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Abstract
The treatment of tracheopleural and bronchopleural fistulas at an anastomosis after sleeve resection is complex and fraught with complications. Morbidity and mortality are very high. Therefore, great care must be taken to avoid such complications. The clinical signs and the early diagnosis of a potentially critical anastomosis or anastomotic leakage as well as the treatment, including secondary pneumonectomy are presented.
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Affiliation(s)
- C Ludwig
- Klinik für Thoraxchirurgie, Florence Nightingale Krankenhaus, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf, Kreuzbergstr. 79, 40489, Düsseldorf, Deutschland.
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152
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Alonso Arroyo V, Sánchez Abuín A, Gómez Beltrán OD, Molina Vázquez ME. [Multilayer repair of palatal fistula with an interpositional collagen matrix]. Cir Pediatr 2019; 32:207-211. [PMID: 31626407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Palatal fistula after the repair of cleft palate appears in 7.7-35% of patients. We present two cases of palatal fistula, detailing a multi-layer repair with an interpositional collagen graft. MATERIAL AND METHODS Patient 1: girl with a cleft palate operated using a Furlow technique. A reintervention was performed due to a Pittsburgh type III fistula. Patient 2: male with cleft palate operated using a Furlow technique. A reintervention was performed due to a type V fistula. RESULTS We used a multilayer repair with a local rotational flap and the interposition of a collagen matrix between the nasal and oral layers. The suture was reinforced with a fibrin hemostatic adhesive. No recurrence of the fistula after 2 years. CONCLUSIONS The three-layer closure is simple, safe, effective and avoids refistulizations. Interpositional grafts of a resorbable collagen membrane provide a "scaffold" for tissue growth, revascularization and epithelialization of the mucosa.
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153
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Frederiksen NA, Hölmich LR, Helgstrand F. [Handling of open abdomen with fistula]. Ugeskr Laeger 2019; 181:V02190140. [PMID: 31495365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The review summarises the handling of open abdomen with fistula, which is one of the most serious complications in connection with abdominal surgery. Most often, morbidity and mortality are caused by lack of fistula control and multi-organ dysfunction. The primary aim is to prevent sepsis, control the fistula and optimise the patient's physiology. Vacuum-assisted closure treatment combined with a creative approach is recommended and increases the possibility of closure of the abdominal wall. Plastic surgical assistance is usually required. As the frequency of the condition is low, and as it is difficult to handle, treatment should be performed in specialised centres.
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154
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Parelkar K, Shere D, Shah K. Butterfly tragal cartilage for repair of focal canal wall defects. Acta Otorrinolaringol Esp (Engl Ed) 2019; 71:88-92. [PMID: 31399151 DOI: 10.1016/j.otorri.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/22/2019] [Accepted: 03/31/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Meato-mastoid fistula is a connection between the external auditory canal and the mastoid cavity. It may be iatrogenic or pathological. The repair of these focal canal wall defects is necessary to prevent retraction pockets or sequential cholesteatoma and attain relief from otorrhoea. AIM/OBJECTIVE To study the effectiveness of an innovative technique for repair of meato-mastoid fistula (less than or equal to 10mm in size) in the bony external auditory canal. MATERIAL AND METHODS We performed a retrospective review of 5 surgeries performed in our hospital between January 2017 and December 2017 for the repair of posterior bony canal wall defects. Active ear disease was ruled out before the repair. We used full-thickness butterfly tragal cartilage graft for the repair of these fistulae. All our surgeries were endoscopic and sutureless. RESULTS The butterfly tragal cartilage graft was in situ at the repair site and viable on examination at 2 years follow-up, in all our cases. CONCLUSION AND SIGNIFICANCE Small posterior canal wall defects can be successfully repaired using this technique. The method is minimally invasive and cosmetic, with good patient compliance. The curling property of the cartilage graft is exploited effectively in this method of repair.
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Affiliation(s)
| | - Devika Shere
- Rajiv Gandhi Medical College & Chhatrapati Shivaji Maharaj Hospital, Kalwa, Thane, India
| | - Keya Shah
- King Edward Memorial Hospital, Mumbai, India
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155
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Rosière NI, Madrid C, Mendoza M, Martínez A, Bellia Munzón G. [Colopericardial fistula after esophageal replacement surgery: case report and literature review]. Cir Pediatr 2019; 32:150-153. [PMID: 31486308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Colopericardial fistula is a rare complication of colonic replacement surgery whose incidence is unknown. Therefore, we present the following case and perform a literature review. CLINICAL CASE 17-year-old female patient of age consults for respiratory distress and precordial pain of 5 days of evolution. Background: Long gap esophageal atresia (esophagostoma and feeding gastrostomy, subsequent colonic graft). Bilateral pneumonia is initially diagnosed. It rapidly evolves to a state of sepsis. On chest x-ray, pneumopericardium is observed. Water-soluble contrasted study confirms diagnosis of colopericardial fistula. Surgical treatment is established, despite this the patient dies due to respiratory distress. COMMENT Colopericardial fistula is a very serious entity with a high mortality rate. The clinical presentation and the complementary methods of diagnostic confirmation must be known in order to carry out the appropriate treatment.
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Affiliation(s)
- N I Rosière
- Servicio de Cirugía Pediátrica. Hospital Teresa Herrera-Materno Infantil. Complejo Hospitalario Universitario de A Coruña
| | - C Madrid
- Servicio de Cirugía Pediátrica. Hospital Teresa Herrera-Materno Infantil. Complejo Hospitalario Universitario de A Coruña
| | - M Mendoza
- Servicio de Cirugía Pediátrica. Hospital Teresa Herrera-Materno Infantil. Complejo Hospitalario Universitario de A Coruña
| | - A Martínez
- Servicio de Cirugía Pediátrica. Hospital Teresa Herrera-Materno Infantil. Complejo Hospitalario Universitario de A Coruña
| | - G Bellia Munzón
- Servicio de Cirugía Pediátrica. Hospital Teresa Herrera-Materno Infantil. Complejo Hospitalario Universitario de A Coruña
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156
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Mehta SS, Adoni N, Shihabi A, Bodine C, Moussa I, Gibb M. Multimodality Imaging and Percutaneous Closure of Right Sinus of Valsalva to Right Ventricular Outflow Tract Fistula After Transcatheter Aortic Valve Replacement. J Invasive Cardiol 2019; 31:E227-E228. [PMID: 31257219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We present the diagnosis and treatment of a 90-year-old male with critical aortic stenosis and multiple medical comorbidities who underwent TAVR that was complicated by annular rupture.
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Affiliation(s)
- Sanjay S Mehta
- University of Illinois at Urbana Champaign, Heart and Vascular Institute, Carle Foundation Hospital, Urbana, IL 61801 USA.
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157
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Abstract
Aortoventricular fistula, a rare congenital or acquired defect of the aortic wall, is characterized by an abnormal connection between the aorta and one of the ventricles. Symptom severity correlates with the diameter of the fistula and with the acute or chronic timing of presentation. The diagnosis is usually made by using echocardiography, and surgical treatment is necessary to avoid progression to heart failure. We describe the case of a 27-year-old woman who underwent successful surgical repair of an aortoventricular fistula that originated from the right coronary sinus and extended into the left ventricle through the interventricular septum. In addition to the patient's case, we briefly discuss this unusual condition.
