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Zhu Y, Xu W, Liu Z, Li B, Wu Y, Hua Z, Wang Y, Wang X, Du P, Yang H. Surface-enhanced Raman spectroscopy analysis reveals biochemical difference in urine of patients with perianal fistula. Asian J Surg 2024; 47:140-146. [PMID: 37308382 DOI: 10.1016/j.asjsur.2023.05.137] [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] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/26/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND & AIMS Perianal fistulising Crohn's disease (PFCD) is different from the characteristics and outcomes of traditional non-inflammatory bowel disease (IBD) anal fistulas. The presence of perianal disease was a poor prognostic indicator for Crohn's disease (CD) patients and PFCD patients were more likely to bear an increased risk of recurrence. However, the effective and accurate diagnosis methods to early distinguish PFCD from simple perianal fistula were still scarce. The purpose of this study is to develop a non-invasive detecting approach to predict CD in patients with perianal fistulas. METHODS Data on patients with anal fistulizing disease were collected from July 2020 to September 2020 in two IBD centers. Urine samples from PFCD and simple perianal fistula patients were investigated by surface-enhanced Raman spectroscopy (SERS). Principal component analysis (PCA)-support vector machine (SVM) was utilized to establish classification models to distinguish PFCD from simple perianal fistula. RESULTS After a case-matched 1:1 selection by age and gender, 110 patients were included in the study. By analyzing the average SERS spectra of PFCD and simple perianal fistula patients, it revealed that there were significant differences in intensities at 11 Raman peaks. The established PCA-SVM model distinguished PFCD from simple perianal fistula with a sensitivity of 71.43%, specificity 80.00% and accuracy 75.71% in the leave-one-patient-out cross-validation. The accuracy of the model in validation cohort was 77.5%. CONCLUSIONS Investigation of urine samples by SERS helps clinicians to predict Crohn's disease from perianal fistulas, which make patients achieve benefit from a more individualized treatment strategy.
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Affiliation(s)
- Yilian Zhu
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China
| | - Weimin Xu
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China
| | - Zhiyuan Liu
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, 200093, Shanghai, China
| | - Bingyan Li
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, 200093, Shanghai, China
| | - Yaling Wu
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Zhebin Hua
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China
| | - Yaosheng Wang
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China
| | - Xiaolei Wang
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Peng Du
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China.
| | - Huinan Yang
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, 200093, Shanghai, China.
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2
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Crigger CB, Harris TGW, Sholklapper TN, Haffar A, Morrill CC, Nasr IW, Yang R, Redett RJ, Gearhart JP. Mucosal Violations and Their Effect on Successful Bladder Neck Closure in Cloacal Exstrophy. J Pediatr Surg 2023; 58:2313-2318. [PMID: 37302866 DOI: 10.1016/j.jpedsurg.2023.05.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/14/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cloacal exstrophy (CE) is rare and challenging to reconstruct. In the majority of CE patients voided continence cannot be achieved and so patients often undergo bladder neck closure (BNC). Prior mucosal violations (MVs), a surgical event when the bladder mucosa was opened or closed, significantly predicted failed BNC in classic bladder exstrophy with an increased likelihood of failure after 3 or more MVs. The aim of this study was to assess predictors for failed BNC in CE. METHODS CE patients who underwent BNC were reviewed for risk factors for failure including osteotomy use, successful primary closure, and number of MVs. Chi-squared and Fisher's exact tests were used for comparing baseline characteristics and surgical details. RESULTS Thirty-five patients underwent BNC. Eleven patients (31.4%) failed BNC including a vesicoperineal fistula in nine, vesicourethral and vesicocutaneous fistula in one each. The fistula rate in patients with 2 or more MVs was 47.4% (p = 0.0252). Two patients subsequently developed a vesicocutaneous fistula after undergoing repeated cystolithotomies. A rectus abdominis or gracilis muscle flap were used to close the fistula in 11 and 2 patients, respectively. CONCLUSIONS MVs have a greater impact in CE with an increased risk of failed BNC after 2 MVs. CE patients are most likely to develop a vesicoperineal fistula while a vesicocutaneous fistula is more likely after repeat cystolithotomy. A prophylactic muscle flap should be considered at time of BNC in patients with 2 or more MVs. LEVELS OF EVIDENCE Prognosis Study, Level III.
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Affiliation(s)
- Chad B Crigger
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas G W Harris
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tamir N Sholklapper
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmad Haffar
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian C Morrill
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Isam W Nasr
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P Gearhart
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Köker İH, Yenidünya Ö, Savaş NA, Tosun ŞD, Davutoğlu C. Accidental late PEG dislodgment in 3 cases with a narrow stoma: Bougie dilatation rescue. ULUS TRAVMA ACIL CER 2023; 29:1382-1384. [PMID: 38073451 PMCID: PMC10767293 DOI: 10.14744/tjtes.2023.09130] [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] [Received: 04/07/2023] [Revised: 08/30/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023]
Abstract
Percutaneous Endoscopic Gastrostomy (PEG) is a simple and effective method of enteral nutrition in many patients who cannot take oral food. The accidental dislodgement of the PEG tube after the maturation of the gastro-cutaneous fistula (stoma) is called late dislodgement. If it is not detected early, the stoma lumen gets narrower; and does not permit the passage of the replacement tube. In this case, the commonly followed method is to continue enteral nutrition by opening a new gastro-cutaneous fistula after the complete closing of the original stoma. Here, we present a stoma-saving bougie dilatation method in 3 cases with severely narrowed stomas after late accidental dislodgement of the PEG tube.
