Tratamiento laparoscópico de fístula vesicovaginal / Vesicovaginal fístula laparoscopic treatment

Las fístulas vesicovaginales están entre las complicaciones más angustiantes de los procedimientos ginecológicos y obstétricos. El manejo de estas fístulas se ha definido mejor y estandarizado en la última década. La reparación de la fístula vesico-vaginal frecuentemente se lleva a cabo a través de un abordaje transvaginal en el caso de las fístulas infratrigonales y mediante un abordaje abdominal transvesical para las fístulas supratrigonales. Presentamos un caso de fístula vesico-vaginal tras histerectomía que fue reparada mediante una abordaje laparoscópico. Vamos a describir una técnica novedosa para el tratamiento de fístula vesico-vaginal de ubicación supratrigonal por vía laparoscópica intraperitoneal (AU)

Vesicovaginal fístula is among the most distressing complications of gynaecological and obstetrical procedures. Management of these fístulas has been better defined and standardised over the last decade. Vesicovaginal fístula repair is most commonly repaired with transvaginal approach in cases of supratrigonal fístula and with abdominal approach in cases of supratrigonal fístula. We report a case of a vesicovaginal fístula after abdominal hysterectomy, which was repaired using a laparoscopic approach. The fístula followed a hysterectomy. We will describe a novel technique for the treatment of vesicovaginal fístula of supratrigonal location by intraperitoneal laparoscopic approach (AU)

Polypropylene with embedded copper metal or copper oxide nanoparticles as a novel plastic antimicrobial agent.

AIMS: To develop novel polypropylene composite materials with antimicrobial activity by adding different types of copper nanoparticles. METHODS AND RESULTS: Copper metal (CuP) and copper oxide nanoparticles (CuOP) were embedded in a polypropylene (PP) matrix. These composites present strong antimicrobial behaviour against E. coli that depends on the contact time between the sample and the bacteria. After just 4 h of contact, these samples are able to kill more than 95% of the bacteria. CuOP fillers are much more effective eliminating bacteria than CuP fillers, showing that the antimicrobial property further depends on the type of copper particle. Cu²âº released from the bulk of the composite is responsible for this behaviour. Moreover, PP/CuOP composites present a higher release rate than PP/CuP composites in a short time, explaining the antimicrobial tendency. CONCLUSIONS: Polypropylene composites based on copper nanoparticles can kill E. coli bacteria depending on the release rate of Cu²âº from the bulk of the material. CuOP are more effective as antimicrobial filler than CuP. SIGNIFICANCE AND IMPACT OF THE STUDY: Our findings open up novel applications of these ion-copper-delivery plastic materials based on PP with embedded copper nanoparticles with great potential as antimicrobial agents.

Aedes aegypti pupal/demographic surveys in southern Mexico: consistency and practicality.

In interventions aimed at the control of the immature stages of Aedes aegypti (L.), the principal vector of the dengue viruses, attempts are often made to treat or manage all larval habitats in households. When there are resource-constraints, however, a concentration of effort on the types of container that produce the most pupae may be required. Identification of these 'key' container types requires surveys of the immature stages and particularly - since these give the best estimates of the numbers of adults produced - of the numbers of pupae in local containers. Although there has been no clearly defined or standardized protocol for the sampling of Ae. aegypti pupae for many years, a methodology for 'pupal/demographic' surveys, which may allow the risk of dengue outbreaks in a given setting to be estimated, has been recently described. The consistency and practicality of using such surveys has now been investigated in three cities in the Mexican state of Chiapas, Mexico. Using a combination of 'quadrat'- and transect-sampling methods, 600 houses in each city were each sampled twice. Containers within each study household were searched for pupae and larvae. Although 107,297 containers, belonging to 26 categories, were observed, only 16,032 were found to contain water and 96% and 92% of these 'wet' containers contained no pupae and no third- or fourth-instar larvae, respectively. Although the random 'quadrat' sampling gave similar results to sampling along transects, there were statistically significant differences in the numbers of pupae according to container type and locality. The most important containers for pupal production were found to be large cement wash basins, which were present in almost every household investigated and from which 84% (10,257/12,271) of all pupae were collected. A focus on this class of container could serve as the basis of a targeted intervention strategy. When traditional Stegomyia indices were calculated they appeared to be correlated with the assessments of pupal abundance. The methodology for pupal/demographic surveys appears to be practical and to give consistent results, although it remains to be seen if monitoring of pupal productivity can adequately reflect the impact of vector-control interventions.

