1
|
Somers T, Klarenbeek BR, Kouijzer IJE, Verhagen AFTM, Verkroost MWA. Surviving the nonsurvivable combination of a mycotic aneurysm progressing into a concomitant aorto-bronchial- and aorto-esophageal fistula, a case report. J Cardiothorac Surg 2023; 18:289. [PMID: 37828603 PMCID: PMC10571321 DOI: 10.1186/s13019-023-02387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Aortic mycotic aneurysms are a rare but life-threatening condition and may be associated with aorto-bronchial- and aorto-esophageal fistulas. Although both very rare, they carry a high mortality and require (urgent) surgical intervention. Surviving all three conditions concomitantly is extraordinary. We describe a patient who underwent staged repair of such combined defects.
Collapse
Affiliation(s)
- Tim Somers
- Department of Cardio-thoracic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10 (Route 615), Nijmegen, 6525 GA, Netherlands
| | | | - Ilse J E Kouijzer
- Department of Internal Medicine and Radboud Centre for Infectious diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ad F T M Verhagen
- Department of Cardio-thoracic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10 (Route 615), Nijmegen, 6525 GA, Netherlands
| | - Michel W A Verkroost
- Department of Cardio-thoracic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10 (Route 615), Nijmegen, 6525 GA, Netherlands.
| |
Collapse
|
2
|
Li K, Ni X, Lin D, Li J. Incorporation of PET Metabolic Parameters With Clinical Features Into a Predictive Model for Radiotherapy-Related Esophageal Fistula in Esophageal Squamous Cell Carcinoma. Front Oncol 2022; 12:812707. [PMID: 35296024 PMCID: PMC8918510 DOI: 10.3389/fonc.2022.812707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/24/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To determine whether the addition of metabolic parameters from fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans to clinical factors could improve risk prediction models for radiotherapy-related esophageal fistula (EF) in esophageal squamous cell carcinoma (ESCC). Methods and Materials Anonymized data from 185 ESCC patients (20 radiotherapy-related EF-positive cases) were collected, including pre-therapy PET/CT scans and EF status. In total, 29 clinical features and 15 metabolic parameters from PET/CT were included in the analysis, and a least absolute shrinkage and selection operator logistic regression model was used to construct a risk score (RS) system. The predictive capabilities of the models were compared using receiver operating characteristic (ROC) curves. Results In univariate analysis, metabolic tumor volume (MTV)_40% was a risk factor for radiotherapy (RT)-related EF, with an odds ratio (OR) of 1.036 [95% confidence interval (CI): 1.009–1.063, p = 0.007]. However, it was excluded from the predictive model using multivariate logistic regression. Predictive models were built based on the clinical features in the training cohort. The model included diabetes, tumor length and thickness, adjuvant chemotherapy, eosinophil count, and monocyte-to-lymphocyte ratio. The RS was defined as follows: 0.2832 − (7.1369 × diabetes) + (1.4304 × tumor length) + (2.1409 × tumor thickness) – [8.3967 × adjuvant chemotherapy (ACT)] − (28.7671 × eosinophils) + (8.2213 × MLR). The cutoff of RS was set at −1.415, with an area under the curve (AUC) of 0.977 (95% CI: 0.9536–1), a specificity of 0.929, and a sensitivity of 1. Analysis in the testing cohort showed a lower AUC of 0.795 (95% CI: 0.577–1), a specificity of 0.925, and a sensitivity of 0.714. Delong’s test for two correlated ROC curves showed no significant difference between the training and testing sets (p = 0.109). Conclusions MTV_40% was a risk factor for RT-related EF in univariate analysis and was screened out using multivariate logistic regression. A model with clinical features can predict RT-related EF.
Collapse
Affiliation(s)
- Kaixin Li
- Department of Radiation Oncology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - XiaoLei Ni
- Department of Radiation Oncology, The First Hospital of Longyan Affiliated to Fujian Medical University, Longyan, China
| | - Duanyu Lin
- Department of Nuclear Medicine, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jiancheng Li
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
- *Correspondence: Jiancheng Li,
| |
Collapse
|
3
|
Zhu X. COMPARISON OF HIGH-LEVEL ATHLETE TRAINING BETWEEN CHINESE AND AMERICAN UNIVERSITIES BASED ON THE INTERNET OF THINGS. REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-8692202127022021_0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT In order to improve the training quality of high-level athletes in Chinese and American universities, an athlete’s sports information transmission model is designed based on the Internet of Things (IoT). The communication protocol between Ayla module and the main motion control board, Ayla module and client APP or cloud platform, and APP and cloud platform in the system is designed in detail. For the Ayla module, the most important hardware part of the system, the internal composition and software design are described. In the mobile phone client part that is closely related to the user, the MVC architecture is adopted, the singleton and agent design patterns are utilized, and the functional design of each part is elaborated, including APP interface animation, data transmission format, network communication, and database storage. The research results show that the system of this study can handle most of the athlete training information, and the prediction accuracy exceeds the traditional algorithm. This research study is of great significance for improving the training efficiency of high-level athletes and further expanding the scope of application of the IoT.