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Affiliation(s)
- İbrahim Hakkı Köker
- Başkent University Medicine Faculty, Istanbul Hospital, Department of Gastroenterology, İstanbul-Türkiye
| | - Özlem Yenidünya
- Başkent University Medicine Faculty, Istanbul Hospital, Department of Anesthesiology, İstanbul-Türkiye
| | - Nurten Akyürek Savaş
- Başkent University Medicine Faculty, Istanbul Hospital, Department of Gastroenterology, İstanbul-Türkiye
| | | | - Can Davutoğlu
- Bezmialem Vakif University Medicine Faculty, Department of Gastroenterology, İstanbul-Türkiye
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Nolte S, Kneser U, Bigdeli AK, Aman M, Struebing F, Tisch M, Gazyakan E. [Interdisciplinary defect reconstruction of upper aerodigestive fistulas-case series and treatment algorithm]. HNO 2023; 71:795-801. [PMID: 37707515 DOI: 10.1007/s00106-023-01358-y] [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] [Accepted: 08/04/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Persistent complex defects and dysfunctions of the upper aerodigestive tract after tumor surgery represent a major challenge. The aim of this study was to evaluate the effectiveness of an interdisciplinary approach using the free anterolateral thigh flap (ALT) as a reconstruction option in the upper aerodigestive tract. MATERIALS AND METHODS The retrospective study identified 5 patients with complex defects after laryngectomy/pharyngolaryngectomy (LE/PLE) and multiple revision surgeries between 2017 and 2023. The operations were performed by an interdisciplinary team from otolaryngology, plastic surgery, and visceral/thoracic surgery. The results of the microsurgical reconstruction were analyzed. RESULTS There was an average of six previous operations. The defects included tracheoesophageal fistulas, pharyngocutaneous fistulas, neopharyngeal stenosis, and combinations thereof. Successful reconstruction was achieved in 100% of patients using the ALT flap. In 2 patients, ALT flow-through flaps were used with an additional free jejunal interposition (JI) and in 3 patients split-ALT flaps were used. The major complication rate was 40% and the minor complication rate was 20%. CONCLUSION Complex defects of the upper aerodigestive tract with multiple previous operations can be successfully reconstructed. Because of its versatility, the ALT flap seems to be a very good option. Prerequisite for this is an interdisciplinary treatment approach with a critical assessment of patient- and disease-specific factors.
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Affiliation(s)
- S Nolte
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Klinik für Hand und Plastische Chirurgie der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
- Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - U Kneser
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Klinik für Hand und Plastische Chirurgie der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - A K Bigdeli
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Klinik für Hand und Plastische Chirurgie der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - M Aman
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Klinik für Hand und Plastische Chirurgie der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - F Struebing
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Klinik für Hand und Plastische Chirurgie der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - M Tisch
- Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - E Gazyakan
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Klinik für Hand und Plastische Chirurgie der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland.
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Kim H, Lee DI, Moon SK, Park SJ, You MW. Typical MR features and interpretation of perianal fistulas in patients with Crohn's disease. Eur J Radiol 2023; 167:111046. [PMID: 37634442 DOI: 10.1016/j.ejrad.2023.111046] [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] [Received: 07/09/2023] [Revised: 08/05/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
Perianal fistulas in Crohn's disease (CD) are a poor prognostic phenotype requiring a combination of medical and surgical management. Perianal fistulas in CD are characterized by more complex and multi-branched fistulas, association with skin tags, and frequent presence of proctitis. A comprehensive approach with clinical examination, endoscopic and MR assessment is required, and in particular, MR interpretation provides detailed information on the type of fistula with its internal component and activity, secondary tracts and extension, internal, external openings, associated abscess, and presence of proctitis. Structured reporting of these items would be recommended for further discussion and management planning both at initial diagnosis and for disease monitoring during treatment follow-up. Management strategy would be individualized for each patient, and control of luminal disease activity could be an important determinant in the selection of treatment options. In this review, we provide an overview of the MRI evaluation of perianal fistulas in CD with a proposed structured MR report.
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Affiliation(s)
- Hyunmin Kim
- Department of Radiology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Da In Lee
- Department of Radiology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Sung Kyoung Moon
- Department of Radiology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Seong Jin Park
- Department of Radiology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Myung-Won You
- Department of Radiology, Kyung Hee University Hospital, Seoul, Republic of Korea.
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Nagano A, Harumatsu T, Sugita K, Iwamoto Y, Ogata M, Takada L, Nishida N, Kedoin C, Murakami M, Yano K, Onishi S, Yamada K, Yamada W, Kawano T, Muto M, Kaji T, Ieiri S. Change over time in the postoperative defecation function in female patients with anovestibular fistula at a single institution: focus on the comparison of anal transposition with anterior sagittal anorectoplasty. Pediatr Surg Int 2023; 39:266. [PMID: 37673850 DOI: 10.1007/s00383-023-05554-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Anovestibular fistula (AVF) is the most common type of ARM in female patients. The present study investigated changes over time in the postoperative defecation function of female patients with AVF. METHODS Patient data were collected from 1984 to 2021. Eighty-eight female patients with AVF were enrolled. Patients' characteristics and the long-term outcome of defecation function were reviewed and analyzed retrospectively. The bowel function was evaluated according to the Japan Society of ARM Study Group evacuation score (ES). RESULTS Thirty-eight patients underwent anal transposition (AT), and 8 underwent anterior sagittal anorectoplasty (ASARP). The total evacuation score (ES) in AVF patients reached "excellent" at nine years old, regardless of the operative procedure. The constipation scores with AT showed better improvement than those with ASARP, but soiling scores in the ASARP group showed better improvement than those in the AT group. The postoperative complications did not affect the postoperative bowel function in AVF patients. CONCLUSION Most patients with AVF eventually achieved a satisfactory total ES. Given the difference in defecation score transition depending on the operative procedure or postoperative complications, it may be important to perform long-term defecation management via surgical procedures.
