Redo ventral rectopexy : is it worthwhile?

Background Minimally invasive ventral mesh rectopexy (VMR) is a widely used surgical treatment for posterior pelvic organ prolapse; however, evidence of the utility of revisional surgery is lacking. Our aim was to assess the technical details, safety and outcomes of redo minimally invasive VMR for patients with external rectal prolapse (ERP) recurrence or relapsed symptoms of internal rectal prolapse (IRP). Methods This is a retrospective cohort study of patients with recurrent ERP or symptomatic IRP who underwent redo minimally invasive VMR between 2011 and 2016. The study was conducted at three hospitals in Finland. Data collected retrospectively included patient demographics, in addition to perioperative and short-term postoperative findings. At follow-up, all living patients were sent a questionnaire concerning postoperative disease-related symptoms and quality of life. Results A total of 43 redo minimally invasive VMR were performed during the study period. The indication for reoperation was recurrent ERP in 22 patients and relapsed symptoms of IRP in 21 patients. In most operations (62.8%), the previously used mesh was left in situ and a new one was placed. Ten (23.3%) patients experienced complications, including 2 (4.7%) mesh-related complications. The recurrence rate was 4.5% for ERP. Three patients out of 43 were reoperated on for various reasons. One patient required postoperative laparoscopic hematoma evacuation. Patients operated on for recurrent ERP seemed to benefit more from the reoperation. Conclusions Minimally invasive redo VMR appears to be a safe and effective procedure for treating posterior pelvic floor dysfunction with acceptable recurrence and reoperation rates.Peer reviewe

Urban aerosol number size distributions

International audienceAerosol number size distributions have been measured since 5 May 1997 in Helsinki, Finland. The presented aerosol data represents size distributions within the particle diameter size range 8-400nm during the period from May 1997 to March 2003. The daily, monthly and annual patterns of the aerosol particle number concentrations were investigated. The temporal variation of the particle number concentration showed close correlations with traffic activities. The highest total number concentrations were observed during workdays; especially on Fridays, and the lowest concentrations occurred during weekends; especially Sundays. Seasonally, the highest total number concentrations were observed during winter and spring and lower concentrations were observed during June and July. More than 80% of the number size distributions had three modes: nucleation mode (30nm), Aitken mode (20-100nm) and accumulation mode (90nm). Less than 20% of the number size distributions had either two modes or consisted of more than three modes. Two different measurement sites were used; in the first (Siltavuori, 5.5.1997-5.3.2001), the arithmetic means of the particle number concentrations were 7000cm, 6500cm, and 1000cm respectively for nucleation, Aitken, and accumulation modes. In the second site (Kumpula, 6.3.2001-28.2.2003) they were 5500cm, 4000cm, and 1000cm. The total number concentration in nucleation and Aitken modes were usually significantly higher during workdays than during weekends. The temporal variations in the accumulation mode were less pronounced. The lower concentrations at Kumpula were mainly due to building construction and also the slight overall decreasing trend during these years. During the site changing a period of simultaneous measurements over two weeks were performed showing nice correlation at both sites

Erosion-oxidation of pressure vessel steel P265GH

The behaviour of pressure vessel steel P265GH was studied in a centrifugal high-temperature erosion apparatus under impacts by silica (SiO2) particles moving at velocities ranging from 20 to 60 m s-1 and contacting the surface at the angles of 30° and 90°. Besides particle impacts, the steel was simultaneously exposed to air and elevated temperatures of 350 and 450°C. For comparison, the tests were also performed in the absence of erodent particles. After the tests, the material behaviour was evaluated in terms of occurred weight changes and surface characteristics, the latter ones of which were investigated by using, for example, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). In the analysis of the test results, special attention was paid to the composition and microstructure of the used silica particles and how these influence the elemental distribution on the exposed surfaces. The results show that the particle impacts introduce weight losses that follow a ductile angle-dependency, i.e., relatively greater weight losses at the shallow than at the steep impact angle. Although evident oxide scales developed on the surfaces at the test temperatures, they did not provide the steel with protection against particle impacts. Particle debris was detected embedded in the surfaces particularly under impacts at 90°, with softer particle constituents being preferentially deposited. These results are discussed in terms of the erosion-oxidation behaviour of the steel and the consequences of the heterogeneous erodent particle quality

