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Sling
Kinds of Sling Terms modified by Sling Selected AbstractsEquine abstracts HELICOPTER RESCUE , TO FLY OR NOT TO FLYJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue S1 2004Rebecca M. Gimenez PhD Improved options for the successful transport of horses trapped in inaccessible areas (floodwater, steep ravines, etc.) during a disaster or emergency are available to practitioners using helicopter assets and the Anderson SlingÔ. Horses present a particularly difficult problem to remove from the rescue environment of a wide flooded area, or difficult steep terrain far from access by vehicles or heavy equipment. Due to their fractious and fearful nature, they may fight any effort to walk, climb or swim them to safety, and those attempts are inherently very dangerous for the rescuer(s). Unfortunately, many disaster or emergency scenarios may occur in areas not conducive to the use of other options (barge, rescue glide, simple vertical lift sling). Veterinary practitioners on scene should have familiarity with helicopter sling-load operations. The use of cargo nets, inappropriate home-made slings, and inadequate equipment has contributed to disastrous efforts by well-intentioned rescuers. There have even been desperate attempts at sling loading of cattle by roping the horns or one leg and transporting them into a waiting truck for removal from public lands. The Anderson SlingÔ has been successfully used for helicopter operations in multiple emergencies and training demonstration flights, and is the only Equine Sling recommended for this purpose. Although it was originally intended for clinical use in long-term recovery cases, it has become the industry standard for helicopter operations with equines because of its demonstrated safety margin, design and strength. In clinical use, leg straps further distribute the animal's weight to the legs, but are not necessary in rescue lifts. In some states, there are Large Animal Rescue Teams associated with the Veterinary School, the State Emergency Management Association, or local private Equine Ambulance Services that may have equipment and personnel trained in helicopter sling-loading. This is a specialty interest that requires prior coordination, significant planning, and training of all personnel involved. [source] Suburethral slingplasty evaluation study in North Queensland, Australia: The SUSPEND trialAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2005Yik Nyok LIM Abstract Objective:, To compare the safety and efficacy of three types of suburethral slings for the treatment of urodynamic stress incontinence. Methods:, Following ethics approval, 195 (3 × 65) patients with urodynamic stress incontinence were randomly assigned to undergo suburethral slingplasty with the Tension-free Vaginal Tape (TVT; Gynecare, Ethicon, Somerville, NJ, USA), Intravaginal Sling (IVS; Tyco Healthcare, Mansfield, MA, USA), or Suprapubic Arc Sling (SPARC; American Medical Systems, Minnetonka, MN, USA). The patients were blinded to the type of sling implanted. Main outcome measures were:, (1) operative and short-term complications; (2) pre- and postoperative symptomatology; and (3) pre- and postoperative urodynamic findings. Results:, There was a statistically significant increased rate of sling protrusion (13.1% vs. 3.3% and 1.7%; P = 0.04) in the SPARC group when compared to TVT and IVS. Otherwise, there were no significant differences between the groups with respect to the incidences of other operative complications, patients' main subjective outcomes, satisfaction rates, or postoperative urodynamic findings. The overall objective stress incontinence cure rates were 87.9%, 81.5% and 72.4% for the TVT, IVS, SPARC groups respectively (P = 0.11). Conclusions:, All three slings appear quite successful for the treatment of stress incontinence. The SPARC tapes showed more sling protrusion complications and a trend towards lower objective cure rates; probably as a result of the insertion method used in this study which favoured a loose SPARC sling placement. The authors recommend that the SPARC slings be left tighter than TVT, or for the cough test to be carried out. [source] Slings and arrows of predaceous fortune: Asian evidence of prehistoric spear useEVOLUTIONARY ANTHROPOLOGY, Issue 4 2004Kenneth A. R. Kennedy First page of article [source] Modified Single-Sling Myocutaneous Island Pedicle Flap: Series of 61 ReconstructionsDERMATOLOGIC SURGERY, Issue 11 2008ANDREA WILLEY MD BACKGROUND Bilevel undermining above and below the transverse nasalis muscle in the construction of a myocutaneous island pedicle flap produces a bilateral or unilateral muscular sling with exceptional vascular supply for reconstruction of defects on the distal nose. We present further modification of the single-sling myocutaneous island pedicle flap that expands its application to a wide variety of nasal defects and further defines its usefulness in nasal reconstruction. METHODS A series of 61 consecutive myocutaneous island pedicle flap reconstructions performed after Mohs surgery between March 2005 and July 2006 are presented. Flap modifications are presented, and advantages and limitations are discussed. RESULTS Flap modifications introduce additional reach and rotational mobility to the flap that permit extension of the flap to defects on the nasal tip and distal ala. CONCLUSION Modifications of the bilevel approach to the single-sling nasalis myocutaneous island pedicle flap further define its practicality in nasal reconstruction and expand its application to a variety of nasal defects. [source] Radial forearm-palmaris longus tenocutaneous free flap; implication in the repair of the moderate-sized postoncologic soft palate defectHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2009Tai Suk Roh MD Abstract Background. Moderate resection of the soft palate results in suboptimal outcomes in terms of postoperative velopharyngeal function. We propose