Paulo Palma

Impacto da reeducação postural global no tratamento da incontinência urinária de esforço feminina

OBJECTIVE: To evaluate the effect of global postural reeducation (GPR) on stress urinary incontinence (SUI) and quality of life in SUI female patients METHODS: The study design was a prospective non-randomized clinical trial. Twenty-six patients with symptoms of SUI were selected from the Urogynecology Outpatient Clinics of the State University of Campinas (Unicamp), state of Sao Paulo, Brazil. Age ranged from 23 to 72 years old (mean 50.8). All women were submitted to anamnesis, physical exam, postural evaluation and urodynamic testing. Patients were treated by the GPR in individual 50 minute sessions weekly for three months and twice a month for the next three months. All patients were re-evaluated at the end of treatment and six months later by means of General Impression of Improvement, Incontinence Impact, General Perception of Health, Functional Evaluation of the Pelvic Floor, Number of Leaking Episodes and Pad Use. RESULTS: At the end of treatment 4 (16%) of the patients were cured, 18 (72%) had improved significantly and 3 (12%) failed. At 6 months, 6 (24%) were cured, 16 (64%) improved and 3 (12%) failed (p<0.001). Quality of Life questionnaires presented significant improvement (p<0.05) in all domains, with emphasis on General Perception of Health, Incontinence Impact and number of leaking episodes. The Functional Evaluation of the Pelvic Floor and Pad Use also presented significant (p<0.001) improvement. CONCLUSION: These results may demonstrate that GPR is an efficient alternative for treatment of stress urinary incontinence.

Evaluation of spatial and temporal variability of pasture based on topography and the quality of the rainy season

Yield and botanical composition of a given dry-land pasture are heavily influenced by rainfall distribution, and vary according to topography. Through analyzing these parameters, it is possible to identify patterns of spatial distribution, related to topographic characteristics, which can be used to improve spatial management of pasture. The main objective of this project was to assess the role of rainfall, temperature and topography in the spatial and temporal variability of pasture and establish models for predicting the spatial distribution and yield of certain plant species, based on its topographic characteristics. This study was carried out over three years, 2004 to 2006, in a dry-land pasture located in Southern Portugal. The data obtained were analyzed as a function of distance to flow lines and the results demonstrate that certain topographical characteristics, associated with agronomic information, can be very useful in explaining the spatial and temporal variability of yield and the botanical composition of the pasture. The slope of the linear regression of the variables mentioned can be used to estimate the spatial variation of yield and the botanical composition as a function of distance to flow lines. The regression coefficient can be estimated from the annual rainfall, given the strong correlation between the two.

Primary fixation of mini slings: a comparative biomechanical study in vivo

INTRODUCTION AND OBJECTIVES The mini sling concept for stress urinary incontinence is an anatomical approach that involves placing a midurethral low-tension tape anchored to the obturator internus muscles bilaterally. They overcome the blind passage of long needles and all the related complications. There are many different devices available and because these are outpatient procedures, primary fixation plays an important role in the outcome. The objective is to evaluate the primary fixation of the various devices of attachment of the commercially available mini-slings through biomechanical tests. MATERIALS AND METHODS A total of 45 Wistar rats were divided in 3 groups of 15 rats each. They underwent 5 subcutaneous implantation of different mini slings and one polipropilene mesh (control), as follows: TVT-Secur® (Gynecare, USA), Type 1 polypropylene mesh (control); Ophira Mini Sling System ® (Promedon, Argentina), Tissue Fixation System ® (TFS PTY, Australia), Zipper Sling ® and ″T device″ (Prosurg, USA). The abdominal wall was removed on bloc at different times after implant for biomechanical evaluation, which consisted in application of unidirectional force to the extremity of the fixation system or mesh, until it was completely removed from the tissue using a tension meter (Nexygen 3.0 Universal Testing Machine-LLOYD Instruments). The force was measured in Newtons (N). RESULTS There was significant difference in the resistance to extraction among the different fixation systems. At 7 days the Ophira Mini Sling System ® presented the best fixation and ″T dispositive″ the worst. CONCLUSION Ophira mini sling System ® presented the best primary fixation at 7°, 14° and 30° days. The impact of this feature in the clinical setting needs to be verified.