A new technique for surgical treatment of stress urinary incontinence: the TVT-secur.

AIM: The aim of this pilot study was to evaluate the surgical feasibility of a new device for the treatment of stress urinary incontinence, named tension-free vaginal tape (TVT)-secur. Fifteen patients underwent the TVT-secur procedure. METHODS: The mean operation time was 13 minutes (range, 7-21). There was no intraoperative complication. Duration of surgery was shorter in the second half of cases than in the first eight procedures. RESULTS: The number of technical difficulties experienced by the surgeon was significantly higher in the first 8 procedures than in the following 7 cases; these difficulties included bleeding reducing the identification of anatomical structures, dislocation or removal of the mesh tape during the removal of the inserter, need to repeat the procedure. The cure rate, determined by urodynamic study, was 80% at 3 months follow-up. The cought test was negative in 86.7% of women at 6 months follow-up. CONCLUSION: The implantation of the TVT-secur is simple, safe, and minimally invasive with a short learning curve.

Prevalence of antimicrobial resistance in Streptococcus pneumoniae circulating in Italy: results of the Italian Epidemiological Observatory Survey (1997-1999).

The Italian Epidemiological Observatory (IEO), a surveillance program supported by the SmithKline Foundation, analyzed the susceptibility of 2,664 community-acquired respiratory Streptococcus pneumoniae derived from over 50 clinical microbiology laboratories during 1997-1999, against 21 antibiotics adopting a quantitative methodology. Throughout these years, total penicillin resistance varied from 14.3% to 10.2%. High-level resistance has remained stable, ranging from 3.8% to 4.1%, while a decrease in low-level resistance (from 10.3% to 6.1%) has been recorded. Lack of susceptibility to macrolides ranged from 29.1% in 1997 to 25.5% in 1999. Similar figures have also been observed with tetracycline and co-trimoxazole (rates of resistance around 30%). As expected, large geographical variations in resistance rates were found for all drugs. Amoxicillin and amoxicillin-clavulanate were 100% active on penicillin-intermediate isolates. Injectable third-generation cephalosporins and carbapenems were also capable of inhibiting a large proportion of these microorganisms. Rifampin was the most potent non-beta-lactam compound tested. In contrast to the situation prevailing elsewhere, in Italian children (aged 0-5 years) presenting with respiratory conditions, the total rate of penicillin resistance (3%) was lower than that shown by the adult population (10.9%). However, lack of susceptibility to macrolides, tetracycline, and cotrimoxazole (35%, 41%, 44%) was more incident in pediatric than in adult patients (25%, 26%, 28% respectively). Strains recovered from blood in 1999 (67) were much more susceptible to penicillin (98.5%) than respiratory pneumococci (89.8%), whereas macrolides, tetracycline, and cotrimoxazole were consistently less active (75%, 67%, 64%).

Unexpected pregnancies after tubal recanalization failure with selective catheterization.

OBJECTIVE: To evaluate selective salpingography sensitivity. DESIGN: Retrospective study. SETTING: Obstetrics and Gynecology Department, University of Genoa, Italy. PATIENTS: One hundred seventeen patients previously submitted to selective salpingography because of unilateral or bilateral proximal tubal injection failure. RESULTS: Seven pregnancies, one of which was ectopic, were obtained in 17 patients who had only recanalized tubes available for conception; 15 pregnancies were obtained in 39 patients who had one tube recanalized and one already patent; 3 tubal pregnancies were obtained in 12 patients who had only one tube already patent; 4 pregnancies, one of which was ectopic, were obtained in 19 patients who had neither patent nor recanalized tubes. CONCLUSIONS: Selective salpingography can give false-positive results; therefore, it is possible to obtain a pregnancy even after selective salpingography failure.

Gestational choriocarcinoma arising in a cornual pregnancy.

A of a case of cornual pregnancy associated with initial transformation to choriocarcinoma is reported. Appropriate monitoring of HCG titers following conservative management of ectopic pregnancy is important not only to diagnose persistent ectopic gestation, but to avoid missing trophoblastic disease, albeit rarely.

