Sample records for bronchial fistula

  1. Successful Treatment of Bronchial Fistula after Pulmonary Lobectomy by Endobronchial Embolization Using an Endobronchial Watanabe Spigot

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    Yuichiro Machida


    Full Text Available A bronchial fistula is one of the most serious complications that can occur following pulmonary lobectomy. We herein report a case of bronchial fistula that was successfully treated by endobronchial embolization using an Endobronchial Watanabe Spigot (EWS. A 72-year-old male underwent right lower lobectomy of the lung with nodal dissection for a pulmonary squamous cell carcinoma. A bronchial fistula developed 53 days after surgery. Tube drainage was performed, and air leakage was apparent. Under endoscopic observation, intrathoracic injection of indigo carmine revealed that a fistula existed at the peripheral site of the B2ai bronchus. After one EWS (small was inserted into the B2a bronchus tightly using a bronchoscope, the air leakage was stopped. Pleurodesis was further carried out, the thoracostomy tube was subsequently removed, and the patient was discharged. Endobronchial embolization using an EWS is an option for the treatment of a bronchial fistula after pulmonary resection.

  2. Duodenal-bronchial fistula: an unusual cause of shortness of breath and a productive cough

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    Cynthia Wong, BMBS


    Full Text Available Duodenal-bronchial fistulas are very uncommon, even among the already rare subgroup of abdominal-bronchial fistulas. We describe a case of a woman with Crohn's disease who presented with shortness of breath and a productive cough who was found to have a duodeanl bronchial fistula on computed tomography scan. We demonstrate with this case how these rare cases can lead to chronic lung aspirations and require multidisciplinary involvement.

  3. [Endovascular managemente of an aorto-bronchial fistula secondary to a thoracic aortic aneurysm]. (United States)

    Vieira, Mário; Dias, Pedro Paz; Rocha E Silva, Augusto; Sampaio, Sérgio; De Albuquerque, R


    Presentation of a case of endovascular repair of aorto-bronchial fistula secondary to thoracic aortic aneurysm. 67 years old male patient, former smoker, with a history of arterial hypertension, dyslipidemia, coronary artery disease, chronic renal insufficiency and carotid endarterectomy, followed in outpatient department with recent diagnosis of descending TAA. The patient presented to the emergency department due to 2 episodes of cough and self-limited abundant hemoptysis. The thoracic angio-CT revealed a rupture of the aneurysm, with 77mm, to the lung parenchyma with aorto-bronchial fistula to the left main bronchus. Patient was submitted to endovascular repair using a Valiant Thoracic endoprosthesis by Medtronic®, via right femoral approach. The procedure went without complications. There was no paraplegia or acute arterial lesion. Postoperatively, there were registed two episodes of self-limited hemoptysis and developed cough that progressively reversed after 2 months. The patient held antibiotic prophylaxis during hospitalization and for 2 months after discharge. 12 months after procedure, no complications were observed and patient remains asymptomatic. The advance of endovascular approach in the treatment of complicated AAT brought a new therapeutic solution, giving a reduction in morbidity and mortality (± 3%), particularly for control of active aorto-bronchial fistula. As regards to success rate and long-term antibiotic prophylaxis, present studies are inconclusive. Concerned to infection risk and fistula recurrence (± 10%), long-term antibiotic administration was the chosen treatment.


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    E. A. Tseymakh


    Full Text Available Formation of bronchopleural fistulas after surgical reduction of pulmonary volume is one of the most frequent complications of surgical treatment of pulmonary emphysema. In order to control bronchopleural fistulas in the patients after surgical reduction of pulmonary volume the technique of valve bronchial block has been o}ered. This technique has been applied in 7 patients, and the favorable outcomes have been achieved in 6 (85.7% patients. The use of endobronchial valve for occlusion of fistulous bronchi allowed stopping air leaking through drainages, reducing time for pleural cavity drain and decreasing duration of patients' hospital stay.

  5. Coronary to Bronchial Artery Fistula Causing Massive Hemoptysis in Patients with Longstanding Pulmonary Tuberculosis

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    Yoon, Ji Young; Jeon, Eui Yong; Lee, In Jae; Koh, Sung Hye [Hallym University College of Medicine, Anyang (Korea, Republic of)


    We report on three cases of longstanding pulmonary tuberculosis patients with coronary to bronchial artery fistula (CBF) who presented with recurrent massive hemoptysis. The first and second patients died because of decreased functional pulmonary volume plus massive hemoptysis and cannulation failure of CBF due to hypovolemic vasospasm, respectively. When recurrent hemoptysis occurs despite successful embolization treatment, CBF should be considered as a potential bleeding source. Moreover, a coronary angiography should be performed, especially in patients with longstanding cardiopulmonary disease such as pulmonary tuberculosis.

  6. Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report.

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    Martin-Smith, James D


    BACKGROUND: The development of a fistula between the tracheobronchial tree and the gastric conduit post esophagectomy is a rare and often fatal complication. CASE PRESENTATION: A 68 year old man underwent radical esophagectomy for esophageal adenocarcinoma. On postoperative day 14 the nasogastric drainage bag dramatically filled with air, without deterioration in respiratory function or progressive sepsis. A fiberoptic bronchoscopy was performed which demonstrated a gastro-bronchial fistula in the posterior aspect of the left main bronchus. He was managed conservatively with antibiotics, enteral nutrition via jejunostomy, and non-invasive respiratory support. A follow- up bronchoscopy 60 days after the diagnostic bronchoscopy, confirmed spontaneous closure of the fistula CONCLUSIONS: This is the first such case where a conservative approach with no surgery or endoprosthesis resulted in a successful outcome, with fistula closure confirmed at subsequent bronchoscopy. Our experience would suggest that in very carefully selected cases where bronchopulmonary contamination from the fistula is minimal or absent, there is no associated inflammation of the tracheobronchial tree and the patient is stable from a respiratory point of view without evidence of sepsis, there may be a role for a trial of conservative management.

  7. Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report

    LENUS (Irish Health Repository)

    Martin-Smith, James D


    Abstract Background The development of a fistula between the tracheobronchial tree and the gastric conduit post esophagectomy is a rare and often fatal complication. Case presentation A 68 year old man underwent radical esophagectomy for esophageal adenocarcinoma. On postoperative day 14 the nasogastric drainage bag dramatically filled with air, without deterioration in respiratory function or progressive sepsis. A fiberoptic bronchoscopy was performed which demonstrated a gastro-bronchial fistula in the posterior aspect of the left main bronchus. He was managed conservatively with antibiotics, enteral nutrition via jejunostomy, and non-invasive respiratory support. A follow- up bronchoscopy 60 days after the diagnostic bronchoscopy, confirmed spontaneous closure of the fistula Conclusions This is the first such case where a conservative approach with no surgery or endoprosthesis resulted in a successful outcome, with fistula closure confirmed at subsequent bronchoscopy. Our experience would suggest that in very carefully selected cases where bronchopulmonary contamination from the fistula is minimal or absent, there is no associated inflammation of the tracheobronchial tree and the patient is stable from a respiratory point of view without evidence of sepsis, there may be a role for a trial of conservative management.

  8. Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report. (United States)

    Yin, Jun Sunny; Govind, Shaylan; Wiseman, Daniele; Inculet, Richard; Kao, Raymond


    Patients with diverticulitis are predisposed to hepatic abscesses via seeding through the portal circulation. Hepatic abscesses are well-documented sequelae of diverticulitis, however instances of progression to hepato-bronchial fistulization are rare. We present a case of diverticulitis associated with hepatic abscess leading to hepato-bronchial fistulization, which represents a novel disease course not yet reported in the literature. A 61-year-old Caucasian man presented with a history of unintentional weight loss and dyspnea both at rest and with exertion. He had a significant tobacco and alcohol misuse history. A massive right-sided pleural effusion was found on chest X-ray, which responded partially to chest tube insertion. A computed tomography scan of his thorax confirmed the presence of innumerable lung abscesses as well as a complex pleural effusion. An indeterminate tiny air pocket at the dome of the liver was also noted. A follow-up computed tomography scan of his abdomen revealed a decompressed hepatic abscess extending into the right pleural space and the right lower lobe. A sigmoid-rectal fistula was also revealed with focal colonic thickening, presumed to be the sequelae of remote or chronic diverticulitis. An interventional radiologist inserted a percutaneous drain into the decompressed hepatic abscess and the instillation of contrast revealed immediate filling of the right pleural space, lung parenchyma, and bronchial tree, confirming a hepato-bronchial fistula. After two concurrent chest tube insertions failed to drain the remaining pleural effusion completely, surgical lung decortication was conducted. Markedly thickened pleura were seen and a significant amount of gelatinous inflammatory material was debrided from the lower thoracic cavity. He recovered well and was discharged 10 days post-thoracotomy on oral antibiotics. The percutaneous liver abscess tube was removed 3 weeks post-discharge from hospital after the drain check revealed that the

  9. Coronary-to-bronchial artery fistula in a patient with multivessel coronary disease treated by percutaneous coronary intervention. (United States)

    Rigattieri, Stefano; Fedele, Silvio; Sperandio, Massimiliano; Martuscelli, Eugenio; Simonetti, Giovanni; Altamura, Giuliano; Loschiavo, Paolo


    We describe the case of a 78-year-old patient, admitted to our hospital with an acute coronary syndrome. Coronary angiography showed multivessel coronary artery disease and an anomalous coronary vessel branching from the right coronary artery. After successful percutaneous revascularization and discharge, the anomalous vessel was diagnosed by contrast enhanced 64-multidetector computed tomography as a coronary-to-bronchial fistula. Since the patient was asymptomatic, conservative treatment was selected.

  10. Bronchial fistula closure with negative pressure wound therapy: a feasible and cost-effective treatment. (United States)

    Nunes, Rodrigo Barboza; Müller, Bruno Francisco; Cipriano, Federico Enrique Garcia; Coltro, Pedro Soler; Farina, Jayme Adriano


    Treatment of bronchial fistula (BF) after pulmonary lobectomy is a challenge. Often, patients require long hospital stay, have recurrent empyema and pneumonia, are susceptible to sepsis, often need broad-spectrum antibiotics, as well as various surgical approaches. With the advent and growing evidence of the benefits of negative pressure therapy (NPT), its use in some patients with BF has been reported with encouraging results concerning its feasibility and cost-effectiveness. The aim of this study was to demonstrate the application of NPT as a resource for BF treatment and comparatively analyze the overall cost of treatment. RESUMO O tratamento de fístula brônquica (FB) após lobectomia pulmonar é um desafio. Muitas vezes, o paciente demanda longo tempo de internação, apresenta recidivas de empiema e pneumonia, pode evoluir para sepse, frequentemente necessita de antibioticoterapia de amplo espectro, bem como de várias abordagens cirúrgicas. Com o advento e acúmulo de evidências dos benefícios da terapia por pressão negativa (TPN), seu uso em alguns pacientes com FB tem sido relatado com resultados animadores relativos à sua viabilidade e ao seu custo-efetividade. O objetivo deste estudo foi demonstrar a aplicação de TPN como recurso para tratamento da FB e analisar comparativamente o custo global do seu tratamento.

  11. [The effectiveness of the valve bronchial occlusion in case of bronchopleural fistulas]. (United States)

    Gasanov, A M; Pinchuk, T P; Danielian, Sh N; Tarabrin, E A


    The experience of endobronchial valve «Medlung" installation in 24 patients with bronchopleural fistula was summarized in the article. In 18 (75%) patients the cause of bronchopleural fistula was purulent - destructive processes in the lungs, including the associated trauma in 4 (22.2%) patients, pneumonia in 14 (77.8%) patients. In 3 (12.5%) cases the cause of the bronchopleural fistula was the lung tumors of different localization and in 3 (12.5%) cases - idiopathic pulmonary fibrosis. Reasonable use of endobronchial valve in patients with bronchopleural fistula provides a persistent separation of the fistula and lets to avoid extensive, traumatic operations.

  12. Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report


    Yin, Jun Sunny; Govind, Shaylan; Wiseman, Daniele; Inculet, Richard; Kao, Raymond


    Background Patients with diverticulitis are predisposed to hepatic abscesses via seeding through the portal circulation. Hepatic abscesses are well-documented sequelae of diverticulitis, however instances of progression to hepato-bronchial fistulization are rare. We present a case of diverticulitis associated with hepatic abscess leading to hepato-bronchial fistulization, which represents a novel disease course not yet reported in the literature. Case Presentation A 61-year-old Caucasian man ...

  13. Bronchial stents

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    Ibrahim Emad


    Full Text Available Bronchial stents are mostly used as a Palliative relief of symptoms often caused by airway obstruction, It is also used for sealing of stump fistulas after pneumonectomy and dehiscence after bronchoplastic operations. Advances in airway prosthetics have provided a variety of silicone stents, expandable metal stents, and pneumatic dilators, enabling the correction of increasingly complex anatomical problems. Several series have been published describing the application and results of these techniques. This manuscript reviews the historical development of stents, types, indication, outcome, and complications. Alternative therapies for tracheobronchial stenting were also reviewed

  14. New technique for the management of vesicorectal fistulas

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    Leifer, G.; Jacobs, W.H.


    We report a new technique for the management of the complications of vesicorectal fistulas. The patient we present had a fistula and severe skin excoriation. The fistula was caused by carcinoma of the prostate that had been treated by radiation therapy. The fistula was patched with a rectal prosthesis similar to that used to patch esophageal-tracheal and esophageal-bronchial fistulas.

  15. Acquired tracheo-oesophageal fistula.

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    Shah C


    Full Text Available Acquired tracheo-oesophageal fistula is rare. The most common causes are tuberculosis and malignancy. Here we report a patient who had come with dysphagia and aspiration pneumonia with paratracheal lymphnodes on X-ray chest and was diagnosed to have a tracheo-bronchial fistula on barium studies. Transtumoral intubation by pull-through method was carried out.

  16. Tuberculosis presenting as bronchoesophageal fistula

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    Santhosh Narayanan


    Full Text Available We report a case of bronchoesophageal fistula associated with tuberculosis. A 25 year old woman presented to us with 3 month history of cough worsening with deglutition. Radiological examination revealed mediastinal lymphadenopathy and bronchoscopy with esophagoscopy confirmed the presence of fistulous communication with features of endobronchial tuberculosis. Histological examination of bronchial biopsy specimen showed non necrotic granuloma with the PCR positive for Mycobacterium tuberculosis in her bronchial secretions. She was begun on antituberculous treatment and became asymptomatic after 2 months. Bronchoscopy done during follow up after 4 months showed normal bronchial lumen with disappearance of fistulous tract. Imaging showed resolution of lung lesions.

  17. Rectovaginal Fistula (United States)

    ... 2015. Browning A, et al. Characteristics, management, and outcomes of repair of rectovaginal fistula among 1100 consecutive cases of genital tract fistula in Ethiopia. International Journal of Gynecology & Obstetrics. Accessed Aug. 23, 2015. Schwartz DA, et al. ...

  18. Bronchobiliary Fistula Evaluated with Magnetic Resonance Imaging

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    Ragozzino, A.; Rosa, R. De; Galdiero, R.; Maio, A.; Manes, G. [Aorn Cardarelli Napoli (Italy). Dept. di Gastroenterologia


    Bronchobiliary fistula (BBF) is a rare disorder consisting of a passageway between the biliary ducts and the bronchial tree. Many conditions may give rise to this development. Management of these fistulas is often difficult and can be associated with high morbidity and mortality rates. We present a case of BBF developing after hemihepatectomy in a 74-year-old man treated with endoscopic biliary drainage and illustrate MRCP findings.

  19. Vesicovaginal Fistula

    African Journals Online (AJOL)


    countries of the world due to their excellent obstetric care.21,31-33. Many of the obstetric fistula patients from the northern Nigeria are teenagers. It is noteworthy that early marriage and pregnancy had been known to contribute to development of vesicovaginal fistula since the time of. Avicenna in 950AD5. The youngest age.

  20. Myocardial Infarction as a Complication of Bronchial Artery Embolization

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    Labbé, Hugo, E-mail: [Université Laval, Department of Medicine (Canada); Bordeleau, Simon [Université Laval, Department of Emergency Medicine (Canada); Drouin, Christine [Université Laval, Department of Anesthesiology and Critical Care Medicine (Canada); Archambault, Patrick [Université Laval, Department of Emergency Medicine (Canada)


    Bronchial artery embolization is now a common treatment for massive pulmonary hemoptysis if flexible bronchoscopy at the bedside failed to control the bleeding. Complications of this technique range from benign chest pain to devastating neurological impairments. We report the case of a 41-year-old man who developed an ST elevation myocardial infarction during bronchial artery embolization, presumably because of coronary embolism by injected particles. In this patient who had no previously known coronary artery disease, we retrospectively found a communication between the left bronchial artery and the circumflex coronary artery. This fistula was not visible on the initial angiographic view and likely opened because of the hemodynamic changes resulting from the embolization. This case advocates for careful search for bronchial-to-coronary arterial fistulas and the need for repeated angiographic views during embolization procedures.

  1. Arteriovenous Fistula (United States)

    ... catheterization. An arteriovenous fistula may develop as a complication of a procedure called cardiac catheterization. During cardiac catheterization, a long, thin tube called a catheter is inserted in an artery or vein in ...

  2. Rectovaginal Fistula (United States)

    ... Vaginal discharge Rectovaginal fistula Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  3. [Spontaneous esophago-pleural fistula secondary to candidiasis in a patient with human immunodeficiency virus infection. An infrequent complication of esophageal moniliasis]. (United States)

    Nari, Gustavo Adrián; Huerta, Cynthia Guerrero; Revelez, Raúl Barragán; González, Antonio Sánchez


    Several nosologic conditions may affect the esophagus and cause fistulas communicating this organ with the respiratory system. Rarely, infections cause perforation and further fistula to the bronchial tree, lungs or pleural space. We present the rare case of an HIV-infected patient with related spontaneous esophago-pleural fistula related to Candida infection.

  4. Medical image of the week: tracheoesophageal fistula

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    Wong C


    Full Text Available A 51 year old woman with a history of tracheal and bronchial stents for airway impingment from small cell carcinoma was intubated for respiratory failure. After prolonged intubation, she underwent tracheostomy to transition into hospice. The tracheal stent was removed during the procedure due to its location. A tracheoesophageal fistula was demonstrated by visualization of her feeding tube on bronchoscopy performed the next day. The patient underwent palliative ablation of the tracheal tumor and died several days later in hospice.

  5. Anal Abscess/Fistula (United States)

    ... and Fistula Expanded Information | ASCRS WHAT IS AN ANAL ABSCESS OR FISTULA? An anal abscess is an ... fistula tract and identifying internal openings. TREATMENT OF ANAL ABSCESS The treatment of an abscess is surgical ...

  6. Coronary artery fistulas

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    V. M. Subbotin


    Full Text Available Coronary artery fistulas are classified as abnormalities of termination and referred to as major congenital anomalies. Most coronary artery fistulas are small, unaccompanied by clinical symptoms, and diagnosed by echocardiography or coronarography performed for an unrelated cause. Such fistulas usually do not cause any complications and can spontaneously resolve. However, larger fistulas are usually >3 tones the size of a normal caliber of a coronary artery and may give rise to clinical symptoms in these cases. The clinical symptoms of coronary artery fistulas may mimic those of various heart diseases depending on which chamber a fistula drains into. Most fistulas are congenital. Congenital coronary artery fistulas may occur as an isolated malformation or be concurrent with other cardiac anomalies, more frequently with critical pulmonary stenosis or atresia with an intact interventricular septum and pulmonary stenoses, Fallot's tetralogy, aortic coarctation, and left heart hypoplasia. When choosing a treatment modality, one should take into account the number of fistula communications, the feeding vessel, localization of drainage, degree of myocardial damage, and hemodynamic relevance of the shunt caused by the presence of a fistula. The goal of treatment is to obliterate a fistula by preserving normal coronary blood flow. The risk for persisting fistula should be balanced with the potential risk of complications related to a procedure of coronarography and fistula occlusion. Percutaneous transcatheter coil occlusion of coronary artery fistulas is the modality of choice in children with the suitable anatomy of fistula communications and without concomitant congenital heart diseases.

  7. Ureteroarterial Fistula

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    D. H. Kim


    Full Text Available Ureteral-iliac artery fistula (UIAF is a rare life threatening cause of hematuria. The increasing frequency is attributed to increasing use of ureteral stents. A 68-year-old female presented with gross hematuria. She had prior low anterior resection for rectal cancer and a retained ureteral stent. CT abdomen and pelvis showed a large recurrent pelvic mass and a retained stent. The patient underwent cystoscopy which showed a normal bladder. Upon removal of the stent, brisk bleeding was noted coming from the ureteral orifice. Antegrade pyelogram was done which revealed a UIAF. Angiography was done and a covered stent was placed. Multiple treatment options are available. All must consider management of the arterial and ureteral side. The arterial side may be addressed by primary open repair, embolization with extra-anatomic vascular reconstruction, or endovascular stenting. The ureter can be managed with nephroureterectomy, ureteral reconstruction, placement of a nephrostomy tube, or ureteral stenting. Being minimally invasive, we believe that endovascular stenting should be the preferred therapeutic option as it also corrects the source of bleeding while preserving distal blood flow.

  8. Methylene Blue for Bronchopleural Fistula Localization. (United States)

    Sakata, Kenneth K; Nasim, Faria; Schiavo, Dante N; Nelson, Darlene R; Kern, Ryan M; Mullon, John J


    A bronchopleural fistula (BPF) is a communication between the pleural space and the bronchial tree. BPFs are challenging to diagnose and are associated with a high morbidity and mortality. Sequential balloon occlusion is commonly used for localization of a BPF. We describe our experience with 4 cases of successful localization of the BPF by instillation of methylene blue into the pleural space through a pigtail catheter, with simultaneous bronchoscopic visualization of dye in the tracheobronchial tree. Two patients were treated with endobronchial valves and 3 had a surgical thoracic muscle flap placed.


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    Full Text Available BACKGROUND: A fistula is defined as abnormal communication between two epithelial surfaces . 1 Enterocutaneous fistula is defined as abnormal communication between hollow organ and skin. They are classified as congenital or acquired. We have excluded congenital and internal fistulas. We have also excluded esophageal, urinary, p ancreatic and biliary fistulas as their management is complex and differs significantly from enterocutaneous fistulas. AIM: 1. Study of aetiology, pathophysiology and management of enterocutaneous fistula. To evaluate previously laid principles of management of enterocutaneous fistula. 2. To assess the feasibility of early intervention safety and outcome as the conservative long term treatment appears to be cost prohibitive. 3. To study morbidity and mortality related to enterocutaneous fistula. MATERIAL AND METHODS: In all, 50 cases of enterocutaneous fistula were studied during a period from June 2012 to N ovember 2014 at a Government tertiary care C entre. Both, patients referred from other centres with post - operative fistulas and fistulas developed in this institute after surgeries or spontaneously were included in the study after fulfilling the inclusion and exclusion criteria. RESULT S : The maximum numbers of cases were between 39 - 48 years of age group. Spontaneous closure was achieved in 72.7% and surgical closure in 76.7% of the patients Vacuum assisted closure was achieved in 66.66% of the patients in whom VAC was used. Of the patients in whom octreotide was used closure was achieved in 66.66% of the patients. The association between serum albumin levels and fistula healing and between fistula output and mortality were statistically significant. Overall mortality in this study was 26% with 44.44% among referred cases and 15.625% among institutional cases.

  10. Scoliosis and Bronchial Obstruction

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    Mehdi Qiabi


    Full Text Available Severe scoliosis may have a significant effect on respiratory function. The effect is most often restrictive due to severe anatomical distortion of the chest, leading to reduced lung volumes, limited diaphragmatic excursion and chest wall muscle inefficiency. Bronchial compression by the deformed spine may also occur but is more unusual. Management options include a conservative approach using bracing and physiotherapy in mild cases, as well as surgical correction of the scoliosis in more severe cases. Bronchial stenting has also been used successfully as an alternative to surgical correction, and in cases in which spinal surgery was either unsuccessful or not feasible. The authors present a case involving a 52-year-old woman who exhibited symptomatic compression of the bronchus intermedius by severe residual scoliosis despite previous corrective surgery. She was treated with an indwelling bronchial stent.

  11. Surgical maneuvers for the management of bronchial complications in lung transplantation. (United States)

    Camargo, José de Jesus Peixoto; Camargo, Spencer Marcantonio; Machuca, Tiago Noguchi; Perin, Fabíola Adélia; Schio, Sadi Marcelo; Felicetti, José Carlos


    Many advances have substantially improved the clinical results of lung transplantation. However, the incidence of bronchial complications is still high, with significant impact on survival and limited interventional strategies for complex cases. Our aim is to evaluate the surgical management of bronchial complications following lung transplantation. From May 1989 to June 2007, 251 patients were submitted to lung transplantation at our institution. In five cases, the bronchial complications observed were dealt with open surgical procedures. Complications surgically dealt were one broncho-arterial fistula and four stenosis. One left upper sleeve lobectomy, one right upper sleeve lobectomy and three segmental bronchial resections with anastomosis were performed. In all five cases the surgical procedure was successful and optimal bronchial healing was observed. Three patients died due to causes unrelated to the bronchial anastomosis 5, 21 and 32 months after the bronchoplastic procedure. Two patients are still alive and functionally well at 52 and 70 months post-bronchoplasty. Surgical management of bronchial complications after lung transplantation may be the last resort in complex, recalcitrant cases, nevertheless it is a feasible procedure and can provide good results not only on short- but also long-term follow-up.

  12. Pancreaticopleural fistula : CT demonstration

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    Hahm, Jin Kyeung [Chuncheon Medical Center, ChunChon (Korea, Republic of)


    In patients with chronic pancreatitis, the pancreaticopleural fistula is known to cause recurrent exudative or hemorrhagic pleural effusions. These are often large in volume and require treatment, unlike the effusions in acute pancreatitis. Diagnosis can be made either by the finding of elevated pleural fluid amylase level or, using imaging studies, by the direct demonstration of the fistulous tract. We report two cases of pancreaticopleural fistula demonstrated by computed tomography.

  13. Fyzioterapie u astma bronchiale


    Šnajberková, Zuzana


    This thessis deals with the treatment of Asthma Bronchiale by using various physioterapeutic methods, especially respiratory physiotherapy. In Theoretical part there is given information about symptomatology of the disease, prevention, methods of examination, respiratory physiotherapy and devices like inhalers. The Empirical parts includes two case reports where the knowledge from theoretical part is applied. The main goal of this thessis is getting to know other methods of treatment than pha...



    Sreedhar, Krishna Prasad


    SUMMARY Using a vernacular adaptation of MAS 50 bronchial asthma patients were compared with 102 normals, 60 hospital general out-patients and 50 neurotics to determine the level of anxiety in asthma. The manifest anxiety scores of the bronchial asthma patients were found to be significantly high showing that their level of anxiety was abnormally higher in comparison with that of the normals and the hospital general out-patients. The bronchial asthmatics and the neurotics did not differ in an...

  15. Congenital parotid fistula

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    Shiggaon Natasha


    Full Text Available Parotid fistula is a cause of great distress and embarrassment to the patient. Parotid fistula is most commonly a post-traumatic situation. Congenital parotid salivary fistulas are unusual entities that can arise from accessory parotid glands or even more infrequently, from normal parotid glands through an aberrant Stensen′s duct. The treatment of fistulous tract is usually surgical and can be successfully excised after making a skin incision along the skin tension line around the fistula opening. This report describes a case of right accessory parotid gland fistula of a 4-year-old boy with discharge of pus from right cheek. Computed tomography (CT fistulography and CT sialography demonstrated fistulous tract arising from accessory parotid gland. Both CT fistulography and CT sialography are very helpful in the diagnosis and surgical planning. In this case, superficial parotidectomy is the treatment of choice. A detailed history, clinical and functional examination, proper salivary gland investigations facilitates in correct diagnosis followed by immediate surgical intervention helps us to restore physical, psychological health of the child patient.

  16. Congenital parotid fistula. (United States)

    Natasha, Shiggaon


    Parotid fistula is a cause of great distress and embarrassment to the patient. Parotid fistula is most commonly a post-traumatic situation. Congenital parotid salivary fistulas are unusual entities that can arise from accessory parotid glands or even more infrequently, from normal parotid glands through an aberrant Stensen's duct. The treatment of fistulous tract is usually surgical and can be successfully excised after making a skin incision along the skin tension line around the fistula opening. This report describes a case of right accessory parotid gland fistula of a 4-year-old boy with discharge of pus from right cheek. Computed tomography (CT) fistulography and CT sialography demonstrated fistulous tract arising from accessory parotid gland. Both CT fistulography and CT sialography are very helpful in the diagnosis and surgical planning. In this case, superficial parotidectomy is the treatment of choice. A detailed history, clinical and functional examination, proper salivary gland investigations facilitates in correct diagnosis followed by immediate surgical intervention helps us to restore physical, psychological health of the child patient.

  17. [Bronchial mucoepidermoid carcinoma]. (United States)

    Bregante, J I; Rituerto, B; Font de Mora, F; Alonso, F; Andreu, M J; Figuerola, J; Mulet, J F


    We submit the case of a child afflicted with a mucoepidermoid bronchial tumor. The patient is a boy, aged seven, who after undergoing antibiotic treatment for six weeks because of a fever and atelectasia-condensation in the right lower lobe showed no signs of clinical improvement and was sent to our department to undergo further study and treatment. A bronchoscopy performed shows a polypoid mass that partially blocks the main bronchial tube a few milimiters under the access to the right upper lobe. A biopsy is carried out and the anatomopathological test shows there is a low degree epidermoid carcinoma. We decide to perform a lobectomy which for the tumor location and the lung condition has to be medium and lower right. We proceed to remove the adenopaty of hilium not affected by the tumor. The postoperative period develops without incidents. A check-up bronchoscopy performed three months later shows two polypoid masses in the right bronchial tube which, once a biopsy is performed, proved to be granulation tissue. Twelve months after undergoing surgery, the patient's condition is good, there is no evidence of tumor relapse and the breathing capacity is adequate, though there is an obstructive restrictive pattern in the espirometry. Even taking into consideration that lung tumors are extremely unusual, the epidermoid carcinoma is the one which most frequently occurs. The tumor's low malignancy is a sign that points to a good prognosis. Performing conservative surgery by means of bronchoplasty should be taken into account so as to keep the sequelae on the lung condition to a minimum, even though in this case the tumor location made it impossible.

  18. Reliability of Oronasal Fistula Classification. (United States)

    Sitzman, Thomas J; Allori, Alexander C; Matic, Damir B; Beals, Stephen P; Fisher, David M; Samson, Thomas D; Marcus, Jeffrey R; Tse, Raymond W


    Objective Oronasal fistula is an important complication of cleft palate repair that is frequently used to evaluate surgical quality, yet reliability of fistula classification has never been examined. The objective of this study was to determine the reliability of oronasal fistula classification both within individual surgeons and between multiple surgeons. Design Using intraoral photographs of children with repaired cleft palate, surgeons rated the location of palatal fistulae using the Pittsburgh Fistula Classification System. Intrarater and interrater reliability scores were calculated for each region of the palate. Participants Eight cleft surgeons rated photographs obtained from 29 children. Results Within individual surgeons reliability for each region of the Pittsburgh classification ranged from moderate to almost perfect (κ = .60-.96). By contrast, reliability between surgeons was lower, ranging from fair to substantial (κ = .23-.70). Between-surgeon reliability was lowest for the junction of the soft and hard palates (κ = .23). Within-surgeon and between-surgeon reliability were almost perfect for the more general classification of fistula in the secondary palate (κ = .95 and κ = .83, respectively). Conclusions This is the first reliability study of fistula classification. We show that the Pittsburgh Fistula Classification System is reliable when used by an individual surgeon, but less reliable when used among multiple surgeons. Comparisons of fistula occurrence among surgeons may be subject to less bias if they use the more general classification of "presence or absence of fistula of the secondary palate" rather than the Pittsburgh Fistula Classification System.

  19. Laparoscopic treatment of genitourinary fistulae. (United States)

    Garza Cortés, Roberto; Clavijo, Rafael; Sotelo, Rene


    We present the laparoscopic management of genitourinary fistulae, mainly five types of fistulae, vesicovaginal, ureterovaginal, vesicouterine, rectourethral and rectovesical fistula. Vesicovaginal fistula (VVF) is mostly secondary to urogynecologic procedures in developed countries, abdominal hysterectomy being the main cause of this condition; they represent 84.9% of the genitourinary fistulae (1).Management has been described for this type of fistula, where low success rate (7-12%) has been reported. Ureterovaginal fistulas may occur following pelvic surgery, particularly gynecological procedures, or as a result of vaginal foreign bodies or stone fragments after shock wave lithotripsy, patients typically present with global and persistent urine leakage through the vagina, this causes patient discomfort, distress, and typically protection is used to stay dry, the initial management is often conservative but typically fails. Vesicouterine fistula is a rare condition that only occurs in 1 to 4% of genitourinary fistulas, the primary cause is low segment cesareansection, and clinically presents in three different forms, which will be described. Treatment of this type of fistulae has been conservative,with hormone therapy and surgery, depending on the presenting symptoms. Recto-urinary (rectovesical and rectourethral) fistulae (RUF) are uncommon and can be difficult to manage clinically. Although they may develop in patients with inflammatory bowel disease and perirectal abscesses, rectourethral fistula frequently result as an iatrogenic complication of extirpative or ablative prostate procedures. Rectovesical fistula usually develops following radical prostatectomy, and occurs along the vesicourethral anastomotic line or along the suture line of a posterior "racquet-handle" closure of the bladder. Conservative management consisting of urinary diversion, broad-spectrum antibiotics and parenteral nutrition is often initially attempted but these measures often fail


    African Journals Online (AJOL)

    CONGENiTAL URETHROPERINEAL FISTULA l8 A'DISTINCT TYPE OF URETHRAL DUPLlCATION. gram revealed a normal dorsal urethra and failed to opacity the fistulous tract, but the fis- tula was demonstrated by injection of contrast through the perineal orifice (tistulogram). Cystourethroscopy revealed a normal dor~.

  1. Fistula in ano

    DEFF Research Database (Denmark)

    Madsen, S M; Myschetzky, P S; Heldmann, U


    Patients suspected of having perianal suppurative disease often undergo a combination of several potentially painful, invasive procedures to establish or rule out the diagnosis. To evaluate the accuracy of low-field magnetic resonance imaging (MRI) in distinguishing patients with active anal fist...... fistulae and patients with no active fistulation we performed a retrospective study....

  2. Robotic rectovaginal fistula repair. (United States)

    Puntambekar, Shailesh; Rayate, Neeraj; Agarwal, Geetanjali; Joshi, Sourabh; Rajmanickam, Sarvana


    Minimally invasive surgery for diseases in the pelvic region is gaining popularity due to advances in technology and increased benefit to the patient. As indications for such surgeries increase, the known boundaries for minimal access are being extended by a few teams. We report a patient who underwent robotic-assisted transabdominal repair of a high rectovaginal fistula which developed following a vaginal hysterectomy. Vaginography revealed a communication between the vaginal vault and the upper rectum. After evaluation of the colon and the vagina, the patient was planned for a robotic-assisted rectovaginal fistula repair. The three-arm daVinci(®) surgical robot was used. A total of five ports were used to complete the entire procedure, which included adhesiolysis, re-creation of the vaginal vault, repair of the fistula and omental interposition. This is the first robotic-assisted rectovaginal fistula repair reported to date. Besides the advantages of minimally invasive surgery for the patient, the surgeon benefits from the ease of suturing deep in the pelvis afforded by the articulated robotic arms.


    Directory of Open Access Journals (Sweden)

    M. A. Mohammadzade


    Full Text Available "nSecondary aortoenteric fistula (SAF is an uncommon but very important complication of abdominal aortic reconstruction. The complication often occurs months to years after aortic surgery. The clinical manifestation of the aortoenteric fistula is always upper gastrointestinal bleeding. Treatment of the disease is early surgical intervention. If operative treatment is not performed promptly, the mortality is high. We present a case of secondary aortoduodenal fistula found 6 years after aortic reconstructive surgery, with the clinical presentation of upper gastrointestinal bleeding. On Immediate exploratory laparatomy, proximal part of abdominal Aorta was clamped. Duodonorrhaphy and aortic reconstruction with patch graft at the proximal suture line of aortic prosthesis was performed. Fortunately there was no pus, so tissue culture was not done. The intervention was concluded with an omentoplasty in order to protect the patch graft and to separate it from duodenorhaphy. Patient did well after the surgical management. Because of the increasing number of elective aortic aneurysm repairs in the aging population, it is likely that more patients with secondary aortoenteric fistula will present to the clinical physicians in the future. So, a high index of suspicion is necessary for prompt diagnosis and treatment of this actually life threatening event.

  4. Treatment of non-IBD anal fistula

    DEFF Research Database (Denmark)

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter


    The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should...

  5. Reflexology and bronchial asthma

    DEFF Research Database (Denmark)

    Brygge, T; Heinig, J H; Collins, P


    Many asthma patients seek alternative or adjunctive therapies. One such modality is reflexology, whereby finger pressure is applied to certain parts of the body. The aim of the study was to examine the popular claim that reflexology treatment benefits bronchial asthma. Ten weeks of active...... or simulated (placebo) reflexology given by an experienced reflexologist, were compared in an otherwise blind, controlled trial of 20+20 outpatients with asthma. Objective lung function tests (peak flow morning and evening, and weekly spirometry at the clinic) did not change. Subjective scores (describing...... diaries was carried out. It was accompanied by a significant pattern compatible with subconscious unblinding, in that patients tended to guess which treatment they had been receiving. No evidence was found that reflexology has a specific effect on asthma beyond placebo influence....

  6. Neurotrophins in bronchial asthma

    Directory of Open Access Journals (Sweden)

    Renz Harald


    Full Text Available Abstract Allergic bronchial asthma (BA is characterized by chronic airway inflammation, development of airway hyperreactivity and recurrent reversible airway obstruction. T-helper 2 cells and their products have been shown to play an important role in this process. In contrast, the mechanisms by which immune cells interact with the cells residing in lung and airways, such as neurons, epithelial or smooth muscle cells, still remains uncertain. Sensory and motor neurons innervating the lung exhibit a great degree of functional plasticity in BA defined as 'neuronal plasticity'. These neurons control development of airway hyperresponsiveness and acute inflammatory responses, resulting in the concept of 'neurogenic inflammation'. Such quantitative and/or qualitative changes in neuronal functions are mediated to a great extent by a family of cytokines, the neurotrophins, which in turn are produced by activated immune cells, among others in BA. We have therefore developed the concept that neurotrophins such as nerve growth factor and brain-derived neurotrophic factor link pathogenic events in BA to dysfunctions of the immune and nervous system.

  7. Multi-detector CT coronary angiographic findings of coronary-to-pulmonary artery fistula

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Seok; Park, Eun Ah; Lim, Ji Yeon; Lee, Whal [Dept. of Radiology, Seoul National University Hospital, Seoul (Korea, Republic of); Park, Jae Hyung [Dept. of Radiology, Myongji Hospital, Seonam University College of Medicine, Goyang (Korea, Republic of)


    To evaluate multi-detector CT (MDCT) coronary angiographic findings of coronary-to-pulmonary artery fistula (CPAF). We retrospectively reviewed images of patients with CPAF from the coronary CT angiography (CCTA) database obtained with a 64-channel MDCT between January 2008 and March 2011. We analyzed the CCTA findings for feeding arteries, fistula, association with peripulmonary arterial aneurysms, and the presence of communication between the CPAF and bronchial arteries. Fifty-five of the 15042 (0.37%) patients were diagnosed with CPAFs. The feeding artery was single (n = 18) or multiple (n = 37). The fistula had a single drainage site (n = 54) or multiple drainage sites (n = 1). The mean diameter of the fistulous opening was 2.7 ± 1.4 mm. A peripulmonary arterial aneurysm was present in 24 (44%) patients. Communication between CPAF and bronchial arteries was present in eight (14.5%) patients. MDCT coronary angiography can provide comprehensive morphologic details on CPAF and may help in presurgical or preinterventional planning.


    NARCIS (Netherlands)

    Lexmond, A. J.; Hagedoorn, P.; Frijlink, H. W.; de Boer, A. H.


    Background: In the adenosine 5'-monophosphate (AMP) bronchial challenge test, AMP is usually administered according to dosing protocols developed for histamine/methacholine. It has never been thoroughly investigated whether these protocols are suitable for AMP as well. Methods: The setup of the

  9. Physiotherapy and bronchial mucus transport

    NARCIS (Netherlands)

    van der Schans, CP; Postma, DS; Koeter, GH; Rubin, BK

    Cough and expectoration of mucus are the best-known symptoms in patients with pulmonary disease, The most applied intervention for these symptoms is the use of chest physiotherapy to increase bronchial mucus transport and reduce retention of mucus in the airways, Chest physiotherapy interventions

  10. Sonographic Diagnosis of Arterioportal Fistula

    Directory of Open Access Journals (Sweden)

    Canan Alkim


    Full Text Available Aim. We aimed to identify and describe characteristic and diagnostic ultrasonographic features of arterioportal fistula cases. Patients. In this case series we describe 3 patients with arterioportal fistula. By depending on shared sonographic features of these patients we describe a “sonographic pattern” for the sonographic diagnosis of arterioportal fistula. Conclusion. In summary; both of the artery and vein related with fistula were wider than normal and seen as adjacent anechoic circles, there was an aneurismatic dilation on vein which has turbulent flow within it, the communication between the artery and aneurism can be seen sonographically, both of the vessels have arterial flow, filling of the vein was retrograde and other branches of the artery and vein unrelated with aneurism were all normal in dimension.

  11. Ureteroarterial fistula: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Sun; Kim, Ji Chang [Daejeon St Mary' s Hospital, Daejeon (Korea, Republic of)


    Ureteroarterial fistula is an extremely rare complication, but is associated with a high mortality rate. Previous pelvic surgery, long standing ureteral catheter insertion, radiation therapy, vascular surgery and vascular pathology contribute the development of this uncommon entity. Herein, a case of ureteroarterial fistula in a 69-year-old female patient, who presented with a massive hematuria, proven in a second attempt at angiography, is reported.

  12. Video Assisted Anal Fistula Treatment in a Child with Perianal Fistula


    Naeem Liaqat; Asif Iqbal; Sajid Hameed Dar; Faheem Liaqat


    Perianal fistula formation is a rare complication in children after rectal biopsy. Perianal fistula may become difficult to treat; therefore a lot of surgical options are present. One of these options is video assisted anal fistula treatment (VAAFT). We present a 6-year-old female who developed perianal fistula following rectal biopsy for which VAAFT was done successfully.

  13. Perforated appendicitis presenting as appendicoumbilical fistula. (United States)

    Killelea, Brigid K; Arkovitz, Marc S


    Perforated appendicitis is one of the most common diagnoses treated by pediatric surgeons. Although rare, a perforated appendix can present with a cutaneous fistula. Here we present the second reported case of perforated appendicitis presenting as an appendicoumbilical fistula.

  14. Management of the immature autogenous arteriovenous fistula. (United States)

    Saad, Theodore F


    A high-quality autogenous arteriovenous fistula provides the optimal access for hemodialysis. Following initial surgical construction of a fistula, the maturation process is driven by hemodynamic, cellular, and humoral factors that must result in increased blood flow, vessel dilation, and thickening of the vessel wall before the fistula can be successfully used for dialysis needle access. Different demands are placed on each fistula depending on the individual patient's hemodialysis requirements, which must be clearly understood to properly assess and treat the immature fistula. When spontaneous maturation fails to achieve a functional fistula, additional surgical or minimally invasive interventional procedures may be necessary to enhance the maturation process. Various techniques have been reported to achieve successful fistula maturation. The purpose of this article is to review the concepts of fistula maturation and the interventions that may be performed in cases where there is failure to mature spontaneously.

  15. Traumatic urethrocutaneous fistula: Case report andliterature review ...

    African Journals Online (AJOL)

    % of all trauma cases.Severe penile trauma may be complicated by urethrocutaneous fistula. A 22 year old male patient presentedwith urethrocutaneous fistula following severe crush injury of his penis from the rollers of a baking machine.

  16. [Anesthetic management in bronchial asthma]. (United States)

    Kozian, Alf; Schilling, Thomas; Hachenberg, Thomas


    In daily practice, acute and chronic pulmonary diseases are common issues presenting to the anesthetist. Respiratory physiology in general is affected by both general and regional anesthesia, which results in an increased number of perioperative complications in pulmonary risk patients. Therefore, anesthetic management of patients with bronchial asthma needs to address different clinical topics: the physical appearance of pulmonary disease, type and extent of surgical intervention as well as effects of therapeutic drugs, anesthetics and mechanical ventilation on respiratory function. The present work describes important precautions in preoperative scheduling of the asthmatic patient. In the operative course, airway manipulation and a number of anesthetics are able to trigger intraoperative bronchial spasm with possibly fatal outcome. It is essential to avoid these substances to prevent asthma attack. If asthmatic status occurs, appropriate procedures according to therapeutic standards have to be applied to the patient. Postoperatively, sufficient pain therapy avoids pulmonary complications and improves outcome. © Georg Thieme Verlag Stuttgart · New York.

  17. Bronchoscopic management of bronchopleural fistula with intrabronchial instillation of glue (N-butyl cyanoacrylate

    Directory of Open Access Journals (Sweden)

    Rakesh K Chawla


    Full Text Available Context: Bronchopleural fistula (BPF is a communication between the pleural space and bronchial tree. Materials and Methods: A series of 9 cases are reported where BPF was identified and managed with intrabronchial instillation of glue (N-butyl-cyanoacrylate through a video bronchoscope. Results: Out of 9 patients the BPF was successfully sealed in 8 cases (88.88%. In 1 patient of postpneumonectomy, the fistula was big, that is >8 mm who had a recurrence after the procedure. In one case of pyopneumothorax the leak reduced slowly and it took us 14 days to remove the intercostal drainage tube. Rest of the patients had a favorable outcome. No complications were observed in a follow-up of 6 months. Conclusions: In our opinion, it is a cost-effective, viable, and safe alternative compared with costly, time-consuming, and high-risk surgical procedures.

  18. Congenital anomalous/aberrant systemic artery to pulmonary venous fistula: Closure with vascular plugs & coil embolization

    Directory of Open Access Journals (Sweden)

    Pankaj Jariwala


    Full Text Available A 7-month-old girl with failure to thrive, who, on clinical and diagnostic evaluation [echocardiography & CT angiography] to rule out congenital heart disease, revealed a rare vascular anomaly called systemic artery to pulmonary venous fistula. In our case, there was dual abnormal supply to the entire left lung as1 anomalous supply by normal systemic artery [internal mammary artery]2 and an aberrant feeder vessel from the abdominal aorta. Left Lung had normal bronchial connections and normal pulmonary vasculature. The fistula drained through the pulmonary veins to the left atrium leading to ‘left–left shunt’. Percutaneous intervention in two stages was performed using Amplatzer vascular plugs and coil embolization to close them successfully. The patient gained significant weight in follow up with other normal developmental and mental milestones.

  19. A case of colouterine fistula managed laparoscopically. (United States)

    Dadhwal, Vatsla; Ghosh, Bhaswati; Jindal, Vijay Laxmi; Vaid, Arvind; Agarwal, Sandeep; Mittal, Suneeta


    Fistulas between the uterus and bowel are rarely reported. We report successful laparoscopic management of a colouterine fistula caused by a foreign body in the uterus. Fistulas between the gastrointestinal tract and the female genital tract are usually found between the vagina and rectum as a result of complications of childbirth or iatrogenic trauma. Communication between the uterus and bowel is rarely reported. We report successful laparoscopic management of an unusual case of colouterine fistula caused by a foreign body in the uterus.

  20. Gastrojejunocolic fistula after gastrojejunostomy: a case series


    Wu Jin-Ming; Wang Ming-Yang; Lee Po-Huang; Lin Ming-Tsan


    Abstract Introduction Gastrojejunocolic (GJC) fistulae represent a significant post-surgical cause of morbidity and mortality. GJC fistulae represent rare post-surgical complications, and most are associated with gastric surgery. In the past, this complication has been under-recognized because a fistula may form years after surgery. Case presentation We describe two cases of gastrojejunocolic fistula in men aged 67 and 60 who both initially presented with watery diarrhea and weight loss. Uppe...

  1. Social networks and bronchial asthma. (United States)

    D'Amato, Gennaro; Cecchi, Lorenzo; Liccardi, Gennaro; D'Amato, Maria; Stanghellini, Giovanni


    To focus on both positive and negative aspects of the interaction between asthmatic patients and the social networks, and to highlight the need of a psychological approach in some individuals to integrate pharmacological treatment is the purpose of review. There is evidence that in some asthmatic patients, the excessive use of social networks can induce depression and stress triggering bronchial obstruction, whereas in others their rational use can induce beneficial effects in terms of asthma management. The increasing asthma prevalence in developed countries seen at the end of last century has raised concern for the considerable burden of this disease on society as well as individuals. Bronchial asthma is a disease in which psychological implications play a role in increasing or in reducing the severity of bronchial obstruction. Internet and, in particular, social media are increasingly a part of daily life of both young and adult people, thus allowing virtual relationships with peers sharing similar interests and goals. Although social network users often disclose more about themselves online than they do in person, there might be a risk for adolescents and for sensitive individuals, who can be negatively influenced by an incorrect use. However, although some studies show an increased risk of depression, other observations suggest beneficial effects of social networks by enhancing communication, social connection and self-esteem.


    Aydinova, P R; Aliyev, E A


    Results of surgical treatment of 21 patients, suffering high transsphincteric and extrasphincteric rectal fistulas, were studied. In patients of Group I the fistula passage was closed, using fistula plug obturator; and in patients of Group II--by the same, but preprocessed by fibrin adhesive. The fistula aperture germeticity, prophylaxis of rude cicatrices development in operative wound zone, promotion of better fixation of bioplastic material were guaranteed, using fistula plug obturator with preprocessing, using fibrin adhesive.

  3. Posterior cranial fossa arteriovenous fistula with presenting as caroticocavernous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Liu, H.M.; Shih, H.C.; Huang, Y.C.; Wang, Y.H. [Dept. of Medical Imaging, National Taiwan University Hospital, Taipei (Taiwan)


    We report cases of posterior cranial fossa arteriovenous fistula (AVF) with presenting with exophthalmos, chemosis and tinnitus in 26- and 66-year-old men. The final diagnoses was vertebral artery AVF and AVF of the marginal sinus, respectively. The dominant venous drainage was the cause of the unusual presentation: both drained from the jugular bulb or marginal sinus, via the inferior petrosal and cavernous sinuses and superior ophthalmic vein. We used endovascular techniques, with coils and liquid adhesives to occlude the fistulae, with resolution of the symptoms and signs. (orig.)

  4. Gastrocolic Fistula: A Shortcut through the Gut

    Directory of Open Access Journals (Sweden)

    Nauzer Forbes


    Full Text Available Gastrocolic fistulas are observed in association with several conditions. Traditionally, peptic ulcer disease was commonly implicated in the formation of gastrocolic fistulas; however, this is now a rare etiology. Here, we present a case of gastrocolic fistula secondary to peptic ulcer disease alone, in addition to reviewing the literature and providing options for diagnosis and treatment.

  5. Physiotherapy in patients with bronchial asthma


    Pichová, Jiřina


    Author: Jiřina Pichová Institution: Department of rehabilitation medicine of teaching hospital in Hradec Králové Topic of the thesis: Physiotherapy in patients with bronchial asthma Supervisor: Mgr. Zuzana Hamarová Number of pages: 69 Year of defences: 2014 Keywords: bronchial asthma, respiratory physiotherapy, risk factors Topic of this bachelor thesis is Physiotherapy of patients with bronchial asthma and it is divided into theoretical and practical part. The theoretical part deals with dan...

  6. Angiogenesis and lymphangiogenesis in bronchial asthma

    National Research Council Canada - National Science Library

    Detoraki, A; Granata, F; Staibano, S; Rossi, F. W; Marone, G; Genovese, A


    ... A. Angiogenesis and lymphangiogenesis in bronchial asthma. Allergy 2010; 65: 946-958. Neovascularization plays a prominent role in inflammation and tissue remodeling in several chronic inflammatory disorders...

  7. Imaging diagnosis of bronchial asthma and related diseases

    Energy Technology Data Exchange (ETDEWEB)

    Sakai, Fumikazu; Fujimura, Mikihiko; Kimura, Fumiko; Fujimura, Kaori; Hayano, Toshio; Nishii, Noriko; Machida, Haruhiko; Toda, Jo; Saito, Naoko [Tokyo Women' s Medical Coll. (Japan)


    We describe imaging features of bronchial asthma and related diseases. The practical roles of imaging diagnosis are the evaluation of severity and complications of bronchial asthma and differential diagnosis of diseases showing asthmatic symptoms other than bronchial asthma. (author)

  8. Fistulas secondary to gynecological and obstetrical operations

    Directory of Open Access Journals (Sweden)

    Jakovljević Branislava N.


