ABSTRACT Introduction: Vesico-vaginal fistula (VVF) is a rare event in Western countries and are mainly consequent to iatrogenic injuries (1, 2). When conservative management fails, surgical repair is needed, although timing and surgical approach (open or minimally invasive (3)) are still controversial (4, 5). Herein we present a step-by-step description of robot-assisted vesico-vaginal fistula repair. Material and Methods: From 2015 to 2018 six patients underwent robotic vesico-vaginal fistula repair. Pre-operative cystoscopy was performed to identify the fistulous tract. The ureters were stented. A small catheter was inserted in the fistula. A longitudinal cystotomy was performed, then a dissection of the posterior bladder from the anterior vaginal wall was performed and the fistolous tract was excised. The vagina was sutured horizontally. Four patients underwent omental flap and two pericolic fat interposition. The bladder was closed with a double-layer suture. Results: All the vesico-vaginal fistulas developed after previous gynaecological surgery. The median operative time was 160 minutes [interquartile range (IQR) (146-177)]. Intraoperative blood loss was 25 (IQR 0-50) mL. No post-operative complications were recorded. Ureteral stents were removed at 4th post-operative day. Catheter was removed 13 (IQR 11-15) days after surgery after cystography assessment. One patient had Clavien I complication (ileus). Surgical pathology report was negative. No fistula recurrence was reported during follow-up. Conclusions: In our experience, robot-assisted fistula repair is a feasible and safe procedure. It presents the advantages of minimally invasive approaches and seems to provide low morbidity and good outcomes. Compared to transvaginal approach, the robotics allows to manage more complex cases with high success rate (6).

The effect of severe food restriction since birth on regulation of fasting glycemia in male Wistar rats was investigated. The control group (CG) had free supply of chow, while the restriction group (RG) received 50% of the amount ingested by the CG. The experiments were done in adult (60 days) overnight fasted rats in which glycemia, liver free glucose levels and hepatic glycogen concentration were measured. In part of the experiments in situ liver perfusion was done. The results showed that livers from the RG had higher glycogenolysis rates but lower gluconeogenesis rates from L-alanine (10 mM). Since RG showed maintained glycemia during fasting, it could be concluded that livers from RG produced glucose preferentially from glycogenolysis in detriment of gluconeogenesis. These findings demonstrated that in spite of severe caloric restriction, the metabolic adaptations of the liver did exist to assure the maintenance of blood glucose for brain supply during fasting.

Esta investigação buscou conhecer e analisar as representações e necessidades de crianças em idade escolar, portadoras de bexiga neurogênica, e de suas mães. A pesquisa foi de natureza qualitativa, sendo as representações sociais o processo metodológico adotado. Na interposição das categorias empíricas com as analíticas, o viver e o cuidar são representados respectivamente pelas mães como um "problema" e "tudo eu"; as crianças, por sua vez, interpretam com "num é justo" a interação diferenciada e preconceituosa que sofrem no contexto em que estão inseridas.

The purpose of this study was to know and analyze the representations and needs of school-age children with neurogenic bladder dysfunction and of their mothers. This is a qualitative study; whose methodology was based on social representations. According to the interposition of empirical end analytical categories, the living and caring are respectively represented by mothers as "a problem" and "all me"; the children, in turn, interpret the differentiated and prejudiced interaction they suffer in the setting they live in as "it is not fair".

Esta investigación busca conocer y analizar las representaciones y necesidades de niños en edad escolar, portadores de vejiga neurogénica y sus madres. Investigación de naturaleza cualitativa, siendo las representaciones sociales el proceso metodológico adoptado. La interposición de las categorías empíricas con las analíticas, el vivir y el cuidar son representados respectivamente por las madres como un "problema" y "todo yo"; los niños, a su vez, interpretan como "no es justa" la interacción diferenciada y con preconceptos que sufren en el contexto en el cual estos niños se desenvuelven cotidianamente.

The purpose of this study was to know and analyze the representations and needs of school-age children with neurogenic bladder dysfunction and of their mothers. This is a qualitative study; whose methodology was based on social representations. According to the interposition of empirical end analytical categories, the living and caring are respectively represented by mothers as "a problem" and "all me"; the children, in turn, interpret the differentiated and prejudiced interaction they suffer in the setting they live in as "it is not fair".

Esta investigación busca conocer y analizar las representaciones y necesidades de niños en edad escolar, portadores de vejiga neurogénica y sus madres. Investigación de naturaleza cualitativa, siendo las representaciones sociales el proceso metodológico adoptado. La interposición de las categorías empíricas con las analíticas, el vivir y el cuidar son representados respectivamente por las madres como un "problema" y "todo yo"; los niños, a su vez, interpretan como "no es justa" la interacción diferenciada y con preconceptos que sufren en el contexto en el cual estos niños se desenvuelven cotidianamente.

Esta investigação buscou conhecer e analisar as representações e necessidades de crianças em idade escolar, portadoras de bexiga neurogênica, e de suas mães. A pesquisa foi de natureza qualitativa, sendo as representações sociais o processo metodológico adotado. Na interposição das categorias empíricas com as analíticas, o viver e o cuidar são representados respectivamente pelas mães como um "problema" e "tudo eu"; as crianças, por sua vez, interpretam com "num é justo" a interação diferenciada e preconceituosa que sofrem no contexto em que estão inseridas.

