Modifying the surface of pelvic mesh with phosphorylcholine (PC) may help reduce the incidence of mesh-related complications, according to the results of a small pilot study.1
When used as a synthetic polymer-based coating, PC can enhance the biocompatibility of medical devices by reducing foreign body responses. This process has been used successfully in cardiac, ophthalmic, and other applications to reduce host inflammatory responses. To determine whether this process would improve the safety and effectiveness of polypropylene mesh grafts implanted to correct pelvic organ prolapse, surgeons from 5 sites in the United States collected data on patients whose pelvic organ prolapse was corrected surgically with Perigee IntePro Lite coated with PC. According to the authors, this is the first published study involving pelvic mesh treated with PC.1
In total, 40 women were enrolled in the study, with 32 women (80%) completing a minimum of 5 to 7 months of follow-up. The patients ranged in age from 36 to 78 years, and the mean patient age was 60 years. The body mass index (BMI) of patients ranged from 20 to 40, and the mean BMI was 28. Follow-up involved assessment of anatomical outcomes, symptomatic improvement, and complications, which included mesh exposure. Surgical success was defined as stage 1 or less using the Pelvic Organ Prolapse Quantification system or grade 1 or less using the Baden-Walker halfway system (Table).2
| Table. Pelvic Organ Prolapse Rating Systems |
| Pelvic Organ Prolapse Quantification (POP-Q) system |
| Stage 0 No prolapse |
| Stage 1 The most distal portion of the prolapse is more than 1 cm above the level of the hymen. |
| Stage 2 The most distal portion of the prolapse is 1 cm or less proximal or distal to the hymenal plane. |
| Stage 3 The most distal portion of the prolapse protrudes more than 1 cm below the hymen but protrudes no farther than 2 cm less than the total vaginal length (eg, not all of the vagina has prolapsed). |
| Stage 4 Vaginal eversion is essentially complete. |
| Baden-Walker halfway system |
| Grade 0 No prolapse. |
| Grade 1 Halfway to hymen. |
| Grade 2 To hymen. |
| Grade 3 Halfway past hymen. |
| Grade 4 Maximum descent. |
| Data from Persu C et al. J Med Life. 2011.2 |
During the follow-up period, there were no cases of mesh exposure or mesh extrusion and no occurrences of granuloma formation. The procedure was associated with an anatomical success rate of 100% among the 32 patients who had an adequate follow-up period. In addition, modification of the mesh surface with PC resulted in no adverse events. Despite these encouraging results, the study authors caution that their results are not statistically significant because of the small study sample.
Pertinent Point:
- Pelvic mesh treated with phosphorylcholine shows promise in reducing complications related to pelvic organ prolapse repair.
B mode and 3D Ultrasound images of a fetal abdomen (35wks) revealing gallbladder calculi
This case study shows a 26 week gestation with a cystic mass close to the sacrum.
CC is a 31 year old primigravida who was referred for ultrasound at a community hospital due to suspected cardiac anomalies noted on a screening sonogram at her doctor's office. Due to concern about a probable cardiac abnormality an amniocentesis was performed at the local hospital.
Single umbilical artery color doppler, transverse scan of urinary bladder shows single umbilical artery (left), transverse section of umbilical cord showing only two vessels: one vein and one artery (right).
Normal 35 week pregnancy