Collapse
|
4
|
Li L, Lao YH. Massive Hemoptysis Caused by an Aortobronchial Fistula Related to Pedicle Screw Impingement. Vasc Endovascular Surg 2021; 55:761-765. [PMID: 33759646 DOI: 10.1177/15385744211005656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of a 50-year-old man with a 10-year history of pedicle screw internal fixation in the thoracic spine and heroin abuse, who presented with sudden-onset massive hemoptysis with hemorrhagic shock and asphyxia. Urgent contrast-enhanced chest computed tomography (CT) characteristically showed thoracic aortic perforation, a paravertebral pseudoaneurysm, and an intrapulmonary hematoma. Emergency percutaneous thoracic endovascular aortic repair (pTEVAR) with the preclose technique using a vascular closure device under local anesthesia achieved success without any complications. The current case highlights the importance of understanding massive hemoptysis caused by an aortobronchial fistula related to pedicle screw impingement in clinical practice and the value of pTEVAR with the preclose technique under local anesthesia in the emergency setting.
Collapse
Affiliation(s)
- Long Li
- Division of Interventional Radiology, Department of Medical Imaging, Guangdong Provincial Corps Hospital of Chinese People's Armed Police Forces, Guangzhou, China
| | - Yong-Hao Lao
- Division of Interventional Radiology, Department of Medical Imaging, Guangdong Provincial Corps Hospital of Chinese People's Armed Police Forces, Guangzhou, China
| |
Collapse
|
5
|
Survival and prognostic factors of patients with esophageal fistula in advanced esophageal squamous cell carcinoma. Biosci Rep 2021; 40:221747. [PMID: 31894852 PMCID: PMC6960064 DOI: 10.1042/bsr20193379] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 11/29/2022] Open
Abstract
The aim of the present study was to investigate the survival and prognostic factors of patients who were with advanced esophageal squamous cell carcinoma (ESCC) and developed an esophageal fistula. The data from 221 patients with advanced ESCC developed esophageal fistula from January 2008 to December 2017 at the Harbin Medical University Cancer Hospital was retrospectively analyzed. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by the Cox proportional hazard models. The median survival time after a diagnosis of the esophageal fistula was calculated using the Kaplan–Meier method. We found that the pathogens infected by patients are common bacteria in nosocomial infection. Besides, the incidence rate of esophagomediastinal fistula was the highest (54.2%) in the lower third of the esophagus. Kaplan–Meier analysis revealed a median survival time of 11.00 months and a median post-fistula survival time of 3.63 months in patients who developed esophageal fistula in advanced esophageal cancer. In the univariate analysis, gender, therapies for ESCC before the development of fistula, type of esophageal fistula, treatment of esophageal fistula and hemoglobin (Hb) level were the factors with significant prognostic value. Gender, type of esophageal fistula and Hb level were identified as independent prognostic factors in further multivariate analysis. In summary, our study demonstrated that several factors are significantly related to patients with esophageal fistula and should be concerned about in clinical practice.
Collapse
|
6
|
Panyko A, Dubovský M, Vician M. Extraabdominal Rupture of an Inflammatory Abdominal Aortic Aneurysm in a Patient With Aortodecubital Fistula: A Case Report. Ann Vasc Surg 2021; 73:542-544. [PMID: 33556524 DOI: 10.1016/j.avsg.2020.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
Aortodecubital fistula is a pathologic communication between aorta and a decubitus ulcer. It is very rarely encountered vascular condition in abdominal aortic aneurysms (AAA), with difficult diagnostics and high mortality. Patients often present with systemic and local infection and are at risk for hemorrhage. We present a paraplegic patient with fistulous communication between an inflamed abdominal aortic aneurysm and a sacral decubitus ulcer, leading to intermittent bleeding episodes and finally to exsanguination. While extremely rare, this case emphasizes the need for early, accurate diagnosis and salvage intervention when possible.