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Affiliation(s)
- Ayaka Nagano
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Koshiro Sugita
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Yumiko Iwamoto
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Masato Ogata
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Lynne Takada
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Nanako Nishida
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Chihiro Kedoin
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan.
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Gendia A, Rehman M, Lin CW, Malik K, Khalil K, Ihedioha U, Kang P, Evans J, Ahmed J. Short- and mid-term outcomes of abdominoperineal resection with perineal mesh insertion: a single-centre experience. Int J Colorectal Dis 2023; 38:220. [PMID: 37606697 DOI: 10.1007/s00384-023-04507-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Abdominoperineal resection (APR) remains a key procedure for the treatment of low rectal/anorectal cancers. However, perineal wound closure remains challenging, particularly in extralevator abdominoperineal resection (ELAPR) due to gapped tissue planes. Different approaches have been attempted to improve perineal wound repair. The aim of this study is to report our 6-year experience in perineal wound closure utilising biological mesh. METHODS We conducted a retrospective study using data from our prospectively maintained database, including patients who underwent APR with perineal mesh closure between 2016 and 2021. RESULTS 49 patients underwent APR with perineal mesh reconstruction for low rectal cancer during the 6-year period. Of these, 63% were males, with a mean age of 68 (± 11), and a mean BMI of 27.9 (± 13.7). 49% (24) of patients received neoadjuvant therapy. 88% (43) of patients underwent standard "S-APR" and only 12% (6) underwent ELAPR. Majority of procedures were laparoscopic (87.8%) with conversion rate of 6.9%. Mean length of stay was 11.7 (± 11.6). The perineal wound infection rate was 30% and only two patient required mesh removal due to entero-cutaneous perineal fistula and pelvic abscess. Perineal hernia was found in only two patients (4.1%). CRM was negative in 81.6% of the patients. Mean follow-up period was 29.2 (± 16.5) months, and disease recurrence occurred in 9 (18.3%) patients with average number of months for recurrence of 21 (± 7). Overall survival during the follow-up period was 91%. CONCLUSION Our series shows a favourable short- and medium-term outcome with routine insertion of mesh for perineal wound closure.
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Affiliation(s)
- Ahmed Gendia
- Colorectal Department, Northampton University Hospital, Northampton, NN1 5BD, UK.
| | - Masood Rehman
- Colorectal Department, Northampton University Hospital, Northampton, NN1 5BD, UK
| | - Cindy W Lin
- Colorectal Department, Northampton University Hospital, Northampton, NN1 5BD, UK
| | - Kamran Malik
- Colorectal Department, Northampton University Hospital, Northampton, NN1 5BD, UK
| | - Khalil Khalil
- Colorectal Department, Northampton University Hospital, Northampton, NN1 5BD, UK
| | - Ugo Ihedioha
- Colorectal Department, Northampton University Hospital, Northampton, NN1 5BD, UK
| | - Peter Kang
- Colorectal Department, Northampton University Hospital, Northampton, NN1 5BD, UK
| | - John Evans
- Colorectal Department, Northampton University Hospital, Northampton, NN1 5BD, UK
| | - Jamil Ahmed
- Colorectal Department, Northampton University Hospital, Northampton, NN1 5BD, UK
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Vu JV, Kurowski JA, Achkar JP, Hull TL, Lipman J, Holubar SD, Steele SR, Lightner AL. Long-term Outcomes of Perianal Fistulas in Pediatric Crohn's Disease. Dis Colon Rectum 2023; 66:816-822. [PMID: 36856689 DOI: 10.1097/dcr.0000000000002690] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Approximately 30% of Crohn's disease-related perianal fistulas heal in the adult population with conventional medical and surgical interventions. This healing rate remains unknown in pediatric patients. OBJECTIVE This study aimed to determine the healing rate of pediatric perianal Crohn's fistulas and identify factors associated with healing. DESIGN Retrospective case series. SETTING A quaternary referral center. PATIENTS Patients aged <18 years with a Crohn's perianal fistula, seen between January 1, 1991, and August 1, 2021, were included in the study. INTERVENTIONS Multivariable logistic regression to identify factors independently associated with perianal fistula healing. MAIN OUTCOME MEASURES Healing of Crohn's perianal fistula at the date of last clinical encounter, defined as the clinical note reporting a healed fistula or normal perianal examination. RESULTS A total of 91 patients aged <18 years with a Crohn's disease-related perianal fistula were identified (59% female, 76% white). The mean (SD) age at Crohn's diagnosis was 12 (±4) years. The mean follow-up after Crohn's diagnosis was 10 (±7) years. Overall, 89% of patients had a perianal fistula, 2% had an anovaginal fistula, and 10% had an ileal pouch-associated fistula. Patients underwent a median (interquartile range) of 2 (1-5) operations. A seton was placed in 60% of patients, 47% underwent abscess drainage, and 44% underwent fistulotomy or fistulectomy. Fistula healing occurred in 71% of patients over a median of 1.3 (0.4-2.5) years. Seven patients (7%) underwent proctectomy, and 3 (3%) underwent ileal pouch excision. After multivariable adjustment, younger age at diagnosis of perianal fistula was associated with an increased likelihood of healing (OR 0.56 for each increased year; 95% CI, 0.34-0.92). LIMITATIONS Retrospective, single institution. CONCLUSIONS Over two-thirds of fistulas heal in pediatric Crohn's disease patients with conventional surgical and medical intervention. Younger age at fistula development is associated with an increased likelihood of healing. See Video Abstract at http://links.lww.com/DCR/C185 . RESULTADOS A LARGO PLAZO DE LAS FSTULAS PERIANALES EN LA ENFERMEDAD DE CROHN EN PACIENTES PEDITRICOS ANTECEDENTES:Aproximadamente el 30% de las fístulas perianales relacionadas con la