    Full Text Available The authors present urogenital and rectogenital fistulas treated at the Department of Obstetrics and Gynecology in Novi Sad in the period from 1976 to 1999. The study comprised 28 cases of fistula out of which 17 were vesicovaginal, 3 ureterovaginal, 1 vesicorecto vaginal and 7 recto vaginal. During the investigated period there were 182 Wertheim operations, 3864 total abdominal hysterectomies, 1160 vaginal hysterectomies and 7111 cesarean sections. The vesicovaginal fistulas were most frequent with the incidence of 0.33%, whereas the tocogenic fistulas did not occur. Urogenital fistulas secondary to radical hysterectomy are extremely rare thanks to the administered measures of prevention during the surgical procedure.

  9. Bronchial stump closure with amniotic membrane in animal model

    Directory of Open Access Journals (Sweden)

    Gholamreza Mohajeri


    Full Text Available Background: Coverage of the bronchial stumps (BSs with adjacent tissues can improve healing and reduce bronchial complications in complex thoracic surgery. There is no evidence for the application of human amnion allograft for prevention of air leak from the BS. The comparison of the amniotic membrane (AM and pleural patch for BS healing after lobectomy in dogs was our aim in this study. Materials and Methods: A total of eight males and females 12-24-month-old dogs between 17 and 22 kg body-weight were used in this study in 2010, Isfahan University of Medical Sciences. Animals were separated into two groups: group A (n = 4; amniotic membrane and group P (n = 4; pleural patch according to the BS closure technique performed. After lobectomy of the right middle lobe, the BS was closed, while a small bronchopleural fistula (BPF was created by inserting a catheter via edges of closed stump. Then, it was covered with a piece of AM3 × 3 cm in group A and with a pedicle graft of pleura in group P. Rethoracotomy was performed after 15 days of observation, and the BS was removed for histological examination. Histological healing was classified as complete or incomplete healing. Neoangiogenesis was measured by Von Willebrand expression using immunohistochemistry (IHC. Data were analyzed by SPSS version 15 using Fisher′s exact test, Mann-Whitney test, and T tests. Results: BPF complications were not seen during observation period. There was no significant difference in histological healing between two groups. Similarly, no significant difference was observed between the groups in terms of neoangiogenesis based on IHC examination (P value = 0.69. Conclusion: Human amnion allograft could be as effective as pleural patch for BS wrapping following pulmonary resections.

  10. [Bronchoplastic surgery in bronchial cancer]. (United States)

    Baros, B; Djuric, B


    Conservative resection is applied in cases with central localisation of the tumour in the surrounding lymph nodes are not affected by the malignant process. This surgery is of great importance for patients with restricted respiratory function if pneumonectomy is contraindicated or is performed under enhanced risk. A total of 29 surgeries were performed on the bronchial system. Blood vessel resection was simultaneously done in two of the cases. Frozen section biopsy was obligatorily performed. In one case atelectasis was an early complication that was resolved by bronchoaspiration. In a thirty-day long postoperative period one (3.4%) of the patients died because of profound intrathoracic bleeding.

  11. Rectal atresia with rectolabial fistula


    Sharma S.; Upadhyaya V; Pandey A; Gangopadhyay A


    Rectal atresia is a rare condition in which the anus and sphincter muscles are normally developed, with usually no fistulous communication with the urinary tract. We describe an unusual case of membranous rectal atresia with recto-labial fistula. It was treated by blind perforation of rectal membrane with lay opening of fistlous tract.

  12. Gastropulmonary Fistula after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Maya Doumit


    Full Text Available The Roux-en-Y gastric bypass is one of the most common operations for morbid obesity. Although rare, gastropulmonary fistulas are an important complication of this procedure. There is only one recently reported case of this complication. The present report describes the serious nature of this complication in a patient after an uneventful laparoscopic gastric bypass surgery.

  13. [Delayed asthma bronchiale due to epoxy resin]. (United States)

    Authried, Georg; Al-Asadi, Haifaa; Møller, Ulla; Sherson, David Lee


    Epoxy resin is a low molecular weight agent, which can cause both acute and delayed allergic reactions. However, it is known causing skin reactions with direct or airborne contact. Rarely it can cause airway reactions like asthma bronchiale. We describe a case of a windmill worker who developed delayed asthma bronchiale due to airborne contact with epoxy resin.

  14. Bronchial asthma, allergic rhinitis and cholecystectomy: An ...

    African Journals Online (AJOL)

    Background: Gallbladder has not been associated with any allergic condition what so ever. However, certain patients with bronchial asthma and cholelithiasis have reported to the author improvement in their asthmatic attack after cholecystectomy. Methods: This was an observational study on 22 bronchial asthma or allergic ...

  15. Laparoscopic Treatment of Vesicovaginal Fistula

    Directory of Open Access Journals (Sweden)

    Marcos Tobias-Machado


    Full Text Available Introduction Vesicovaginal fistula is a rare disease with great impact for the patients. Laparoscopic repair can be an interesting option in selected cases with goods results but few experience is reported.Objectives Detailed demonstration of our laparoscopic vesicovaginal fistula repair technique. Initial results for ten patients are provided Methods: We treated all cases by the same technique. The surgical steps were: Patient positioning in Lloyd-Davis; Cystoscopy and implant of guide wire on fistula and ureteral catheters (that was removed after procedure; Transperitoneal access and 4 or 5 ports in V or W shape; Opening the bladder wall; Dissection between bladder and vagina for tension free repair; Fistula resection; Vagina repair with Vicryl 3-0; Bladder repair with Vicryl 3-0; Peritoneum/omentum interposition; Positioning 20 Fr urethral catheter.Results Mean age was 50 years. Mean number of fistulas was 1,2. The most common etiology was gynecologic surgery (7. Mean operative time was 2,5 (1,8-3,2 hours. Mean blood loss was 150 (100-200mL. Complication rate was 10% (one case of urinary infection treated conservatively. Mean hospital stay was 1,2 (1-2 days. Mean return to normal and activities was 20 (15-30 days. For nine patients mean sexual intercourse time was 3 (1-6 months. Success rate after 1 year was 90% (one case of recurrence in patient with previous radiotherapy. Mean follow-up was 36 (12-60 months.Conclusions Laparoscopic repair is feasible, reproducible and present all advantages of minimally invasive surgical procedure. Long term results are similar to conventional open approaches.

  16. Management of Postpneumonectomy Bronchopleural Fistulae

    Directory of Open Access Journals (Sweden)

    Kemal Karapinar


    Full Text Available Aim: Postpneumonectomy bronchopleural fistula (PPBPF is a hard-to-treat complication that may develop after pneumonectomy. It follows a persistent course. Although there is no commonly adopted method, closure of the fistula with flaps is the general principle. The use of the omental flap may provide higher success rates in the treatment. Material and Method: PPBPF developed in 12 out of 162 pneumonectomies performed at the department of thoracic surgery between 2011 and 2014. The demographic characteristics, fistula management strategies, morbidity, and mortalities were retrospectively studied by analysis of operative reports and a digital database. Results: The rate of PPBPF was 7.4%. The bronchopleural fistulae could be closed by various treatments in 10 patients; omentopexy constituted the basis of treatment in 8 of them. In the other patients with successful results, resuturing with staplers and vacuum assisted closure were performed during the early period. One of the patients who failed treatment died due to ARDS; therefore, it was not possible to apply all the treatment alternatives. In the other patient, despite the use of all treatment alternatives (eloesser flap, tracheal stent, omentopexy, thoracomyoplasty, vacuum assisted closure, the treatment failed. Discussion: PPBPF is one of the most significant causes of morbidity and mortality in thoracic surgery units. Because its treatment may be long, a good plan and its execution by experienced units are necessary. The omental flap is increasingly popular due to good perfusion. We believe that omentopexy and j type tracheal stent performed by experienced teams will provide successful results in fistula treatment.

  17. Concentrations of ceftibuten in bronchial secretions. (United States)

    Scaglione, F; Triscari, F; Demartini, G; Arcidiacono, M; Cocuzza, C; Fraschini, F


    Ceftibuten is a broad-spectrum oral cephalosporin exhibiting antimicrobial activity against a wide range of gram-negative and some gram-positive pathogens. Pharmacokinetic studies have shown that the molecule has an oral bioavailability higher than 90% of the administered dose (reaching peak serum concentrations of 5-19 mg/l after a single dose of 200 and 400 mg). Moreover, ceftibuten has been shown to be useful in the treatment of acute lower respiratory tract infections. This study was performed to determine the distribution of ceftibuten in bronchial secretions from patients affected by the exacerbation of chronic bronchitis. Patients were treated with a single 400-mg oral dose of ceftibuten. Blood and bronchial-secretion samples were obtained just before, and at 0.5, 1, 2, 4, 8, 12, 16 and 24 h after dosing. Cells were separated from bronchial secretions by centrifugation. Ceftibuten in duplicate samples of both serum and bronchial secretion was quantified by HPLC. Ceftibuten reached peak levels 2 and 4 h after oral administration in serum and in bronchial secretions, respectively (18.12 +/- 2.13 and 9.19 +/- 3.1 mg/l, respectively). Falling curves after the peaks showed a monoexponential decay. The absorption was very rapid both in serum and bronchial secretions, but elimination was slower in bronchial secretions than in serum.

  18. Management of Complex Perineal Fistula Disease (United States)

    Akiba, Ricardo Tadayoshi; Rodrigues, Fabio Gontijo; da Silva, Giovanna


    Management of complex perineal fistulas such as high perianal, rectovaginal, pouch-vaginal, rectourethral, or pouch-urethral fistulas requires a systematic approach. The first step is to control any sepsis with drainage of abscess and/or seton placement. Patients with large, recurrent, irradiated fistulas benefit from stoma diversion. In patients with Crohn's disease, it is essential to induce remission prior to any repair. There are different approaches to repair complex fistulas, from local repairs to transperineal and transabdominal approaches. Simpler fistulas are amenable to local repair. More complex fistulas, such as those secondary to irradiation, require interposition of healthy, well-vascularized tissue. The most common flap used for this treatment is the gracilis muscle with good outcomes reported. Once healing is confirmed by imaging and endoscopy, the stoma is reversed. PMID:27247533

  19. Minimally invasive management of urological fistulas. (United States)

    Núñez Bragayrac, Luciano A; Azhar, Raed A; Sotelo, Rene


    Urological fistulas are an underestimated problem worldwide and have devastating consequences for patients. Many urological fistulas result from surgical complications and/or inadequate perinatal obstetric healthcare. Surgical correction is the standard treatment. This article reviews minimally invasive surgical approaches to manage urological fistulas with a particular emphasis on the robotic techniques of fistula correction. In recent years, many surgeons have explored a minimally invasive approach for the management of urological fistulas. Several studies have demonstrated the feasibility of laparoscopic surgery and the reproducibility of reconstructive surgery techniques. Introduction of the robotic platform has provided significant advantages given the improved dexterity and exceptional vision that it confers. Fistulas are a concern worldwide. Laparoscopic surgery correction has been developed through the efforts of several authors, and difficulties such as the increased learning curve have been overcome with innovations, including the robotic platform. Although minimally invasive surgery offers numerous advantages, the most successful approach remains the one with the surgeon is most familiar.

  20. Spontaneous esophageal-pleural fistula

    Directory of Open Access Journals (Sweden)

    Sameer Vyas


    Full Text Available Spontaneous esophageal-pleural fistula (EPF is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed.

  1. Fistula gastrocólica


    Henriques, Alexandre Cruz; Pezzolo, Sergio; Henriques, Simone A. Chiconelli


    A case of gastrocolic fistula(GCF) in a patient with duodenal stenosis who had previously undergone gastroenteric anastomosis is reported. The patient went through hemigastrectomy, partial colectomy and segmental enterectomy with bloc resection. Reconstruction was carried out through Billroth II gastrojejunostomy, jejunojejunostomy and end-to-end anastomosis of the colon. The patient had good post-operative evolution and was discharged from hospital seven days after surgery. GCF should be sus...

  2. Emphysematous prostatic abscess with rectoprostatic fistula

    Directory of Open Access Journals (Sweden)

    Po-Cheng Chen


    Full Text Available Emphysematous prostatic abscess is a rare but relatively serious infectious disease, and its association with rectoprostatic fistula is extremely unusual. The reported risk factors for this condition include diabetes mellitus, immunosuppression, and prostate surgery. We report a rare case of emphysematous prostatic abscess successfully treated by transurethral drainage. Nonetheless, a rectoprostatic fistula was found postoperatively. The fistula healed spontaneously without fasting or fecal diversion after suprapubic cystostomy and placement of a urethral catheter. This case highlights the importance of surgical drainage for the treatment of an emphysematous prostatic abscess and that conservative treatment can be a safe and effective approach for an associated rectoprostatic fistula.

  3. Operative treatment of radiation-induced fistulae

    Energy Technology Data Exchange (ETDEWEB)

    Balslev, I.; Harling, H.


    Out of 136 patients with radiation-induced intestinal complications, 45 had fistulae. Twenty-eight patients had rectovaginal fistulae while the remainder had a total of 13 different types of fistulae. Thirty-seven patients were treated operatively and eight were treated conservatively. Thirty-three patients were submitted to operation for rectal fistulae. Of these, 28 were treated by defunctioning colostomy, three were treated by Hartmann's method and resection and primary anastomosis was carried out in two patients. In the course of the period of observation, 35% of the patients developed new radiation damage. The frequency in the basic material without fistulae was 21% (0.05fistulae in 25 patients, eight patients developed new fistulae, Significantly more patients with fistulae died of recurrence as compared with patients with other lesions (p<0.01). Defunctioning colostomy in the treatment of rectal fistula is a reasonable form of treatment in elderly patients and in case of recurrence. Younger patients should be assessed in a special department in view of the possibility of a sphincter-preserving procedure following resection of the rectum and restorative anastomosis. 11 refs.

  4. Report of a complete second branchial fistula.

    LENUS (Irish Health Repository)

    Khan, Mohammad Habibullah


    We report a case of complete congenital branchial fistula with an internal opening near the tonsillar fossa. Cysts, fistulas, and sinuses of the second branchial cleft are the most common developmental anomalies arising from the branchial apparatus. In our case, a 43-year-old man presented with a several-year history of a discharging sinus from the right side of his neck, consistent with a branchial fistula. He underwent various investigations and finally was treated with a one-stage complete surgical excision of the fistula tract. We describe the general clinical presentation, investigations, and surgical outcome of this case.

  5. Choledochoduodenal fistula of ulcer etiology

    Directory of Open Access Journals (Sweden)

    Čolović Radoje


    Full Text Available Introduction Choledochoduodenal fistulas are very rare and in most cases are caused by a long-lasting and poorly treated chronic duodenal ulcer. They may be asymptomatic or followed by symptoms of ulcer disease, by attacks of cholangitis or bleeding or vomiting in cases of ductoduodenal stenosis. The diagnosis is simple and safe, however treatment is still controversial. If surgery is the choice of treatment, local findings should be taken into consideration. As a rule, intervention involving closure of fistula is not recommended. Case Outline The authors present a 60-year-old woman with a long history of ulcer disease who developed attacks of cholangitis over the last three years. Ultrasonography and CT showed masive pneumobilia due to a choledochoduodenal fistula. . As there was no duodenal stenosis or bleeding, at operation the common bile duct was transected and end-to-side choledochojejunostomy was performed using a Roux-en Y jejunal limb. From the common bile duct, multiple foreign bodies of herbal origin causing biliary obstruction and cholangitis were removed. After uneventful recovery the patient stayed symptom free for four years now. Conclusion The performed operation was a simple and good surgical solution which resulted in complication-free and rapid recovery with a long-term good outcome. .

  6. Intermittent Haemoptysis due to an Aortobronchial Fistula in a Warmblood Mare. (United States)

    Versnaeyen, H; Saey, V; Vermeiren, D; Chiers, K; Ducatelle, R


    A 7-year-old warmblood mare showed sudden onset of mild intermittent haemoptysis. Clinical examination revealed no significant abnormalities. Haematological examination showed mild anaemia, hypoalbuminaemia and neutrophilia. Coagulation tests were normal. Endoscopic examination revealed unilateral pulmonary haemorrhage with blood clots in the bronchi and trachea. Treatment with antibiotics was started and the horse was given stable rest. Two weeks later, the horse was found dead with blood and frothy sputum leaking from the nostrils. Post-mortem examination revealed a large thoracic aortic aneurysm communicating with a pseudoaneurysm that had formed a fistula into a right bronchial branch. Microscopical examination of the aneurysm showed extensive medial fibrosis with prominent degeneration, fragmentation and mineralization of the elastic fibres and deposition of mucoid material in the tunica media. The pseudoaneurysm was lined by collagen bundles admixed with fibroblasts and a small amount of adipose tissue. Aortobronchial fistula is a rare condition in man that is usually associated with primary aortic pathology, most often aneurysms. To the authors' knowledge this is the first case of a fatal aortobronchial fistula in a horse or any other animal species. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Permanent Cortical Blindness After Bronchial Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Doorn, Colette S. van, E-mail:; De Boo, Diederick W., E-mail: [Academic Medical Centre, Department of Radiology (Netherlands); Weersink, Els J. M., E-mail: [Academic Medical Centre, Department of Pulmonology (Netherlands); Delden, Otto M. van, E-mail:; Reekers, Jim A., E-mail:; Lienden, Krijn P. van, E-mail: [Academic Medical Centre, Department of Radiology (Netherlands)


    A 35-year-old female with a known medical history of cystic fibrosis was admitted to our institution for massive hemoptysis. CTA depicted a hypertrophied bronchial artery to the right upper lobe and showed signs of recent bleeding at that location. Bronchial artery embolization (BAE) was performed with gelfoam slurry, because pronounced shunting to the pulmonary artery was present. Immediately after BAE, the patient developed bilateral cortical blindness. Control angiography showed an initially not opacified anastomosis between the embolized bronchial artery and the right subclavian artery, near to the origin of the right vertebral artery. Cessation of outflow in the bronchial circulation reversed the flow through the anastomosis and allowed for spill of embolization material into the posterior circulation. Unfortunately the cortical blindness presented was permanent.

  8. Recent developments regarding periostin in bronchial asthma

    National Research Council Canada - National Science Library

    Izuhara, Kenji; Matsumoto, Hisako; Ohta, Shoichiro; Ono, Junya; Arima, Kazuhiko; Ogawa, Masahiro


    Although it is currently recognized that bronchial asthma is not a single disease but a syndrome, we have not yet made use of our new understanding of this heterogeneity as we treat asthma patients...

  9. Martius procedure revisited for urethrovaginal fistula

    Directory of Open Access Journals (Sweden)

    N P Rangnekar


    Full Text Available Background: Urethrovaginal fistula is a dreadful com-plication of obstetric trauma due to prolonged labour or obstetric intervention commonly seen in developing coun-tries. Due to prolonged ischaemic changes, the fistula is resistant to healing. The strategic location of the fistula leads to postoperative impairment of continence mecha-nism. Anatomical repair was previously the commonest mode of surgical management, but was associated with a miserable cumulative cure rate ranging from 16-60%. Hence we tried to study the efficacy of Martius procedure in the management of urethrovaginal fistula. Material and Methods: We studied the outcome of 12 urethrovaginal fistulae, all caused by obstetric trauma, treated surgically with Martius procedure in 8 and with anatomical repair in 4, retrospectively. 9 patients had re-current fistulae while I patient had multiple fistulae. Pa-tients were followed up for the period ranging from 6 months to 4′/2 years for fistula healing, continence and postoperative complications like dvspareunia. Results: Cumulative cure rate ofMartius procedure was 87.5% with no postoperative stress incontinence, while fistula healing rate of anatomical repair was only 25% (I patient out of 4 which was also complicated by Intrin-sic Sphincter Deficiency (ISD. In case of recurrent fistu-lae the success rate of anatomical repair was 0% compared to 83.33% with Martius procedure. Conclusions: Martius procedure has shown much bet-ter overall cure rate compared to anatomical repair be-cause - a it provides better reinforcement to urethral suture line, b it provides better blood supply and lymph drainage to the ischaemic fistulous area, c provides sur-face for epithelialization and, d helps to maintain conti-nence. Hence we recommend Martius procedure as a surgical modality for the treatment of urethrovaginal fis-tula.

  10. The Patency Rate of Arteriovenous Fistulas

    Directory of Open Access Journals (Sweden)

    Aşkın Ender Topal


    Full Text Available The purpose of this investigation is to determine the patency of thearteriovenous (A-V fistulas, created in patients with chronic renal failure, inthe early and late periods according to sex.The A-V fistulas created for hemodialisis were investigated retrospectively.Of 238 patients, there were 130 male.269 operations were made to 238 patients. Of these, 198 (73.6 % wereradiochephalic, 56 (20.8 % were brachiochephalic, 8 (3 % were brachiobasilicA-V fistulas. In 3 (1.1 % patients loop graft between brachial artery and vein,in 1 (0.37 % patient graft between radial artery and brachial vein, in 1 patientgraft between brachial artery and basilic vein, in 1 patient graft betweensuperficial femoral artery and saphenous vein were placed. Of 198radiochephalic A-V fistulas 24 (12.1 % in early period and 3 (1.5 % in lateperiod became inactive. Of 56 brachiochephalic A-V fistulas 4 (7.1 % and of 8brachiobasilic A-V fistulas 2 (25 % became unsuccessful in early period. 1 of 6A-V fistulas with prosthetic graft failed in late period because of thrombosis. Inradial level patency rate of A-V fistulas in females were lower than in males(82.3 %-89.8 %.The patency rate of A-V fistulas in radial and brachial levels were similar,but in radial level rate of successful of A-V fistulas decreased in femalesaccording to males. Use of graft in A-V fistula didn’t give superiority to A-Vfistulas without graft.

  11. Bronchopleural fistula after pneumonectomy: interdisciplinary surgical closure by an ipsilateral pedicled latissimus dorsi flap supported by video-assisted thoracoscopy. (United States)

    Wolter, A; Scholz, T; Diedrichson, J; Arens-Landwehr, A; Schroeder-Finckh, R; Liebau, J


    Post-pneumonectomy bronchopleural fistula (BPF) remains a rare but often life-threatening complication and therapeutic challenge. Traditional surgical procedures include chronic open drainage, attempts at direct stump closure, thoracoplasty with or without chest wall muscle transposition and trans-sternal bronchial closure. We describe a case with successful closure of a chronic BPF after pneumonectomy by intrathoracic transposition of a pedicled latissimus dorsi muscle flap circumferentially fixed on the surrounding pleural tissue under continuous video-assisted thoracoscopic overview. The postoperative course was without complications; no tumour, empyema or fistula re-occurred. In this article we want to present the potential advantages of video-assisted thoracoscopic support and interdisciplinary teamwork to improve the outcome of patients with BPFs after pneumonectomy. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Anatomical modeling of the bronchial tree (United States)

    Hentschel, Gerrit; Klinder, Tobias; Blaffert, Thomas; Bülow, Thomas; Wiemker, Rafael; Lorenz, Cristian


    The bronchial tree is of direct clinical importance in the context of respective diseases, such as chronic obstructive pulmonary disease (COPD). It furthermore constitutes a reference structure for object localization in the lungs and it finally provides access to lung tissue in, e.g., bronchoscope based procedures for diagnosis and therapy. This paper presents a comprehensive anatomical model for the bronchial tree, including statistics of position, relative and absolute orientation, length, and radius of 34 bronchial segments, going beyond previously published results. The model has been built from 16 manually annotated CT scans, covering several branching variants. The model is represented as a centerline/tree structure but can also be converted in a surface representation. Possible model applications are either to anatomically label extracted bronchial trees or to improve the tree extraction itself by identifying missing segments or sub-trees, e.g., if located beyond a bronchial stenosis. Bronchial tree labeling is achieved using a naïve Bayesian classifier based on the segment properties contained in the model in combination with tree matching. The tree matching step makes use of branching variations covered by the model. An evaluation of the model has been performed in a leaveone- out manner. In total, 87% of the branches resulting from preceding airway tree segmentation could be correctly labeled. The individualized model enables the detection of missing branches, allowing a targeted search, e.g., a local rerun of the tree-segmentation segmentation.

  13. Recent developments regarding periostin in bronchial asthma. (United States)

    Izuhara, Kenji; Matsumoto, Hisako; Ohta, Shoichiro; Ono, Junya; Arima, Kazuhiko; Ogawa, Masahiro


    Although it is currently recognized that bronchial asthma is not a single disease but a syndrome, we have not yet made use of our new understanding of this heterogeneity as we treat asthma patients. To increase the efficacy of anti-asthma drugs and to decrease costs, it is important to stratify asthma patients into subgroups and to develop therapeutic strategies for each subgroup. Periostin has recently emerged as a biomarker for bronchial asthma, unique in that it is useful not in diagnosis but in categorizing asthma patients. We first found that periostin is a novel component of subepithelial fibrosis in bronchial asthma downstream of IL-13 signals. Thereafter, it was shown that periostin can be a surrogate biomarker of type 2 immune responses, the basis of the notion that a detection system of serum periostin is potentially a companion diagnostic for type 2 antagonists. Furthermore, we have recently shown that serum periostin can predict resistance or hyporesponsiveness to inhaled corticosteroids, based on its contribution to tissue remodeling or fibrosis in bronchial asthma. Thus, serum periostin has two characteristics as a biomarker for bronchial asthma: it is both a surrogate biomarker of type 2 immune responses and a biomarker reflecting tissue remodeling or fibrosis. We can take advantage of these characteristics to develop stratified medicine in bronchial asthma. Copyright © 2015 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  14. [Relationship between congenital heart disease and bronchial dysplasia]. (United States)

    Zeng, Shuang-Lin; Li, Ya-Jun; Huang, Ting; Tan, Li-Hua; Mei, Xi-Long; Sun, Jian-Ning


    To study the relationship of the incidence of bronchial dysplasia (bronchial anomalous origin and bronchial stenosis) with congenital heart disease. A total of 185 children with congenital heart disease or bronchial dysplasia were enrolled. Bronchial dysplasia was identified by the 64-MSCT conventional scanning or thin slice scanning with three-dimensional reconstruction. Forty-five children (25.3%) had coexisting bronchial dysplasia and congenital heart disease. The incidence rate of bronchial dysplasia in children with congenital heart disease associated with ventricular septal defect was higher than in those without ventricular septal defect (33.7% vs 15.0%; Pincidence rate of bronchial dysplasia between the children with congenital heart disease who had a large vascular malformation and who did not. Bronchial dysplasia often occurs in children with congenital heart disease. It is necessary to perform a tracheobronchial CT scanning with three-dimensional reconstruction to identify tracheobronchial dysplasia in children with congenital heart disease, especially associated with ventricular septal defect.

  15. Combined Vesicovaginal and Rectovaginal Fistulas Associated with ...

    African Journals Online (AJOL)

    the history is obtained after discovery of the fistula2. Fewer than ten case reports in the ... the bladder into the vagina and the rectum. Cystoscopy under anesthesia revealed a vesicovaginal fistula above the trigone, 3 cm in diameter, and the presence of a hard, blue, calcified mass. Pelvic examination under anesthesia.

  16. Diagnosis and Treatment of Transsphincteric Perianal Fistulas

    NARCIS (Netherlands)

    D.D.E. Zimmerman (David)


    textabstractFistula’ is the Latin word for a reed, pipe or flute. In medicine it implies a chronic granulating track connecting two epithelium lined surfaces. These surfaces may be cutaneous or mucosal. Perianal fistulas run from the anal canal to the perianal skin or perineum. Perianal fistulas are

  17. An unusual presentation of congenital bronchoesophageal fistula ...

    African Journals Online (AJOL)

    An unusual presentation of congenital bronchoesophageal fistula. OM Atalabi, AG Falade, OM Obajimi, OO Akinyinka, SB Lagundoye, PO Ibinaiye. Abstract. We present the case of a 5-week-old neonate with multiple congenital abnormalities including a broncho-oesophageal fistula, which showed radiological features ...

  18. Assessment and management of urethrocutaneous fistula ...

    African Journals Online (AJOL)

    at time of fistula repair, type of original hypospadias procedure, and number of previous fistula repairs. An algorithm was suggested by some researchers for the management of different types of UCF [8]. Successful repair of these UCF depends on several basic principles, which are the avoidance of procedures on inflamed ...

  19. Erratum: Complications of Arteriovenous Fistula with ...

    African Journals Online (AJOL)


    Sep 14, 2017 ... Erratum: Complications of Arteriovenous Fistula with. Polytetraflouroethylen Grafts in Hemodialysis Patients. In the article titled “Complications of arteriovenous fistula with polytetraflouroethylen grafts in hemodialysis patients” published in pages 120-123, issue 1, vol. 18 of Nigerian Journal of Clinical ...

  20. Endobronchial valves in the management of bronchial fistulae caused by bronchopulmonary aspergillosis. (United States)

    Williams, Rhys; Krishnadas, Rakesh; Patel, Bipen; Jarad, Nabil


    Following an aggressive episode of bronchopulmonary aspergillosis, a 54-year-old man developed a symptomatic air leak via a tunnel between the left upper lobe and an extra chest wall cavity. Following the failure of several surgical procedures to close the tunnel, endobronchial valves normally used in management of emphysema were used to successfully treat the air leak. 2015 BMJ Publishing Group Ltd.

  1. Aggravation of bronchial eosinophilia in mice by nasal and bronchial exposure to Staphylococcus aureus enterotoxin B

    NARCIS (Netherlands)

    Hellings, P. W.; Hens, G.; Meyts, I.; Bullens, D.; Vanoirbeek, J.; Gevaert, P.; Jorissen, M.; Ceuppens, J. L.; Bachert, C.


    The role of bacterial enterotoxins like Staphylococcus aureus enterotoxin B (SEB) in allergic asthma remains unknown. We used a mouse model of airway allergy to study the effects of nasal or bronchial contact with SEB on bronchial allergic inflammation. The features of allergic asthma were induced

  2. Case report: Primary aortosigmoid fistula

    DEFF Research Database (Denmark)

    Khalaf, Chirin; Houlind, Kim Christian


    : Aortoenteric fistulas are more common secondary to previous vascular surgery of aorta, however, PAEF’s involve the sigmoid in only 2 %. Fistulization can be due to diverticulitis and can be difficult to diagnose. CONCLUSION: Retroperitoneal bleeding from the left iliac artery is more common due to a ruptured...... aneurism. This case, however, demonstrates a special PAEF formation as a very rare complication of diverticulitis. The pathophysiology of the PAEF is very unique along with the anatomic localization in the sigmoid colon and left external iliac artery....

  3. Aortoesophageal fistula in a child

    Directory of Open Access Journals (Sweden)

    Shasanka Shekhar Panda


    Full Text Available Aortoesophageal fistulae (AEF are rare and are associated with very high mortality. Foreign body ingestions remain the commonest cause of AEF seen in children. However in a clinical setting of tuberculosis and massive upper GI bleed, an AEF secondary to tuberculosis should be kept in mind. An early strong clinical suspicion with good quality imaging and endoscopic evaluation and timely aggressive surgical intervention helps offer the best possible management for this life threatening disorder. Our case is a 10-year-old boy who presented to the pediatric emergency with massive bouts of haemetemesis and was investigated and managed by multidisciplinary team effort in the emergency setting.

  4. Anal fistulas : New perspectives on treatment and pathogenesis

    NARCIS (Netherlands)

    R.S. van Onkelen (Robbert)


    markdownabstractAbstract The objective of modern anal fistula treatment is healing of the fistula without diminished fecal continence. Sphincter saving techniques have been developed for anal fistulas, for which fistulotomy is not suitable. Treatment of these anal fistulas remains challenging

  5. Women's Intention to Prevent Vesico Vaginal Fistula Recurrence in ...

    African Journals Online (AJOL)

    Objective: The study purpose was to determine the association between intention to prevent Vesico-Vaginal Fistula recurrence and knowledge of the risk factors of Vesico Vaginal Fistula recurrence, attitude towards Vesico Vaginal Fistula prevention and self esteem among women with Vesico-Vaginal Fistula in two repair ...

  6. [Bronchial asthma pathogenesis and genetic prognosis development]. (United States)

    Balmasova, I P; Sepiashvili, R I; Sepiashvili, Ia R; Malova, E S


    The review is dedicated to an actual problem--genetic prognosis of risk of bronchial asthma development that is quite a complex aspect of studies from a methodological viewpoint. Bronchial asthma--heterogeneous disease by both etiology and clinical characteristics. At the same time genetic prognosis is based on the unity of pathogenetic mechanisms of development, though in immunological reactions that are the base of this disease, alternative variants are possible. The aim of this review is carrying out parallels between modern achievements in the field of deciphering trigger mechanisms of bronchial asthma pathogenesis and object of genetic studies based on these mechanisms. Among the examined conceptions--role of epithelial tissue in trigger mechanisms of bronchial asthma, variants of key role of immune system cells, first of all, T-helpers of various types for further development of inflammatory-effector reactions with damage characteristic for this disease. Compliance of contemporary approaches of genetic studies and novel concepts of bronchial asthma pathogenesis is shown.

  7. Enterovesical Fistulae: Aetiology, Imaging, and Management

    Directory of Open Access Journals (Sweden)

    Tomasz Golabek


    Full Text Available Background and Study Objectives. Enterovesical fistula (EVF is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature review by searching the Medline database for articles published from its inception until September 2013 based on clinical relevance. Electronic searches were limited to the keywords: “enterovesical fistula,” “colovesical fistula” (CVF, “pelvic fistula”, and “urinary fistula”. Results. EVF is a rare pathology. Diverticulitis is the commonest aetiology. Over two-thirds of affected patients describe pathognomonic features of pneumaturia, fecaluria, and recurrent urinary tract infections. Computed tomography is the modality of choice for the diagnosis of enterovesical fistulae as not only does it detect a fistula, but it also provides information about the surrounding anatomical structures. Conclusions. In the vast majority of cases, this condition is diagnosed because of unremitting urinary symptoms after gastroenterologist follow-up procedures for a diverticulitis or bowel inflammatory disease. Computed tomography is the most sensitive test for enterovesical fistula.

  8. Vesicovaginal fistula: a review of nigerian experience. (United States)

    Ijaiya, M A; Rahman, A G; Aboyeji, A P; Olatinwo, A W; Esuga, S A; Ogah, O K; Raji, H O; Adebara, I O; Akintobi, A O; Adeniran, A S; Adewole, A A


    Vesicovaginal fistula is a preventable calamity, which has been an age-long menace in developing countries. To review the causes, complications, and outcome of Vesicovaginal fistula in Nigeria. Studies on Vesicovaginal fistula were searched on the internet. Information was obtained on PubMed(medline), WHO website, Bioline International, African Journal of Line, Google scholar, Yahoo, Medscape and e Medicine. Many Nigerian women are living with Vesicovaginal fistula. The annual obstetric fistula incidence is estimated at 2.11 per 1000 births. It is more prevalent in northern Nigeria that southern Nigeria. Obstetric fistula accounts for 84.1%-100% of the Vesicovaginal fistula and prolonged obstructed labour is consistently the most common cause (65.9%-96.5%) in all the series. Other common causes include caesarean section, advanced cervical cancer, uterine rupture, and Gishiri cut. The identified predisposing factors were early marriage and pregnancy, which were rampant in northern Nigeria, while unskilled birth attendance and late presentation to the health facilities was common nationwide. Among the significant contributory factors to high rate of unskilled birth attendance and were poverty, illiteracy, ignorance, restriction of women's movement, non-permission from husband and transportation. All but one Nigerian studies revealed that primiparous women were the most vulnerable group. Pregnancy outcome was dismal in most cases related to delivery with still birth rate of 87%-91.7%. Stigmatization, divorce and social exclusion were common complications. Overall fistula repair success rate was between 75% and 92% in a few centres that offer such services. Vesicovaginal fistula is prevalent in Nigeria and obstetric factors are mostly implicated. It is a public health issue of concern.

  9. Bronchial epithelium: morphology, function and pathophysiology in asthma

    NARCIS (Netherlands)

    Velden, van der V.H.J.; Savelkoul, H.F.J.; Versnel, M.A.


    Summary : Human bronchial epithelium has a number of mechanical functions, including mucociliary clearance and protection against noxious agents. Bronchial epithelial cells are also able to release a variety of mediators, including cytokines, chemokines, growth factors, and arachidonic acid

  10. Comparison of different bronchial closure techniques following pneumonectomy in dogs. (United States)

    Salci, Hakan; Bayram, A Sami; Ozyigit, Ozgur; Gebitekin, Cengiz; Gorgul, O Sacit


    The comparison of the histologic healing and bronchopleural fistula (BPF) complications encountered with three different BS closure techniques (manual suture, stapler and manual suture plus tissue flab) after pneumonectomy in dogs was investigated for a one-month period. The dogs were separated into two groups: group I (GI) (n = 9) and group II (GII) (n = 9). Right and left pneumonectomies were performed on the animals in GI and GII, respectively. Each group was further divided into three subgroups according to BS closure technique: subgroup I (SGI) (n = 3), manual suture; subgroup II (SGII) (n = 3), stapler; and subgroup III (SGIII) (n = 3), manual suture plus tissue flab. The dogs were sacrificed after one month of observation, and the bronchial stumps were removed for histological examination. The complications observed during a one-month period following pneumonectomy in nine dogs (n = 9) were: BPF (n = 5), peri-operative cardiac arrest (n = 1), post-operative respiratory arrest (n = 1), post-operative cardiac failure (n = 1) and cardio-pulmonary failure (n = 1). Histological healing was classified as complete or incomplete healing. Histological healing and BPF complications in the subgroups were analyzed statistically. There was no significant difference in histological healing between SGI and SGIII (p = 1.00; p > 0.05), nor between SGII and SGIII (p = 1.00; p > 0.05). Similarly, no significant difference was observed between the subgroups in terms of BPF (p = 0.945; p > 0.05). The results of the statistical analysis indicated that manual suture, stapler or manual suture plus tissue flab could be alternative methods for BS closure following pneumonectomy in dogs.

  11. Vesicoovarian Fistula on an Endometriosis Abscessed Cyst

    Directory of Open Access Journals (Sweden)

    C. Tran


    Full Text Available We report the case of a patient who developed a vesicoovarian fistula on an endometriosis abscessed cyst. The patient presented with an advanced endometriosis stage IV complicated with a right ovarian abscessed cyst of 10 cm. A first coelioscopy with cystectomy was realized. After surgery, a voiding cystography highlighted a fistula between the ovarian abscess and the bladder. A second surgery by median laparotomy was realized with the resection of the right ovarian abscess and the resection of vesical fistula.

  12. Pericardial fat pad tissue produces angiogenic factors for healing the bronchial stump. (United States)

    Shoji, Fumihiro; Yano, Tokujiro; Miura, Naoko; Morodomi, Yosuke; Yoshida, Tsukihisa; Onimaru, Mitsuho; Maehara, Yoshihiko


    Maintaining blood flow in and supplying various anti-inflammatory or angiogenic cytokines to the bronchial stump are very important factors involved in its healing. Pericardial fat pad tissue samples surgically obtained from 20 patients were assessed, and their angiogenic ability was investigated. The messenger RNA level of all angiogenic cytokines, including vascular endothelial growth factor, fibroblast growth factor-2 (FGF-2), platelet-derived growth factor-A (PDGF-A), angiopoietin-1 (Ang-1), Ang-2 and hepatocyte growth factor (HGF) were detected in the pericardial fat pad tissue. The protein levels of all cytokines except PDGF-A increased with time from day one to day seven after primary culture of the pericardial fat pad tissue. In particular, both HGF and Ang-2 protein levels on day seven were significantly higher than those on day one (P=0.0475 and P=0.0417, respectively). On the other hand, the protein level of FGF-2 decreased in time and was significantly lower on day seven than on day one (P=0.0296). The present study demonstrated the angiogenic ability of the pericardial fat pad. These results suggest that reinforcement of the bronchial stump by the pericardial fat pad is a worthwhile and justified procedure, and may prevent bronchopleural fistula after pulmonary resections.

  13. Chronic Pulmonary Aspergillosis Complicating Bronchial Atresia

    Directory of Open Access Journals (Sweden)

    Mazen O. Al-Qadi


    Full Text Available Bronchial atresia is a rare pulmonary developmental anomaly characterized by the presence of a focal obliteration of a segmental or lobar bronchial lumen. The lung distal to the atretic bronchus is typically emphysematous along with the presence of mucus filled ectatic bronchi (mucoceles. BA is usually asymptomatic but pulmonary infections can rarely develop in the emphysematous lung distal to the atretic bronchus. We present a unique case of chronic pulmonary aspergillosis (CPA in a patient with BA with no evidence of immune dysfunction. The patient was treated initially with voriconazole and subsequently underwent surgical excision of the involved area. On follow-up, she has done extremely well with no evidence for recurrence. In summary, we describe the first case of chronic pulmonary aspergillosis in an immunocompetent patient with bronchial atresia.

  14. Our first experience in treatment of ano rectal fistula with SURGISIS AFP Anal Fistula Plug. (United States)

    Hadzhiev, B


    The aim of this study is to present the early results and to discuss the new method of treatment of ano-rectal fistula with SURGISIS AFP ANAL FISTULA PLUG. Three patients with ano-rectal fistula have been treated in the Department of General Surgery with Coloproctology, using Surgisist AFP anal fistula Plug. Two were with transsphincter and one with extrasphincter ano-rectal fistula. This method of SURGISIS AFP ANAL FISTULA PLUG treatment is presented in details. All patients are with closed fistulas after period of 4, 8 and 12 weeks of follow up. The author emphasized, that with the presented way of treatment the period of hospitalization is shorter, postoperative pain and period of healing are reduced. There are a lot of advantages using this method, compared with the traditional surgical methods. The presented material is insignificant, but it helps to initiate a new noninvasive method of treatment of ano-rectal fistula. Surgisist AFP anal fistula Plug method is a safe and successful. It preserves the anal anatomy and function. The data results, which are presented should be reproduced in a wider future study.

  15. Features of Bronchial Asthma in Children with Overweight and Obesity

    Directory of Open Access Journals (Sweden)

    О.P. Volosovets


    Full Text Available The article deals with the problem of comorbi­dity of bronchial asthma in children with overweight and obesity. The basic pathogenetic mechanisms of correlation between bronchial asthma and overweight and obesity are described. The attention is focused on the role of neutrophilic inflammation in the pathogenesis of bronchial asthma in these patients.

  16. Bronchial diverticula in smokers on thin-section CT

    Energy Technology Data Exchange (ETDEWEB)

    Sverzellati, Nicola; Ingegnoli, Anna [University of Parma, Department of Clinical Sciences, Division of Radiology, Parma (Italy); Calabro, Elisa; Pastorino, Ugo [National Cancer Institute, Division of Thoracic Surgery, Milan (Italy); Randi, Giorgia; La Vecchia, Carlo [Mario Negri Institute, Department of Epidemiology, Milan (Italy); University of Milano, Institute of Medical Statistics and Biometry ' ' G. A. Maccacaro' ' , Milan (Italy); Marchiano, Alfonso [National Cancer Institute, Division of Radiology, Milan (Italy); Kuhnigk, Jan-Martin [Fraunhofer MEVIS - Institute for Medical Image Computing, Bremen (Germany); Hansell, David M. [Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Zompatori, Maurizio [S. Orsola-Malpighi Hospital, Department of Radiology, Bologna (Italy)


    The objective was to determine the prevalence of bronchial diverticula in smokers on thin-section CT and the relationship to clinical and other morphological features on CT. Thin-section CT images of 503 cigarette smokers were assessed for the profusion and location of diverticula in the major airways. The extent of the bronchial diverticula was recorded as follows: grade 0, none; grade 1, one to three diverticula; grade 2, more than three diverticula. The extent of emphysema, bronchial wall thickness, clinical features, and pulmonary function were compared in the sub-groups stratified according to the extent of bronchial diverticula. A total of 229/503 (45.5%) smokers had bronchial diverticula, with 168/503 (33.3%) and 61/503 (12.2%) having grade 1 and 2 bronchial diverticula respectively. Subjects with grade 2 bronchial diverticula were heavier smokers, reported a history of coughing more frequently, and showed more severe functional impairment, greater extent of emphysema and more severe bronchial wall thickening compared with subjects with grade 1 and those individuals without bronchial diverticula (P<0.05). Multivariate regression analysis revealed that only bronchial wall thickness predicted the extent of the bronchial diverticula (P<0.0001). Bronchial diverticula are a frequent finding in the major airways of smokers, and they are associated with other markers of smoking-related damage. (orig.)

  17. Modern druh treatment of bronchial asthma


    Schnitterová, Terezie


    Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Farmacology and Toxicology Candidate: Terezie Schnitterová Supervisor: PharmDr. Marie Vopršalová, CSc. Title of diploma thesis: Modern Pharmacotherapy of Asthma Bronchiale The purpose of this search thesis is to analyse the most common chronic in- flammatory disorder of the airways - asthma bronchiale. The issues are discussed comprehensively and the focus of this thesis is on the current view of treatment, its p...

  18. Analysis of risk factors in the development of bronchopleural fistula after major anatomic lung resection: experience of a single centre. (United States)

    Nachira, Dania; Chiappetta, Marco; Fuso, Leonello; Varone, Francesco; Leli, Ilaria; Congedo, Maria T; Margaritora, Stefano; Granone, Pierluigi


    The bronchopleural fistula (BPF) is a rare but potentially fatal complication of major thoracic surgery. The purpose of this work is to investigate the risk factors associated with the development of fistulas after lobectomy and pneumonectomy. We retrospectively reviewed the records of 835 patients who underwent major anatomic lung resection at our centre from January 2003 to December 2013. Of these, 49 underwent pneumonectomy (P group) and 786 lobectomy (L group). A total of 18 patients (2.6%) developed a BPF in the postoperative period, of which there were 11 in the L group (1.3%) and seven in the P group (14.28%). The 30-day mortality was 0.05% (one patient after right pneumonectomy). In the L group, three patients developed a fistula after a left lobectomy and eight after a right one, of which four developed after bilobectomy. Univariate analysis showed that induction therapy, lower lobectomy, manual suture of the bronchus, 'not covered' bronchial stump, empyema, postoperative anaemia and pulmonary infections and mechanical ventilation >24 h are associated with the development of fistulas after lobectomy. Multivariate analysis confirmed that induction therapy, manual closure of the bronchus, postoperative pulmonary infections and anaemia are the main risk factors involved in our series. In the P group, four patients developed a fistula after a right pneumonectomy and three after a left one. Postoperative empyema and pulmonary infections, mechanical ventilation >24 h and female gender emerged as the main risk factors on univariate analysis, while on multivariate analysis, only the female gender presented a trend towards significance. Postoperative pulmonary infections, empyema and mechanical ventilation >24 h are strongly associated with the development of BPFs after both pneumonectomy and lobectomy in our series. © 2017 Royal Australasian College of Surgeons.

  19. Tracheoesophageal fistula associated with paracoccidioidomicosis

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira


    Full Text Available Paracoccidioidomycosis is a systemic fungal disease caused byParacoccidioides brasiliensis, agent geographically distributed to certainareas of Central and South America. The infection by P. brasiliensis hasbeen reported from north Mexico to south Argentina. Paracoccidioidomycosispresents similar clinical findings of many other diseases whatever in acute or chronic scenarios. Chronic pulmonary paracoccidioidomycosis is frequentlymisdiagnosed as malignancy or tuberculosis. The authors present a caseof a 57 year-old man admitted to the hospital due to a chronic consumptivesyndrome. He underwent anti-tuberculous treatment with rifampin, isoniazid andpyrazinamide 1 year ago without resolution of the simptoms. During the clinicalinvestigation, pulmonary paracoccidioidomycosis with tracheoesophagealfistula was diagnosed. The systemic infection was treated with deoxicolate Bamphotericin followed by sulfametoxazole and trimetoprin due to acute renalfunction impairment. The fistula was endoscopically treated; inittialy with theprotection of left main bronchus with a tracheal prosthesis followed by theesophageal fistula’s ostium clipping.

  20. Malignant duodenocolic fistula. A case report. (United States)

    Giusto, F; Arzillo, G; Lodo, N; Falchero, F; Gramegna, A


    Malignant duodenocolic fistula is a rare condition in which radical surgical treatment is seldom possible. A personal case treated by pancreaticoduodenectomy is presented with a review of the literature.

  1. Enterocutaneous Fistula: Proven Strategies and Updates (United States)

    Gribovskaja-Rupp, Irena; Melton, Genevieve B.


    Management of enterocutaneous fistula represents one of the most protracted and difficult problems in colorectal surgery with substantial morbidity and mortality rates. This article summarizes the current classification systems and successful management protocols, provides an in-depth review of fluid resuscitation, sepsis control, nutrition management, medication management of output quantity, wound care, nonoperative intervention measures, operative timeline, and considerations, and discusses special considerations such as inflammatory bowel disease and enteroatmospheric fistula. PMID:27247538

  2. Management of lymph fistulas in thyroid surgery. (United States)

    Lorenz, Kerstin; Abuazab, Mohammed; Sekulla, Carsten; Nguyen-Thanh, Phuong; Brauckhoff, Michael; Dralle, Henning


    Postoperative lymphatic leakage following thyroid surgery represents a management problem with considerate potential morbidity, psychological, and economical impact. Conservative and surgical management strategies for high- and low-output lymph fistulas are inconsistent. Reliable criteria to predict outcome of conservative versus surgical treatment in clinically evident lymph fistula are lacking. A retrospective single-center chart review of consecutively quality-control-documented thyroid surgeries from January 1998 to December 2009 was performed to identify reported postoperative lymph fistulas. Documentation of surgical procedures, drainage, medical, and nutritional management was analyzed to identify risk factors for occurrence and criteria for management of evident lymph fistulas. There were 29 patients identified with postoperative clinical evidence of lymph fistulas following thyroid surgery; incidence was 0.5%. Indication to surgery comprised benign nodular goiter, recurrent nodular goiter, and thyroid carcinoma or local and lymphonodal carcinoma recurrences. There were 12 (41%) primary and 17 (59%) redo surgeries performed. Surgical procedures performed included thyroidectomy, completion thyroidectomy, and primary and redo central and lateral systematic microdissection of lymphatic compartments. All patients were initially submitted to fasting diet and medical treatment, successfully in 19 (66%), whereas ten (34%) patients underwent surgical intervention for fistula closure after failure of conservative treatment. Complications were one wound infection and fistula recurrence in five (26%) patients in the conservative group and two (20%) in the surgical group. Hospital stay was exceedingly prolonged in both groups with a median of 21 and 11 versus 6 days in patients with regular postoperative course following thyroid surgery. Data of this series support definition of the two categories of high- and low-output fistulas according to drainage collection with

  3. Radiology in cutaneous sinuses and fistulae

    Energy Technology Data Exchange (ETDEWEB)

    Sundgren-Borgstroem, P.; Ekberg, O.; Lasson, A.


    In patients with cutaneous openings, sinograph and fistulography an usually performed. Fistulae in the head/neck region and perineum are seldom life-threatening while enterocutaneous fistulae involving the small bowel can be a serious threat due to loss of fluid. Radiology contributes to the preoperative examination of these patients. Fistulography outlines communications to the gastrointestinal tract, pleura, joints and other underlying crucial structures. Involved bowel segments are further demonstrated with barium examination.

  4. Quality of life with anal fistula. (United States)

    Owen, H A; Buchanan, G N; Schizas, A; Cohen, R; Williams, A B


    Anal fistula affects people of working age. Symptoms include abscess, pain, discharge of pus and blood. Treatment of this benign disease can affect faecal continence, which may, in turn, impair quality of life (QOL). We assessed the QOL of patients with cryptoglandular anal fistula. Newly referred patients with anal fistula completed the St Mark's Incontinence Score, which ranges from 0 (perfect continence) to 24 (totally incontinent), and Short form 36 (SF-36) questionnaire at two institutions with an interest in anal fistula. The data were examined to identify factors affecting QOL. Data were available for 146 patients (47 women), with a median age of 44 years (range 18-82 years) and a median continence score of 0 (range 0-23). Versus population norms, patients had an overall reduction in QOL. While those with recurrent disease had no difference on continence scores, QOL was worse on two of eight SF-36 domains (pfistula patients, 19.4% of patients experienced urgency versus 36.3% of those with recurrent fistulas. Patients with anal fistula had a reduced QOL, which was worse in those with recurrent disease, secondary extensions and urgency. Loose seton had no impact on QOL.

