Imaging visceral adhesion to polymeric mesh using pneumoperitoneal-MRI in an experimental rat model.

BACKGROUND: Intraperitoneal mesh implantation is often associated with formation of adhesion to the mesh. This experimental study examines the potential of minimally invasive pneumoperitoneal-MRI to assess these adhesions in a preclinical context. METHODS: Uncoated polyethylene terephthalate meshes were placed intraperitoneally in rats, in regard to the caecum previously scraped to promote petechial bleeding and subsequent adhesions. Examinations were performed 2-weeks post mesh implantation using a rodent dedicated high field MRI. Respiratory-triggered T2-weighted images were acquired prior to and after intraperitoneal injection of ~8-10 mL gas to induce a mechanical stress on the abdominal wall. RESULTS: Adhesions are occasionally seen in sham-operated rats as opposed to rats receiving polyethylene terephthalate meshes. On high-resolution images, meshes can be detected due to their characteristic net shape. However, evidence of adherence is only found if intraperitoneal gas injection is performed, when a ~1-cm elevation of the abdominal wall is observed. When adherence occurs between the mesh and the caecum, the latter remains in contact with the wall. Looser adherences between visceral tissue and meshes are also observed. CONCLUSIONS: T2-weighted pneumoperitoneal-MRI is a powerful tool for assessing adherence after intraperitoneal mesh implantation. According to the mini-invasive procedure adopted here, this approach may allow a temporal follow-up of adherence fate.

Relationship between ovarian cysts and infertility: what surgery and when?

The relationship between ovarian cysts and infertility is a subject of debate, mainly because it is difficult to determine the real impact of the cyst and its treatment on later fertility. For a long time it was hoped that surgical treatment could prevent potential complications (such as rupture or malignancy). For presumed benign ovarian tumors, fertility sparing should be the main concern. The goal of this survey of current knowledge on the subject is to thoroughly explore the potential relationship between cysts, their treatment, and infertility. Our study is based on a review of the literature dealing with the epidemiology of ovarian cysts and the effects of their surgical management in relation to infertility. Analysis of the epidemiologic data, drawn mainly from comparative studies and cohorts, shows that the role of cysts in infertility is controversial and that the effects of surgical treatment are often more harmful than the cyst itself to the ovarian reserve. Surgery does not seem to improve pregnancy rates. When a surgical option is nonetheless chosen, a conservative laparoscopic approach is more suitable. Besides excision, sclerotherapy and plasma vaporization are promising, offering a greater preservation of the ovarian parenchyma, especially in endometriomas. These techniques must be better defined. The context of the infertility is essential, and surgeons and specialists in reproductive medicine should decide management jointly.

Interferon-alpha for treatment of essential thrombocythemia during pregnancy: case report and review of the literature.

Described as a myeloproliferative disorder mainly affecting elderly women, recent reports now confirm the occurrence of essential thrombocythemia at younger ages, which questions treatment during pregnancy. We report a further case of uneventful full term pregnancy with the use of interferon-alpha for maternal essential thrombocythemia which suggests that interferon-alpha could be considered as an effective and safe treatment during pregnancy for women with essential thrombocythemia. Further studies are warranted to determine whether interferon-alpha is the optimal therapeutic option during pregnancy for this patient population.

Successful expectant management for a cornual heterotopic pregnancy.

OBJECTIVE: To report the obstetric outcome after expectant management for a right cornual heterotopic pregnancy. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 33-year-old salpingectomized woman with an 8-year history of primary infertility who conceived after in utero transfer of two embryos obtained by in vitro fertilization. INTERVENTION(S): Expectant management and close ultrasonographic and clinical monitoring. MAIN OUTCOME MEASURE(S): Obstetric outcome. RESULT(S): The intrauterine pregnancy proceeded unremarkably. A caesarean section was performed for dystocia and allowed the delivery of a healthy 4170 g male infant. The examination of the uterus showed a prerupture of the right uterine horn. CONCLUSION(S): Expectant management for cornual heterotopic pregnancy could be considered a successful option in a symptom-free patient where the ectopic embryo has a limited craniocaudal length with no cardiac activity. Our case also suggests that elective cesarean section could be the optimal mode of delivery for rare cases of successful management for cornual heterotopic pregnancy, regardless of the therapeutic option chosen for the cornual pregnancy, due to the theoretical increase risk of uterine rupture during labor.

Incidental finding of an intrauterine device in the sigmoid colon.

BACKGROUND: Translocation of an intrauterine device (IUD) to the sigmoid colon lumen is an extremely rare presentation of an ectopic IUD that usually results in fever and gastrointestinal symptoms. We report the exceptional case of an asymptomatic IUD translocation to the sigmoid colon lumen secondary to uterine perforation. CASE REPORT: A CT-scan was carried out during the follow-up of a 53-year-old woman with a metastatic epidermoid carcinoma of the tongue evolving over the previous eight years. It incidentally revealed the presence of an IUD in the sigmoid colon lumen. The patient being completely asymptomatic and at the terminal stage of her disease, removal of the device by means of a surgical or endoscopic procedure was not attempted. The patient died four months later due to lung cancer; during that period of time the IUD located in the colon remained asymptomatic. CONCLUSION: Asymptomatic migration of IUD to the sigmoid colon lumen can occur. Except when the patient's condition does not allow it, as in the case reported, removal of the IUD is indicated because of the risk of fistula formation and colon perforation with a high ensuing morbidity. This case report highlights the need for follow-up of patients wearing an IUD.