Collapse
Affiliation(s)
- Arpád Panyko
- 4th Department of Surgery, University Hospital Bratislava, Slovakia; Faculty of Medicine, Comenius University Bratislava, Slovakia.
| | - Martin Dubovský
- Faculty of Medicine, Comenius University Bratislava, Slovakia
| | - Marián Vician
- Faculty of Medicine, Comenius University Bratislava, Slovakia
| |
Collapse
|
7
|
Wu R, Geng L, Zhao Z, Liao D, He B, Hu H, Lin Y, Li M, Xiang M, Zhang Y, Feng G, Tan B, Du X. Clinical Application of Oral Meglumine Diatrizoate Esophagogram in Screening for Esophageal Fistula During Radiotherapy or Chemoradiotherapy for Esophageal Cancer. Front Oncol 2020; 10:562147. [PMID: 33123474 PMCID: PMC7566907 DOI: 10.3389/fonc.2020.562147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/20/2020] [Indexed: 12/24/2022] Open
Abstract
Background: This study aimed to investigate the specificity and sensitivity of oral meglumine diatrizoate esophagogram in screening for esophageal fistula during radiotherapy or chemoradiotherapy for esophageal cancer and determine if early detection and intervention could improve the prognosis of esophageal fistulas. Methods: Esophageal cancer patients undergoing radiotherapy or chemoradiotherapy were included. Weekly oral meglumine diatrizoate esophagograms were performed to screen for esophageal fistulas during radiotherapy. When an esophageal fistula was detected, fibroesophagoscopy and computed tomography (CT) were used for confirmation; once confirmed, radiotherapy was discontinued, and the patient received intervention. The esophagogram results were reviewed weekly to assess the recovery of the esophageal fistula. If the fistula was healed, the patient resumed and completed radiotherapy. Results: A total of 206 patients with cancer of the esophagus undergoing chemotherapy/radiotherapy were included. During radiotherapy, 10 cases of esophageal fistula were detected or suspected based on the oral meglumine diatrizoate esophagography findings, and eight of those cases were confirmed by CT and esophagoscopy. All patients with esophageal fistula received intervention; among them, 62.5% (5/8) recovered after 1 to 2 weeks of treatment and continued radiotherapy to completion. The sensitivity and specificity of oral meglumine diatrizoate esophagography in screening for esophageal fistulas during radiotherapy or chemoradiotherapy were 100 and 98.9%, respectively. The median survival period of patients with esophageal fistulas was 6.4 months. Conclusion: Oral meglumine diatrizoate esophagography has high sensitivity and specificity in screening for esophageal fistulas during radiotherapy or chemoradiotherapy with minimal side effects. Early diagnosis and timely intervention can significantly improve the prognosis and prolong the survival period of patients. Trial Registration: Chictr.org.cn, Identifier: ChiCTR-DDD-17012617. Registered on September 7, 2017. The first participant was enrolled on September 25, 2017. http://www.chictr.org.cn/showproj.aspx?proj=21526.
Collapse
Affiliation(s)
- Rong Wu
- Department of Oncology, Mianyang Central Hospital, Mianyang, China
| | - Lidan Geng
- Department of Oncology, Mianyang Central Hospital, Mianyang, China.,Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhenhua Zhao
- Department of Oncology, Mianyang Central Hospital, Mianyang, China
| | - Dongbiao Liao
- Department of Oncology, Mianyang Central Hospital, Mianyang, China
| | - Bin He
- Department of Oncology, Yan Ting County Cancer Hospital, Yanting County, China
| | - He Hu
- Department of Oncology, Yan Ting County Cancer Hospital, Yanting County, China
| | - Yanqun Lin
- Department of Oncology, Yan Ting County Cancer Hospital, Yanting County, China
| | - Musheng Li
- Department of Radiology, Mianyang Cancer Hospital, Mianyang, China
| | - Miao Xiang
- Department of Oncology, Mianyang Central Hospital, Mianyang, China
| | - Yu Zhang
- Department of Oncology, Mianyang Central Hospital, Mianyang, China
| | - Gang Feng
- Department of Oncology, Mianyang Central Hospital, Mianyang, China
| | - Bangxian Tan
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaobo Du
- Department of Oncology, Mianyang Central Hospital, Mianyang, China.,Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| |
Collapse
|
8
|
Abstract
Aortobronchial fistulas (ABFs) are rare but fatal if left untreated. Hemoptysis is the most common symptom of the patients. ABFs may occur after any thoracic aortic lesions or maneuveurs for these lesions. The treatment of ABF can be surgical or thoracic endovascular aortic repair. Thoracic endovascular aortic repair can be a safe and less invasive procedure for the treatment of ABFs. However, ABFs might occur in much shorter time after thoracic endovascular aortic repair than any other etiologies. The prognoses of patients with ABFs are poor with a high morbidity and mortality. The selection of a suitable endovascular graft and avoidance of postinterventional complications might effectively prevent the occurrence of ABFs.
