Pectopexia Laparoscópica

Different operative approaches for the repair of a genital prolapse have been reported. However, for the reconstitution of a physiological axis of the vagina, a sacropexy seems to be the most adequate approach. We describe a method of laparoscopic apical prolapse surgery, where the lateral parts of the iliopectineal ligament are used for a bilateral mesh fixation of the descended structures. The iliopectineal ligament is a stable structure for the fixation of meshes and sutures, statistically significant stronger than the sacrospinous ligament and arcus tendinous of pelvic fascia. The incidence of defecation disorders, are reduced by a more physiological lateral fixation, which does not reduce the pelvic space. We used a single-port transumbilical device, with an additional 5 mm port, where at the end of the procedure, the drain is placed. This technique, a virtually scarless surgery, represents also, an option for women, who have an esthetic concern about scars.Existem várias abordagens, na reparação cirúrgica de prolapsos genitais. No entanto, afim de obter uma reconstituição do eixo fisiológico da vagina, a sacrocolpopexia, apresenta-se como o método mais adequado. Descrevemos uma técnica de correcção cirurgica laparoscópica de prolapsos apicais, através da sua fixação por prótese, bilateralmente, na face lateral do ligamento iliopectínio. O ligamento iliopectínio é uma estrutura estável para a fixação de próteses e suturas, sendo estatisticamente mais resistente que o ligamento sacroespinhoso e que o arco tendínio da fáscia pélvica. Existe uma menor incidência de alterações do trânsito intestinal, devido a esta fixação lateral mais fisiológica, que não resulta, numa redução do espaço pélvico. É utilizado um sistema de porta única transumbilical, com uma porta acessória de 5 mm, onde no final do procedimento, é colocado o dreno. Esta técnica, virtualmente sem cicatrizes, representa também uma opção para doentes, com preocupações estéticas

Adverse Features of Rectourethral Fistula Requiring Extirpative Surgery and Permanent Dual Diversion: Our Experience and Recommendations

Introduction: To report a series of men with a rectourethral fistula (RUF) resulting from pelvic cancer treatments and explore their therapeutic differences and impact on the functional outcomes and quality of life highlighting the adverse features that should determine permanent urinary or dual diversion. Methods: A retrospective database search was performed in four centers to identify patients with RUF resulting from pelvic cancer treatment. Medical records were analyzed for the demographics, comorbidities, diagnostic evaluation, fistula characteristics, surgical approaches and outcomes. The endpoints analyzed included a successful fistula closure following a repair and the impact of the potential adverse features on outcomes. Results: Twenty-three patients, aged 57–79 years (median 68), underwent an RUF reconstruction. The median follow-up (FU) was 54 months (range 18–115). The patients were divided into two groups according to the etiology: radiation/energy-ablation treatments with or without surgery (G1, n = 10) and surgery only (G2, n = 13). All of the patients underwent a temporary diverting colostomy and suprapubic cystostomy. Overall, a successful RUF closure was achieved in 18 (78%) patients. An interposition flap was used in six (60%) patients and one (7.7%) patient in groups G1 and G2, respectively (p = 0.019). The RUF was managed successfully in all 13 patients in group G2 as opposed to 5/10 (50%) in group G1 (p = 0.008). The patients in the radiation/energy-ablation group were more likely to require permanent dual diversion (50% vs. 0%, p < 0.0075). Conclusion: Radiation/energy-ablation therapies are associated with a more severe RUF and more complex reconstructions. Most of these patients require an abdominoperineal approach and flap interposition. The failure of an RUF repair with the need for permanent dual diversion, eventually combined with extirpative surgery, is higher after previous radiation/energy-ablation treatment. Therefore, permanent dual diversion as the primary treatment should always be included in the decision-making process as reconstruction may be futile in specific settings

Publisher Correction:Discovery of rare variants associated with blood pressure regulation through meta-analysis of 1.3 million individuals (Nature Genetics, (2020), 52, 12, (1314-1332), 10.1038/s41588-020-00713-x)

Genetic studies of blood pressure (BP) to date have mainly analyzed common variants (minor allele frequency > 0.05). In a meta-analysis of up to ~1.3 million participants, we discovered 106 new BP-associated genomic regions and 87 rare (minor allele frequency ≤ 0.01) variant BP associations (P < 5 × 10−8), of which 32 were in new BP-associated loci and 55 were independent BP-associated single-nucleotide variants within known BP-associated regions. Average effects of rare variants (44% coding) were ~8 times larger than common variant effects and indicate potential candidate causal genes at new and known loci (for example, GATA5 and PLCB3). BP-associated variants (including rare and common) were enriched in regions of active chromatin in fetal tissues, potentially linking fetal development with BP regulation in later life. Multivariable Mendelian randomization suggested possible inverse effects of elevated systolic and diastolic BP on large artery stroke. Our study demonstrates the utility of rare-variant analyses for identifying candidate genes and the results highlight potential therapeutic targets

Discovery of rare variants associated with blood pressure regulation through meta-analysis of 1.3 million individuals

Abstract Genetic studies of blood pressure (BP) to date have mainly analyzed common variants (minor allele frequency > 0.05). In a meta-analysis of up to similar to 1.3 million participants, we discovered 106 new BP-associated genomic regions and 87 rare (minor allele frequency ≤ 0.01) variant BP associations (P < 5 x 10(⁻⁸)), of which 32 were in new BP-associated loci and 55 were independent BP-associated single-nucleotide variants within known BP-associated regions. Average effects of rare variants (44% coding) were similar to 8 times larger than common variant effects and indicate potential candidate causal genes at new and known loci (for example, GATA5 and PLCB3). BP-associated variants (including rare and common) were enriched in regions of active chromatin in fetal tissues, potentially linking fetal development with BP regulation in later life. Multivariable Mendelian randomization suggested possible inverse effects of elevated systolic and diastolic BP on large artery stroke. Our study demonstrates the utility of rare-variant analyses for identifying candidate genes and the results highlight potential therapeutic targets.A Publisher Correction to this article was published on 16 March 2021