Claudia Mehedintu

Effect of the surface modification of the synthetic meshes used in the surgical treatment of pelvic organ prolapse on the tissue adhesion and clinical functionality

Abstract Stress urinary incontinence and pelvic organ prolapse represent important conditions affecting adult women’s health. Lately, the properties and performance of the polymer materials used in the treatment of pelvic organ prolapse have been improved by modulating from their formula. Materials investigated in our study are polypropylene meshes used by clinicians in surgical treatment of urinary incontinence and utero-vaginal prolapse. In order to make a comparative analysis, we confronted the structure and surface morphology of native synthetic polypropylene meshes with explanted fragments from the same mesh type after clinical use. FTIR investigations revealed little change in structure after implantation, somehow insignificant. Scanning electron microscopy (SEM) demonstrates modification in surface morphology even just by passing through the transobturator passage, whereas after implantation the surface deteriorates. SEM on explanted meshes proves the encapsulation process of the mesh to be more similar to a foreign body reaction rather than to the adhesion and integration of the synthetic mesh into the organism. Histological analysis of the surrounding tissues near explanted mesh was made in some relevant clinical cases, because the tissue response is an important factor in order to evaluate the tissue adhesion at the polypropylene mesh surface. Based on our experiments and clinical experience we’ve designed an adhesion score. It applies to meshes used in pelvic organ prolapse surgery measuring the following important factors: tenacity, extent of adhesion, macroscopic and microscopic aspects and ease of dissection from surrounding tissues.

Maternal-fetal management and outcome in a case of uterine anatomic abnormality and obstetric antiphospholipid syndrome

The progress of biologic and ultrasound assessments in preg nancy has a favorable impact, demonstrated in the case we are presenting, in terms of monitoring the pregnancy rea ching the term, in a patient diagnosed with obstetrical antiphospholipid syndrome and septated uterus diagnosed after a previous spontaneous abortion at 6 weeks of gestation, when ultrasonographic evaluation and uterine cavity control have been performed. We pay attention to this case from the point of view of placental abnormalities that can occur if the uterine malformation leads to an anatomical perturbation of the insertion and development of the placenta, but also to the placental abnormalities from the antiphospholipid syndrome in which thrombosis can lead to placental dys function. These aspects are supported by laboratory tests that high light the antiphospholipid antibodies and ultrasound findings obtained from pregnancy monitoring (placental anomalies, fetal growth curve, uterine artery, umbilical artery and middle cerebral artery Doppler flows, amniotic fluid index). From the category of anti-phospholipid antibodies, anti-annexin V antibodies are directly involved in the disruption of placenta as early as 7 weeks of gestation.

Colposcopic assessment and outcome in low grade cervical intraepithelial neoplasia treated with loop electrosurgical excision procedure

The aim of the research was to assess the outcome of persistent (≥two years) low-grade cervical intraepithelial neoplasia (CIN 1) medicated with loop electrosurgical excision procedure (LEEP). An analysis of 38 topics with persistent biopsy-confirmed CIN 1 diagnosed after low-grade squamous intraepithelial lesion (LSIL) or atypical squamous cells of undetermined significance (ASC-US) on Pap test and treated using LEEP was performed. Post-LEEP follow-up were scheduled in 6 months, 1 year, and yearly thereafter: cytology, colposcopy, and plasma diagnostic examinations. There were 38 LSIL patients treated with LEEP conization. About 6 patients were excluded from the study due to subsequent hysterectomy and 2 patients never attended the follow-up schedule in the rest. The remaining 30 patients were retrospective studied for the incidence of recurrent rate. The mean age of the patient was 44 years. About 50% of patients were multiparity and nearly one - third used oral contraceptive pill. The results of this study suggest that the incidence of CIN 2+ lesions during follow-up of persistent biopsy-confirmed CIN 1 after ASC-US/LSIL treated by LEEP is very low.

EP31.03: The role of ultrasonography in the evaluation of functional and anatomical disorders associated with static pelvic disorders.

E. Falò4, M. Leombroni4, D. Buca4, R. Savone4, S. Gustapane1, A. Santarelli4, F. Frondaroli4, A. Ricciardulli2, C. Di Matteo4, F. Fanfani4, M. Liberati4, F. D’Antonio3 1Department of Obstetrics and Gynecology, ”D’Annunzio” University, Chieti, Italy; 2Department of Obstetrics and Gynecology, University of Chieti, Francavilla al Mare, Italy; 3Department of Fetal Medicine, UiT, University of Northern Norway, Tromsø, Norway; 4Department of Obstetrics and Gynecology, G.d’Annunzio University, Chieti-Pescara, Chieti, Italy

The role of adipose tissue as endocrine organ in the metabolic programming of fetuses derived from obese mothers

We aim to present the endocrine and paracrine role of the cytokines secreted by hypertrophied maternal fat cells on fetal and later on neonatal metabolic profile. The study used an animal model in order to analyze the influence of maternal adipokines secretion of fetal metabolism. We selected 50 female Wistar rats weighing between 200-250 g (normal weight 100-150g) to whom we induced obesity by high-fat, high-calorie food intake (80% of diet saturated fatty acids) and tracked the correlation of maternal adipokines secretion with placental and fetal lipid peroxidation level. The low adiponectin and increased leptin values as adipokines secreted by adipocytes of obese mothers were correlated with the level of placental and fetal tissue lipid peroxidation (from the liver, pancreas, brain), measured by elevated malonyldialdehyde and total thiols and the decreased levels of glutathione. It has been known for decades that fat tissue is not inert, but a true endocrine organ, which responds by secreting adipokines to different energy and hormonal stimuli. Endocrine secretion of adipokines from the adipocytes of obese mothers is positively correlated with placental and fetal lipid peroxidation levels. Fetal metabolic programming as an inducible phenomenon is explained partly by the influence of excess secretion of maternal adipokines.