Effect of Novaluron (Rimon 10 EC) on the mosquitoes Anopheles albimanus, Anopheles pseudopunctipennis, Aedes aegypti, Aedes albopictus and Culex quinquefasciatus from Chiapas, Mexico.

Dengue fever is a serious problem in Mexico and vector control has not been effective enough at preventing outbreaks. Malaria is largely under control, but it is important that new control measures continue to be developed. Novaluron, a novel host-specific insect growth regulator and chitin synthesis inhibitor, has proved to be effective against agricultural pests, but its efficacy against larval mosquito vectors under field conditions remains unknown. In accordance with the World Health Organization Pesticide Evaluation Scheme, phase I, II and III studies were conducted to evaluate the efficacy and residual effect of Novaluron (Rimon 10 EC, Makhteshim, Beer-Sheva, Israel) on the malaria vectors Anopheles albimanus Wiedemann (Diptera: Culicidae) and Anopheles pseudopunctipennis Theobald, the dengue vectors Aedes aegypti (L) and Aedes albopictus Skuse and the nuisance mosquito Culex quinquefasciatus Say. Laboratory susceptibility tests yielded diagnostic concentrations for all five target species. Field trials to identify the optimum field dosage of Novaluron against Anopheles mosquitoes were carried out under semi-natural conditions in artificial plots and in vessels with wild mosquitoes. Efficacy was measured by monitoring mortality of larvae and pupae and the percentage of inhibition of emergence from floating cages. Dosages of Novaluron for field tests were based on pupal LC(99) (lethal concentration 99%) of An. pseudopunctipennis (0.166 mg/L) in plots and average pupal LC(99) of Ae. aegypti and Ae. albopictus (0.55 mg/L). At all dosages tested, Novaluron significantly reduced larval populations of An. albimanus, Culex coronator Dyar & Knab, Ae. albopictus and Cx. quinquefasciatus by approximately 90%, inhibited adult emergence of An. albimanus and An. pseudopunctipennis by approximately 97% for almost 4 months in experimental plots, and inhibited adult emergence of Ae. aegypti and Ae. albopictus by approximately 97% for up to 14 weeks. Recommended dosages of Novaluron for non-container breeding and container breeding mosquitoes are 0.166 mg/L and 0.55 mg/L, respectively. Overall, the residual effect was more sustained than that of temephos. The lowest dosage of Novaluron had less of an impact on non-target organisms than did temephos. Small-scale field trials in natural breeding sites treated with Novaluron at 0.6 L/ha eliminated adult emergence of An. albimanus and Cx. coronator for 8 weeks. For phase III studies, Novaluron was tested at the local and village levels, applying the optimum field rate to all natural breeding habitats within 1 km of a pair of neighbouring villages. Village-scale trials of Novaluron at 0.6 L/ha reduced An. albimanus larval populations for at least 8 weeks and, more importantly, sharply reduced the densities of adult host-seeking mosquitoes approaching houses. We conclude that Novaluron is effective and environmentally safer than temephos.

Comparison of oral fluconazole and itraconazole for progressive, nonmeningeal coccidioidomycosis. A randomized, double-blind trial. Mycoses Study Group.

BACKGROUND: In previous open-label noncomparative clinical trials, both fluconazole and itraconazole were effective therapy for progressive forms of coccidioidomycosis. OBJECTIVE: To determine whether fluconazole or itraconazole is superior for treatment of nonmeningeal progressive coccidioidal infections. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: 7 treatment centers in California, Arizona, and Texas. PATIENTS: 198 patients with chronic pulmonary, soft tissue, or skeletal coccidioidal infections. INTERVENTION: Oral fluconazole, 400 mg/d, or itraconazole, 200 mg twice daily. MEASUREMENTS: After 4, 8, and 12 months, a predefined scoring system was used to assess severity of infection. Findings were compared with those at baseline. RESULTS: Overall, 50% of patients (47 of 94) and 63% of patients (61 of 97) responded to 8 months of treatment with fluconazole and itraconazole, respectively (difference, 13 percentage points [95% CI, -2 to 28 percentage points]; P = 0.08). Patients with skeletal infections responded twice as frequently to itraconazole as to fluconazole. By 12 months, 57% of patients had responded to fluconazole and 72% had responded to itraconazole (difference, 15 percentage points [CI, 0.003 to 30 percentage points]; P = 0.05). Soft tissue disease was associated with increased likelihood of response, as in previous studies. Azole drug was detected in serum specimens from all but 3 patients; however, drug concentrations were not helpful in predicting outcome. Relapse rates after discontinuation of therapy did not differ significantly between groups (28% after fluconazole treatment and 18% after itraconazole treatment). Both drugs were well tolerated. CONCLUSIONS: Neither fluconazole nor itraconazole showed statistically superior efficacy in nonmeningeal coccidioidomycosis, although there is a trend toward slightly greater efficacy with itraconazole at the doses studied.

