Patients with cystic fibrosis (CF) have low bone mineral density (BMD). The clinical relevance of this is not clearly established. The aim of this study was to determine the prevalence of low BMD and vertebral deformities in CF adults with varied disease severity. One hundred and seven patients (58 men) aged 18-60 years underwent dual-energy X-ray absorptiometry scanning of the lumbar spine and hip, radiology of the spine and biochemical studies. Thirty-eight percent had a Z-score of < -1, with 13% having Z-scores < -2. Seventeen percent had evidence of vertebral deformity on radiography, mostly in the thoracic spine. Thirty-five percent reported past fractures, of which 9% were rib fractures. Percent predicted forced expiratory volume in 1 second (FEV1) and the amount of daily physical activity were positively related to BMD. The number of intravenous antibiotic courses in the previous 5 years was negatively related to BMD. Patients with a history of rib fracture and CF-related diabetes had significantly lower femoral neck BMD (p < 0.02). The median serum 25-hydroxyvitamin D was 28 nmol/l, with 36% of patients having levels below 25 nmol/l despite vitamin D supplementation. Forty-four percent had raised levels of urinary pyridinium crosslinks (NTx). In conclusion, fragility fractures and hypovitaminosis D occur commonly in adult patients with CF. Low BMD occurs in patients with more severe disease and significantly relates to FEV1, infective exacerbations and daily energy expended in physical activity.

As with BMD, alendronate impairs the action of teriparatide to increase bone turnover in men.

Vesicovaginal fistulas-vault fistulas as they are called when located at the vaginal apex following total hysterectomy-are rare lesions that are located on the anterior vaginal wall just in front of the transverse vaginal scar made when the cervix is removed. Latzko, in 1942, described a technique of treating vault fistulas solely through a vaginal approach. A vault colpocleisis is performed without attempting to dissect the fistulous tract. Although this is an effective and relatively simple procedure, there is as yet no consensus on first-line treatment of these lesions. The authors report the results of the Latzko procedure in 11 women with a mean age of 50 years who had a postoperative vesicovaginal fistula. All but one of the fistulas followed total hysterectomy. The mean interval between primary surgery and a fistula was just short of 2 weeks. Urethral bladder drainage for 5-8 days did not prevent a fistula from forming in these patients.Urinary drainage was maintained for at least 6 weeks before surgical repair. The fistula was drawn downward using a balloon catheter placed in its opening and was then circumcised 1.5 to 2 cm from the opening. All epithelium from the circumcised area to the edge of the fistula's opening was removed before approximating the anterior and posterior vaginal walls using interrupted absorbable sutures. The vaginal mucosa then was closed by a second layer of sutures. The bladder was drained with a Foley catheter until the cystogram was normal.The Latzko procedure succeeded in all cases as evidenced by the absence of urine loss during a bladder tightness test 1 month postoperatively. There were no intraoperative complications, and the only postoperative problem was a lower urinary tract infection. The patients were followed for a mean of 19 months after repair. These results show that the Latzko procedure is a safe, technically simple, and effective means of treating vault vesicovaginal fistulas. The investigators recommend it as the most appropriate first-line surgical treatment. GYNECOLOGYVolume 62, Number 1 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTObjective cure rates exceeding 75% are reported after colposuspension in women with stress incontinence, but extended follow-up has not been the rule. Small-scale studies also have been done to evaluate laparoscopic colposuspension after its introduction in 1991. A Cochrane review in the year 2000 yielded no conclusions about the long-term efficacy of this procedure.The present randomized controlled trial recruited, from six gynecology units in the United Kingdom, 291 women with proven stress urinary incontinence who required surgery. Participants were randomized to undergo open abdominal retropubic colposuspension or laparoscopic colposuspension. Subjective outcomes were based on patient satisfaction, and objective outcomes on a negative 1-hour pad test. Data on objective outcomes were available after 2 years of follow-up in 85% of women having laparoscopic surgery and 80% of those having open surgery. The respective figures for s...