[Active pharmacologic monitoring of oral contraceptives. The Italian experience]. / La farmacovigilanza attiva dei contraccettivi orali. L'esperienza italiana.

The Active Drug Monitoring project aims to assess the positive and negative effects of drugs following commercialisation. It was decided to use a study on "series of cases" in women who were taking an oral contraceptive containing 0.075 mg of Gestodene and 0.030 mg of Ethynylestradiol (Ginoden, Schering; Minulet, Wyeth). Twenty-seven centres took part in the study. 1166 women were recruited with a total of 10320 cycles studied. A data base was set up on a PC which was then used by each participating centre. Data were transmitted from the various centres using floppy disks. On enrollment a detailed medical history was recorded and, in addition to a careful objective examination, a blood sample was taken to assess biochemical parameters. The monitoring protocol consisted in the assessment of biochemical parameters at the start and end of treatment (12 months), as well as blood pressure, weight and menstrual characteristics after 3, 6 and 12 months. At each visit patients were questioned about the possible onset of collateral effects and their intensity. At the end of the study a reduction was noted in the mean cycle length (29.34 vs 27.45 days) and a parallel reduction in the quantity of menstruation. In spite of an increase in all the biochemical parameters examined, only HDL-cholesterol was statistically significant (p less than 0.01). 122 women decided not to complete the study, but only 72 due to side effects. It is however interesting to note that this decision was usually not related to the severity of symptoms.

Chronic pelvic pain: oral contraceptives and non-steroidal anti-inflammatory compounds.

A correct classification of female pelvic pain originating from gynaecological disorders is essential if the most appropriate therapy is to be chosen. Certain types of non-steroidal anti-inflammatory drugs and oral contraceptives reduce the production of prostaglandins, which are responsible in large part for primary dysmenorrhoea. Oestroprogestin formulations become the drugs of choice if the patient also requests contraception. Secondary dysmenorrhoea and chronic pelvic pain may require combined medical and surgical treatment. Oral contraceptives can also be used as post-treatment agents in endometriosis, one of the most common causes of pelvic pain, whereas more specific compounds (GnRH-analogues and Danazol) are used to produce anatomical regression of endometriosis.

Fenticonazole tissue levels after the application of 3 different dosage forms of vaginal ovules.

Fenticonazole vaginal ovules of 200 mg, 600 mg and 1,000 mg were administered to 42 women prior to gynecological surgery. Tissue concentrations in the vaginal mucosa were determined after 3 h and 12 h in biopsy specimens taken from the same position in the posterior fornix. Tissue concentrations were higher at 3 h in comparison to 12 h with all 3 doses. There was no statistical difference between the concentrations yielded by the 3 different ovules at 3 h, while after 12 h the concentrations were dose-dependent and significantly higher after 1,000 mg in comparison to 200 mg, but not to 600 mg.

Ultrasonic evaluation of cervical incompetence.

Ultrasound can provide important information for the assessment of cervical incompetence (C.I.) and for the follow-up of pregnant women submitted to a cervical cerclage. Attention must be paid to the technical problems involved in the examination and the physiological variations in anatomical configuration must be taken into account.

Effect of terguride on prolactin levels in normal, puerperal and hyperprolactinaemic women.

Terguride, is an 8 - alpha - ergoline derived from lisuride, acts as a partial dopamine (DA) agonist. The effect and tolerance of terguride has been investigated by an acute administration of 0.2 mg p.o. to 8 normal women, 8 patients with hyperprolactinaemia and 8 women with puerperal hyperprolactinaemia. Prolactin (PRL) levels were markedly suppressed in all subjects, with no significant differences between the groups. Treatment for 5 days with terguride 0.4 mg/day or 0.8 mg/day was studied as an inhibitor of lactation. PRL levels were suppressed in a dose-related manner. No untoward side-effects were noted.