  5. Late caliceal fistula after kidney transplantation. (United States)

    Król, Robert; Ziaja, Jacek; Kolonko, Aureliusz; Chudek, Jerzy; Wiecek, Andrzej; Cierpka, Lech


    Caliceal fistula is a rare urological complication that can occur usually shortly after kidney transplantation (KTx). The occlusion of the renal accessory artery with subsequent necrosis of the kidney pole is the most common cause of the fistula development. We report a case of a 57-year-old man with reconstruction of two accessory renal arteries by anastomosis to the side of the main artery during graft placement complicated by late caliceal fistula, managed surgically. Directly after KTx good kidney graft function (serum creatinine concentration 151 micromol/L) was observed. The patient noticed protuberance and pain in the kidney graft area 5 months later. Diagnostic imaging revealed moderate urostasis and liquid collection in the region of the lower graft pole. Administration of a contrast medium through the inserted drain visualized a fistula of a lower renal calyx and ureteric stenosis. Percutaneous drainage was applied with subsequent stop of diuresis through the urethral catheter. During the surgery, the resection of a lower kidney graft pole necrosis was performed, with the closure of caliceal fistula. Simultaneously double pigtail ureteric stent was inserted. After the next two months the pigtail catheter was removed, and neither urostasis in the kidney graft nor liquid collection in the perigraft area were observed. The exceptionality of the case is the late caliceal fistula occurrence. We may only speculate, why it happened 5 months after KTx. The thrombosis of stenosed accessory artery is the most probable cause.

  6. Associations between asthma and bronchial hyperresponsiveness ...

    African Journals Online (AJOL)

    Objectives. To determine asthma and allergy phenotypes in unselected urban black teenagers and to associate bronchial hyperresponsiveness (BHR) with asthma, other atopic diseases and allergen sensitisation. Methods. This was a cross-sectional study of 211 urban highschool black children of Xhosa ethnicity. Modified ...


    African Journals Online (AJOL)


    Jan 2, 1971 ... BRONCHIAL FRACTURE FOLLOWING BLUNT CHEST TRAUMA*. J. F. HITCHCOCK, M.B., CH.B., M.MED. (SURG.), Department of Cardiolhoracic SlIrger.\\", Croote Schllllr Hospilal,. Cape Town. Fractures of the trachea or major bronchi are becoming increasingly common. in particu:ar fractures of one or.

  8. Bronchial carcinoid tumors: A rare malignant tumor

    African Journals Online (AJOL)


    Feb 3, 2015 ... Nigerian Journal of Clinical Practice • Sep-Oct 2015 • Vol 18 • Issue 5. Abstract. Bronchial carcinoid tumors (BCTs) are an uncommon group of lung tumors. They commonly affect the young adults and the middle aged, the same age group affected by other more common chronic lung conditions such as ...

  9. Bronchial mucoepidermoid carcinoma: A case report

    Directory of Open Access Journals (Sweden)

    Alessandro G. Fois


    Conclusions: Low grade type of Bronchial MEC, as our case, is often characterized by an optimal clinical management and prognosis. The lack of EGFR sensitizing mutations does not preclude the use of TKIs, which may be extremely useful in patients non responsive to other therapies.

  10. Determinants and regulating processes in bronchial hyperreactivity

    NARCIS (Netherlands)

    H.J. Neijens (Herman)


    textabstractBronchial hyperresponsiveness (BHR) can be considered as a feature of asthma, although only a loose relationship is present with symptoms and severity of the disease. Epidemiology of BHR may inform about determining factors in BHR and its role as a risk factor. BHR is found already at a

  11. Clavicular osteoma associated with bronchial osteomas

    Energy Technology Data Exchange (ETDEWEB)

    Saglik, Yener; Yiliz, H. Yusuf; Erakar, Aziz [Department of Orthopaedic Surgery, Ankara University School of Medicine, 06100, Ankara (Turkey); Kendi, Tuba Karaguelle [Integra MR Imaging Center, Ankara (Turkey); CMRR, University of Minnesota, 2021 6th Street SE, MN 55455, Minneapolis (United States); Guengoer, Adem [Department of Chest Surgery, Ankara University School of Medicine, 06100, Ankara (Turkey); Erekul, Selim [Department of Pathology, Ankara University School of Medicine, 06100, Ankara (Turkey)


    Osteoma is a rare benign tumor, composed of bony tissues. It predominantly involves the skull but rarely the long bones. In this report we present a case of clavicular osteoma associated with bronchial osteomas. This association has not previously been reported. There was no evidence of Gardner's syndrome. (orig.)

  12. Management of anal fistula by ligation of the intersphincteric fistula tract

    DEFF Research Database (Denmark)

    Zirak-Schmidt, Samira; Perdawood, Sharaf


    INTRODUCTION: Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-preserving procedure for treatment of anal fistulas described in 2007 by Rojanasakul et al. Several studies have since then assessed the procedure with varied results. This review assesses the relevant literature...

  13. [Bronchial hypersensitivity in children with the neutrophilic phenotype of bronchial asthma and GSTM1 and GSTT1 gene polymorphism]. (United States)

    Bezrukov, L A; Koloskova, E K; Galushchinskaia, A V


    The relationship between bronchial hypersensitivity as the key phenomenon ofbronchial asthma and detoxication GSTM1 or GSTT1 gene polymorphism in children with neutrophilic phenotype of this disease remains unclear 33 children with bronchial asthma of neutrophile phenotype were examined in histamine and dosed physical exercise (running) tests. In addition GSTM1 and GSTT1 genotyping was performed. Histamine test revealed bronchial hypersensitivity (HTC bronchial asthma having deletions in the GSTT1/GSTM1 system are characterized by bronchial hypersensitivity to histamine and dosed physical exercises.

  14. Congenital rectovestibular fistula associated with rectal atresia: A rare occurrence


    Rizwan Ahmad Khan; Rajendra Singh Chana


    We report a rare variety of anorectal malformation, rectal atresia associated with rectovestibular fistula. The case was successfully treated by posterior sagittal repair. The fistula was mobilized and the continuity of the rectum was established by circumferential anastomosis.

  15. Urethrovaginal Fistula in a 5-Year-Old Girl (United States)

    Coulibaly, Noël; Sangaré, Ibrahima Séga


    Urethral fistulas are rare in girls. They occur most of the time during trauma. The case presented here is an iatrogenic fistula. The treatment was simple and consisted of a simple dissection and suture of urethra and vagina. PMID:25954566

  16. Imaging diagnosis of dural and direct cavernous carotid fistulae* (United States)

    dos Santos, Daniela; Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Cruz, Antonio Augusto Velasco e; Colli, Benedicto Oscar; Abud, Daniel Giansante


    Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae. PMID:25741093

  17. Imaging diagnosis of dural and direct cavernous carotid fistulae. (United States)

    Dos Santos, Daniela; Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Cruz, Antonio Augusto Velasco E; Colli, Benedicto Oscar; Abud, Daniel Giansante


    Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae.

  18. Imaging diagnosis of dural and direct cavernous carotid fistulae

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Daniela dos; Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Cruz, Antonio Augusto Velasco e; Colli, Benedicto Oscar; Abud, Daniel Giansante, E-mail: [Universidade de Sao Paulo (HCFMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas


    Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae. (author)


    Directory of Open Access Journals (Sweden)

    Barbara Cvenkel


    Full Text Available Background. Dural carotid-cavernous sinus fistulas (CCF are communications fed by meningeal branches of the intracavernous internal carotid artery (ACI or/and external carotid artery (ACE. In contrast to typical CCF, the arteriovenous shunting of blood is usually low flow and low pressure. Spontaneous dural CCF are more common in postmenopausal women. Aetiology is unknown, but congenital malformation or rupture of thin-walled dural arteries within venous sinuses is believed to be the cause.Case reports. 3 cases lacking the typical clinical signs of CCF who had been treated as chronic conjunctivitis, myositis of the extraocular muscle and orbital pseudotumour are presented. Clinical presentation depends on the direction and magnitude of fistular flow and on the anatomy of the collateral branches. If increased blood flow is directed anteriorly in ophthalmic veins the signs of orbito-ocular congestion are present (»redeyed shunt syndrome«. Drainage primarly in the inferior petrosal sinus may cause painful oculomotor and abducens palsies without signs of ocular congestion (»white-eyed shunt syndrome«. Also different therapeutic approaches as well as possible complications are described.Conclusions. For definite diagnosis angiography is obligatory and is also therapeutic as one third to one half of dural CCF close spontaneously. Because of potential severe eye and systemic complications, surgical intervention is indicated only in cases with uncontrolled secondary glaucoma and hypoxic retinopathy.

  20. Fistula gastrocólica

    Directory of Open Access Journals (Sweden)

    Alexandre Cruz Henriques

    Full Text Available A case of gastrocolic fistula(GCF in a patient with duodenal stenosis who had previously undergone gastroenteric anastomosis is reported. The patient went through hemigastrectomy, partial colectomy and segmental enterectomy with bloc resection. Reconstruction was carried out through Billroth II gastrojejunostomy, jejunojejunostomy and end-to-end anastomosis of the colon. The patient had good post-operative evolution and was discharged from hospital seven days after surgery. GCF should be suspected in patients presenting weight loss, diarrhea and fecal vomiting, mainly with history of peptic ulcer surgery, gastric or colonic malignancy and use of steroidal and nonsteroidal antiinflamatory drugs. Barium enema is the choice test for diagnosis, however, the benign or malignant nature of the lesion should always be evaluated through high digestive endoscopy. Clinical treatment with oral H2-antagonists and discontinuing ulcerogenic medications might be indicated in some cases; surgical treatment is indicated in cases of malignant disease and might be indicated in cases of peptic disease as it treats GCF and also the baseline disease. Some advise upwards colostomy at first. The most used technique is bloc resection, including the fistulous tract, hemigastrectomy and partial colectomy. Gastrectomy, fistulous tract excision and colon suturing may be performed in some cases. The mortality rate is related to metabolic disorders and the recurrence with the use of antiinflammatory drugs.

  1. Endoscopic Management of Gastrointestinal Leaks and Fistulae. (United States)

    Willingham, Field F; Buscaglia, Jonathan M


    Gastrointestinal leaks and fistulae can be serious acute complications or chronic morbid conditions resulting from inflammatory, malignant, or postsurgical states. Endoscopic closure of gastrointestinal leaks and fistulae represents major progress in the treatment of patients with these complex presentations. The main goal of endoscopic therapy is the interruption of the flow of luminal contents across a gastrointestinal defect. In consideration of the proper endoscopic approach to luminal closure, several basic principles must be considered. Undrained cavities and fluid collections must often first be drained percutaneously, and the percutaneous drain provides an important measure of safety for subsequent endoscopic luminal manipulations. The size and exact location of the leak/fistula, as well as the viability of the surrounding tissue, must be defined. Almost all complex leaks and fistulae must be approached in a multidisciplinary manner, collaborating with colleagues in nutrition, radiology, and surgery. Currently, gastrointestinal leaks and fistulae may be managed endoscopically by using 1 or more of the following modalities: stent placement, clip closure (including through-the-scope clips and over-the-scope devices), endoscopic suturing, and the injection of tissue sealants. In this article, we discuss these modalities and review the published outcomes data regarding each approach as well as practical considerations for successful closure of luminal defects. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  2. Lacrimal Gland Fistula following Severe Head Trauma

    Directory of Open Access Journals (Sweden)

    Cemil Demir


    Full Text Available We aim to present a unique case with discharging lacrimal gland fistula secondary to severe head trauma by an animal. A 9-year-old girl presented with serous fluid discharge from a cutaneous fistula in the left orbital region. The patient had history of surgery for traumatic frontal bone fracture and skin laceration in the superior orbital rim three weeks earlier. She underwent a complete ophthalmological examination and there was no anterior segment or fundus pathology. The orifice of the fistula was detected in mediolateral part of the left superior orbital rim and fluid secretion was increasing with irritation of the left eye. Neurosurgical complications were excluded and radiological assessment was nonremarkable. The patient’s legal representatives were informed and lacrimal gland fistulectomy was planned. However, the fistula was self-closed one week after initial ophthalmological examination, and the patient had no symptoms. In conclusion, traumatic injuries of superior orbital region should be carefully evaluated and wounds should be well closed to prevent consecutive lacrimal gland fistula.

  3. Intraventricular hemorrhage after dural fistula embolization

    Directory of Open Access Journals (Sweden)

    Joana Chaves Gonçalves Rodrigues de Carvalho

    Full Text Available Abstract Background and objectives: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. Case report: A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. Conclusion: Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.

  4. A simple procedure for management of urethrocutaneous fistulas ...

    African Journals Online (AJOL)

    Objectives: The treatment of urethral fistulas is quite challenging. We try to evaluate the results of a simple procedure in post-hypospadias urethral fistula repair. Materials and Methods: In the period from 2003 to 2007, 35 patients with 35 fistulas, with an average age 3.5 years [range: 2-8], were classified into coronal 12, ...

  5. An Experience in Arterio-Venous Fistula creation for Chronic ...

    African Journals Online (AJOL)

    Obtaining a vascular access for haemodialysis is very vital in the long-term management of patients with end-age renal disease. This is achieved via an autogenous (primary) arteriovenous fistula or a grafted fistula in situations where autogenous fistulas may not function. Complications such as thrombosis and infection are ...

  6. Histological identification of epithelium in perianal fistulae: a prospective study

    NARCIS (Netherlands)

    van Koperen, P. J.; ten Kate, F. J. W.; Bemelman, W. A.; Slors, J. F. M.


    A procedure often performed following fistulotomy and advancement flap is curettage of the fistula tract after fistulotomy or after closing the internal opening. Epithelialization of the fistula tract might prevent closure of the fistula tract. The aim of this study was to assess the incidence and

  7. Paediatric Acquired Recto –Vestibular Fistula: Experience In Accra ...

    African Journals Online (AJOL)

    The association of acquired recto-vaginal fistula (RVF) with the human immunodeficiency virus is increasingly being recognized and reported in the literature Congenital recto - vestibular fistulae associated with imperforate anus is not uncommon, but it is rare to see children with acquired recto - vestibular fistula. From 1997 ...

  8. A simple procedure for management of urethrocutaneous fistulas ...

    African Journals Online (AJOL)

    Midline relaxing incision was used for large fistulas and then covered with a vascularised flap dartos-based flap [flip flap] in 19 and tunica vaginalis in 16. If a patient had more than one small fistula adjacent to each other, they were joined into a large single fistula and then repaired. Results: We have successfully repaired all ...

  9. The management of a coronary cameral fistula: lessons learnt

    African Journals Online (AJOL)


    Sep 21, 2011 ... Surgery for closure of the fistulae was planned months later when the patient was symptom-free. Preoperatively, on admission to the cardiothoracic ward, his blood pressure was. 138/89 mmHg ... Keywords: coronary arteriovenous fistula, coronary cameral fistula, cardiac disease, coronary artery anomaly.

  10. Post-Anastomotic Enterocutaneous Fistulas: Associated Factors and ...

    African Journals Online (AJOL)

    Enterocutaneous fistulas cause significant morbidity and mortality and can challenge even the most experienced surgeon (1). In the developed countries, most fistulas are due to Crohn's disease (2) but may also arise to postoperatively (3). Historically, when enterocutaneous fistulas developed, less than half closed ...

  11. Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, J.; Flower, C. [Department of Radiology, Addenbrooke`s Hospital, University of Cambridge Teaching Hospital (United Kingdom); Schnyder, P. [Department of Radiology, University Hospital, Lausanne (Switzerland); Herold, C. [Department of Radiology, University Hospital of Vienna (Austria)


    Idiopathic bronchiolitis obliterans organising pneumonia (BOOP) is an uncommon but well-recognised condition that usually presents radiologically as bilateral multifocal patchy areas of consolidation on the chest radiograph and on computed tomography (CT). Five cases are described in which the presenting feature was that of a solitary pulmonary nodule. Four of these nodules showed evidence of cavitation and three patients presented with haemoptysis. In all cases the appearances closely resembled bronchial carcinoma. (orig.) With 5 figs., 21 refs.

  12. Relationship Between Atopy and Bronchial Hyperresponsiveness


    Suh, Dong In; Koh, Young Yull


    Both atopy and bronchial hyperresponsiveness (BHR) are characteristic features of asthma. They are also found among non-asthmatic subjects, including allergic rhinitis patients and the general population. Atopy and BHR in asthma are closely related. Atopy induces airway inflammation as an IgE response to a specific allergen, which causes or amplifies BHR. Moreover, significant evidence of the close relationship between atopy and BHR has been found in non-asthmatic subjects. In this article, w...

  13. Eyelid liquoric fistula secondary to orbital meningocele

    Directory of Open Access Journals (Sweden)

    Renato Antunes Schiave Germano


    Full Text Available Liquoric fistula (LF is defined as the communication of the subarachnoid space with the external environment, which main complication is the development of infection in the central nervous system. We reported the case of a patient with non-traumatic eyelid liquoric fistula secondary to orbital meningocele (congenital lesion, which main clinical manifestation was unilateral eyelid edema. Her symptoms and clinical signs appeared in adulthood, which is uncommon. The patient received surgical treatment, with complete resolution of the eyelid swelling. In conclusion, eyelid cerebrospinal fluid (CSF fistula is a rare condition but with great potential deleterious to the patient. It should be considered in the differential diagnosis of unilateral eyelid edema, and surgical treatment is almost always mandatory.

  14. Pancreatic Pseudocyst Pleural Fistula in Gallstone Pancreatitis

    Directory of Open Access Journals (Sweden)

    Sala Abdalla


    Full Text Available Extra-abdominal complications of pancreatitis such as pancreaticopleural fistulae are rare. A pancreaticopleural fistula occurs when inflammation of the pancreas and pancreatic ductal disruption lead to leakage of secretions through a fistulous tract into the thorax. The underlying aetiology in the majority of cases is alcohol-induced chronic pancreatitis. The diagnosis is often delayed given that the majority of patients present with pulmonary symptoms and frequently have large, persistent pleural effusions. The diagnosis is confirmed through imaging and the detection of significantly elevated amylase levels in the pleural exudate. Treatment options include somatostatin analogues, thoracocentesis, endoscopic retrograde cholangiopancreatography (ERCP with pancreatic duct stenting, and surgery. The authors present a case of pancreatic pseudocyst pleural fistula in a woman with gallstone pancreatitis presenting with recurrent pneumonias and bilateral pleural effusions.

  15. Eguchipsammia fistula Microsatellite Development and Population Analysis

    KAUST Repository

    Mughal, Mehreen


    Deep water corals are an understudied yet biologically important and fragile ecosystem under threat from recent increasing temperatures and high carbon dioxide emissions. Using 454 sequencing, we develop 14 new microsatellite markers for the deep water coral Eguchipsammia fistula, collected from the Red Sea but found in deep water coral ecosystems globally. We tested these microsatellite primers on 26 samples of this coral collected from a single population. Results show that these corals are highly clonal within this population stemming from a high level of asexual reproduction. Mitochondrial studies back up microsatellite findings of high levels of genetic similarity. CO1, ND1 and ATP6 mitochondrial sequences of E. fistula and 11 other coral species were used to build phylogenetic trees which grouped E. fistula with shallow water coral Porites rather than deep sea L. Petusa.


    Directory of Open Access Journals (Sweden)

    Sushma Ramteke


    Full Text Available BACKGROUND Fistula in ano is one of the common problem faced in today’s world. Fistula in ano is track lined by granulation tissue that connect deeply in the anal canal or rectum and superficially on the skin around the anus. It usually results from cryptoglandular infection causing abscess, which burst spontaneously or was drained inadequately. The study is conducted to find most common aetiological factor and to evaluate various surgical technique and their outcome. The aim of the study is to- 1. Study the incidence of various aetiologies of fistula in ano. 2. Study the clinical presentation of fistula in ano. 3. Evaluate different modalities of surgical approach and their outcome. MATERIALS AND METHODS This prospective study was conducted at Late Lakhiram Agrawal Memorial Government Medical College, Raigarh, during the study period of July 2015 to July 2016. All the 50 cases were included in this study who were above 15 year of age diagnosed with fistula in ano on the basis of clinical examination who underwent surgical procedure. RESULTS In present study of 50 cases, 60% of cases were in the age group of 31-50 years. Male:female ratio was 9:1. 80% of cases belong to low socioeconomic status. The most common mode of presentation was discharging sinus in 96% of cases. 70% of patient had past history of burst abscess or surgical drainage of abscess. 90% of cases have single external opening. 80% of cases had posterior external opening. Most of the fistula are of low anal type, which was 92% and rest of the patient had an internal opening situated above the anorectal ring. The most common surgical approach done was fistulectomy. Only fistulectomy was done in 80% of patients. Fistulectomy with sphincterectomy was done in two patients. These two patients had associated anal fissure. Fistulectomy with seton placement was done in two patients of high level of fistula type. Fistulotomy was done in four patients (8%, these were of low fistula type

  17. Dynamic Properties of Human Bronchial Airway Tissues

    CERN Document Server

    Wang, Jau-Yi; Pallai, Prathap; Corrigan, Chris J; Lee, Tak H


    Young's Modulus and dynamic force moduli were measured on human bronchial airway tissues by compression. A simple and low-cost system for measuring the tensile-strengh of soft bio-materials has been built for this study. The force-distance measurements were undertaken on the dissected bronchial airway walls, cartilages and mucosa from the surgery-removed lungs donated by lung cancer patients with COPD. Young's modulus is estimated from the initial slope of unloading force-displacement curve and the dynamic force moduli (storage and loss) are measured at low frequency (from 3 to 45 Hz). All the samples were preserved in the PBS solution at room temperature and the measurements were perfomed within 4 hours after surgery. Young's modulus of the human bronchial airway walls are fond ranged between 0.17 and 1.65 MPa, ranged between 0.25 to 1.96 MPa for cartilages, and between 0.02 to 0.28 MPa for mucosa. The storage modulus are found varying 0.10 MPa with frequency while the loss modulus are found increasing from ...

  18. [Charcoal smoke causes bronchial anthracosis and COPD]. (United States)

    Huttner, Hans; Beyer, Michael; Bargon, Joachim


    Bronchopulmonary disease due to inhalation of smoke from open woodfires represents a major health problem in developing countries. Due to increasing migration such patients also present to medical services in Europe. An 84-year-old Afghan housewife who never smoked nor has a history of exposure to inorganic dusts, presents with chronic obstructive pulmonary disease (COPD) in association with bronchial anthracosis and stenosis of a bronchus. The complaints are found to be caused by chronic inhalation of smoke from an open woodfire which was used for cooking. The main complaints of "woodsmoke-associated lung disease" are cough und dyspnea with bronchial obstruction. Radiology and bronchoscopy usually reveal changes which are similar to pneumoconiosis of miners but without patients' relevant exposure. There is a frequent association of anthracotic bronchial stenosis and infection with tuberculosis. Since patients rarely recognize the risks of woodsmoke inhalation, they hardly report their exposure. Thus, the anamnesis is crucial to establish the right diagnosis and guide the patient to the appropriate diagnostic and therapeutic procedures.

  19. Laparoscopic repair for vesicouterine fistulae

    Directory of Open Access Journals (Sweden)

    Rafael A. Maioli


    Full Text Available ABSTRACT Objective: The purpose of this video is to present the laparoscopic repair of a VUF in a 42-year-old woman, with gross hematuria, in the immediate postoperative phase following a cesarean delivery. The obstetric team implemented conservative management, including Foley catheter insertion, for 2 weeks. She subsequently developed intermittent hematuria and cystitis. The urology team was consulted 15 days after cesarean delivery. Cystoscopy indicated an ulcerated lesion in the bladder dome of approximately 1.0cm in size. Hysterosalpingography and a pelvic computed tomography scan indicated a fistula. Materials and Methods: Laparoscopic repair was performed 30 days after the cesarean delivery. The patient was placed in the lithotomy position while also in an extreme Trendelenburg position. Pneumoperitoneum was established using a Veress needle in the midline infra-umbilical region, and a primary 11-mm port was inserted. Another 11-mm port was inserted exactly between the left superior iliac spine and the umbilicus. Two other 5-mm ports were established under laparoscopic guidance in the iliac fossa on both sides. The omental adhesions in the pelvis were carefully released and the peritoneum between the bladder and uterus was incised via cautery. Limited cystotomy was performed, and the specific sites of the fistula and the ureteral meatus were identified; thereafter, the posterior bladder wall was adequately mobilized away from the uterus. The uterine rent was then closed using single 3/0Vicryl sutures and two-layer watertight closure of the urinary bladder was achieved by using 3/0Vicryl sutures. An omental flap was mobilized and inserted between the uterus and the urinary bladder, and was fixed using two 3/0Vicryl sutures, followed by tube drain insertion. Results: The operative time was 140 min, whereas the blood loss was 100ml. The patient was discharged 3 days after surgery, and the catheter was removed 12 days after surgery

  20. Tracheoesophageal fistula after blunt chest trauma. (United States)

    Reed, W J; Doyle, S E; Aprahamian, C


    Tracheoesophageal fistula is a very rare but potentially life-threatening complication of blunt chest trauma. Prior reviews have revealed that the victims were all young men involved in deceleration or crush injuries. Of those involved in motor vehicle accidents, most were thrown against the steering wheel. Herein, we review the world literature on this injury and include our own report of 1 of the few cases of traumatic tracheoesophageal fistula involving a female victim. In this case, the victim was an unrestrained driver thrown against an air bag.

  1. Vector Volume Flow in Arteriovenous Fistulas

    DEFF Research Database (Denmark)

    Hansen, Peter Møller; Heerwagen, Søren; Pedersen, Mads Møller


    The majority of patients with end stage renal disease are in hemodialysis, and therefore dependent on a well functioning vascular access. The arteriovenous fistula is the recommended access and in order to maintain and keep the fistula patent, regular monitoring of the function is necessary....... The Ultrasound Dilution Technique is the reference method for volume flow measurement, but it only works in conjunction with the dialysis machine, and use is therefore restricted to dialysis sessions. Volume flow measurement with conventional Doppler ultrasound provides a non invasive, highly accessible solution...

  2. Intrahepatic arterioportal fistulae: role of transcatheter embolization. (United States)

    Tarazov, P G


    Management of 26 arterioportal fistulae (APFs) is reported. Among 13 hepatoma-induced fistulae (group A), conservative treatment was ineffective in 8 patients, and arterial embolization alleviated portal hypertension in the other 5. Of 10 iatrogenic APFs (group B), the 3 largest were successfully embolized, the remaining lesions resolved spontaneously. Three spontaneous nonmalignant APFs (group C) were embolized. Excellent results were obtained in 2 patients, and the other died of severe postembolization hepatic failure. Because long-standing APFs may cause severe portal hypertension with consequent variceal bleeding they should be treated. Arterial embolization is indicated in most patients.

  3. [Ruptured aortoiliac aneurysm with AV-fistula]. (United States)

    Kinkel, B; Ertecoglou, E; Pauleit, D


    A 65-year-old man presented an acute swelling of the left leg as the main sign. A pulsatile bruit could be auscultated over the abdomen. Doppler ultrasound suggested an aortic aneurysm with fistula. Dynamic bolus-triggered computed tomography demonstrated an aortoiliac aneurysm with a fistula into the confluence of the common iliac veins. An aorto-iliac graft was inserted surgically and and the patient recovered well. In patients with an acute swelling of a lower limb an aorto-iliac aneurysm, though a rare cause, should be considered.

  4. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation. (United States)

    Demartini, Zeferino; Liebert, Fernando; Gatto, Luana Antunes Maranha; Jung, Thiago Simiano; Rocha, Carlos; Santos, Alex Marques Borges; Koppe, Gelson Luis


    Unilateral carotid cavernous fistula presents with ipsilateral ocular findings. Bilateral presentation is only seen in bilateral fistulas, usually associated with indirect (dural) carotid cavernous fistulas. Direct carotid cavernous fistulas are an abnormal communication between the internal carotid artery and the cavernous sinus. They typically begin with a traumatic disruption in the artery wall into the cavernous sinus, presenting with a classic triad of unilateral pulsatile exophthalmos, cranial bruit and episcleral venous engorgement. We report the case of a 38-year-old male with traumatic right carotid cavernous sinus fistula and bilateral ocular presentation successfully treated by interventional neuroradiology.

  5. Eosinophils promote epithelial to mesenchymal transition of bronchial epithelial cells.

    Directory of Open Access Journals (Sweden)

    Atsushi Yasukawa

    Full Text Available Eosinophilic inflammation and remodeling of the airways including subepithelial fibrosis and myofibroblast hyperplasia are characteristic pathological findings of bronchial asthma. Epithelial to mesenchymal transition (EMT plays a critical role in airway remodelling. In this study, we hypothesized that infiltrating eosinophils promote airway remodelling in bronchial asthma. To demonstrate this hypothesis we evaluated the effect of eosinophils on EMT by in vitro and in vivo studies. EMT was assessed in mice that received intra-tracheal instillation of mouse bone marrow derived eosinophils and in human bronchial epithelial cells co-cultured with eosinophils freshly purified from healthy individuals or with eosinophilic leukemia cell lines. Intra-tracheal instillation of eosinophils was associated with enhanced bronchial inflammation and fibrosis and increased lung concentration of growth factors. Mice instilled with eosinophils pre-treated with transforming growth factor(TGF-β1 siRNA had decreased bronchial wall fibrosis compared to controls. EMT was induced in bronchial epithelial cells co-cultured with human eosinophils and it was associated with increased expression of TGF-β1 and Smad3 phosphorylation in the bronchial epithelial cells. Treatment with anti-TGF-β1 antibody blocked EMT in bronchial epithelial cells. Eosinophils induced EMT in bronchial epithelial cells, suggesting their contribution to the pathogenesis of airway remodelling.

  6. Secondary Iliac-Enteric Fistula to the Sigmoid Colon Complicated with Entero-Grafto-Cutaneous Fistula

    Directory of Open Access Journals (Sweden)

    Gábor Bognár


    Full Text Available We report the case of a 67-year-old man who was admitted to our department with acute rectal bleeding. The patient had had previous aortoiliac surgery with the utilization of an aortobifemoral vascular prosthesis. Diagnosis of aortoenteric fistula was made between the distal suture line of the right graft leg and the sigmoid colon. This fistula had an enterocutaneous component. After exploratory laparotomy, primary resection of the sigmoid colon, exstirpation of the enterocutaneous fistula, excision of the right graft leg and extraanatomical crossover bypass were successfully performed. This study reports a rare type of aorto/ilac-enteric fistula to the left colon complicated with an entero-grafto-cutaneous component and describes an unusual and successful surgical treatment method.

  7. The brachio-brachial arteriovenous fistula: mid-term results. (United States)

    Dorobantu, Lucian Florin; Iliescu, Vlad Anton; Stiru, Ovidiu; Bubenek, Serban; Novelli, Eugenio


    To evaluate the mid-term results of the brachio-brachial arteriovenous fistula in patients without adequate superficial venous circulation in the upper limb. Retrospective analysis included 49 patients, in whom a brachio-brachial fistula had been created in an end-to-side configuration. After the maturation period (1 month), the brachial vein was transposed into the subcutaneous tissue. Follow-up study was performed in patients with functional brachio-brachial fistula after the superficialization. Forty-nine patients underwent 49 brachio-brachial fistula constructions. All fistulas were functional. One month after surgery, 40 (81.6%) of these patients had a functional fistula, but in only 39 (79.6%) cases was the fistula suitable for hemodialysis (HD) following transposition to subcutaneous tissue. During the 1-month maturation period, the fistula became occluded in nine patients, and in one case the vein was permeable, so the fistula was functional, but too small to permit HD. Seventeen patients developed temporary edema of the forearm during the first month, in three cases the edema was extended to the entire arm, but no other complications were associated with the procedure. Follow-up lasted 18.0 +/- 11.1 (3-37) months, during which 7/39 patients presented with fistula occlusion. Three patients died and another three were out of the study for various reasons. The brachio-brachial fistula is a good alternative to prosthetic grafts in patients without superficial venous circulation in the upper limb.

  8. A Delayed Recrudescent Case of Sigmoidocutaneous Fistula due to Diverticulitis

    Directory of Open Access Journals (Sweden)

    Takaaki Fujii


    Full Text Available Colocutaneous fistula caused by diverticulitis is relatively rare, and a delayed recrudescent case of colocutaneous fistula is very uncommon. We herein report a rare case of a Japanese 56-year-old male with delayed recrudescent sigmoidocutaneous fistula due to diverticulitis. A colocutaneous fistula was formed after a drainage operation against a perforation of the sigmoid colon diverticulum. After 5 years from treatment, he was admitted to our hospital because of lower abdominal pain. We diagnosed the recrudescent sigmoidocutaneous fistula by abdominal computed tomography and gastrografin enema, and managed the patient with total parenteral nutrition and antibiotics. As the fistula formation did not improve, a low anterior resection with fistulectomy was performed. The postoperative course was uneventful and the patient was discharged. It has been reported that, in fistulas of the skin caused by diverticular disease, complete closure of the fistula by conservative therapy may not be possible. This case also implies the possibility of a recurrence of the fistula even if the conservative treatment was effective. In cases of colocutaneous fistulas due to diverticulitis, radical surgery is considered necessary because of possibility of recurrence of the fistula.

  9. Obstetric urogenital fistula: The Ilorin experience, Nigeria

    African Journals Online (AJOL)


    Dec 31, 1998 ... tula managed over a ten-year period (lst January, 1989 to. 31st December, 1998) at the University of Ilorin Teaching. Hospital is reported. The incidence of obstetric urogenital fistula is 1.1 per 1000 births. The condition is associated with illiteracy and poorly supervised delivery. The peak incidence is in 15 ...

  10. Assessment and management of urethrocutaneous fistula ...

    African Journals Online (AJOL)

    Background/Purpose To highlight and assess the different factors related to the development of urethrocutaneous fistulae (UCFs) after hypospadias repair, and the outcome of their repair using two different techniques. Patients and methods In the period June 2009 to October 2010, all patients presenting to the Pediatric ...

  11. Urethrocutaneous fistula complicating circumcision in children

    African Journals Online (AJOL)


    May 22, 2013 ... Thus, the patients might be uncooperative intraoperatively resulting in hasty clamping of urethral wall alongside the frenular vessels while securing hemostasis or in some cases inadvertent scalpel injury to the urethral wall. The consequent fistula is synonymous with this method as reported in some studies.

  12. Current Evidence Supporting Obstetric Fistula Prevention Strategies ...

    African Journals Online (AJOL)

    Grey literature provided context. Evidences from the articles were linked to prevention strategies retrieved from grey literature. The strategies were classified using an innovative target-focused method. Gaps in the literature show the need for fistula prevention research to aim at systematically measuring incidence and ...

  13. Coronary Arteriovenous Fistula Causing Hydrops Fetalis

    Directory of Open Access Journals (Sweden)

    Nilüfer Çetiner


    Full Text Available Fetal heart failure and hydrops fetalis may occur due to systemic arteriovenous fistula because of increased cardiac output. Arteriovenous fistula of the central nervous system, liver, bone or vascular tumors such as sacrococcygeal teratoma were previously reported to be causes of intrauterine heart failure. However, coronary arteriovenous fistula was not reported as a cause of fetal heart failure previously. It is a rare pathology comprising 0.2–0.4% of all congenital heart diseases even during postnatal life. Some may remain asymptomatic for many years and diagnosed by auscultation of a continuous murmur during a routine examination, while a larger fistulous coronary artery opening to a low pressure cardiac chamber may cause ischemia of the affected myocardial region due to steal phenomenon and may present with cardiomyopathy or congestive heart failure during childhood. We herein report a neonate with coronary arteriovenous fistula between the left main coronary artery and the right ventricular apex, who presented with hydrops fetalis during the third trimester of pregnancy.

  14. Management of fistulae in the abdominal region. (United States)

    Hocevar, Barbara J; Erwin-Toth, Paula; Landis-Erdman, Judy; Wu, James S; Navage, Ann; Duell, Ellen; Dunbar, Shirley; Barnard, Anne; Skinner, Catherine; Anderson, Diana; Shires, George Thomas; Hietala, Lea; Griffin, Sandra; Owens, Cindy; Lynch, Cheryl; Snyder, Susan


    We evaluated a new fistula and wound management system; ostomy and wound care nurses were queried about willingness to use the product in future patients, product wear time and pouch leakage, perifistular skin condition, access for wound care, pouching time, patient mobility and comfort, odor management, pouch flexibility, adhesiveness, and erosion. A health economic assessment was also done. Twenty-two patients (5 males and 17 females) with an abdominal fistula participated in the study. Participants tested 75 pouches, representing an average of 3.4 pouches per subject. The investigator at each site who performed the pouch changes completed a questionnaire at baseline, during the test, and after testing the pouches. Participants also completed a set of questions after each test pouch was removed. In 21 of 22 cases, the nurses would consider using the new system on future patients. After each pouch removal, patients were asked whether they were able to move around while wearing the test pouch and they answered yes 95% of the time. The new system was found to have significantly longer wear time than traditional systems (P = .003), but the average time spent on changing the pouches was not significantly different (P = .07). Access for fistula and wound care was rated as excellent in the new pouching system, and comfort was rated as very good. The results of the study suggest that all of the key requests received from nurses for an improved system for fistula and wound management were met by the new system.

  15. [Therapeutical options in lithiasic biliary fistula]. (United States)

    Ungureanu, D; Brătucu, E; Daha, C


    Chronic lythiasic cholecystitis is a disease distinguished by the pathologic changes because of the chronic inflammation of the biliary extrahepatic tree. Sometimes these morphological changes are associated with internal biliary fistulas arising spontaneously in patients with advanced calculus cholecystitis. The vast majority of fistulas result from the adherence of the inflamed gallbladder or common bile duct to an adjacent viscus and erosion of the gallstones into the adherent organ. The authors analyze an amount of 43 patients with bilio-biliary and bilio-digestive lythiasic fistulas, caused by the long evolution of chronic lythiasic atrophic cholecystitis, for 126 cases which were operated in the Surgery Department of the Caritas Clinic Hospital along 20 years. In these 126 cases the surgical strategy was determinated by the method of dealing with the pericolecystitis sclerotic blocks, by the identification methods of the biliary elements and by the approach of the main billiary way and digestive loops injuries occurred after suppressing the fistulae. The surgical solutions adapted for each separate case and the advantages of the axial drainage of prostheting the surgical reconstructions of the main biliary way as well as the results obtained along this project, are in fact the aims of this presentation.

  16. Combined Vesicovaginal and Rectovaginal Fistulas Associated with ...

    African Journals Online (AJOL)

    but rarely lead to the formation of a fistula. Such complications are frequently associated with the insertion of aerosol caps into the vagina, but also other objects including small cups, metal boxes and plastic bottle caps have been reported3,4. Due to the association with sexual gratification, these patients are ashamed, so.

  17. The predictive value of bronchial histamine challenge in the diagnosis of bronchial asthma

    DEFF Research Database (Denmark)

    Madsen, F; Holstein-Rathlou, N H; Mosbech, H


    A prospective survey aiming to study the predictive value of bronchial histamine challenge was performed on 151 patients with a forced expiratory volume1 (FEV1) above 60% of predicted. According to variations in peak expiratory flow rate (PEFR) and medical history the patients were classified as ...

  18. [Allergy diagnosis in patients with bronchial asthma (bronchial provocation test, skin test and RAST) (author's transl)]. (United States)

    Baur, X; Fruhmann, G; von Liebe, V


    87 patients with bronchial asthma underwent skin test, RAST and measurment of airway resistance before and after inhalation of control solution as well as at least 10 times after each of one to four bronchial provocations (making up a total of 171 tests) with extracts of house dust, house dust mite, animal dander, mould spores and pollen in increasing concentrations. An actual clinical significance of the skin test reactions was found in 60% of all cases and of the RAST results in 66% of all cases. The overall agreement between skin test results and RAST results was 61%. The correlations between the different tests depended on the degree of hypersensitivity, on the tested allergen and on whether the results of skin test and RAST, respectively, were positive or negative. There existed a good correlation between the results of all three test methods and case history only for pollen allergens and animal dander. Noticeably often negative RAST results with house dust and mould spores, as well as positive skin tests with house dust mite and mould spores could not be confirmed by the provocation test. Important indications for a bronchial provocation test in asthmatics are doubtful case history, doubtful skin test or RAST results with the problem-allergens house dust, house dust mite and mould spores; the bronchial provocation test is especially commendable when drastic or cumbersome therapeutic measures (immunotherapy, change of home, change of job) are to follow or if late asthmatic reactions are expected.

  19. The immediate management of fresh obstetric fistulas. (United States)

    Waaldijk, Kees


    It has been a general rule to wait with the repair of an obstetric fistula for a minimum period of 3 months allowing the patient to become an outcast. In a prospective way an immediate management was studied and antibiotics were not used, all according to basic surgical principles. A total of 1716 patients with a fistula duration of 3 to 75 days after delivery were treated immediately on presentation by catheter and/or early closure. Instead of antibiotics, a high oral fluid regimen was instituted. The fistulas were classified according to anatomic and physiologic location in types I, IIAa, IIAb, IIBa, and IIBb, and according to size in small, medium, large, and extensive. The operation became progressively more complicated from type I through type IIBb and from small through extensive. At first attempt 1633 fistulas (95.2%) were closed and another 57 could be closed at further attempt(s), accounting for a final closure in 1690 patients (98.5%); 264 patients (15.4%) were healed by catheter only. Of these 1690 patients with a closed fistula, 1575 (93.2%) were continent and 115 (6.8%) were incontinent. The results as to closure and to continence became progressively worse from type I through type IIBb and from small through extensive. Postoperative wound infection was not noted; postoperative mortality was encountered in 6 patients (0.4%). This immediate management proves highly effective in terms of closure and continence and will prevent the patient from becoming an outcast with progressive downgrading medically, socially, and mentally.

  20. [Endovascular management of cavernous sinus dural fistulas]. (United States)

    Zenteno, Marco; Santos Franco, Jorge; Moscote-Salazar, Luis Rafael; Lee, Angel


    Describe the outcomes of patients diagnosed with indirect carotid-cavernous fistula treated by endovascular methods. A retrospective case series. Twelve patients with dural cavernous sinus fistula with important ophthalmologic involvement admitted and treated at the National Institute of Neurology and Neurosurgery between February 1990 and January 2005. Patients were managed by endovascular embolization for all fistulas. Angiographic controls to 24 hours and at 6 and 12 months were performed. 67 % were female and 33 % male. The mean age was 44 years. 67 % were spontaneous and 33% of traumatic origin. All patients had eye involvement with proptosis (92%) and involvement of the oculomotor nerve (67%). Headache and pulsatile tinnitus were not frequent ophthalmologic data. All were diagnosed by cerebral angiography, 33 % were type C, type D 67 %, and none of the type B classification Barrow. In 17 % of cases the distal arterial robbery showed severe. Predominance of anterior and superior venous drainage in 83 % and 42 % of cases occurred respectively. The surgical approach was arterial in 84% of cases, while in 17 % venous through the superior ophthalmic vein. Cyanoacrylate embolization material was used in 58 % of the cases, as it was associated with the use of removable ball with polyvinyl alcohol particles in 16 % in of venous approach cases. 17% detachable coils were utilized. There were no complications. After angiographic controls at 24 hours 100% occlusion was seen in patients treated with cyanoacrylate (58%) (p = 0.03). The remaining 42% were prescribed maneuver of manual compression. At 12-months angiography all patients had 100% occlusion of the carotid-cavernous fistula. CONCLSUIONS: This is the world's second largest series with indirect carotid-cavernous fistulas treated after trauma. 100 % of cases were cured with the use of a transarterial-controlled approach and N-butyl-cyanoacrylate after long-term observation.

  1. Noncavernous arteriovenous shunts mimicking carotid cavernous fistulae. (United States)

    Kobkitsuksakul, Chai; Jiarakongmun, Pakorn; Chanthanaphak, Ekachat; Pongpech, Sirintara


    The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinus with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outside the cavernous sinus, but mimic symptoms and radiography of the cavernous shunt. We would like to present the other locations of the arteriovenous shunt, which mimic the clinical presentation of carotid cavernous fistulae, and analyze venous drainages. We retrospectively examined the records of 350 patients who were given provisional diagnoses of carotid cavernous sinus fistulae or cavernous sinus dural AVF in the division of Interventional Neuroradiology, Ramathibodi Hospital, Bangkok between 2008 and 2014. Any patient with cavernous arteriovenous shunt was excluded. Of those 350 patients, 10 patients (2.85%) were identified as having noncavernous sinus AVF. The angiographic diagnoses consisted of three anterior condylar (hypoglossal) dural AVF, two traumatic middle meningeal AVF, one lesser sphenoid wing dural AVF, one vertebro-vertebral fistula (VVF), one intraorbital AVF, one direct dural artery to cortical vein dural AVF, and one transverse-sigmoid dural AVF. Six cases (60%) were found to have venous efferent obstruction. Arteriovenous shunts mimicking the cavernous AVF are rare, with a prevalence of only 2.85% in this series. The clinical presentation mainly depends on venous outflow. The venous outlet of the arteriovenous shunts is influenced by venous afferent-efferent patterns according to the venous anatomy of the central nervous system and the skull base, as well as by architectural disturbance, specifically, obstruction of the venous outflow.

  2. Bronchial Smooth Muscle Remodeling in Nonsevere Asthma. (United States)

    Girodet, Pierre-Olivier; Allard, Benoit; Thumerel, Matthieu; Begueret, Hugues; Dupin, Isabelle; Ousova, Olga; Lassalle, Régis; Maurat, Elise; Ozier, Annaig; Trian, Thomas; Marthan, Roger; Berger, Patrick


    Increased bronchial smooth muscle (BSM) mass is a key feature of airway remodeling that classically distinguishes severe from nonsevere asthma. Proliferation of BSM cells involves a specific mitochondria-dependent pathway in individuals with severe asthma. However, BSM remodeling and mitochondrial biogenesis have not been examined in nonsevere asthma. We aimed to assess whether an increase in BSM mass was also implicated in nonsevere asthma and its relationship with mitochondria and clinical outcomes. We enrolled 34 never-smoker subjects with nonsevere asthma. In addition, we recruited 56 subjects with nonsevere asthma and 19 subjects with severe asthma as comparative groups (COBRA cohort [Cohorte Obstruction Bronchique et Asthme; Bronchial Obstruction and Asthma Cohort; sponsored by the French National Institute of Health and Medical Research, INSERM]). A phenotypic characterization was performed using questionnaires, atopy and pulmonary function testing, exhaled nitric oxide measurement, and blood collection. Bronchial biopsy specimens were processed for immunohistochemistry and electron microscopy analysis. After BSM remodeling assessment, subjects were monitored over a 12-month period. We identified characteristic features of remodeling (BSM area >26.6%) and increased mitochondrial number within BSM in a subgroup of subjects with nonsevere asthma. The number of BSM mitochondria was positively correlated with BSM area (r = 0.78; P asthma with high BSM had worse asthma control and a higher rate of exacerbations per year compared with subjects with low BSM. This study reveals that BSM remodeling and mitochondrial biogenesis may play a critical role in the natural history of nonsevere asthma (Mitasthme study). Clinical trial registered with (NCT00808730).

  3. Laparoscopic dissection and division of distal fistula in boys with rectourethral fistula. (United States)

    Wang, Chen; Diao, Mei; Li, Long; Liu, Shuli; Chen, Zheng; Li, Xu; Cheng, Wei


    Congenital rectourethral fistula (RUF) is the most common form of anorectal malformations found in boys. The aim of this study is to review our experience with dissection and division of distal fistula using laparoscopic surgery in the management of RUF, especially rectourethral bulbar fistula. One hundred and two consecutive boys with congenital RUF who underwent conventional or single-incision laparoscopic surgery between July 2008 and June 2015 were enrolled in the study. The dissection of the distal fistula was performed along submucosal layer to a level 0.5 cm proximal to the urethra. Rectal mucosa of the fistula was dissected to the distal most point and completely transected flush with the posterior urethra. The residual muscular cuff was ligated with Hem-o-Lock clip or 5-0 PDS suture. Voiding cystourethrography and pelvic magnetic resonance imaging were performed at 3 mo, 6 mo, and 1 y postoperatively. All patients successfully underwent laparoscopic surgery without conversion. The mean age at the time of operation was 4.3 ± 2.9 mo. The operative times for the rectoprostatic fistula and rectobulbar fistula were similar (118.2 versus 119.4 min, P = 0.082). There was no significant difference in average operative time between conventional laparoscopic surgery group and single-incision laparoscopic surgery group (118.8 versus 119.1 min, P = 0.281). There was no injury to the urethra or vas deferens. The urethral catheter was removed on postoperative day 10. All patients were followed up. The median follow-up period was 3.3 ± 1.8 y. No recurrent fistula or urethral diverticulum was detected on voiding cystourethrography and pelvic MRI at 1 y. Submucosal dissection and division of distal fistula using a laparoscopic approach is safe, feasible, and effective for congenital RUF, especially bulbar fistula, in boys. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Radioaerosol Inhalation Imaging in Bronchial Asthma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bum Soo; Park, Young Ha; Park, Jeong Mi; Chung, Myung Hee; Chung, Soo Kyo; Shinn, Kyung Sub; Bahk, Yong Whee [Catholic University College of Medicine, Seoul (Korea, Republic of)


    Radioaerosol inhalation imaging (RII) has been used in radionuclide pulmonary studies for the past 20 years. The method is well accepted for assessing regional ventilation because of its usefulness, easy fabrication and simple application system. To evaluate its clinical utility in the study of impaired regional ventilation in bronchial asthma, we obtained and analysed RIIs in 31 patients (16 women and 15 men; age ranging 21-76 years) with typical bronchial asthma at the Department of Radiology, Kangnam St. Mary's Hospital, Catholic University Medical college, from January, 1988 to August, 1989. Scintiscans were obtained with radioaerosol produced by a HARC(Bhabha Atomic Research Center, India) nebulizer with 15 mCi of {sup 99m}Tc-phytate. The scanning was performed in anterior, posterior and lateral projections following 5-minute inhalation of radioaerosol on sitting position. The scans were analysed and correlated with the results of pulmonary function study and the findings of chest radiography. Fifteen patients had concomitant lung perfusion image with {sup 99m}Tc-MAA. Follow-up scans were obtained in 5 patients after bronchodilator therapy. 1 he patients were divided into (1) attack type (4 patients), (2) resistant type (5 patients), (3) remittent type (10 patients) and (4) bronchitic type (12 patients). Chest radiography showed hyperinflation, altered pulmonary vascularity, thickening of the bronchial wall and accentuation of hasal interstitial markings in 26 of the 31 patients. Chest radiographs were normal in the remaining 5 patients. Regardless of type, the findings of RII were basically the same, and characterized by the deposition of radioaerosol in the central parts or in the main respiratory air ways along with mottled nonsegmental ventilation defects in the periphery. Peripheral parenchymal defects were more extensive than that of expected findings from clinical symptoms, pulmonary function test and chest radiograph. Broomstick sign was present

  5. Assessment of quality of life among children with bronchial asthma ...

    African Journals Online (AJOL)

    Background: The global disease burden associated with bronchial asthma has continued to increase particularly among children. Asthma-related quality of life is a health related assessment of disease impact on patient and care givers. Aim: To determine the perceived quality of life (QOL) among children with bronchial ...

  6. Bronchial asthma among workers in Alexandria and its association ...

    African Journals Online (AJOL)

    Introduction: Many workers in Alexandria are exposed to a variety of occupational and environmental allergens and/or irritants that predispose them to the development of bronchial asthma. The present study was conducted to determine the role of occupational exposure as a determinant of occurrence of bronchial asthma ...

  7. [Safe local anesthesia in patients with bronchial asthma]. (United States)

    Anisimova, E N; Gromovik, M V

    The paper presents the analysis of studies of local anesthesia in patients with bronchial asthma. It was found that the diagnosis of hypersensitivity to sodium metabisulfite in patients with bronchial asthma must be optimized for development of local anesthesia selection algorithm in outpatient dentistry.


    Directory of Open Access Journals (Sweden)

    A.K. Gevorkyan


    Full Text Available The article provides the results of montelukast efficiency depending on bronchial asthma severity level and the duration of a disease; the assessment of functional figures dynamics, disease pattern before and after the treatment with montelukast and the possibility of its application as mono therapy to achieve long term disease remission and asthma symptoms control.Key words: bronchial asthma, montelukast, children.

  9. December 2004 45 Bronchial Asthma, Allergic Rhinitis and chole

    African Journals Online (AJOL)



    Dec 2, 2004 ... Background: Gallbladder has not been associated with any allergic condition what so ever. However, certain patients with bronchial asthma and cholelithiasis have reported to the author improvement in their asthmatic attack after cholecystectomy. Methods: This was an observational study on 22 bronchial ...

  10. (D) deficiency in children and adolescents suffering from bronchial ...

    African Journals Online (AJOL)

    Detection of Vitamin (D) deficiency in children and adolescents suffering from bronchial asthma in Suez Canal University Hospital, Ismailia. ... Egyptian Journal of Pediatric Allergy and Immunology (The). Journal Home ... Therefore, the examination of relationship between vitamin D and bronchial asthma was important.

  11. Asthma control during the year after bronchial thermoplasty

    DEFF Research Database (Denmark)

    Cox, Gerard; Thomson, Neil C.; Rubin, Adalberto S.


    BACKGROUND: Bronchial thermoplasty is a bronchoscopic procedure to reduce the mass of airway smooth muscle and attenuate bronchoconstriction. We examined the effect of bronchial thermoplasty on the control of moderate or severe persistent asthma. METHODS: We randomly assigned 112 subjects who had...

