Mario Colombo

Randomised comparison of Burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapse

Objective To compare the Burch colposuspension and the anterior colporrhaphy in women with both stress urinary incontinence and advanced anterior vaginal wall prolapse (cystocele).

Sacrospinous ligament fixation and modified McCall culdoplasty during vaginal hysterectomy for advanced uterovaginal prolapse

OBJECTIVE Our purpose was to compare anatomic and functional results of 2 procedures performed at vaginal hysterectomy for vaginal vault suspension in patients with advanced uterovaginal prolapse. STUDY DESIGN A retrospective case-control study was designed comparing 62 patients who underwent sacrospinous ligament fixation and 62 members of a matched control group who underwent modified McCall culdoplasty during vaginal hysterectomy and reconstructive pelvic surgery. The 62 pairs were matched for grade of uterine prolapse, age, parity, dystocia, menopause, body mass index, previous prolapse surgery, heavy work, constipation, and chronic cough. RESULTS Operative time and blood loss were significantly greater (P < .001) in the group with sacrospinous suspension. With a follow-up from 4 to 9 years, 17 (27%) patients receiving sacrospinous suspension had prolapse recurrence at any vaginal site compared with 9 (15%) patients receiving modified McCall culdoplasty (P = .14). Recurrent vault prolapse was recorded in 5 (8%) and 3 (5%) subjects, respectively (P = .72). Thirteen (21%) and 4 (6%) patients, respectively, had recurrent cystocele (matched odds ratio 4.1, 95% confidence interval 1.3 to 14.2, P = .04). No significative difference was observed in postoperative sexual function. CONCLUSION Sacrospinous ligament fixation is not recommended as a prophylactic measure at vaginal hysterectomy in patients with uterovaginal prolapse.

The Burch colposuspension for women with and without detrusor overactivity

Objective To compare the results of the Burch colposuspension in women with stress urinary incontinence and detrusor overactivity with those obtained in women with stress incontinence and stable bladders. Additionally, to analyse the value of two detrusor instability indexes and of standard cystometric parameters in predicting the surgical outcome.

Coumaphos distribution in the hive ecosystem: Case study for modeling applications

Pesticides are currently used inside hives, against the honeybee parasite Varroa destructor, producing unwanted contamination effects. To assess the distribution and fate of one of these pesticides (coumaphos), two experimental hives were treated with Perizin (the commercial product containing the active ingredient coumaphos). Samples of honey, wax, pollen, adult bees and larvae taken before treatment and up to 104 days afterwards, showed diffuse contamination. Wood hedges and wax bridges, where the pesticide solution was applied, were analysed as well. A mass balance was calculated, yielding a recovered amount of around 60% just after treatment and 38% 1 month later. Directly contaminated surfaces and wax contained the highest amount of residues. Wax and honey contained different amounts (10, and 0.1% respectively) but both retained residues for long time. Bees ingest most of the product just after treatment, then rapidly eliminate it by metabolism, advection and deposition processes. On the basis of analytical results, a simple model (level I of the fugacity model) was applied to the hive system for different pesticides (coumaphos, malathion, fluvalinate and bromopropylate). Predicted concentrations in wax and honey were compared with those measured, indicating the good predictive capability of this approach.

Surgery for genitourinary prolapse and stress incontinence: A randomized trial of posterior pubourethral ligament plication and Pereyra suspension

OBJECTIVE Our purpose was to compare two antiincontinence procedures in patients with severe genitourinary prolapse and coexisting clinical or potential stress incontinence. STUDY DESIGN In addition to cystopexy, 109 patients with a urethrocystocele of grade 2 or more and a positive stress test result with prolapse reduction received posterior pubourethral ligament plication or Pereyra suspension. RESULTS Of 55 patients undergoing posterior pubourethral ligament plication, 15 were clinically and 40 potentially incontinent; the same figures were 21 and 33, respectively, among 54 patients undergoing the Pereyra procedure. Follow-up was for 3 to 9 years. Subjective (60% vs 71%, p = 0.72) and objective (27% vs 57%, p = 0.14) cure rates were not statistically different among patients who were clinically incontinent (posterior pubourethral ligament plication vs Pereyra suspension). Among potentially incontinent patients, subjective (85% vs 100%, p = 0.03) and objective (50% vs 76%, p = 0.04) continence rates were higher after the Pereyra procedure. Overall, the cotton swab test had negative results (maximum straining angle < or = 30 degrees) after successful surgery in 79% and 96%, respectively, of patients (p = 0.03). Four subjects (7%) underwent removal of one Pereyra suture because of urinary retention or suprapubic wound infection. CONCLUSION Cystopexy with Pereyra suspension is recommended, particularly for patients with prolapse and potential stress incontinence.

Burch colposuspension versus modified Marshall-Marchetti-Krantz urethropexy for primary genuine stress urinary incontinence: A prospective, randomized clinical trial

OBJECTIVE Our purpose was to compare the effects of the Burch colposuspension with those of the modified Marshall-Marchetti-Krantz urethropexy. STUDY DESIGN Eighty women underwent the two types of operation. A full urodynamic investigation was repeated 6 months after surgery. RESULTS Clinical follow-up continued for 2 to 7 years. Differences in subjective and objective cure rates were not statistically significant (respectively, 92% and 80% for the Burch colposuspension and 85 and 65% for the modified Marshall-Marchetti-Krantz urethropexy). The latter induced a longer hospital stay (7.4 vs 6.3 days, p = 0.001), a later resumption of spontaneous voiding (13.8 vs 8.5 days, p = 0.002), and was associated with considerable complications (one case of blood replacement for retropubic hematoma, one case of severe voiding difficulty, one case of further treatment for stress incontinence, and three cases of symptomatic de novo detrusor instability). CONCLUSION For its high cure rate, short time to resumption of spontaneous voiding, short hospital stay, and low associated morbidity, the Burch colposuspension should remain the procedure of choice for stress incontinence.

