A 72-year-old woman was seen in the emergency room with a 2-h history of acute abdominal pain and transvaginal prolapse of the bowel, which had developed immediately after a strong fit of coughing. The patient had undergone transvaginal hysterectomy and colpoperineoplasty 10 years previously for vaginouterine prolapse. A soft rubber vaginal ring pessary of 5.5 cm diameter had been inserted 5 years later because the woman had developed a recurrent rectocystocele but had refused further operation. Periodic follow-up examinations had always been unremarkable.On clinical examination bowel loops were visible, protruding externally from the vagina (Figure I ). The blood pressure was 200/130mmHg and the heart rate 88 beats/min. The abdomen was tender with no guarding and bowel sounds were decreased. The white blood cell count was slightly raised at 12.5 x 10y/l. Plain abdominal radiography showed distended small bowel loops but no air-fluid levels.At emergency laparotomy, exploration of the pelvis revealed perforation of the vaginal stump and incarceration of the terminal ileum into the vaginal pessary. A 45-cm segment of ischaemic bowel was removed, and end-to-end ileoileal anastomosis performed. The vagina was stabilized by fixation to remnants of the sacrouterine and round ligaments, and the vaginal defect was closed.The patient had an uneventful postoperative course and was discharged on day 11. DiscussionThere is agreement that definitive treatment of genital prolapse should consist of extirpative or reconstructive surgery, because this is well tolerated even in elderly patients'. Vaginal supportive devices should be restricted to patients who refuse or are awaiting operation, since their use is frequently associated Intestinal obstruction caused by a vaginal pessary is a clinical rarity. A literature review of this complication revealed two reports of compression ileus but not a single instance of incarceration and transvaginal bowel prolapse. Seling and Lindenfelser3 described a patient in whom a retrovaginal small bowel loop was compressed by a ring pessary; a similar case was reported by Lukowski4. In the present patient, intestinal obstruction and bowel prolapse resulted from perforation of the vaginal stump and incarceration into the ring of the pessary. This was clearly related to the preceding hysterectomy, since the uterus with its fixation in the pelvis acts as a barrier between the abdominal cavity and vagina.

Superparamagnetic iron oxide nanoparticles (SPIONs) are used in nanomedicine as transporter systems for therapeutic cargos, or to magnetize cells to make them magnetically guidable. In cancer treatment, the site-directed delivery of chemotherapeutics or immune effector cells to the tumor can increase the therapeutic efficacy in the target region, and simultaneously reduce toxic side-effects in the rest of the body. To enable the transfer of new methods, such as the nanoparticle-mediated transport from bench to bedside, suitable experimental setups must be developed. In vivo, the SPIONs or SPION-loaded cells must be applied into the blood stream, to finally reach the tumor: consequently, targeting and treatment efficacy should be analyzed under conditions which are as close to in vivo as possible. Here, we established an in vitro method, including tumor spheroids placed in a chamber system under the influence of a magnetic field, and adapted to a peristaltic pump, to mimic the blood flow. This enabled us to analyze the magnetic capture and antitumor effects of magnetically targeted mitoxantrone and immune cells under dynamic conditions. We showed that the magnetic nanoparticle-mediated accumulation increased the anti-tumor effects, and reduced the unspecific distribution of both mitoxantrone and cells. Especially for nanomedical research, investigation of the site-specific targeting of particles, cells or drugs under circulation is important. We conclude that our in vitro setup improves the screening process of nanomedical candidates for cancer treatment.