  12. Children with bronchial asthma assessed for psychosocial problems ...

    African Journals Online (AJOL)

    Background: Paediatric bronchial asthma causes respiratory related mortality and morbidity globally and elevates the risk ... Methods: Seventy five (75) children aged 7 to 14 years with bronchial asthma who were attending clinics at the University of Ilorin ... Inadequate spousal support and lower maternal occupational level.

  13. Bronchial asthma among workers in Alexandria and its association ...

    African Journals Online (AJOL)

    Noha S. Elshaer


    Jun 23, 2011 ... opment, with approximately 85% of children who develop asthma and 40–50% .... year history; (e) had no respiratory symptoms or disease and never reporting ..... Table 5 Eosinophil count and total serum IgE level in different bronchial asthma severity categories in workers with bronchial asthma. Variable.

  14. Sensitivity of bronchial responsiveness measurements in young infants

    DEFF Research Database (Denmark)

    Loland, Lotte; Buchvald, Frederik F; Halkjaer, Liselotte Brydensholt


    of variations for Ptco(2) and FEV(0.5) were 4% and 7%, respectively. CONCLUSIONS: Ptco(2) and FEV(0.5) are the most sensitive parameters for measurement of bronchial responsiveness in young infants. Measurements of baseline lung function should preferably be made using FEV(0.5.) Measurements of bronchial...

  15. Bronchial Thermoplasty: A Novel Therapy for Severe Asthma (United States)

    Sheshadri, Ajay; Castro, Mario; Chen, Alexander


    Synopsis This article presents an overview of bronchial thermoplasty, a novel treatment for severe asthma. Within, the authors discuss the rationale for bronchial thermoplasty in severe asthma, current clinical evidence for the use of this procedure, clinical recommendations, and future directions. PMID:23993815

  16. Bronchial artery embolisation for the treatment of massive ...

    African Journals Online (AJOL)

    Bronchial arteriography and embolisation were performed using a 4 French C2 catheter and polyvinyl alcohol (PVA) particles ranging from 300 to 900 micrometers. Results. Seven bronchial arteries in total were embolised (2 patients required embolisation of 2 arteries each). The haemoptysis was controlled during the first ...

  17. December 2004 45 Bronchial Asthma, Allergic Rhinitis and chole

    African Journals Online (AJOL)



    Dec 2, 2004 ... Introduction. Bronchial asthma is characterized by a widespread and reversible narrowing of the air passage and clinically by paroxysms of dyspnoea, cough and wheezing which are episodic. 100-150 million people around the world suffer from bronchial asthma1. In Kenya the prevalence is approaching.

  18. Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils

    Energy Technology Data Exchange (ETDEWEB)

    Jansen, O.; Doerfler, A.; Forsting, M.; Hartmann, M.; Kummer, R. von; Tronnier, V.; Sartor, K. [Dept. of Neuroradiology, University of Heidelberg Medical School (Germany)


    We report our experience in using Guglielmi electrolytically detachable coils (GDC) alone or in combination with other materials in the treatment of intracranial or cervical high-flow fistulae. We treated 14 patients with arteriovenous fistulae on brain-supplying vessels - three involving the external carotid or the vertebral artery, five the cavernous sinus and six the dural sinuses - by endovascular occlusion using electrolytically detachable platinum coils. The fistula was caused by trauma in six cases. In one case Ehlers-Danlos syndrome was the underlying disease, and in the remaining seven cases no aetiology could be found. Fistulae of the external carotid and vertebral arteries and caroticocavernous fistulae were reached via the transarterial route, while in all dural fistulae a combined transarterial-transvenous approach was chosen. All fistulae were treated using electrolytically detachable coils. While small fistulae could be occluded with electrolytically detachable coils alone, large fistulae were treated by using coils to build a stable basket for other types of coil or balloons. In 11 of the 14 patients, endovascular treatment resulted in complete occlusion of the fistula; in the remaining three occlusion was subtotal. Symptoms and signs were completely abolished by this treatment in 12 patients and reduced in 2. On clinical and neuroradiological follow-up (mean 16 months) no reappearance of symptoms was recorded. (orig.)

  19. Laparoscopic resection of chronic sigmoid diverticulitis with fistula. (United States)

    Abbass, Mohammad A; Tsay, Anna T; Abbas, Maher A


    A growing number of operations for sigmoid diverticulitis are being done laparoscopically. There is a paucity of data on the outcome of laparoscopy for sigmoid diverticulitis complicated by colonic fistula. The aim of this study was to compare the results of laparoscopic resection of sigmoid diverticulitis with and without colonic fistula. A retrospective review was conducted of all patients who underwent laparoscopic resection of sigmoid diverticulitis complicated by fistula at a single tertiary care institution over a 7-year period. Comparison was made with a group of patients who underwent resection for diverticulitis without fistula during the same study period. Forty-two patients were analyzed (group 1: diverticular fistula, group 2: no fistula). The median age was similar (49 vs. 50 years, P = .68). A chronic abscess was present in 24% of patients in group 1 and 10% in group 2 (P = .40). Fistula types were colovesical (71%), colovaginal (19%), and colocutaneous (10%). Operation types were sigmoidectomy (57% vs. 81%) and anterior resection (43% vs. 19%) in groups 1 and 2, respectively (P = .18). Ureteral catheters were used more frequently in group 1 (67% vs. 33% [P = .06]). No difference was noted in operative time, blood loss, conversion rate, length of stay, overall complications, wound infection rate, readmission rate, reoperation rate, and mortality. All patients healed without fistula recurrence. Patients with sigmoid diverticulitis with fistula can be successfully treated with laparoscopic excision, with similar outcomes for patients without fistula.

  20. Surgical management of complex obstetric fistula in Eritrea. (United States)

    Husain, Amreen; Johnson, Khaliah; Glowacki, Carol A; Osias, Joelle; Wheeless, Clifford R; Asrat, Kibreab; Ghebrekidan, Abrehet; Polan, Mary Lake


    To evaluate the incidence of and demographic characteristics associated with obstetric fistula in Eritrea. To determine the outcomes of surgical repair of complex fistula in Eritrea by a visiting surgical team. A surgical team comprising expert gynecologic surgeons traveled to Eritrea in September 2004. We evaluated 50 patients with genitourinary fistula and performed surgical repairs of these fistulas on 37 women via both vaginal and abdominal approaches. Demographic and basic medical data were obtained at the time of evaluation, and follow-up questionnaires were completed at 4 weeks postoperative. The majority of the women had fistulas related to obstructed labor at their first pregnancy unattended by any healthcare professional. The average duration of labor was 3 days, and more than half had resulted in stillbirths. The rate of successful repair in women with primary vesicovaginal fistulas (VVF) was 63%, and that in women with recurrent vesicovaginal fistulas was 61%. Two women required urinary diversion procedures because of the severity of the damage to the genital tract. Urethral reconstruction in women with urethrovaginal fistulas (UVFs) was successfully accomplished in 77% of patients. The rate of successful repair of rectovaginal fistulas (RVFs) was 87%. We have demonstrated that a team of specialized surgeons can successfully accomplish surgical procedures and repairs of very complex urinary tract fistulas in a very short mission to a resource-poor nation.

  1. Digestive system fistula: a problem still relevant today. (United States)

    Głuszek, Stanisław; Korczak, Maria; Kot, Marta; Matykiewicz, Jarosław; Kozieł, Dorota


    Digestive system fistula originates most frequently as a complication after surgical procedures, less often occurs in the course of inflammatory diseases, but it can also result from neoplasm and injuries. THE AIM OF THE STUDY was to analyze the causes and retrospectively assess the perioperative procedures as well as the results of digestive system fistula treatment. MATERIAL AND METHODS. Own experience in digestive system fistula treatment was presented. The subject group consisted of 32 patients treated at the General Surgery, Oncology and Endocrinology Clinical Department between 01.05.2005 and 30.04.2010 due to different digestive tract diseases. The causes of the occurrence of digestive system fistula, methods and results of treatment were analyzed. RESULTS. The analysis covered 32 patients with digestive system fistula, among them 15 men and 17 women. Average age for men was 57 years (20-78), and for women 61 years (24-88). In 11 patients idiopathic fistula causally connected with primary inflammatory disease (7 cases) and with neoplasm (4 cases) was diagnosed, in 19 patients fistula was the result of complications after surgery, in 2 - after abdominal cavity injury. Recovery from fistula was achieved in 23 patients (72%) with the use of individually planned conservative therapy (TPN, EN, antibiotics, drainage, and others) and surgery, depending on the needs of individual patient. 5 patients (16%) died, whereas in 4 left (12%) recovery wasn't achieved (fistula in palliative patients, with advanced stages of neoplasm - bronchoesophageal fistula, the recurrence of uterine carcinoma). CONCLUSIONS. Recently the results of digestive system fistula treatment showed an improvement which manifests itself in mortality decrease and shortening of fistula healing time. Yet, digestive system fistula as a serious complication still poses a very difficult surgical problem.

  2. Pro-inflammatory cytokines in cryptoglandular anal fistulas. (United States)

    van Onkelen, R S; Gosselink, M P; van Meurs, M; Melief, M J; Schouten, W R; Laman, J D


    Sphincter-preserving procedures for the treatment of transsphincteric fistulas fail in at least one out of every three patients. It has been suggested that failure is due to ongoing disease in the remaining fistula tract. Cytokines play an important role in inflammation. At present, biologicals targeting cytokines are available. Therefore, detection and identification of cytokines in anal fistulas might have implications for future treatment modalities. The objective of the present study was to assess local production of a selected panel of cytokines in anal fistulas, including pro-inflammatory interleukin (IL)-1β and tumor necrosis factor α (TNF-α). Fistula tract tissue was obtained from 27 patients with a transsphincteric fistula of cryptoglandular origin who underwent flap repair, ligation of the intersphincteric fistula tract or a combination of both procedures. Patients with a rectovaginal fistula or a fistula due to Crohn's disease were excluded. Frozen tissue samples were sectioned and stained using advanced immuno-enzyme staining methods for detection of selected cytokines, IL-1β, IL-8, IL-10, IL-12p40, IL-17A, IL-18, IL-36 and TNF-α. The presence and frequencies of cytokine-producing cells in samples were quantitated. The key finding was abundant expression of IL-1β in 93 % of the anal fistulas. Frequencies of IL-1β-producing cells were highest (>50 positive stained cells) in 7 % of the anal fistulas. Also, cytokines IL-8, IL-12p40 and TNF-α were present in respectively 70, 33 and 30 % of the anal fistulas. IL-1β is expressed in the large majority of cryptoglandular anal fistulas, as well as several other pro-inflammatory cytokines.

  3. [Anomalies of mucus and bronchial pathology in adults]. (United States)

    Polu, J M; Delorme, N


    Recent studies have shown that normal bronchial secretion composed of proteoglycans, atypical glycoproteins and neutral lipids neither includes mucins nor glycolipids, nor phospholipids. The rheological characteristics of bronchial mucus thus depend on mucociliary clearance and clearance of bronchial secretions by cough, which in turn depend on the properties of the glycoprotein acids secreted and on the degree of their entanglement which is linked to their water content and on the chemical bonds with other protein or lipid components which are present in the secretions. Chronic bronchitis, asthma and bronchorrhoea allow for changes in the biochemical composition and the physical and rheological characteristics of the bronchial mucus which alter the clearance. In certain conditions mucus plugs can form. An understanding of the pathology of bronchial mucus in the adult enables one to choose the best therapeutic prescriptions but the efficacy of measurements available remains imperfect.


    Directory of Open Access Journals (Sweden)

    E.A. Vishneva


    Full Text Available The article analyzes current situation of bronchial asthma non medicated therapy. The need to apply such therapy is associated with the on going trend of more frequent severe bronchial asthma cases, as well as not always efficient standard schemes of medicated treatment. The authors announce a physiotherapy device «aster» — it is based on innovative technologies and designed for noninvasive impact of electromagnetic waves with non thermal intensity upon the «pulmonary triangle» body area. A randomized multicentered survey of Russia's pediatricians union is being conducted to prove the efficiency of this device for children with bronchial asthma and basic therapy adequate to the severity degree. The application of this device is expected to reduce symptoms and eliminate dysfunctions of respiratory system typical for bronchial asthma, which cannot be totally eliminated with the current anti inflammatory agents.Key words: bronchial asthma, non medicated therapy.

  5. Metastatic urachal carcinoma in bronchial brush cytology

    Directory of Open Access Journals (Sweden)

    Fatima Zahra Aly


    Full Text Available Urachal carcinoma is rare comprising less than 1% of all bladder carcinomas. Metastases of urachal carcinoma have been reported to meninges, brain, ovary, lung, and maxilla. Cytologic features of metastatic urachal carcinoma have not been previously reported. We present a case of metastatic urachal adenocarcinoma in bronchial brushings and review the use of immunohistochemistry in its diagnosis. A 47-year-old female was seen initially in 2007 with adenocarcinoma of the bladder dome for which she underwent partial cystectomy. She presented in 2011 with a left lung mass and mediastinal adenopathy. Bronchoscopy showed an endobronchial lesion from which brushings were obtained. These showed numerous groups of columnar cells with medium sized nuclei and abundant cytoplasm. The cells were positive for CK20 and CDX2 and negative for CK7. The cytomorphological findings were similar to those in the previous resection specimen and concurrent biopsy. This is the first case report of bronchial brushings containing metastatic urachal carcinoma. No specific immunohistochemical profile is available for its diagnosis. The consideration of a second primary was a distinct possibility in this case due to the lapse of time from primary resection, absence of local disease, and lack of regional metastases.

  6. Asymptomatic Cholecystocolonic Fistula: A Diagnostic and Therapeutic Dilemma

    Directory of Open Access Journals (Sweden)

    Nicola Antonacci


    Full Text Available Cholecystocolonic fistulas (CCF are rare complications of gallstones with a variable clinical presentation. Despite modern diagnostic tools, cholecystocolonic fistulas are often asymptomatic and it is difficult to diagnose them preoperatively. Biliary-enteric fistulae have been found in 0.9% of patients undergoing biliary tract surgery. The most common site of communication of the fistula is the cholecystoduodenal (70%, followed by the cholecystocolic (10–20%, and the least common is the cholecystogastric fistula. Herein, we report a case of female patient with multiple episodes of acute recurrent cholangitis due to common bile duct and gallbladder stones in which preoperative imaging studies were negative for cholecystocolonic fistula that was incidentally discovered and treated during surgery and was appropriately treated. A review of the literature is reported too.

  7. Tentorial artery embolization in tentorial dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N. [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)


    The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

  8. Closure of oroantral fistula with rotational palatal flap technique

    Directory of Open Access Journals (Sweden)

    David B. Kamadjaja


    Full Text Available Oroantral fistula is one of the common complications following dentoalveolar surgeries in the maxilla. Closure of oroantral fistula should be done as early as possible to eliminate the risk of infection of the antrum. Palatal flap is one of the commonly used methods in the closure of oroantral fistula. A case is reported of a male patient who had two oroantral communication after having his two dental implants removed. Buccal flap was used to close the defects, but one of them remained open and resulted in oroantral fistula. Second correction was performed to close the defect using buccal fat pad, but the fistula still persisted. Finally, palatal rotational flap was used to close up the fistula. The result was good, as the defect was successfully closed and the donor site healed uneventfully.

  9. Comparative Analysis of the Antioxidant Activity of Cassia fistula Extracts


    Irshad, Md.; Zafaryab, Md.; Singh, Man; Rizvi, M. Moshahid A.


    Antioxidant potential of various extracts of Cassia fistula was determined by the DPPH, FRAP, Fe3+ reducing power, and hydrogen peroxide scavenging assay. Methanolic extracts of Cassia fistula showed the highest amount of phenolic and flavonoid content and reducing capacity, whereas hexane extracts exhibited the lowest level of reducing capacity. The order of antioxidant activity in Cassia fistula extracts displayed from higher to lower level as methanolic extracts of pulp, methanolic extract...

  10. Role of diaphragm in pancreaticopleural fistula. (United States)

    Ninos, Anestis P; Pierrakakis, Stephanos K


    A pancreatic pleural effusion may result from a pancreatopleural fistula. We herein discuss two interesting issues in a similar case report of a pleural effusion caused after splenectomy, which was recently published in the World Journal of Gastroenterology. Pancreatic exudate passes directly through a natural hiatus in the diaphragm or by direct penetration through the dome of the diaphragm from a neighboring subdiaphragmatic collection. The diaphragmatic lymphatic "stomata" does not contribute to the formation of such a pleural effusion, as it is inaccurately mentioned in that report. A strictly conservative approach is recommended in that article as the management of choice. Although this may be an option in selected frail patients, there has been enough accumulative evidence that a pancreaticopleural fistula may be best managed by early endoscopy in order to avoid complications causing prolonged hospitalization.

  11. Role of diaphragm in pancreaticopleural fistula (United States)

    Ninos, Anestis P; Pierrakakis, Stephanos K


    A pancreatic pleural effusion may result from a pancreatopleural fistula. We herein discuss two interesting issues in a similar case report of a pleural effusion caused after splenectomy, which was recently published in the World Journal of Gastroenterology. Pancreatic exudate passes directly through a natural hiatus in the diaphragm or by direct penetration through the dome of the diaphragm from a neighboring subdiaphragmatic collection. The diaphragmatic lymphatic “stomata” does not contribute to the formation of such a pleural effusion, as it is inaccurately mentioned in that report. A strictly conservative approach is recommended in that article as the management of choice. Although this may be an option in selected frail patients, there has been enough accumulative evidence that a pancreaticopleural fistula may be best managed by early endoscopy in order to avoid complications causing prolonged hospitalization. PMID:21990959

  12. Nephrobronchial fistula secondary to xantogranulomatous pyelonephritis

    Directory of Open Access Journals (Sweden)

    Jose R. De Souza


    Full Text Available INTRODUCTION: Nephrobronchial fistula is a rare complication of xanthogranulomatous pyelonephritis, a disease that can fistulize to lungs, skin, colon and other organs. CASE REPORT: A 37-year old patient presented a chronic history of lumbar pain and thoracic symptoms such as cough, dyspnea and oral elimination of pus. Patient went to several services and was submitted to 2 thorax surgeries before definitive treatment (nephrectomy was indicated. After nephrectomy, the patient presented an immediate improvement with weight gain (8 kg / 1 month and all his symptoms disappeared. CONCLUSION: This clinical case illustrates the natural history of nephrobronchial fistula, the importance of clinical history for diagnosis and the relevance of early treatment of renal lithiasis.

  13. [Clinical study of 18 vesicointestinal fistulas]. (United States)

    Yoshida, Takahiro; Harada, Yasunori; Uemura, Motohide; Kanno, Nobuhumi; Nishimura, Kensaku; Miyoshi, Susumu; Nezu, Riichiro


    We studied 18 cases of vesicointestinal fistula surgically treated between January 2001 and July 2005. The underlying'cause was an inflammatory disease in 12 cases, a carcinoma in 5 and injury (post-radiation therapy) in 1 case. The fistula was visualized by cystography in 2 cases and enterography in 4. Surgical procedures were cystectomy with enterectomy in 2 cases, partial cystectomy with enterectomy in 3, bladder wall overlay-suture with enterectomy in 6 and enterectomy alone in 4. In 3 cases, colostomy without enterectomy was performed for palliative surgery. In all cases the postoperative course was good and surgical treatment was effective. Surgical procedures varied in each case depending on the etiology and the patient's condition.

  14. Coronary fistula resembling patent ductus arteriosus

    Directory of Open Access Journals (Sweden)

    Sgarbieri Ricardo Nilsson


    Full Text Available A 14-year-old girl, presenting with heart failure and a continuous murmur, similar to that of a patent arterial duct, was investigated using echocardiogram and cardiac catheterization revealing a left to right shunt throught a coronary artery fistulae between the first septal branch and the right ventricular outflow tract. The patient was submitted to surgery, occluding the anomalous branch by the suturing of its orifice in the right ventricular outflow tract, under cardiopulmonary bypass. After the operation, cardiac catheterization revealed complete occlusion of the fistula without any residual shunt or compromise to the coronary circulation. In seven years of follow-up the patient is completely free of symptoms.

  15. Role of diaphragm in pancreaticopleural fistula


    Ninos, Anestis P; Pierrakakis, Stephanos K


    A pancreatic pleural effusion may result from a pancreatopleural fistula. We herein discuss two interesting issues in a similar case report of a pleural effusion caused after splenectomy, which was recently published in the World Journal of Gastroenterology. Pancreatic exudate passes directly through a natural hiatus in the diaphragm or by direct penetration through the dome of the diaphragm from a neighboring subdiaphragmatic collection. The diaphragmatic lymphatic “stomata” does not contrib...

  16. [Nonsurgical treatment of coronary pulmonary arteriovenous fistula]. (United States)

    Cano, M N; Kambara, A; Maldonado, G; Mattos, L A; Tanajura, L F; Fontes, V F; Pinto, I M; Feres, F; Sousa, A G; Sousa, J E


    Fifty eight year old man, with dyspnea, fatigue and progressive angina underwent cinecoronarography, which showed an arterio-venous coronary-pulmonary fistula originating from the circumflex artery to the pulmonary circulation. We decided to occlude it percutaneously, using a detachable balloon technic. The occlusion was accomplished successfully. Clinical evolution was excellent and the follow-up cinecoronarography 6 months later showed the maintainance of the initial results.

  17. Traumatic fistula:the case for reparations

    Directory of Open Access Journals (Sweden)

    Arletty Pinel


    Full Text Available As a conflict strategy, women are often sexually assaulted using sticks, guns, branches of trees and bottles. Women’s genitals are deliberately destroyed, some permanently. Traumatic fistula often results. As with victims of torture and other grave human rights abuses, there exists an obligation to restore the women to health as far as possible and to provide reparation for their violations.

  18. Isolated arterioportal fistula presenting with variceal hemorrhage


    Nookala, Anupama; Saberi, Behnam; Ter-Oganesyan, Ramon; Kanel, Gary; Duong, Phillip; Saito, Takeshi


    We report a case of life-threatening hematemesis due to portal hypertension caused by an isolated arterioportal fistula (APF). Intrahepatic APFs are extremely rare and are a cause of presinusoidal portal hypertension. Etiologies for APFs are comprised of precipitating trauma, malignancy, and hereditary hemorrhagic telangiectasia, but these were not the case in our patient. Idiopathic APFs are usually due to congenital vascular abnormalities and thus usually present in the pediatric setting. T...

  19. Arterioportal Fistulas in Liver Transplant Recipients


    Saad, Wael E. A.


    Arterioportal fistulas (APFs) are classified into intrahepatic (>75% of all reported) and extrahepatic (90% of APFs). All reported APFs in liver transplant recipients have been intrahepatic. Hemodynamically significant APFs in liver transplant recipients are rare, occurring in 0.2%; however, APFs (hemodynamically significant or not) are not uncommonly seen in hepatic angiograms of liver transplant recipients (up to 5.4% of hepatic arteriograms in transplants). Interestingly, hemodynamically s...

  20. An unusual presentation of congenital bronchoesophageal fistula. (United States)

    Atalabi, O M; Falade, A G; Obajimi, O M; Akinyinka, O O; Lagundoye, S B; Ibinaiye, P O


    We present the case of a 5-week-old neonate with multiple congenital abnormalities including a broncho-oesophageal fistula, which showed radiological features suggestive of congenital diaphragmatic hernia. Emergency limited barium swallow done was initially reported as a case of diaphragmatic hernia. Autopsy revealed pus within the right lung, and a fistulous connection between the oesophagus and an intralobar sequestrated lung. No diaphragmatic hernia or intra-abdominal organ abnormality were seen, and an occipital meningomyelocoele was also confirmed.

  1. Urethrocutaneous fistulae after hypospadias repair: When do they occur? (United States)

    Liao, Adelene Y; Smith, Grahame Hh


    The aim is to determine the incidence and timing of urethrocutaneous fistula diagnosis after hypospadias surgery. A retrospective review of all patients who had both initial hypospadias surgery and subsequent fistula repair from 1995 to 2012. A comparison was made between patients who had an initial onlay island flap procedure and those who had a tubularised incised plate repair. Patient age at initial surgery ranged from 6 months to 16 years of age. The median time to fistula presentation was 8.5 months with a range of less than 1 month to 13.9 years post-hypospadias surgery. The median time to fistula repair was 17 months. The overall fistula rate was 8%. There was no significant difference between the rates of fistulae for onlay island flap (9%) versus tubularised incised plate procedure (7%). Urethrocutaneous fistulae can present many years after the original hypospadias repair. The majority are diagnosed within the first year after surgery. Rates of fistulae are probably underreported due to short follow-up, but more importantly, due to patients transferring to other surgeons for fistula repair. © 2016 The Author Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  2. An algorithm for the physical examination of early fistula failure. (United States)

    Beathard, Gerald A


    Evaluation of a newly created fistula 4-6 weeks after surgery should be considered mandatory. If the fistula is going to become adequate for dialysis, it will be apparent at this time. This evaluation can be accomplished by physical examination. However, it must be performed by someone who is knowledgeable. Using a systematic approach facilitates the evaluation and ensures that a problem is not overlooked. Once it is determined that the fistula is dysfunctional, the case should be immediately referred for management to an interventionalist who is experienced in dealing with early fistula failure. The majority of these cases can be salvaged.

  3. Arteriovenous fistulas aggravate the hemodynamic effect of vein bypass stenoses

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Djurhuus, Christian Born; Morre-Pedersen, Erik


    Doppler spectra obtained 10 cm downstream of the fistula. All measurements were carried out with open and clamped fistula. RESULTS: At 30% diameter reducing stenosis opening of the fistula induced a 12% systolic pressure drop across the stenosis but had no adverse effect on the Doppler waveform parameters......PURPOSE: The purpose of this study was to assess the impact of arteriovenous fistulas combined with varying degrees of stenosis on distal bypass hemodynamics and Doppler spectral parameters. METHODS: In an in vitro flow model bypass stenoses causing 30%, 55%, and 70% diameter reduction were induced...

  4. Volume Flow in Arteriovenous Fistulas Using Vector Velocity Ultrasound

    DEFF Research Database (Denmark)

    Hansen, Peter Møller; Olesen, Jacob Bjerring; Pihl, Michael Johannes


    Volume flow in arteriovenous fistulas for hemodialysis was measured using the angle-independent ultrasound technique Vector Flow Imaging and compared with flow measurements using the ultrasound dilution technique during dialysis. Using an UltraView 800 ultrasound scanner (BK Medical, Herlev......, Denmark) with a linear transducer, 20 arteriovenous fistulas were scanned directly on the most superficial part of the fistula just before dialysis. Vector Flow Imaging volume flow was estimated with two different approaches, using the maximum and the average flow velocities detected in the fistula. Flow...

  5. Detachable balloon embolization of an aneurysmal gastroduodenal arterioportal fistula

    Energy Technology Data Exchange (ETDEWEB)

    Defreyne, Luc; De Schrijver, Ignace; Vanlangenhove, Peter; Kunnen, Marc [Department of Radiology and Medical Imaging, Ghent University Hospital (Belgium)


    Extrahepatic arteriovenous fistulas involving the gastroduodenal artery and the portal venous system are rare and almost always a late complication of gastric surgery. Secondary portal hypertension and mesenteric ischemia may provoke abdominal pain, upper and lower gastrointestinal hemorrhage, diarrhea, and weight loss. Until recently, surgical excision has been the therapy of choice with excellent results. The authors report a case of gastroduodenal arterioportal fistula with a rare large interpositioned aneurysm in a cardiopulmonary-compromised patient who was considered a non-surgical candidate. The gastroduodenal arterioportal fistula was occluded endovascularly by means of a detachable balloon. A survey of the literature of this rare type of arterioportal fistula is included. (orig.)

  6. Oronasal Fistula and Complete Edentulism: What to Do?

    Directory of Open Access Journals (Sweden)

    Pushappreet Kaur


    Full Text Available Oronasal fistula is an internal fistula which represents an abnormal epitheliazed tract between oral and nasal cavity, thus impairing associated functions of deglutition and speech by nasal regurgitation of fluid and nasal speech respectively, besides risk of nasal infection resulting from food lodgement. This paper provides a brief yet definitive insight on the etiology, diagnosis and surgical closure of oronasal fistula along with a case report and discussion on prosthodontic rehabilitation of a 65 year old female with an iatrogenic oronasal fistula developed as a result of maxillary molar extraction using a complete metal based denture.

  7. Surgical treatment of labyrinthine fistula in cholesteatoma surgery. (United States)

    Quaranta, Nicola; Liuzzi, Cristina; Zizzi, Stefania; Dicorato, Anna; Quaranta, Antonio


    Evaluate the treatment of labyrinthine fistula in a large series of middle ear cholesteatomas. Case series in a tertiary referral center. Between January 2001 and December 2007, 361 ears affected by mastoid and middle ear cholesteatoma were operated at our institution. The incidence of labyrinthine fistula, preoperative and postoperative hearing function, preoperative symptoms, type of surgery, and intraoperative findings were all analyzed. The incidence of labyrinthine fistula was 12.7 percent. During surgery the matrix over the fistula was removed in all but one case. A labyrinthine fistula occurred in larger cholesteatomas as demonstrated by the higher number of cases with more than two sites involved (P < 0.001), facial nerve exposed (P < 0.001), and stapes superstructure eroded (P = 0.010). Postoperative change of bone conduction threshold and postoperative dead ears were not significantly different between fistula and nonfistula cases. The preservation of the bone conduction threshold is a common finding in small fistulas and can be obtained also in "large" fistulas when appropriate surgical technique is used. In fistulas involving the promontory the matrix should be left in situ when the endosteum is involved.

  8. Air pollution, bronchial hyperreactivity and airway disease in children; Luftverschmutzung, bronchiale Hyperreagibilitaet und Atemwegserkrankungen bei Kindern

    Energy Technology Data Exchange (ETDEWEB)

    Forster, J. [Freiburg Univ. (Germany). Universitaets-Kinderklinik; Hendel-Kramer, A. [Freiburg Univ. (Germany). Universitaets-Kinderklinik; Karmaus, W. [Freiburg Univ. (Germany). Universitaets-Kinderklinik; Kuehr, J. [Freiburg Univ. (Germany). Universitaets-Kinderklinik; Moseler, M. [Freiburg Univ. (Germany). Universitaets-Kinderklinik; Urbanek, R. [Freiburg Univ. (Germany). Universitaets-Kinderklinik; Weiss, K. [Freiburg Univ. (Germany). Universitaets-Kinderklinik


    In the study population the lifetime prevalence of asthma (4,97% of n = 704) and point prevalence of bronchial hyperreactivity (26.7% of n = 558: positive bronchial challenge test with 400 {mu}g carbachol) could be attributed partially to the use of single-room heatings. The finding was confirmed by a nested case-control-study. Outdoor NO{sub 2} and related particle pollution, both found to be relatively low compared to other German towns, were not associated with the prevalence of asthma or bronchial hyperreactivity. The Incidence of asthmatic symptoms during the study period (22 months) was associated with an NO{sub 2} exposure of more than 40 {mu}g/m{sup 3} (average outdoor concentration in fall/winter). In individuals with asthmatic symptoms (n = 106) forced expiratory volume (FEV{sub 1}/VC{sub IN}) was reduced in a dose dependent manner, if the average exposure exceeded 40 {mu}g/m{sup 3}. Conclusion: Individuals with asthmatic symptoms are prone to detrimental effects of NO{sub 2} air pollution exceeding 40 {mu}g/m{sup 3} (average outdoor concentration in fall/winter). In so far the current outdoor air pollution gives cause for concern, thus we recommend further effort in order to reduce NO{sub 2} and related pollutants. On an individual basis, in children with asthma (and with asthma in the family) the parents should be advised not to use single-room heatings. (orig./MG) [Deutsch] Mit Hilfe statistischer Erklaerungsmodelle wurde im ersten Studien-Querschnitt (N = 704) die Lebenszeitpraevalenz von Asthma bronchiale und die bronchiale Hyperreagibilitaet untersucht. Die Lebenszeit-Praevalenz von Asthma bronchiale betrug 4.97% (n = 35). Als ein signifikanter Risikofaktor fuer Asthma wurde die Verwendung einer Einzelraumheizung identifiziert. Zugleich trat bei 558 mit 400 {mu}g Carbachol provozierten Probanden in 26.6% eine bronchiale Hyperreagibilitaet auf. Die in der Untersuchungsregion probandennah gemessene relativ niedrigen Aussenluft-Immissionen von NO{sub 2


    Directory of Open Access Journals (Sweden)

    M.A. Shabani H. Saberi


    Full Text Available Massive hemoptysis is one of the most important respiratory emergencies and pulmonary infiltrating diseases are among the rare causes of hemoptysis. Bronchial artery embolization (BAE is a safe and effective treatment in these patients. Our case was a 45 years old woman with a 7 year history of Hodgkin's lymphoma who presented with massive hemoptysis of 20 days duration. CT scan revealed prebronchial infiltrating pattern. Diagnostic angiography showed hypervascularity in both hilar and perihilar areas and simultaneous opacification of both bronchial arteries from a right common trunk. BAE was successfully performed with 300 µ diameter polyvinyl alcohol. In follow up, hemoptysis did not recurred and patient was in good general health.

  10. Coronary artery to left ventricle fistula

    Directory of Open Access Journals (Sweden)

    Kumar Vivek


    Full Text Available Abstract Background Coronary cameral fistulas are an uncommon entity, the etiology of which may be congenital or traumatic. They involve abnormal termination of a coronary artery, usually the right coronary, into a cardiac chamber, usually the right ventricle. Case Presentation We describe a case of female patient with severe aortic stenosis and interventricular septal hypertrophy that underwent bioprosthetic aortic valve replacement with concomitant septal myectomy. On subsequent follow-up an abnormal flow traversing the septum into the left ventricle was identified and Doppler interrogation demonstrated a continuous flow, with a predominantly diastolic component, consistent with coronary arterial flow. Conclusion The literature on coronary cameral fistulas is reviewed and the etiology of the diagnostic findings discussed. In our patient, a coronary artery to left ventricle fistula was the most likely explanation secondary to trauma to the septal perforator artery during myectomy. Since the patient was asymptomatic at the time of diagnosis no intervention was recommended and has done well on follow-up.

  11. Do the Surgical Outcomes of Rectovaginal Fistula Repairs Differ for Obstetric and Nonobstetric Fistulas? A Retrospective Cohort Study. (United States)

    Karp, Natalie E; Kobernik, Emily K; Berger, Mitchell B; Low, Chelsea M; Fenner, Dee E


    Rectovaginal fistulas can occur from both obstetric and nonobstetric (eg, inflammatory bowel disease, iatrogenic, or traumatic) etiologies. Current data on factors contributing to rectovaginal repair success or failure are limited, making adequate patient counseling difficult. Our objective was to compare outcomes of transperineal rectovaginal fistula repair performed in a single referral center on women with obstetric and nonobstetric causes. We performed a retrospective cohort study of women who had a transperineal rectovaginal fistula repair performed by a urogynecologist at the University of Michigan from 2005 to 2015. Data were obtained by chart review and included demographics, medical comorbidities, fistula etiology, history of a prior fistula repair, failure of current repair, time to failure, and operative details. Repair failure was defined as fistula symptoms with presence of recurrent fistula on exam or imaging in the postoperative follow-up period. Comparisons between the obstetric and nonobstetric cohorts were performed using χ, Fisher exact, and Wilcoxon rank sum tests. Relative risks were calculated to identify predictors of failure. Eighty-eight women were included-53 obstetric and 35 nonobstetric fistulas. The overall fistula repair failure rate was 22.7% (n = 20). Median follow-up was 157.0 days (range, 47.5-402.0). Of all the factors, only nonobstetric etiology was significantly associated with an increased risk of repair failure (relative risk, 3.53 [range, 1.50-8.32]; P = 0.004. Nonobstetric rectovaginal fistulas have a nearly 4-fold increased risk of repair failure compared with obstetric fistulas. Our results will help surgeons adequately counsel patients on potential outcomes of surgical repair of obstetric versus nonobstetric rectovaginal fistulas.

  12. Pancreatic pseudocyst-portal vein fistula: Serial imaging and clinical follow-up from pseudocyst to fistula

    Energy Technology Data Exchange (ETDEWEB)

    Jee, Keun Nahn [Dept. of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan (Korea, Republic of)


    Pancreatic pseudocyst-portal vein fistula is an extremely rare complication of pancreatitis. Only 18 such cases have been previously reported in the medical literature. However, a serial process from pancreatic pseudocyst to fistula formation has not been described. The serial clinical and radiological findings in a 52-year-old chronic alcoholic male patient with fistula between pancreatic pseudocyst and main portal vein are presented.

  13. Sphincter-Sparing Anal Fistula Repair: Are We Getting Better? (United States)

    Sugrue, Jeremy; Mantilla, Nathalie; Abcarian, Ariane; Kochar, Kunal; Marecik, Slawomir; Chaudhry, Vivek; Mellgren, Anders; Nordenstam, Johan


    Sphincter-sparing repairs are commonly used to treat anal fistulas with significant muscle involvement. The current study evaluates the trends and efficacy of sphincter-sparing repairs and determines risk factors for fistula recurrence. A retrospective review was performed at 3 university-affiliated teaching hospitals. All 462 patients with cryptoglandular anal fistulas who underwent 573 sphincter-sparing repairs between 2005 and 2015 were included. Patients with Crohn's disease were excluded. The primary outcome was the rate of fistula healing defined as cessation of drainage with closure of the external opening. Risk factors for nonhealing were also analyzed. Five hundred three sphincter-sparing repairs were analyzed, whereas 70 were lost to follow-up. Two hundred twenty sphincter-sparing repairs (44%) resulted in healing, 283 (56%) resulted in nonhealing with a median follow-up of 9 (range, 1-125) months. The median time to fistula recurrence was 3 (range, 0-75) months with 79% and 91% of recurrences noted within 6 and 12 months. Patients treated with a dermal advancement flap, rectal advancement flap, or ligation of the intersphincteric tract procedure were less likely to have a recurrence than patients treated with a fistula plug or fibrin glue (p fistula plugs and fibrin glue (p fistula characteristics. This study was limited by its retrospective design. Healing rates following sphincter-sparing repairs of cryptoglandular anal fistulas are modest, but have improved over time with the use of better surgical techniques. In this study, ligation of the intersphincteric fistula tract and flaps were superior to fistula plugs and fibrin glue; the former procedures are therefore favored. See Video Abstract at

  14. Allelic Polymorphism of enos Gene in Children Who Suffer from Bronchial Asthma, with Eosinophilic and Paucigranulocytic Subtypes of Bronchial Inflammation

    Directory of Open Access Journals (Sweden)

    L.O. Bezrukov


    GT/TT genotype, children with paucigranulocytic bronchial inflammation were characterized by more frequent clinical manifestations of atopic dermatitis and allergic rhinitis, higher bronchial lability index and lower concentrations of NO metabolites in the exhaled breath condensate.

  15. Thoracic lymphangiectasis presenting with chyloptysis and bronchial cast expectoration

    Energy Technology Data Exchange (ETDEWEB)

    Orliaguet, O. [Pneumology Center Henri Bazire, St. Julien de Ratz, BP 129, 38504 Voiron Cedex (France); Beauclair, P. [General Hospital St. Marcellin (France); Gavazzi, G. [Department of Internal Medicine, Centre Hospitalier Universitaire Grenoble (France); Winckel, P. [Clinique du Mail, Grenoble (France); Laporte, F. [Department of Biochemistry, Centre Hospitalier Universitaire Grenoble (France); Coulomb, M.; Ferretti, G.R. [Department of Radiology, Centre Hospitalier Universitaire Grenoble (France)


    A 70-year-old man with recurrent undiagnosed episodes of bronchial cast expectoration and pulmonary infiltrates on chest radiography for 15 years is described. The diagnosis of chyloptysis was established by chemical analysis of the bronchial aspiration. We emphasize the radiological findings of this rare observation. The CT-associated lymphangiography showed mediastinal lymphangiectasis with retrograde opacification of mediastinal and hilar lymph nodes as well as submucosal lymphatic vessels protruding into the lumen of the tracheo-bronchial tree without evidence of thoracic duct obstruction as well as a ''crazy-paving appearance.'' Congenital incompetence of the valves of the lymphatic vessels originating from the thoracic duct is held to be the cause. Chyloptysis and pulmonary lymphatic disorder should be sought in cases of bronchial cast expectoration. (orig.)

  16. Imaging findings of bronchial atresia in fetuses, neonates and infants

    Energy Technology Data Exchange (ETDEWEB)

    Alamo, Leonor; Meuli, Reto [University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Vial, Yvan [University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Department of Obstetrics and Gynecology, Lausanne (Switzerland); Gengler, Carole [University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Department of Pathology, Lausanne (Switzerland)


    Congenital lung malformations are increasingly detected before birth. However, bronchial atresia is rarely identified in utero and not always recognized in neonates. There are two types of atresia: (1) proximal, located at the level of the mainstem or the proximal lobar bronchi, which is extremely rare and usually lethal during pregnancy, causing a tremendous volume increase of the distal involved lung with secondary hypoplasia of the normal lung, and (2) peripheral, located at the segmental/subsegmental bronchial level, which may present as an isolated lesion or as part of a complex congenital malformation. Prenatal findings are mostly nonspecific. Postnatal exams show overinflated lung areas and focal bronchial dilations. The typical fluid-filled bronchoceles are not always observed in neonates but develop progressively in the first months of life. This pictorial essay describes the spectrum of imaging findings of bronchial atresia in fetuses, neonates and infants. (orig.)

  17. Acute Radiological Abnormalities after Bronchial Thermoplasty: A Prospective Cohort Trial

    NARCIS (Netherlands)

    d'Hooghe, Julia N. S.; van den Berk, Inge A. H.; Annema, Jouke T.; Bonta, Peter I.


    Background: Bronchial thermoplasty (BT) is a novel treatment for severe asthma based on radiofrequency energy delivery to the larger airways. Although impressive radiological abnormalities have been reported, the incidence, pattern, and behavior over time of acute radiological abnormalities

  18. Bronchial epithelium in children: a key player in asthma. (United States)

    Carsin, Ania; Mazenq, Julie; Ilstad, Alexandra; Dubus, Jean-Christophe; Chanez, Pascal; Gras, Delphine


    Bronchial epithelium is a key element of the respiratory airways. It constitutes the interface between the environment and the host. It is a physical barrier with many chemical and immunological properties. The bronchial epithelium is abnormal in asthma, even in children. It represents a key component promoting airway inflammation and remodelling that can lead to chronic symptoms. In this review, we present an overview of bronchial epithelium and how to study it, with a specific focus on children. We report physical, chemical and immunological properties from ex vivo and in vitro studies. The responses to various deleterious agents, such as viruses or allergens, may lead to persistent abnormalities orchestrated by bronchial epithelial cells. As epithelium dysfunctions occur early in asthma, reprogramming the epithelium may represent an ambitious goal to induce asthma remission in children. Copyright ©ERS 2016.

  19. pharmcopieal standards for the fruits of cassia fistula and cassia ...

    African Journals Online (AJOL)

    The pods of Cassia fistula L. and C. podocarpa Guill. et Perr. known for their laxative properties were examined macro- and microscopially. The pods can be distinguished in powder form by the presence of uniseriate trichomes in the C. podocarpa, which are absent in C. fistula. Chemical evaluation showed that both pods ...

  20. Congenital rectovestibular fistula associated with rectal atresia: A rare occurrence

    Directory of Open Access Journals (Sweden)

    Rizwan Ahmad Khan


    Full Text Available We report a rare variety of anorectal malformation, rectal atresia associated with rectovestibular fistula. The case was successfully treated by posterior sagittal repair. The fistula was mobilized and the continuity of the rectum was established by circumferential anastomosis.

  1. Management of Small Urethrocutaneous Fistula by Tight Ligation ...

    African Journals Online (AJOL)

    Background/Purpose: Urethrocutaneous fistula (UCF) is the most common reported complication of hypospadias repair. The success of the operative technique is usually measured by its effectiveness in reduction of the incidence of UCF. Materials & Methods: In a prospective study, 11 patients with 12 small caliber fistulae ...

  2. Enterocutaneous Fistula : Aetiology and Management Outcome in a ...

    African Journals Online (AJOL)

    Background: Enterocutaneous fistula is a major surgical challenge worldwide. It has a potential for serious morbidity and mortality, especially the high output type. Objective: To review the cases of Enterocutaneous fistula that presented to Federal Medical Center, Owerri, over a 6 year period with the aim of determining the ...

  3. Treatment of pharyngocutaneous fistula acquired from incisions and ...

    African Journals Online (AJOL)

    Treatment of pharyngocutaneous fistula acquired from incisions and drainage of deep neck space abscess in a patient with occult third branchial anomaly. ... We did surgical exploration to excise and close the fistula but only succeeded at the second attempt. Conclusion: We conclude that branchial apparatus anomaly ...

  4. Enterocutaneous fistula: a Tanzanian experience in a tertiary care ...

    African Journals Online (AJOL)

    ... outcome and prognostic factors for fistula closure and mortality in our local setting. Methods: A prospective study of patients with enterocutaneous fistulae was conducted at Bugando Medical Centre between December 2007 and November 2009. After informed written consent for the study and HIV testing, all patients who ...

  5. Pyloro-duodenal hernia with formation of enterocutaneous fistula in ...

    African Journals Online (AJOL)

    A body wall hernia entrapping abomasum and concurrent duodenal fistula in a buffalo calf aged about 8 months, secondary to a dog bite was successfully treated by closure of fistulous orifice and ventro lateral herniorrhaphy. Keywords: Abomaso-epiplocele, Buffalo calf, Duodenal fistula, Herniorrhaphy.

  6. Aetiology, management and outcome of entero-cutaneous fistula in ...

    African Journals Online (AJOL)

    Aetiology, management and outcome of entero-cutaneous fistula in Maiduguri, Nigeria. UE Eni, BM Gali. Abstract. Background: Enterocutaneous fistula (ECF) remains an important surgical problem with significant morbidity and mortality. This study aims to review the aetiology and management outcome in a depressed ...

  7. Genito-Urinary Fistula Patients at Bugando Medical Centre ...

    African Journals Online (AJOL)

    Background: Information was collected on 1500 obstetric fistula patients attending Bugando Medical Centre (BMC) in Mwanza, Tanzania. Objectives: To identify high risk populations of fistula patients treated from 1998-2006. Design: A prospective description study of 1294 patients treated for urine and faecal incontinence ...

  8. An unusual case of hematemesis: Spontaneous reno-duodenal fistula

    Directory of Open Access Journals (Sweden)

    Vincenzo De Francesco


    Full Text Available Different diseases may cause gastrointestinal bleeding. A fistula infrequently manifest with severe intestinal bleeding, when excluding those directly involving vascular structures. We described a case of upper digestive bleeding by a spontaneous renal-duodenal fistula in the patient with kidney cancer. Bleeding was successfully stopped by transarterial embolization.

  9. Enterocutaneous fistula: A review of 82 cases | Njeze | Nigerian ...

    African Journals Online (AJOL)

    Objective: Enterocutaneous fistula is an unpleasant and troublesome complication of abdominal operations. The objective was to review the outcome of treatment of patients treated for enterocutaneous fistula. Materials and Methods: This is a retrospective study of 82 teenage and adult patients, who suffered from ...

  10. Tuberculous anal fistulas – prevalence and clinical features in an ...

    African Journals Online (AJOL)

    Introduction. The aim of this study was to determine the prevalence of tuberculosis (TB) in anal fistulas at a referral hospital in Cape Town, and to document the clinical features and course of patients with tuberculous anal fistulas. Patients and methods. This was a prospective study of all patients who underwent surgery for ...

  11. [One case of postoperative facial paralysis after first branchial fistula]. (United States)

    Wang, Xia; Xu, Yaosheng


    Pus overflow from patent's fistula belew the left face near mandibular angle 2 years agowith a little pain. Symptoms relieved after oral antibiotics. This symptom frequently occurred in the past six months. Postoperative facial paralysis occurred after surgery, and recovered after treatment. It was diagnosed as the postoperative facial paralysis after first branchial fistula surgery.

  12. Tracheo-oesophageal fistula diagnosed with multidetector computed tomography.

    LENUS (Irish Health Repository)

    Hodnett, Pa


    This case highlights important issues in investigation of patients with suspected tracheo-oesophageal fistula including the value of multidetector computed tomography, the importance of thorough imaging evaluation when high clinical suspicion of tracheo-oesophageal fistula exists and the value of close interaction between radiologists and intensive care physicians in the investigation of these patients.

  13. [Giant cervical angioma caused by "malignant" arteriovenous fistulae]. (United States)

    Palou, J; Mir y Mir, L


    A case of angioma by malignant AV fistula (described by F. Martorell in 1970) is reported. Such kind of fistulas have usually a lethal course. The case reported underwent a surgical correction, and after a following of 10 years, no major complications have been reported.

  14. An orbital fistula complicating anaerobic frontal sinusitis and osteomyelitis

    NARCIS (Netherlands)

    H.J. Simonsz (Huib); H.J.F. Peeters; G.M. Bleeker


    textabstractA patient is described with an orbital fistula complicating frontal sinusitis and osteomyelitis of the frontal bone. The fistula was excised, but a fortnight later an acute exacerbation occurred. From the discharging pus a Staphylococcus aureus was cultured and from mucosa obtained

  15. Vesicovaginal Fistula: A Review of Nigerian Experience | Ijaiya ...

    African Journals Online (AJOL)

    OBJECTIVE: To review the causes, complications, and outcome of vesicovaginal fistula in Nigeria. METHODS: Studies on vesicovaginal fistula were searched on the internet. Information was obtained on Pubmed (medline), WHO website, Bioline Innternational, African Journal on Line, Google scholar, Yahoo, Medscape ...

  16. Congenital anterior penile isolated urethrocutaneous fistula: A case ...

    African Journals Online (AJOL)

    Urethrocutaneous fistula is a common complication after hypospadias repair. If congenital, it is usually associated with other genitourinary and gastrointestinal anomalies. Isolated congenital urethral fistula is a very rare anomaly. We present a 4-year old circumcised boy with this unusual anomaly. Etiology, embryology, and ...

  17. Treatment of ureterovaginal fistula using a Memokath stent

    DEFF Research Database (Denmark)

    Mohammad, Wael; Fode, Mikkel Mejlgaard; Azawi, Nessn Htum


    Ureterovaginal fistula (UVF) is a challenging problem for patients and doctors, especially in patients who have been treated by radiation for malignancy. UVF may occur in conjunction with surgeries involving the uterus. A success rate of 70-100% has been reported for fistula repair with the best...

  18. [Nutrition therapy in enterocutaneous fistula; from physiology to individualized treatment]. (United States)

    Rodríguez Cano, Ameyalli Mariana


    Enterocutaneous fistula is the most common of all intestinal fistulas. Is a condition that requires prolonged hospital stay due to complications such as electrolyte imbalance, malnutrition, metabolic disorders and sepsis. Nutritional support is an essential part of the management; it favors intestinal and immune function, promotes wound healing and decreases catabolism. Despite the recognition of the importance of nutrition support, there is no strong evidence on its comprehensive management, which can be limiting when establishing specific strategies. The metabolic imbalance that a fistula causes is unknown. For low-output fistulas, energy needs should be based on resting energy expenditure, and provide 1.0 to 1.5 g/kg/d of protein, while in high-output fistulas energy requirement may increase up to 1.5 times, and provide 1.5 to 2.5 g/kg of protein. It is suggested to provide twice the requirement of vitamins and trace elements, and between 5 and 10 times that of Vitamin C and Zinc, especially for high-output fistulas. A complete nutritional assessment, including type and location of the fistula, are factors to consider when selecting nutrition support, whether is enteral or parenteral nutrition. The enteral route should be preferred whenever possible, and combined with parenteral nutrition when the requirements cannot be met. Nutritional treatment strategies in fistulas may include the use of immunomodulators and even stress management.

  19. Vesicovaginal fistula: Do the patients know the cause?

    African Journals Online (AJOL)

    Int Urogynecol J Pelvic Floor Dysfunct. 1998;9:189-94. 2. Kelly J. Vesicovaginal fistula: The burden of maternal ill health. Safe Mother 1999;27:5-7. 3. Danso KA, Martey JO, Wall LL, Elkins TE. The epidemiology of genitourinary fistulae in Kumasi, Ghana, 1977-1992. Int Urogyecol J Pelvic Floor Dysfunct 1996;7:117-20. 4.

  20. Splenic arteriovenous fistula treated with percutaneous transarterial embolization

    DEFF Research Database (Denmark)

    Madsen, M.A.; Frevert, S.; Madsen, P.L.


    Splenic arteriovenous fistula is a rare complication following splenectomy. We report a case of a large splenic arteriovenous fistula 23 years after splenectomy in a 50-year old male with abdominal pain, gastro-intestinal bleeding, ascites, diarrhoea, dyspnoea, portal hypertension and heart failure...

  1. Experience with enterocutaneous fistula management in a district ...

    African Journals Online (AJOL)

    Our objective was to review the practice of the nutritional management and outcome of ECF in a resource limited setting in Nigeria. Methods: A retrospective ... Thirty-nine (68.42%) fistulae closed spontaneously on conservative management while 12 (21.05%) fistulae healed following restorative surgery. Mortality rate was ...