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158
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Abstract
BACKGROUND Long gap esophageal atresia presents a challenge to pediatric surgeons due to the variability in surgical management when primary anastomosis is not feasible. Mechanical traction procedures enhance tissue growth that allows early anastomosis, before delayed primary closure (DPC) would be attempted to allow for rapid oral feeding, or when operative discoveries require flexibility of the surgical plan. The Suture Fistula procedure, first published by Alan Shafer and Tirone David in 1974, is a simple, effective, but underutilized single-stage procedure which results in spontaneous fistulization of approximated, non-anastomosed esophageal segments using tension sutures. METHODS A retrospective chart review was performed of patients who underwent the Suture Fistula procedure at a single institution since 1992. A literature review of all published case series of patients who underwent this procedure was also performed. RESULTS There were 5 case series found with a total of 24 patients, and three new cases presented. Patients were noted to have spontaneous fistulization with gastrostomy tube feed reflux noted in the upper esophagus or mouth on average of post-operative day 14, which occurred in over 85% of patients. While nearly all patients required esophageal dilation and anti-reflux procedures, the morbidity of the procedure, including esophageal leak, is very low, and similar to the Foker or Kimura procedures, which have been more popular despite their surgical complexity. CONCLUSION We propose the Suture Fistula technique to be a simpler, more effective, and safe alternative to other mechanical traction suture procedures in cases where primary anastomosis is not feasible. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kevin Janek
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - David Meagher
- Division of Pediatric Surgery, Department of Surgery, Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, OH
| | - Charles Goodwin
- Division of Pediatric Surgery, Department of Surgery, Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, OH.
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159
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160
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Ying GY, Chang KS, Tang YJ, Cheng CY, Zhu YJ, Chen CM. Utilizing real-time contrast medium to detect the fistula of giant spinal arachnoid cyst and treat with minimal invasive surgery. BMC Surg 2019; 19:11. [PMID: 30665385 PMCID: PMC6341693 DOI: 10.1186/s12893-019-0475-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Spinal arachnoid cysts are rare and have varied clinical manifestations depending on the affected spinal region and nerve roots. A complete cyst excision with fistula closure is the first choice of treatment. However, it might be difficult to localize the specific position of the fistula because previous images have no enhancements or the fistula is too tiny to be detected. CASE PRESENTATION This case is a giant lumbar extradural arachnoid cyst. We administered a lumbar injection with contrast medium into subarachnoid space under digital subtraction angiography (DSA) and disclosed the fistula. Confirming the location of fistula enabled us to perform minimally invasive surgery to ligate the fistula. Surgical intervention for a spinal arachnoid cyst might encounter the problem of the formation of a postoperative cerebrospinal fluid (CSF) fistula. We propose the option of detecting the fistula preoperatively for minimal invasive surgery. Recurrence depends on the long-term follow-up, and more cases are needed to further evaluate our technique. CONCLUSIONS The real-time contrast medium technique for spinal arachnoid cysts contributes to the complete ligation with minimally invasive surgery.
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Affiliation(s)
- Guang-Yu Ying
- Department of Neurosurgery, Second Affiliate Hospital Zhejiang University School of Medicine, Zhejiang, China
| | - Kai-Sheng Chang
- Department of Neurosurgery, Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 500 Taiwan, Republic of China
| | - Ya-Juan Tang
- Department of Neurosurgery, Second Affiliate Hospital Zhejiang University School of Medicine, Zhejiang, China
| | - Chun-Yuan Cheng
- Department of Neurosurgery, Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 500 Taiwan, Republic of China
| | - Yong-Jian Zhu
- Department of Neurosurgery, Second Affiliate Hospital Zhejiang University School of Medicine, Zhejiang, China
| | - Chien-Min Chen
- Department of Neurosurgery, Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 500 Taiwan, Republic of China
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
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161
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Wu Q, Jin Y, Zhou L, Liu Y, Wu D. A dissecting aneurysm of interventricular septum resulting from congenital coronary artery fistula. J Clin Ultrasound 2019; 47:55-58. [PMID: 30264460 DOI: 10.1002/jcu.22639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 07/08/2018] [Accepted: 08/20/2018] [Indexed: 06/08/2023]
Abstract
RATIONALE Ventricular septal dissecting aneurysms are rarely caused by congenital coronary artery fistulas. PATIENT CONCERNS We present a rare case of ventricular septal dissecting aneurysm that resulted from a congenital coronary artery fistula in a 41-year-old female patient with the complaint of chest pain. DIAGNOSIS Ventricular septal dissecting aneurysm resulting from a right coronary artery fistula. INTERVENTIONS The patient was advised to receive transcatheter interventional therapy in the department of cardiology. OUTCOMES It was difficult for the cardiac catheter to reach the orifice of fistula due to the long and circuitous nature of the right coronary artery, which ultimately resulted in abandoning interventional fistula occlusion therapy. The patient finally decided to undergo surgical treatment in Shanghai and the symptoms have been markedly improved after hemodynamic correction. LESSONS The right coronary artery was the dominant vessel and the fistula was located in the distal part of the posterior descending branch of right coronary artery. Hence, transcatheter closure was appropriate; however, due to the fact that right coronary artery was too long and circuitous, the length of cardiac catheter was relatively insufficient. For this reason, a comprehensive and careful assessment before the operation is necessary.
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Affiliation(s)
- Qing Wu
- Department of Ultrasonography, Ezhou Central Hospital, Hubei University of Science and Technology, Ezhou, Hubei, China
| | - Yanping Jin
- Department of Ultrasonography, Ezhou Central Hospital, Hubei University of Science and Technology, Ezhou, Hubei, China
| | - Lin Zhou
- Department of Ultrasonography, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yongfang Liu
- Department of Ultrasonography, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Daozhu Wu
- Department of Ultrasonography, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
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162
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Kato Y, Okazaki Y, Fukui Y, Kushitani Y, Kametani N, Yoshii M, Ako E, Yamamoto A, Yamada N, Nishimura S, Taenaka N, Mastunaga Y, Fujita S. [A Case of Appendiceal Adenocarcinoma with Vesico-Appendiceal Fistula Treated by Additional Laparoscopic Excision]. Gan To Kagaku Ryoho 2018; 45:1848-1850. [PMID: 30692374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 40-year-old woman was admitted to our hospital with the chief complaint of miction pain. MRI showed fundal wall thickening of the bladder in contact with the appendix. Under cystoscopy, redness of the mucous membrane was found in the posterior wall of the bladder. Therefore, laparo-appendectomy with partial cystectomy was performed. Microscopically, adenocarcinoma cells were observed in the lumen of the appendix, invading the wall of the urinary bladder at the fundus of the appendix. We performed laparo-ileocecal resection for a regional lymphadenectomy. Thus, the patient was diagnosed with adenocarcinoma of the appendix[V, type 3, 16×7 mm, tub2, pT4b(SI, urinary bladder), int, INF b, ly0, v0, pN0, cM0, pStage Ⅱ]. The patient has been receiving adjuvant chemotherapy using capecitabine for 6 months. There was no evidence of recurrence after 9 months of follow-up.
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163
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Fujinaga T, Ikeda M, Takahashi K, Komatsu T, Suzuki T, Yasuda K. [Usefulness of Nutritional Enforcement by Percutaneous Gastrostomy in Successful Omentoplasty for Empyema with Fistula]. Kyobu Geka 2018; 71:903-905. [PMID: 30309998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Omentoplasty has been accepted as an effective surgical procedure for fistulated empyema. However, it is difficult for patients with poor nutritional status because their omental volume is often too poor to be applied for omentoplasty. Percutaneous endoscopic gastrostomy(PEG) is useful for long-term nutritional management. There is no report on safety and usefulness of PEG before omentoplasty. We report a case of omentoplasty that was successfully performed after nutritional enforcement by using percutaneous endoscopic gastrostomy in a patient of postoperative empyema with fistula.
