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Obesity is a chronic disease which affects a substantial number of patients. It also increases a person’s risk of genital prolapse. Conventional techniques of prolapse repair (sacropexy, transvaginal meshes and sacrospinal fixation) are used in very adipose women, but the effectiveness of this technique is sometimes restricted due to the difficultly of performing the surgery. Here we will describe a new method of endoscopic prolapse surgery, which is especially developed for obese patients. The lateral parts of the iliopectineal ligament are used for a bilateral mesh fixation of the descended structures. We have already used this method successfully in 12 patients without any complications. This method provides a stable and durable repair. The laparoscopic access reduces morbidity. The operation time for this procedure is approximately 50 min.

Objective Our autopsy studies show possible links between classical Alzheimer pathology and decreased expression of nicotinic acetylcholine receptors. For further elucidation we are now using in vitro models. We report preliminary evidence for the impact of β-amyloid on nicotinic receptor expression in hippocampal dissociation culture. Methods Cultures (E18 rats) were grown in a serum-free medium and incubated at 8 days in vitro for 3 days with 1 μM Aβ 1-42 . Expression of α4, a7, and β2 nicotinic receptor subunit protein was assessed immunohistochemically and rated semiquantitatively. Results - Aβ 1 42 incubation resulted in a massive reduction of α4 protein-expressing neurons, this effect was less pronounced for the α7 and β2 subunit protein. Conclusion These findings provide first evidence for a direct impact of classical Alzheimer pathology features on nicotinic receptor expression in vitro. Our model will be useful for testing the potential of drugs to stop or reverse these effects.

Cognitive deficits in Alzheimer's and Parkinson's disease are closely related to disturbed cholinergic transmission. The decrease of nicotinic acetylcholine receptor protein has been assessed by Western blotting and immunohistochemistry. Stereology, however, has not been used to assess numbers of receptor-expressing human cerebrocortical neurons. Our approach applies a combination of alpha7 subunit-immunohistochemistry with a stereological technique using defined stretches of pial surface as reference standard. The number of alpha7 subunit protein-expressing neurons in the Alzheimer temporal cortices amounted to approximately half of that of controls while numbers in Parkinson patients lay in between. No differences in the total number of neurons were seen. These results corroborate nonstereological studies on Alzheimer cortices and for the first time show a similar decrease in receptor expression in Parkinson's disease. They provide evidence that not only Alzheimer dementia but also cognitive deficits in Parkinson's disease may be related to decreased nicotinic receptor expression.

The lateral repair is an accepted method for the reconstitution of paravaginal defects. Several open or vaginal approaches have been described, but there is still a deficit of reproducible laparoscopic approaches. Thus, only a few clinics perform the laparoscopic approach although it offers several advantages compared to open or vaginal surgery. This article describes our modified laparoscopic approach with inlay of a polypropylene mesh. Operation time will go on about 50 minutes using the here-presented modified approach. The inlay of a mesh with induction of connective tissue may increase long-term stability.

Introduction: No data regarding sexuality following laparoscopic prolapse surgery are available to date. Our hypothesis is that laparoscopic sacropexy does not influence sexuality negatively, whereas concomitant (vaginal) surgery negatively influences sexuality. Methods: Participants were 132 patients who underwent laparoscopic sacropexy. We compared pre- and postoperative sexual scores by 2 validated questionnaires. Results: The response rate was 84% (111/132). No change in sexual activity was reported after surgery. In the sexually active group (56.8%; 63/111) the impairment of sexuality was significantly reduced in all age groups independently of concomitant vaginal surgery. In the sexually inactive group, only 4.3% (2/48) were inactive because of vaginal symptoms before operation. After the operation these patients stayed inactive; however, 1 reported reasons unrelated to prolapse. Conclusions: Laparoscopic prolapse surgery reduces sexual impairment in sexually active patients. There appears to be no benefit for patients who are not sexually active for reasons related to the prolapse. Concomitant surgery does not affect sexual activity.

Introduction: No validated questionnaire that evaluates vaginal symptoms is currently available in the German language. Here, we report the translation and validation process of the German ICIQ-VS. Subjects: Pilot study: 10 patients without any specific disease. Main study: 58 patients (cases) suffering from genital descensus higher than grade 1 pelvic organ prolapse quantification (POPQ) and 51 patients (controls) without vaginal affections. Methods: To establish a cultural-adaptive equivalent in German, recommendations from Guillemin et al. [J Clin Epidemiol 1993;46:1417–1432] were carefully followed. Participants of the main study were asked to fill in the questionnaire at three time points [baseline (T1), 7 days later (T2) and 1 year later (T3)]. Reliability, validity and sensitivity to change were evaluated. Results: In our pilot study, all questionnaire items were correctly interpreted and answered. In the main study, no changes from the original format were observed after translation and cultural adaptation. For the cases, internal consistency was acceptable (Cronbach’s alpha 0.72–0.79) and test-retest reliability was moderate to near-perfect for single items (weighted kappa 0.67–0.94). Sensitivity to change and content validity were excellent. Construct validity revealed statistically significant differences between groups. Conclusion: The ICIQ-VS has successfully been translated and validated into the German language.