  2. Group Psychological Therapy in Obstetric Fistula Care: A ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    Group psychotherapy in Obstetric fistula care. African Journal of Reproductive Health March 2014; 18(1): 156. ORIGINAL RESEARCH ARTICLE. Group Psychological Therapy in Obstetric Fistula Care: A. Complementary Recipe for the Accompanying Mental Ill Health. Morbidities? Oladosu A Ojengbede. 1. , Yvonne Baba. 2.

  3. Analysis of 137 obstetric fistula cases seen at three fistula centres in ...

    African Journals Online (AJOL)

    Conclusion: This study shows that child marriage, low education, unskilled birth attendance and low contraceptive uptake are common among the obstetric fistula patients in north west Nigeria. Public advocacy and formulation of laws and policies to protect girls from early marriage, girl child education to secondary school ...

  4. Does consanguinity increase the risk of bronchial asthma in children?


    El Mouzan Mohammad; Al Salloum Abdullah; Al Herbish Abdullah; Al Omar Ahmad; Qurachi Mansour


    There is a high prevalence of consanguinity and bronchial asthma in Saudi Arabia. The objective of this study is to explore the effect of parental consanguinity on the occurrence of bronchial asthma in children. The study sample was determined by multistage random probability sampling of Saudi households. The families with at least one child with asthma were matched with an equal number of families randomly selected from a list of families with healthy children, the latter families being desi...

  5. Does consanguinity increase the risk of bronchial asthma in children? (United States)

    El Mouzan, Mohammad I.; Al Salloum, Abdullah A.; Al Herbish, Abdulah S.; Al Omar, Ahmad A.; Qurachi, Mansour M.


    There is a high prevalence of consanguinity and bronchial asthma in Saudi Arabia. The objective of this study is to explore the effect of parental consanguinity on the occurrence of bronchial asthma in children. The study sample was determined by multistage random probability sampling of Saudi households. The families with at least one child with asthma were matched with an equal number of families randomly selected from a list of families with healthy children, the latter families being designated as controls. There were 103 families with children having physician-diagnosed bronchial asthma, matched with an equal number of families with no children with asthma. This resulted in 140 children with bronchial asthma and 295 children from controls. The age and gender distribution of the children with bronchial asthma and children from controls were similar. There were 54/103 (52.4%) and 61/103 (59.2%) cases of positive parental consanguinity in asthmatic children and children from controls respectively (P = 0.40). Analysis of consanguinity status of the parents of children with asthma and parents among controls indicates that 71/140 (51%) of the children with asthma and 163/295 (55.3%) of the children from controls had positive parental overall consanguinity (P = 0.43). The results of this study suggest that parental consanguinity does not increase the risk of bronchial asthma in children. PMID:19561903

  6. Does consanguinity increase the risk of bronchial asthma in children?

    Directory of Open Access Journals (Sweden)

    El Mouzan Mohammad


    Full Text Available There is a high prevalence of consanguinity and bronchial asthma in Saudi Arabia. The objective of this study is to explore the effect of parental consanguinity on the occurrence of bronchial asthma in children. The study sample was determined by multistage random probability sampling of Saudi households. The families with at least one child with asthma were matched with an equal number of families randomly selected from a list of families with healthy children, the latter families being designated as controls. There were 103 families with children having physician-diagnosed bronchial asthma, matched with an equal number of families with no children with asthma. This resulted in 140 children with bronchial asthma and 295 children from controls. The age and gender distribution of the children with bronchial asthma and children from controls were similar. There were 54/103 (52.4% and 61/103 (59.2% cases of positive parental consanguinity in asthmatic children and children from controls respectively ( P = 0.40. Analysis of consanguinity status of the parents of children with asthma and parents among controls indicates that 71/140 (51% of the children with asthma and 163/295 (55.3% of the children from controls had positive parental overall consanguinity ( P = 0.43. The results of this study suggest that parental consanguinity does not increase the risk of bronchial asthma in children.

  7. Preliminary study on pathogenesis of bronchial asthma in children. (United States)

    Ren, Ya-Feng; Li, Hong; Xing, Xiao-Hong; Guan, Hai-Shan; Zhang, Bo-Ai; Chen, Chuan-Liang; Zhang, Jian-Hua


    The etiology and pathogenesis of bronchial asthma remain unclear. This study is to investigate the risk factors related to bronchial asthma onset in children from genetics and immunology and preliminarily reveal the pathogenesis of bronchial asthma in children. Real-time quantitative PCR was adopted to detect the expression level of TRPV1 gene and mRNA and enzyme-linked immunosorbent assay method to the total immunoglobulin E level and levels of IL-4, IL-5, and IFN-γ in serum in peripheral venous blood for children in two groups. Logistic regression analysis was applied to analyze the most essential factors inducing bronchial asthma in children. The mRNA level of TRPV1 in peripheral blood in the case group was higher than that in the control group (P bronchial asthma in children. The levels of TRPV1 gene expression and Th1/Th2 cytokines have a close relationship with asthma onset in children, which provides theoretical evidences for molecular targeted treatment in children with bronchial asthma.

  8. Bronchial Artery Embolization for Massive Hemoptysis: a Retrospective Study

    Directory of Open Access Journals (Sweden)

    Ali Fani


    Full Text Available   Introduction: To assess the efficacy and safety of bronchial artery embolization in the treatment of massive hemoptysis.   Materials and Methods: A retrospective study on 46 patients (26 males and 20 females who were referred to the Razavi Hospital from April 2009 to May 2012 with massive hemoptysis and had bronchial artery embolization procedures. General characteristics of the patients including age, gender, etiology, and thorax computed tomograms, findings of bronchial angiographic, results of the embolization, complications related to bronchial artery embolization and clinical outcome during follow-up were reviewed. Results: The etiology included previous pulmonary tuberculosis in 20 cases, previous tuberculosis with bronchiectasis in 16 cases, bronchiectasis in 6 cases, and active pulmonary tuberculosis in one case. No identifiable causes could be detected in three patients. Moreover, massive hemoptysis was successfully and immediately controlled following the embolization procedure in all patients. One patient developed recurrent hemoptysis during one month following the procedure and was treated by re-embolization. No major procedure–related complication such as bronchial infarction was identified However none of the patientsexperienced neurological complications. Conclusion: Bronchial artery embolization is a safe and effective means of controlling massive hemoptysis and should be regarded as the first-line treatment for this condition.

  9. A Case of Pyriform Sinus Fistula Infection with Double Tracts

    Directory of Open Access Journals (Sweden)

    Masato Shino


    Full Text Available Pyriform sinus fistula is a rare clinical entity and the precise origin remains controversial. The fistula is discovered among patients with acute suppurative thyroiditis or deep neck infection of the left side of the neck and is usually located in the left pyriform sinus. To the best of our knowledge, only a single tract has been reported to be responsible for pyriform sinus fistula infection. We present a case of a 13-year-old female patient with a pyriform sinus fistula that caused a deep infection of the left side of the neck and showed double-tract involvement discovered during surgical resection of the entire fistula. Both tracts arose around the pyriform sinus and terminated at the upper portion of the left lobe of the thyroid.

  10. Robotic-assisted laparoscopic repair of a vesicouterine fistula. (United States)

    Chang-Jackson, Shao-Chun R; Acholonu, Uchenna C; Nezhat, Farr R


    As cesarean sections become a more common mode of delivery, they have become the most likely cause of vesicouterine fistula formation. The associated pathology with repeat cesarean deliveries may make repair of these fistulas difficult. Computer-enhanced telesurgery, also known as robotic-assisted surgery, offers a 3-dimensional view of the operative field and allows for intricate movements necessary for complex suturing and dissection. These qualities are advantageous in vesicouterine fistula repair. A healthy 34-year-old woman who underwent 4 cesarean deliveries presented with a persistent vesicouterine fistula. Conservative management with bladder decompression and amenorrhea-inducing agents failed. Robotic-assisted laparoscopic repair was successfully performed with the patient maintaining continence after surgery. Robotic-assisted laparoscopic repair of vesicouterine fistulas offers a minimally invasive approach to treatment of a complex disease process.

  11. Ramiprilate inhibits functional matrix metalloproteinase activity in Crohn's disease fistulas

    DEFF Research Database (Denmark)

    Efsen, Eva; Saermark, Torben; Hansen, Alastair


    Increased expression of matrix metalloproteinase (MMP)-2, -3 and -9 has been demonstrated in Crohn's disease fistulas, but it is unknown whether these enzymes are biologically active and represent a therapeutic target. Therefore, we investigated the proteolytic activity of MMPs in fistula tissue...... and examined the effect of inhibitors, including clinically available drugs that beside their main action also suppress MMPs. Fistula specimens were obtained by surgical excision from 22 patients with Crohn's disease and from 10 patients with fistulas resulting from other causes. Colonic endoscopic biopsies......-diamine-tetraacetic acid (EDTA), the synthetic broad-spectrum inhibitor, GM6001, the angiotensin-converting enzyme (ACE) inhibitor, ramiprilate, and the tetracycline, doxycycline. In Crohn's disease fistulas, about 50% of the total protease activity was attributable to MMP activity. The average total MMP activity...

  12. Stable gastric pentadecapeptide BPC 157 heals rectovaginal fistula in rats. (United States)

    Baric, Marko; Sever, Anita Zenko; Vuletic, Lovorka Batelja; Rasic, Zarko; Sever, Marko; Drmic, Domagoj; Pavelic-Turudic, Tatjana; Sucic, Mario; Vrcic, Hrvoje; Seiwerth, Sven; Sikiric, Predrag


    Rectovaginal fistula is a devastating condition providing more than 99% of patients for surgical treatment. We hypothesized that rectovaginal fistula may be healed by therapy with stable gastric pentadecapeptide BPC 157, in consistence with its initial clinical application and effect on external fistulas. BPC 157 (10μg/kg or 10ng/kg) was given perorally, in drinking water (0.16μg/ml or 0.16ng/ml, 12ml/rat/day) till sacrifice, or alternatively, intraperitoneally, first application at 30min after surgery, last at 24h before sacrifice. Controls simultaneously received an equivolume of saline (5.0ml/kg ip) or water only (12ml/rat/day). The assessment (i.e., rectal and vaginal defect, fistula leakage, defecation through the fistula, adhesions and intestinal obstruction as healing processes) was at day 1, 3, 5, 7, 10, 14 and 21. Regularly, rectovaginal fistulas exhibited poor healing, with both of the defects persisting, continuous fistula leakage, defecation through the fistula, advanced adhesion formation and intestinal obstruction. By contrast, BPC 157 given perorally or intraperitoneally, in μg- and ng-regimens rapidly improved the whole presentation, with both rectal and vaginal defects simultaneously ameliorated and eventually healed. The maximal instilled volume was continuously raised till the values of healthy rats were achieved, there were no signs of defecation through the fistula. A counteraction of advanced adhesion formation and intestinal obstruction was achieved. Microscopic improvement was along with macroscopic findings. BPC 157 effects appear to be suited to induce a full healing of rectovaginal fistulas in rats. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Clinical evaluation of genito-urinary fistula

    Directory of Open Access Journals (Sweden)

    Companywala Rashida


    Full Text Available Clinical evaluation of 50 cases of genito-urinary fistula from January 1969 to March 1917 is presented. In 84% of the cases the aetiological factor was obstetric injury while in 12% it followed hysterectomy. Sixty per cent of the patients had come within one year of the development of symptoms. Eighty per cent of the cases were operated upon by vaginal route while 14% were operated upon by abdominal route and 6% by pereineo-abdominal route. The operative management is discussed. The success rate was 72%. The literature on this subject is reviewed.

  14. Multimodal endovascular treatment for traumatic carotidcavernous fistula

    Directory of Open Access Journals (Sweden)

    ZENG Tao


    Full Text Available 【Abstract】Objective: To present our experience in treating traumatic carotid-cavernous fistula (TCCF by multimodal endovascular treatment. Methods: The management of 28 patients with TCCF between January 2004 and October 2012 in our hospital was retrospectively analyzed. According to imaging charateristics, 24 cases were categorized into Type I, 3 Type II and 1 Type III. Totally 30 endovascular treatments were performed: Type I TCCFs were obliterated via transvenous approach (7/25, or transarterial approach (18/25 including 6 by detachable balloon occlusion, 6 by microcoil embolization, 3 by Hyperglide balloon-assisted coil embo- lization and 3 by a combination of detachable balloon and coil embolization. Two patients were treated with closure of internal carotid artery (ICA. Type II TCCFs were treated with transvenous embolotherapy (2/3 or carotid artery com- pression therapy (1/3. The Type III patient underwent de- tachable balloon embolization. Results: Immediate postoperative angiography showed recovery in 26 cases. One recurrent TCCF was found 2 weeks after detachable balloon embolization, and then re- Chin J Traumatol 2013;16(6:334-338 obliterated by transarterial coils. Reexamination found bal- loon deflation and fistula recanalization in 1 patient one month after combination of detachable balloons and coil embolization, which was cured by a second treatment via transvenous approach. The immediate angiography revealed residual blood flow in 4 patients. Among them, 2 patients with delayed symptoms at follow-up needed a second treatment, 1 patient recovered after carotid artery compres- sion therapy, and the remaining patient’s symptoms disap- peared on digital subtraction angiography at five-month follow-up. CT angiography revealed anterior communicat- ing artery aneurysm in the patient who was treated with closure of ICA 4 years later. Conclusion: According to results of images, characteristics of the fistula and type of drainage

  15. An arteriovenous fistula following chalazion excision

    Directory of Open Access Journals (Sweden)

    Dias-Amborcar Yuri


    Full Text Available An arteriovenous fistula secondary to a chalazion is a rare occurrence. It may follow spontaneous necrosis or surgical trauma. Digital subtraction angiography and identification of the arterial feeders combined with direct puncture of the nidus and embolization is recommended, as surgical excision becomes much easier and results in a complete excision of the lesion. Conchal cartilage graft is a useful lining material for reconstruction of the tarsal plate due to its natural curvature. It restores lid integrity and ensures a stable and functional eyelid.

  16. Isolated arterioportal fistula presenting with variceal hemorrhage. (United States)

    Nookala, Anupama; Saberi, Behnam; Ter-Oganesyan, Ramon; Kanel, Gary; Duong, Phillip; Saito, Takeshi


    We report a case of life-threatening hematemesis due to portal hypertension caused by an isolated arterioportal fistula (APF). Intrahepatic APFs are extremely rare and are a cause of presinusoidal portal hypertension. Etiologies for APFs are comprised of precipitating trauma, malignancy, and hereditary hemorrhagic telangiectasia, but these were not the case in our patient. Idiopathic APFs are usually due to congenital vascular abnormalities and thus usually present in the pediatric setting. This is one of the first cases of adult-onset isolated APF who presented with portal hypertension and was successfully managed through endoscopic hemostasis and subsequent interventional radiological embolization.

  17. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.


    . All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed...

  18. Accidental Left Circumflex Artery to Right Lung Fistula in a Suspected Case of Pulmonary Hypertension

    Directory of Open Access Journals (Sweden)

    Saeed Alipourparsa


    Full Text Available A 56-year-old woman was referred to the cardiology department of the Shahid Modarres hospital. The patient had a history of pulmonary thromboembolism 20 years ago which had been managed by the inferior vena cava filter and since then the patient has been on warfarin. Her chief complaint was chronic dyspnea on exertion (NYHA class II from several years ago. Right and left heart catheterization was performed for evaluation of pulmonary artery pressure. We found rich collateral formations between LCX as well as RCA and right pulmonary artery, primarily assumed as multiple fistulas. Among patients who have chronic thromboembolic pulmonary hypertension, systemic collateral supply to the pulmonary parenchyma has been previously reported to occur from both bronchial and/or nonbronchial systemic circulations. Our patient had neither signs of heart failure nor myocardial ischemia and, thus, was a candidate for conservative management. The adenosine pulmonary reactivity test was not performed because of low pulmonary pressure which had been estimated to be high.

  19. Bronchial hyper-responsiveness after preterm birth. (United States)

    Clemm, Hege H; Engeseth, Merete; Vollsæter, Maria; Kotecha, Sailesh; Halvorsen, Thomas


    Being born preterm often adversely affects later lung function. Airway obstruction and bronchial hyperresponsiveness (BHR) are common findings. Respiratory symptoms in asthma and in lung disease after preterm birth might appear similar, but clinical experience and studies indicate that symptoms secondary to preterm birth reflect a separate disease entity. BHR is a defining feature of asthma, but can also be found in other lung disorders and in subjects without respiratory symptoms. We review different methods to assess BHR, and findings reported from studies that have investigated BHR after preterm birth. The area appeared understudied with relatively few and heterogeneous articles identified, and lack of a pervasive understanding. BHR seemed related to low gestational age at delivery and a neonatal history of bronchopulmonary dysplasia. No studies reported associations between BHR after preterm birth and the markers of eosinophilic inflammatory airway responses typically found in asthma. This should be borne in mind when treating preterm born individuals with BHR and airway symptoms. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  20. Spinal Dural Arteriovenous Fistula: A Review. (United States)

    Maimon, Shimon; Luckman, Yehudit; Strauss, Ido


    Spinal dural arteriovenous fistula (SDAVF) is a rare disease, the etiology of which is not entirely clear. It is the most common vascular malformation of the spinal cord, comprising 60-80 % of the cases. The clinical presentation and imaging findings may be nonspecific and misleading, often mistaking it for other entities like demyelinating or degenerative diseases of the spine.This chapter describes the imaging findings, clinical signs, and symptoms of this disease and also the available treatment options according to the current literature.Angiography is still considered the gold standard for diagnosis; however, MRI/MRA is increasingly used as a screening tool. Modern endovascular techniques are becoming increasingly more effective in treating SDAVF offering a less invasive treatment option; however, they still lag behind surgical success rates which approach 100 %. The outcome of both treatment options is similar if complete obliteration of the fistula is obtained and depends mainly on the severity of neurological dysfunction before treatment.Heightened awareness by radiologists and clinicians to this rare entity is essential to make a timely diagnosis of this treatable disease. A multidisciplinary treatment approach is required in order to make appropriate treatment decisions.

  1. A simple skin flap plasty to repair tracheocutaneous fistula after tracheotomy

    Directory of Open Access Journals (Sweden)

    Huang Qilin


    Full Text Available The tracheocutaneous fistula after tracheostomy is a complex clinical problem. An ideal fistula closure is still difficult at present though a variety of fistula-closing methods have been reported in the literature. We used a turnover skin flap to cover the fistula. All the procedures were completed at bedside under local anesthesia. The fistula was successfully closed and well healed without complications within 7-9 days. It has been proven that this operation is simple, effective, and safe.

  2. Diagnosis of gastrogastric fistula on computed tomography: a quantitative approach. (United States)

    Gao, Guangzu; Nezami, Nariman; Mathur, Mahan; Balcacer, Patricia; Israel, Gary; Spektor, Michael


    To determine if the attenuation of contrast material in the excluded stomach compared with the gastric pouch is helpful in diagnosing gastrogastric (GG) fistula. In a retrospective study, 13 CT scans in 12 patients (age 43.2 ± 9.2, 10 females) who had undergone Roux-en-Y gastric bypass and who had oral contrast in both the gastric pouch and excluded stomach were qualitatively and quantitatively evaluated for GG fistula by two radiologists, using upper GI series (UGI) as the gold standard. Quantitative analysis was performed by computing the relative attenuation (RA) ratio (HU in excluded stomach/HU in gastric pouch). Statistical analysis was performed to determine if the RA ratio values correlated with the UGI findings of GG fistula. 46.2% (6/13) of UGI studies demonstrated a GG fistula. Statistical analysis demonstrated a significant difference in RA ratio (P ratio of 0.8 that maximized sensitivity (100%), at the expense of specificity (78.6%), for diagnosing GG fistula. In contrast, the initial qualitative evaluation for GG fistula yielded a lower sensitivity (45.8%) and a higher specificity (89.2%). After taking RA ratios into account, radiologists' final conclusions achieved higher sensitivity (58.3%) and specificity (100%). The relative attenuation ratio of oral contrast in the excluded stomach versus the gastric pouch can be a reliable tool in differentiating GG fistula from oral contrast reflux up the biliopancreatic limb on CT.

  3. The psychosocial impact of vesico-vaginal fistula in Niger. (United States)

    Alio, Amina P; Merrell, Laura; Roxburgh, Kimberlee; Clayton, Heather B; Marty, Phillip J; Bomboka, Linda; Traoré, Salamatou; Salihu, Hamisu M


    To explore the psycho-social impact of vesico-vaginal fistula (VVF) on women in Niger. We conducted a qualitative study on 21 women in convalescence at the DIMOL Reproductive Health Center in Niamey, Niger, in 2008 and 2009. The women had undergone 1-3 fistula repair operations and all had stillborn infants. Women reported many psychological consequences of VVF including depression, feelings of shame, and loneliness. Others reported feeling devalued as a woman and wanting to end their lives. Social consequences of fistula reported by these women included rejection from society, isolation, rejection from husband and/or divorce. Almost half of the women reported of having lost their social network and support as a result of the fistula. Women with VVF were deemed unworthy, and their illness was often attributed to some fault of their own. Our findings support the notion that socio-economic factors, though they certainly contribute to obstetric fistula, are not the primary reason for fistula, particularly in Niger. Fistula is a direct result of lack of access to skilled birth attendants and emergency obstetric care.

  4. Vesicocutaneous fistula formation during treatment with sunitinib malate: Case report

    Directory of Open Access Journals (Sweden)

    Sakashita Hiroyuki


    Full Text Available Abstract Background The oral multi-kinase inhibitor sunitinib malate improves the survival of patients with gastrointestinal stromal tumors (GIST after the disease progresses or intolerance to imatinib mesylate develops. Urinary fistulae arising during treatment with sunitinib for GIST have not been described. Case presentation We describe a 62-year-old female patient diagnosed with unresectable GIST that involved the abdominal wall, urinary bladder wall, bowel, mesentery and peritoneum in the pelvic cavity. Intestinocutaneous fistulae developed on a surgical lesion after orally administered imatinib was supplemented by an arterial infusion of 5-flurouracil. Sunitinib was started after the patient developed resistance to imatinib. On day 4 of the fourth course of sunitinib, a widely dilated cutaneous fistula discharged large amounts of fluid accompanied by severe abdominal pain. Urinary communication was indicated based on the results of an intravenous injection of indigo carmine. Computed tomography findings suggested a small opening on the anterior urinary bladder wall and fistulous communication between the bladder and abdominal walls bridged by a subcutaneous cavity. The fistula closed and the amount of discharge decreased when sunitinib was discontinued. Therefore, sunitinib might have been associated with the development of the vesicocutaneous fistula in our patient. Conclusion This is the first description of a vesicocutaneous fistula forming while under sunitinib treatment. Clinicians should be aware of the possible complication of vesicocutaneous fistula formation during treatment with molecular targeting agents in patients with extravesical invasion and peritoneal dissemination of GIST.

  5. The lived experience of Malawian women with obstetric fistula. (United States)

    Yeakey, Marissa Pine; Chipeta, Effie; Taulo, Frank; Tsui, Amy O


    Data on women who experience obstetric fistula paints an often tragic picture. The majority of previous research has focused on facility-based data from women receiving surgical treatment. The goal of this qualitative study was to gain an understanding of the lived experience of obstetric fistula in Malawi. Forty-five women living with fistula were interviewed in their homes to learn how the condition affected them and their families on a daily basis. Findings indicate that the experiences of Malawian women with fistula were more varied than anticipated. Concerning relationships with husbands and family, we found high rates of divorce and stigma, yet these outcomes were far from universal or inevitable. Many women, in addition to their families, discussed high levels of support from those individuals closest to them. Nonetheless, many women experienced the fistula as a direct assault on their ability to fulfil social expectations of them as women, wives and mothers. Women identified fertility and continued childbearing as central concerns. The data suggest that we cannot discount the experiences of women living with fistula from continued participation in marriage, community and childbearing. Programmes for outreach and services should consider a broadened range of outcomes of women living with fistula.

  6. Gurya cutting and female genital fistulas in Niger: ten cases. (United States)

    Ouedraogo, Itengre; McConley, Regina; Payne, Christopher; Heller, Alison; Wall, L Lewis


    The objective was to determine the contribution of female genital cutting to genital fistula formation in Niger from the case records of a specialist fistula hospital. A retrospective review was undertaken of the records of 360 patients seen at the Danja Fistula Center, Danja, Niger, between March 2014 and September 2016. Pertinent clinical and socio-demographic data were abstracted from the cases identified. A total of 10 fistulas resulting from gurya cutting was obtained: 9 cases of urethral loss and 1 rectovaginal fistula. In none of the cases was genital cutting performed for obstructed labor or as part of ritual coming-of-age ceremonies, but all cutting procedures were considered "therapeutic" within the local cultural context as treatment for dyspareunia, lack of interest in or unwillingness to engage in sexual intercourse, or female behavior that was deemed to be culturally inappropriate by the male spouse, parents, or in-laws. Clinical cure (fistula closed and the patient continent) was obtained in all 10 cases, although 3 women required more than one operation. Gurya cutting is an uncommon, but preventable, cause of genital fistulas in Niger. The socio-cultural context which gives rise to gurya cutting is explored in some detail.

  7. Surgical aspects and biological considerations of arteriovenous fistula placement. (United States)

    Achneck, Hardean E; Sileshi, Bantayehu; Li, Madison; Partington, Erin J; Peterson, David A; Lawson, Jeffrey H


    Since the Fistula First Initiative was formulated in 2003, providers and payers have increasingly emphasized the need to create more arteriovenous fistulae. To maximize the chances of successful fistula maturation, a thorough understanding of the biology and surgical aspects of fistula placement are essential. A functional endothelium in the target vessels is the prerequisite for the adaptive remodeling of the vessel wall, which has to take place after fistula formation. Mechanoreceptors of the endothelium sense the increase in shear stress and, through a variety of activated signaling cascades, induce the necessary changes and vasodilation of the respective vessels. The successful fistula placement starts with a thorough preoperative evaluation, which focuses on protecting the target vessels and avoiding intravenous catheters and devices. Intraoperatively, the risk of endothelial dysfunction and hyperplasia is further minimized through an atraumatic dissection with minimal manipulation of the vein and artery. The surgical technique should also focus on decreasing the vessel compliance mismatch and avoiding an inflammatory response secondary to hematoma formation. Postoperatively, the fistula must be diligently monitored for the complications of thrombosis, postoperative steal syndrome, neuropathy, aneurysm formation, infection, and high-output cardiac failure. Early recognition of a problem is the key to saving an otherwise doomed fistula. An armamentarium of percutaneous techniques is available to the access surgeon to treat the most common causes of failed access formation. However, in some cases a surgical revision of the access site through patch angioplasty, a jump graft, and graft interposition is necessary to create a fistula which can be successfully used for hemodialysis.

  8. Fistuloclysis: An Interprofessional Approach to Nourishing the Fistula Patient. (United States)

    Willcutts, Kate; Mercer, David; Ziegler, Jane


    Enteric fistulas can be classified as enterocutaneous and/or enteroatmospheric. Both are devastating complications of bowel disease, abdominal surgery, and/or open abdomen. Enteric fistulas are associated with a mortality rate varying from 1% to 33%; the main cause of death is sepsis. Coordinated and skillful efforts of an interprofessional team are required in customizing successful treatment regimens appropriate to each patient's unique clinical scenario. A 65-year-old white woman experienced an enteroatmospheric fistula patient after ventral hernia repair. Care of this patient was based on the complementary relationship between professionals from 2 disciplines: the wound and ostomy continence nurse (WOC nurse) and the nutrition support registered dietitian/nutritionist. Working together, they developed a comprehensive wound, ostomy, and nutritional plan. Initially, the patient received parenteral nutrition exclusively. After the fistula tract was clearly defined, a feeding tube was placed into the distal limb of the fistula, and she received nourishment via a fistuloclysis (ie, enteral feedings administered via the fistula). A special wound management system was created to contain fistula output while allowing feeding through the distal limb of the fistula. Enterocutaneous and enteroatmospheric fistulas originating from the small bowel present a management challenge to the entire healthcare team. WOC nurses are often called upon to meet the challenge of maintaining skin health while promoting dignity and function. Nutrition support via registered dietitian/nutritionists play a critical role in managing the nutrition regimen for these patients. In this case, the use of fistuloclysis met the patient's nutritional needs while avoiding the risks associated with parenteral nutrition.

  9. Stable gastric pentadecapeptide BPC 157 heals rat colovesical fistula. (United States)

    Grgic, Tihomir; Grgic, Dora; Drmic, Domagoj; Sever, Anita Zenko; Petrovic, Igor; Sucic, Mario; Kokot, Antonio; Klicek, Robert; Sever, Marko; Seiwerth, Sven; Sikiric, Predrag


    To establish the effects of BPC 157 on the healing of rat colovesical fistulas, Wistar Albino male rats were randomly assigned to different groups. BPC 157, a stable gastric pentadecapeptide, has been used in clinical applications-specifically, in ulcerative colitis-and was successful in treating both external and internal fistulas. BPC 157 was provided daily, perorally, in drinking water (10µg/kg, 12ml/rat/day) until sacrifice or, alternatively, 10µg/kg or 10ng/kg intraperitoneally, with the first application at 30min after surgery and the last at 24h before sacrifice. Controls simultaneously received an equivolume of saline (5.0ml/kg ip) or water only (12ml/rat/day). Assessment (i.e., colon and vesical defects, fistula leaking, fecaluria and defecation through the fistula, adhesions and intestinal obstruction as healing processes) took place on days 7, 14 and 28. Control colovesical fistulas regularly exhibited poor healing, with both of the defects persisting; continuous fistula leakage; fecaluria and defecation through the fistula; advanced adhesion formation; and intestinal obstruction. By contrast, BPC 157 given perorally or intraperitoneally and in µg- and ng-regimens rapidly improved the whole presentation, with both colon and vesical defects simultaneously ameliorated and eventually healed. The maximal instilled volume was continuously raised until it reached the values of healthy rats, there were no signs of fecaluria and no defecation through the fistula, there was counteraction of advanced adhesion formation or there was an intestinal obstruction. In conclusion, BPC 157 effects appear to be suited to inducing full healing of colocutaneous fistulas in rats. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. [Enterovesical fistula caused by a prosthesis made of synthetic material]. (United States)

    Pros, I; Puyol, M; Franco, A; Alcaraz, A; Llovera, J M; Gutierrez, R; Carretero, P


    Enterovesical fistulas affect mainly male patients, due to the interposition of the uterus in women. They can be caused by neoplastic, inflammatory or traumatic processes. A case of ilovesical fistula due to migration of a silastic plate used to repair an epigastric infissional hernia is presented. This case has two distinctive features: first, the cause is extraurological, causing a fistula between both systems due to an inflammatory process. Secondly, we report the long distance travelled by the synthetic mesh, causing a peculiar clinical picture five years after its implantation.

  11. Clinical spectrum of spontaneous carotid-cavernous fistula

    Directory of Open Access Journals (Sweden)

    Das Jayanta


    Full Text Available A carotid-cavernous fistula (CCF is an abnormal communication between the cavernous sinus and the carotid arterial system. A CCF is divided into two categories, direct and indirect. Direct fistulas usually account for 70 to 90% of all CCF. Spontaneous, low-flow fistulas are usually associated with atherosclerosis, hypertension and collagen vascular disease or may develop in females during peripartum period. The elderly age group, especially women are at increased risk. We report three cases of spontaneous CCF presenting with ocular manifestations and hypertension, without any collagen vascular disease. One case was a direct variety and the other two were of indirect variety.

  12. Ramiprilate inhibits functional matrix metalloproteinase activity in Crohn's disease fistulas

    DEFF Research Database (Denmark)

    Efsen, Eva; Saermark, Torben; Hansen, Alastair


    Increased expression of matrix metalloproteinase (MMP)-2, -3 and -9 has been demonstrated in Crohn's disease fistulas, but it is unknown whether these enzymes are biologically active and represent a therapeutic target. Therefore, we investigated the proteolytic activity of MMPs in fistula tissue......-diamine-tetraacetic acid (EDTA), the synthetic broad-spectrum inhibitor, GM6001, the angiotensin-converting enzyme (ACE) inhibitor, ramiprilate, and the tetracycline, doxycycline. In Crohn's disease fistulas, about 50% of the total protease activity was attributable to MMP activity. The average total MMP activity...

  13. First Branchial Arch Fistula: A Rarity and a Surgical Challenge. (United States)

    Rajkumar, J S; Ganesh, Deepa; Anirudh, J R; Akbar, S; Joshi, Niraj


    Although 2(nd) Branchial arch fistulae (from incomplete closure of Cervical sinus of His) are well known, 1(st) arch fistulae are much rarer (<10%) and are usually not tackled comprehensively. We present a case of a rare first branchial arch fistula of the type II Arnot classification, which presented with two external openings of more than 20 years duration. Patient had a successful resection of all the concerned fistulous tract. Review of literature and the surgical challenges of the procedure are presented herewith.

  14. [Arteriovenous fistula in patients with a complicated postphlebitic syndrome]. (United States)

    Quiñones Castro, M; Fernández de la Vara Sánchez, L; Perera González, F; Alvarez Sánchez, J A


    An investigation, which goal is to evidencing AV fistulas in patients with a complicated postthrombotic syndrome, as well as to determinate the efficacy of noninvasive methods used for the study of AV fistulas in such patients, is presented. So, patients with a complicated postphlebitic syndrome interned into the Instituto de Angiología were studied. Twenty-five patients were included in the study, 9 of these patients (36%) had arteriovenous fistulas, arteriographically evidenced. Haemodynamic study do not support the evidence of such communications.

  15. Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings. (United States)

    Erdim, Ibrahim; Sirin, Ali Ahmet; Baykal, Bahadir; Oghan, Fatih; Guvey, Ali; Kayhan, Fatma Tulin

    Tracheoesophageal peristomal fistulae can often be solved by reducing the size of the fistula or replacing the prosthesis; however, even with conservative techniques, leakage around the fistula may continue in total laryngectomy patients. Also, several techniques have been developed to overcome this problem, including injections around the fistula, fistula closure with local flaps, myofascial flaps, or free flaps and fistula closure using a septal perforation silicon button. To present the results of the application of silicon ring expanding the voice prosthesis in patients with large and persistent peri-prosthetic fistula. A voice prosthesis was fitted to 42 patients after total laryngectomy. Leakage was detected around the prosthesis in 18 of these 42 patients. Four patients demonstrated improvement with conservative methods. Eight of 18 patients who couldn't be cured with conservative methods were treated by using primary suture closure and 4 patients were treated with local flaps. As silicon ring was applied as a primary treatment in the 2 remaining patients and also, applied to 2 patients who had recurrence after suture repair and to 2 patients who had recurrence after local flap implementation. Silicon rings were used in a total of 6 patients due to the secondary trachea-esophageal fistula. Patients were treated with provox-1 initially and later with provox-2. At the time of leakage around the fistula, 6 patients had provox-2. Fistulae were treated successfully in 6 patients, and effective speech of patients was preserved. Patients experienced no adaptation problem. Prosthesis changing time was not different between silicon rings expanded and normal prosthesis applied patients. Silicon ring combined voice prosthesis was used 26 times; there was no recurrence in fistula complication during 29±6 months follow up. Silicon rings for modified expanded voice prosthesis seems to be an effective treatment for persistent peri-prosthetic leakage, for both, fistula

  16. Repair of a recurrent rectovaginal fistula with a biological graft. (United States)

    Berger, Kate; Faro, Jonathan; Faro, Sebastian


    This case involves a patient with the congenital absence of the lower third of the vagina. While undergoing surgical restoration of the vagina, she sustained a laceration, which ultimately led to the development of a rectovaginal fistula. After two unsuccessful attempts at repair, the recommendation was for a diverting colostomy with another attempted repair, and she presented to our clinic to discuss other possible surgical options. The patient underwent repair of the fistula using a porcine-derived small intestinal submucosal extracellular matrix graft, which resulted in the repair of the rectovaginal fistula without recurrence at 18 months' follow-up.

  17. Clinical Features of Functional Dyspepsia in Combination with Bronchial Asthma

    Directory of Open Access Journals (Sweden)

    M.V. Rostoka-Reznikova


    Full Text Available The objective of the study was to determine the clinical features of dyspepsia in case of combination with bronchial asthma. We examined 152 patients with functional dyspepsia, 102 of them were diagnosed with bronchial asthma. In patients with functional dyspepsia combined with bronchial asthma we detected worsening of functional dyspepsia (significantly higher levels of epigastric pain, feeling of fullness after eating and nausea and significant gender differences of its course in comparison with patients with functional dyspepsia without bronchial asthma. There was a significant prevalence of postprandial distress syndrome in women vs. men with functional dyspepsia and bronchial asthma. Among women in this group, there were also a higher rates of dyspeptic complaints generally and pain syndrome particularly, with more significant polymorphism of complaints in terms of pain nature (fasting pain and night pain, pain through the abdomen and/or with radiation to the back, the connection with spicy food and psychoemotional stress, whereas men from this group significantly more often complained only of the limosis.

  18. Psychological dysfunctions in women with bronchial asthma

    Directory of Open Access Journals (Sweden)

    Natalia G. Astafieva


    Full Text Available Background. The importance of psychosocial factors in the management of bronchial asthma (BA is discussed in clinical guidelines, including in international and national clinical guidelines. However, a specific evaluation of their role as a cause of poor asthma control in susceptible patients is required. Aim. Assessment of psychological health of women with different levels of asthma control.Materials and methods. The study included 108 women with asthma observed in Saratov center for Allergology who were stratified into 3 groups according to the control level (good, partial, uncontrolled, according to GINA. In establishing a diagnosis of asthma, standard methods were used (medical history, symptoms, spirography. To assess the level of control, ACQ-5 (Asthma Control Questionnaire 5 items-self-administered was used, to assess the quality of life, questionnaires AQLQ-S (Asthma Quality of Life Questionnaire S; SF-36 (36-ltem MOS Short-Form Health Survey, a standardized and validated Russian version of the women’s health questionnaire WHQ (Women’s Health Questionnaire were used; for psychological diagnosis and evaluation of social and personal competencies that contribute to the preservation and improvement of human health (the intellectual, personal, emotional, physical, social, creative, spiritual aspects, integrated multimodal questionnaire was used. The comparison was conducted with a control group of men with bronchial asthma, comparable in age and level of control.Results. Women with poorly controlled asthma had worse performance of AQLQ-S (combined median score of 3,43 instead of 5,13 in the group of good control; p < 0,05; all scales of the SF-36, including the general condition (43,48 against 55,07, role of physical (25,93 against 57,76 and emotional problems (43,83 against 64,37; at p < 0.05. According to the WHQ questionnaire (the inverse relationship: the higher the score, the lower the quality of life in the group with poor control

  19. Clinical and economic consequences of pancreatic fistula after elective pancreatic resection. (United States)

    Čečka, Filip; Jon, Bohumil; Šubrt, Zdeněk; Ferko, Alexander


    Postoperative pancreatic fistula is the main cause of morbidity after pancreatic resection. This study aimed to quantify the clinical and economic consequences of pancreatic fistula in a medium-volume pancreatic surgery center. Hospital records from patients who had undergone elective pancreatic resection in our department were identified. Pancreatic fistula was defined according to the International Study Group on Pancreatic Fistula (ISGPF). The consequences of pancreatic fistula were determined by treatment cost, hospital stay, and out-patient follow-up until the pancreatic fistula was completely healed. All costs of the treatment are calculated in Euros. The cost increase index was calculated for pancreatic fistula of grades A, B, and C as multiples of the total cost for the no fistula group. In 54 months, 102 patients underwent elective pancreatic resections. Forty patients (39.2%) developed pancreatic fistula, and 54 patients (52.9%) had one or more complications. The median length of hospital stay for the no fistula, grades A, B, and C fistula groups was 12.5, 14, 20, and 59 days, respectively. The hospital stay of patients with fistula of grades B and C was significantly longer than that of patients with no fistula (P8239, and 30 820 Euros in the no fistula, grades A, B, and C fistula groups, respectively. The grading recommended by the ISGPF is useful for comparing the clinical severity of fistula and for analyzing the clinical and economic consequences of pancreatic fistula. Pancreatic fistula prolongs the hospital stay and increases the cost of treatment in proportion to the severity of the fistula.

  20. Eosinophils in the bronchial mucosa in relation to methacholine dose-response curves in atopic asthma

    NARCIS (Netherlands)

    G.M. Moller (Trude); S.E. Overbeek (Shelley); C.G. van Helden-Meeuwsen; H.C. Hoogsteden (Henk); J.M. Bogaard (Jan)


    textabstractAsthma is characterized by both local infiltration of eosinophils in the bronchial mucosa and bronchial hyperreactivity (BHR). A detailed characterization of BHR implies analysis of a histamine or methacholine dose-response curve yielding not only the dose

  1. International variations in bronchial responsiveness in children: findings from ISAAC phase two.

    NARCIS (Netherlands)

    Buchele, G.; Genuneit, J.; Weinmayr, G.; Bjorksten, B.; Gehring, U.; von Mutius, E.; Priftanji, A.; Stein, R.T.; Addo-Yobo, E.O.; Priftis, K.N.; Shaham, J.R.; Forastiere, F.; Svabe, V.; Crane, J.; Nystad, W.; Garcia-Marcos, L.; Saracar, Y.; El-Sharif, N.; Strachan, D.P.


    RATIONALE: Bronchial responsiveness is an objectively measurable trait related to asthma. Its prevalence and association with asthma symptoms among children in many countries are unknown. OBJECTIVES: To investigate international variations in bronchial responsiveness (BR) and their associations with

  2. Fistula recurrence, pregnancy, and childbirth following successful closure of female genital fistula in Guinea: a longitudinal study. (United States)

    Delamou, Alexandre; Delvaux, Therese; El Ayadi, Alison M; Tripathi, Vandana; Camara, Bienvenu S; Beavogui, Abdoul H; Romanzi, Lauri; Cole, Bethany; Bouedouno, Patrice; Diallo, Moustapha; Barry, Thierno H; Camara, Mandian; Diallo, Kindy; Leveque, Alain; Zhang, Wei-Hong; De Brouwere, Vincent


    Female genital fistula is a devastating maternal complication of delivery in developing countries. We sought to analyse the incidence and proportion of fistula recurrence, residual urinary incontinence, and pregnancy after successful fistula closure in Guinea, and describe the delivery-associated maternal and child health outcomes. We did a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by EngenderHealth in Guinea. We recruited women retrospectively (via medical record review) and prospectively at hospital discharge. We used Kaplan-Meier methods to analyse the cumulative incidence, incidence proportion, and incidence ratio of fistula recurrence, associated outcomes, and pregnancy after successful fistula closure. The primary outcome was recurrence of fistula following discharge from repair hospital in all eligible women who consented to inclusion and could provide follow-up data. 481 women eligible for analysis were identified retrospectively (from Jan 1, 2012, to Dec 31, 2014; 348 women) or prospectively (Jan 1 to June 20, 2015; 133 women), and followed up until June 30, 2016. Median follow-up was 28·0 months (IQR 14·6-36·6). 73 recurrent fistulas occurred, corresponding to a cumulative incidence of 71 per 1000 person-years (95% CI 56·5-89·3) and an incidence proportion of 18·4% (14·8-22·8). In 447 women who were continent at hospital discharge, we recorded 24 cases of post-repair residual urinary incontinence, equivalent to a cumulative incidence of 23·1 per 1000 person-years (14·0-36·2), and corresponding to 10·3% (5·2-19·6). In 305 women at risk of pregnancy, the cumulative incidence of pregnancy was 106·0 per 1000 person-years, corresponding to 28·4% (22·8-35·0) of these women. Of 50 women who had delivered by the time of follow-up, only nine delivered by elective caesarean section. There were 12 stillbirths, seven delivery-related fistula recurrences, and one maternal death. Recurrence of

  3. Immunologycal Status of Children with Bronchial Asthma during Febrile Episodes

    Directory of Open Access Journals (Sweden)

    O.K. Koloskova


    Full Text Available The aim of the research was to study the diagnostic value of some immunological tests for the verification of bacterial and/or viral infection during febrile episodes of bronchial asthma exacerbations in children. On the base of allergological unit of Chernivtsi Regional Child Hospital by the method of simple random sampling there have been examined 119 child patients with bronchial asthma who were admitted to the hospital due to asthma exacerbation caused by fever. They were divided into two groups of clinical observation. The analysis of clinical and laboratory data in children with bacterial and viral febrile bronchial asthma attacks revealed that such patients more likely had higher level of T-lymchocyte of various subpopulations and indices of NBT test neutrophils.


    Directory of Open Access Journals (Sweden)

    A. V. Smyk


    Full Text Available Abstract. Bronchial asthma is a classic psychosomatic disease by immunopathological origin. In present investigation, we studied influence of body-oriented psychotherapeutic methods directed towards clinico-immunological parameters and special psychological features of the patients with bronchial asthma, i.e., decrease in alexithymia, as an important pathogenetic factor of bronchial asthma, and improvement in motor coordination and interhemispheric interactions in motor sphere. We investigated 38 patients (18 men and 20 women, while discriminating those patients who underwent a course of body-oriented psychotherapy, and a group of comparison, who did not undergo similar therapy. When observing conventional standards of randomization according to sex, age, clinical variants, and disease severity, some heterogeneity of these groups was revealed. In general, the people with active life attitude, being ready to work with a psychologist, possessed special features both in psychological and immunological spheres.


    Directory of Open Access Journals (Sweden)

    T.V. Kulichenko


    Full Text Available Antibodies to IgE are a totally new class of medications currently used to enhance the supervision over severe persistent atopic bronchial asthma. Omalizumab is the most well studied, first and only medication of this group, which is recommended for the application and is allowed for treatment of uncontrolled bronchial asthma among adults and children aged 12 and over in different countries of the world, including Russia. High omalizumab assisted treatment costs, as well as the need in the monthly visits to the doctor for the omalizumab injections are justified for the patients, requiring repeat hospitalizations, emergency medical aid, using high doses of the inhalation and/or systemic glucocorticosteroids. The article reviews the criteria for the selection of patients fit for omalizumab assisted treatment.Key words: omalizumab, anti-ige-antibodies, bronchial asthma, allergic rhinitis, treatment, children.

  6. Iliac arteriovenous fistulas after lumbar spinal surgery. (United States)

    Ocal, Osman; Peynircioglu, Bora; Eldem, Gonca; Akpinar, Erhan; Onur, Mehmet Ruhi; Kabakci, Giray


    Iatrogenic arteriovenous fistula (AVF) is an unusual and potentially fatal complication of lumbar spinal surgery. The presentation of these injuries is usually late, with symptoms such as leg swelling or cardiac failure. It is crucial to suspect AVF in the patient which presents to emergency with lumbar spinal surgery history. The diagnosis is often based on imaging studies such as computed tomography (CT) or magnetic resonance (MR) angiography. Surgery was the first choice of treatment, but with recent advances in stent technology endovascular approach has become widely popular. We present two cases of AVF secondary to lumbar spinal surgery, one of them presenting with overt heart failure and the other one with leg swelling.

  7. Inoperable aggressive mesenteric fibromatosis with ureteric fistula

    Energy Technology Data Exchange (ETDEWEB)

    Khanna, Paritosh C. [Radiology Department, Nanavati Hospital, Mumbai (India)]. E-mail:; Lath, Chinar [Radiology Department, Nanavati Hospital, Mumbai (India); Gadewar, Swapna B. [Radiology Department, Nanavati Hospital, Mumbai (India); Agrawal, Dilpesh [Internal Medicine Department, Wockhardt Hospital, Mumbai (India)


    The purpose of our report is to illustrate an aggressive case of mesenteric fibromatosis in a 17-year-old girl with a ureteric fistula and to review imaging and pathological features, natural history and treatment options of this disease. Our patient underwent computed tomography that revealed a widespread intra-abdominal mass. The necrotic centre of this mass had a fistulous communication with the right ureter. Fibromatoses represent a spectrum of uncommon benign conditions characterised by proliferating fibrous tissue. The deep intra-abdominal form of mesenteric fibromatosis (MF), one of the rare subtypes of the 'fibromatoses' or 'desmoid tumours', grows rapidly and may become extensive. Surgery provides good results in limited disease and non-surgical modalities in cases of unresectable and residual disease.

  8. Arterioportal fistulas in liver transplant recipients. (United States)

    Saad, Wael E A


    Arterioportal fistulas (APFs) are classified into intrahepatic (>75% of all reported) and extrahepatic (APFs), so the actual prevalence of intrahepatic APFs is probably much higher (likely >90% of APFs). All reported APFs in liver transplant recipients have been intrahepatic. Hemodynamically significant APFs in liver transplant recipients are rare, occurring in 0.2%; however, APFs (hemodynamically significant or not) are not uncommonly seen in hepatic angiograms of liver transplant recipients (up to 5.4% of hepatic arteriograms in transplants). Interestingly, hemodynamically significant APFs warranting endovascular treatment are reported more commonly in the literature in native compared with transplanted livers (n >280-300 versus n = 13, respectively). This article discusses APFs that are specific to liver transplant recipients; their incidence, etiology, pathogenesis, natural history, clinical presentation, and endovascular management are discussed in detail.

  9. Presentation and perioperative management of arterioportal fistulas. (United States)

    Strodel, W E; Eckhauser, F E; Lemmer, J H; Whitehouse, W M; Williams, D M


    Arterioportal fistulas (APFs) are usually traumatic in origin and may result in portal hypertension and its complications. Over six years, six patients (aged 20 to 59 years) presented with APFs. Two APFs developed after percutaneous liver biopsy, but only one was complicated (hemobilia). Neither patient was treated operatively. Four APFs occurred two days to three years after gunshot wounds. Three patients presented with gastrointestinal tract hemorrhage. All patients had abdominal bruits. Two patients underwent primary repair. One patient underwent APF resection and replacement of the superior mesenteric artery with autogenous vein. Another patient underwent APF and bowel resection. Three patients survived. One patient died of liver failure. The development of an abdominal bruit in a patient with penetrating abdominal trauma suggests APF and should prompt angiography. Elective repair is recommended before complications of portal hypertension develop.

  10. Acquired lacrimal sac fistula mimicking basal cell carcinoma. (United States)

    Litwin, A S; Timlin, H; Sagili, S; Wright, M; Malhotra, R


    Lacrimal sac fistulae can arise after an episode of dacryocystitis, usually forming below the medial canthus. Preceding symptoms of a watery eye with mucous discharge and a history or signs of inflammation are typical. To highlight the features of lacrimal sac fistulae and encourage readers to consider this in the differential diagnosis of apparently ulcerative medial canthal skin lesions. We describe three patients with inferior-medial canthal ulcerative skin lesions, all referred to ophthalmic plastic surgeons either by dermatologists or plastic surgeons, presumed clinically to have basal cell carcinoma (BCC). All three were in fact due to acquired lacrimal sac fistulae, and syringing of the nasolacrimal system confirmed the presence of a fistula. These cases illustrate the importance of questioning patients about their previous ocular symptoms when dealing with less familiar periocular lesions. © 2013 The Authors. BJD © 2013 British Association of Dermatologists.

  11. Imperforate anus and perianal fistula in Ancient Greek medical writings. (United States)

    Tsoucalas, Gregory; Gentimi, Fotini; Kousoulis, Antonis A; Karamanou, Marianna; Androutsos, George


    Anorectal malformations remain a challenging topic in pediatric surgery, known since antiquity. In our paper we expose the main descriptions and therapeutic approaches of imperforate anus and perianal fistula through the works of the ancient Greek and Byzantine physicians.

  12. Biliary-pleural fistulas without biliary obstruction: percutaneous catheter management

    National Research Council Canada - National Science Library

    Feld, R; Wechsler, RJ; Bonn, J


    ...: Our purpose was to report the use of percutaneous catheter drainage as a therapeutic option in the management of three patients with biliary-pleural fistulas without biliary obstructions. CONCLUSION...

  13. Vesico-vaginal Fistula Surgery in Uganda. Brian Hancock, Mhairi ...

    African Journals Online (AJOL)



    Dec 2, 2004 ... first attempt but a further 10% may have unacceptable stress incontinence. Conclusion: We ... fistula camps can make a significant contribution to teaching and cure of patients. ... outcome from prolonged labour, which every.

  14. Obstetric Fistula: A Narrative Review of the Literature on Preventive ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    , especially in the developing context. This study brings together the ...... Current Opinion in. Obstetrics and Gynecology, (18). 26. Shefren, J. (2009). The tragedy of obstetric fistula and strategies for prevention. American Journal of. Obstetrics ...