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Affiliation(s)
- Takuji Fujinaga
- Department of Thoracic Surgery, Nagara Medical Center, Gifu, Japan
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164
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Capote W, Wright J, Zoog E, Bhattacharya SD, Koontz CS. Omphalomesenteric Duct Fistula with Ileal Prolapse within an Omphalocele. Am Surg 2018; 84:e413-e415. [PMID: 30269727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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165
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Czogalla B, Trillsch F, Burges A. Cyclic transcutaneous bleeding after repeated cesarean section deliveries. Am J Obstet Gynecol 2018; 219:202. [PMID: 29548753 DOI: 10.1016/j.ajog.2018.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/18/2018] [Accepted: 03/03/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Bastian Czogalla
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany.
| | - Fabian Trillsch
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Alexander Burges
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
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166
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Keya KT, Sripad P, Nwala E, Warren CE. "Poverty is the big thing": exploring financial, transportation, and opportunity costs associated with fistula management and repair in Nigeria and Uganda. Int J Equity Health 2018; 17:70. [PMID: 29859118 PMCID: PMC5984775 DOI: 10.1186/s12939-018-0777-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 05/10/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Women living with obstetric fistula often live in poverty and in remote areas far from hospitals offering surgical repair. These women and their families face a range of costs while accessing fistula repair, some of which include: management of their condition, lost productivity and time, and transport to facilities. This study explores, through women's, communities', and providers' perspectives, the financial, transport, and opportunity cost barriers and enabling factors for seeking repair services. METHODS A qualitative approach was applied in Kano and Ebonyi in Nigeria and Hoima and Masaka in Uganda. Between June and December 2015, the study team conducted in-depth interviews (IDIs) with women affected by fistula (n = 52) - including those awaiting repair, living with fistula, and after repair, and their spouses and other family members (n = 17), along with health service providers involved in fistula repair and counseling (n = 38). Focus group discussions (FGDs) with male and female community stakeholders (n = 8) and post-repair clients (n = 6) were also conducted. RESULTS Women's experiences indicate the obstetric fistula results in a combined set of costs associated with delivery, repair, transportation, lost income, and companion expenses that are often limiting. Medical and non-medical ancillary costs such as food, medications, and water are not borne evenly among all fistula care centers or camps due to funding shortages. In Uganda, experienced transport costs indicate that women spend Ugandan Shilling (UGX) 10,000 to 90,000 (US$3.00-US$25.00) for two people for a single trip to a camp (client and her caregiver), while Nigerian women (Kano) spent Naira 250 to 2000 (US$0.80-US$6.41) for transportation. Factors that influence women's and families' ability to cover costs of fistula care access include education and vocational skills, community savings mechanisms, available resources in repair centers, client counseling, and subsidized care and transportation. CONCLUSIONS The concentration of women in poverty and the perceived and actual out of pocket costs associated with fistula repair speak to an inability to prioritize accessing fistula treatment over household expenditures. Findings recommend innovative approaches to financial assistance, transport, information of the available repair centers, rehabilitation, and reintegration in overcoming cost barriers.
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Affiliation(s)
- Kaji Tamanna Keya
- Population Council, Maternal and Newborn Health, 4301 Connecticut Avenue NW Suite 280, Washington, DC 20008 USA
| | - Pooja Sripad
- Population Council, Maternal and Newborn Health, 4301 Connecticut Avenue NW Suite 280, Washington, DC 20008 USA
| | - Emmanuel Nwala
- Population Council, No. 16 Mafemi Crescent, Off Solomon Lar Way, Utako District, Abuja, Nigeria
| | - Charlotte E. Warren
- Population Council, Maternal and Newborn Health, 4301 Connecticut Avenue NW Suite 280, Washington, DC 20008 USA
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167
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Waqar T, Farhan Ali Rizvi HM, Ahmed Ansari MZ. Surgical repair of congenital coronary artery fistula: A case report. J PAK MED ASSOC 2018; 68:804-806. [PMID: 29885189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Coronary artery fistula is an exceedingly uncommon congenital disorder characterized by fistulous communication of a coronary artery with asystemic or pulmonary vessel or a heart chamber. Small fistulas are asymptomatic and benign while large fistulas present in a variety of ways like heart failure, arrhythmias or endocarditis. We report here a rare case of eight years old girl who presented to us with history of shortness of breath and palpitation. Her echocardiography revealed a moderately large right coronary artery fistula that was opening into right ventricle. Angiography later confirmed its presence. We surgically closed it with a pericardial patch on cardiopulmonary bypass. The girl showed uneventful recovery and her postoperative echocardiography revealed no residual fistula. She was discharged on 5th postoperative day and her follow up was also unremarkable.
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Affiliation(s)
- Tariq Waqar
- Chaudhary Pervaiz Elahi Institute of Cardiology, Multan
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168
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Suzuki Y, Yazawa M, Kishi K. Wound Bed Preparation for Capsulectomy Using a Hydrosurgery System. Wounds 2018; 30:E49-E51. [PMID: 29718823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Wound bed preparation is necessary for proper wound healing. CASE REPORT The case of a 75-year-old man with good outcomes after using a hydrosurgery system for capsulectomy is presented. At a 2-month follow-up visit, a fistula measuring 15 cm x 10 cm was found to have developed in the patient's left scapular region after the first wide-excision surgery for soft tissue sarcoma and reconstruction of the defect using a local flap. The wound had fluid collection and a capsule that was then debrided with a hydrosurgery system. Since no infection was detected, closure with a pedicled latissimus dorsi (LD) muscle flap (15 cm x 6 cm) was performed. Due to persistent fluid collection, the LD harvest site had to be drained after discharge (18 days postoperatively); however, in the regions debrided by the hydrosurgery system, the suction drain could be removed early. CONCLUSIONS In the case reported herein, the hydrosurgery system proved beneficial for capsulectomy.
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Affiliation(s)
- Yushi Suzuki
- Department of Plastic and Reconstructive Surgery, Keio Gijuku Daigaku, Shinanomachi Campus, Shinjuku-ku, Tokyo, Japan
| | - Masaki Yazawa
- Department of Plastic and Reconstructive Surgery, Keio Gijuku Daigaku, Shinanomachi Campus, Shinjuku-ku, Tokyo, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio Gijuku Daigaku, Shinanomachi Campus, Shinjuku-ku, Tokyo, Japan
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169
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Ariffuddin I, Arman Zaharil MS, Wan Azman WS, Ahmad Sukari H. The use of facial artery musculomucosal (FAMM) readvancement flap in closure of recurrent oronasal fistula. Med J Malaysia 2018; 73:112-113. [PMID: 29703876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
High failure rate for recurrent palatal fistulas closure pose a great challenge to plastic surgeons. Tongue and facial artery musculomucosal (FAMM) flaps are the more commonly used flaps for closure of these recurrent fistulas. We report a case of a formerly inset FAMM flap to effectively close a previously repaired oronasal fistula.
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Affiliation(s)
- I Ariffuddin
- Universiti Sains Malaysia, School of Medical Sciences, Reconstructive Sciences Unit, Health Campus, Kubang Kerian, Malaysia.
| | - M S Arman Zaharil
- Universiti Sains Malaysia, School of Medical Sciences, Reconstructive Sciences Unit, Health Campus, Kubang Kerian, Malaysia
| | - W S Wan Azman
- Universiti Sains Malaysia, School of Medical Sciences, Reconstructive Sciences Unit, Health Campus, Kubang Kerian, Malaysia
| | - H Ahmad Sukari
- Universiti Sains Malaysia, School of Medical Sciences, Reconstructive Sciences Unit, Health Campus, Kubang Kerian, Malaysia
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170
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Sheikh NA, Nadeem K. Forgotten Post Operative Nasal Splint & Oro-Nasal Fistula. J Ayub Med Coll Abbottabad 2018; 30:293-294. [PMID: 29938439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
of the oral cavity. It may develop as a congenital defect e.g. cleft palate, or rarely, consequent to an operative procedure like a sub muco-perichondrial resection surgery of the nasal septum. After nasal septal corrective surgery, follow up of the patient with meticulous nasal toilet and detailed examination is mandatory. In operated patients who do not report to follow up, and later on present with persisting nasal discharge, pain, nasal blockage and exsanguination must alert a clinician for any evidence of a possibly retained foreign object. Inadvertently retained nasal splints can cause long lasting morbidity due to a possible chronic sinusitis, toxic shock syndrome and palatal perforation.