the radial forearm tenocutaneous free flap incorporating the palmaris longus tendon for reconstruction of the levator sling in these cases. Methods. Twenty-six patients underwent reconstruction with this method. Group I defect involved up to one-fourth of the soft palate. Group II defect involved up to one-half of the soft palate whether or not including the uvula. Group III defect involved more than three-fourths of the soft palate. Postoperative function was assessed by means of speech intelligibility, swallowing performance, nasalance score, and nasoendoscopy. Results. Groups I and II showed normal results for speech intelligibility and swallowing function at 44 months. In group III, both parameters proved to be suboptimal. Conclusions. Moderate-sized soft palatal resection cases (group II) benefited most from this particular method of dynamic reconstruction using the radial forearm tenocutaneous free flap. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source] Comparison of bone-anchored male sling and collagen implant for the treatment of male incontinenceINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2006RAHMI ONUR Aim: To compare the effectiveness of transurethral collagen injection and perineal bone-anchored male sling for the treatment of male stress urinary incontinence (SUI). Methods: Seventy-one men with SUI underwent either transurethral collagen injections (n = 34) or perineal bone-anchored male sling (n = 37) between June 1999 and October 2003. Most of the patients in each group had radical retropubic prostatectomy and/or external beam radiation therapy (EBRT) in relation to the cause of incontinence. There was one patient in both groups who only had EBRT for the cause. The mean duration of incontinence were 4.2 and 4.4 years, respectively. Collagen injections were carried out transurethrally either under regional or general anesthesia until co-aptation of mucosa was observed. The male sling was placed under spinal anesthesia with a bone drill using either absorbable or synthetic materials. Retrospectively, all patients were assessed for continence status and procedure-related morbidity, if present. The outcome of both procedures was also compared with the degree of incontinence. Results: Ten (30%) patients in the collagen group showed either significant improvement or were cured following injections. Preoperatively, the mean pad use in collagen group was 4.5 (SD 2.8) per day, whereas it was 2.2 (SD 1.1) after the injection(s). Collagen injection failed in 24 (70%) of the patients. Patients who received the male sling had a mean preoperative pad use of 3.7 (SD 1.5) and postoperatively, the number decreased to 1.6 (SD 1.2). Most of the patients in this group were either totally dry or significantly improved (n: 28, 76%). There was a statistically significant difference between two groups in respect to success rate (P < 0.05). Analysis of treatment outcome with the degree of incontinence revealed that the male sling is most effective in patients with minimal-to-moderate incontinence. Conclusions: Our results suggest that the male sling, a minimally invasive procedure, is more effective than collagen implant in the treatment of mild-to-moderate SUI in men. [source] Transobturatory tension-free composite sling for urethral support in patients with stress urinary incontinence: Favorable experience after 1 year follow upINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2006IVAN IGNJATOVIC Objective:, Symptomatic, anatomic and urodynamic results of a composite transobturatory tension-free sling with an absorbable middle part, in patients with stress urinary incontinence (SUI), were studied. Methods:, A prospective study in 40 women with SUI was performed. Symptoms, urodynamics and anatomical improvements were evaluated separately. Surgery was performed with the transobturatory approach. Results:, All patients had both clinically and urodynamically confirmed SUI. Clinical outcome was favorable in 36/40 (90%) patients, after 1 year. Operation improved the position of the bladder neck (2.8 cm and 1.4 cm below the pubic bone, respectively) and significantly decreased mobility of the bladder neck during abdominal straining (3.3 cm and 1.7 cm, respectively). Both symptoms and quality of life were significantly improved 1 month after the surgery. Postoperative maximum flow was lower than the preoperative one but with borderline significance (25.8 and 23.7 mL/s; P = 0.05). Pressure flow study showed unobstructed voiding both preoperatively and postoperatively. Detrusor pressure at the maximum flow was increased (20, 4 and 22, 8 cmH2O, respectively) but not significantly. Conclusion:, Our results confirmed a high objective cure rate, improvement of symptoms and quality of life, and at the same time, corrected position of the bladder neck and unobstructed voiding. [source] Comparison of outcomes of three different surgical techniques performed for stress urinary incontinenceINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2003Hakan Kilicarslan Abstract Background: The aim was to compare the efficacy of Burch colposuspension, transvaginal four-corner bladder neck suspension (FCBNS) and the vaginal wall sling (VWS) procedures in patients with stress urinary incontinence. Methods: A retrospective analysis was performed on 88 patients who underwent Burch colposuspension (n = 20), FCBNS (n = 29) and VWS (n = 39) for stress urinary incontinence. Objective and subjective cure rates at 3 months and annually after the operation were the primary outcome measures. Results: The patients were similar in age, parity, menopausal status, grade of cystocel and preoperative residual urine volumes. Fourteen out of 20 (70%) patients showed improvement in the group undergoing Burch colposuspension, 29 out of 39 (74.4%) patients showed improvement in the FCBNS group, and 28 out of 29 (96.6%) patients showed improvement in the VWS group. The mean length of follow up was 3.8 years (range 3,5). Conclusion: In this study, the VWS procedure had a higher long-term cure rate of stress urinary incontinence when compared with the Burch colposuspension and the FCBNS procedures. [source] Long-term results of transarticular pinning for surgical stabilisation of coxofemoral luxation in 20 catsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 3 2009T. R. Sissener Objectives: The objective of this study was to describe initial and long-term results of open reduction and transarticular pinning for treatment of coxofemoral luxations in cats. Methods: Cats were treated by open reduction and transarticular pinning for coxofemoral luxation over a five year period at two institutions. Follow-up assessment included orthopaedic examination, radiography and owner questionnaires. Results: Twenty cats were included in the study (14 males and six females). One cat was affected bilaterally. Mean time to follow-up was 21 months. Seventeen joints were stabilised with a 1·6 mm pin, three with 2·0 mm pins and a 1·2 mm pin was used in the remaining joint. An Ehmer sling was not utilised in any case. All transarticular pins except one were removed (mean 3·5 weeks), with all hips still in reduction The overall success rate was 77 per cent, with two reluxations and one resorbed femoral head noted on radiographs of 13 joints followed long term. All 20 owners reported good to excellent long-term functional outcome for their cats. Clinical Significance: Results from this study indicate that transarticular pinning for stabilisation of coxofemoral luxation in cats can provide a good long-term outcome without sacrificing the integrity of the coxofemoral joint. [source] Equine abstracts HELICOPTER RESCUE , TO FLY OR NOT TO FLYJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue S1 2004Rebecca M. Gimenez PhD Improved options for the successful transport of horses trapped in inaccessible areas (floodwater, steep ravines, etc.) during a disaster or emergency are available to practitioners using helicopter assets and the Anderson SlingÔ. Horses present a particularly difficult problem to remove from the rescue environment of a wide flooded area, or difficult steep terrain far from access by vehicles or heavy equipment. Due to their fractious and fearful nature, they may fight any effort to walk, climb or swim them to safety, and those attempts are inherently very dangerous for the rescuer(s). Unfortunately, many disaster or emergency scenarios may occur in areas not conducive to the use of other options (barge, rescue glide, simple vertical lift sling). Veterinary practitioners on scene should have familiarity with helicopter sling-load operations. The use of cargo nets, inappropriate home-made slings, and inadequate equipment has contributed to disastrous efforts by well-intentioned rescuers. There have even been desperate attempts at sling loading of cattle by roping the horns or one leg and transporting them into a waiting truck for removal from public lands. The Anderson SlingÔ has been successfully used for helicopter operations in multiple emergencies and training demonstration flights, and is the only Equine Sling recommended for this purpose. Although it was originally intended for clinical use in long-term recovery cases, it has become the industry standard for helicopter operations with equines because of its demonstrated safety margin, design and strength. In clinical use, leg straps further distribute the animal's weight to the legs, but are not necessary in rescue lifts. In some states, there are Large Animal Rescue Teams associated with the Veterinary School, the State Emergency Management Association, or local private Equine Ambulance Services that may have equipment and personnel trained in helicopter sling-loading. This is a specialty interest that requires prior coordination, significant planning, and training of all personnel involved. [source] Combined peroneal and proximal tibial nerve palsies,MICROSURGERY, Issue 4 2009Eric H. Williams M.D. Combined compression of both the common peroneal nerve and the proximal tibial nerve at the level of the popliteal fossa is rare. Recently, an anatomic site of compression of the proximal tibial nerve at the soleal sling (originating arch for the soleus muscle) has been described in cadavers. The present report includes three patients who had a combined compression of the common peroneal nerve at the fibular neck (fibular tunnel syndrome) and compression of the proximal tibial nerve at the soleal sling (soleal sling syndrome). In each case, blunt trauma was the precipitating event. Neurolysis of both nerves resulted in restoration of motor and sensory function in each ofthese three patients. This is the first clinical report illustrating combined neurolysis of the common peroneal at the knee and the proximal tibial nerve in the soleal sling. © 2009 Wiley-Liss, Inc. Microsurgery, 2009. [source] Midurethral sling procedures for stress urinary incontinence in women over 80 years,,NEUROUROLOGY AND URODYNAMICS, Issue 7 2010Kobi Stav Abstract Aims To compare the safety and efficacy of midurethral sling surgery for management of urinary stress incontinence in women over 80 years versus younger women. Methods 1225 consecutive women with urodynamic stress incontinence had a synthetic midurethral sling (955 retropubic, 270 transobturator) at our institution between 1999 and 2007. Ninety one percent (n,=,1112) of the patients were interviewed via phone call with a structured questionnaire and were included in the analysis. The mean follow-up was 50,±,24 months (range 12,114). Comparison between elderly (,80 years, n,=,96) and younger patients (<80 years, n,=,1016) was performed. Results The overall subjective cure rate was 85% (elderly 81%, younger 85%, ,=,0.32). There was no significant difference in cure rate between retropubic and transobturator sling in the elderly group (82% vs. 79.3%, P,=,0.75). The bladder perforation rate was similar between the two groups (3%). The hospitalization time was significantly longer in the elderly (1.6,±,1.7 days vs. 0.7,±,1.1 days, P<0.001). However, major perioperative complications were uncommon (1%). Of the patients who had an isolated sling procedure, 37% of the elderly and 9% of the young patients failed their 1st trial of void (P,<,0.001). However, the long-term rate of voiding difficulty was similar between the two groups (elderly 8% vs. young 6%, P,=,0.21). The rate of de novo urge incontinence was similar between the two groups (7%). Conclusion Retropubic and transobturator slings in women older than 80 years are effective and safe but are associated with an increased risk of transient postoperative voiding difficulty. Neurourol. Urodynam. 