  15. Clinical and echocardiographic features of aorto-atrial fistulas

    Directory of Open Access Journals (Sweden)

    Ananthasubramaniam Karthik


    Full Text Available Abstract Aorto-atrial fistulas (AAF are rare but important pathophysiologic conditions of the aorta and have varied presentations such as acute pulmonary edema, chronic heart failure and incidental detection of the fistula. A variety of mechanisms such as aortic dissection, endocarditis with pseudoaneurysm formation, post surgical scenarios or trauma may precipitate the fistula formation. With increasing survival of patients, particularly following complex aortic reconstructive surgeries and redo valve surgeries, recognition of this complication, its clinical features and echocardiographic diagnosis is important. Since physical exam in this condition may be misleading, echocardiography serves as the cornerstone for diagnosis. The case below illustrates aorto-left atrial fistula formation following redo aortic valve surgery with slowly progressive symptoms of heart failure. A brief review of the existing literature of this entity is presented including emphasis on echocardiographic diagnosis and treatment.

  16. Salpingocutaneous fistula in an adolescent resulting from septic ...

    African Journals Online (AJOL)

    ... challenge for the adolescent because of the various reproductive and social consequences. ... The issue of unsafe abortion within the context of the unmet sexual and reproductive ... Keywords: Fistula, adolescent, unsafe abortion, abscess

  17. Endovascular treatment of carotid cavernous sinus fistula: A systematic review (United States)

    Korkmazer, Bora; Kocak, Burak; Tureci, Ercan; Islak, Civan; Kocer, Naci; Kizilkilic, Osman


    Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions. PMID:23671750

  18. Intracranial dural arteriovenous fistula with spinal medullary venous drainage

    Energy Technology Data Exchange (ETDEWEB)

    Wiesmann, M.; Padovan, C.S.; Pfister, H.W.; Yousry, T.A. [Muenchen Univ. (Germany). Abt. fuer Neuroradiologie


    We report on a 46-year-old patient in whom an intracranial dural arteriovenous (AV) fistula, supplied by a branch of the ascending pharyngeal artery, drained into spinal veins and produced rapidly progressive symptoms of myelopathy and brainstem dysfunction including respiratory insufficiency. Magnetic resonance imaging studies demonstrated brainstem oedema and dilated veins of the brainstem and spinal cord. Endovascular embolization of the fistula led to good neurological recovery, although the patient had been paraplegic for 24 h prior to embolization. This case demonstrates the MRI characteristics of an intracranial dural AV fistula with spinal drainage and illustrates the importance of early diagnosis and treatment. Even paraplegia may be reversible, if angiography is performed and the fistula treated before ischaemic and gliotic changes become irreversible. (orig.)

  19. Empirical description of bronchial and nonbronchial arteries with MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Yu Hong, E-mail: [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Liu Shiyuan, E-mail: [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Li Huimin, E-mail: [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Xiao Xiangsheng, E-mail: [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Dong Weihua, E-mail: [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China)


    Purpose: We aimed to retrospectively evaluate bronchial and nonbronchial systemic arteries using multi-detector row helical computed tomographic (MDCT) angiography in patients with pulmonary disorders. Materials and Methods: Thirty-nine patients (24 men, 15 women; mean age, 63.4 years; range, 20-82 years) with congenital and acquired pulmonary disorders of the bronchial and nonbronchial systemic arteries underwent multi-detector row helical computed tomographic angiography of the thorax using a 16-detector row scanner. Each of these patients had experienced an episode of hemoptysis. Computed tomographic angiogram data, which included maximum intensity projections, multiplanar reconstruction, and three-dimensional volume-rendered images, were used to retrospectively analyse the characteristics of the bronchial and nonbronchial systemic arteries. Results: We identified a total of 128 bronchial arteries (76 on the right side and 52 on the left) in 39 patients. We detected 42 nonbronchial systemic artery branches, including 19 internal mammary artery branches, 8 subclavian artery branches, 8 inferior phrenic artery branches, 5 intercostal artery branches, 1 thyrocervical trunk branch, and 1 celiac trunk branch. Thirty-five dilated and tortuous nonbronchial systemic arteries entered into the lung parenchyma and extended down to the lesions. Every case, except the one case of sequestration, was associated with pleural thickening where the vascular structures passed through the extrapleural fat. Conclusions: The variations in both the bronchial artery anatomy and the location and type of the nonbronchial arteries were great. Nonbronchial arteries may be a significant source of hemoptysis. MDCT angiography can be used to detect detailed anatomical information about the origins and courses of bronchial and nonbronchial systemic arteries and their pathophysiologic features.

  20. Bronchial wash cytology: A study on morphology and morphometry (United States)

    Rao, Shalinee; Rao, Shivani; Lal, Archana; Barathi, Gunabooshanam; Dhanasekar, Thangaswamy; Duvuru, Prathiba


    Background: Bronchial wash cytology of lung lesions is a non/minimally invasive procedure utilized for diagnosis of pulmonary lesions. Aim: The aim of this study was to evaluate the efficacy of bronchial wash cytology in the diagnosis of bronchopulmonary lesions and assess the role of morphometry in categorizing dysplastic/malignant lesions. Materials and Methods: All cases of bronchial wash cytology received from January 2006 to June 2010 were retrieved and reviewed. Cases with adequate clinical data or a subsequent biopsy were selected for the study and cytodiagnosis was correlated with available clinical details. Morphometry was done on alcohol fixed hematoxylin and eosin stained cytosmears using computer assisted Image Pro software. Results: One hundred and seventy-six cases of the 373 cases of bronchial cytology received were included for the study. Bronchial wash cytology technique showed high specificity. Cytohistopathology correlation showed 62.06% concordance rate. Cells from normal epithelium, reactive atypia, neoplastic atypia, squamous metaplasia, non-small cell and small cell carcinoma showed a mean nuclear diameter of 7.4 μm, 11.7 μm, 13.9 μm, 13.0 μm, 10.7 μm, and 17.7 μm, respectively, which was statistically significant with P < 0.05. Multiple comparisons between various groups using analysis of variance and Bonferroni tests also showed remarkable statistical significance. Conclusions: Bronchial wash cytology has low sensitivity in detecting pulmonary lesions. It can be of value in patients with contraindication for biopsy. Morphometry can be a useful adjunct to cytomorphology, especially in situations where biopsy is contraindicated. PMID:25210231

  1. Airway Inflammation after Bronchial Thermoplasty for Severe Asthma. (United States)

    Denner, Darcy R; Doeing, Diana C; Hogarth, D Kyle; Dugan, Karen; Naureckas, Edward T; White, Steven R


    Bronchial thermoplasty is an alternative treatment for patients with severe, uncontrolled asthma in which the airway smooth muscle is eliminated using radioablation. Although this emerging therapy shows promising outcomes, little is known about its effects on airway inflammation. We examined the presence of bronchoalveolar lavage cytokines and expression of smooth muscle actin in patients with severe asthma before and in the weeks after bronchial thermoplasty. Endobronchial biopsies and bronchoalveolar lavage samples from 11 patients with severe asthma were collected from the right lower lobe before and 3 and 6 weeks after initial bronchial thermoplasty. Samples were analyzed for cell proportions and cytokine concentrations in bronchoalveolar lavage and for the presence of α-SMA in endobronchial biopsies. α-SMA expression was decreased in endobronchial biopsies of 7 of 11 subjects by Week 6. In bronchoalveolar lavage fluid, both transforming growth factor-β1 and regulated upon activation, normal T-cell expressed and secreted (RANTES)/CCL5 were substantially decreased 3 and 6 weeks post bronchial thermoplasty in all patients. The cytokine tumor-necrosis-factor-related apoptosis-inducing ligand (TRAIL), which induces apoptosis in several cell types, was increased in concentration both 3 and 6 weeks post bronchial thermoplasty. Clinical improvement and reduction in α-SMA after bronchial thermoplasty in severe, uncontrolled asthma is associated with substantial changes in key mediators of inflammation. These data confirm the substantial elimination of airway smooth muscle post thermoplasty in the human asthmatic airway and represent the first characterization of significant changes in airway inflammation in the first weeks after thermoplasty.

  2. Epidemiology and outcome of patients with postoperative abdominal fistula. (United States)

    Wercka, Janaina; Cagol, Patricia Paola; Melo, André Luiz Parizi; Locks, Giovani de Figueiredo; Franzon, Orli; Kruel, Nicolau Fernandes


    to present the epidemiological profile, incidence and outcome of patients who developing postoperative abdominal fistula. This observational, cross-sectional, prospective study evaluated patients undergoing abdominal surgery. We studied the epidemiological profile, the incidence of postoperative fistulas and their characteristics, the outcome of this complication and the predictors of mortality. The sample consisted of 1,148 patients. The incidence of fistula was 5.5%. There was predominance of biliary fistula (26%), followed by colonic fistulas (22%) and stomach (15%). The average time to onset of fistula was 6.3 days. For closure, the average was 25.6 days. The mortality rate of patients with fistula was 25.4%. Predictors of mortality in patients who developed fistula were age over 60 years, presence of comorbidities, fistula closure time more than 19 days, no spontaneous closure of the fistula, malnutrition, sepsis and need for admission to the Intensive Care Unit. abdominal postoperative fistulas are still relatively frequent and associated with significant morbidity and mortality. apresentar o perfil epidemiológico, incidência e desfecho em pacientes que evoluíram com fístula abdominal pós-operatória. trata-se de um estudo prospectivo transversal observacional que avaliou pacientes submetidos à cirurgia abdominal. Foram estudados o perfil epidemiológico, a incidência das fístulas pós-operatórias e suas características, desfecho desta complicaçãoe fatores preditivos de mortalidade. a amostra constou de 1148 pacientes. A incidência de fístula foi 5,5%. Houve predominância de fístulas biliares (26%), seguidas de fístulas colônicas (22%) e gástricas (15%). O tempo médio para o surgimento da fístula foi 6,3 dias. Para o fechamento, a média foi 25,6 dias. A taxa de mortalidade dos pacientes com fístula foi 25,4%. Os fatores preditivos de mortalidade nos casos que desenvolveram fístula foram idade maior do que 60 anos, presença de

  3. Arteriovenous fistulas aggravate the hemodynamic effect of vein bypass stenoses

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Djurhuus, Christian Born; Morre-Pedersen, Erik


    PURPOSE: The purpose of this study was to assess the impact of arteriovenous fistulas combined with varying degrees of stenosis on distal bypass hemodynamics and Doppler spectral parameters. METHODS: In an in vitro flow model bypass stenoses causing 30%, 55%, and 70% diameter reduction were induced...... hemodynamic conditions of a more severe stenosis. Assessment of the hemodynamic impact of fistulas must be undertaken in the evaluation of in situ vein bypass stenoses....

  4. Biliary-pleural fistulas without biliary obstruction: percutaneous catheter management. (United States)

    Feld, R; Wechsler, R J; Bonn, J


    Our purpose was to report the use of percutaneous catheter drainage as a therapeutic option in the management of three patients with biliary-pleural fistulas without biliary obstructions. In the proper clinical setting, the CT findings of liver dome laceration or abscess, diaphragm disruption, and pleural effusion should suggest biliary-pleural fistula. Percutaneous catheter management can be curative or serve a temporizing function before surgery.

  5. Successful Use of Modified Suprapubic Catheter to Rescue Prostatorectal Fistula

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    Yi-Chun Chiu


    Full Text Available Prostatorectal fistula is a complication following radiotherapy. It remains a clinical challenge to treat because most patients experience a poor quality of life. This case report discusses a modified suprapubic catheter for use in a patient with a prostatorectal fistula that developed after radiotherapy for localized prostate cancer. It is an inexpensive, easily available, and more patient-tolerable catheter that improves quality of life. Herein, we describe the development of this catheter.

  6. Benign duodenocolic fistula. A case presenting with acidosis

    DEFF Research Database (Denmark)

    Benn, Marianne; Nielsen, F T; Antonsen, H K


    A case of benign duodenocolic fistula as a complication to peptic ulcer disease is presented, the case being interesting for the rarity of the diagnosis and by being complicated with acidosis. The etiology, clinical features, diagnosis, and treatment are reviewed.......A case of benign duodenocolic fistula as a complication to peptic ulcer disease is presented, the case being interesting for the rarity of the diagnosis and by being complicated with acidosis. The etiology, clinical features, diagnosis, and treatment are reviewed....

  7. Care of arteriovenous fistula by patients with chronic renal failure.


    Monteiro Furtado, Angelina; Elisângela Teixeira Lima, Francisca


    This descriptive study aimed at identifying care of arteriovenous fistula (AVF) performed patients under hemodialysis. Twenty one hemodialysis patients were randomly selected in a clinic in Fortaleza, Ceara, Brazil:11 female and 11 male patients, age between 30 and 50 yearold, and most were single, retired, and had low education level. Semi-structured interview was applied. The following procedures were mentioned: cleaning the fistula arm, thrill palpation, avoiding lifting weight with AVF...

  8. [Spontaneous bilio-digestive fistula of lithiasic origin]. (United States)

    Marzocca, G; Botta, G; Lorenzini, L


    Personal experience about 11 cases of spontaneous biliary enteric fistula caused by lithiasic disease operated in the General Surgical Clinic of the University of Siena from 1969 to 1988, is reported. The epidemiology, pathogenesis, symptomatology, indications for operation and various operating techniques performed are discussed. In the gallstone intestinal obstruction, the authors prefer to resolve immediately the obstruction, deferring to a later moment the specific operation for the treatment of the biliary enteric fistula and the lithiasic disease.

  9. Radiological evaluation of anal fistulae: a prospective study of fistulograms. (United States)

    Ani, A N; Lagundoye, S B


    A review of 33 fistulograms in a four-year study is presented. Four types of communicating tracts have emerged: single (58%), branched (18%), fistulous abscess (15%) and compound (9%). This classification has formed the basis of selection of operative treatment in all the cases. Diminished lumbo-sacral angle was also found in most of the anal fistula cases and this establishes a possible association between the pathology of anal fistula and the low back syndrome.

  10. Thoracic fistulas of the pancreas and their complications in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Fritsch, R.; Schirg, E.; Buerger, D.


    The article reports on two thoracic fistulas of the pancreas in infants. Anamnesis revealed that recurring abdominal pain had occured in those children for years; at the time of their admission to hospital there was considerable dyspnoea with thoracic pain depending on the respiration. Fistulas of the pancreas with thoracic connection were identified as the cause. The article goes into the details of genesis, differential diagnosis and course of the disease.

  11. Enterocutaneous Fistulas in the Setting of Trauma and Critical Illness (United States)


    aortic aneurysm leads to increased intraperitoneal and retroperitoneal volume, visceral edema, abdominal wall edema, and may lead to ACS. The term...patients that had developed oliguria and abdominal distention after abdominal aortic aneurysm repair.30 The advent of endovascular techni- ques for...fistula complicating electric burns a case report. J Pediatr Surg 2003;38(8):1232 1233 13. Prasad JK, Thomson PD, East MK. Faecal fistula as the

  12. [Autonomic regulation of cardiac rhythm in elderly patients with bronchial asthma]. (United States)

    Ramazanova, K A; Orakova, F Kh; Inarokova, A M


    Evaluation of independent and combined interrelations of bronchial obstruction and autonomic regulation of cardiac rhythm in elderly patients with bronchial asthma was carried out. Positive correlation of the extent of bronchial obstruction and decrease of absolute indices of cardiac rhythm variability was established.

  13. Bronchial abnormalities found in a consecutive series of 40 brachycephalic dogs. (United States)

    De Lorenzi, Davide; Bertoncello, Diana; Drigo, Michele


    To detect abnormalities of the lower respiratory tract (trachea, principal bronchi, and lobar bronchi) in brachycephalic dogs by use of endoscopy, evaluate the correlation between laryngeal collapse and bronchial abnormalities, and determine whether dogs with bronchial abnormalities have a less favorable postsurgical long-term outcome following correction of brachycephalic syndrome. Prospective case series study. 40 client-owned brachycephalic dogs with stertorous breathing and clinical signs of respiratory distress. Brachycephalic dogs anesthetized for pharyngoscopy and laryngoscopy between January 2007 and June 2008 underwent flexible bronchoscopy for systematic evaluation of the principal and lobar bronchi. For dogs that underwent surgical correction of any component of brachycephalic syndrome, owners rated surgical outcome during a follow-up telephone survey. Correlation between laryngeal collapse and bronchial abnormalities and association between bronchial abnormalities and long-term outcome were assessed. Pugs (n = 20), English Bulldogs (13), and French Bulldogs (7) were affected. A fixed bronchial collapse was recognized in 35 of 40 dogs with a total of 94 bronchial stenoses. Abnormalities were irregularly distributed between hemithoraces; 15 of 94 bronchial abnormalities were detected in the right bronchial system, and 79 of 94 were detected in the left. The left cranial bronchus was the most commonly affected structure, and Pugs were the most severely affected breed. Laryngeal collapse was significantly correlated with severe bronchial collapse; no significant correlation was found between severity of bronchial abnormalities and postsurgical outcome. Bronchial collapse was a common finding in brachycephalic dogs, and long-term postsurgical outcome was not affected by bronchial stenosis.


    Directory of Open Access Journals (Sweden)

    V.A. Revyakina


    Full Text Available In the article the problems of classification, diagnostics and treatment of allergic rhinitis in children are viewed, the therapy with local antihistamines is detailed. The state of bronchial reactivity in children with allergic rhinitis has been studied, the methods of the prophylaxis of bronchial asthma progress are discussed.Key words: allergic rhinitis, bronchial asthma, azelastine, children, treatment.

  15. A case of endobronchial lipoma mimicking bronchial asthma

    Directory of Open Access Journals (Sweden)

    Sevket Ozkaya


    Full Text Available Sevket Ozkaya1, Hasan Demir1, Serhat Findik21Samsun Chest Diseases and Thoracic Surgery Hospital, Samsun, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, Samsun, TurkeyAbstract: Endobronchial lipoma is a rare neoplasm of the tracheobronchial tree and it may cause irreversible pulmonary damage due to recurrent pneumonia. Rarely, it may mimic bronchial asthma. We present a 53-year-old woman with an endobronchial lipoma, which had been treated as a bronchial asthma for four years. She also had developed recurrent pneumonia three times.Keywords: endobronchial lipoma, asthma, radiology, bronchoscopy

  16. Treatment of traumatic carotid cavernous fistulas using detachable balloons

    Energy Technology Data Exchange (ETDEWEB)

    Han, Moon Hee; Han, Joon Koo; Chang, Kee Hyun [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    Since the introduction of the concept of detachable balloon technique to occlude arteriovenous fistulas, this technique has become the treatment of choice in the management of traumatic carotid cavernous fistulas (CCF). We tried the occlusion of fistula using detachable balloons in 30 consecutive cases of traumatic CCF and the result of our experience is reported. Transarterial approach with manually-tied latex balloons is tried in all cases and the fistulas were successfully occlude in 28 cases of all. In 20 cases, internal carotid artery was preserved and the arterial lumen was occluded along with fistula opening in 9 cases. In rest of 2 cases, surgical ligation was done because of procedure-related thromboembolism and incomplete occlusion of fistula. We experienced hemiparesis as a major complication in 3 cases. In one of them, the symptom developed during occlusion tolerance test, one just after insertion of guiding catheter into the internal carotid artery, and in one case 2 days after the occlusion of internal carotid artery. In one case, the procedure was performed by the direct puncture of carotid artery because of the ligation of common carotid artery by previous surgery. It is suggested that the systemic heparinization during the procedure is indispensable and starting the procedure with No 9 balloon is considered reasonable.

  17. Congenital nasolacrimal duct fistula in Brown Swiss cattle. (United States)

    Braun, Ueli; Jacober, Simon; Drögemüller, Cord


    An increased incidence of nasolacrimal duct fistula in the offspring of dam J and three of her sons (bulls A, B and C) prompted a study to investigate the prevalence and clinical manifestation of this anomaly. The dam J, bull B, 255 direct offspring of bulls A, B, and C and eight other direct and indirect offspring of cow J were examined. The periocular region of each animal was examined for unilateral or bilateral nasolacrimal duct fistula and the location, appearance and size of the lesions. Of 265 cattle examined, 54 had unilateral (n = 24) or bilateral fistula (n = 30). The prevalence of affected offspring differed significantly among the three bulls. The fistulae were located medial to the medial canthus of the eye and were 1 to 10 mm (median, 1 mm) in height and 1 to 12 mm (median, 2 mm) in length. The shape of the opening was circular in 58, oval in 23 and slit-like in three. One other animal had a large opening with an atypical shape and another had an abnormal medial canthus with several fistulous openings. Seventy openings were pigmented and 52 were hairless. The fistulae were clinically significant in 12 animals. The findings suggest a hereditary cause of nasolacrimal duct fistula in Brown Swiss cattle.

  18. Elevated Shear Stress in Arteriovenous Fistulae: Is There Mechanical Homeostasis? (United States)

    McGah, Patrick; Leotta, Daniel; Beach, Kirk; Aliseda, Alberto


    Arteriovenous fistulae are created surgically to provide access for dialysis in patients with renal failure. The current hypothesis is that the rapid remodeling occurring after the fistula creation is in part a process to restore the mechanical stresses to some preferred level (i.e. mechanical homeostasis). Given that nearly 50% of fistulae require an intervention after one year, understanding the altered hemodynamic stress is important in improving clinical outcomes. We perform numerical simulations of four patient-specific models of functioning fistulae reconstructed from 3D Doppler ultrasound scans. Our results show that the vessels are subjected to `normal' shear stresses away from the anastomosis; about 1 Pa in the veins and about 2.5 Pa in the arteries. However, simulations show that part of the anastomoses are consistently subjected to very high shear stress (>10Pa) over the cardiac cycle. These elevated values shear stresses are caused by the transitional flows at the anastomoses including flow separation and quasiperiodic vortex shedding. This suggests that the remodeling process lowers shear stress in the fistula but that it is limited as evidenced by the elevated shear at the anastomoses. This constant insult on the arterialized venous wall may explain the process of late fistula failure in which the dialysis access become occluded after years of use. Supported by an R21 Grant from NIDDK (DK081823).

  19. Sexual activity among Nigerian women following successful obstetric fistula repair. (United States)

    Anzaku, Stephen A; Lengmang, Sunday J; Mikah, Samaila; Shephard, Steven N; Edem, Bassey E


    To evaluate post-operative sexual activity among women who have undergone obstetric fistula repair. The present descriptive cross-sectional study recruited married women who had undergone successful obstetric fistula repair who were attending reunion activities at Bingham University Teaching Hospital, Jos, Nigeria, between March 13 and March 15, 2014. Participants were interviewed regarding penetrative vaginal intercourse after surgery, and any changes in sexual desire, arousal, orgasm, sexual satisfaction, and the presence of coital pain compared with before they experienced obstetric fistula. There were 102 patients who participated in interviews; 23 (22.5%) reported not being able to engage in penetrative vaginal intercourse and 12 (52%) of these patients ascribed this to a "tight" or "narrow" vagina. Compared with the pre-fistula period, 63 (61.7%) patients reported reduced sexual desire, 57 (55.9%) reported lack of or inadequate lubrication during intercourse, 12 (11.8%) reported anorgasmia, and 60 (58.8%) reported reduced attainment of orgasm. Dyspareunia was reported by 48 (47.1%) patients; 43 (90%) experienced superficial or deep dyspareunia, and 5 (10%) experienced both. A lack of and lower sexual satisfaction were reported by 20 (19.6%) and 40 (39.2%) patients, respectively. Following obstetric fistula repair, many women experienced difficulty engaging in penetrative vaginal intercourse and reported sexual dysfunction. Management of sexual dysfunction should be part of fistula rehabilitation programs. © 2016 International Federation of Gynecology and Obstetrics.

  20. Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era

    Directory of Open Access Journals (Sweden)

    M. Crespi


    Full Text Available Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.

  1. Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era. (United States)

    Crespi, M; Montecamozzo, G; Foschi, D


    Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.

  2. Primary aortoduodenal fistula after radiotherapy. Report of a case

    Energy Technology Data Exchange (ETDEWEB)

    Oshima, Takeshi; Inoue, Hitoshi; Oshima, Akira; Minami, Tomohito; Matsumine, Takao [Tokyo Metropolitan Fuchu Hospital (Japan)


    Aortoduodenal fistula is a rare and life-threatening cause of gastrointestinal hemorrhage. The patient was a 44-year-old woman who repeated intermittent hematemesis and melena after hysterectomy, para-aortic lymph node dissection, and subsequent radiotherapy. Angiography revealed no bleeding point. Upper gastrointestinal endoscopy showed an ulcer at the third portion of the duodenum. Emergency laparotomy revealed an aortoduodenal fistula which was inferred to be caused by radiotherapy because no recurrence of malignancy was detected. After the fistula was closed, the patient repeated hematemesis and anal bleeding. She died of acute hemorrhagic shock, in spite of three operations including axillo-femoral bypass. We propose that radiation might have played a role in the pathogenesis of the aortoduodenal fistula in our case. The new case of primary aortoduodenal fistula following radiotherapy is added to four cases previously reported in the literature. Six cases in which the lesion of the duodenum could be demonstrated by endoscopy, have been reported in Japan. Aortoduodenal fistula should be considered as a probable diagnosis in patients presenting massive gastrointestinal hemorrhage after radiotherapy. Rapid surgical treatments are needed, and operative procedures to be considered include resection of the aorta with aortic stump closure and axillo-femoral bypass. (author)

  3. A rare case of congenital bronchoesophageal fistula in an adult. (United States)

    Taira, Naohiro; Kawasaki, Hidenori; Atsumi, Eriko; Furugen, Tomonori; Ichi, Takaharu; Kushi, Kazuaki; Yohena, Tomofumi; Baba, Motoo; Kawabata, Tsutomu


    When congenital bronchoesophageal fistulas exist without atresia of the esophagus, the diagnosis can be delayed, although symptoms may occur early following fistula development. Therefore, while they are usually found in infants, they can be extremely rarely found in adults. We herein report a rare case of bronchoesophageal fistula without atresia in an adult. An 69-year-old male presented to the outpatient clinic with a decades-long history of cough with expectoration immediately after taking food, especially liquids. Computed tomograph, esophagoscopy, and esophagography revealed the fistulous communication between the mid-esophagus and right lower lobe bronchus, with consolidation in the right lower lobe. We performed right lower lobectomy with the closure and excision of the fistula. The histopathology of the fistula revealed the mucosa to be lined by stratified squamous epithelium. There was no evidence of inflammation, granuloma, or carcinoma. In conclusion, despite the benign nature of this malformation, if left untreated, it can cause long-term debilitating respiratory symptoms associated with the fistula. Therefore, the diagnosis should be considered in the evaluation of recurrent lung infection. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.


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    M. V. Smolnikova


    Full Text Available Bronchial asthma is a prevalent chronic allergic disease of lungs at early ages. A priority  task in allergology  is to search  biological  markers  related  to uncontrolled atopic  bronchial asthma. Cytokines fulfill their distinct function in pathogenesis of atopic  bronchial asthma, participating at the initiation, development and persistence of allergic inflammation in airways, causing different  variations of clinical course of the disease (with  respect  to its acuteness, severity, frequency of exacerbations. The  present  work has studied  indices  of cellular  and  humoral links of immunity, as well as levels of some  pro and  anti-inflammatory cytokines in peripheral blood serum (IL-4, IL-10, IL-2 and TNFα, aiming to determine potential markers of uncontrolled atopic bronchial asthma in children. A group of Caucasian (European children was involved into the research: Cohort 1, moderate atopic  bronchial asthma with controlled course during the last 3 months (n = 59; Cohort 2, severe/moderate-severe atopic bronchial asthma with uncontrolled course of the disease within last 3 months (n = 51,  Cohort 3 – control, practically healthy  children without signs of atopy  (n = 33. All the  children included in the group with atopic  bronchial asthma underwent regular mono/combined basic therapy  at high/ intermediate therapeutic doses.  We performed a comparative analysis  of cell  population indices  reflecting certain cellular  immunity links,  and  determined significantly  lower  levels of CD3+   lymphocytes, as well as decrease in relative  and  absolute  contents of CD4+  and  CD8+  cells in the  cohort with  uncontrolled course of atopic  bronchial asthma, as compared with controlled-course cohort. When  evaluating concentrations  of cytokines in peripheral blood serum of the patients with controlled and uncontrolled atopic  bronchial asthma, we revealed  significantly  higher

  5. A rare complication of Meckel's diverticulum: A fistula between Meckel's diverticulum and the appendix

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    Ping-Fu Yang


    Full Text Available Meckel diverticulum is the most common congenital anomaly of the small intestine, occurring in about 2%–4% of the population. Meckel diverticulum results from incomplete closure of the omphalomesenteric duct. The presentation of symptomatic Meckel diverticulum includes gastrointestinal hemorrhage, intestinal obstruction, volvulus, intussusception, diverticulitis, and neoplasms. The development of fistula is an extremely rare complication. Previous literature has even shown an enterocolonic fistula, a vesicodiverticular fistula, ileorectal fistula, and fistula-in-ano. To the best of our knowledge, we present the first case of the fistula complicated between Meckel diverticulum and the appendix in a review of the English literature.

  6. Traumatic rectourethral fistula repair: A potential application of porcine small intestinal submucosa

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    Shanmugasundaram Rajaian


    Full Text Available Rectourethral fistula is an uncommon but devastating condition. Traumatic rectourethral fistula is still uncommon and repair of traumatic rectourethral fistula involves a complex procedure. Most of the urologists would prefer to repair the fistula through perineal route especially when urethral reconstruction is also required. The repaired ends of the fistula are separated with various interposition flaps and grafts in order to prevent recurrence. Gracilis interposition muscle flap is commonly used. We describe the first case of traumatic rectourethral fistula repair in a 45-year-old man using interposition of a porcine small intestinal submucosal (Biodesign™ (Surgisis ® graft.

  7. Surgical management of aneurysms of arteriovenous fistulae in hemodialysis patients: A case series

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    Christopher SP Valentine


    Full Text Available Christopher SP Valentine, Olugbenga AworantiDepartment of Surgery, Cornwall Regional Hospital, Montego Bay, JamaicaBackground: One of the complications of arteriovenous (AV fistulae used for hemodialysis is aneurysm formation and subsequent risk for rupture. Surgery is one of the modalities utilised to treat this condition.Methods: A retrospective review of medical records was done to identify patients managed surgically at our institution over a four-year period. The surgical procedures varied from aneurysmectomy alone, to partial aneurysmectomy with preservation of the fistula, to aneurysmectomy and creation of a new fistula.Results: Seven patients who had undergone AV fistula aneurysm were identified. The usual presentation was of a pulsatile, expansile mass at the site of the AV fistula scar associated with pain. Two patients presented with bleeding. Patients in whom preservation of the fistula was attempted had poor patency of the fistula postoperatively. All patients in whom aneurysmectomy with creation of a new fistula was done had a functional fistula postoperatively.Discussion: Others have described surgical techniques for fistula preservation, but these have necessitated a significant delay until use of the fistula. Arterial blood flow in a new fistula increases gradually for up to 10 days, then tapers off. Therefore, it should be possible to begin use of the fistula at this time.Conclusions: AV fistula aneurysms may be treated by aneurysmectomy and creation of a new fistula. This may also reduce the waiting time before the fistula can be used for dialysis.Keywords: arteriovenous fistula, aneurysm, hemodialysis aneurysm, pseudoaneurysm

  8. Does postoperative mechanical ventilation predispose to bronchopleural fistula formation in patients undergoing pneumonectomy? (United States)

    Toufektzian, Levon; Patris, Vasileios; Sepsas, Evangelos; Konstantinou, Marios


    A best evidence topic was written according to a structured protocol. The question addressed was whether postoperative mechanical ventilation has any effect on the incidence of development of bronchopleural fistulas (BPFs) in patients undergoing pneumonectomy. A total of 40 papers were identified using the reported search, of which 8, all retrospective, represented the best evidence to answer the clinical question. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. Of the eight identified papers, six of them reported a statistically significant relationship between postoperative mechanical ventilation and the occurrence of bronchopleural fistula in patients undergoing pneumonectomy (P = 0.027-0.0001). In two of these studies, postoperative mechanical ventilation was identified during multivariate analysis as an independent predictor for the development of BPF after pneumonectomy (odds ratio 15.57 and 33.1), indicating a causal relationship whereas, in the other four reports, statistical significance was the result of univariate analysis. In another study, the difference between these two groups approached but did not reach statistical significance (P = 0.057). Finally, one study reported no association between postoperative mechanical ventilation and the development of post-pneumonectomy BPF (0.16). Apart from mechanical ventilation, pre-existing pleuropulmonary infection was reported by one study as an independent predictor for the development of post-pneumonectomy BPF whereas, in two other studies, its impact approached but did not reach statistical significance. Another study did not find any association between preoperative infection and postoperative BPF occurrence. In conclusion, the majority of the reported studies report a significant relationship between mechanical ventilation after pneumonectomy and the occurrence of BPF. Every effort should be made to achieve extubation at the earliest possible time to

  9. Does bronchial thermodilution allow estimation of cardiac output?

    NARCIS (Netherlands)

    Loer, SA; Wietasch, JKG; Scheeren, TWL

    Objective: Transcapillary heat transfer after injections of cold saline into the right atrium generates bronchial thermodilution curves resembling those observed in the aorta. Under the assumption that no indicator is lost or gained within the pulmonary capillary bed and changes in blood temperature

  10. Assessment of left ventricular diastolic function in bronchial asthma ...

    African Journals Online (AJOL)

    Conclusion: Transmitral inflow velocity patterns during acute severe asthma in children are suggestive of altered LV preload due to an acute transient elevation in pulmonary artery pressure secondary to the altered lung mechanics, and are not reflective of intrinsic LV diastolic dysfunction. Keywords: Bronchial asthma, right ...

  11. Children with bronchial asthma assessed for psychosocial problems ...

    African Journals Online (AJOL)

    Background: Paediatric bronchial asthma causes respiratory related mortality and morbidity globally and elevates the risk of psychological and social problems (psychosocial problems); which may result in poorer asthma control. The rate of and associated factors for psychosocial problems among our asthmatic children ...

  12. Bronchial carcinoid tumors: A rare malignant tumor | Orakwe ...

    African Journals Online (AJOL)

    Bronchial carcinoid tumors (BCTs) are an uncommon group of lung tumors. They commonly affect the young adults and the middle aged, the same age group affected by other more common chronic lung conditions such as pulmonary tuberculosis. Diagnosis is commonly missed or delayed due to a low index of suspicion.

  13. Bronchial Hyperresponsiveness in Farmers: Severity and Work-Relatedness

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    Saso Stoleski


    CONCLUSION: Our data suggest that workplace exposure in farmers may cause respiratory impairment which is closely related to its duration, characteristics, and intensity. The results suggest that cow breeders in general have higher rates of work-related respiratory symptoms and bronchial hyperresponsiveness than agricultural farmers, whereas their severity increases with an increase in frequency and duration of animal contact.

  14. Allergic bronchopulmonary aspergillosis as a cause of bronchial ...

    African Journals Online (AJOL)

    Background: Allergic bronchopulmonary aspergillosis (ABPA) occurs in patients with asthma and cystic fibrosis. When aspergillus fumigatus spores are inhaled they grow in bronchial mucous as hyphae. It occurs in non immunocompromised patients and belongs to the hypersensitivity disorders induced by Aspergillus.

  15. Ascorbic acid in bronchial asthma | Anderson | South African ...

    African Journals Online (AJOL)

    Sixteen White children with bronchial asthma were divided into two groups; one received standard antiasthma chemoprophylaxis (SAC) and the other SAC supplemented with 1 g ascorbic acid (Redoxon) given as a single daily dose for a 6-month period. In 10 patients the effects of ascorbic acid on exerciseinduced ...

  16. Mechanical compression attenuates normal human bronchial epithelial wound healing

    Directory of Open Access Journals (Sweden)

    Malavia Nikita


    Full Text Available Abstract Background Airway narrowing associated with chronic asthma results in the transmission of injurious compressive forces to the bronchial epithelium and promotes the release of pro-inflammatory mediators and the denudation of the bronchial epithelium. While the individual effects of compression or denudation are well characterized, there is no data to elucidate how these cells respond to the application of mechanical compression in the presence of a compromised epithelial layer. Methods Accordingly, differentiated normal human bronchial epithelial cells were exposed to one of four conditions: 1 unperturbed control cells, 2 single scrape wound only, 3 static compression (6 hours of 30 cmH2O, and 4 6 hours of static compression after a scrape wound. Following treatment, wound closure rate was recorded, media was assayed for mediator content and the cytoskeletal network was fluorescently labeled. Results We found that mechanical compression and scrape injury increase TGF-β2 and endothelin-1 secretion, while EGF content in the media is attenuated with both injury modes. The application of compression after a pre-existing scrape wound augmented these observations, and also decreased PGE2 media content. Compression stimulated depolymerization of the actin cytoskeleton and significantly attenuated wound healing. Closure rate was partially restored with the addition of exogenous PGE2, but not EGF. Conclusion Our results suggest that mechanical compression reduces the capacity of the bronchial epithelium to close wounds, and is, in part, mediated by PGE2 and a compromised cytoskeleton.

  17. Assessment of Serum Vitamin D in Patients with Bronchial Asthma

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    Hisham E. Abd El Aaty


    Conclusions: Vitamin D deficiency was highly prevalent in asthmatic patients, there was a strong correlation between asthma severity and 25(OH vitamin D concentrations and there was a direct and a positive significant correlation between vitamin D levels and pulmonary function tests in asthmatic patients, so the measurement of serum vitamin D levels in patients with bronchial asthma is very useful.

  18. Dry powder formulation in the twincertm for bronchial challenge testing

    NARCIS (Netherlands)

    Lexmond, A.J.; Hagedoorn, P.; Frijlink, H.W.; Ten Hacken, N.H.T.; Steckel, H.; De Boer, A.H.

    Summary Background: In bronchial challenge testing lung deposition of the stimulus may be poorly controlled due to incorrect use of nebulisers. Furthermore, the need for freshly prepared solutions burdens personnel and budget. In this study we aim to develop a dry powder alternative with higher

  19. Doses and models in risk assessment analysis for bronchial hyperresponsiveness

    NARCIS (Netherlands)

    de Marco, R; Bugiani, M; Zanolin, E; Verlato, G; Rijcken, B

    The aims of this study are: (1) to evaluate whether the estimates of the association of risk factors with bronchial hyperresponsiveness (BHR) depends on the accumulated dose administered in challenge tests; and (2) to verify whether a model developed for survival studies (Weibull regression) is

  20. Inhaled Mannitol as a Laryngeal and Bronchial Provocation Test. (United States)

    Tay, Tunn Ren; Hoy, Ryan; Richards, Amanda L; Paddle, Paul; Hew, Mark


    Timely diagnosis of vocal cord dysfunction (VCD), more recently termed "inducible laryngeal obstruction," is important because VCD is often misdiagnosed as asthma, resulting in delayed diagnosis and inappropriate treatment. Visualization of paradoxical vocal cord movement on laryngoscopy is the gold standard for diagnosis, but is limited by poor test sensitivity. Provocation tests may improve the diagnosis of VCD, but the diagnostic performance of current tests is less than ideal. Alternative provocation tests are required. This pilot study demonstrates the feasibility of using inhaled mannitol for concurrent investigation of laryngeal and bronchial hyperresponsiveness. Consecutive patients with suspected VCD seen at our institution's asthma clinic underwent flexible laryngoscopy at baseline and following mannitol challenge. VCD was diagnosed on laryngoscopy based on inspiratory adduction, or >50% expiratory adduction of the vocal cords. Bronchial hyperresponsiveness after mannitol challenge was also assessed. We evaluated the interrater agreement of postmannitol laryngoscopy between respiratory specialists and laryngologists. Fourteen patients with suspected VCD in the context of asthma evaluation were included in the study. Mannitol provocation demonstrated VCD in three of the seven patients with normal baseline laryngoscopy (42.9%). Only two patients had bronchial hyperresponsiveness. There was substantial interrater agreement between respiratory specialists and laryngologists, kappa = 0.696 (95% confidence interval: 0.324-1) (P = 0.006). Inhaled mannitol can be used to induce VCD. It is well tolerated and can evaluate laryngeal and bronchial hyperresponsiveness at the same setting. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  1. Non-matured arteriovenous fistulae for haemodialysis: diagnosis, endovascular and surgical treatment

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    Marko Malovrh


    Full Text Available Non-maturation is a feature of autologous vascular access. The autologous arteriovenous fistula needs time to mature and for the vein to enlarge to a size where it can be needled for dialysis. A fistula that fails early is one that either never develops adequately to support dialysis or fails within the first three months of its use. Two variables are required for fistula maturation. Firstly, the fistula should have adequate blood flow to support dialysis and secondly, it should have enough size to allow for successful repetitive cannulation. Three main reasons for maturation failure are: arterial and venous problems and the presence of accessory veins. Early diagnostics and intervention for fistula maturation minimizes catheter use and its associated complications. The identification of immature fistulae is relatively simple. Physical examination has been highlighted to be a valuable tool in assessing fistula. Any fistula that fails to mature adequately and demonstrates abnormal physical findings should be studied aggressively. Ultrasonography can successfully identify candidates who fail to meet the recently developed criteria for immature fistulae. In recent years, digital subtraction angiography and contrast-enhanced magnetic resonance angiography has been introduced for assessment of dysfunctional haemodialysis conduits, including immature fistulae. A great majority of non-matured fistulae can be successfully salvaged using percutaneous techniques. In addition to endovascular techniques, surgical intervention can also be an option. This paper reviews the process of fistula maturation and presents information regarding how to obtain a mature fistula.

  2. Air pollution, bronchial hyperreactivity and bronchial pulmonary disorders in children and adults. Luftverschmutzung, bronchiale Hyperreagibilitaet und Atemwegserkrankungen bei Kindern und Erwachsenen

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    Kuehr, J.; Hendel-Kramer, A.; Hader, S.; Urbanek, R. (Freiburg Univ. (Germany, F.R.). Universitaets-Kinderklinik); Karmaus, W. (Wissenschaftszentrum Berlin fuer Sozialforschung gGmbH (WZB) (Germany, F.R.)); Steinitz, H. (Staatliches Gesundheitsamt, Freiburg im Breisgau (Germany, F.R.)); Stephan, V. (National Institutes of Health, Bethesda, MD (USA))


    Bronchial hyperreactivity (BH) is a common feature of bronchial asthma. A sample of 560 school children of 2 different climate areas in the South-West of Germany was analyzed by standardized questionnaire, residential factors, passive smoking and skin prick testing (SPT) with 10 common aeoroallergens. BH was investigated by a standardized carbachol inhalation procedure (CIP) in cumulative manner. Pollutants (NO{sub 2}, particulate combustion products) in the outdoor air near the childrens residences were measured in the same winter season. The mode of heating and the ventilation manners (VM) in houses were characterized as parameters for indoor climate. In 149 children (26.6%) a BH in the CIP appeared. For multiple logistic regression analysis the best model to explain the existence of BH was fitted. In this final model the relative risk was significantly increased (odds ratio 2.39, 95%-confidence interval 1.19-4.77) by use of stoves within the dwelling burnt with gas, coal or oil. As confounding variable sensitization in SPT and passive smoking appeared significant. Outdoor air pollution and VM were not of significant relative risk. Therefore the indoor climate in residences which are heated by stoves within the rooms burnt with gas, coal or oil must be considered as a potential risk factor for bronchial hyperreactivity in childhood. (orig./MG).

  3. Direct Traumatic Carotid Cavernous Fistula: Angiographic Classification and Treatment Strategies (United States)

    Chi, Cuong Tran; Nguyen, Dang; Duc, Vo Tan; Chau, Huynh Hong; Son, Vo Tan


    Summary We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies. Only type A CCF patients (Barrow's classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fiatula. After the confirm angiogram, endovascular embolization would be performed impromptu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization. A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion under endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases

  4. Robotic repair of vesicovaginal fistula - initial experience

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    Ankush Jairath


    Full Text Available ABSTRACT Objective The most common acquired fistula of the urinary tract is Vesicovaginal fistulae (VVF (1 posing social stigmata for the patient as well as a surgical challenge for the urologist. Here we present our initial experience with Robotic assisted laparoscopic repair of VVF, its safety and efficacy. Materials and Methods Seven out of eight fistulas were post hysterectomy; five had undergone abdominal while two had laparoscopic hysterectomy while one was due to prolonged labour. Two had associated ureteric injury. All underwent robotic assisted laparoscopic trans abdominal extravesical approach. Three 8 mm ports for robotic arms, one 12 mm port for camera and another 12 mm for assistant were used in a fan shaped manner. All had preoperative ureteric catheter placed. Bladder was closed in two layers and vagina in one layer. Omental flap placed in all cases except two where it was not possible. Drain and per urethral catheter placed in all cases. Double J stents were placed in two cases requiring ureteric implantation additionally. Results The mean age of presentation was 39.25 years (26-47 range with mean BMI being 26.25 kg/m2 (21-32 range. Mean duration between insult and repair was 9.37 months (3-24 months. Only in single case there was history of previous repair attempt. On cystoscopy four had supratrigonal VVF and four were trigonal with mean size of 13.37 mm (7-20 mm. Mean operative time was 117.5 minutes (90-150. There were no intraoperative/postoperative complications or need for open conversion. Mean haemoglobin drop was 1.4 gm/dL (0.3-2 gm. Drain was removed once 24-48 hours output is negligible. One patient had post-operative urinary leak at 2 weeks which ceased with continuation of catheterisation for another 2 weeks. Catheter was removed after voiding cystourethrogram showed no leak at 2-3 weeks postoperatively. Mean duration of drain was 3.75 days (3-5 and per urethral catheterisation (which was removed after voiding

  5. Eosinophil cationic protein mRNA expression in children with bronchial asthma. (United States)

    Yu, H Y; Li, X Y; Cai, Z F; Li, L; Shi, X Z; Song, H X; Liu, X J


    Studies have shown that eosinophils are closely related to pathogenesis of bronchial asthma. Eosinophils release eosinophil cationic protein (ECP), which plays an important role in infection and allergic reactions. Serum ECP mRNA expression in children with bronchial asthma has not been adequately investigated. We analyzed serum ECP mRNA expression in 63 children with bronchial asthma and 21 healthy children by using reverse-transcriptase polymerase chain reaction to understand the role of ECP in children with bronchial asthma. The children with bronchial asthma were segregated into acute-phase and stable-phase groups, based on the severity of the illness. Serum ECP mRNA expression in children with bronchial asthma (0.375 ± 0.04) was significantly higher than that in healthy controls (0.20 ± 0.02; P bronchial asthma.

  6. Surgical management of chronic fistula after sleeve gastrectomy. (United States)

    Nedelcu, A Marius; Skalli, Mehdi; Deneve, Eric; Fabre, Jean Michel; Nocca, David


    There is no clear definition of the chronic leak after sleeve gastrectomy. There are several endoscopic approaches, including endoprothese, endoscopic clips, endoscopic sealing glue, or balloon dilation. In case of failure of the endoscopic treatment, a definitive surgical approach can be attempted. The objective was to evaluate the surgical treatment of chronic leak after sleeve gastrectomy. From November 2010 through March 2012, 8 patients with chronic gastric fistula after laparoscopic sleeve gastrectomy had definitive surgical repair. The initial intervention, the diagnosis and management of the fistula, and the endoscopic approach were carefully reviewed. Five patients had their original laparoscopic sleeve gastrectomies performed at another hospital, while 3 had laparoscopic sleeve gastrectomy at our institution. The mean period of time from the diagnosis of the fistula to definitive surgical treatment was 14.4 months (range 5-44 months). Seven patients initially had surgical drainage by laparoscopy (5) and by laparotomy (2), with concomitant feeding jejunostomy in 6 patients. The endoscopic treatment consisted of endoprothese in 4 patients, endoscopic sealing glue in 2 patients, and sequential approach with glue and prosthesis in 2 other patients. One patient was treated exclusively by endoscopic approach with no surgical drainage. The surgical procedures performed for chronic fistula were gastrojejunal lateral anastomosis (4), Roux-en-Y gastric bypass (2), and gastrectomy with esojejunal anastomosis (2). Four patients presented with postoperative fistula, with a mean healing time of 32 days (range 22-63 days). No mortality was recorded. In chronic forms of fistulas with no improvements by endoscopic approach, the surgical treatment can be a solution. It remains a difficult procedure with a high percentage of leakage, but this type of fistula is more easily tolerated by the patient and heals faster. Crown Copyright © 2013. Published by Elsevier Inc. All

  7. Pentadecapeptide BPC 157 and the esophagocutaneous fistula healing therapy. (United States)

    Cesarec, Vedran; Becejac, Tomislav; Misic, Marija; Djakovic, Zeljko; Olujic, Danijela; Drmic, Domagoj; Brcic, Luka; Rokotov, Dinko Stancic; Seiwerth, Sven; Sikiric, Predrag


    Esophagocutaneous fistulas are a failure of the NO-system, due to NO-synthase blockage by the NOS-blocker L-NAME consequently counteracted by l-arginine and gastric pentadecapeptide BPC 157 (l-arginine BPC 157), precipitating a therapeutic benefit. Previously, there was an established BPC 157-NO-system interaction. BPC 157 GEPPPGKPADDAGLV, MW 1419 (LD1 not achieved), is a safe and stable anti-ulcer peptide, successful in inflammatory bowel disease trials, counteracting esophagitis, sphincter failure, gastrointestinal and skin ulcers, gastrocutaneous or colocutaneous fistulas. We treated rats with established cervical esophagocutaneous fistulas throughout four days (both open skin and esophageal defects, with significant leakage) with BPC 157 (parenterally and perorally) and L-NAME (blocking NO genesis) and l-arginine (NO-substrate) alone or in combination. RT-PCR investigated eNOS, iNOS, COX-2 mRNA levels in the fistulas. We evidenced a closely inter-related process of unhealed skin, esophageal defects, unhealed fistulas (up regulated eNOS, iNOS and COX2 mRNA levels), usually lethal, particularly NO-system related and therapy dependent. Generally, the course of fistula healing was accelerated either to a greater extent (with BPC 157 (in particular, less eNOS gene expression) completely counteracting L-NAME effects, in L-NAME+BPC 157 and L-NAME+l-arginine+BPC 157 groups), or to a lesser extent (with l-arginine). Conversely, the process was aggravated, rapidly and prominently (with L-NAME). In particular, BPC 157 was effective either given per-orally/intraperitoneally, in μg- and ng-regimens. Shortly, defects started to heal, with less fistula leakage and no mortality at day 4. Failure of pyloric and lower esophageal sphincter pressure was restored, with practically no esophagitis. Copyright © 2012 Elsevier B.V. All rights reserved.

  8. Direct and indirect costs for anal fistula in Sweden. (United States)

    Lundqvist, Adam; Ahlberg, Ida; Hjalte, Frida; Ekelund, Mats


    Anal fistula is an abnormal tract with an external and internal opening that cause leakage, discomfort, and occasionally pain. Surgery is standard treatment, but recurrence and anal incontinence is common. The objective of the study was to analyze resource use, costs and sick leave for newly diagnosed patients with anal fistula in Sweden. The study was based on register data from linkages between Swedish population-based registers including patients treated for anal fistula in Västra Götaland County, Sweden. Health care resource use, costs and sick leave were estimated. The sample included 362 patients of which 27% had no surgery, 37% had one surgery and 36% had multiple surgeries. Patients with multiple surgeries underwent over four surgeries on average. Approximately 67% of the contacts occurred during the first year after diagnosis. Estimated mean sick leave was 10.4 full-time equivalent days per patient. Total discounted costs were €5,561 per patient where approximately 80% were direct costs. To our knowledge this is the first study of resource use, costs and sick leave related to anal fistulas. The study indicates that anal fistula is a condition that is costly for society and that the burden of anal fistula in terms of health care resources and sick leave is especially high for patients experiencing multiple surgeries. Anal fistula is a condition that is costly for society and there is an unmet need for the group of patients with multiple surgeries to find appropriate treatment interventions. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  9. Distal bronchial tubes damage in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    M V Sheyanov


    Full Text Available Objective. To study prevalence and clinical picture of distal parts of bronchial tree(bronchiolitis in pts with rheumatoid arthritis (RA. Material and methods. 104 nonsmoking pts with RA and 100 pts without RA and chronic diseases of respiratory apparatus were included. General clinical examination, spirometry, bodyplethysmography, examination of lung diffusion capacity (LDC and multispiralcomputed tomography (MSCT of lungs were performed. Results. Direct and indirect bronchiolitis signs were revealed with MSCT in 36 (35% ptswith RA and 1 pt of control group (p<0,01. Pts with signs of bronchiolitis complained of shortness of breath (69% of pts, cough (56%, phlegm discharge (56%, heavy breathing (25%. Obstructive lung ventilation disturbances were revealed in 19 (53% RA pts with bronchiolitis. Restrictive disturbances and LDC decrease were present in 3 (8% pts. High frequency of oligosymptomatic bronchiolitis course was found in RA pts. Bronchiolitis symptoms in RA pts coincided with signs of proximal bronchial tubes damage forming picture of diffuse damage of bronchial tree. Conclusion. Bronchiolitis is a prevalent variant of respiratory apparatus damage in pts with RA. Pts with MSCT signs of bronchiolitis often have cough, phlegm discharge, shortness of breath, heavy breathing. Lung ventilation disturbances of obstructive type are common but part of pts has normal lung functional measures or restriction. Oligosymptomatic forms of distal bronchial tubes damage are prevalent in RA pts. Lung MSCT is the main method of bronchiolitis diagnostics because bronchiolitis induces nonspecific clinical signs and RA pts have multilevel respiratory apparatus damage. MSCT reveals signs of distal bronchial tubes damage in 35% of RA pts.