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Affiliation(s)
- Nadeem Ahmed Sheikh
- ENT Department, Combined Military Hospital, Abbottabad, Medical officer, Army Burn Hall College for Girls, Abbottabad, Pakistan
| | - Kanwal Nadeem
- ENT Department, Combined Military Hospital, Abbottabad, Medical officer, Army Burn Hall College for Girls, Abbottabad, Pakistan
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171
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Abstract
PURPOSE Congenital lacrimal fistula is a rare abnormality of the lacrimal system. The patients may be asymptomatic but treatment of those with symptoms such as epiphora and dacryocystitis is still controversial. METHODS The clinical findings, methods of surgical treatment and results were evaluated in seven patients (four male, three female) with congenital lacrimal fistula. Three were asymptomatic, types of surgical treatment were fistula excision with dacryocystorhinostomy (DCR) (two cases), fistula excision with conjunctival DCR (one case) and closed fistula excision alone (one case). RESULTS Three of the four patients who underwent surgery had relief of symptoms. The fistula recurred in the case that had undergone fistula excision alone. CONCLUSIONS It is difficult to design controlled studies to detect which method is superior for the treatment of lacrimal fistula, considering the small number of cases in the literature. We recommend treating each case according to its own characteristics.
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Affiliation(s)
- S H Uğurbaş
- Department of Ophthalmology, Ankara University Faculty of Medicine, Turkey
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172
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Garner O, Iardino A, Ramirez A, Ahmed Y. Role of modified Eloesser flap in the treatment of bronchopleural fistula caused by pulmonary coccidioidomycosis. BMJ Case Rep 2018; 2018:bcr-2017-223717. [PMID: 29351943 DOI: 10.1136/bcr-2017-223717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Orlando Garner
- Department of Internal Medicine, Texas Tech University at the Permian Basin, Odessa, Texas, USA
| | - Alfredo Iardino
- Department of Internal Medicine, Texas Tech University at the Permian Basin, Odessa, Texas, USA
| | - Ana Ramirez
- Department of Internal Medicine, Texas Tech University at the Permian Basin, Odessa, Texas, USA
| | - Yasir Ahmed
- Department of Infectious Disease, Texas Tech University of Health Science Center at the Permian Basin, Odessa, Texas, USA
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173
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Rama-López J, Tomás-Fernandez M, García-Garza C, Martínez-Madrigal M. Pharyngeal perforation after anterior cervical spine surgery treated by transoral endoscopic surgery. Head Neck 2017; 40:E13-E16. [PMID: 29206327 DOI: 10.1002/hed.25030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 10/01/2017] [Accepted: 10/25/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Anterior cervical fixation has been used since 1967 for multiple pathologies like traumatism, compressive myelopathy, or spinal infections. METHODS We report the case of a patient who had undergone cervical spine surgery 10 years previously and presented to our clinic with a pharyngeal fistula due to surgical screw displacement that was treated by transoral endoscopic surgery. RESULTS The immediate postoperative period occurred without incidence and complete odynophagia resolution. The patient was discharged home the fourth day after surgery. Follow-up after 1 year showed no evidence of spinal fixation hardware mobilization. CONCLUSION We consider the transoral endoscopic approach a feasible low comorbidity technique to treat anterior cervical plate mobilization with pharyngeal and pharyngoesophageal perforations.
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Affiliation(s)
- Julio Rama-López
- Ear, Nose, and Throat Department, University Hospital Son Espases, Palma Mallorca, Spain
| | | | - César García-Garza
- Ear, Nose, and Throat Department, University Hospital Son Espases, Palma Mallorca, Spain
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174
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Abstract
RATINALE Empyema is a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. An empyema caused by colo-pleural fistula is a rare but potentially life-threatening condition. PATIENT CONCERNS We describe a case of 42-year-old man was brought to our Emergency Department for chest pain with dyspnea and fever. DIAGNOSES The final diagnoses are empyema caused by colo-pleural fistula and colon cancer. INTERVENTIONS The patient underwent laparotomy surgery, during which a tumor was found in the splenic flexure of the descending colon. The tumor penetrated the colonic serosa and invaded the left side of the diaphragm. A left hemicolectomy was performed. OUTCOMES After the operation, the patient recovered smoothly and was discharged on postoperative day 14. It's been over 3 years now, CT and colonoscopy assessments show no recurrence or metastasis. LESSONS This case serves as a reminder to test for pathogens in patients with an unexplained empyema. If normal intestinal bacteria are detected, the empyema may be derived from intestinal disease. In addition, an abdominal examination should be performed in patients with an empyema of unknown origin.
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Affiliation(s)
- Rui Lian
- Department of Emergency Medicine
| | - Guochao Zhang
- Departmentof General Surgery, China-Japan Friendship Hospital, Beijing, China
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175
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Horvath SA, Gowani SA, Koelbl C, Rhodes JF, Escolar E, Santana O. Percutaneous Closure of Two Acquired Aorto-Right Ventricular Fistulae Following Right Ventricular Outflow Tract Surgery. J Invasive Cardiol 2017; 29:E101. [PMID: 28878101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The present case illustrates the successful transcatheter closure of an unusual double aortic root-to-right ventricular outflow tract fistula utilizing two Amplatzer duct occluders II.
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Affiliation(s)
| | | | | | | | | | - Orlando Santana
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, 4300 Alton Road, Miami Beach, FL 33140 USA.
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176
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Tokmak A, Esercan A, Sarıkaya E. An incidental finding of chronic salpingitis complications: Tubo-uterine fistula. J Exp Ther Oncol 2017; 11:81-83. [PMID: 28976128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/27/2015] [Indexed: 06/07/2023]
Abstract
Pelvic inflammatory disease (PID) is an infection of the upper genital tract in women that can include endometritis, parametritis, salpingitis, oophoritis, tubo-ovarian abscess, and peritonitis. The spectrum of the disease ranges from subclinical and asymptomatic infection to severe, lifethreatening illness; squealae include chronic pelvic pain, ectopic pregnancy, and infertility. In this case we report an uncommon complication of pelvic inflammatory disease, a tubo-uterian fistula. Our case was diagnosed by laparoscopy incidentally during assessment of infertility.
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Affiliation(s)
- Aytekin Tokmak
- Zekai Tahir Burak Women's Health Research and Education Hospital, Department of Obstetrics and Gynecology; Division of Gynecological Endocrinology, Ankara, Turkey
| | - Alev Esercan
- Zekai Tahir Burak Women's Health Research and Education Hospital, Department of Obstetrics and Gynecology; Division of Gynecological Endocrinology, Ankara, Turkey
| | - Esma Sarıkaya
- Zekai Tahir Burak Women's Health Research and Education Hospital, Department of Obstetrics and Gynecology; Division of Gynecological Endocrinology, Ankara, Turkey
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177
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Nakamura H. [Bronchopleural Fistula;Intraoperative Prevention and Postoperative Treatment]. Kyobu Geka 2017; 70:673-677. [PMID: 28790287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Postoperative bronchopleural fistula( BPF) is a life-threatening complication requiring immediate and proper treatments. Now days, the main method for closure of the bronchial stump after lung resection is mechanical stapling because of prevailing of commonly performed video-assisted thoracoscopic surgery. The frequencies of BPF seem to be decreased compared with the age of manual sutures under open thoracotomy, probably due to improvement of the stapling instruments. However, if once BPF occurs, the severity of the disease does not differ between these 2 closing methods. Thoracic surgeons should well understand the etiology, prevention, diagnosis, and treatment of the postoperative BPF.
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Affiliation(s)
- Haruhiko Nakamura
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
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178
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Anzalone CL, Cockerill CC, Cofer SA. Hyperbaric oxygen therapy for wound breakdown after oronasal fistula and cleft palate repair: four cases. Undersea Hyperb Med 2017; 44:315-319. [PMID: 28783887 DOI: 10.22462/7.8.2017.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We offer the first report of hyperbaric oxygen (HBO₂) therapy to treat early surgical wound breakdown after oronasal fistula and cleft palate repair in the pediatric population. We present four patients' experiences after undergoing HBO₂ therapy. HBO₂ was initiated as soon as an oronasal fistula was identified. Three of the children underwent 10 HBO₂ treatments with the fourth undergoing 11 treatments. There were no adverse effects during treatment; none of the patients required decompressive myringotomy. Follow-up shows portions of the repair have been salvaged by initiating HBO₂ at the first sign of fistula formation. In our case series, the fistulas all decreased in size over the course of treatment and demonstrated granulation tissue at the wound edges. Given the positive outcomes from our preliminary results, our results suggest concurrent usage of HBO₂ therapy for wound breakdown after cleft palate repair is an effective treatment option.