enfermedad de Crohn se curan en la población adulta con intervenciones médicas y quirúrgicas convencionales. Esta tasa de curación sigue siendo desconocida en pacientes pediátricos.OBJETIVO:Determinar la tasa de curación de las fístulas de Crohn perianales en población pediátrica e identificar los factores asociados con la curación.DISEÑO:Serie de casos retrospectiva.ESCENARIO:Un centro de referencia cuaternario.PACIENTES:Pacientes menores de 18 años con fístula(s) perianal(es) por enfermedad de Crohn, atendidos entre el 1 de enero de 1991 y el 1 de agosto de 2021.INTERVENCIONES:Regresión logística multivariable para identificar factores asociados de forma independiente con la cicatrización de la fístula perianal.PRINCIPALES MEDIDAS DE RESULTADO:Curación de la fístula perianal de Crohn en la fecha del último encuentro clínico, definida como la nota clínica que informa una fístula curada o un examen perianal normal.RESULTADOS:Se identificó un total de 91 pacientes <18 años de edad con una fístula perianal relacionada con la enfermedad de Crohn (59% mujeres, 76% blancos). La edad media (DE) al diagnóstico de Crohn fue de 12 (±4) años. El seguimiento medio tras el diagnóstico de Crohn fue de 10 (±7) años. En general, el 89 % de los pacientes tenía fístula perianal, el 2 % tenía fístula anovaginal y el 10 % de los pacientes tenía fístula asociada a reservorio ileal. Los pacientes fueron sometidos a una mediana (RIC) de 2 (1-5) operaciones. En el 60% de los pacientes se colocó sedal, en el 47% se drenó el absceso y en el 44% se realizó fistulotomía o fistulectomía. La curación de la fístula se produjo en el 71% de los pacientes durante una mediana de 1,3 (0,4-2,5) años. Siete pacientes (7%) se sometieron a proctectomía y 3 (3%) se sometieron a escisión del reservorio ileal. Después del ajuste multivariable, la edad más joven en el momento del diagnóstico de la fístula perianal se asoció con una mayor probabilidad de curación (OR 0,56 por cada año de aumento, IC del 95%, 0,34-0,92).LIMITACIONES:Retrospectivo, institución única.CONCLUSIONES:Más de dos tercios de las fístulas se curan en pacientes pediátricos con enfermedad de Crohn con intervención médica y quirúrgica convencional. Una edad más joven en el momento del desarrollo de la fístula se asocia con una mayor probabilidad de curación. Consulte Video Resumen en http://links.lww.com/DCR/C185 . (Traducción--Dr. Felipe Bellolio ).
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Affiliation(s)
- Joceline V Vu
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jacob A Kurowski
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jean-Paul Achkar
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tracy L Hull
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jeremy Lipman
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Stefan D Holubar
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Scott R Steele
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Amy L Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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9
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Imaizumi M, Suzuki T, Murono S. Cone beam computed tomography with oral contrast for accurate diagnosis and surgical planning of pharyngeal leakage and fistula: a case series. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S50-S57. [PMID: 34716103 DOI: 10.1016/j.bjorl.2021.08.001] [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] [Received: 06/15/2021] [Revised: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Pharyngocutaneous fistula is one of the severe complications related to head and neck surgeries. Detecting the accurate three-dimensional location of both the fistula and leakage is essential for surgical treatment. Videofluoroscopy is usually used for locating these; however, its imaging is two-dimensional. We evaluated pharyngeal leakage and fistulae using Cone Beam Computed Tomography (CBCT), known for its three-dimensional high spatial resolution imaging, taken in a sitting position, with oral contrast (contrast CBCT). METHODS Pharyngeal leakage and fistulae were evaluated in a total of 31 subjects by sequentially performing videofluoroscopy and contrast CBCT. The detection accuracy of videofluoroscopy and contrast CBCT for leakage and fistula, as well as the ability to determine the extent and depth for surgical planning, were investigated and compared. RESULTS Videofluoroscopy and contrast CBCT showed suspicious leakage and/or fistula in six and three of the 31 subjects, respectively. Surgical findings revealed the presence of leakage and/or fistula in three of the 31 subjects. The positive predictive values of videofluoroscopy and contrast CBCT were 50% (3/6) and 100% (3/3), respectively. Contrast CBCT provided more precise images, showing the extent and depth of leakage and fistula in three-dimensions. CONCLUSION The present study's results indicate the usefulness of contrast CBCT in terms of accurate diagnosis of leakage and fistula, due to its three-dimensional imaging being performed with the patient in a sitting position. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Mitsuyoshi Imaizumi
- Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan.
| | - Toshihiko Suzuki
- Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan
| | - Shigeyuki Murono
- Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan
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10
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Dalby HR, Perregaard H, Dige A, Hagen KB, Nordholm-Carstensen A, Lundby L. [Treatment of perianal fistulas with mesenchymal stem cells]. Ugeskr Laeger 2022; 184:V05210392. [PMID: 35410650] [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: 06/14/2023]
Abstract
Treatment of perianal fistulas are challenged by insufficient healing and a high rate of relapse. Existing sphincter-sparing procedures have healing rates of around 50%. Treatment with mesenchymal stem cells of both autologous and allogenic origin and freshly collected autologous adipose tissue show both promising healing rates and few complications and may be offered to patients with complicated fistulas not suited for other treatment modalities.