A randomized comparison of continuous versus interrupted mass closure of midline incisions in patients with gynecologic cancer

Objective To address the incidence of deep wound dehiscence and incisional hernia formation with two types of mass closure after vertical midline laparotomy performed in patients with gynecologic cancer. Methods Continuous and interrupted mass closures were compared randomly in 632 patients. Both methods were performed with absorbable material. Of the 614 subjects who could be evaluated, 308 underwent a continuous, nonlocking closure with looped polyglyconate suture, and 306 were closed with interrupted polyglycolic acid according to the Smead-Jones technique. Results Three (1%) subjects with the continuous closure and five (1.6%) with the interrupted closure had an abdominal wound infection (P = .50). One patient whose incision was closed with continuous suturing had a deep wound dehiscence (without evisceration). The follow-up period was 6 months to 3 years. No patient had evidence of chronic sinus drainage. Thirty-two (10.4%) of the patients who had the continuous closure and 45 (14.7%) of those who were closed with the interrupted method had evidence of incisional hernia (P = .14). No hernia developed in any patient with a wound infection. Four (1.3%) hernias after the continuous closure and eight (2.6%) after the interrupted closure required surgical repair because of patient discomfort (P = .38). Conclusion The interrupted closure was not superior to the continuous closure for short- and long-term wound security. The continuous method was preferable because it was more cost-efficient and faster.

Prevention of postoperative urinary stress incontinence after surgery for genitourinary prolapse

Objective To compare cystopexy alone versus cystopexy with posterior pubourethral ligaments plication for the occurrence of postoperative stress incontinence after prolapse surgery, and to compare the two surgical series in terms of complications and urodynamic effects. Methods One hundred two continent patients randomly underwent cystopexy alone (N = 52) or cystopexy with posterior pubourethral ligaments plication (N = 50). All had a urethrocystocele grade 2 or greater and a negative stress test with the prolapse repositioned. A full urodynamic investigation was repeated 6 months after surgery. Results Twelve (23%) and 14 (28%) patients (P = .73) required intermittent self-catheterization for 11.1 ± 5.1 and 16.5 ± 11.1 days, respectively (cystopexy alone versus cystopexy with posterior pubourethral ligaments plication, P = .002). Long-lasting difficulties in voiding were present in zero and five (10%) patients (P = .02). One subject receiving posterior pubourethral ligaments plication underwent urethral dilation for complete urinary retention. At 1 year follow-up, four patients (8%) in each series developed postoperative stress incontinence (P = .62). Symptomatic detrusor instability complicated the postoperative course in one patient (2%) of each group. Conclusion Cystopexy alone implied lower morbidity in terms of resumption of spontaneous voiding and long-lasting difficulties in voiding. The procedure could be recommended as an effective and safe treatment for continent patients with severe urethrocystocele. Additional plication of the posterior pubourethral ligaments did not seem superior to cystopexy alone in preventing the postoperative occurrence of stress incontinence.

Characterization of the Bacterial Community Associated with Larvae and Adults of Anoplophora chinensis Collected in Italy by Culture and Culture-Independent Methods

The wood-boring beetle Anoplophora chinensis Forster, native to China, has recently spread to North America and Europe causing serious damage to ornamental and forest trees. The gut microbial community associated with these xylophagous beetles is of interest for potential biotechnological applications in lignocellulose degradation and development of pest-control measures. In this study the gut bacterial community of larvae and adults of A. chinensis, collected from different host trees in North Italy, was investigated by both culture and culture-independent methods. Larvae and adults harboured a moderately diverse bacterial community, dominated by Proteobacteria, Actinobacteria, and Firmicutes. The gammaproteobacterial family Enterobacteriaceae (genera Gibbsiella, Enterobacter, Raoultella, and Klebsiella) was the best represented. The abundance of such bacteria in the insect gut is likely due to the various metabolic abilities of Enterobacteriaceae, including fermentation of carbohydrates derived from lignocellulose degradation and contribution to nitrogen intake by nitrogen-fixing activity. In addition, bacteria previously shown to have some lignocellulose-degrading activity were detected at a relatively low level in the gut. These bacteria possibly act synergistically with endogenous and fungal enzymes in lignocellulose breakdown. The detection of actinobacterial symbionts could be explained by a possible role in the detoxification of secondary plant metabolites and/or protection against pathogens.

Chemoenzymatic synthesis of the enantiomers of iopanoic acid

The two enantiomers of Iopanoic acid 1 were prepared in enantiomeric excess higher than 90% by enzyme-catalyzed hydrolysis of precursors (±)-2a and (±)-3a, followed by standard chemical transformations. Among the tested enzymes, chymotrypsin and Lipase PS proved to be the most selective catalysts. The stereochemical outcome of the lipase-catalyzed hydrolyses of esters (±)-2a-d is strictly dependent upon both the size of the alkyl group attached to the chiral center and the substituent in the aromatic ring. The enantioselectivity of the reactions was evaluated by chiral HPLC and the configurations of the new products were assigned by chemical correlations.