Radio observations of globulettes in the Carina nebula

Context. The Carina nebula hosts a large number of globulettes. An optical study of these tiny molecular clouds shows that the majority are of planetary mass, but there are also those with masses of several tens up to a few hundred Jupiter masses. Aims. We seek to search for, and hopefully detect, molecular line emission from some of the more massive objects; in case of successful detection we aim to map their motion in the Carina nebula complex and derive certain physical properties. Methods. We carried out radio observations of molecular line emission in (CO)-C-12 and (CO)-C-13 (2-1) and (3-2) of 12 globulettes in addition to positions in adjacent shell structures using APEX. Results. All selected objects were detected with radial velocities shifted relative to the emission from related shell structures and background molecular clouds. Globulettes along the western part of an extended dust shell show a small spread in velocity with small velocity shifts relative to the shell. This system of globulettes and shell structures in the foreground of the bright nebulosity surrounding the cluster Trumpler 14 is expanding with a few km s(-1) relative to the cluster. A couple of isolated globulettes in the area move at similar speed. Compared to similar studies of the molecular line emission from globulettes in the Rosette nebula, we find that the integrated line intensity ratios and line widths are very different. The results show that the Carina objects have a different density/temperature structure than those in the Rosette nebula. In comparison the apparent size of the Carina globulettes is smaller, owing to the larger distance, and the corresponding beam filling factors are small. For this reason we were unable to carry out a more detailed modelling of the structure of the Carina objects in the way as performed for the Rosette objects. Conclusions. The Carina globulettes observed are compact and denser than objects of similar mass in the Rosette nebula. The distribution and velocities of these globulettes suggest that they have originated from eroding shells and elephant trunks. Some globulettes in the Trumpler 14 region are quite isolated and located far from any shell structures. These objects move at a similar speed as the globulettes along the shell, suggesting that they once formed from cloud fragments related to the same foreground shell.Peer reviewe

Intraoperative Complications and Mid-Term Follow-Up of Large-Diameter Head Metal-on-Metal Total Hip Arthroplasty and Hip Resurfacing Arthroplasty

Background and Aims: Large-diameter head total hip arthroplasty and hip resurfacing arthroplasty were popular in Finland from 2000 to 2012 for the treatment of hip osteoarthritis. The aim of this retrospective study was to investigate the mid-term survival of large-diameter head total hip arthroplasty patients operated on in three university hospitals and to compare these results to the survival of hip resurfacing arthroplasty patients. Material and Methods: A total of 3860 hip arthroplasties (3029 large-diameter head total hip arthroplasties in 2734 patients and 831 hip resurfacing arthroplasties in 757 patients) were operated on between January 2004 and December 2009. The mean follow-up was 4.3years (range: 0.3-8.0years) in the total hip arthroplasty group and 5.1years (range: 1.7-7.9years) in the hip resurfacing arthroplasty group. Cox multiple regression model and Kaplan-Meier survival analysis were used to study the survival of the total hip arthroplasties and the hip resurfacing arthroplasties. Intraoperative complications and reasons for revisions were also evaluated. Results: In Cox regression analysis, the hazard ratio for revision of hip resurfacing arthroplasty was 1.5 compared with large-diameter head total hip arthroplasty (95% confidence interval: 1.0-2.2) (p=0.029). The cumulative Kaplan-Meier survival rate was 90.7% at 7.7years for the large-diameter head total hip arthroplasty (95% confidence interval: 86.8-94.6) and 92.2% at 7.6years for hip resurfacing arthroplasty (95% confidence interval: 89.9-94.6). There were a total of 166/3029 (5.5%) intraoperative complications in the large-diameter head total hip arthroplasty group and 20/831 (2.4%) in the hip resurfacing arthroplasty group (p=0.001). Revision for any reason was performed on 137/3029 (4.5%) of the arthroplasties in the large-diameter head total hip arthroplasty group and 52/831 (6.3%) in the hip resurfacing arthroplasty group (p=0.04). Conclusion: The mid-term survival of both of these devices was poor, and revisions due to adverse reactions to metal debris will most likely rise at longer follow-up. There were more intraoperative complications in the large-diameter head total hip arthroplasty group than in the hip resurfacing arthroplasty group.Peer reviewe