Collapse
Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, 389 Longdejing Street, Chengxiang District, Putian, 351100, Fujian Province, People's Republic of China.
| |
Collapse
|
9
|
Maffeis V, Simmini S, Rossato M, Fioretto P, Fallo F, Basso C, Rizzo S. Sudden death with massive hemoptysis from aortobronchial fistula. Cardiovasc Pathol 2019; 44:107158. [PMID: 31760244 DOI: 10.1016/j.carpath.2019.107158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 11/19/2022] Open
Abstract
Aortobronchial fistula is an uncommon clinical entity, with unpredictable clinical course and significant mortality. Here, we describe a case of fistulous tract between a descending aortic graft and a branch of the left upper lobar bronchus leading to massive hemoptysis causing death for hemorrhagic shock in a 72-year-old man.
Collapse
Affiliation(s)
- Valeria Maffeis
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padova, Padova, Italy
| | - Stefano Simmini
- Clinica Medica 3, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Marco Rossato
- Clinica Medica 3, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Paola Fioretto
- Clinica Medica 3, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Francesco Fallo
- Clinica Medica 3, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
| |
Collapse
|
10
|
Benítez E, Alfonso M, Lesmes MC, Barón V, Hernández Ó, Oliveros G. Perforación aorto-esofágica, diagnóstico clínico e imaginológico: reporte de dos casos clínicos con manejo endovascular. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|
11
|
Gurien SD, Stright A, Garuthara M, Klein JDS, Rosca M. An iliac-appendiceal fistula causing gastrointestinal bleeding. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:107-109. [PMID: 31193446 PMCID: PMC6529689 DOI: 10.1016/j.jvscit.2018.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022]
Abstract
Aortoenteric fistulas are an uncommon cause of gastrointestinal bleeding, and iliac-appendiceal fistulas are an even rarer cause. We describe a case of an iliac-appendiceal fistula in a patient who presented several months after aortic reconstruction with gastrointestinal bleeding. An extensive workup revealed that the source of bleeding was localized to the appendiceal orifice. The patient underwent an appendectomy with a two-stage procedure involving the iliac graft for definitive repair and ultimately recovered well. Despite the rarity of aortoenteric and iliac-appendiceal fistulas causing gastrointestinal bleeding, keeping a high index of suspicion in patients with a prior vascular repair can prevent death.
Collapse
Affiliation(s)
- Steven D Gurien
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Adam Stright
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Melissa Garuthara
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Jonathan D S Klein
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Mihai Rosca
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| |
Collapse
|
12
|
Sumarsono A, Brown TJ, Atkin SD, Clark J. A 57-Year-Old Man With Subacute Progressive Hemoptysis and Fevers. Chest 2018; 154:e181-e185. [PMID: 30526987 DOI: 10.1016/j.chest.2018.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 06/25/2018] [Accepted: 07/24/2018] [Indexed: 10/27/2022] Open
Abstract
CASE PRESENTATION A 57-year-old man was admitted for 1 month of accelerating hemoptysis and hematemesis. Two weeks earlier, he first presented with fevers and hemoptysis of 2 weeks' duration and was diagnosed with community-acquired pneumonia treated with 5 days of ceftriaxone and azithromycin. He improved and was discharged, but his hemoptysis recurred 1 day after discharge and progressed over 9 days, leading to the present admission. He endorsed an 5-kg weight loss, daily fevers up to 39.4°C, and night sweats since discharge. His medical history was significant for peptic ulcer disease complicated by a perforated gastric ulcer 30 years ago, type 2 diabetes, and Barrett esophagus with recent normal upper endoscopy. The patient had coarctation of the aorta repaired 35 years ago. The patient takes aspirin, atorvastatin, and pantoprazole. He emigrated from Mexico 10 years before presentation and lives in Texas with his family. He returns to Mexico several times per year, most recently 2 days before admission. He works at a supermarket. He does not smoke, drink, or use illicit drugs. He denied sick contacts, pets, or incarceration.
Collapse
Affiliation(s)
- Andrew Sumarsono
- Department of Medicine, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Timothy J Brown
- Department of Medicine, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Stan D Atkin
- Department of Medicine, Oregon Health Sciences University, Portland, OR
| | - Jason Clark
- Department of Medicine, The University of Texas Southwestern Medical Center, Dallas, TX.
| |
Collapse
|