Robotic repair of vesicovaginal fistulae with the transperitoneal-transvaginal approach: A case series

Objective To describe a novel technique of repairing the VVF using the transperitoneal-transvaginal approach. Materials and Methods From June 2011 to October 2013, four patients with symptoms of urine leakage in the vagina underwent robotic repair of VVF with the transperitoneal-transvaginal approach. Cystoscopy revealed the fistula opening on the bladder. A ureteral stent was placed through the fistulous tract. After trocar placement, the omental flap was prepared and mobilized robotically. The vagina was identified and incised. The fistulous tract was excised. Cystorrhaphy was performed in two layers in an interrupted fashion. The vaginal opening was closed with running stitches. The omentum was interposed and anchored between the bladder and vagina. Finally, the ureteral catheters were removed in case they have been placed, and an 18 Fr urethral catheter was removed on the 14th postoperative day. Results The mean age was 46 years (range: 41 to 52 years). The mean fistula diameter was 1.5 cm (range 0.3 to 2 cm). The mean operative time was 117.5 min (range: 100 to 150 min). The estimated blood loss was 100 mL (range: 50 to 150 mL). The mean hospital stay was 1.75 days (range: 1 to 3 days). The mean Foley catheter duration was 15.75 days (range: 10 to 25 days). There was no evidence of recurrence in any of the cases. Conclusions The robot-assisted laparoscopic transperitoneal transvaginal approach for VVF is a feasible procedure when the fistula tract is identified by first intentionally opening the vagina, thereby minimizing the bladder incision and with low morbidity. .

Pathological lesions observed in chickens pre-infected with LP H7N1 A/CK/Italy/1279/99 avian influenza and challenged with homologous HP H7N1 A/ostrich/Italy/984/00

Most highly pathogenic avian influenza viruses [AIV] emerge after field passage of non-pathogenic AIVs in birds. The outbreak of low-pathogenic H7N1 avian influenza virus in Italy during 1999-2000 followed by outbreak of highly pathogenic H7N1 avian influenza virus is one example in this regard. This experiment has been designed to investigate the effect of pre-infection of birds with LPAI on subsequent challenge with HPAI virus from the same outbreak. Chickens were inoculated intranasally with LP H7N1 A/CK/ItaIy/1279/99 avian influenza virus at 3 weeks of age and two groups of 10 birds were challenged at 18 and 24 weeks of age with homologous HP H7N1 A/ostrich/Italy/984/00 virus from the same outbreak. The overall mortality of birds was 60%; pre-infected challenged birds died 4-17 days post challenge [PC], while naive birds died 2 days PC. Pre-infected birds showed peritonitis, salpingitis and oophoritis in necropsy and histopathology showed very severe necrosis of the spleen, pancreas, moderate to severe necrosis of the liver and inconsistent degeneration and inflammation of the lung. Necropsy of the control bird showed petechial haemorrhage on the heart, caecal tonsils and the tracheal mucosa

Pathological changes in turkeys experimentally infected with different doses of A/ostrich/Italy/984/2000 H7N1 avian influenza virus

Following experimental inoculation of 3-week-old turkeys with different titres [10[6], 10[4], 10[3], 10[2] and 10[1] egg infectious dose [EID50]] of A/ostrich/Italy/984/2000 H7NI highly pathogenic avian influenza virus [HPAIV], the selected tissues and organs were examined for pathological changes. Tissue samples from different organs that obtained from dead and sacrificed birds were fixed in 10% neutral buffer formaldehyde. Mortality of turkeys which inoculated with different doses of EID50 at different times post inoculation [PI] is as follows: 1] at 48 h PI [HPI]: one, two and four turkeys inoculated with 10[3], 10[4] and 10[6] EID50, respectively 2] at 72 HPI: two, two and one turkeys inoculated with 10[2], 10[3] and 10[6] EID50, respectively 3] at 96 HPI: one and two turkeys inoculated with 10[2] and 10[4] EID50, respectively and 4] at 120 HPI: just one turkey inoculated with 10[4] EID50. Birds inoculated with 10[1] EID50 did not show any mortality. Seven days PI [DPI] the remaining birds were sacrificed. Postmortem examination of birds that died 48 HPI showed very severe hyperaemia and haemorrhage of the lung, slight swelling of kidneys and splenomegaly. Moderate to slight hyperaemia of the lung was observed in the birds sacrificed on day 7. Histopathology showed very severe haemorrhage and vasculitis in the lung, multifocal areas of degeneration and necrosis in the pancreas of birds inoculated with 10[6] EID50. Hyperaemia, haemorrhage, degeneration and vasculitis were also observed in the lung of birds from the other groups; however the severity of lesions correlated positively with the viral dose. The spleen, caecal tonsils and thymus showed extensive necrosis and lymphoid depletion, even in birds inoculated with 10[2] and 10[1] EID50 that were sacrificed 7 DPI, and some repopulation of the spleen was observed 7 DPI. Other organs including the kidneys and adrenal gland showed moderate to slight hyperaemia and necrosis. In conclusion, the lung vascular damage, lymphoid tissue destruction and necrosis were notable even with low viral doses

Intervención educativa para mejorar la calidad del diagnóstico coproparasitológico en la red de salud de Ciudad Habana, Cuba / An educational intervention to improve the quality of coproparasitological diagnosis in laboratories of Havana City, Cuba

Evalua la efectividad de una intervención educativa con participación voluntaria realizada en 1993, a partir de los resultados obtenidos en un primer control de la calidad del diagnóstico coproparasitológico, en 77 laboratorios de la red de salud de Ciudad Habana. Se comparan los resultados obtenidos por los centros que adiestraron con los que no participaron en la actividad; se obtuvieron resultados superiores en los municipios 10 de Octubre, Plaza y Cerro y en la totalidad de los laboratorios que enviaron personal para el adiestramiento. Se encontró un mejor diagnóstico de los helmintos Trichuris trichiura, Taenia sp. y Fasciola hepatica, y de los protozoos Blastocystis hominis y Enndolimax nana, en los laboratorios que recibieron el curso. Además se observó que la mayoría de los laboratorios que adiestraron un técnico subieron significativamente sus notas, mientras que los que no lo efectuaron las bajaron, lo que demuestra la efectividad de la intervención. Proponemos que estas actividades de Control de la Calidad y Educación Continuada se mantengan de forma periódica y con un carácter obligatorio, para garantizar una mejoría creciente del diagnóstico coproparasitológico en la red de salud.