  10. Bronchial inflammation and hyperresponsiveness in well controlled asthma. (United States)

    Muñoz, X; Sanchez-Vidaurre, S; Roca, O; Torres, F; Morell, F; Cruz, M J


    Little research has been devoted to the characteristics of bronchial inflammation in patients with stable, well controlled asthma. The aim of this study was to assess the degree and type of airway inflammation and to investigate the relationship between inflammation and bronchial hyperresponsiveness in patients with well controlled asthma. A cross-sectional study was conducted in 84 adult patients (43 men, mean age 43 years) with documented well controlled asthma. Induced sputum samples were obtained and cell types determined by differential cell count. Spirometry and methacholine challenge testing were performed. Asthma Control Questionnaire (ACQ) was used to assess symptoms. Patients were included if their ACQ score was bronchial inflammation: 28 cases were considered eosinophilic, 28 neutrophilic, and 3 mixed. Median (range) percentage of eosinophils was 4% (0-64) in patients testing positive to methacholine challenge (n = 66) and 1% (0-3) in those testing negative (n = 18) (P = 0.003). A positive correlation was found between eosinophil percentage and the methacholine dose/response ratio (r = 0.477, P = 0.0001). The geometric mean (95% CI) of the methacholine PC20 was 1.74 mg/mL (1.04-2.93) in patients with eosinophilic inflammation and 4.14 mg/mL (2.5-6.84) in those with neutrophilic inflammation (P = 0.03). Inflammation and bronchial hyperresponsiveness persist in most patients with well controlled asthma. The study demonstrates that eosinophilic or neutrophilic inflammation persisted in most well controlled asthma patients despite the fact that their condition was controlled and therefore, measurement of bronchial inflammation seems essential to achieve proper asthma control. © 2012 Blackwell Publishing Ltd.

  11. Use of MDCT to Assess the Results of Bronchial Thermoplasty. (United States)

    Zanon, Matheus; Strieder, Débora L; Rubin, Adalberto S; Watte, Guilherme; Marchiori, Edson; Cardoso, Paulo F G; Hochhegger, Bruno


    The purpose of this study was to evaluate the use of MDCT to assess response to bronchial thermoplasty treatment for severe persistent asthma. MDCT data from 26 patients with severe persistent asthma who underwent imaging before and after bronchial thermoplasty were analyzed retrospectively. Changes in the following parameters were assessed: total lung volume, mean lung density, airway wall thickness, CT air trapping index (attenuation < -856 HU), and expiratory-inspiratory ratio of mean lung density (E/I index). Asthma Quality of Life Questionnaire score changes were also assessed. Median total lung volumes before and after bronchial thermoplasty were 2668 mL (range, 2226-3096 mL) and 2399 mL (range, 1964-2802 mL; p = 0.08), respectively. Patients also showed a pattern of obstruction improvement in air trapping values (median before thermoplasty, 14.25%; median after thermoplasty, 3.65%; p < 0.001] and in mean lung density values ± SD (before thermoplasty, -702 ± 72 HU; after thermoplasty, -655 ± 66 HU; p < 0.01). Median airway wall thickness also decreased after bronchial thermoplasty (before thermoplasty, 1.5 mm; after thermoplasty, 1.1 mm; p < 0.05). There was a mean Asthma Quality of Life Questionnaire overall score change of 1.00 ± 1.35 (p < 0.001), indicating asthma clinical improvement. Our study showed improvement in CT measurements after bronchial thermoplasty, along with Asthma Quality of Life Questionnaire score changes. Thus, MDCT could be useful for imaging evaluation of patients undergoing this treatment.

  12. Neurofibromatosis with vertebral artery A-V fistula and cervical meningocele -a case report-

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    Kim, Yong Joo; Suh, Kyung Jin; Kim, Tae Heon; Kang, Duk Sik; Park, Yeun Mook; Park, June Sik [College of Medicine, Kyungpook National University, Daegu (Korea, Republic of)


    Arteriovenous fistula is a rare abnormality in patient with neurofibromatosis. A review of English-language literature revealed only 3 reported cases. We report a case of neurofibromatosis with vertebral artery A-V fistula and cervical meningocele.

  13. Giant coronary cameral fistula with coarctation of aorta in a neonate

    Directory of Open Access Journals (Sweden)

    Neeraj Awasthy


    Full Text Available A coronary cameral fistula (CCF involves a sizable communication between a coronary artery and a cardiac chamber. We present a case of giant coronary cameral fistula associated with coarctation of aorta in a 13 days old neonate.


    Directory of Open Access Journals (Sweden)

    Kishore Babu


    Full Text Available Objective to determine the effectiveness of seton tie as treatment modality in a high anal fistula in contrary to diversion colostomy which also can be used for treating a high anal fistula.

  15. A case of gastrocolic fistula secondary to adenocarcinoma of the colon

    Directory of Open Access Journals (Sweden)

    BiaoHuan Zhou


    Conclusion: It is rare for gastrocolic fistula case to be caused by colon adenocarcinoma, and has been rarely reported inside China. The best therapy of gastrocolic fistula remains radical en-bloc surgery.

  16. Preserving arteriovenous fistula outcomes during surgical training. (United States)

    McGrogan, Damian G; Maxwell, Alexander P; Inston, Nicholas G; Krishnan, Hari; Field, Mel


    Arteriovenous fistulae (AVFs) are the preferred option for vascular access, as they are associated with lower mortality in hemodialysis patients than in those patients with arteriovenous grafts (AVGs) or central venous catheters (CVCs). We sought to assess whether vascular access outcomes for surgical trainees are comparable to fully trained surgeons. A prospectively collected database of patients was created and information recorded regarding patient demographics, past medical history, preoperative investigations, grade of operating surgeon, type of AVF formed, primary AVF function, cumulative AVF survival and functional patency. One hundred and sixty-two patients were identified as having had vascular access procedures during the 6 month study period and 143 were included in the final analysis. Secondary AVF patency was established in 123 (86%) of these AVFs and 89 (62.2%) were used for dialysis. There was no significant difference in survival of AVFs according to training status of surgeon (log rank x2 0.506 p=0.477) or type of AVF (log rank x2 0.341 p=0.559). Patency rates of successful AVFs at 1 and 2 years were 60.9% and 47.9%, respectively. We have demonstrated in this prospective study that there are no significant differences in outcomes of primary AVFs formed by fully trained surgeons versus surgical trainees. Creation of a primary AVF represents an excellent training platform for intermediate stage surgeons across general and vascular surgical specialties.

  17. [Internal biliary fistula of lithiasic origin]. (United States)

    Oancea, T; Cojocea, V; Timaru, I; Bumbac, A; Andrei, V


    The authors present 17 cases of patients with internal biliary fistulae of lithiasic origin. Nine of these were of the cholecystoduodenal type, 2 of the cholecysto-gastric type, 2 had developed between the cholecyst and the colon, and 4 were of the bilio-biliary type, between the cholecyst and the choledochus. These cases represented 1.1% of the 1,500 interventions carried out on the extra-hepatic biliary pathways over a period of 10 years, between 1971 and 1980, and 13% of the total number of interventions performed for biliary lithiasis. The advanced age of the patients, the background disease and the complications that accompanied it, as well as the associated deficiencies have given rise to diagnostic and therapeutic difficulties. A correct diagnosis before surgery was made in only two of the patients. The postoperative evolution was good in 13 of the cases (representing 76% of the total), and this confirmed the correct surgical attitude which aimed at restoration of the physiological conditions and a normal digestive and biliary transit. In cases with biliary ileus the first therapeutic measure was to secure intestinal transit.

  18. Medical image of the week: bronchopleural fistula

    Directory of Open Access Journals (Sweden)

    Desai H


    Full Text Available No abstract available. Article truncated at 150 words. A 58-year-old man with past medical history significant for chronic smoking and seizures was referred to the emergency room after a chest x-ray done by his primary care physician for evaluation of cough showed a hydropneumothorax. His symptoms included dry cough for past 2 months without fever, chills or other associated symptoms. He did not have any thoracic procedures performed and had no past history of recurrent infections. He was hemodynamically stable. Physical examination was only significant with decreased breath sounds on the right side of the chest. Thoracic CT with contrast was performed which showed complete collapse of the right lower lobe, near complete collapse of right middle lobe as well as an air-fluid level. There was a suspicion of a direct communication between bronchi and pleural space at the posterior lateral margin of the collapsed right lower lobe (Figure 1. The presence of bronchopleural fistula (BPF was confirmed ...

  19. Role of magnetic resonance imaging in pre-operative assessment of ano-rectal fistula


    Mohamed, Rania E.; Dina M. Abo-Sheisha


    Aim of the work: To evaluate the role of magnetic resonance imaging (MRI) in preoperative assessment of ano-rectal fistula and tracing its full extent and relationship. Materials and methods: Twenty-four patients with ano-rectal fistula were enrolled in this study. They were examined with different MRI sequences for evaluation of the fistulas and their extent. Fistulas were classified according to St. James’s University Hospital MRI based classification system (which correlates the Parks s...

  20. Vacuum-assisted Closure of a Vesicocutaneous Fistula in a Pediatric Patient After Bladder Cystoplasty. (United States)

    Elizondo, Rodolfo A; Au, Jason K; Gargollo, Patricio C; Tu, Duong T


    A vesicocutaneous fistula is an abnormal communication from the bladder to the skin (Pritts et al, 2001). Recently, wound vacuum-assisted closure (VAC) has been used to facilitate fistula closure. There are no reports of using VAC to help fistula closure in the pediatric population. We present a case of an adolescent patient who develops a vesicocutaneous fistula after bladder augment cystoplasty and was treated with VAC only. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Radial Artery Approach to Salvage Nonmaturing Radiocephalic Arteriovenous Fistulas

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    Hsieh, Mu-Yang; Lin, Lin; Tsai, Kuei-Chin; Wu, Chih-Cheng, E-mail: [National Taiwan University Hospital, Department of Cardiology (China)


    PurposeTo evaluate the usefulness of an approach through the radial artery distal to the arteriovenous anastomosis for salvaging nonmaturing radiocephalic arteriovenous fistulas.MethodsProcedures that fulfilled the following criteria were retrospectively reviewed: (1) autogenous radiocephalic fistulas, (2) fistulas less than 3 months old, (3) distal radial artery approach for salvage. From 2005 to 2011, a total of 51 patients fulfilling the above criteria were enrolled. Outcome variables were obtained from angiographic, clinical and hemodialysis records, including the success, complication, and primary and secondary patency rates.ResultsThe overall anatomical and clinical success rates for the distal radial artery approach were 96 and 94 %, respectively. The average procedure time was 36 {+-} 19 min. Six patients (12 %) experienced minor complications as a result of extravasations. No arterial complication or puncture site complication was noted. The postinterventional 6-month primary patency rate was 51 %, and the 6-month secondary patency rate was 90 %. When the patients were divided into a stenosed group (20 patients) and an occluded group (31 patients), there were no differences in the success rate, complication rate, or primary and secondary patency rates.ConclusionAn approach through the radial artery distal to the arteriovenous anastomosis is an effective and safe alternative for the salvage of nonmaturing radiocephalic arteriovenous fistulas, even for occluded fistulas.

  2. [Management of postoperative pancreatic fistula resistant to octreotide therapy]. (United States)

    Dobosz, M; Dymecki, D; Babicki, A; Hać, S; Gruca, Z; Wajda, Z


    Pancreatic fistula is a rare postoperative complication, usually occurring after pancreatic surgery. Majority of them heal spontaneously, some patients require somatostatin/octreotide treatment. The authors have presented 11 patients with postoperative pancreatic fistula, in whom octreotide therapy in dose of 0.1 mg t.i.d./10 days has been ineffective. The causes of pancreatic fistula have been as follows: necrosectomy of the infected pancreatic necrosis--5 patients, distal pancreatic resection--2 patients, insulinoma enucleation--2 patients, gastrectomy with partial pancreatectomy--2 patients. In 9 patients endoscopic stenting of the main pancreatic duct has been performed. In remained 2 patients after Roux-en-Y gastrectomy the endoscopic access to Vater papilla has been impossible and the patients have received one intramuscular injection of long acting somatostatin analogue. In 8 of 9 patients with pancreatic stenting and in two patients after gastrectomy the fistula has been closed within the period of 6-17 days. In one patient after the necrosectomy the prosthesis implacement has been ineffective. This patient has been successfully treated with two additional injections of long acting somatostatin analogue (one injection/14 days). Authors have concluded that endoscopic pancreatic stenting has been an effective method of treatment of the postoperative pancreatic fistula, resistant to octreotide therapy. In some cases, additional administration of long acting somatostatin analogue has been necessary.

  3. Chronic kidney disease aggravates arteriovenous fistula damage in rats. (United States)

    Langer, Stephan; Kokozidou, Maria; Heiss, Christian; Kranz, Jennifer; Kessler, Tina; Paulus, Niklas; Krüger, Thilo; Jacobs, Michael J; Lente, Christina; Koeppel, Thomas A


    Neointimal hyperplasia (NIH) and impaired dilatation are important contributors to arteriovenous fistula (AVF) failure. It is unclear whether chronic kidney disease (CKD) itself causes adverse remodeling in arterialized veins. Here we determined if CKD specifically triggers adverse effects on vascular remodeling and assessed whether these changes affect the function of AVFs. For this purpose, we used rats on a normal diet or on an adenine-rich diet to induce CKD and created a fistula between the right femoral artery and vein. Fistula maturation was followed noninvasively by high-resolution ultrasound (US), and groups of rats were killed on 42 and 84 days after surgery for histological and immunohistochemical analyses of the AVFs and contralateral femoral vessels. In vivo US and ex vivo morphometric analyses confirmed a significant increase in NIH in the AVFs of both groups with CKD compared to those receiving a normal diet. Furthermore, we found using histological evaluation of the fistula veins in the rats with CKD that the media shrank and their calcification increased significantly. Afferent artery dilatation was significantly impaired in CKD and the downstream fistula vein had delayed dilation after surgery. These changes were accompanied by significantly increased peak systolic velocity at the site of the anastomosis, implying stenosis. Thus, CKD triggers adverse effects on vascular remodeling in AVFs, all of which contribute to anatomical and/or functional stenosis.

  4. Transitional Flow in an Arteriovenous Fistula: Effect of Wall Distensibility (United States)

    McGah, Patrick; Leotta, Daniel; Beach, Kirk; Aliseda, Alberto


    Arteriovenous fistulae are created surgically to provide adequate access for dialysis in patients with end-stage renal disease. Transitional flow and the subsequent pressure and shear stress fluctuations are thought to be causative in the fistula failure. Since 50% of fistulae require surgical intervention before year one, understanding the altered hemodynamic stresses is an important step toward improving clinical outcomes. We perform numerical simulations of a patient-specific model of a functioning fistula reconstructed from 3D ultrasound scans. Rigid wall simulations and fluid-structure interaction simulations using an in-house finite element solver for the wall deformations were performed and compared. In both the rigid and distensible wall cases, transitional flow is computed in fistula as evidenced by aperiodic high frequency velocity and pressure fluctuations. The spectrum of the fluctuations is much more narrow-banded in the distensible case, however, suggesting a partial stabilizing effect by the vessel elasticity. As a result, the distensible wall simulations predict shear stresses that are systematically 10-30% lower than the rigid cases. We propose a possible mechanism for stabilization involving the phase lag in the fluid work needed to deform the vessel wall. Support from an NIDDK R21 - DK08-1823.

  5. Fistula-associated anal adenocarcinoma: good results with aggressive therapy. (United States)

    Gaertner, Wolfgang B; Hagerman, Gonzalo F; Finne, Charles O; Alavi, Karim; Jessurun, Jose; Rothenberger, David A; Madoff, Robert D


    To evaluate the clinical features, pathology, treatment, and outcome of patients with fistula-associated anal adenocarcinoma. We identified 14 patients with histologically proven fistula-associated anal adenocarcinoma. We reviewed their medical records and pathology specimens to characterize their presentation, treatment, and clinical outcome. Nine patients presented with a persistent fistula, 3 with a perianal mass, 1 with pain and drainage, and 1 with a recurrent perianal abscess. The average age at time of diagnosis was 59 (range, 37-76) years. Eleven patients had preexisting chronic anal fistulas. Ten had Crohn's disease, and 1 had previously received pelvic radiation therapy. The diagnosis of cancer was suspected during physical examination in 6 of the 14 patients (43 percent). Twelve patients had extensive local disease at presentation. Primary abdominoperineal resection was performed in 11 patients, 7 following neoadjuvant chemoradiation. Six patients received postoperative chemotherapy, and 2 received postoperative radiation. Four patients died with metastatic disease. The remaining 10 patients are alive without evidence of disease at a mean follow-up of 64.3 (range, 14-149) months. The diagnosis of fistula-associated anal adenocarcinoma is often unsuspected. Most patients can be cured with aggressive surgical and adjuvant chemoradiotherapy.

  6. Surgical procedures for digestive fistulae caused by radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Satoshi; Honda, Ichiro; Watanabe, Kazuo; Nagata, Matsuo; Yamamoto, Hiroshi; Soda, Hiroaki; Tasaki, Kentaro [Chiba Cancer Center Hospital (Japan)


    We evaluated the effectiveness of surgery to treat ileal fistulations associated with radiation exposure. An ileal fistula developed in eight patients, 13-102 months after 60 Gy of irradiation to the pelvic cavity, given as initial treatment or supportive therapy following resection of the primary tumor. The underlying diseases were cervical cancer in seven women and bladder cancer in one man. Two patients had an ileorectal fistula, two had an ileosigmoidal fistula, three had an ileovesical fistula, and one had an ileourethral fistula. We performed a partial enterectomy in one patient, a simple bypass operation without exclusion in one, and bypass operations with exclusion in the other six. Intestinal expansion in the exclusion site occurred in one patient, but there were no other complications related directly to surgery, such as sutural insufficiency. The patient who underwent a simple bypass operation died of emaciation 2 months after the surgery, but all of the other patients were discharged capable of oral ingestion. Our findings showed that surgery was beneficial for alleviating the various conditions related to digestive fistulation following radiation therapy. (author)

  7. Bronchial thermoplasty for moderate or severe persistent asthma in adults. (United States)

    Torrego, Alfons; Solà, Ivan; Munoz, Ana Maria; Roqué I Figuls, Marta; Yepes-Nuñez, Juan Jose; Alonso-Coello, Pablo; Plaza, Vicente


    Bronchial thermoplasty is a procedure that consists of the delivery of controlled radiofrequency-generated heat via a catheter inserted into the bronchial tree of the lungs through a flexible bronchoscope. It has been suggested that bronchial thermoplasty works by reducing airway smooth muscle, thereby reducing the ability of the smooth muscle to bronchoconstrict. This treatment could then reduce asthma symptoms and exacerbations, resulting in improved asthma control and quality of life. To determine the efficacy and safety of bronchial thermoplasty in adults with bronchial asthma. We searched the Cochrane Airways Group Specialised Register of Trials (CAGR) up to January 2014. We included randomised controlled clinical trials that compared bronchial thermoplasty versus any active control in adults with moderate or severe persistent asthma. Our primary outcomes were quality of life, asthma exacerbations and adverse events. Two review authors independently extracted data and assessed risk of bias. We included three trials (429 participants) with differences regarding their design (two trials compared bronchial thermoplasty vs medical management and the other compared bronchial thermoplasty vs a sham intervention) and participant characteristics; one of the studies included participants with more symptomatic asthma compared with the others.The pooled analysis showed improvement in quality of life at 12 months in participants who received bronchial thermoplasty that did not reach the threshold for clinical significance (3 trials, 429 participants; mean difference (MD) in Asthma Quality of Life Questionnaire (AQLQ) scores 0.28, 95% confidence interval (CI) 0.07 to 0.50; moderate-quality evidence). Measures of symptom control showed no significant differences (3 trials, 429 participants; MD in Asthma Control Questionnaire (ACQ) scores -0.15, 95% CI -0.40 to 0.10; moderate-quality evidence). The risk of bias for these outcomes was high because two of the studies did not

  8. Fistulotomy versus fistulectomy as a treatment for low anal fistula in ...

    African Journals Online (AJOL)

    fistula-in-ano in children. Br J Surg 2003; 90:220–221. 7 Piazza DJ, Radhakrishnan J. Perianal abscess and fistula-in-ano in children. Dis Colon Rectum 1990; 33:1014–1016. 8 Longo WE, Touloukian RJ, Seashore JN. Fistula in ano in infants and children: implications and management. Pediatrics 1991; 87 (I):. 737–739.

  9. Dural arteriovenous fistula associated with neoplastic dural sinus thrombosis: two cases

    Energy Technology Data Exchange (ETDEWEB)

    Vilela, P. [Neuroradiology Department, Garcia de Orta Hospital (Portugal); Willinsky, R.; TerBrugge, K. [Toronto Western Hospital, ON (Canada). Div. of Neuroradiology


    Intracranial dural arteriovenous fistulae are direct arteriovenous shunts within the dura matter. We report two cases of arteriovenous fistulae upstream to a neoplastic dural sinus thrombosis. These cases add further support to the acquired etiology of dural arteriovenous fistulae and to the fact that venous hypertension is one of the most important precipitating factors. (orig.)

  10. Acceptable results using plug for the treatment of complex anal fistulas

    DEFF Research Database (Denmark)

    Kleif, Jakob; Hagen, Kikke; Wille-Jørgensen, Peer


    The management of complex fistula-in-ano remains a surgical challenge. Previously published studies on the treatment of fistula-in-ano with the anal fistula plug (AFP) have reported a success rate reaching 35-87%. The aim of this study was to assess the results of the AFP procedure in a group...

  11. Obstetric Fistula “Disease” and Ensuing Care: Patients' Views in ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    We explored obstetric fistula patients' real-life experience of care in modern Health System. Our aim was to analyze how these women's views impacted their care uptake and coping. We conducted 67 in-depth interviews with 35 fistula patients or former patients in 5 fistula repair centers within referral hospitals in Mali and ...

  12. Vesical fistulae--an experience from a developing country.

    Directory of Open Access Journals (Sweden)

    Raut V


    Full Text Available This study analyses patients with vesical fistulae presenting at a teaching, referral hospital over the last ten years. There were 62 cases of vesical fistulae of which 60 were obstetric in origin (44 home and 16 hospital deliveries and 2 were following gynaecological surgery. Of the hospital deliveries which culminated in fistula formation, 8 were vaginal and 7 forceps deliveries. In one patient, lower segment caesarean section was carried out. After a thorough urological work-up, patients were subjected to standard technique of layered closure (61 by vaginal approach and one by abdominal. Repair was successful in 53 (87.09% patients. Of the 9 failures, 4 were repeat repairs.

  13. Spontaneous Direct Carotid-Cavernous Fistula in an Elderly Patient

    Directory of Open Access Journals (Sweden)

    Sirakov Stanimir S.


    Full Text Available We describe the case of an 83-year-old woman with left-sided ophthalmoplegia. She had no family history of connective tissue disease. The computed tomography study found a dilated left cavernous sinus. The conventional cerebral panangiography confirmed the diagnosis - a direct carotid-cavernous fistula (CCF, with no evidence of ruptured aneurysm. The woman underwent endovascular treatment with coiling of the cavernous sinus in combination with application of the Onyx embolic agent in the fistula. During the first 48 hours after the embolization the local pain, exophthalmos and conjunctival injection of the left eye were significantly ameliorated. The pulsatile tinnitus on the left disappeared and the ptosis of the left eyelid partially recovered. Selective angiography is the best method for the diagnosis and classification of CCF. Currently, treatment is possible with low mortality and morbidity rates. The endovascular intervention is able to completely occlude the fistula and maintain adequate blood fl ow through the carotid artery.

  14. Aphallia with urethrorectal fistula, bladder and urethral calculi

    Directory of Open Access Journals (Sweden)

    M Movarrekh


    Full Text Available Introduction: Aphallia is a very rare urogenital anomaly with incidence rate of 1 in 30,000,000. It usually coexists with other anomalies such as cardiovascular anomalies which are incompatible with normal life, and therefore infants are delivered stillbirth or live for a very short period of time. Methods: We present an 18 months old boy with aphallia associated with congenital urethrorectal fistula, bladder and urethral stones. All stones were removed endourologically, recto-urethral fistula was repaired and perincal urethrostomy was performed. Results: The stones were composed of calcium phosphate colonized by klebiella pneumonia and proteus mirabilis. Urethrorectal fistula repairment was confirmed by cystography. Patient was discharged without a urinary catheter. Conclusion: In developed countries, management of such patients is to raise them as females. However, we must consider socio-cultural conditions, parents preference and patients tendency in management of aphallia.

  15. MR angiography of hemodialysis access fistula. Evaluation before PTA procedure

    Energy Technology Data Exchange (ETDEWEB)

    Morimoto, Atsuko; Yoshimura, Hirohide; Hosokawa, Chisa; Yoshida, Toshiko [Yodogawa Christian Hospital, Osaka (Japan)


    We evaluated the feasibility of MR angiography for hemodialysis fistula. Eleven patients with suspected stenosis or occlusion of an autogenous hemodialysis fistula in the forearm underwent MRA. MRA was obtained using both the 3D-PC method and 3D gadolinium contrast-enhanced (CE) method with a knee coil. The two methods were compared with DSA in seven patients. CE-MRA clearly demonstrated the entire dialysis fistula. However, signals of the stenotic area are effaced in PC-MRA. The diameter of the vessels evaluated in the CE-MRA was well correlated with angiography. CE-MRA demonstrated smaller collateral vessels more clearly than PC-MRA. CE-MRA provided useful information before the PTA procedure. (author)

  16. Management of pharynx fistula after upper digestive tract instrumentation

    Directory of Open Access Journals (Sweden)

    Bogdan Popescu


    Full Text Available Pharynx fistula is a pathological state that can pose serious problems for both physician and patient and can lead up to the death of the patient in complicated cases. The authors describe a series of guidelines for the management of the pharynx fistula regarding the complications of the instrumentation of the upper digestive tract. Most of the cases that are addressed to our clinic can be treated with a conservative approach and a nutrition therapy plan tailored to each case. In selected cases surgery is the method of choice for therapy. The management of the pharynx fistula can be well managed in a multidisciplinary approach using resources from the E.N.T. and H.N.S. department and more important from the ICU department.

  17. Negotiating living with an arteriovenous fistula for hemodialysis. (United States)

    Richard, Cleo J; Engebretson, Joan


    The purpose of this study was to examine how clients with end stage renal disease on hemodialysis negotiate living with an arteriovenous fistula. A fistula is the preferred access for hemodialysis, and clients must continually monitor and protect their fistula. In this qualitative, ethnographic study, data were collected during fieldwork and semistructured interviews. Constructivism and a cultural negotiation model provided frameworks for the study. Fourteen clients were interviewed; interviews lasted 1.5 to 4 hours. Results revealed new insights into informants'perspectives and experiences with a vascular access. The overarching theme was vulnerability, and underlying themes were body awareness, dependency, mistrust, and stigma. The response to vulnerability was to be continually vigilant and assertive to protect the holistic self Stigma of the vascular access was an important issue for informants and evoked the greatest emotional responses.

  18. Endovascular Modalities for the Treatment of Cavernous Sinus Arteriovenous Fistulas: A Single-Center Experience. (United States)

    Hassan, Tamer; Rashad, Sherif; Aziz, Waseem; Sultan, Ahmed; Ibrahim, Tamer


    Cavernous sinus (CS) fistulas are classified into traumatic and spontaneous. Traumatic carotid-cavernous fistulas (CCFs) are usually direct internal carotid artery (ICA) high-flow fistulas; whereas spontaneous CCFs are usually dural, low-flow fistulas and generally possess less severe symptoms than direct carotid-cavernous fistulas. This study involved 34 patients who were classified into 2 groups: Group A included 26 patients with direct carotid-cavernous fistula; and Group B included 8 patients with indirect dural cavernous fistula. All patients had ocular manifestations. One patient had subarachnoid hemorrhage. Coils were used alone in 19 cases of direct fistula and in 1 case of dural fistulas. Coils and Onyx (Covidien, Mansfield, MA, USA) were used in 7 cases of direct fistula and in 2 cases of dural fistulas. Onyx alone was used to treat 5 cases with dural fistulas but none of the cases with direct fistulas. Covered stents and coils were used in 2 cases of direct fistulas. All patients in both groups showed full recovery of their clinical signs and symptoms. Only 1 procedure-related complication was observed (3%) in which a patient had an embolic event and trigeminal dysesthesia as a result of Onyx reflux through external carotid artery-ICA anastomosis. Coils are superior solid embolic agents used for the treatment of direct high-flow fistulas, while Onyx is more valuable in dural low-flow CCF. Onyx shortens the procedure time and decreases procedure cost. Onyx injection inside the CS proper through the transarterial or transvenous route may be safer than Onyx injected inside dural arteries supplying the CS. However, more cases are needed to determine this. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. Thrombophilia and arteriovenous fistula survival in ESRD. (United States)

    Salmela, Birgitta; Hartman, Jari; Peltonen, Seija; Albäck, Anders; Lassila, Riitta


    The role of thrombophilia in failing arteriovenous fistula (AVF) among patients with ESRD undergoing hemodialysis is not established. This study aimed to assess whether AVF primary patency is associated with thrombophilia and coagulation abnormalities. This observational study screened 219 patients between 2002 and 2004 for thrombophilia before AVF surgery. Thrombophilia included factor V Leiden and prothrombin G20210A mutations, protein C and antithrombin activities, and protein S. Coagulation abnormalities included high factor VIII:C, homocysteine, fibrinogen, and d-dimer levels; presence of antiphospholipid antibodies; and short thrombin time. We reviewed patient charts for comorbid conditions, AVF maturation and interventions, kidney transplantation, and patient survival (mean follow-up duration, 3.6 [range, 2.3-5.8] years). Primary patency from the AVF placement and functional primary patency from the first AVF cannulation were analyzed with Kaplan-Meier and Cox proportional hazards models. Thrombophilia was present in 9% of the patients, and coagulation abnormalities occurred in 77%. One-year primary patency was 68%; 46% of the AVF failures occurred before the initiation of hemodialysis. Female sex (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.7-4.1) and thrombophilia (HR, 2.2; 95% CI, 1.2-4.2) were independent risk factors for loss of primary patency. Thrombophilia mutations or low antithrombin level (HR, 3.8), female sex (HR, 2.5), and diabetes (HR, 1.9) were associated with shortened functional primary patency of AVF. Against the background of frequent coagulation abnormalities, thrombophilia and female sex predispose patients with ESRD to access failure, mostly due to thrombosis or stenosis.

  20. Cutaneous metastases of a bronchial adenocarcinoma in a cat. (United States)

    Favrot, Claude; Degorce-Rubiales, Frederique


    This case report describes a cat with metastasis of a bronchial adenocarcinoma to the abdominal skin. The cat had been treated with antibiotics and corticosteroids for several episodes of coughing when it acutely developed erythema, pustules and plaques on the abdominal skin. Diagnosis was based on cytological examination of fine-needle aspirates of cutaneous pustules, X-ray examination of the thorax and histological examination of skin biopsy samples. As the prognosis was poor, the cat was euthanased. Necropsy findings confirmed the diagnosis. Cutaneous metastases of lung carcinoma are rare in cats but have been reported in the digits with underlying bone involvement. To the authors' knowledge, this is the first report of metastasis of a feline bronchial carcinoma to the ventral skin.


    Directory of Open Access Journals (Sweden)

    Mona Olar


    Full Text Available Bronchial asthma is one of the most common pathologies of the chronic diseases of childhood, recording an ever-increasing frequency. The paper develops a control-type case study on the carious experience of 25 children suffering from bronchial asthma, comparatively with 25 healthy children. In both groups, the dmf-t/DMFT indices were calculated and the presence of Streptococcus mutans (SM and Lactobacillus acidophillus (LA in stimulated saliva, in concentrations with high cariogeneity risk, was determined. Carious experience and the SM level in concentrations with cariogenic risk were statistically significant in children with bronchic asthma (p=0.02. The presence of LA in concentrations with cariogenic risk was also higher in these children, yet statistically insignificant, comparatively with the reference (p>0.05.

  2. Endometriosis mimicking the perianal fistula tract: Case report

    Directory of Open Access Journals (Sweden)

    Gül Türkcü


    Full Text Available Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. Nowadays, in many cases, although routine use of episiotomy perineal endo metriosis is extremely rare. A 36 year old female patient was referred to our hospital with complaints of pain in the perianal region for five months. On physical examination, stiffness was palpated and then magnetic resonance im aging (MRI was performed. MRI is compatible with fistula tract. The lesion was excised and the histopathological appearance correspond to endometriosis. Perianal endo metriosis is rare in the perianal region and in the clinic mimicking perianal fistulas and malignancy should be kept in mind in the differential diagnosis

  3. MR enterography of ileocolovesicular fistula in pediatric Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Sakala, Michelle D. [Wayne State University School of Medicine, Detroit, MI (United States); Dillman, Jonathan R.; Ladino-Torres, Maria F. [University of Michigan Health System, Department of Radiology, C.S. Mott Children' s Hospital, Section of Pediatric Radiology, Ann Arbor, MI (United States); McHugh, Jonathan B. [University of Michigan Health System, Department of Pathology, Ann Arbor, MI (United States); Adler, Jeremy [University of Michigan Health System, Department of Pediatrics and Communicable Diseases, C. S. Mott Children' s Hospital, Division of Pediatric Gastroenterology, Ann Arbor, MI (United States)


    Crohn disease, a form of chronic inflammatory bowel disease is characterized by discontinuous inflammatory lesions of the gastrointestinal tract, has a variety of behavioral patterns, including penetrating or fistulous disease. While magnetic resonance enterography (MRE) excellently depicts inflamed bowel segments, it can also be used to assess for a variety of Crohn-disease-related extraintestinal complications, including fistulae. We present the MRE findings of a complex ileocolovesicular fistula in a 14-year-old boy with Crohn disease, where the fistulous tract to the urinary bladder was best delineated on precontrast T1-W imaging because of the presence of fecal material. (orig.)

  4. Biomaterials in the Treatment of Anal Fistula: Hope or Hype? (United States)

    Scoglio, Daniele; Walker, Avery S.; Fichera, Alessandro


    Anal fistula (AF) presents a chronic problem for patients and colorectal surgeons alike. Surgical treatment may result in impairment of continence and long-term risk of recurrence. Treatment options for AFs vary according to their location and complexity. The ideal approach should result in low recurrence rates and minimal impact on continence. New technical approaches involving biologically derived products such as biological mesh, fibrin glue, fistula plug, and stem cells have been applied in the treatment of AF to improve outcomes and decrease recurrence rates and the risk of fecal incontinence. In this review, we will highlight the current evidence and describe our personal experience with these novel approaches. PMID:25435826

  5. Congenital anterior urethrocutaneous fistula: Report of two rare cases

    Directory of Open Access Journals (Sweden)

    Jayalaxmi Shripati Aihole


    Full Text Available Isolated congenital anterior urethrocutaneous fistiula (CAUF is a rare anomaly. CAUF can be defined as a fistula of the penile urethra associated with a normal foreskin, in which urethral meatus and prepuce are intact. Additionally, it may be associated with other anomalies such as congenital hernias and anorectal malformations. Treatment of CAUF is individualized according to site of fistula, associated anomalies and condition of the distal urethra. We are reporting our experience of two cases that had abnormal openings on the ventral aspect of distal penis with normal foreskin without hypospadias and chordee.

  6. Unique Presentation of Hematuria in a Patient with Arterioureteral Fistula

    Directory of Open Access Journals (Sweden)

    Tomas Mujo


    Full Text Available Active extravasation via an arterioureteral fistula (AUF is a rare and life-threatening emergency that requires efficient algorithms to save a patient’s life. Unfortunately, physicians may not be aware of its presence until the patient is in extremis. An AUF typically develops in a patient with multiple pelvic and aortoiliac vascular surgeries, prior radiation therapy for pelvic tumors, and chronic indwelling ureteral stents. We present a patient with a left internal iliac arterial-ureteral fistula and describe the evolution of management and treatment algorithms based on review of the literature.

  7. Traumatic esophageopleural fistula due to fish bone injury

    Directory of Open Access Journals (Sweden)

    Ajay Kumar Verma


    Full Text Available Oesophageopleural fistula (EPF is an abnormal communication in between the oesophagous and pleural space such that the contents of oesophagous are drained into the pleural space surrounding the lungs. We describe a case of a middle-aged female who presented with right sided pyothorax secretions of which consisted of food particles. Chest computed tomography and barium swallow confirmed the diagnosis of oesophageopleural fistula, cause of which was found to be an accidental fish bone injury. Conservative management was done by chest tube drainage along with ryles tube feeding. Patient expired following severe sepsis.

  8. [Massive pneumocephalus and cerebrospinal fluid fistula after thoracotomy]. (United States)

    Olarra, J; Longarela, A


    We report the case of a 70-year-old man (ASA physical status 2) who developed massive pneumocephalus caused by a fistula between the subarachnoid and pleural spaces following a left pneumonectomy. After an uneventful immediate postoperative period, the patient was readmitted to the recovery care unit with dyspnea, intense headache, confusion, and diminished level of consciousness. Computed tomography confirmed a cerebrospinal fluid fistula secondary to the opening of the intradural space during tumor resection. Treatment was conservative, consisting of rest in a slightly Trendelenburg position, antibiotic prophylaxis to prevent meningitis, and a water seal on the thoracic drainage tube.

  9. Endoscopic Management of Recurrent Tracheoesophageal Fistula with Fibringlue and Electrocautery


    Ospina, Juan Camilo; Hospital Universitario San Ignacio; Wuesthoff, Carolina; Pontificia Universidad Javeriana-Hospital Universitario San Ignacio


    Recurrent Tracheoesophageal Fistulas (RTEF) remains a therapeutic challenge, cause of the high rates of morbidity and mortality associated with open surgical closure and their frequent recurrence. Endoscopic techniques provide an alternative approach with the potential for improved surgical outcomes. We present a case of successful repair of recurrent tracheoesophageal fistula using bronchoscopy and esophagoscopy, as well as a combined technique with electrocautery and fibrin glue. We believe...

  10. Doppler findings in a rare coronary artery fistula. (United States)

    Jung, Christian; Jorns, Carl; Huhta, James


    One of the primary forms of congenital anomalies of the coronary arteries is coronary artery fistula (CAF). It is defined as a direct communication between the coronary artery and any surrounding cardiac chamber or vascular structure, which bypasses the myocardial capillary bed. We present a newborn baby with a large coronary artery fistula connecting the left anterior descending (LAD) artery to the left ventricular (LV) apex. Associated cardiac abnormalities were found: a ventricular septal defect (diameter 4 mm), a patent foramen ovale as well as trivial tricuspid and mitral regurgitation. Here we demonstrate the echocardiograms of an extremely rare form of CAF diagnosed within the first days of postnatal life.

  11. Comparison of different bronchial closure techniques following pneumonectomy in dogs


    SALCI, Hakan; BAYRAM, A. Sami; Ozyigit, Ozgur; Gebitekin, Cengiz; Gorgul, O. Sacit


    The comparison of the histologic healing and bronchopleural fistula (BPF) complications encountered with three different BS closure techniques (manual suture, stapler and manual suture plus tissue flab) after pneumonectomy in dogs was investigated for a one-month period. The dogs were separated into two groups: group I (GI) (n = 9) and group II (GII) (n = 9). Right and left pneumonectomies were performed on the animals in GI and GII, respectively. Each group was further divided into three sub...

  12. The quality of life in children with bronchial asthma


    Boušková, Michaela


    The thesis discusses the quality of life in children with bronchial asthma. It outlines causes, classification, symptoms, diagnostics, treatment, prevention, education of children with asthma and their quality of life. The qualitative assessment is the key issue of the work. The object of the research is represented by the children with asthma. The aim of the research is to describe the influence of asthma on the quality of life in children.

  13. Use of Physiotherapy at Asthma Bronchiale in Childhood


    Petržílková, Zuzana


    This work deal with use of physiotherapyst methodes within the global treatment of bronchial asthma in childhood. In the first part is served a brief overview about physiology of respiration and charakteristic illness. In the next one, the main part, is present listing options, how the physiotherapy can favorably affect the process and progress of disease and describes, what need to be focus on during the treatment of children with asthma.

  14. Randomized controlled study of CBT in bronchial asthma


    Grover Naveen; D′Souza G; Thennarasu K; Kumaraiah V


    The aim of the present study was to find out efficacy of cognitive behavior therapy, as an adjunct to standard pharmacotherapy, in bronchial asthma. In a random-ized two-group design with pre-and post assessments, forty asthma patients were randomly allotted to two groups: self management group and cognitive behavior therapy group. Both groups were exposed to 6-8 weeks of intervention, asthma self management program and cognitive behavior therapy. Assessment measures used were-Semi structured...

  15. Sleeve resection for delayed presentation of traumatic bronchial transection.

    LENUS (Irish Health Repository)

    Mohamed, H Y


    Tracheobronchial disruption is uncommon in blunt chest trauma. Many of these patients die before reaching the hospital. In the majority of survivors diagnosis is occasionally delayed resulting in complications like airway stenosis and lung collapse. Thus it is important to have radiological follow up after severe thoracic trauma. Sleeve resection can be an excellent option to conserve lung tissue in delayed presentation of bronchial transection.

  16. [Diagnosis of children with occult bronchial foreign body]. (United States)

    He, Beibei; Huang, Ying; Li, Qubei; Dai, Jihong; Yuan, Xiaoping


    To investigate the clinical manifestation of children with occult bronchial foreign body, to analyze the reasons of misdiagnosis, to summarize the way of diagnosis and to emphasize the value of bronchoscopy in diagnosis and treatment of children with such disease. A retrospective analysis of 22 cases of occult bronchial foreign body diagnosed and treated with bronchoscopy in Children's Hospital of Chongqing Medical University during the period from March 1, 2009 to February 28, 2014. Of the 22 cases, 15 were male and 7 female. Their age ranged from nine months and eight days to fourteen years and six months. The course of disease ranged in length from six days to one year. It took us one to thirty-three days in diagnosing the problem. They or their parents all denied aspirating foreign body and the patients did not have irritating chokes. They did not have tracheal displacement or flapping sound. There were no direct signs of bronchial foreign body in their imaging examination. Twenty-one patients were diagnosed as pneumonia before bronchoscopy, and the remaining one was diagnosed as tuberculosis. All of the patients were complicated with infection; atelectasis was found in 15 cases/times, lung consolidation in 10 cases/times, emphysema in 4, pleural effusion in 5, bronchiectasis in 4, one case had respiratory failure, one case had septicemia. The clinical symptoms were relieved in the patients after bronchoscopy, 3 cases were cured, 19 cases were improved. Occult bronchial foreign body with certain complications and great harm is hard to diagnose. We should pay more attention to the important clues, such as a child with repeated pulmonary infection, indirect signs of airway obstruction and difficult to treat. Early bronchoscopy will be useful to improve diagnostics once the vital clue is found.

  17. Use motion games in exercise with children with bronchial asthma

    Directory of Open Access Journals (Sweden)

    Viktoriya Polkovnyk-Markova


    Full Text Available Purpose: to analyze the possibility of using moving games in the rehabilitation of children with bronchial asthma. Material & Methods: the modern scientific literature on integrated prevention and treatment of children with asthma. Results: A high frequency of morphological and functional deviations at children with asthma. Classification and examples of mobile games, which can be used for this group of children. Conclusions: the results of modern research that show the effectiveness the use of physical rehabilitation, including moving games.

  18. Role of HIDA scanning in the assessment of external biliary fistulae

    Energy Technology Data Exchange (ETDEWEB)

    McPherson, G.A.; Collier, N.A.; Lavender, J.P.; Blumgart, L.H.


    Three patients with postoperative external biliary fistula are described. In each, radionuclide /sup 99m/Tc HIDA was used to define the anatomy of the fistula. The extent of the fistula and the presence of distal obstruction to bile flow could also be determined. This information was used to predict the likelihood of spontaneous fistula closure. HIDA scanning is a useful noninvasive alternative to other investigations, such as fistulography and cholangiography, which do not always provide useful information. The results of HIDA scanning can aid the clinical decision on the need for surgical intervention to correct an external biliary fistula.

  19. [A case of intractable fistula after low anterior resection repaired by transsacral direct suture]. (United States)

    Yamada, Takanobu; Kodato, Takashi; Shirai, Junya; Kamiya, Mariko; Sujishi, Ken; Kumazu, Yuta; Sugano, Nobuhiro; Hatori, Shinsuke; Osaragi, Tomohiko; Yoneyama, Katsuya; Kasahara, Akio; Rino, Yasushi; Masuda, Munetaka; Yamamoto, Yuji


    We report a case of an intractable fistula repaired by transsacral direct suture. A 65-year-old man underwent low anterior resection for rectal cancer. He subsequently underwent ileostomy due to anastomosis leakage. The fistula of the anastomosis persisted 3 months after surgery. He underwent surgery to repair the fistula using a transsacral approach. After removing the coccyx, the fistula in the postrectal space was exposed directly. The presence of the fistula was confirmed by an air leak test and was closed by direct suture. After 33 days, the patient underwent ileostomy closure.

  20. Orbital Cellulitis: A Rare Presentation of Metastatic Bronchial Carcinoma

    Directory of Open Access Journals (Sweden)

    Rohit Kumar


    Full Text Available Objective. We report a rare and unusual case of bronchial carcinoma presenting with symptoms of complications of sinonasal disease. Case Report. A 66-year-old lady was referred with a 1-week history of progressive ocular pain, chemosis, and visual disturbance. Computed tomography of the paranasal sinuses revealed frontal and ethmoidal sinus opacification with orbital involvement consistent with a diagnosis of orbital cellulitis secondary to sinusitis. Surgical exploration revealed that the sinuses and right orbit were filled with soft tissue and subsequent histopathological examination of the biopsies indicating metastases from an adenosquamous bronchial carcinoma. Further imaging revealed a large, asymptomatic, bronchial primary with deposits in the brain and liver. The advanced presentation of the disease limited treatment to best supportive care. Conclusion. Orbital cellulitis and sinonasal malignancies have a similar pattern of clinical presentation, posing a potential diagnostic pitfall. There are only two previously reported cases of metastatic lung carcinoma in the frontal sinus with 15 cases of sinonasal tract involvement reported overall. There are no reported cases of adenosquamous carcinoma in the sinonasal tract.

  1. Risk factors of bronchial asthma in bahrah, saudi arabia. (United States)

    Al-Mazam, A; Mohamed, A G


    Asthma is a common health problem whose prevalence in Saudi Arabia has risen over the last few decades. Brick factories in the city of Bahrah have exacerbated the problem, and increasing numbers of asthma cases are attending local primary health care centers. Determine the risk factors of asthma in Bahrah. The study was comprised of 110 cases of bronchial asthma resident in Bahrah who were diagnosed by the treating physicians and 110 healthy controls matched in age and sex. A questionnaire was completed from cases and controls, consisting of data regarding personal, familial, indoor and outdoor environmental factors that may be potential risk factors to asthma. Bivariate and multivariate logistic regression analyses were done to assess risk factors. The mean ages of cases and controls were 22.4 (± 16.7) and 22.8 (± 16.1) years, respectively. Each group consisted of 64 males (58%) and 46 (42%) females. There was a significant association between distance from houses to brick factories and bronchial asthma (Chi square for linear trend = 26.6, pfactories, family history and history of rhinitis, skin atopy, or recurrent respiratory tract infections are risk factors of bronchial asthma. An in-depth study to asses air pollution in Bahrah is recom-mended. People are advised not to live near brick factories.

  2. Decreased physical activity in adults with bronchial asthma. (United States)

    van 't Hul, Alex J; Frouws, Siete; van den Akker, Edmee; van Lummel, Rob; Starrenburg-Razenberg, Anja; van Bruggen, Alie; Braunstahl, Gert-Jan; In 't Veen, Johannes C C M


    Contradictory findings have been reported in the literature on the impact that bronchial asthma may have on habitual physical activity. The present study was designed to compare physical activity, objectively measured with an activity monitor, between adults with bronchial asthma and apparently healthy controls. Valid registrations of physical activity were obtained in 226 patients with asthma and 201 healthy controls. A multiple general linear model was used to test between group differences and to correct for confounding of the results due to between group differences in BMI and employment status. In the patients, statistically significantly lower values were found for average steps/day (-1202; CI -1893 to -511; P = 0.001), physical activity level based on an estimate of a person's total energy expenditure (-0.035; CI -0.067 to -0.003); P = 0.034) and daily time (minutes) spent at vigorous intensive physical activity (-11; CI -17 to -1; P asthma control. We conclude that bronchial asthma in adults is associated with a significant reduction in physical activity as compared to apparently healthy controls and is accompanied by a lower perceived health status. This is in support of the postulation of PA as potential pathway to better the outcome of care for these patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Prevalence of bronchial asthma among orang asli in peninsular malaysia. (United States)

    Ngui, R; Lim, Y A L; Chow, S C; de Bruyne, J A; Liam, C K


    A survey was carried out to determine the prevalence of bronchial asthma and their contributing risk factors among Orang Asli subgroups living in Malaysia using IUATLD questionnaire and spirometry without being discriminatory towards age or gender. Of the 1171 distributed questionnaires, 716 (61.1%) comprising of 62.7% Semai Pahang, 51.3% Temiar, 74.2% Mah Meri, 65.6% Semai Perak, 53.6% Temuan, 53.8% Semelai, 61.1% Jakun and 67.4% Orang Kuala subgroups completed their questionnaire and were included in the data analysis. Participants comprised 549 (76.7%) children and 167 (23.3%) adults, age between 1 to 83 years old, 304 (42.5%) males and 412 (57.5%) females. The overall prevalence of bronchial asthma was 1.4% of which 1.5% was children, 1.3% adults, 1.0% male and 1.7% female, respectively. Of the 8 subgroups surveyed, 5 out of 10 confirmed asthma cases were Semai Pahang, followed by 3 cases among Mah Meri, and one case each among Temuan and Semai Perak subgroups, respectively. This study also demonstrated that the prevalence of self-reported and confirmed bronchial asthma tend to be higher among those who had close contact with pets, smoking individuals and among those who had a family history of asthma.

  4. Pancreatic fistula after central pancreatectomy: case series and review of the literature. (United States)

    Zhou, Yan-Ming; Zhang, Xiao-Feng; Wu, Lu-Peng; Su, Xu; Li, Bin; Shi, Le-Hua


    Postoperative pancreatic fistula is one of the most common complications after pancreatectomy. This study aimed to assess the occurrence and severity of pancreatic fistula after central pancreatectomy. The medical records of 13 patients who had undergone central pancreatectomy were retrospectively studied, together with a literature review of studies including at least five cases of central pancreatectomy. Pancreatic fistula was defined and graded according to the recommendations of the International Study Group on Pancreatic Fistula (ISGPF). No death was observed in the 13 patients. Pancreatic fistula developed in 7 patients and was successfully treated non-operatively. None of these patients required re-operation. A total of 40 studies involving 867 patients who underwent central pancreatectomy were reviewed. The overall pancreatic fistula rate of the patients was 33.4% (0-100%). Of 279 patients, 250 (89.6%) had grade A or B fistulae of ISGPF and were treated non-operatively, and the remaining 29 (10.4%) had grade C fistulae of ISGPF. In 194 patients, 15 (7.7%) were re-operated upon. Only one patient with grade C fistula of ISGPF died from multiple organ failure after re-operation. Despite the relatively high occurrence, most pancreatic fistulae after central pancreatectomy are recognized a grade A or B fistula of ISGPF, which can be treated conservatively or by mini-invasive approaches.

  5. Arteriovenous fistula in the rat tail: a new model of hemodialysis access dysfunction. (United States)

    Lin, Tao; Horsfield, Catherine; Robson, Michael G


    Problems with vascular access are an important cause of morbidity and mortality in hemodialysis patients. We established a rodent model of arteriovenous fistula by anastomosing the end of a lateral vein to the side of the ventral artery of the rat tail. All operations were technically successful and in all animals the fistula was patent with a dilated fistula vein clearly visible after 28 days. Neointimal hyperplasia was found in 4 out of 5 fistulae with varied pathology from immature to more mature lesions seen both proximal and distal to the anastomosis. There was no particular pattern to the presence of or type of lesion found at any particular site of the fistulae. This fistula promises to be useful in analyzing pathologic processes that occur in native arteriovenous fistulae since the vein is accessible to functional studies and to test new subcutaneous or intravascular treatments.


    Directory of Open Access Journals (Sweden)

    A.S. Kolbin


    Full Text Available In the given article, the authors discuss the most difficult issue of the pediatrics, which is the treatment of the severe bronchial asthma. Our columnist is professor A.S. Kolbin introduces omalizumab, a new medication from the monoclonal antibodies group, to our readers. It allows practitioners to control the severe persistent bronchial asthma. The article accentuates the clinical effectiveness and pharmacoeconomic aspects of the medication application.Key words: bronchial asthma, severe run, treatment, monoclonal antibodies, children.