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Affiliation(s)
| | - Helene Perregaard
- Kirurgisk Afdeling, Københavns Universitetshospital - Nordsjællands Hospital
| | - Anders Dige
- Lever-, Mave- og Tarmsygdomme, Aarhus Universitetshospital
| | | | | | - Lilli Lundby
- Mave- og Tarmkirurgi, Aarhus Universitetshospital
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11
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Fuschillo G, Pellino G. Chronic Perineal Sinus After Proctectomy for Crohn's Disease: Risk Reduction Strategies and Management. Dis Colon Rectum 2022; 65:468-471. [PMID: 35067504 DOI: 10.1097/dcr.0000000000002413] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Giacomo Fuschillo
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli," Naples, Italy
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12
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Chandrasekharam VVS, Babu R. Letter to the Editor concerning "Postoperative outcomes in distal hypospadias: a meta-analysis of Mathieu and tubularised incised plate repair methods for the development of urethro cutaneous fistula and urethral stricture". Pediatr Surg Int 2022; 38:651. [PMID: 35174402 DOI: 10.1007/s00383-022-05082-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Accepted: 02/06/2022] [Indexed: 10/19/2022]
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13
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Holubar SD. Expert Commentary on Chronic Perineal Sinus After Proctectomy for Crohn's Disease: Risk Reduction Strategies and Management. Dis Colon Rectum 2022; 65:472. [PMID: 35030556 DOI: 10.1097/dcr.0000000000002414] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Stefan D Holubar
- Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, Ohio
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14
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Alser O, Gallastegi AD, Christensen MA, Mashbari H, Saillant N, Parks J, Mendoza A, Fagenholz P, King D, Hwabejire J, Kaafarani HMA, Velmahos GC, Fawley JA. Modified Frailty Index-5 Score and Post-Operative Infectious Complications in Patients Undergoing Surgery for Intestinal- Cutaneous Fistula: A Nationwide Retrospective Cohort Analysis. Surg Infect (Larchmt) 2021; 22:903-909. [PMID: 33926272 DOI: 10.1089/sur.2020.441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Post-operative infectious complications after repair of intestinal-cutaneous fistulas (ICF) represent a substantial burden and these outcomes vary widely in the literature. We aimed to evaluate the use of the modified frailty index-5 (mFI-5) to account for physiologic reserve to predict infectious complications in patients with ICF undergoing operative repair. Methods: We used the American College of Surgeon National Surgical Quality Improvement Program (ACS-NSQIP) 2006-2017 dataset to include patients who underwent ICF repair. The main outcome measure was 30-day infectious complications (surgical site infection [SSI], sepsis, pneumonia, and urinary tract infection [UTI]). The risk of 30-day post-operative infectious complications was assessed based on mFI-5 score. We performed multivariable logistic regression analyses to evaluate the association between infectious complications and mFI-5. Results: We identified 4,197 patients who underwent an ICF repair. The median age (interquartile range [IQR]) was 57 (46, 67) years, and the majority of patients were female (2,260; 53.9%); white (3,348; 79.8%); and 1,586 (38.3%) were obese. After adjustment for relevant confounders such as baseline patient characteristics, and operative details, mFI-5 was independently associated with infectious complications (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.25-3.21), particularly SSI (OR, 2.16; 95% CI, 1.28-3.63) and pneumonia (OR, 5.31; 95% CI, 2.29-12.35), but not UTI or sepsis. Conclusions: We showed that the mFI-5 is a strong predictor of infectious complications after ICF repair. It can be utilized to account for physiologic reserve, therefore reducing the variability of outcomes reported for ICF repair.
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Affiliation(s)
- Osaid Alser
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ander Dorken Gallastegi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mathias A Christensen
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hassan Mashbari
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Parks
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - April Mendoza
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Fagenholz
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David King
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John Hwabejire
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason A Fawley
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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15
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Sievert M, Goncalves M, Binder B, Mueller SK, Rupp R, Koch M, Dürr S, Traxdorf M, Hecht M, Iro H, Gostian AO. [Salvage laryngectomy after primary radio- and radiochemotherapy : A retrospective study. German version]. HNO 2021; 70:44-50. [PMID: 33837444 PMCID: PMC8760217 DOI: 10.1007/s00106-021-01029-w] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Abstract
Hintergrund Das rezidivierende und residuelle Larynxkarzinom nach organerhaltender Radio- bzw. Radiochemotherapie ist mit einer schlechten Prognose verbunden. Die Salvage-Operation stellt in diesen Fällen die wichtigste therapeutische Option dar. Ziel der Arbeit Erfasst wurden die Rate an Rezidiv- und Residualtumoren sowie die Überlebensraten und die Komplikationsrate nach Salvage-Chirurgie des Kehlkopfs an dem akademischen Tumorzentrum der Autor(inn)en. Material und Methoden Retrospektiv wurden alle Patienten untersucht, bei denen zwischen 2001 und 2019 eine Salvage-Operation aufgrund eines Tumorresiduums oder Rezidivs nach primärer nichtchirurgischer Therapie erfolgt war. Ergebnisse Es wurden 33 Salvage-Operationen durchgeführt. Die Defektrekonstruktion erfolgte in 30,3 % der Fälle (n = 10) mittels freier und in 15,2 % (n = 5) mittels regionaler Lappenplastik. Ein Patient hat sowohl eine freie als auch gleichzeitig eine gestielte Lappenplastik erhalten. Das Gesamtüberleben nach einem, 2 und 5 Jahren betrug 68,7 %; 47,9 % bzw. 24,2 %, das krankheitsfreie Überleben 81,6 %; 47,8 % bzw. 24,2 % bei insgesamt 48,5 % (n = 16) postoperativen Tumorrezidiven. Das krankheitsfreie Überleben war signifikant kürzer bei Tumorausdehnung im bzw. auf den Hypopharynx (p = 0,041). Postoperativ entwickelten 72,7 % der Patienten eine pharyngokutane Fistel unabhängig von einer simultanen Defektrekonstruktion. Nur 24 % der der aufgetretenen Fisteln mussten operativ therapiert werden. Der Krankenhausaufenthalt betrug 28,0 ± 16,1 Tage. Schlussfolgerung Die Salvage-Laryngektomie ist mit vielen, aber beherrschbaren Komplikationen und einer hohen Morbidität verbunden. In Anbetracht der behandelten fortgeschrittenen Tumorkategorien und der Gesamtsituation des Patienten sind respektable onkologische Ergebnisse zu erreichen. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00106-021-01029-w) enthält eine Übersicht über die Patientenkohorte. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
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Affiliation(s)
- Matti Sievert
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 1, 91054, Erlangen, Deutschland.