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Affiliation(s)
- C Lane Anzalone
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S
| | - Cara C Cockerill
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S
| | - Shelagh A Cofer
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S
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179
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Hoppmann P, Dirschinger R, Greif M, Bleiziffer S, Laugwitz KL, Kupatt C. Right ventricular fistula post-TAVR: amenable to interventional closure treatment. Clin Res Cardiol 2017; 106:846-848. [PMID: 28656477 DOI: 10.1007/s00392-017-1130-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 06/12/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Petra Hoppmann
- Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
- Munich Heart Alliance, DZHK Site Munich, Munich, Germany
| | - Ralf Dirschinger
- Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
- Munich Heart Alliance, DZHK Site Munich, Munich, Germany
| | - Martin Greif
- Heart and lung center Ebersberg, Altstadtpassage 6, 85560, Ebersberg, Germany
| | | | - Karl-Ludwig Laugwitz
- Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
- Munich Heart Alliance, DZHK Site Munich, Munich, Germany
| | - Christian Kupatt
- Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.
- Munich Heart Alliance, DZHK Site Munich, Munich, Germany.
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180
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Dellis SL, Pennel T, Said-Hartley Q, Zilla P. Sinus of Valsalva-right atrial tunnel causing heart failure in a 38-year-old. J Thorac Cardiovasc Surg 2017; 155:e51-e53. [PMID: 28673702 DOI: 10.1016/j.jtcvs.2017.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/16/2017] [Accepted: 06/03/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Sophia L Dellis
- Division of Cardiothoracic Surgery, Albany Medical Center, Albany, NY.
| | - Timothy Pennel
- Chris Barnard Division of Cardiothoracic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | | | - Peter Zilla
- Chris Barnard Division of Cardiothoracic Surgery, Groote Schuur Hospital, Cape Town, South Africa
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181
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Bradley MS, Bickhaus JA, Amundsen CL. Vaginal repair of a vesicocervical fistula after labored-cesarean delivery without concomitant hysterectomy. Int Urogynecol J 2017; 28:1603-1604. [PMID: 28585045 DOI: 10.1007/s00192-017-3384-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/13/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Megan S Bradley
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Duke University Medical Center, 5324 McFarland Drive, Suite 310, Durham, NC, 27707, USA.
| | - Jennifer A Bickhaus
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Duke University Medical Center, 5324 McFarland Drive, Suite 310, Durham, NC, 27707, USA
| | - Cindy L Amundsen
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Duke University Medical Center, 5324 McFarland Drive, Suite 310, Durham, NC, 27707, USA
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182
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Zhu Z, Li Z, He Z, Wang Y. [Endoscopic trans-fistula drainage for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2017; 46:637-642. [PMID: 29658667 PMCID: PMC10396874 DOI: 10.3785/j.issn.1008-9292.2017.12.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective: To evaluate the efficiency and safety of endoscopic trans-fistula drainage (ETFD) for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy. Methods: Among 456 esophageal cancer patients receiving esophagectomy between February 2012 and February 2017 in Sir Run Run Shaw Hospital, 15 cases were diagnosed as gastroesophageal anastomotic fistula with para-fistula abscess after surgery. Seven cases received ETFD treatment (ETFD group), and 8 cases received conventional treatment (control group). Recovery of inflammatory markers and fistula, length of hospital stay after esophagectomy and total medical expenses were compared between ETFD group and control group. Results: All patients recovered in ETFD group. Time of white cell count returning to normal and decline of C-reactive protein, time of fistula healing and length of hospital stay after esophagectomy in ETFD group were significantly shorter than those of control group (all P<0.05). And medical expenses in ETFD group was also lower (P<0.05). Conclusion: ETFD is effective and safe for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy.
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Affiliation(s)
- Ziyi Zhu
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Zhijun Li
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Zhengfu He
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Yunzhen Wang
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
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183
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Zhang H, Yuan W, Zhou Q, Gu X, Wang F. [Efficacy comparison of robotic and laparoscopic radical surgery in the treatment of middle-low rectal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:540-544. [PMID: 28534332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To compare the clinical efficacy of robotic and laparoscopic radical surgery in the treatment of middle-low rectal cancers. METHODS From January 2015 to March 2016, intra-operative and postoperative follow-up data of 30 patients with middle-low rectal cancers who underwent robotic radical resection(robot group) and 32 patients with middle-low rectal cancers who underwent laparoscopic radical resection (laparoscopy group)n in our department were retrospectively collected. The distance from cancer to anal margin was less than 10 cm in both two groups and advanced rectal cancers were confirmed by preoperative colonoscopy biopsy. Associated data were compared between two groups. RESULTS There were 13 males and 17 females in robot group with age of 27 to 85 (mean 59.7) years, disease course of 3 to 12 (mean 6.2) months and clinical stage T2-3N0-1. There were 16 males and 16 females in laparoscopic group with age of 32 to 79 (mean 60.3) years, disease course of 2 to 10(mean 5.9) months and clinical stage T2-3N0-1. The baseline data of two groups were not significantly different (all P>0.05). All the patients in two groups completed operations successfully without conversion to open operation. Compared with laparoscopic group, the blood loss was less [(100.3±43.7) ml vs. (150.3±68.2) ml, t=3.413, P=0.001], the first flatus time [(49.3±12.4) h vs. (58.6±12.5) h, t=2.838, P=0.006] and urinary catheter removal time [(3.0±0.7) d vs. (4.8±0.9) d, t=5.491, P=0.000] were shorter, while the operation time [(217.3±57.8) min vs. (187.9±23.1) min, t=2.772, P=0.009] was longer in robot group. No cancer tissue was observed in resection margin of two groups. Number of harvested lymph node per case (15.2±7.4 vs. 13.9±4.9, t=-0.764, P=0.448), distance from anal margin to tumor distal edge [(7±3) cm vs. (6.5±3) cm, t=-1.952, P=0.056] and postoperative hospital stay [(13.6±1.3) d vs. (13.8±1.8) d, t=0.925, P=0.359] were not significantly different between two groups. No serious complications occurred in two groups during intra-operative and postoperative period. During following up of 3 to 12 (average 8.7) months, 1 case of anastomotic fistula occurred in each group and was cured by conservative treatment without significant difference [3.3%(1/30) vs. 3.1%(1/32), P=1.000]. No sexual dysfunction was found in either groups. Two cases in laparoscopic group presented relapse and metastasis, but no recurrence and metastasis was observed in robot group. There was no death in two groups. CONCLUSION Robotic radical surgery in the treatment of middle-low rectal cancers is safe and effective with the advantages of less trauma, less bleeding, rapid recovery of intestinal function and urinary function.
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Affiliation(s)
| | - Weitang Yuan
- Department of Colonrectal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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184
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de Souza HJM, Amorim FV, Corgozinho KB, Tavares RR. Management of the traumatic oronasal fistula in the cat with a conical silastic prosthetic device. J Feline Med Surg 2017; 7:129-33. [PMID: 15771950 DOI: 10.1016/j.jfms.2004.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2004] [Indexed: 11/19/2022]
Abstract
Management of a traumatic oronasal fistula with a prosthetic device in an 8-year-old male neutered domestic shorthair cat is described. The animal had fallen from a height of three stories at the age of 1 year. The fall had resulted in a fracture of the hard palate and a split in the palatal mucosa. Two surgical attempts to close the defect had been unsuccessful and an autopolymerizable acrylic resin prosthesis had produced unsatisfactory results. The management of the chronic traumatic fistula with a conical prosthetic device was fast, easy and efficient. The device was removed and a second one was put in place after 2 years. This method would appear particularly useful for obturation of large palatal defects that have failed to heal after attempts at surgical closure and is an alternative treatment for debilitated cats which may not be candidates for longer surgical procedures.
