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Background: While attending to women presenting with pelvic floor relaxation and pelvic organ prolapse, both with intact uterus or after hysterectomy, urogynecologists are constantly looking for simple, safe and effective ways to cure this supportive pelvic floor defect. A novel surgical technique, the Prolift mesh operation, was reported recently entailing both a high therapeutic rate and a low complication rate., Aim: To evaluate the preliminary data of first 100 Prolift patients' series., Methods: A total of 100 patients with advanced pelvic floor supportive defects and pelvic organ prolapse underwent the Prolift operation., Results: The Prolift procedure does not require laparotomy. Intra-operative and post operative complications were recorded. Hospitalization period was relatively short. All patients but five (5%) reported satisfaction with the therapeutic results. Three patients had bladder penetration and were treated with surgical closure at the same session, three patients had tape protrusion that was removed successfully at the outpatient clinic and one patient had therapeutic failure., Conclusions: The Prolift is a novel operation, designed to cure advanced pelvic floor relaxation, reduce complication rate and rehabilitation period. The results of this series agree with previously reported efficacy, safety and simplicity of this procedure. However, more long-term data is required for drawing solid conclusions concerning the superiority of the discussed operative technique.

Background: One of the most significant challenges in surgical gynecology during the last decade was the treatment of vaginal vault prolapse after hysterectomy. Difficult extensive procedures have been advocated for this purpose. The posterior intra-vaginal slingplasty (PIVS) has recently been introduced. This procedure is based on the integral theory of pelvic floor stability and the use of mesh implants to achieve more reliable tissue stability than attaching the prolapsed tissue to the pelvic bones and ligaments., Aim: To evaluate the therapeutic outcome, safety and complications of the PIVS procedure., Methods: A total of 80 post hysterectomy patients with vagina vault prolapse underwent PIVS operation within one year., Results: All patients but one expressed satisfaction with the 12 months therapeutic results. The PIVS procedure does not require either laparotomy or deep trans-vaginal dissection., Conclusions: The PIVS was shown to be safe, effective and minimally invasive, and is therefore recommended as another treatment option for women with post hysterectomy vaginal vault prolapse.

Background: The risk of women who undergo surgery for the treatment of pelvic organ prolapse (POP) by the age of 80 is reported to exceed 10%, and is expected to rise with the increase in life expectancy. Most women affected are in their 5th or 6th decade, and the majority will suffer other medical problems. The current medical literature asserts that the vaginal surgical approach for POP operations are followed by less complications and provide a shorter rehabilitation period than the abdominal route. Hysterectomy is widely accepted as part of POP reconstructive surgery whenever the uterus is significantly prolapsed, however, there is no clear evidence to support the role of hysterectomy in improving surgery outcome. We present our experience with a new minimally invasive procedure - the posterior intravaginal slingplasty (IVS) for utero-suspension in the presence of moderate and advanced uterine prolapse., Aim: To evaluate the feasibility, intra- and post-operative complications and short term results of the posterior IVS procedure and uterosuspension for uterine prolapse., Methods: Reconstructive surgery using the posterior IVS was performed on 18 women with moderate to severe uterine prolapse who chose to preserve their uterus. Patients were then followed 1,6,12 months and 2 years post-operatively to assess any recurrence of pelvic organ prolapse., Results: No major intra- or post-operative complications were reported. Follow-up of one to 13 months showed good results., Conclusions: Reconstructive POP surgery may not necessitate hysterectomy. The posterior IVS is a novel safe, minimally invasive, simple and effective surgical procedure for the treatment of POP, permitting uterine preservation. A larger number of patients and a longer follow-up period are required for proper evaluation of the actual safety and efficacy of this procedure.