| | - Miguel Goncalves
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Benedicta Binder
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Sarina K Mueller
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Robin Rupp
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Michael Koch
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Stephan Dürr
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Maximilian Traxdorf
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Markus Hecht
- Strahlenklinik, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Heinrich Iro
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Antoniu-Oreste Gostian
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 1, 91054, Erlangen, Deutschland
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Milinis K, Gaskell P, Lau A, Lancaster J, Jones T. Early versus late oral feeding following total (pharyngo)laryngectomy: Systematic review and meta-analysis. Head Neck 2021; 43:1359-1368. [PMID: 33543554 DOI: 10.1002/hed.26616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/23/2020] [Revised: 11/24/2020] [Accepted: 01/14/2021] [Indexed: 11/07/2022] Open
Abstract
Timing of oral feeding following total laryngectomy is a contentious issue with highly varied practices. Multiple database search was performed to identify studies comparing outcomes of early (≤5 days) versus late (>5 days) oral feeding. Bias assessment was carried out using Cochrane bias tool. Random-effects meta-analysis was used. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The rate of pharyngocutaneous fistula (PCF) in randomized control trials (RCTs) in early versus late feeding was 15.2% versus 11.7% (RR 1.35, 95%CI [0.68-2.7], p = 0.40). The rate of PCF in the cohort studies was 14.1% versus 20.5% (RR 1.0, 95%CI [0.76-1.3], p = 0.98). The length of hospital stay was significantly shorter in the early feeding group (mean difference (days) -4.68 (-6.2 to -3.1, p < 0.0001). Early oral feeding appears to be safe and is associated with shorter hospital stay. However, the quality of evidence is low and the patient characteristics are not representative of current practices.
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Affiliation(s)
- Kristijonas Milinis
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Peter Gaskell
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Andrew Lau
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Jeffrey Lancaster
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Terry Jones
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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Akgul OL, Dalbasi E. Reliable treatment of perianal fistulas using laser ablation. Results in 67 patients. Ann Ital Chir 2021; 92:390-396. [PMID: 34982733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKROUND We aim to show that fistula ablation with laser (FAL) is a reliable method to repair a perianal fistula, and we share the results of a 24-month follow-up on FAL treatments of different perianal fistula types. STUDY DESIGN The FAL procedure was performed using a ceramic diode laser platform (30-50 J/cm of energy at a wavelength of 1470 nm). All operations were performed under spinal anesthesia in the jackknife position. RESULTS Of the 67 patients, 48 (71.6%) were male and 19 (28.4%) were female. Of these, 40 (59.7%) had intersphincteric fistulas, 21 (31.3%) had transsphincteric fistulas, 3 (4.47%) had suprasphincteric fistulas, and 3 (4.47%) had extrasphincteric fistulas. Based on perianal fistula disease severity scores, 40 patients (59.70%) experienced complete healing, 10 (14.92%) had persistent symptomatic drainage, 14 (20.89%) had slight drainage with minimal symptoms, and 3 (4.47%) had painful, symptomatic drainage. No major complications were observed in any patient. CONCLUSIONS The FAL is a minimally invasive initiative with the lowest morbidity and highest curative recovery rate, especially for simple fistulas. KEY WORDS Anal fistula, Fistula ablation with laser, Reliable surgery.
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Unal VM, Ozdemir N, Karadag A, Oguzoglu S, Celik H. Primary Sacral Hydatid Cyst Causing Cutaneous Fistula. J Coll Physicians Surg Pak 2017; 27:311-312. [PMID: 28599696] [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] [Received: 06/09/2016] [Accepted: 01/24/2017] [Indexed: 06/07/2023]
Abstract
Echinococcus granulosus and Echinococcus multilocularis are the causes of hydatid disease and the main characteristic is endemic. Generally, it affects the liver and lungs. Spinal hydatidosis accounts for less than 1% of the cases. Vertebral hydatidosis is usually silent and a slowly progressive disease with a long latent period. Another rare form is the primary sacral hydatid cyst. Generally, patients suffer from back pain and neural compression symptoms. A 43-year woman was admitted with left leg pain and a fluid leakage from a cutaneous fistula on the left hip. It was diagnosed on MRI as a bilateral cystic lesion which eroded the first sacral wing, extending to the paravertebral region and left intervertebral for a men. We present a case with fluid leakage from cutaneous fistula.