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Affiliation(s)
- Heloisa Justen M de Souza
- Department of Medicine and Surgery, Veterinary Institute, Universidade Federal Rural do Rio de Janeiro, Br 465, Km 7, Seropédica, Rio de Janeiro, RJ CEP 23890-000, Brazil
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185
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Hanuliak J, Szkorupa M, Chudáček J, Stašek M, Neoral Č. [Combined treatment of early tracheobronchopleural fistula after right tracheal sleeve pneumonectomy]. Rozhl Chir 2017; 96:213-217. [PMID: 28758760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Extended tracheo-bronchoplastic resection for lung cancer with carinal involvement ranks among technically demanding procedures. Despite certain progress in oncological therapy, this type of resection remains the only potentially curative treatment of NSCLC in this localization. However, given the severity of complications postoperative mortality is relatively high (711%). The main cause of death is tracheobronchopleural fistula complicated by thoracic empyema, bronchopneumonia and septic shock. If ARDS (acute respiratory distress syndrome) develops, the mortality rate rises up to 70%. The treatment of tracheobronchopleural fistula is arduous, long-term and essentially multidisciplinary. In this case report, the authors present the case of a 58 years old patient developing the tracheobronchopleural fistula early after carinal resection and sleeve pneumonectomy for a centrally localised squamous cell carcinoma of the right lung. The fistula was primarily sutured and secured using a muscular flap. For recurrence of the fistula, tissue adhesive glue was applied in combination with the introduction of a plastic stent, which resulted in healing of the tracheobronchopleural fistula.Key words: sleeve pulmonectomy carinal resection tracheobronchopleural fistula tracheobronchial stenting.
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186
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Shehab HM, Hakky SM, Gawdat KA. An Endoscopic Strategy Combining Mega Stents and Over-The-Scope Clips for the Management of Post-Bariatric Surgery Leaks and Fistulas (with video). Obes Surg 2016; 26:941-8. [PMID: 26464242 DOI: 10.1007/s11695-015-1857-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Endoscopic stenting has proved effective in the management of post-surgical leaks but is strongly hampered by the high rate of stent migration. In this study, we evaluate our experience with a new approach involving the use of novel ultra-large expandable stents tailored for bariatric surgery leaks (Mega stents), combined with the use of the innovative over-the-scope clips (OTSC). METHODS Retrospective analysis of patients with post-bariatric surgery leaks managed at our institution by an approach combining Mega stents and over-the-scope clips. RESULTS Twenty-two patients were treated for post-bariatric surgery leaks; 13 (59%) had a sleeve gastrectomy while nine (41%) had a RYGB. A total of 30 stents were inserted. Successful endoscopic insertion and removal were achieved in all patients. OTSC clips were applied in 12 patients (55%); five simultaneously with stents and seven after stent removal. Primary closure (after one endoscopic procedure) was achieved in 13 patients (59%) and in a total of 18 patients after multiple endoscopic procedures (82%). An average of 1.4 stents and 2.8 endoscopic procedures were required per patient. Stent migration occurred in four patients (18%), and all were retrievable endoscopically. Other complications included retrosternal pain and vomiting in 20 patients (91%) including one necessitating early removal, bleeding in two patients (9%), and perforation and esophageal stricture in one patient each (5%). Two mortalities were encountered, and one of them was stent-related (bleeding). CONCLUSION Mega stents are effective in the management of post-bariatric surgery leaks. The combined use of Mega stents and OTSC clips is associated with a low incidence of migration and a low number of stents and procedures required per patient.
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Affiliation(s)
- Hany M Shehab
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, Kasr Alainy University Hospital, Cairo University, Cairo, Egypt.
| | - Sherif M Hakky
- Bariatric Surgery Department, Kasr Alainy University Hospital, Cairo University, Cairo, Egypt
| | - Khaled A Gawdat
- General Surgery Department, Ain Shams University Hospital, Ain Shams University, Cairo, Egypt
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187
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Lv X, Chen X, Ge H, He H, Jiang C, Li Y. Adjunct to Embolize the High-Flow Fistula Part of Arteriovenous Malformation Using a Double-Lumen Balloon Catheter. World Neurosurg 2016; 96:370-374. [PMID: 27633716 DOI: 10.1016/j.wneu.2016.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/01/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study is to report our initial experience of Onyx embolization of the high-flow fistula part of arteriovenous malformation (AVM) using a double-lumen balloon catheter. METHODS A Scepter C balloon catheter was used in 2 patients with AVMs associated with high-flow fistulas. The fistulas were located in the anterior cerebral artery and the middle cerebral artery. RESULTS Onyx embolization was successful in 2 cases, resulting in elimination of the high-flow fistula part of the AVM. There were no treatment-related events. CONCLUSIONS The double-lumen Scepter balloon appears to be a safe and convenient device for Onyx embolization of high-flow fistulas.
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Affiliation(s)
- Xianli Lv
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiheng Chen
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Huijian Ge
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hongwei He
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chuhan Jiang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Youxiang Li
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
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188
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Hakim S, Amin M, Cappell MS. Limited, local, extracolonic spread of mucinous appendiceal adenocarcinoma after perforation with formation of a malignant appendix-to-sigmoid fistula: Case report and literature review. World J Gastroenterol 2016; 22:8624-8630. [PMID: 27784975 PMCID: PMC5064044 DOI: 10.3748/wjg.v22.i38.8624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/31/2016] [Accepted: 09/12/2016] [Indexed: 02/06/2023] Open
Abstract
A 68-year-old man presented with progressive right lower quadrant abdominal pain and tenderness without rebound tenderness, and with constipation during the prior 9 mo. Abdomino-pelvic computed tomography and magnetic resonance imaging demonstrated a dilated appendix forming a fistula to the sigmoid colon. Open laparotomy revealed a bulky abdominal tumor involving appendix, cecum, and sigmoid, and extending up to adjacent viscera, without ascites or peritoneal implants. The abdominal mass was removed en bloc, including resection of sigmoid colon, cecum (with preservation of ileocecal valve), appendix, right vas deferens, testicular vessels, and minimal amounts of anterior abdominal wall; and shaving off of small parts of the walls of the urinary bladder and small bowel. Gross and microscopic pathologic examination revealed an appendix-to-sigmoid malignant fistula secondary to perforation of mucinous adenocarcinoma of the appendix with minimal local spread (stage T4). However, the surgical margins were clear, all 13 resected lymph nodes were cancer-free, and pseudomyxoma peritonei or peritoneal implants were not present. The patient did well during 1 year of follow-up with no clinical or radiologic evidence of local recurrence, metastases, or pseudomyxoma peritonei despite presenting with extensive stage T4 cancer that was debulked without administering chemotherapy, and despite presenting with malignant appendiceal perforation. This case illustrates the non-aggressive biologic behavior of this low-grade malignancy. The fistula may have prevented free spillage of cancerous cells and consequent distant metastases by containing the appendiceal contents largely within the colon.
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189
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Zhou B, Cen XJ, Qian LY, Pang J, Zou H, Ding YH. Treatment strategy for treating atrial-esophageal fistula: esophageal stenting or surgical repair?: A case report and literature review. Medicine (Baltimore) 2016; 95:e5134. [PMID: 27787367 PMCID: PMC5089096 DOI: 10.1097/md.0000000000005134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Atrial-esophageal fistula (AEF) is a rare severe disease, which may be associated with radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) or intraoperative radiofrequency ablation of atrial fibrillation (IRAAF). CLINICAL FINDINGS We reported a case of a 67-year-old man with AEF following RFCA of AF, who treated with esophageal stenting and surgical repair. OUTCOMES He was attacked by out-of-control sepsis and infectious shock after surgery and died. LITERATURE REVIEW We analyzed 57 relevant articles about AEF from 2003 to 2015 by searching PubMed database. According literatures, the most common symptoms were fever, rigor, sepsis, and neurologic symptoms. Chest computer tomography (CT) and contrast enhanced CT may be the reliable noninvasive diagnosis methods because of high sensitive for AEF. CONCLUSION Make a definition diagnosis in time with early primary surgical repair may save their lives. Conservative treatment or esophageal stenting alone may not be a better choice for AEF patients.