Foram investigados os efeitos do diabetes agudo sobre a densidade e o tamanho dos neurônios mioentéricos do colo proximal de ratos adultos. À injeção de estreptozootocina seguiu-se um período de observação de sete dias, durante os quais os animais diabéticos apresentaram perda de peso, ingestão excessiva de alimento e água, grande débito urinário e hiperglicemia. Os preparados de membrana do colo proximal foram corados pelas técnicas de Giemsa e da NADH-diaforase. A aplicação dessas técnicas permitiu constatar uma redução da densidade neuronal e do tamanho do corpo celular dos neurônios mioentéricos no colo dos ratos diabéticos. Essas observações foram discutidas em termos da patofisiologia do diabetes e do protocolo experimental.

The effects of acute diabetes on the density and size of the myenteric neurons of the proximal colon of adult rats were investigated. The injection of streptozotocin was followed by a period of observation of seven days, during which the diabetic animals showed weight loss, excessive food and water intake, large urinary debt and hyperglicemia. The whole-mounts from the proximal colon were stained with the techniques of Giemsa and of the NADH-diaphorase, and the employment of these techniques made it possible to verify a decrease on the neuronal density and on the cell body size of the myenteric neurons in the colon of the diabetic rats. These observations were discussed in terms of the pathophysiology of the diabetes and the experimental protocol.

Este estudo comparou as áreas dos perfis dos corpos celulares e dos núcleos neuronais dos neurônios mientéricos nas regiões antimesentérica e intermediária do duodeno de ratos adultos. Cinco ratos machos foram usados. O duodeno foi removido e dissecado a preparados de membrana, os quais foram corados pela técnica de Giemsa. As áreas dos perfis dos corpos celulares e dos núcleos neuronais de 100 neurônios, 50 de cada região, de cada animal, foram avaliadas com analisador de imagens. Com base na média global±SD das áreas dos perfis dos corpos celulares, os neurônios foram classificados como pequenos, médios ou grandes. Foi observado que os neurônios não diferiram significativamente de tamanho ou incidência entre as regiões antimesentérica e intermediária. Contudo, os núcleos dos neurônios pequenos e médios foram significativamente menores na última. Discute-se que o menor tamanho nuclear poderia estar relacionado ao fato dos corpos celulares serem ligeiramente menores nesta região e a uma atividade biossintética possivelmente menor, que influenciaria o tamanho nuclear.

This study compared the areas of cell body and nucleus profiles of the myenteric neurons in the antimesenteric and intermediate regions of the duodenum of adult rats. Five male rats were used. The duodenum was removed and dissected to whole-mount preparations, which were stained by the Giemsa technique. The areas of cell body and nucleus profiles of 100 neurons, 50 from each region, of each animal, were assessed with image analyser. Based on the global mean±SD of the areas of cell body profiles, neurons were labelled as small, medium or large. It was observed that the neurons did not differ significantly in size or incidence between the antimesenteric and intermediate regions. However, the nuclei of the small and medium neurons were significantly smaller in the latter region. It is discussed that the smaller nuclear size could be related to the cell bodies being slightly smaller on this region and to a possible smaller biosynthetic activity which would influence nuclear size.

Este estudo teve como objetivo avaliar os efeitos do diabetes agudo induzido por estreptozootocina (35 mg/kg de peso corporal) sobre o número e tamanho dos neurônios mientéricos do duodeno de ratos adultos considerando de forma equivalente as regiões antimesentérica e intermediária da circunferência intestinal. O período experimental se estendeu por uma semana. As contagens neuronais foram feitas em igual número de campos nas duas regiões da circunferência duodenal e as mensurações das áreas neuronais e nucleares em igual número de células. O número e o tamanho dos neurônios corados por Giemsa não foram significativamente diferentes entre os grupos. Por outro lado, a proporção de neurônios NADH-positivos aumentou de 18,54% nos animais controles para 39,33% nos diabéticos. Os autores discutem que essa maior reatividade possivelmente resultou do aumento da proporção NADH/NAD+, descrita em diversos tecidos de animais diabéticos, que repercute na modulação das enzimas que utilizam esses cofatores e cuja atividade é detectada pela técnica da NADH-diaforase.

This study had as its purpose to assess the effects of acute diabetes induced by streptozotocin (35 mg/kg body weight) on the number and size of the myenteric neurons of the duodenum of adult rats considering equally the antimesenteric and intermediate regions of the intestinal circumference. Experimental period extended for a week. Neuronal counts were carried out on the same number of fields of both regions of the duodenal circumference and measurements of neuronal and nuclear areas on equal numbers of cells. Number and size of the myenteric neurons stained with Giemsa were not significantly different between groups. On the other hand, the proportion of NADH-positive neurons increased from 18.54% on the controls to 39.33% on the diabetics. The authors discuss that this increased reactivity probably results from a greater NADH/NAD+ ratio, described in many tissues of diabetic animals, which has consequences on the modulation of the enzymes that use these cofactors and whose activity is detected by the NADH-diaphorase technique.