29:1262,1266, 2010. © 2010 Wiley-Liss, Inc. [source] Mixed incontinence: Comparing definitions in women having stress incontinence surgery,,§¶NEUROUROLOGY AND URODYNAMICS, Issue 4 2009Linda Brubaker Abstract Objective To develop an empirically derived definition of mixed urinary incontinence (MUI) for use in incontinence outcomes research. Methods Participants in a randomized trial comparing the fascial sling and. Burch colposuspension were assessed using standardized measures including the Medical, Epidemiologic and Social Aspects of Aging (MESA), UI questionnaire, the Urogenital Distress Inventory (UDI), 3-day urinary diary and urodynamic studies (UDS). Participants were required to have stress incontinence with a MESA stress subscale score,>,MESA urge subscale score. Several definitions of MUI were considered. Logistic and linear regression analysis methods were used to predict clinical outcomes based on the different MUI definitions. Analyses were carried out using SAS (SAS Institute, Inc., Cary, NC, Version 9.1). Statistical significance was defined at P -value <0.05. Results In 655 participants, the proportion of women with MUI varied from 8.3% to 93.3% depending on the MUI definition All definitions were associated with severity as measured by the frequency of incontinence episodes at baseline; however little of the variability was explained by any single definition. No strict cut-off value for these baseline measures was identified to predict clinical outcomes. Conclusions These MUI definitions do not adequately categorize clinically relevant UI subgroups. For research reporting, MUI subcomponents of stress and urge UI should be described separately rather than as a single dimension. Neurourol. Urodynam. 28:268,273, 2009. © 2009 Wiley-Liss, Inc. [source] Comparison between reduction in 24-hour pad weight, International Consultation on Incontinence-Short Form (ICIQ-SF) score, International Prostate Symptom Score (IPSS), and Post-Operative Patient Global Impression of Improvement (PGI-I) score in patient evaluation after male perineal slingNEUROUROLOGY AND URODYNAMICS, Issue 1 2007Christian O. Twiss Abstract Aims We assessed the utility of three self-assessment instruments: the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the post-operative Patient Global Impression of Improvement (PGI-I) score, and the International Prostate Symptom Score (IPSS) by correlating them with an objective outcome, the change in 24-hr pad weight, after a male perineal sling. Methods Twenty-six men with urodynamically confirmed stress incontinence underwent a male perineal sling. Patients were evaluated pre-operatively and post-operatively with a 24-hr pad test, IPSS and ICIQ-SF. Patients also completed the PGI-I post-operatively. Changes in study parameters were compared via the paired t -test, and correlations were performed using Spearman's rho. Results There were significant reductions in 24-hr pad weight (,274 g, P,<,0.001), percentage 24-hr pad weight (54.2%), ICIQ-SF score (,6.3, P,<,0.001), and the three ICIQ-SF subscores (,1.2, ,1.7, ,3.4 for Questions 3, 4, and 5, respectively, P,<,0.001 for all). The change in total ICIQ-SF score and the post-operative PGI-I score correlated strongly with percentage reduction in 24-hr pad weight (r,=,,0.68, P,<,0.001; r,=,,0.81, P,<,0.001, respectively) and with each other (r,=,0.79, P,<,0.001). The change in all three ICIQ-SF subscores correlated significantly with percentage reduction in 24-hr pad weight and with post-operative PGI-I score. There was no significant change in the IPSS or the voiding or storage subscores, and none correlated with any other study parameter. Conclusions This study validates the construct validity of the ICIQ-SF and PGI-I in the assessment of treatment for male stress incontinence and should make clinicians confident in comparing studies of incontinence treatment utilizing the change ICIQ-SF score, the post-operative PGI-I score, and percentage reduction in 24-hr pad weight as outcome measures. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation,,NEUROUROLOGY AND URODYNAMICS, Issue 1 2007Jonathan S. Starkman Abstract Aims We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures. Methods A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: significant response (,80% improvement), moderate response (,50% and <80% improvement), and poor response (<50% response). Results Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal fistula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow-up was 7.2 months. Twenty-two women (88%) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50% improvement in clinical symptoms at last follow-up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 (P,<,0.001). There were no significant differences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters. Conclusion Sacral neuromodulation appears to be an effective therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow-up are needed to assess the durability of this therapeutic modality. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Complications following surgical intervention for stress urinary incontinence: A national perspectiveNEUROUROLOGY AND URODYNAMICS, Issue 7 2005David A. Taub Abstract Aims Stress urinary incontinence (SUI) impacts many women. Treatment is primarily surgical. Post-operative morbidity considerably affects individuals and the health care system. Our objective is to describe complications following surgery for SUI and how they affect resource utilization. Methods Utilizing the Nationwide Inpatient Sample (a nationally representative dataset), 147,473 patients who underwent surgery for SUI from 1988 to 2000 were identified by ICD-9 codes. Comorbid conditions/complications were extracted using ICD-9 codes, including complication rates, length of stay (LOS), hospital charges, and discharge status. Results Overall complication rate was 13.0% (not equal to sum of complication sub-types, as each woman may have had,=,1 complication), with 2.8% bleeding, 1.4% surgical injury, 4.3% urinary/renal, 4.4% infectious, 0.1% wound, 1.1% pulmonary insufficiency, 0.5% myocardial infarction, 0.2% thromboembolic. The "gold standard" surgical technique for SUI, the pubovaginal sling, had the lowest morbidity at 12.5%. Mean LOS increased with morbidity: from 2.9 to 4.1 to 6.1 days for those with 0, 1, and =2 complications respectively (P,<,0.001). Similarly, inflation-adjusted hospital charges increased with morbidity: from $7,918 to $9,828 to $15,181 for those with 0, 1, and =2 complications respectively (P,<,0.001). The percentage of patients requiring post-discharge subacute or home care increased with morbidity: from 4.4% to 8.4% to 14.3% for those with 0, 1, and =2 complications (P,<,0.001). Conclusions A substantial percentage of women experience complications following surgery for SUI. Post-operative morbidity leads to dramatically increased resource utilization. Prospective studies are needed to identify pre-operative risk factors and intraoperative process measures to optimize the quality of care. Neurourol. Urodynam. © 2005 Wiley-Liss, Inc. [source] Use of devices to prevent subluxation of the shoulder after strokePHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2005Anchalee Foongchomcheay Abstract Background and Purpose. Supportive devices, such as slings, wheelchair or chair attachments and orthoses, have been used for many years by physiotherapists to support the affected shoulder after stroke. The purpose of the present paper was to examine the alignment between current practice with evidence for the use of supportive devices in the prevention of subluxation of the shoulder after stroke and to provide guidance for clinical practice and future research. Method. In order to determine the evidence regarding the most appropriate supportive devices to prevent subluxation after stroke, a systematic review was undertaken following the guidelines set out by the Cochrane Collaboration. In order to determine current practice with regard to the most commonly used supportive devices to prevent subluxation after stroke, a questionnaire was designed and administered for use in Australia. Results. The collar-and-cuff sling is the most commonly used sling. However, a small amount of lower-level evidence shows that the collar-and-cuff sling only reduces subluxation by half, suggesting that it may not be the most effective to use for prevention. In contrast, this evidence supports the use of wheelchair or chair attachments. Conclusions. We found that there was a lack of high-level evidence to guide clinical practice. In order to determine evidence-based practice for the prevention of shoulder subluxation, there is a need to test the efficacy of the most promising supportive devices based on available evidence. Copyright © 2005 John Wiley & Sons, Ltd. [source] Novel reconstruction of the orientation of the pectoral girdle in sauropodsTHE ANATOMICAL RECORD : ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGY, Issue 1 2007Daniela Schwarz Abstract The orientation of the scapulocoracoid in sauropod dinosaurs is reconstructed based on comparative anatomical investigations of pectoral girdles of extant amniotes. In the reconstruction proposed here, the scapula of sauropods stands at an angle of at least 55° to the horizontal plane in mechanical coherence with the sternal apparatus including the coracoids. The coracoids are oriented cranioventrally to the rib cage and the glenoid is directed mediolaterally, which allows the humerus to swing in a sagittal plane. The inclination of the scapula to the horizontal plane is reconstructed for Diplodocus (60,65°), Camarasaurus (60,65°), and Opisthocoelicaudia (55,65°). The inclination of the scapulocoracoid has consequences for the overall body posture in Camarasaurus and Opisthocoelicaudia, where the dorsal contour would have ventrally declined toward the sacrum. Scapulocoracoid mobility depends on the arrangement of clavicles, the reconstruction of a coracosternal joint, and the reconstructed musculature of the shoulder girdle. In a crocodylian model of the shoulder musculature, m. serratus profundus and superficialis form a muscular sling, which suspends the trunk from the shoulder girdle and would allow a certain mobility of the scapulocoracoid. An avian model of the shoulder musculature would also mean suspension by means of the m. serratus complex, but indicates a closer connection of the scapula to the dorsal ribs, which would lead to more restricted movements of the scapulocoracoid in sauropods. Anat Rec, 290:32,47, 2007. © 2006 Wiley-Liss, Inc. [source] Cellular and molecular tunnels surrounding the forebrain commissures of human fetusesTHE JOURNAL OF COMPARATIVE NEUROLOGY, Issue 4 2005Roberto Lent Abstract Glial cells and extracellular matrix (ECM) molecules surround developing fiber tracts and are implicated in axonal pathfinding. These and other molecules are produced by these strategically located glial cells and have been shown to influence axonal growth across the midline in rodents. We searched for similar cellular and molecular structures surrounding the telencephalic commissures of fetal human brains. Paraffin-embedded brain sections were immunostained for glial fibrillary