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Affiliation(s)
- Bing Zhou
- Department of Cardiac Surgery, Zhejiang Provincial People's Hospital
| | - Xue-Jiang Cen
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Lin-Yan Qian
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Jie Pang
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Hai Zou
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou, China
- Correspondence: Ya-Hui Ding and Hai Zou, Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou 310000, China (e-mail: [Y-HD] and [HZ])
| | - Ya-Hui Ding
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou, China
- Correspondence: Ya-Hui Ding and Hai Zou, Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou 310000, China (e-mail: [Y-HD] and [HZ])
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190
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Abstract
In a 144-month period, 27 cases of labyrinthine fistula (LF) were seen, and 360 mastoid operations were performed; the LF prevalence was 7.5%. Primary symptoms were hypoacusis, otorrhea, vertigo, tinnitus, and otalgia. All patients underwent preoperative CT scans and preoperative audiometry. LF diagnosis was made before surgery for 93% of patients on the basis of symptoms, signs, and imaging studies. With respect to surgical technique, the canal-wall-down procedure was performed in 92%, and the canal-wall-up procedure was performed in 8%. In 88% of patients the fistula was located in the horizontal semicircular canal. In 96% of patients the cholesteatoma matrix was removed, and the fistula was sealed; in 4% of patients the matrix was left. With a follow-up of 13 years, vertigo disappeared in 96% of patients, and hearing remained unchanged in 70% of patients. Further complications of chronic otitis media existed in approximately half of the patients with LF. Open surgery with removal of the cholesteatoma matrix and sealing of the fistula with temporalis fascia in a canal-wall-down manner is a safe procedure that can make vertigo disappear and helps to preserve cochlear function.
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Affiliation(s)
- A Soda-Merhy
- Department of Otolaryngology, National Institute of Respiratory Diseases, Mexico City, Mexico
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191
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Komori M, Yamamoto Y, Yaguchi Y, Ikezono T, Kojima H. Cochlin-tomoprotein test and hearing outcomes in surgically treated true idiopathic perilymph fistula. Acta Otolaryngol 2016; 136:901-4. [PMID: 27055739 DOI: 10.3109/00016489.2016.1165861] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Approximately 50% of patients with sPLF based on the clinical diagnosis criteria were definitively diagnosed with CTP-positive sPLF. These results suggest that early surgery within 7 days of the disease onset contributes to improvements in the therapeutic response of hearing loss. OBJECTIVES/HYPOTHESIS Idiopathic spontaneous perilymph fistula (sPLF) cannot be diagnosed reliably. It is speculated that this condition occurs in patients with vertigo-accompanied acute sensorineural hearing loss that progresses rapidly in spite of steroid therapy. This study herein evaluated cochlin-tomoprotein (CTP) test results in patients with sPLF who underwent exploratory tympanotomy and considered surgical outcomes with true sPLF. STUDY DESIGN Retrospective study. METHODS Twenty-three patients diagnosed with sPLF based on the clinical diagnosis criteria who underwent exploratory tympanotomy were included. RESULTS CTP test results were positive in 11 cases. In CTP-positive cases, the mean hearing level was 66.5 dB pre-operatively and 42.3 dB post-operatively. The hearing level post-operatively completely recovered in four cases, markedly recovered in three cases, slightly recovered in one case and showed no response in three cases. Hearing level improvements were significantly better in CTP-positive patients who underwent surgery within 7 days of the disease onset than in those treated 8 or more days after the disease onset.
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Affiliation(s)
- Manabu Komori
- a Department of Otorhinolaryngology , The Jikei University School of Medicine , Tokyo , Japan
| | - Yutaka Yamamoto
- a Department of Otorhinolaryngology , The Jikei University School of Medicine , Tokyo , Japan
| | - Yuichiro Yaguchi
- a Department of Otorhinolaryngology , The Jikei University School of Medicine , Tokyo , Japan
| | - Tetsuo Ikezono
- b Department of Otorhinolaryngology , Saitama Medical University , Saitama , Japan
| | - Hiromi Kojima
- a Department of Otorhinolaryngology , The Jikei University School of Medicine , Tokyo , Japan
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192
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Piski Z, Büki A, Nepp N, Burián A, Révész P, Gerlinger I. [CLOSURE OF NASOCRANIAL FISTULAS WITH "BATH-PLUG" TECHNIQUE AND MULTILAYER RECONSTRUCTION]. Ideggyogy Sz 2016; 69:211-6. [PMID: 27468611 DOI: 10.18071/isz.69.0211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In case of dehiscenses developing on the anterior scull base, complete closure resulting in the cessation of the communication between the nasal cavity and the intracranial space is mandatory as soon as possible, in order to prevent serious complications. With the development of the endoscopic techniques, the endonasal management for the reconstruction has become available in recent decades. METHODS We aim to present the reconstruction techniques applied in our department in the cases of two patients recently operated at our institute. The choice of methods primarily depends on the size and the localization of the defect. Dehiscenses under 5 mm of diameter can be closed with the so called "bath-plug" technique, while bigger defects, where the required closure of the plug is not possible, can be solved with multilayer reconstruction. We use autogenous fascia, fat and muco-periosteum in both cases. RESULTS Our patient, who underwent the aforementioned "bath-plug" procedure, could be discharged after a few days of uneventful postoperative period. During a ten-month follow-up period new fistula formation was not observed. In the case of a patient who underwent multilayer reconstruction, meningitis occurred postoperatively, which was resolved after antibiotic therapy. During a 17-month follow-up period recurrent liquorrhoea did not occur. CONCLUSION With suitable technical background and appropriate endoscopic skills the surgeries of the anterior skull base cerebrospinal fluid fistulas can be performed efficiently and with low complication rate. These are minimally invasive procedures accompanied by less surgical trauma, morbidity and shorter hospitalization, hence these techniques are considered to be cost-effective and well-tolerated for the patients.
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193
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Abstract
The purpose of this article is to review and summarize the etiopathogenesis, symptomatology, systemic associations, management, complications and clinical outcomes of congenital lacrimal fistulae. The authors performed an electronic database (PubMed, MEDLINE, EMBASE and Cochrane Library) search of all articles published in English on congenital lacrimal fistulae. Congenital subsets of patients from series of mixed lacrimal fistulae were included in the review. These articles were reviewed along with their relevant cross-references. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. The prevalence of congenital lacrimal fistulae is reported to be around 1 in 2000 live births. They are frequently unilateral, although familial cases tend to be bilateral. Lacrimal and systemic anomalies have been associated with lacrimal fistulae. Exact etiopathogenesis is unknown but mostly believed to be an accessory out budding from the lacrimal drainage system during embryogenesis. Treatment is indicated when significant epiphora or discharge is present and is mostly achieved by various fistulectomy techniques with or without a dacryocystorhinostomy. Congenital lacrimal fistulae are a distinct clinical entity with unique features. Surgical management can be challenging and successful outcomes are usually achieved with widely accepted protocols.
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Affiliation(s)
- Jia Quan Chaung
- a Yong Loo Lin School of Medicine , National University of Singapore , Singapore
| | - Gangadhara Sundar
- b Orbit and Oculofacial Surgery, Department of Ophthalmology , National University of Singapore, National University Hospital , Singapore
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194
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Ozgul O, Ozgul BM, Dursun E, Kocyigit ID, Tözüm TF. Combined Endodontic and Surgical Treatment of Dens Invaginatus-Associated Extraoral Fistula: A Case Report with Seven-year Follow-up. N Y State Dent J 2016; 82:44-47. [PMID: 30512268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Dens invaginatus (dens in dente) is a developmental malformation of permanent or deciduous teeth that has various complex forms. It most commonly affects permanent maxillary lateral incisor teeth, and rarely affects the mandibular teeth. In this report, a rare case of dens invaginatus of a mandibular lateral tooth with an extraoral fistula is presented. A 10-year-old patient was referred to our clinic with extraoral symptoms that could not be diagnosed by medical doctors. Successful treatment with endodontic treatment and periapical surgery is described. Seven-year follow-up of the case is provided.