  7. Arteriovenous Fistulae for Haemodialysis: A Systematic Review and Meta-analysis of Efficacy and Safety Outcomes. (United States)

    Bylsma, L C; Gage, S M; Reichert, H; Dahl, S L M; Lawson, J H


    Arteriovenous fistulae are the currently recommended gold standard vascular access modality for haemodialysis because of their prolonged patency, improved durability, and low risk of infection for those that mature. However, notable disadvantages are observed in terms of protracted maturation time, associated high rates of catheter use, and substantial abandonment rates. The aim of this study was to quantitatively summarize the outcomes of fistula patency, infection, maturation, and abandonment published in the scientific literature. This was a systematic review and meta-analyses of studies evaluating fistula outcomes. Literature searches were conducted in multiple databases to identify observational and interventional studies of mean fistula patency rates at 1 year, infection risk, maturation time, and abandonment. Digitisation software was used to simulate individual patient level data from Kaplan-Meier survival plots. Over 8000 studies were reviewed, and from these, 318 studies were included comprising 62,712 accesses. For fistulas the primary unassisted, primary assisted, and secondary patency rates at one year were 64%, 73% and 79% respectively, however not all fistulas reported as patent could be confirmed as being clinically useful for dialysis (i.e. functional patency). For fistulas that were reported as mature, mean time to maturation was 3.5 months, however only 26% of created fistulas were reported as mature at 6 months and 21% of fistulas were abandoned without use. Overall risk of infection in fistula patients was 4.1% and the overall rate per 100 access days was 0.018. Reported fistula patency rates may overstate their potential clinical utility when time to maturation, maturation rate, abandonment and infection are considered. Protracted maturation times, abandonment and infection all have a significant impact on evaluating the clinical utility of fistula creation. A rigorous and consistent set of outcomes definitions for hemodialysis access are

  8. Endoscopic treatment of congenital H-Type and recurrent tracheoesophageal fistula with electrocautery and histoacryl glue. (United States)

    Tzifa, K T; Maxwell, E L; Chait, P; James, A L; Forte, V; Ein, S H; Friedburg, J


    Congenital H-Type tracheoesophageal fistulae (H-Type TEF) and recurrent fistulae after primary repair of esophageal atresia represent a difficult problem in diagnosis and management. The treatment traditionally involved an open technique via a cervical or thoracic route, approaches with high morbidity and mortality rates of up to 50%. Endoscopic closure of fistulae has been reported with various techniques such as tissue adhesives, electrocautery, sclerosants and laser. However, the published case series contain a small number of patients with usually short-term follow-up. The aim of this paper is to present the experience of a decade at Toronto's Hospital for Sick Children, using diathermy and histoacryl tissue adhesive and discuss the indications and limitations of this technique. Since 1995, 192 patients have been managed in this institution with tracheoesophageal fistulae of which 10 patients have been treated endoscopically. The fistulae were both of H-Type and recurrent tracheoesophageal fistulae following surgery for esophageal atresia and fistula division. One fistula occurred following trauma. The procedure was undertaken under general anesthesia in the image guided therapy suite under fluoroscopic control. Flexible ball electrocautery and injection of histoacryl glue were used either on their own or in combination. Fistula closure was achieved in 9 out of 10 fistulae. Four patients had a second endoscopic procedure. No major respiratory or other complications were encountered in association with the procedure. Follow-up has been between 3 months and 9 years. We conclude, endoscopic treatment of tracheoesophageal fistulae with electrocautery and histoacryl glue has been a safe and successful technique of managing H-Type and recurrent tracheoesophageal fistulae. In this paper, we discuss the indications and the surgical steps of the procedure. We highlight that diathermy should be carefully controlled and applied preferably in the small non

  9. Bronchial reactivity and intracellular magnesium: a possible mechanism for the bronchodilating effects of magnesium in asthma

    National Research Council Canada - National Science Library

    Dominguez, L J; Barbagallo, M; Di Lorenzo, G; Drago, A; Scola, S; Morici, G; Caruso, C


    .... In the present study we investigated the relationship between bronchial reactivity, assessed by methacholine-provocation test, and magnesium concentrations both at extracellular and intracellular...

  10. Obstetric vesico-vaginal fistulae seen in the Northern Democratic ...

    African Journals Online (AJOL)

    and involuntary leakage of urine through the vagina6. An obstetric vesico-vaginal fistula results from trauma ... During both missions, patients who presented com- plaining of uncontrolled leakage of urine were recruit- ... We calculated frequency and percent age of each cat- egorical socio-demographic variable (education ...

  11. The Spectrum of Hand Dysfunction After Hemodialysis Fistula Placement


    Rehfuss, Jonathan P.; Berceli, Scott A.; Sarah M. Barbey; He, Yong; Kubilis, Paul S.; Beck, Adam W.; Huber, Thomas S.; Salvatore T Scali


    Contemporary dogma has classically attributed hand dysfunction following hemodialysis arteriovenous fistula (AVF) placement to regional ischemia. We hypothesize that hemodynamic perturbations alone do not entirely explain the postoperative changes in hand function and, furthermore, that various elements of hand function are differentially affected following surgery. Methods: Bilateral wrist and digital pressures and upper extremity nerve conduction tests were recorded preoperatively and at...

  12. Factors predictive of failure of Brescia-Cimino arteriovenous fistulas

    NARCIS (Netherlands)

    Zeebregts, C; van den Dungen, J; Franssen, C; Verhoeven, E; van Schilfgaarde, R


    Objective: To evaluate patency rates of Brescia-Cimino fistulas and to find out which independent factors were predictors of failure. Design: Retrospective clinical study. Setting: University hospital, The Netherlands. Subjects: 150 consecutive patients (mean age 56 years. range 17-80) who had 153

  13. El agua en Segobriga (Saelices, Hispania Citerior: Las fistulae plumbeae

    Directory of Open Access Journals (Sweden)

    Cebrián, Rosario


    Full Text Available In the present article the lead pipes found in the archaeological site of Segobriga and in its surroundings are presented. Some of these fistulae are related to the siphon aqueduct that brought drinking water from Fuente la Mar in Saelices, while others correspond to the internal water supply in the city. Both epigraphic references containing the abbreviated name of the municipality, r(es p(ublica S(egobrigensis vel Segobrigensium, identified on a fistula and in a lead cover, show the public property of the Segobriga hydraulic network.En este artículo presentamos las tuberías de plomo halladas en el yacimiento arqueológico de Segobriga y su entorno. Algunas de estas fistulae están relacionadas con el sifón del acueducto que condujo el agua potable desde la Fuente de la Mar en Saelices, mientras que otras corresponden a la red de distribución del agua en el interior de la ciudad. Las dos menciones epigráficas con el nombre abreviado del municipio, r(es p(ublica S(egobrigensis vel Segobrigensium, documentadas en una fistula y en la tapa de un registro ponen de manifiesto la propiedad pública del sistema hidráulico de Segobriga.

  14. [Tactic of surgical treatment of complex rectal fistula]. (United States)

    Grubnik, V V; Degtiarenko, S P


    The experience of the examination and treatment of 646 patients for different forms of complex rectal fistula (CRF) summarized. A working classification of the CRF with regard to their complication was developed and implemented. A differentiated approach has allowed greater use sphincter-preserving methods to improve functional outcome, quality of life, reduce the duration of the disability period and frequency of patients disability.

  15. Histoacryl injection in the management of fourth branchial fistula

    African Journals Online (AJOL)

    J Laryngol Otol 1995; 109:999–1000. 6 Chaudhary N, Gupta A, Motwani G, Kumar S. Fistula of the fourth branchial pouch. Am J Otolaryngol Head Neck Med Surg 2003; 24:250–252. 7 Franciosi JP, Sell LL, Conley SF, Bolender DL. Pyriform sinus malformations: a cadaveric representation. J Pediatr Surg 2002; 37:533–538.

  16. Vesicovaginal fistula following an induced abortion with a huge ...

    African Journals Online (AJOL)

    A case of a 26 year old P +1 woman who developed vesico-vaginal fistula (VVF) following an induced 1 abortion is presented. She presented with five year history of continous leakage of urine following a voluntary termination of pregnancy at about 11 weeks of gestation using metallic instruments in a chemist shop by a ...

  17. Effect of Ethanolic Leaf Extract of Senna Fistula on some ...

    African Journals Online (AJOL)

    This study was designed to investigate the effect of chronic administration of ethanolic leave extract of Senna fistula on haematological values, oxidative stress and dyslipidemia in experimental diabetic rats. Twenty-four albino rats weighing 120-150 g were divided into 4 experimental groups of six rats each; control, diabetic ...

  18. Large Vesico‑Vaginal Fistula Caused by a Foreign Body

    African Journals Online (AJOL)

    Vesico‑vaginal fistula is commonly caused by obstructed labor, gynecological surgery, occasionally due to malignancy and rarely foreign body; in most cases being ring pessaries.[1] Cases of a foreign body in the vagina have been reported mostly in developed countries.[1‑4] Foreign body within the vagina can result in ...

  19. Enterovaginal or Vesicovaginal Fistula Control Using a Silicone Cup. (United States)

    Russell, Katie W; Robinson, Ryan E; Mone, Mary C; Scaife, Courtney L


    An enterovaginal or vesicovaginal fistula is a complication resulting in vaginal discharge of succus, urine, or stool that can lead to significant complications. For low-volume fistulae, tampons or pads may be used. With high-volume fistulae, frequent product change can be painful and unpredictable in terms of efficacy. The psychologic distress is profound. Surgery may not be an option, making symptom control the priority. We report the use of a reusable menstrual silicone vaginal cup placed to divert and contain drainage. The menstrual cup provided significant symptom relief. Drainage is immediately diverted from tissue, unlike with tampon or pad use, which involves longer contact periods with caustic fluids. A system was created by adapting the end of the cup by adding silastic tubing and an external leg bag to provide long-term drainage control. Improvement in quality of life is of primary importance when dealing with fistula drainage. This simple and inexpensive device should be considered in those cases in which the drainage can be diverted as a viable option, especially in those who are symptomatic and awaiting surgical repair or in those for whom surgery cannot be performed.

  20. Carotid cavernous fistula after elective carotid endarterectomy: Case report

    Directory of Open Access Journals (Sweden)

    Andres Asser


    This is a case to illustrate a rare complication of carotid artery surgery. The patient had atherosclerotic vessel damage of ICA visible on earlier CT scans. This combined with abrupt increase of transmural pressure due to the revascularization procedure could possibly lead to arterial wall rupture and fistula formation.

  1. Management of a vesicovaginal fistula using holmium laser ablation. (United States)

    Singh, Ruchira; Schmitt, Jennifer J; Knoedler, John J; Occhino, John A


    The objective was to demonstrate a surgical technique for the management of a small vesicovaginal fistula (VVF) involving a combination of cystoscopic holmium laser ablation and vaginal repair. A 55-year-old morbidly obese female presented with complaints of menometrorrhagia and complex adnexal mass. She underwent an attempted robotic hysterectomy, which was converted to open hysterectomy, omentectomy, and lymphadenectomy owing to an intraoperative diagnosis of endometrioid carcinoma of the endometrium and dense pelvic adhesions. Postoperatively, the patient developed intermittent urinary leakage associated with position change. On evaluation, a speculum examination did not reveal any fistulous tract or leakage of fluid in the vagina. A tampon test was positive, but no evidence of a fistula was noted on a CT urogram. Cystourethroscopy was performed and identified a small VVF. The patient subsequently underwent repair of her VVF using a combination of cystoscopic holmium laser ablation and transvaginal excision of the suspected fistula opening. About 2 weeks after the surgery, a tampon test was negative and cystourethroscopy revealed healing bladder mucosa. The patient remains fistula-free at 12 months post-operatively. Holmium laser ablation combined with partial vaginal excision may be considered as a management option for a small VVF.

  2. Management of Complex Urogenital Fistulae in the Female | Al ...

    African Journals Online (AJOL)

    The procedures were individualized according to the existing pathology and included bladder augmentation and construction of a bladder tube. Results: The fistulae were repaired successfully and socially acceptable continence was achieved in all patients. Conclusion: Through urological evaluation of complex urinary ...

  3. genito-urinary fistula patients at bugando medical centre

    African Journals Online (AJOL)


    Jul 7, 2010 ... Kegel exercises before discharge. We are also beginning to see more “fresh” fistula-that which has happened in the past 1-3 months. We are now attempting repair on these women at an earlier time. DISCUSSION. The most prominent feature of these patients is their low level of education (98% have low or ...

  4. Acquired Salpingo-Enteric Fistula – A Case Report | Ogbeide ...

    African Journals Online (AJOL)

    Hysterosalpingogram a common radiological examination is routinely used in the investigation of infertility and sub-fertility in women. The close proximity of the uterus to adjacent pelvic structures results in various types of pelvic fistulas after pelvic disease, pelvic radiation therapy, trauma or pelvic surgery. The case of a 34 ...

  5. Living with vesico-vaginal fistula: experiences of women awaiting ...

    African Journals Online (AJOL)

    Vesico-vaginal fistula (VVF) is one of maternal health problems confronting public health workers in Nigeria today. Information on how women suffering from this condition cope is important in that it can inform the design and delivery of programmes and interventions to address the challenges that face victims of VVF.

  6. Bladder perforation and development of a vesico - vaginal fistula ...

    African Journals Online (AJOL)

    Conservative management by continuous bladder drainage was not successful. A low-pressure cystogram done on day eight revealed a bladder leakage. On day 21, a repeat low-pressure cystogram showed a vesico-vaginal fistula. A successful transvesical repair by laparotomy was undertaken on day 23. The possible ...

  7. Classification Types Of Postoperative Enterocutaneous Fistula As A ...

    African Journals Online (AJOL)

    Methodology: Consecutive patients with clinical postoperative external enterocutaneous fistula seen between 1994 and 2006 were studied. ... Compared with the other classifications considered in the study classification into high and low output highly correlated with the outcome of treatment logistic regression p < 0.006 ...

  8. Post-laparotomy haemoptysis due to broncho-abdominal fistula ...

    African Journals Online (AJOL)

    as a right-sided lung abscess.6 Broncho-abdominal fistula (BAF) is similarly rare with a search yielding two reports .... conservative treatment without needing surgery.7. The use of sampling tracers such as Xenon-133 ... fundus was thought to be a result of the damage inflicted by the swab abscess complex in the left upper ...

  9. Effect of Ethanolic Leaf Extract of Senna Fistula on some ...

    African Journals Online (AJOL)


    leave extract of Senna fistula on haematological values, oxidative stress and dyslipidemia in experimental diabetic rats. Twenty-four albino rats ... might improve the diabetic induced disturbances of some haematological parameters, reduces the plasma lipid imbalances .... Malaysia, alloxan monohydrate and all other.

  10. Classification Types Of Postoperative Enterocutaneous Fistula As A ...

    African Journals Online (AJOL)

    The case files were retrieved and information on demographic data, type of initial surgery, source of referral, and characteristic of the fistula in terms of effluent per day and type of intestine ... Three (11.1%) cases each had burst abdomen and Acquired Immunodeficiency Syndrome (AIDS) in 3 cases (11.1%) additionally.

  11. Oesophageal bleeding from aorto- oesophageal fistula due to aortic ...

    African Journals Online (AJOL)


    Jan 22, 1983 ... ing gives warning of fistula formation. S Air Med J 1983: 63: 124-127. Exsanguinating oesophageal haemorrhage due to an established .... tive review has persuaded us that a more alert and vigorous approach in our cases might well have achieved some success. We are indebted to the Department of ...

  12. Outcomes after ulnar-basilic arteriovenous fistula formation. (United States)

    Liu, Wing; Lagaac, Regin; Pettigrew, Gavin J; Callaghan, Christopher J


    The ulnar-basilic arteriovenous fistula (UBAVF) is rarely used owing to perceived problems with poor patency and prolonged maturation times. We report outcomes after UBAVF formation. Patients who had a forearm UBAVF formed between October 1, 2002 and September 31, 2010 were identified from a prospectively maintained database. Fifty-two UBAVFs were formed in 48 patients. The majority were male (77.1%), with a median (range) age of 69.5 (18-86) years. Primary and secondary patencies at 1, 3, and 5 years were 43%, 13%, 13%, and 54%, 18%, and 13%, respectively. Primary patencies were higher in those with previously functioning radiocephalic arteriovenous fistulas on the same arm (P = 0.03). Thirty-six percent of UBAVFs became functional, with a median (range) time to maturation of 100 (32-471) days. Nine UBAVFs (17.3%) required revision surgery. Complications were rare (7.7%), with only one case of steal syndrome. Although UBAVF patency and functionality rates are low, we believe that these are acceptable, given the low risk of complications and preservation of precious upper-arm venous capital. Maturation can be prolonged, but when the forearm cephalic vein is unusable, UBAVFs can provide an alternative to upper-arm fistulas, and should be utilized more widely, especially in those with previously functioning ipsilateral radiocephalic arteriovenous fistulas. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Robotic versus laparoscopic resection for sigmoid diverticulitis with fistula. (United States)

    Elliott, Peter A; McLemore, Elisabeth C; Abbass, Mohammad A; Abbas, Maher A


    Robotic abdominal surgery is growing despite a paucity of clinical reports to evaluate its impact on patient outcomes. In this retrospective case series, we aim to analyze our early experience with robotic resection in 11 consecutive patients with chronic colonic diverticulitis complicated by fistula to bladder, vagina, or skin and to compare the results of the robotic approach to 20 patients undergoing laparoscopic resection for the same indication. Our main outcome measures include operative time, blood loss, conversion rate, transfusion rate, hospital length of stay, complications, readmission, and fistula healing rate. In our study, we found robotic resection for colonic diverticulitis with fistula was technically feasible and yielded 100% fistula healing rate. The operative time, complication and readmission rates were similar to laparoscopy. A higher conversion rate, diverting stoma need, and longer hospital length of stay were noted in the robotic group; however, these findings could have been attributed to a higher number of cases involving rectal excision in the robotic group. Larger studies are needed to further examine the impact of robotic surgery on the outcome of patients with complicated chronic sigmoid diverticulitis.

  14. Variation in flowering phenology of Cassia fistula Linn. population in ...

    African Journals Online (AJOL)

    Flowering phenology in the population of Cassia fistula Linn. at Ota, Ogun State, Nigeria was investigated for three years to determine if there was variation in the phenology and the patterns were compared with some environmental factors to determine if there was any correlation. The number of plants flowering each ...

  15. A Case Report of Cholecystocolonic Fistula in a Cadaveric Setting

    Directory of Open Access Journals (Sweden)

    E Esfandiari


    Full Text Available ABSTRACT: Introduction & Objective: About 12% of complications of cholecystitis are reported to be the fistula between the gall bladder and the gastrointestinal tract. In this article, a case of inflammatory adhesion between the gall bladder and the transverse colon is reported. Due to the importance of this phenomenon, the literature has been reviewed in order to highlight anatomical relation between these two viscera. Case: A case of inflammatory adhesion between the gall bladder and the adjacent part of transverse colon was observed during routine dissection of abdominal cavity of a male middle age cadaver. The adhesional fold contained multiple fistulae between the fundus of gall bladder and the adjacent part of transverse colon. Through the round openings of these fistulae, the green bile material appeared to have been passed from the gall bladder to the colon. Conclusion: In cases of untreated chronic cholecystitis, this kind of inflammatory adhesion between the gall bladder and the adjacent part of transverse colon and subsequent fistulae used to be a usual complication. Because of low level of hygiene and medical services, the frequency of these complications, was not uncommon in the past, but their occurrence has decreased in recent decades. Meanwhile, due to the possibility of occurrence, the emphasis on anatomical relation of these two viscera, and drafting an integrated discussion of anatomy, developmental and clinical aspects of heptorenal pouch is mandatory in the educational areas.

  16. uncomplicated midvaginal vesico-vaginal fistula repair in ibadan

    African Journals Online (AJOL)

    leadership for capacity building and training of specialists that are interested in acquiring the skills. The case records of women that presented with genitourinary ..... Postgrad Med. 1993 Jan-Mar;39(1):20-21. 20. Wall L.L., Wilkinson J., Arrowsmith S.D.,. Ojengbede O., and Mabeya H. A code of ethics for the fistula surgeon.

  17. Determinants of obstetric fistula in Ethiopia | Andargie | African ...

    African Journals Online (AJOL)

    Background: Obstetric fistula is a maternal morbidity creating devastating health problems for the women. Continuous and uncontrollable leaking of urine or faeces from vagina can lead to life changing stigmatization for women in third world countries. The underlying factors and consequences of this problem are not yet fully ...

  18. Vesico-vaginal fistula surgery in Uganda | Hancock | East and ...

    African Journals Online (AJOL)

    Background: Childbirth injuries are common in Uganda. This paper describes our experience with Vesico-vaginal Fistula repair and aftercare. Methods: Between 1999 and 2003, 341 consecutive patients underwent VVF repair complicating childbirth trauma. Another 29 VVF patients were seen but not operated because of ...

  19. Modified transanal repair of congenital H-type rectovestibular fistula ...

    African Journals Online (AJOL)

    Congenital H-type rectovestibular fistulas are rare in the spectrum of anorectal malformations. Repair is associated with recurrence rates of up to 30%, using perineal repair, vestibuloanal pull-through or anterior anorectoplasty. The rarity of the malformation has limited experience with the surgical approach; hence, the rate ...

  20. Determinants of obstetric fistula in Ethiopia. Asrat Atsedeweyn ...

    African Journals Online (AJOL)


    Sep 3, 2017 ... and Biostatistics,. University of Gondar, Ethiopia. Email: Introduction. Obstetric fistula is a child birth injury usually caused by unrelieved, prolonged obstructed labor. Obstructed labor can develop during the second stage of labor, when the fetus cannot fit through the birth canal because ...

  1. Bronchopleural fistula: the Damocles sword of all pneumonectomies. (United States)

    Pop, Daniel; Nadeemy, Ahmad S; Venissac, Nicolas; Mouroux, Jérôme


    The postpneumonectomy bronchopleural fistula (BPF) remains a difficult challenge for the thoracic surgeon. We report the case of a very late-onset (60 years) left BPF managed by video-assisted mediastinoscopy discussing the direct consequences of this complication in the postpneumonectomy period.

  2. Neonatal perforated Amyand's hernia presenting as an enterocutaneous scrotal fistula

    Directory of Open Access Journals (Sweden)

    Antonios Panagidis


    Full Text Available Perforation of the vermiform appendix in a septic neonate with an Amyand's hernia resulted in the formation of a scrotal enterocutaneous fistula. In conclusion from this exceptional complication, active parental awareness for any neonatal scrotal swelling is required, and an early operative policy for the neonatal inguinal hernia is significant.

  3. Chronic foot ulcer complicating a traumatic arteriovenous fistula ...

    African Journals Online (AJOL)

    Background: Chronic foot ulcers could be a complication of traumatic arteriovenous (A-V) fistulation. We report a rare case of chronic foot ulcer and deformity resulting from arteriovenous fistula of the anterior tibial artery. Method: The clinical presentation and the outcome of treatment in a patient treated at the University of ...

  4. Obstetric vesico-vaginal fistulae seen in the Northern Democratic ...

    African Journals Online (AJOL)

    Background: The Democratic Republic of Congo (DRC) is a developing country with poor obstetric indicators. Despite ongoing efforts to improve care, women continue to suffer multiple complications of child birth including vesico-vaginal fistulae (VVF). Objective: To describe socio-demographic and clinical characteristics of ...

  5. Formation of a vesicovaginal fistula in a pig model

    DEFF Research Database (Denmark)

    Lindberg, Jennifer; Rickardsson, Emilie; Andersen, Margrethe


    Objective: To establish an animal model of a vesicovaginal fistula that can later be used in the development of new treatment modalities. Materials and methods: Six female pigs of Landrace/Yorkshire breed were used. Vesicotomy was performed through open surgery. An standardized incision between t...

  6. Acquired tubercular bronchoesophageal fistula in a hemophiliac child

    Directory of Open Access Journals (Sweden)

    Jyoti Bothra


    Full Text Available Acquired bronchoesophageal fistula in children is usually a late diagnosis, due to the rarity of the condition. The diagnosis was further complicated by presence of multiple co-morbid conditions. We would like to emphasize the importance of tackling the co-morbid factors strategically along with the surgical aspects in this case report.

  7. Risk factors for postoperative pancreatic fistula in distal pancreatectomy. (United States)

    Soga, Koji; Ochiai, Toshiya; Sonoyama, Teruhisa; Inoue, Koji; Ikoma, Hisashi; Kikuchi, Shojiro; Ichikawa, Daisuke; Fujiwara, Hitoshi; Okamoto, Kazuma; Otsuji, Eigo


    The purpose of this study was to identify risk factors related to severe pancreatic fistula in patients who underwent distal pancreatectomy (DP). From 2000 to 2008, 63 patients underwent DP. We retrospectively identified the risk factors for Grade B or C postoperative pancreatic fistula (POPF) occurring after DP. POPF was classified according to the International Study Group on Pancreatic Fistula definition. Postoperative mortality and morbidity rate were 0% and 61%, respectively. POPF developed in 32 patients (51%); 21 of fistulas were classified as Grade A, nine as Grade B and two as Grade C. The incidence of severe POPF (Grade B or C) was significantly associated with two factors by univariate analyses: polyethylene glycolic acid (PGA) felt with fibrin sealant and blood loss during operation. To clarify the useful manner in DP, multivariate analysis was performed using 5 surgery-related factors. The use of polyethylene glycolic acid felt (PGA) with fibrin sealant and blood loss during operation were the significant factors for severe POPF (p=0.026 and 0.012, respectively). Using PGA felt with fibrin sealant for the pancreatic stump could reduce the risk of severe POPF.

  8. Arterioportal fistulas: introduction of a novel classification with therapeutic implications. (United States)

    Guzman, Eduardo A; McCahill, Laurence E; Rogers, Frederick B


    Arterioportal fistulas (APFs) are arteriovenous communications between the splanchnic arteries and the portal vein that represent an infrequent cause of presinusoidal portal hypertension. They can be acquired or congenital. Penetrating hepatic trauma, including liver biopsies, represent the most common etiology. They can be asymptomatic or manifest with portal hypertension. An abdominal bruit is a valuable physical finding. Persistence of an APF can cause hepatoportal sclerosis and possibly portal fibrosis. A detailed radiologic evaluation is mandatory. One must differentiate between small peripheral intrahepatic APFs (type 1) and large central APFs (type 2). The former usually resolve spontaneously, whereas the latter can cause portal hypertension and hepatic parenchymal changes. Type 1 APFs caused by needle injury can be followed by Doppler ultrasound. All other fistulas need treatment. Arterioportal fistulas are first treated by transcatheter embolization. Surgical approaches are reserved for complex cases. Congenital APFs (type 3) are diffuse and intrahepatic and can be difficult to manage. Overall, the prognosis is good. Herein, we propose a novel classification for arterioportal fistulas with therapeutic implications.

  9. [Post-partum vesicovaginal fistula: abdominal muscle strip treatment]. (United States)

    Perata, E; Severoni, S; Schietroma, M; Rossi, M; Perata, A; Natuzzi, G; Coiera, F; Carlei, F; Palmieri, R; Capperucci, G


    The Vesico-Vaginal Fistula (VVF) very often occur in tropical countries, but their treatment is usually not correct. A surgical treatment was carried put on 68 patients affected by VVF from March 1986 to December 19997 in the Nazareth Hospital (Nairobi). Their mean age was 22 years old; 27 patients (39.7%) underwent surgery for the first time, while for 41 patients (60.2%) the treatment was repeated. Fourteen patients (20.5%) had also Vesico-Rectum-Vaginal Fistula (VRV). The VVF was cured with a transvaginal treatment using a Martius strip for 32 cases. For 16 cases both vaginal and abdominal treatment was performed in the same time using an abdominal muscle strip, which was inserted in the space between the vagina and bladder. In VRV and VVF combined cases, the VVF was treated in the following way: first of all, during the same session, the VVF was cured by making a colostomy and then, after 2 months VRV was treated. The follow-up took about 7.2 months; 62 patients (91.1%) recovered, for 6 cases treated only with transvaginal operation, it has been necessary a second surgical procedure owing to relapsing, and for 2 of them an abdominal muscle strip was used. In conclusion, while the transvaginal repair is satisfactory treatment for little fistula never surgically treated before, on the other hand the transabdominal vaginal treatment is the best cure forge large or relapsing fistulas.

  10. Vesico vaginal fistula (VVF): a shift in epidemiology in northeastern ...

    African Journals Online (AJOL)

    Prolonged obstructed labour was the leading cause in 90% and most were in social class IV and V ( using standard occupational classification, OPCS.). Seventy five percent had successful repair, while about 50% were either divorced or neglected by their husbands. Conclusion: Vesico-vaginal fistula remains one ...

  11. Management of Hemorrhagic Pseudoaneurysmal Arteriovenous Fistula of the Sphenopalatine Artery

    Directory of Open Access Journals (Sweden)

    Ajeet Gordhan


    Full Text Available n-Butyl cyanoacrylate (n-BCA embolization of a hemorrhagic pseudoaneurysmal arteriovenous fistula of the sphenopalatine artery in a patient with paranasal sinus squamous cell carcinoma treated with regional surgery and radiation has, to our knowledge, not been previously reported.

  12. Group Psychological Therapy in Obstetric Fistula Care: A ...

    African Journals Online (AJOL)

    %) and mild (25.0 to 21.7%) and those without increased (43.3 to 73.3%). In conclusion, GPT is a useful adjunct to OF care as it improves their overall mental health status. (Afr J Reprod Health 2014; 18[1]: 156-160). Keywords: Obstetric fistula ...

  13. Management dilemma of cholecysto-colonic fistula: Case report

    Directory of Open Access Journals (Sweden)

    Waleed Gibreel


    Conclusion: Based on our experience with this particular case, we could safely conclude that an operation for cholecystocolonic fistula presence in the setting of biliary obstruction that failed decompressive attempts should be performed in an urgent fashion to avoid biliary sepsis development.

  14. Mesenchymal Stem Cells to Treat Crohn's Disease with Fistula. (United States)

    Zhang, Xiao-Mei; Zhang, Yu-Jing; Wang, Wei; Wei, Yu-Quan; Deng, Hong-Xin


    Crohn's disease, which mainly affects the gastrointestinal tract, is a refractory inflammatory disease that has clinical manifestations of abdominal pain, fever, bowel obstruction, and diarrhea with blood or mucus. Together, these symptoms can severely impair a patient's quality of life. Besides the common complication of intestinal obstruction, fistulas, particularly anorectal fistulas, are common in Crohn's disease patients. Since radical surgical cures can be difficult to achieve and relapse is common, Crohn's disease patients often seek other effective treatments in addition to surgery. Stem-cell therapies have recently been proposed as a method to address the challenges and prospective medical needs of Crohn's disease patients in general and those with fistulas. Several studies suggest that mesenchymal stem cells (MSCs) could improve Crohn's disease and Crohn's fistula. Moreover, studies concerning MSC transplantation or local rejection of stem cells derived from bone marrow or adipose tissue-derived stem cells have assessed stem cell-based treatments for refractory Crohn's disease. Many patients in these studies are now in remission. A number of clinical trials for refractory Crohn's disease have also evaluated transplantation of autologous or allogenic MSCs and showed that MSCs can be safely administered to Crohn's disease patients, with some achieving positive clinical responses.

  15. Vesicovaginal fistula, bladder calculus, retained foreign body or all ...

    African Journals Online (AJOL)

    L. Paik

    Retained foreign bodies causing vesicovaginal fistula has been reported in the literature, specifically aerosol bottle caps [1–3]. Contraception and masturbation have been described as reasons for placing an aerosol cap within the vagina [1], but sexual abuse must also be considered as a possibility in these cases. It is also ...

  16. Crohn's disease presenting as a recurrent perianal fistula: A case ...

    African Journals Online (AJOL)

    Crohn's disease (CD) is a multifactorial polygenic disease characterized by chronic inflammation of the gastrointestinal tract (GIT), often complicated by the development of intestinal strictures and/or formation of fistulas. Several diagnostic criteria have been proposed, usually relying on clinical, endoscopic, radiological or ...

  17. gastrocolic fistula as a complication of benign gastric ulcer

    African Journals Online (AJOL)

    Fourteen patients presenting at a surgical ward at King Edward VIII Hospital, Durban, with gastrocolic fistula as a complication of benign gastric ulcer between 1983 and 1994 were retrospectively reviewed. Patients were categorised clinically into two groups. Group A patients (N = 8) underwent surgery and group B patients.

  18. Echinococcal Cyst of the Pancreas with Cystopancreatic Duct Fistula ...

    African Journals Online (AJOL)

    Echinococcal Cyst of the Pancreas with Cystopancreatic. Duct Fistula Successfully Treated by Partial Cystectomy and. Cystogastrostomy. Ahmed Elaffand, Adarsh Vijay1, Samah Mohamed, Hassan Hani Al-Battah1, Ayda Youssef, Ahmed Farahat. INTRODUCTION. Hydatid disease (HD) is a rare endemic disease in.

  19. Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula


    Sung, Kyoung-Su; Song, Young-Jin; Kim, Ki-Uk


    The spinal dural arteriovenous fistula (SDAVF) is rare, presenting with progressive, insidious symptoms, and inducing spinal cord ischemia and myelopathy, resulting in severe neurological deficits. If physicians have accurate and enough information about vascular anatomy and hemodynamics, they achieve the good results though the surgery or endovascular embolization. However, when selective spinal angiography is unsuccessful due to neurological deficits, surgery and endovascular embolization m...

  20. Combined oesophageal atresia with upper pouch fistula and ...

    African Journals Online (AJOL)

    Upper pouch tracheoesophageal fistula occurs is less than 1% of all oesophageal atresia variants. Meconium peritonitis is a rare neonatal condition with an incidence of 1:30 000 live births. In this case report, we describe the presentation, clinical findings and management of a patient diagnosed with an oesophageal ...

  1. Aortocaval fistula – rare complication of ruptured abdominal aortic ...

    African Journals Online (AJOL)

    Aortocaval fistula (ACF) formation is a rare condition occurring in 0.2 - 1.3% of patients with degenerative aortic aneurysms. 1 This paper describes the presentation and successful management of a patient with such an ACF. We wish to highlight the need to maintain a high index of suspicion for this condition in patients with ...

  2. A Case of Esophagopericardial Fistula as a Complication of Upper ...

    African Journals Online (AJOL)

    A case of suppurative pericarditis from an esophagopericardial fistula (EPF) following the upper gastrointestinal endoscopy (UGIE). A 38‑year‑old schizophrenic male patient with gastro-esophageal reflux disease (GORD) and previously dilated esophageal stricture was presented with acute retrosternal chest pain.

  3. A Case of Esophagopericardial Fistula as a Complication of Upper ...

    African Journals Online (AJOL)

    A case of suppurative pericarditis from an esophagopericardial fistula (EPF) following the upper gastrointestinal endoscopy. (UGIE). A 38‑year‑old schizophrenic male patient with gastro‑esophageal reflux disease (GORD) and previously dilated esophageal stricture was presented with acute retrosternal chest pain.

  4. Traumatic carotid-cavernous fistula presenting as massive epistaxis. (United States)

    Wyrick, Deidre; Smith, Samuel D; Dassinger, Melvin S


    Carotid-cavernous sinus fistulae (CCF) are a rare complication with the potential for great morbidity including intracranial hemorrhage, blindness, cranial nerve palsy and stroke. Traumatic CCF are the most common type of CCF. Here we discuss a patient who sustained blunt head trauma and had substantial epistaxis, requiring massive transfusion, intraoperatively due to unrecognized CCF. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Risk factors for obstetric fistulae in north-eastern Nigeria. (United States)

    Melah, G S; Massa, A A; Yahaya, U R; Bukar, M; Kizaya, D D; El-Nafaty, A U


    This prospective comparative study of obstetric fistulae (OF) was aimed at identifying risk factors. A total of 80 obstetric fistulae treated at the gynaecological unit of the FMCG, and 80 inpatients without fistulae recruited randomly as controls formed the basis of this study. Through interview and case record review, information on age, parity and marital status was collected. Other features were educational status, occupation and booking status of the pregnancy that might have led to this condition. The duration of labour, place of birth and mode of delivery, including its outcome were also collected. The data were analysed using the Epi Info. The majority of the patients were Hausa/Fulani 87.5%, Muslims 91.2%, with large vesicovaginal fistulae (average size 5.0 cm) mainly resulting from obstructed labour (93.7%). Major risk factors included early age at first marriage (average 14 years), short stature (average height 146.2 cm) and illiteracy (96.3%). Also low social class and lack of gainful employment were factors. Failure to book for antenatal care (93.7%), and rural place of residence (95%) were also factors associated with acquiring the fistulae. Living far away (>3 km) from a health facility also contributed or predisposed to the development of an obstetric fistula. Social violence and stigma associated with the fistulae included divorce, being ostracised as a social outcast, and lack of assistance from relations in terms of finding and funding treatment. This study supports improved access to basic essential obstetric care, family planning services, and timely referral when and where necessary. Universal education will provide a long-term solution by improving the standard of living and quality of life. Especially important are media- and community-based programmes on the ills of teenage marriage and child pregnancy using cultural and religiously-based values to give sound advice. In a male dominated society, reaching out to men with traditionally

  6. Fistula-Associated Anorectal Cancer in the Setting of Crohn's Disease. (United States)

    Shwaartz, Chaya; Munger, Jordan A; Deliz, Juan R; Bornstein, Joseph E; Gorfine, Stephan R; Chessin, David B; Popowich, Daniel A; Bauer, Joel J


    Cancer arising from perianal fistulas in patients with Crohn's disease is rare. There are only a small series of articles that describe sporadic cases of perianal cancer in Crohn's disease fistulas. Therefore, there are no clear guidelines on how to appropriately screen patients at risk and choose proper management. The purpose of this study was to describe patients diagnosed with cancer in perianal fistulas in the setting of Crohn's disease. The study involved an institutional review board-approved retrospective review of medical charts of patients with perianal Crohn's disease. The data extracted from patient charts included demographic and clinical characteristics. Patients seen at the Mount Sinai Medical Center were included. We identified patients who were diagnosed with perianal cancer in biopsies of fistula tracts. We observed the number of patients with Crohn's disease who had fistulas, cancer in fistula tract, and time to diagnosis. The charts of 2382 patients with fistulizing perianal Crohn's disease were reviewed. Cancer in a fistula tract was diagnosed in 19 (0.79%) of these patients, 9 with squamous-cell carcinoma and 10 with adenocarcinoma. The majority of the 19 patients (68%) had symptoms typical of perianal fistula. The mean time from diagnosis of Crohn's disease to fistula diagnosis and from fistula diagnosis to cancer diagnosis was 19.4 and 6.0 years. In 5 patients (26%), cancer was not diagnosed in the first biopsy obtained from the fistula tract. This is a retrospective chart review of a rare outcome; the results may not be generalizable. Routine biopsies of long-standing fistula tracts in patients with Crohn's disease should be strongly considered and may yield an earlier diagnosis of cancer in the fistula tracts.

  7. The Role of Eosinophilic Cationic Proteins, Total IgE and Eosinophilia in Children with Bronchial Hyperresponsiveness

    Directory of Open Access Journals (Sweden)

    Ungureanu Adina


    Full Text Available Bronchial hyperreactivity (HRB, is defined as an excessive bronchial constriction that acts as an exaggerated bronchoconstrictor of the airways. This occurs as a secondary action of a nonspecific stimuli.

  8. Functional diagnostic parameters for arteriovenous fistula. (United States)

    Rajabi-Jagahrgh, Ehsan; Banerjee, Rupak K


    The inability to detect the arteriovenous fistula (AVF) dysfunction in a timely manner under the current surveillance programs, which are based on either diameter (d), flow rate (Q), or pressure (p) measurements, is one of the major challenges of dialysis treatment. Thus, our aim is to introduce new functional diagnostic parameters that can better predict AVF functionality status. Six AVFs were created between the femoral arteries and veins of three pigs, each pig having two AVFs on either limb. Flow fields and pressure drop (Δp) in AVFs were obtained via numerical analysis utilizing the CT scan and Doppler ultrasound data at 2D (D: days), 7D, and 28D postsurgery. The dataset included 16 (two pigs [four AVFs] for three time points, and one pig [two AVFs] for two time points) repeated measurements over time, and the statistical analysis was done using a mixed model. To evaluate the nature of pressure drop-flow relationships in AVFs, the Δp was correlated with the average velocity at proximal artery (v) and also the corresponding scaled velocity (v*) by the curvature ratio of anastomotic segment. Based on these relationships, two new functional diagnostic parameters, including the nonlinear pressure drop coefficient (Cp ; pressure drop divided by dynamic pressure at proximal artery) and the linear resistance index (R; pressure drop divided by velocity at proximal artery), were introduced. The diagnostic parameters that were calculated based on scaled velocity are represented as R* and Cp *. A marginal (P = 0.1) increase in d from 2D (5.4 ± 0.7 mm) to 7D (6.8 ± 0.7 mm), along with a significant increase in Q (2D: 967 ± 273 mL/min; 7D: 1943 ± 273 mL/min), was accompanied by an almost unchanged Δp over this time period (2D: 16.42 ± 4.6 mm Hg; 7D: 16.40 ± 4.6 mm Hg). However, the insignificant increase in d and Q from 7D to 28D (d = 7.8 ± 0.8 mm; Q = 2181 ± 378 mL/min) was accompanied by the elevation in Δp (24.6 ± 6.5 mm Hg). The functional diagnostic

  9. Impact of obesity on bronchial asthma in Indian population. (United States)

    Ramasamy, Anandha K; Gupta, Nitesh; Kumar, Raj


    Obesity and asthma are common inflammatory conditions, having presence of both local and systemic inflammation and this relationship is not well understood. This study was undertaken to compare pulmonary function parameters, inflammatory marker like C-reactive protein (hs-CRP), exhaled nitric oxide (FENO) and atopic profile between non-obese and obese bronchial asthma patients in Indian population. The study aims to elucidate the association between the systemic and local inflammatory response relating to obesity in asthmatics. Sixty bronchial asthma patients were recruited for the study, and were divided equally into obese (BMI>30 kg/m(2)) and non-obese (BMIanalysis of nitric oxide and skin prick testing for atopic profile. The study was approved by institutional ethical committee. The mean body mass index (BMI) for the non-obese and obese group was 21.64 kg/m(2) and 34.1 kg/m(2) respectively (P = 0.001). The functional residual capacity (FRC% predicted) (100.9 ± 4.21 vs 80.40 ± 4.03; P = 0.009) and expiratory reserve volume (ERV% predicted) (95.13 ± 6.71 vs. 67.03 ± 4.54; P = 0.001) both were significantly lower in the obese group. The non-obese and obese group had hs-CRP levels of 3.01 mg/L and 4.07 mg/L, respectively; the difference being statistically insignificant (P = 0.15). Similarly, FENO levels of non-obese and obese group were 63.20 ppb and 63.75 ppb, respectively; difference was not statistically significant (P = 0.95). Atopic profile of both the groups did not differ significantly. Obesity does not appear to increase the local and systemic inflammatory responses in bronchial asthma patients in Indian population.

  10. Importance of education in bronchial asthma treatment - gender differences. (United States)

    Jankowska-Polańska, Beata; Pleśniak, Justyna; Seń, Mariola; Uchmanowicz, Izabella; Rosińczuk, Joanna


    Despite significant progress in understanding mechanisms and effective treatment there are still therapeutic failures in patients treated for bronchial asthma. Education is vital in the therapeutic process. It improves the control of the disease at the individual level by influencing the adherence and compliance. The study included 100 patients suffering from bronchial asthma and treated according to GINA 2002 guidelines in Allergy Clinic. Asthma control test (ACT), analysis of patients' medical documentation and a self-constructed questionnaire concerning health promotion and education were used in the study. Aim of this work was to assess differences in the influence of education on results of bronchial asthma control between sexes. Average duration of asthma was similar in women and men (13.0 ± 11.16 vs.12.7 ± 9.74 years). Weaker asthma control was found in women (ACT 17.7 vs. 20.4), as well as lower FEV1 values (80-50% of predicted value in 60.3% of women vs. 43.25 of men). In women an analysis of correlation concerning patients' knowledge and conducted health education with asthma control revealed a statistically significant positive correlation of knowledge acquired from the allergologist with asthma control, information about proceeding in acute attack, whereas negative correlation with asthma control with knowledge passed on by family doctor was found. Among the male respondents positive correlations of knowledge with asthma control within the scope of knowledge from allergologist and information concerning proceeding in asthmatic attack were found, while negative correlation with information coming from family doctor was revealed. Health education in patients with asthma should be conducted by a specialist in allergic diseases and well-prepared healthcare professionals.

  11. Increased myoepithelial cells of bronchial submucosal glands in fatal asthma. (United States)

    Green, F H Y; Williams, D J; James, A; McPhee, L J; Mitchell, I; Mauad, T


    Fatal asthma is characterised by enlargement of bronchial mucous glands and tenacious plugs of mucus in the airway lumen. Myoepithelial cells, located within the mucous glands, contain contractile proteins which provide structural support to mucous cells and actively facilitate glandular secretion. To determine if myoepithelial cells are increased in the bronchial submucosal glands of patients with fatal asthma. Autopsied lungs from 12 patients with fatal asthma (FA), 12 patients with asthma dying of non-respiratory causes (NFA) and 12 non-asthma control cases (NAC) were obtained through the Prairie Provinces Asthma Study. Transverse sections of segmental bronchi from three lobes were stained for mucus and smooth muscle actin and the area fractions of mucous plugs, mucous glands and myoepithelial cells determined by point counting. The fine structure of the myoepithelial cells was examined by electron microscopy. FA was characterised by significant increases in mucous gland (p = 0.003), mucous plug (p = 0.004) and myoepithelial cell areas (p = 0.017) compared with NAC. When the ratio of myoepithelial cell area to total gland area was examined, there was a disproportionate and significant increase in FA compared with NAC (p = 0.014). Electron microscopy of FA cases revealed hypertrophy of the myoepithelial cells with increased intracellular myofilaments. The NFA group showed changes in these features that were intermediate between the FA and NAC groups but the differences were not significant. Bronchial mucous glands and mucous gland myoepithelial cell smooth muscle actin are increased in fatal asthma and may contribute to asphyxia due to mucous plugging.

  12. [Research advances in association between pediatric obesity and bronchial asthma]. (United States)

    Zhu, Lian; Xu, Zhi-Liang; Cheng, Yan-Yang


    This review article introduces the research advances in the pathophysiological mechanism of obesity in inducing pediatric bronchial asthma, including the role of leptin in obesity and asthma, the association of plasminogen activator inhibitor-1 with obesity and asthma, the association of adiponectin and interleukins with obesity and asthma, and the influence of neurotransmitter on asthma. In particular, this article introduces the latest research on the inhibition of allergic asthma through targeting at the nociceptor of dorsal root ganglion and blocking the signaling pathway of the nociceptor.

  13. Bronchial atresia in a neonate with congenital cytomegalovirus infection

    Directory of Open Access Journals (Sweden)

    Abdullah A Yousef


    Full Text Available Bronchial atresia (BA is characterized by a mucus-filled bronchocele in a blind-ending segmental or lobar bronchus with hyperinflation of the obstructed segment of the lung. We describe a neonate who presented on his 9 th day of life with respiratory distress. Chest computed tomography showed a soft tissue density involving the right middle lobe (RML. RML lobectomy confirmed the diagnosis of BA. Cytomegalovirus was detected by polymerase chain reaction in blood, urine, and tracheal aspirates which may provide further insight into the pathogenesis of BA.

  14. Lung Sound Analysis and Airway Inflammation in Bronchial Asthma. (United States)

    Shimoda, Terufumi; Obase, Yasushi; Nagasaka, Yukio; Nakano, Hiroshi; Kishikawa, Reiko; Iwanaga, Tomoaki


    Our previous study on lung sound analysis (LSA) revealed that the expiration-to-inspiration sound power ratio in a low-frequency range (E/I LF) was increased in patients with bronchial asthma, even when they have no wheezes. We also monitored the expiration-to-inspiration sound power ratio in a mid-frequency range (E/I MF) and the mid- to low-frequency sound power ratio for inspiration and expiration (ie, I MF/LF and E MF/LF, respectively) using a new software program to examine which parameter is most suitable as an index of airway inflammation in patients with asthma. A study was conducted in 31 patients with mild-to-moderate bronchial asthma to examine potential correlations of LSA parameters (E/I LF, E/I MF, I MF/LF, and E MF/LF) with spirogram parameters, airway hyperresponsiveness (PC20), fractional exhaled nitric oxide (NO), and sputum eosinophils. E/I LF was significantly correlated with airway narrowing (forced expiratory volume in 1 second [FEV1.0]/forced vital capacity [FVC]%: r = -0.50, maximal expiratory flow at 50% [V50],%pred: r = -0.50) and peripheral airway inflammation (alveolar NO: r = 0.36, eosinophils in peripheral sputum: r = 0.41). E/I MF was significantly correlated with airway narrowing (FEV1.0/FVC%: r = -0.46, V50,%pred: r = -0.49), airway inflammation (bronchial NO: r = 0.43, alveolar NO: r = 0.47, eosinophils in peripheral sputum: r = 0.50), and airway hyperresponsiveness (logPC20: r = -0.49). E MF/LF was significantly correlated with airway inflammation (NO: r = 0.36, eosinophils in sputum: r = 0.40) and airway hyperresponsiveness (logPC20: r = -0.40). I MF/LF was not significantly correlated with any parameters. Among the 4 LSA parameters investigated, E/I MF demonstrated the highest correlation with airway inflammation, and also with bronchial hyperresponsiveness. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  15. Multiple synchronous bronchial carcinoid tumors: report of a case. (United States)

    Camargo, S M; Machuca, T N; Moreira, A L S; Schio, S M; Moreira, J S; Camargo, J J P


    Peripheral bronchial carcinoids are uncommon. Their presentation as synchronous tumors is rare and limited to anecdotal cases.We report the case of a 62-year-old female with the radiological finding of multiple bilateral nodular lesions. Bilateral sequential thoracotomies were performed and all three nodules were treated by sublobar resections. Pathological examination revealed all specimens to be carcinoid tumors and subsequent investigation confirmed the lung as the primary site. A review of previous cases of multiple carcinoids is presented and the particularities of their management are discussed.

  16. Health-related quality of life in childhood bronchial asthma | Al ...

    African Journals Online (AJOL)

    Health-related quality of life in childhood bronchial asthma. ... diagnosed bronchial asthma were clinically evaluated to determine level of asthma control and were administered pediatric asthma quality of life questionnaire (PAQLQ), ... Control of the main determinants of QoL scores might improve the QoL of these patients.

  17. An increase in bronchial responsiveness is associated with continuing or restarting smoking

    NARCIS (Netherlands)

    Chinn, S; Jarvis, D; Luczynska, CM; Ackermann-Liebrich, U; Anto, JM; Cerveri, [No Value; de Marco, R; Gislason, T; Heinrich, J; Janson, C; Kunzli, N; Leynaert, N; Neukirch, FO; Schouten, JP; Sunyer, J; Svanes, C; Wjst, M; Burney, PG


    Rationale: Bronchial responsiveness (BHR) has been found to be associated with smoking, atopy, and lower lung function in cross-sectional studies, but there is little information on determinants of change in adults. Objectives: To analyze change in bronchial responsiveness in an international

  18. Lung function and bronchial responsiveness after Mycoplasma pneumoniae infection in early childhood

    DEFF Research Database (Denmark)

    Boysen, Birgitte Kjær; Jensen, Jørgen S; Nielsen, Kim G


    by whole-body plethysmography and bronchial hyperresponsiveness was assessed by cold, dry air hyperventilation. Neither baseline lung function nor bronchial response to cold dry air hyperventilation differed between M. pneumoniae-positive and -negative children: mean baseline lung function were 1.17 versus...

  19. Effect of Bronchial Asthama on Porphyrin Levels in Patients of Atopic Dermatitis - a Spectrophotometric Study

    Directory of Open Access Journals (Sweden)

    R L Singh


    Full Text Available A quantitative assay of porphyrins in blood, urine and stool of 30 patients with atopic dermatitis, 17 without and 13 with bronchial asthma was done. Rimington′s technique for the estimation of porphyrins was employed. No statistically significant difference in porphyrin levels was observed between patients without and with bronchial asthma.

  20. Effect of Bronchial Asthama on Porphyrin Levels in Patients of Atopic Dermatitis - a Spectrophotometric Study. (United States)

    Singh, R L; Handa, F; Sidhu, K S


    A quantitative assay of porphyrins in blood, urine and stool of 30 patients with atopic dermatitis, 17 without and 13 with bronchial asthma was done. Rimington's technique for the estimation of porphyrins was employed. No statistically significant difference in porphyrin levels was observed between patients without and with bronchial asthma.