as inert, PP is associated with high complication rates. Some recent literature suggests polyester prosthetics based on poly(ethylene terephthalate) (PET), which may be more inert in vivo. METHODS: A sample of 100 implants explanted from patients due to complications was examined to evaluate the relative degradation characteristics of PP and PET prosthetics. Histological, microscopic (scanning electron microscopy, SEM) and chemical analysis (Fourier transform infrared (FTIR) spectroscopy and differential scanning calorimetry (DSC)) were conducted on these explants. RESULTS: Poly(ethylene terephtahlate) explants appeared to sustain less degradation in vivo than the PP explants observed in this cohort. CONCLUSIONS: This is the first study to evaluate synthetic implants used in a vaginal approach for pelvic floor reinforcement. The study provides evidence contrary to published literature characterizing PP as inert in such applications. Additionally, the study suggests the need for clinical trials comparatively investigating the performance of new types of monofilament prosthetics, such as those comprising PET.

An anatomical study of the nasal superficial musculoaponeurotic system: surgical applications in rhinoplasty.

OBJECTIVE: To give a unifying description of nasal muscles and ligaments corresponding to anatomical and surgical findings such as the dermocartilaginous ligament described by Pintanguy in 2001. METHODS: In 30 fresh cadavers of white individuals, nasal dissections were performed, divided into 3 different approaches: from radix to nasal tip, from nasal tip to radix, and from midline to lateral. The anatomical and surgical planes of dissection were followed to isolate the nasal superficial musculoaponeurotic system (SMAS). Correlations between the nasal SMAS and the nasal framework were noticed. In 9 specimens, the left nasal wall was resected for histologic examination. RESULTS: The nasal SMAS consists of a unique layer, and it divides at the level of the nasal valve into deep and superficial layers. Each layer has medial and lateral components. The dermocartilaginous ligament corresponds to the deep medial expansion. Both the deep and the superficial medial expansions correspond to the lowering ligaments of the nasal tip; the cephalic rotation of the nasal tip is allowed by their cut. The histological examination showed that the deep lateral expansion is composed of fat. CONCLUSIONS: This description of the nasal SMAS explains the relationship between the nasal muscles and ligaments, including the dermocartilaginous ligament described by Pitanguy. Furthermore, it is helpful to surgeons during rhinoplasty.

Thin-layer cytology: identification of human papillomavirus by hybridization, capture and signal amplification assay using an alcoholic cell preservative medium.

OBJECTIVE: To ensure complete reliability in the detection of hyman papillomavirus using either Specimen Transport Medium (Digene Inc., Gaithersburg, Maryland, U.S.A) or an alcoholic cell preservative. STUDY DESIGN: In order to compare both media, we adjusted the cell content of specimens and optimized the denaturation duration to avoid chemiluminescence inhibition. RESULTS: We validated this protocol in 2 groups of 90 patients, leading to agreement of 100% in both positive and negative tests. This was confirmed using linear regression curves. We demonstrated that any change in the Digene protocol, especially the use of other preservatives, should be carefully evaluated since it may interfere with DNA denaturation and hybridization and the chemiluminescence signal. The main risk was obtaining false positive responses from nonspecific DNA hybridization and false negative ones because of chemiluminescence signal inhibition. CONCLUSION: It is necessary to take into account preservative characteristics when a new protocol is under validation.