Detection of coccidioidal antibodies by 33-kDa spherule antigen, Coccidioides EIA, and standard serologic tests in sera from patients evaluated for coccidioidomycosis.

During a 9-month study of patients being evaluated for coccidioidomycosis, 1 or more serum samples were obtained from 138 patients with an illness suggestive of recent infection. In this group, standard immunodiffusion tests of unconcentrated sera were positive for 25; 49 additional patients had at least 1 reactive test result by newer enzyme-linked serologic tests. At least 11 of these 49 patients had coccidioidomycosis as determined by culture or subsequent standard serologic tests. Patients with coccidioidomycosis identified only by newer tests had fewer or milder clinical abnormalities than did patients in whom the disease was detected by standard tests. For 31 other patients with illness of a chronic or undetermined duration, newer tests detected only 10 more than the 18 identified by standard tests, suggesting that later in the course of illness, standard testing gains in sensitivity for coccidioidal infection.

Canonical parameterization of excess motor degrees of freedom with self-organizing maps.

The problem of sensorimotor control is underdetermined due to excess (or "redundant") degrees of freedom when there are more joint variables than the minimum needed for positioning an end-effector. A method is presented for solving the nonlinear inverse kinematics problem for a redundant manipulator by learning a natural parameterization of the inverse solution manifolds with self-organizing maps. The parameterization approximates the topological structure of the joint space, which is that of a fiber bundle. The fibers represent the "self-motion manifolds" along which the manipulator can change configuration while keeping the end-effector at a fixed location. The method is demonstrated for the case of the redundant planar manipulator. Data samples along the self-motion manifolds are selected from a large set of measured input-output data. This is done by taking points in the joint space corresponding to end-effector locations near "query points", which define small neighborhoods in the end-effector work space. Self-organizing maps are used to construct an approximate parameterization of each manifold which is consistent for all of the query points. The resulting parameterization is used to augment the overall kinematics map so that it is locally invertible. Joint-angle and end-effector position data, along with the learned parameterizations, are used to train neural networks to approximate direct inverse functions.

Tumor necrosis factor-alpha and interleukin-1 beta in cerebrospinal fluid of patients with coccidioidal meningitis during therapy with fluconazole. National Institute of Allergy and Infectious Diseases Mycoses Study Group.

The levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL)-1 beta in the cerebrospinal fluid (CSF) of 66 patients with coccidioidal meningitis during therapy with fluconazole were measured by ELISA. The median concentration of TNF-alpha was 15.2 pg/mL for 322 samples; for IL-1 beta, it was 4.7 pg/mL for 316 samples. There were no significant changes in the level of either cytokine over 24 months of follow-up nor was there an association between the initial CSF concentrations of TNF-alpha and IL-1 beta and subsequent fluconazole treatment failure. Over time, concentrations of IL-1 beta were significantly associated with both clinical symptoms and white blood cell counts in CSF. These results indicate that CSF levels of TNF-alpha and IL-1 beta are relatively low compared with those associated with acute bacterial meningitis.

The association of formula samples given at hospital discharge with the early duration of breastfeeding.

Conflicting results have been reported regarding the association of formula samples given at hospital discharge with breastfeeding duration. This study investigated the relationship between the distribution of formula samples and breastfeeding duration in low-income Hispanic women. A gift pack of formula was distributed randomly to 88 breastfeeding women. All women received a telephone call at one and three weeks to collect information about infant feeding. Chi-square analysis revealed no significant difference in the proportion of women exclusively breastfeeding at one week. However, fewer women were exclusively breastfeeding in the gift pack group at three weeks (p less than .004). Gift packs given to Hispanic breastfeeding women are associated with a decrease in exclusively breastfeeding during the first three weeks postpartum.