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Affiliation(s)
- Volkan Murat Unal
- Department of Neurosurgery, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Nail Ozdemir
- Department of Neurosurgery, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Ali Karadag
- Department of Neurosurgery, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Serdar Oguzoglu
- Department of Neurosurgery, Government Hospital of Malatya, Malatya, Turkey
| | - Haydar Celik
- Department of Neurosurgery, Ankara Research and Training Hospital, Ankara, Turkey
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Shen H, Zhao EM, Xiao SF, Qin Y, Jing ZB, Li TC. [Treatments of oropharyngeal anterior wall cancer by transhyoid surgery radiotherapy]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013; 48:573-577. [PMID: 24313207] [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: 06/02/2023]
Abstract
OBJECTIVE To evaluate the transhyoid resection of oropharyngeal anterior wall cancer and oncological outcomes of the surgery combined with radiotherapy. METHODS A total of 24 cases with carcinoma located in the anterior wall of oropharynx was reviewed. The TNM stages were as follows: T2 in 7 cases, T3 in 2 cases, T4 in 15 cases; NO in 7 cases, N1 in 4 cases, N2 in 12 cases and N3 in 1 case. Tumor resection was performed via transhyoid approach, including 9 cases with partial glossectomy + partial laryngectomy, 7 cases with partial glossectomy + total laryngectomy, 7 cases with total glossectomy + partial laryngectomy and 1 case with partial glossectomy alone pectoralis major myocutaneous flaps were applied to repair synchronously the defects of tongue and lateral pharyngeal wall in 16 cases and the defect of cervical skin in 1 case. Radial forearm free flap and sternohyoid myocutaneous flap were used to repair the defect of tongue and lateral and posterior pharyngeal wall in 1 case. Sternohyoid myocutaneous flap was applied to reconstruct the tongue base in 2 cases. Bilateral and unilateral neck dissections were performed in 20 cases and 4 cases respectively. Five cases received preoperative radiotherapy and 16 cases received postoperative radiotherapy. RESULTS All cases had negative surgical margin. Pathological examination showed neck lymph metastasis in 17 cases (70.8%). Three patients had postoperative pharyngocutaneous fistula. Two of them who underwent partial glossectomy + total laryngectomy and pectoralis major myocutaneous flaps synchronously reconstruction suffered from pharyngocutaneous fistula 4 days after operation. The fistula was closed by re-suturation following debridement and 2 weeks dressing change. The other one who underwent partial glossectomy + partial laryngectomy suffered from pharyngocutaneous fistula during postoperation radiotherapy and healed by the pectoralis major myocutaneous repair. Tracheostomy tubes were removed within 1-6 months, with good voice and swallowing functions, in 16 of 17 cases who underwent partial laryngectomy. Another one failed to pull out tracheotomy tube because of dyspnea. Twenty one cases were followed up over 3 years and Kaplan-Meier survival analysis showed the 3-year overall survival rate was 72.6%. CONCLUSIONS The transhyoid tumor resection is an effective surgical approach for oropharyngeal anterior wall cancer. The defect following tumor resection is commonly need repair synchronously with various flaps. Acceptable outcome could be received by surgery combined with radiotherapy.
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Affiliation(s)
- Hong Shen
- Department of Otorhinolaryngology Head and Neck Surgery, Peking University First Hospital, Beijing 100034, China
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Li Destri G, Cocuzza A, Cavallaro M. Late cutaneous fistula after inguinal hernia repair without prosthesis. Acta Chir Belg 2010; 110:609-610. [PMID: 21337843] [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: 05/30/2023]
Abstract
Late onset of cutaneous fistulas associated with inguinal hernia repair represents an extremely rare complication that occurs especially after affixing a prosthesis. The authors report a case of a patient developing this complication after a hernia repair (Shouldice's technique), emphasize that the fistula appeared after more than 12 years (the longest interval reported in the literature), and explain how it resolved only with the surgical removal of the suture used for hernia repair. The authors emphasize the aetiology of this complication and stress that it can occur even after a hernia repair without prosthesis.
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Affiliation(s)
- G Li Destri
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Catania, Italy.
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Affiliation(s)
- L Lujber
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Pécs University Medical School, Pécs, Hungary
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Hu ZH, Shen M, Sun L, Qiao R, Jia FM, Yang SY. [Gastric fistulation with transcutaneous endoscopy in a child]. Zhonghua Er Ke Za Zhi 2004; 42:222-3. [PMID: 15144722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Tedeschi A, Di Mezza G, D'Amico O, Ermann A, Montone L, Siciliano M, Cobellis G. A case of pelvic actinomycosis presenting as cutaneous fistula. Eur J Obstet Gynecol Reprod Biol 2003; 108:103-5. [PMID: 12694981 DOI: 10.1016/s0301-2115(02)00361-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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
Actinomycosis of the female genital tract has greatly increased over the last two decades. A pelvic form of the disease, associated with the use of Intra-uterine Devices (IUD), can severely damage pelvic organs and even can lead to death. We report a case of pelvic actinomycosis presenting as cutaneous fistula.
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Affiliation(s)
- Amando Tedeschi
- II University of Naples, Department of Gynecology and Obstetrics, SMDP Incurabili, A.S.L. 1, Via M. Longo, 38, Naples 80132, Italy.
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Abstract
Crohn's disease often involves the stomach, yet a permanent enterocutaneous fistula does not usually occur, after a percutaneous endoscopic gastrostomy is removed from a patient with Crohn's disease. This is because the factors that are related to the non-closure of a fistula are absent or have been treated (distal bowel obstruction, abdominal sepsis, undernutrition, poor gastric blood supply or abnormal serum levels of C-reactive protein and albumin). Gastric involvement in patients with Crohn's disease is common. Enterocutaneous fistulas from the stomach are rare. Percutaneous endoscopic gastrostomy (PEG) insertion and subsequent removal rarely cause problems in patients with Crohn's disease. Endoscopic removal of a PEG is advised in patients with Crohn's disease. Steroids may delay gastric adhesion to the anterior abdominal wall.
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Affiliation(s)
- J Nightingale
- General Medicine and Gastroenterology, Leicester Royal Infirmary, UK
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Abstract
An enterocutaneous malignant fistula developed in a patient who had a retroperitoneal angiosarcoma. He was treated with octreotide acetate subcutaneously. Drainage decreased and ceased after 2 weeks of therapy. The closure of this malignant fistula suggests that palliative therapy with octreotide acetate merits further study in view of the grave prognosis of this complication.