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195
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Abstract
There continues to be considerable confusion concerning the diagnosis and treatment of perilymphatic fistulas (PLFs) and Meniere's disease. This paper reports an 8-year experience with patients whose symptoms were compatible with Meniere's disease but who had some other element that raised the possibility of their having a PLF. This review is a retrospective report on 64 patients who had fluctuating hearing loss, vertigo, tinnitus, and aural fullness typical of Meniere's disease. However, they also had a positive fistula test and/or symptoms beginning immediately after head trauma. They all underwent at least a unilateral PLF repair, and some also underwent an endolymphatic sac–mastoid shunt operation. This report provides a literature review to help put this series' results into perspective. Of those 40 patients who underwent an initial PLF repair, 58% had a successful outcome. Of the 10 patients who underwent an initial PLF repair plus an endolymphatic sac–mastoid shunt, 70% had a successful outcome. Since it is often difficult to distinguish patients with PLFs and secondary endolymphatic hydrops (Meniere's syndrome) from patients with Meniere's disease (idiopathic endolymphatic hydrops), PLF repair is a reasonable first operation, reserving an endolymphatic sac–mastoid shunt operation as a secondary procedure if needed. The decision to consider a PLF repair is guided by a positive fistula test or an immediate onset of Meniere's disease symptom complex after head or ear trauma.
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Affiliation(s)
- D C Fitzgerald
- Department of Otology/Neurotology, Washington Hospital Center, DC, USA
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196
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Abstract
A surgically documented case of barotrauma-induced perilymph fistula is presented in this case report. A brief review of the literature on this entity confirms the difficulty of making a definitive preoperative diagnosis in most instances. Clinical, audiometric, radiologic, and intraoperative findings are presented, and the classic presumed mechanisms for this uncommon cause of sudden sensorineural hearing loss are discussed. The presence of intact evoked otoacoustic emissions in an ear demonstrating a severe cochlear-type loss was considered helpful in narrowing the differential diagnosis in this case, and may suggest a productive avenue for future study.
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Affiliation(s)
- Patrick J Collison
- Yankton Medical Clinic, University of South Dakota School of Medicine, Yankton, South Dakota, USA
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197
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Bos WTGJ, Verhoeven ELG, Zeebregts CJAM, Tielliu IFJ, Prins TR, Oranen BI, van den Dungen JJAM. Emergency Endovascular Stent Grafting for Thoracic Aortic Pathology. Vascular 2016; 15:12-7. [PMID: 17382049 DOI: 10.2310/6670.2007.00002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Our aim was to report single-center results of emergency endovascular treatment for thoracic aortic disease. From March 1998 to January 2006, 30 acute thoracic EVAR procedures were carried out in 29 patients. One patient received two procedures in different settings. Four patients died before treatment could be initiated. The pathology of aortic lesions included atherosclerotic aneurysm ( n = 13), pseudoaneurysm ( n = 6), aortic rupture ( n = 5), type B dissection ( n = 5), aortobronchial or aortoesophageal fistula ( n = 4), and intramural hematoma ( n = 1). The surgical mortality rate was 21%. Three patients died as a result of technical complications, and three patients died after technically successful procedures. The mean follow-up was 31 ± 23 months. The late mortality rate was 40% (8 of 20). Four patients died of causes unrelated to the procedure; two patients died at home without autopsy. Two patients died as a consequence of graft infections. Three late nonfatal complications occurred. Two of these resulted in additional treatment: one patient developed a mycotic aneurysm that was treated with additional stent grafting, and one patient developed a type 3 endoleak after 6 years of follow-up and was successfully treated with a bridging stent graft. Endovascular treatment for acute thoracic disease is feasible and associated with a reasonable outcome. In selected cases, it may be considered as a first option.
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Affiliation(s)
- Wendy T G J Bos
- Department of Surgery, University Medical Center Groningen, 9700 RB Groningen, the Netherlands.
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198
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Morvan JB, Gempp E, Rivière D, Louge P, Vallee N, Verdalle P. Perilymphatic fistula after underwater diving: a series of 11 cases. Diving Hyperb Med 2016; 46:72-75. [PMID: 27334993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 04/24/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Onset of cochleovestibular symptoms (hearing loss, dizziness or instability, tinnitus) after a dive (scuba or breath-hold diving) warrants emergency transfer to an otology department. One priority is to investigate the possibility of the development of decompression sickness with a view to hyperbaric oxygen treatment of bubble-induced inner-ear damage. If this injury is ruled out, inner-ear barotrauma should be considered together with its underlying specific injury pattern, perilymphatic fistula. METHODS We report on a series of 11 cases of perilymphatic fistula following ear barotrauma between 2003 and 2015, eight after scuba diving and three after free diving. All patients underwent a series of laboratory investigations and first-line medical treatment. RESULTS Seven patients had a perilymphatic fistula in the left ear and four in the right. Eight cases underwent endaural surgical exploration. A fistula of the cochlear fenestra was visualised in seven cases with active perilymph leakage seen in six cases. After temporal fascia grafting, prompt resolution of dizziness occurred, with early, stable, subtotal recovery of hearing in seven. Of six patients in whom tinnitus occurred, this disappeared in two and improved in a further two. Two patients were not operated on because medical treatment had been successful, and one patient refused surgery despite the failure of medical treatment. Median follow-up time was 7.4 years (range 0.3 to 12). CONCLUSION The diagnosis of perilymphatic fistula is based on clinical assessments and various laboratory findings. When there was strong evidence of this condition, surgery yielded excellent functional outcomes in all patients treated early.
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Affiliation(s)
- Jean-Baptiste Morvan
- Ear, Nose and Throat, and Cervicofacial Surgery, Institut de Recherche Biomédicale des Armées Hôpital d'Instruction des Armées Sainte Anne, BP 600 - 83800, Toulon Cedex 9, France,
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199
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Spinelli C, Rossi L, Strambi S, Piscioneri J, Natale G, Bertocchini A, Messineo A. Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases. J Endocrinol Invest 2016; 39:529-35. [PMID: 26403983 DOI: 10.1007/s40618-015-0390-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/10/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Branchial abnormalities occur when there is disturbance in the maturation of the branchial apparatus during fetal development. Branchial anomalies are congenital lesions usually present in childhood, even if they can be diagnosed later for enlargement or infection. A correct diagnosis will lead to proper management: complete surgical excision is the treatment of choice. The purpose of this article is to present clinical features, diagnostic methods and surgical treatment of branchial anomalies in childhood, based on a series of 50 patients. METHODS We conducted a retrospective analysis of a total of 50 pediatric patients operated from June 2005 to June 2014 for the presence of branchial cleft anomalies. RESULTS 27 cases (54 %) presented a second branchial cleft fistula and 11 cases (22 %) a second branchial cleft cyst and one case (2 %) presented both cyst and sinus of the second branchial cleft; four cases (8 %) presented first branchial cleft cyst whereas four cases (8 %) a first branchial cleft sinus and two cases (4 %) a first branchial cleft fistula; one case (2 %) presented a piriform sinus fistula (third branchial cleft). None of our patients presented anomalies of the fourth branchial cleft. All patients underwent surgical treatment and lesions have been removed by excision or fistulectomy. No post-surgical complication occurred. The rate of recurrence was 4 %. CONCLUSIONS Pre-operative diagnosis supplies important information to the surgeon for a proper therapy: a complete excision of the lesion without inflammatory signs is essential to avoid re-intervention and to achieve a good outcome.
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Affiliation(s)
- C Spinelli
- Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - L Rossi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - S Strambi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - J Piscioneri
- Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - G Natale
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126, Pisa, Italy
| | - A Bertocchini
- Department of Pediatric Surgery, Children's Hospital A. Meyer, University of Florence, Via Luca Giordano 13, 50132, Florence, Italy
| | - A Messineo
- Department of Pediatric Surgery, Children's Hospital A. Meyer, University of Florence, Via Luca Giordano 13, 50132, Florence, Italy
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200
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Harounian JA, Goldenberg D, May JG. The rare fourth branchial cleft anomaly. Ear Nose Throat J 2016; 95:154-156. [PMID: 27140014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- Jonathan A Harounian
- Department of Surgery, The Pennsylvania University College of Medicine, Hershey, PA, USA
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