Background: Facing the fact that 20% of the parturient women suffer urinary stress incontinence, urogynecologists are constantly searching for simple, safe and effective ways to cure the underlying pelvic floor herniation. A novel surgical technique was reported lately to entail both high therapeutic rates and low complication rates., Aim: To evaluate preliminary data from the first 100 TVT-Obturator patient series., Methods: A total of 100 patients with urodynamically proven USI underwent the TVT-Obturator operations., Results: The TVT-Obturator procedure did not require bladder catheterization or intra-operative diagnostic cystoscopy. Operative complications were not recorded. Ninety-three patients reported cure, six patients had minimal residual urinary leak and one patient reported therapeutic failure., Conclusions: The TVT-Obturator is a novel mid urethral sling, designed to cure female urinary stress incoritinence and reduce peri-operative complications. These results agree with the previously reported efficacy, safety and simplicity of this procedure. However, long-term data is required prior to incorporating this operative technique within the armamentarium of anti-incontinence procedures.

Quality of life of 5% of the female population is impaired by urinary stress incontinence. Its cause is pelvic floor relaxation and the cure is surgical. The most widely performed operations are retropubic colposuspensions and sling operations, which have relatively high, well-proven cure rates. Yet because of the long rehabilitation required, gyneco-urologists seek minimally invasive ways to solve the problem. Vaginal colporrhaphy and laparoscopic operations are not common, but the recently reported TVT might become popular if proven effective.

Sacrospinous ligament fixation is a well-known method for correction of vaginal vault prolapse. The procedure is primarily indicated after hysterectomy and as a prophylactic measure for total uterine prolapse. 8 women with post-hysterectomy vaginal vault prolapse aged 48-72 years, were referred 1-25 years following primary surgery. Sacrospinous ligament fixation was elected to enable simultaneous correction of cystocele and rectocele, and to preserve sexual function. All operations were completed without significant complications. In 6 of the 8 patients located for long-term interview, 1 reported mild bulging of the introitus, another mild urinary stress incontinence, urgency and frequency and 1 reported frequency only. Sexual function in 4 was without complaints. Defecation in all patients was normal. We conclude that this operation is safe and effective. We encourage gynecologic surgeons to consult an experienced tutor prior to performing this procedure, as this type of surgery is quite dangerous and many gynecologists are not familiar enough with it.

Female urinary stress incontinence diminishes the quality of life of about 5% of women. It is usually dealt with by surgery to correct the relaxed pelvic floor, the cause of the incontinence. Tension-free vaginal tape is used in a newly described procedure. It consists of the vaginal introduction of a prolene needle-guided mid-urethral sling. The procedure is easy to perform under local anesthesia, recovery is rapid, and results are similar to those of other effective operations. We report 44 patients who underwent this type of surgery. There were no significant complications. The early results were good and although the follow-up has been short, we believe that experience with this operation will play an important role in the treatment of urinary stress incontinence.

Approximately 10% of psychiatric patients are violent and their violence is often directed towards the treating staff. Up to half of all psychiatrists have been physically assaulted at some time during their careers. Emotional reactions of the psychiatric staff to assault by patients vary, and include fear, anger and helplessness. Psychological defense mechanisms employed include projection, denial and isolation. For the staff, these reactions are a source of distress and a cause of burn-out. Anger can lead to nontherapeutic interventions such as counter-aggression.

Reports of hepatic damage following multiple stings by hornets led to this study of the effects of venom sac extract (VSE) from the oriental hornet. We used in-vivo models (serum of cats following a single exposure, and of rats following repeated exposures), in-situ models (perfusion of intact livers) and in-vitro models (monolayers of fetal rat liver tissue culture). Enzyme activities were measured in serum, in perfusates, and in media of cultures, as well as in liver fractions obtained by ultracentrifugation. In cats, levels of albumin, total proteins, electrolytes, urea, cholesterol, bilirubin and blood gases were determined. Bile acids were determined in bile secreted from perfused rat livers. Histologic, histochemical and electron-microscopic studies were also performed. It is concluded that VSE is the first animal product known to possess hepatotoxic properties. The venom mainly damages hepatic cellular membranes, and mitochondria are the organelles most severely injured; cholestasis also results. The damage is partially reversible, and occurs in mammals, including man.