Is anatomical failure following anterior vaginal repair associated with weak native vaginal tissues? A biomechanical and immunohistochemical study.

INTRODUCTION AND HYPOTHESIS: This study was performed to determine whether anatomical recurrence of cystocoele 1 year after anterior vaginal repair is related to biomechanical properties and/or the content of collagen in the vaginal wall and epithelial tissues. METHODS: In this prospective, observational study in a UK teaching hospital, we assessed women undergoing surgery for symptomatic anterior compartment prolapse. Outcome measures were anatomical recurrence, biomechanical strength and collagen content in vaginal tissues. In part one of the study, 42 women underwent biomechanical testing of full-thickness anterior vaginal wall tissue samples to determine the elastic moduli and yield stress. In part two, 59 women underwent immunohistochemical testing of anterior vaginal wall tissue samples to determine tissue content of procollagen I; collagen types I, III, V; and matrix metalloproteinases 1 and 2 (MMP-1 and 2). Results were then compared with anatomical outcome at 1 year postsurgery. RESULTS: Differences in yield strain in all outcome groups (optimal, satisfactory and unsatisfactory) were not statistically significant. Considerable variation was found in collagen type I in both satisfactory and unsatisfactory groups. There was no difference or correlation with procollagen, collagen types III and V, and MMP-1 and recurrence of pelvic organ prolapse (POP) between groups. There was a weak correlation between collagen type I and higher yield stress in both groups. CONCLUSIONS: Anatomical failure of anterior repair does not appear to be related to the biomechanical strength or collagen content of the anterior vaginal wall.

Experimental comparison of mesenteric vessel sealing and thermal damage between one bipolar and two ultrasonic shears devices.

BACKGROUND: Several instruments are available for open and laparoscopic dissection, including electrothermal bipolar vessel sealers and ultrasonically coagulating shears. The vessel sealing ability of three devices in colorectal specimens was compared in an experimental study. METHODS: Surgical specimens from patients scheduled for elective open or laparoscopic colorectal resection were allocated to one of the three devices. After removal of the surgical specimen, up to eight mesenteric vessels were dissected ex vivo and sealed using the allocated instrument. The vessel seal was tested for the maximum pressure at which it leaked and then assessed by a pathologist for depth of thermal tissue damage. RESULTS: A total of 93 vessels from 18 patients were assessed ex vivo (LOTUS™ n = 33; Harmonic Ace® n = 30; LigaSure™ n = 30), a median of 6 (range 1-8) vessels per surgical specimen with a mean(s.d.) diameter of 1·06(0·70) mm and wall thickness of 0·29(0·19) mm. Mean(s.d.) bursting pressures were 1170(440), 1470(670) and 1510(740) mmHg with LOTUS(™) , Harmonic Ace® and LigaSure™ respectively. ANCOVA showed no difference in bursting pressure between the instruments (P = 0·058). The depth of thermal damage was significantly greater with LigaSure™ (3·37(1·44) mm) than with LOTUS(™) (2·18(0·99) mm; P < 0·001) or Harmonic Ace® (1·95(0·92) mm; P < 0·001). CONCLUSION: All three instruments were equally good at sealing blood vessels, with bursting pressures well above physiological blood pressure levels. REGISTRATION NUMBER: NCT01121614 (http://www.clinicaltrials.gov).

Alveolar soft part sarcoma of the uterine cervix.

A 19-year-old woman presented with 1-year history of heavy irregular vaginal bleeding and iron deficiency anemia. Pelvic examination revealed a 3-4 cm size cervical lesion distorting the cervical canal but with no obvious parametrial involvement. Histology and immunohistochemistry on a wedge biopsy had features consistent with alveolar soft part sarcoma (ASPS). Preoperative imaging excluded metastasis. She subsequently underwent radical hysterectomy, left salpingo-oophorectomy, right salpingectomy, and pelvic lymph node sampling--preserving the right ovary. The histology showed negative margins and no involvement of the lymph nodes. Postoperative adjuvant radiotherapy was administered. At 18 months posttreatment, there is no sign of recurrence. We review literature on diagnosis and treatment of genital ASPS.

Myxoglobulosis, a rare variant of appendiceal mucocele, occurring secondary to an occlusive membrane.

A 77-year-old man presented with altered bowel habit and episodic right lower abdominal discomfort. A barium enema showed a large smooth filling defect in the caecum and at operation his appendix was seen to be hugely distended. Pathological examination showed myxoglobulosis, a rare variant of mucocele of the appendix. The appendiceal orifice was completely occluded by an imperforate membrane with no communication between the appendix and caecum. This is the first published report in the English language of appendiceal myxoglobulosis in association with such an occlusive membrane.