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Affiliation(s)
- S Ayache
- Department of Veterans Affairs Medical Center, Washington, DC, USA
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Bültmann O, Philipp C, Ladeburg M, Berlien HP. Creation of a caecostoma in mice as a model of an entero cutaneous fistula. Res Exp Med (Berl) 1998; 198:215-28. [PMID: 9879600 DOI: 10.1007/s004330050105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the past, physiological, oncological and pharmaceutical investigations led to the development of different models of enterocutaneous fistulas. For a few years, fistula models were also created to investigate the efficacy of minimal invasive therapies in closing these fistulas. As most experimental surgical procedures are difficult to perform and are often combined with a high mortality or spontaneous closure rate, a new model in mice was developed with the aim of avoiding these disadvantages. Twenty mice, divided into two groups of 10 animals each, had a caecostoma created surgically. The two groups differed regarding the technique of creating the stoma. All animals survived and gained weight during a postoperative period of 4 months. The operation was easy to perform and lasted no longer than about 30 min. Neither a spontaneous closure of the fistula nor any prior death of animals occurred. In conclusion, because of its simplicity and low complication rate, the presented model of an enterocutaneous fistula may offer an interesting alternative to other models for a variety of indications.
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Affiliation(s)
- O Bültmann
- Hospital Neukölln, Department of Laser Medicine, Berlin, Germany
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Amano K, Matsumoto T, Iida M, Kimoto M. Beclomethasone through artificial ceco cutaneous fistula for ulcerative colitis: a case report. J Clin Gastroenterol 1997; 25:556-7. [PMID: 9412979 DOI: 10.1097/00004836-199710000-00018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- K Amano
- Division of Gastroenterology, Kawasaki Medical School, Okayama, Japan
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31
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Kobayashi M. [Entero cutaneous fistula]. Nihon Rinsho 1994; Suppl 6:551-2. [PMID: 7837559] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M Kobayashi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University
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GRABSTALD H, VAUGHT RL. URINARY-BRONCHOCUTANEOUS FISTULA WITH SECONDARY AMYLOIDOSIS. A COMPLICATION OF ATTEMPTED NEPHRECTOMY. N Y State J Med 1965; 65:1031-6. [PMID: 14269702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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TREMOLIERES J. [MEDICAL TREATMENT OF EXTERNAL DIGESTIVE FISTULA]. Rev Prat 1965; 15:665-77. [PMID: 14306403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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CALVO FF. [SPONTANEOUS EXTERNAL BILIARY FISTULA]. Rev Esp Enferm Apar Dig Nutr 1965; 24:64-8. [PMID: 14271526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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TREMOLIERES J, LAMBERT J. [MEDICAL TREATMENT OF EXTERNAL DIGESTIVE FISTULAS]. Rein Foie 1965; 7:75-91. [PMID: 14337651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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PAPILLON-LEAGE E, MUGNIER A. [CUTANEOUS FISTULAE OF THE LOWER PART OF THE FACE IN CHILDREN. THEIR DENTAL ETIOLOGY]. Ann Pediatr (Paris) 1964; 11:582-91. [PMID: 14226013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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MAJEWSKI J. [SPONTANEOUS URETERO- CUTANEOUS FISTULA FOLLOWING PYONEPHROSIS]. Pol Tyg Lek 1964; 19:1653-4. [PMID: 14317113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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ZARAPICO M. [EXTERNAL BILIARY FISTULA]. Med Esp 1964; 52:265-85. [PMID: 14257083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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RIBET M, GAUTIER C, HASSOUN A. [LOCAL PERFUSION OF LACTIC ACID IN TREATMENT OF EXTERNAL DIGESTIVE FISTULAS]. Lille Chir 1964; 19:215-21. [PMID: 14228671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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POPOV SD, GURIN NN. [ON THE TREATMENT OF EXTERNAL BILIO-BRONCHIAL FISTULAE]. Vestn Khir Im I I Grek 1964; 92:76-7. [PMID: 14230519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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BERET MJ. [EXTERNAL FISTULAS OF THE SMALL INTESTINE]. Rev Sanid Milit Argent 1964; 63:141-4. [PMID: 14339206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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IZAWA K. [FENESTRATION OF THE INTRAMURAL WALL OF THE FRONTAL SINUS IN SURGERY OF THE EXTERNAL FRONTAL SINUS]. Jibiinkoka 1964; 36:339-42. [PMID: 14149322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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GAGNON R, BEIQUE L, DUTRON G. [EXTERNAL BILIARY FISTULAS]. Union Med Can 1964; 93:276-81. [PMID: 14142338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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VELASQUEZ V, VANTMAN A. [URO- CUTANEOUS FISTULAS]. Rev Chil Obstet Ginecol 1964; 29:21-3. [PMID: 14250298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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TOPCHIASHVILI ZA. [EXTERNAL BILIARY FISTULA AS AN EARLY COMPLICATION OF CHOLECYSTECTOMY]. Khirurgiia (Mosk) 1963; 39:18-23. [PMID: 14150057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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MERKUSHEVA IS. [ERRORS IN THE DIAGNOSIS OF BRONCHO- CUTANEOUS FISTULA]. Vestn Khir Im I I Grek 1963; 91:134. [PMID: 14133177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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BREGADZE IL, IVANOV NA. [SURGICAL TREATMENT OF THE EXTERNAL BILIARY FISTULA]. Vestn Khir Im I I Grek 1963; 91:18-22. [PMID: 14133178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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SACINO G. [CLINICAL STUDY OF THE THERAPEUTIC ACTION OF RIFAMYCIN SV IN THE LOCAL TREATMENT OF POST-OPERATIVE CUTANEOUS FISTULA]. Gazz Int Med Chir 1963; 67:1894-911. [PMID: 14088389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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