Spacetime Foam Model of the Schwarzschild Horizon

We consider a spacetime foam model of the Schwarzschild horizon, where the horizon consists of Planck size black holes. According to our model the entropy of the Schwarzschild black hole is proportional to the area of its event horizon. It is possible to express geometrical arguments to the effect that the constant of proportionality is, in natural units, equal to one quarter.Comment: 16 pages, 2 figures, improved and extended version with some significant changes. Accepted for publication in Phys.Rev.

Repeated cobalt and chromium ion measurements in patients with large-diameter head metal-on-metal ReCap-M2A-Magnum total hip replacement

Background and purpose - Whole blood (WB) cobalt (Co) and chromium (Cr) ion levels have a major role in the follow-up of metal-on-metal total hip replacement (MoM THR). We investigated, first, if there was a change in WB Co or Cr levels over repeated measurements in patients with ReCap-M2A-Magnum THR, and, second, determined how many patients had WB Co or Cr levels that exceeded the safe upper limits (SUL) in the repeated whole blood metal ion assessment. Patients and methods - A Recap-M2A-Magnum THR was used in 1,329 operations (1,188 patients) at our institution between 2005 and 2012. We identified all patients (n = 319) with unilateral ReCap-M2A-Magnum implants who had undergone at least 2 repeated metal ion measurements with the first blood sample taken mean 5.5 years (1.8-9.3) after surgery and the second taken mean 2 years (0.5-3) after the first. Results - The median WB Co and Cr ion levels decreased in repeated measurements from 1.40 (0.40-63) ppb to 1.10 (0.20-68) ppb and from 1.60 (0.60-13.0) ppb to 1.10 (0.30-19.0) ppb, respectively. 7% of the Co ion values exceeded SUL at the initial measurement, and 7% at the control measurement. The proportion of Cr ion values exceeding the safe upper limit (SUL) decreased during the measurement interval from 5% to 4%. Interpretation - Repeated metal ion measurements in unilateral ReCap-M2A-Magnum patients in a mean 2-year time interval did not show any increase. Long-term ion levels are, however, not yet known

Quantum-mechanical model of the Kerr-Newman black hole

We consider a Hamiltonian quantum theory of stationary spacetimes containing a Kerr-Newman black hole. The physical phase space of such spacetimes is just six-dimensional, and it is spanned by the mass $M$, the electric charge $Q$ and angular momentum $J$ of the hole, together with the corresponding canonical momenta. In this six-dimensional phase space we perform a canonical transformation such that the resulting configuration variables describe the dynamical properties of Kerr-Newman black holes in a natural manner. The classical Hamiltonian written in terms of these variables and their conjugate momenta is replaced by the corresponding self-adjoint Hamiltonian operator and an eigenvalue equation for the Arnowitt-Deser-Misner (ADM) mass of the hole, from the point of view of a distant observer at rest, is obtained. In a certain very restricted sense, this eigenvalue equation may be viewed as a sort of "Schr\"odinger equation of black holes". Our "Schr\"odinger equation" implies that the ADM mass, electric charge and angular momentum spectra of black holes are discrete, and the mass spectrum is bounded from below. Moreover, the spectrum of the quantity $M^2-Q^2-a^2$, where $a$ is the angular momentum per unit mass of the hole, is strictly positive when an appropriate self-adjoint extension is chosen. The WKB analysis yields the result that the large eigenvalues of $M$, $Q$ and $a$ are of the form $\sqrt{2n}$, where $n$ is an integer. It turns out that this result is closely related to Bekenstein's proposal on the discrete horizon area spectrum of black holes.Comment: 30 pages, 3 figures, RevTe