Relationship Between Applied Load and Clearance in Suture Knots

Ethicon Coated Vicryl absorbable sutures of different diameters were studied in order to determine if a relationship exists between the load and measured clearance. A prototype was designed to simulate knot location. Tensile tests were conducted on the suture knots followed by clearance measurements after each load level was applied. From the results it was concluded that the measured clearance was directly proportional to the amount of load applied to the suture knot. Also, based on the diameter of the suture, the smaller the diameter, the lower was the total displacement of the knot or the clearance

Vaginal Urinary Calculi Formation Secondary to Vaginal Mesh Exposure with Urinary Incontinence

Background. Vaginal stones may form in the setting of mesh exposure with urinary incontinence. This report serves to help understand the presentation, evaluation, and management of vaginal urinary stones. Case. A 68-year-old female presented with a vaginal calculus. She had a history of anterior and posterior polypropylene mesh placement for prolapse 7 years earlier and urinary incontinence. The stone was identified on a portion of exposed mesh and removed in office. Pathology confirmed urinary etiology. The exposed mesh resolved with topical estrogen. Cystourethroscopy excluded urinary fistula and bladder mesh erosion. Conclusions. When identified, a vaginal calculus should be removed and evaluated for composition. Cystourethroscopy should be performed to assess potential urinary tract fistulas and mesh erosion. Additional imaging should be considered

Characterization of fetal microchimeric immune cells in mouse maternal hearts during physiologic and pathologic pregnancies

Introduction: During pregnancy, fetal cells can be incorporated into maternal tissues (fetal microchimerism), where they can persist postpartum. Whether these fetal cells are beneficial or detrimental to maternal health is unknown. This study aimed to characterize fetal microchimeric immune cells in the maternal heart during pregnancy and postpartum, and to identify differences in these fetal microchimeric subpopulations between normal and pregnancies complicated by spontaneous preterm induced by ascending infection.Methods: A Cre reporter mouse model, which when mated with wild-type C57BL/6J females resulted in cells and tissues of progeny expressing red fluorescent protein tandem dimer Tomato (mT+), was used to detect fetal microchimeric cells. On embryonic day (E)15, 104 colony-forming units (CFU) E. coli was administered intravaginally to mimic ascending infection, with delivery on or before E18.5 considered as preterm delivery. A subset of pregnant mice was sacrificed at E16 and postpartum day 28 to harvest maternal hearts. Heart tissues were processed for immunofluorescence microscopy and high-dimensional mass cytometry by time-of-flight (CyTOF) using an antibody panel of immune cell markers. Changes in cardiac physiologic parameters were measured up to 60 days postpartum via two-dimensional echocardiography.Results: Intravaginal E. coli administration resulted in preterm delivery of live pups in 70% of the cases. mT + expressing cells were detected in maternal uterus and heart, implying that fetal cells can migrate to different maternal compartments. During ascending infection, more fetal antigen-presenting cells (APCs) and less fetal hematopoietic stem cells (HSCs) and fetal double-positive (DP) thymocytes were observed in maternal hearts at E16 compared to normal pregnancy. These HSCs were cleared while DP thymocytes persisted 28 days postpartum following an ascending infection. No significant changes in cardiac physiologic parameters were observed postpartum except a trend in lowering the ejection fraction rate in preterm delivered mothers.Conclusion: Both normal pregnancy and ascending infection revealed distinct compositions of fetal microchimeric immune cells within the maternal heart, which could potentially influence the maternal cardiac microenvironment via (1) modulation of cardiac reverse modeling processes by fetal stem cells, and (2) differential responses to recognition of fetal APCs by maternal T cells

Vaginal Urinary Calculi Formation Secondary to Vaginal Mesh Exposure with Urinary Incontinence

Background Vaginal stones may form in the setting of mesh exposure with urinary incontinence. This report serves to help understand the presentation, evaluation, and management of vaginal urinary stones. Case A 68-year-old female presented with a vaginal calculus. She had a history of anterior and posterior polypropylene mesh placement for prolapse 7 years earlier and urinary incontinence. The stone was identified on a portion of exposed mesh and removed in office. Pathology confirmed urinary etiology. The exposed mesh resolved with topical estrogen. Cystourethroscopy excluded urinary fistula and bladder mesh erosion. Conclusions When identified, a vaginal calculus should be removed and evaluated for composition. Cystourethroscopy should be performed to assess potential urinary tract fistulas and mesh erosion. Additional imaging should be considered

Laparoscopic Power Morcellation and Gynecologic Surgery: Lets Not Jump to Conclusions

It is impossible to conduct any surgical procedure without risk. We need to be solution driven and evidence based to not draw to poor conclusions. A frequent quote from Samuel Butler: “There is a big difference between what we know and what we think we know, we need to learn more before we jump to conclusions”. Let’s not be reactive, but proactive! We need to acknowledge the FDA warning regarding the use of LPM during LH and LM; however, let’s also advocate for a national tumor registry. This would go a long way to identify clinical factors that may reliably detect US and LMS where currently there are none

Laparoscopic Power Morcellation and Gynecologic Surgery: Lets Not Jump to Conclusions

It is impossible to conduct any surgical procedure without risk. We need to be solution driven and evidence based to not draw to poor conclusions. A frequent quote from Samuel Butler: “There is a big difference between what we know and what we think we know, we need to learn more before we jump to conclusions”. Let’s not be reactive, but proactive! We need to acknowledge the FDA warning regarding the use of LPM during LH and LM; however, let’s also advocate for a national tumor registry. This would go a long way to identify clinical factors that may reliably detect US and LMS where currently there are none