Transvaginal repair of vesicovaginal fistula: surgical techniques to improve access and successful vaginal closure

This video demonstrates surgical techniques to improve closure of high vesicovaginal fistula using the vaginal approach and the Latzko procedure.     

Evidence of zinc deficiency in competitive swimmers

ObjectiveThe aim of this study was to assess the nutritional zinc (Zn) status of elite swimmers during different training periods.MethodsA longitudinal paired study was performed at the University of Sao Paulo in eight male swimmers 18 to 25 y old who had been swimming competitively at the state and national levels for at least 5 y. The swimmers were evaluated over a total period of 14 wk: before the basic and specific preparatory period (BSPP-baseline), at the end of the basic and specific preparatory period (post-BSPP), and at the end of the polishing period (PP). Levels of Zn were determined in the plasma, erythrocyte, urine, and saliva by atomic absorption spectrophotometry. Anthropometric measurements and a 3-d food record were also evaluated.ResultsThe median plasma Zn concentration was below the reference value in all training periods (BSPP-baseline 59 μg/dL, post-BSPP 55.9 μg/dL, after PP 58.8 μg/dL, P > 0.05), as were threshold values for erythrocytes (BSPP-baseline 36.5 μg of Zn/g of hemoglobin, post-BSPP 42 μg of Zn/g of hemoglobin, after PP 40.7 μg of Zn/g of hemoglobin, P > 0.05), urinary Zn (BSPP-baseline 280 μg/24 h, post-BSPP 337 μg/24 h, after PP 284 μg/24 h, P > 0.05), and salivary Zn (BSPP-baseline 66.1 μg/L, post-BSPP 54.1 μg/L, after PP 79.7 μg/L, P > 0.05). Salivary Zn did not correlate with plasma and erythrocyte Zn levels.ConclusionThe results suggest that the elite swimmers studied presented a possible Zn deficiency and that salivary Zn was not adequate to evaluate the Zn nutritional status.     

Ambulatory Blood Pressure Monitoring in Children and Adolescents: Coming of Age?

Over the last years, ambulatory blood pressure monitoring has been introduced into the pediatric population, contributing to a significant increase in the bulk of knowledge of crucial clinically relevant issues. Guidelines have established the currently known conditions where ambulatory blood pressure monitoring is useful and where it will provide additional information in children and adolescents. How common and important the intra-individual differences are within clinical and ambulatory blood pressure is the keystone to the use of ambulatory blood pressure monitoring as a diagnostic tool. By using not only office, but also ambulatory blood pressure, four possible situations arise. Two of these have values in agreement for normotension or hypertension. Two have values that are discrepant. The latter two are known as white coat and masked hypertension. The relationship with hypertension-induced organ damage, the prognostic value and the assessment of treatment goals are key issues of ambulatory blood pressure monitoring. In children, the accurate identification of hypertension at the earliest possible age would, therefore, give health-care providers the opportunity to initiate preventive measures, thereby reducing the chance of developing end-organ damage and its attendant morbidity and mortality.     

Effectiveness of diaphragmatic stimulation with single-channel electrodes in rabbits

Every year, a large number of individuals become dependent on mechanical ventilation because of a loss of diaphragm function. The most common causes are cervical spinal trauma and neuromuscular diseases. We have developed an experimental model to evaluate the performance of electrical stimulation of the diaphragm in rabbits using single-channel electrodes implanted directly into the muscle. Various current intensities (10, 16, 20, and 26 mA) produced tidal volumes above the baseline value, showing that this model is effective for the study of diaphragm performance at different levels of electrical stimulation