In vitro and in vivo assessment of silver-coated polypropylene mesh to prevent infection in a rat model.

INTRODUCTION AND HYPOTHESIS: The purpose of this study is to determine the effect of silver coating of polypropylene implants on infection in hernia surgery. METHODS: Silver-coated and non-silver-coated large pore monofilament polypropylene mesh implants were compared with and without infection (four groups). The implants were inserted in the abdominal wall of female Wistar rats. An Escherichia coli strain was inoculated intraoperatively in the two infected groups. The implants were removed, and clinical, bacteriological, and histological analyses were performed at 2, 15, and 30 days postoperatively. RESULTS: Eighty-four rats were studied. All inoculated rats (n = 21) in the non-silver-coated polypropylene group presented periprosthetic E. coli infection, compared with only five inoculated rats in the silver-coated polypropylene group (p < 0.0001). Erosion was significantly higher in the infected than in the non-infected silver-coated polypropylene groups (p < 0.01). There was no histological difference between the four groups. CONCLUSIONS: Silver-coated implants appear effective against bacterial infection in our rat model, with good histological tolerance but delayed healing.

Short vs long second stage of labour: is there a difference in terms of postpartum anal incontinence?

OBJECTIVE: Our purpose was to determine if prolonged second-stage labour independently increases postpartum anal incontinence. STUDY DESIGN: 360 primiparous women were studied retrospectively after vaginal delivery of term cephalic singletons, including a group with short second-stage labour (<30min, n=163) and a group with a prolonged second stage (>90min, n=197). A quality of life questionnaire on anal incontinence (FIQOL) was sent out at 15 months after delivery. RESULTS: 184 women (96 with short second-stage labour and 88 with a prolonged second stage) answered the questionnaire (response rate 51%). Flatus incontinence was reported after prolonged second-stage labour in 9.1% of women vs 15.6% after short second stage (p=0.18). Fecal incontinence was reported after prolonged second-stage labour in 2.3% vs 5.2% after a short second stage (p=0.45). CONCLUSION: We suggest that prolonged second stage of labour should not be associated with an increased risk of postpartum incontinence.

Efficacy of selective arterial embolisation for the treatment of life-threatening post-partum haemorrhage in a large population.

BACKGROUND: The objective of this study was to assess efficacy and determine the optimal indication of selective arterial embolisation (SAE) in patients with life-threatening post-partum haemorrhage (PPH). METHODOLOGY/PRINCIPAL FINDINGS: One hundred and two patients with PPH underwent SAE and were included from January 1998 to January 2002 in our university care center. Embolisation was considered effective when no other surgical procedure was required. Univariate and multivariate statistical analysis were performed. SAE was effective for 73 patients (71.5%), while 29 required surgical procedures. SAE was effective in 88.6% of women with uterine atony that was associated with positive outcome (OR 4.13, 1.35-12.60), whereas caesarean deliveries (OR 0.16, 0.04-0.5) and haemodynamic shock (OR 0.21, 0.07-0.60) were associated with high failure rates, 47.6% and 39.1%, respectively. CONCLUSIONS/SIGNIFICANCE: Success rate for SAE observed in a large population is lower than previously reported. It is most likely to succeed for uterine atony but not recommended in case of haemodynamic shock or after caesarean section.

Comparative histological analysis of anterior vaginal wall in women with pelvic organ prolapse or control subjects. A pilot study.

The purpose of this study was to compare smooth muscle content of anterior vaginal wall in women with pelvic organ prolapse (POP) and control subjects. Specimens were taken in the midline from the apex of anterior vaginal cuff from eleven women with POP and eight control subjects operated for hysterectomy without prolapse. Masson's trichrome stain was used to determine the distribution of collagen in the extracellular matrix of the vaginal muscularis and to quantify the collagen in area of interest. Slides of alpha smooth muscle actin were detected using antibodies. Morphometric analysis was used to compare and to quantify the smooth muscle content of the vaginal muscularis. Fractional area of nonvascular vaginal smooth muscle of women with POP was significantly decreased in comparison to control subjects (41.9 vs 61.9%, p = 0.005). Fractional area of connective tissue was significantly increased (56.8 vs 35%, p = 0.004). Fractional area of blood vessels was similar (2.2 vs 3.4%, p = 0.20).