acidic protein (GFAP) and vimentin (VN) to identify glial cells; for microtubule-associated protein-2 (MAP-2) and neuronal nuclear protein (NeuN) to document neurons; for neurofilament (NF) to identify axons; and for chondroitin sulfate (CS), tenascin (TN), and fibronectin (FN) to show the ECM. As in rodents, three cellular clusters surrounding the corpus callosum were identified by their expression of GFAP and VN (but not MAP-2 or NeuN) from 13 to at least 18 weeks postovulation (wpo): the glial wedge, the glia of the indusium griseum, and the midline sling. CS and TN (but not FN) were expressed pericellularly in these cell groups. The anterior commissure was surrounded by a GFAP+/VN+ glial tunnel from 12 wpo, with TN expression seen between the GFAP+ cell bodies. The fimbria showed GFAP+/VN+ cells at its lateral and medial borders from 12 wpo, with pericellular expression of CS. The fornix showed GFAP+ cells somewhat later (16 wpo). Because these structures are similar to those described for rodents, we concluded that the axon guiding mechanisms postulated for commissural formation in nonhuman mammals may also be operant in the developing human brain. J. Comp. Neurol. 483:375,382, 2005. © 2005 Wiley-Liss, Inc. [source] Long-term outcomes of patients who failed to attend following midurethral sling surgery , A comparative study and analysis of risk factors for non-attendanceAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010Kobi STAV Background and aims:, To assess long-term subjective cure and subjective complication rates of women who underwent midurethral sling (MUS) for stress urinary incontinence (SUI) in those who failed to attend (FTA) versus those who attended for postoperative follow-up. Predictive factors for non-attendance were identified. Methods:, A total of 1225 consecutive women with urodynamic SUI had a synthetic MUS at our institution between 1999 and 2007. Patients were interviewed via phone call with a structured questionnaire. Comparison between FTA and non-FTA patients was performed and multivariate analysis was utilised to identify risk factors for non-attendance. Results:, Univariate analysis revealed that the FTA rate was lower in patients who underwent concomitant prolapse surgery (29% vs. 84%, P < 0.001), FTA patients were younger (mean age 56 vs. 67 years, P < 0.001) and more depressed (14% vs. 4%, P < 0.05). At a mean follow-up of 50 ± 24 months, the subjective cure rate was similar between the two groups (84% vs. 86%, NS). The incidence of overactive bladder symptoms was significantly higher in the non-FTA patients (34% vs. 6%P < 0.001). Isolated sling procedure (OR = 2.71, P < 0.01) and age <50 years (OR = 3.15, P < 0.05) were significant predictors for failed attendance. Conclusions:, Our results indicate that the subjective cure rate is similar between non-FTA and FTA patients subsequent to a MUS procedure. However, the rate of overactive bladder symptoms is higher in the non-FTA patients. Isolated MUS procedure and younger age are significant risk factors of failure to attend in the longer term. [source] The TFS mini-sling for uterine/vault prolapse repair: A three-year follow-up reviewAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Peter E. P. PETROS Aims: To assess the three-year prolapse recurrence rate of the tissue fixation system (TFS) posterior mini-sling, an operation that works much like a McCall procedure. Patients and methods: Patients who originally presented with major symptomatic prolapse were contacted by telephone three years after a posterior TFS mini-sling operation, and invited to attend for review. All patients were questioned as to recurrence of any lumps, ,dragging pain', satisfaction with the procedure and existence of any vaginal discharge. Results: Of the original group of 39 patients, 35 were interviewed, 22 attended for review and four patients were uncontactable. Symptomatic cure was reported by 30 patients (86%), improvement in two (6%), and failure in three (9%). Conclusions: The longer-term results from the TFS posterior sling are encouraging. The procedure is evolving, and more studies are required. [source] Suburethral slingplasty evaluation study in North Queensland, Australia: The SUSPEND trialAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2005Yik Nyok LIM Abstract Objective:, To compare the safety and efficacy of three types of suburethral slings for the treatment of urodynamic stress incontinence. Methods:, Following ethics approval, 195 (3 × 65) patients with urodynamic stress incontinence were randomly assigned to undergo suburethral slingplasty with the Tension-free Vaginal Tape (TVT; Gynecare, Ethicon, Somerville, NJ, USA), Intravaginal Sling (IVS; Tyco Healthcare, Mansfield, MA, USA), or Suprapubic Arc Sling (SPARC; American Medical Systems, Minnetonka, MN, USA). The patients were blinded to the type of sling implanted. Main outcome measures were:, (1) operative and short-term complications; (2) pre- and postoperative symptomatology; and (3) pre- and postoperative urodynamic findings. Results:, There was a statistically significant increased rate of sling protrusion (13.1% vs. 3.3% and 1.7%; P = 0.04) in the SPARC group when compared to TVT and IVS. Otherwise, there were no significant differences between the groups with respect to the incidences of other operative complications, patients' main subjective outcomes, satisfaction rates, or postoperative urodynamic findings. The overall objective stress incontinence cure rates were 87.9%, 81.5% and 72.4% for the TVT, IVS, SPARC groups respectively (P = 0.11). Conclusions:, All three slings appear quite successful for the treatment of stress incontinence. The SPARC tapes showed more sling protrusion complications and a trend towards lower objective cure rates; probably as a result of the insertion method used in this study which favoured a loose SPARC sling placement. The authors recommend that the SPARC slings be left tighter than TVT, or for the cough test to be carried out. [source] A randomised trial of a retropubic tension-free vaginal tape versus a mini-sling for stress incontinenceBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2010M Basu Please cite this paper as: Basu M, Duckett J. A randomised trial of a retropubic tension-free vaginal tape versus a mini-sling for stress incontinence. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02513.x. Objective, To compare a mini-sling with a retropubic tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence (SUI) and urodynamic stress incontinence (USI). Design, Randomised trial. Setting, Urogynaecology unit in large UK district general hospital. Population, Women with USI resistant to conservative management and requiring a suburethral sling. Methods, A total of 71 women with SUI and confirmed USI were randomised to undergo treatment with either a retropubic TVT or mini-sling. Follow-up was at 6 weeks, with a history, examination and quality of life questionnaire, and at 6 months with further subjective evaluation and twin-channel subtraction cystometry and pressure-flow studies. Main outcome measures, The presence of SUI at 6 weeks and 6 months after treatment. Results, The mini-sling was associated with a significantly higher rate of persistent SUI at 6 weeks (OR 9.49, 95% CI 2.8,32.6) and 6 months (OR 8.14, 95% CI 2.7,24.7), and of USI at 6 months (OR 7.58, 95% CI 2.7,24.7). The rate of complication was similar in the two groups. Conclusions, The mini-sling is associated with a higher failure rate than a retropubic TVT. Longer term and multicentre outcome data are necessary to explore these findings further. Until this is available, the mini-sling should be used with caution. [source] A multifilament polypropylene mesh for urinary incontinence: ten cases of infections requiring removal of the slingBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2006P Richardson No abstract is available for this article. [source] Prevention of residual urinary incontinence following successful repair of obstetric vesico-vaginal fistula using a fibro-muscular slingBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2004Andrew Browning Obstetric vesico-vaginal fistula remains a significant cause of female urinary incontinence worldwide. Approximately 2 million women suffer from this condition, perhaps many more, most of whom are in Africa. Very few centres are treating these patients, and although success rate in the closure of the fistula is high, up to 92%, this does not necessarily equate to a cure. A significant proportion of women remains with urinary incontinence. Little is known about the nature of this incontinence, and even less is known about how to manage it. This article describes a new and simple surgical procedure, which, when employed at the time of fistula closure, seems to reduce the incidence of residual incontinence in those women at a higher risk of developing it. [source] Intermediate-term results, up to 4 years, of a bone-anchored male perineal sling for treating male stress urinary incontinence after prostate surgeryBJU INTERNATIONAL, Issue 4 2009Miguel Guimarães OBJECTIVE To examine the intermediate-term outcome (up to 4 years) of a bone-anchored perineal sling (InVanceTM, American Medical Systems, Minnetonka, MN, USA) in men with stress urinary incontinence (SUI) after prostate surgery. PATIENTS AND METHODS In all, 62 men with SUI were implanted with the InVance sling. SUI was diagnosed after radical prostatectomy in 58 patients and after benign prostatic hyperplasia (BPH) prostatectomy in four patients. Implantation of the InVance bone-anchored bulbourethral sling was conducted primarily under spinal anaesthesia. Patients were considered cured, if they stopped wearing continence pads and improved if the daily number of pads used decreased by at least half. The Incontinence Quality of Life questionnaire and a simple verbal question about patient satisfaction with the surgery were also used and complications were measured. RESULTS In all, 40 patients (65%) were cured and 14 (23%) were improved after a mean follow-up of 28 months. The UI cure rates at 3 and 4 years follow-up were 70% and 66%, respectively. The most common side-effect was transient scrotal or perineal pain or numbness, which affected 12 patients (19%). There was a prolonged postvoid residual urine volume of >100 mL in six patients (10%), which resolved within 2 weeks of indwelling catheterization. Explantation of the sling was required in two cases (3%) because of infection. In one patient (2%), revision was required for bone-anchor dislodgement. CONCLUSION The InVance sling offers good intermediate-term cure and improvement rates for SUI after prostatectomy. The procedure has an acceptably low rate of minor complications, and should be considered for treating men with less severe forms (,5 pads per day) of SUI. [source] 87 French multicentric prospective study for treatment of postprostatectomy stress urinary incontinence (SUI) using adjustable continence therapy (PROACTÔ)BJU INTERNATIONAL, Issue 2006E. CHARTIER KASTLER Introduction:, This study assessed the feasibility and efficacy of ProACTÔ for treatment of postprostatectomy incontinence. Material and methods:, Using fluoroscopic control two percutaneous balloons are placed at the vesico-urethral anastomosis (Prostatectomy; Ablatherm) or the apex (TURP) and filled with isotonic solution. Postoperatively, 1 ml can be titrated monthly until optimum continence is achieved. Results:, Fifty-eight patients were implanted, 52 postcancer treatment (51 Radical Prostatectomy with 11/51 postradiotherapy and 1/52 Ablatherm) and six following benign surgery (four TURP and two other prostatectomies). Mean age was 70.8 years old (56.6,87.2) with time since initial surgery 5.3 years (6 months,20.6 years). Prior surgical incontinence treatments included artificial urinary sphincters (eight), bulking agent injections (three) and male sling (one). Mean urethral closure pressure (n = 36) was 49 cm of H2O at baseline. Average pads/day was 2.9 (1 to 10). Mean quality of life (I-QoL) was 45 (2,85). At median follow-up (14 months), 11 patients (19%) were dry, 21 (36%) improved, 17 (29 %) unchanged; 2 (3.4%) worse and seven (12%) had undergone explanation. Quality of Life increased to 61 (17,100). Of the 24 postradical prostatectomy patients without radiotherapy, 92 % are improved, 38 % being completely dry. However six (55%) of postradiotherapy patients failed. Sixteen patients required explanation due to infection (two); urinary retention (one); urethral erosion (one); pain (one), defective balloons (two); other (one) non-response (eight). Four patients were successfully re-implanted. Conclusion:, ProACT is an effective treatment option as an alternative to the artificial urinary sphincter. [source] A tissue-engineered suburethral sling in an animal model of stress urinary incontinenceBJU INTERNATIONAL, Issue 4 2005Tracy W. Cannon OBJECTIVE To create and evaluate the functional effects of a tissue-engineered sling in an animal model of stress urinary incontinence (SUI). MATERIALS AND METHODS Twenty female Sprague-Dawley rats were divided into four equal groups: a control group (C) had no intervention before the leak-point pressure (LPP) was measured; a denervated group (D) had bilateral proximal sciatic nerve transection (PSNT) and periurethral dissection with no sling placed; group S had concomitant bilateral PSNT and a suburethral sling of small intestinal submucosa (SIS) placed; and group (M) had concomitant bilateral PSNT with implantation of a tissue-engineered sling. The suburethral sling was placed via a transabdominal approach with the sling sutured to the pubic bone. Tissue-engineered slings were prepared with muscle-derived cells obtained via the pre-plate technique and subsequently seeded for 2 weeks on a SIS scaffold. Suburethral slings were implanted 2 weeks before LPP testing, using the vertical-tilt method. RESULTS Surgically placing a suburethral sling is feasible in the female rat, with few complications. LPPs from both sling groups (S and M) were not significantly different from untreated controls (C). The S, M and C groups all had significantly higher LPPs than group D. Importantly, no rat from either sling group (S and M) had signs of urinary retention. CONCLUSIONS Placing tissue-engineered slings in an animal model of SUI resulted in LPP values that were not significantly different from those in untreated control or SIS (S) groups. These data show that incorporating muscle stem cells into SIS slings does not adversely alter the advantageous mechanical properties of the SIS sling in a model of SUI, and provide the basis for future functional studies of tissue-engineered sling materials with long-term retention. [source] Porcine small intestinal submucosa as a percutaneous mid-urethral sling: 2-year resultsBJU INTERNATIONAL, Issue 1 2005J. Stephen Jones OBJECTIVE To report the 2-year follow-up results on patients treated with a novel minimally invasive outpatient procedure for placing a mid-urethral sling, using porcine small intestinal submucosa (SIS). PATIENTS AND METHODS Thirty-four women with urodynamic evidence of stress urinary incontinence (SUI, 19) or of SUI with a positive cough test (15) were treated. A curved ligature carrier was used to create a tract between bilateral suprapubic stab incisions and a 2-cm mid-urethral vaginal incision. A suture secured to each end of the SIS sling was placed through the eyelet of the ligature carrier. Extraction was used to position the sling at the mid-urethra, providing a backboard of support that was remodelled with ingrowth of the patient's autologous tissue. RESULTS SUI was reportedly cured in 27 of the 34 women (79%) at the 2-year follow-up; three (9%) of those with no complete resolution were pleased with their results, because the improvement allowed them to wear an average one or fewer pads per day. One patient developed de novo urge incontinence. Three patients (9%) developed suprapubic inflammation at 10, 21 and 45 days after surgery; all resolved, but one had a recurrence of SUI. No prolonged retention, erosion or other complications were noted. CONCLUSIONS Early results with the percutaneous mid-urethral placement of SIS are promising and potentially comparable with those after using synthetic minimally invasive slings. [source] Combined external urethral bulking and artificial urinary sphincter for urethral atrophy and stress urinary incontinenceBJU INTERNATIONAL, Issue 6 2005Nadeem U. Rahman OBJECTIVE To describe a technique of externally bulking the urethra with a soft-tissue graft before placing another artificial urinary sphincter (AUS), as when placing another AUS for recurrent male stress urinary incontinence (SUI) other manoeuvres, e.g. placing a tandem cuff or transcorporal cuff, must be used to obtain urinary continence in an atrophic urethra, and each is associated with morbidity. PATIENTS AND METHODS From January 2003 to July 2004, five patients (mean age 74 years, range 62,84) treated by radical prostatectomy were referred for recurrent SUI after placing an AUS (four, including one with urethral erosion) or a male sling (one, with a resulting atrophic urethra). Each patient was treated with an external urethral bulking agent (Surgisis® ES, Cook Urological, Spencer, Indiana) and had an AUS placed. RESULTS In each patient the greatest urethral circumference was <4 cm. To place a functional 4 cm cuff, the diameter of the urethra was enhanced by wrapping it with Surgisis ES. Continence was significantly improved in all patients except one 84-year-old man who had the replanted artificial sphincter removed because of erosion 14 months after surgery. CONCLUSION In cases of severe recurrent SUI from urethral atrophy after placing an AUS, externally bulking the urethra with Surgisis ES before placing another AUS is well tolerated, and gives satisfactory results. [source] | ||||||||||||||||||||||||||||