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Sample records for anal fistula plug

  1. Treating anal fistula with the anal fistula plug: case series report of 12 patients

    PubMed Central

    Saba, Reza Bagherzadeh; Tizmaghz, Adnan; Ajeka, Somar; Karami, Mehdi

    2016-01-01

    Introduction Recurrent and complex high fistulas remain a surgical challenge. This paper reports our experience with the anal fistula plug in patients with complex fistulas. Methods Data were collected prospectively and analyzed from consecutive patients undergoing insertion of a fistula plug from January 2011 through April 2014 at Hazrat-e-Rasoul Hospital in Tehran. We ensured that sepsis had been eradicated in all patients prior to placement of the plug. During surgery, a conical shaped collagen plug was pulled through the fistula tract. Results Twelve patients were included in this case study. All patients had previously undergone failed surgical therapy to cure their fistula and had previously-placed Setons. There were eight males and four females with an average age of 44 who were treated for complex fistulas. At a median time of follow-up of 22.7 months, 10 of the 12 patients had healed (83.3%). One patient developed an abscess that was noted on the sixth postoperative day, and there was one recurrence during follow-up. Conclusions Fistula plugs are effective for the long-term closure of complex anal fistulas. Success of treatment with the fistula plug depends on the eradication of sepsis prior to plug placement. PMID:27280009

  2. Modern management of anal fistula

    PubMed Central

    Limura, Elsa; Giordano, Pasquale

    2015-01-01

    Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. For the simple and most distal fistulae, conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore, well accepted in clinical practise. However, for the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcome, which is quite inevitable following conventional surgical treatment. For this reason, over the last two decades, many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function. Among them, the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula. Another technique, the anal fistula plug, derived from porcine small intestinal submucosa, is safe but modestly effective in long-term follow-up, with success rates varying from 24%-88%. The failure rate may be due to its extrusion from the fistula tract. To obviate that, a new designed plug (GORE BioA®) was introduced, but long term data regarding its efficacy are scant. Fibrin glue showed poor and variable healing rate (14%-74%). FiLaC and video-assisted anal fistula treatment procedures, respectively using laser and electrode energy, are expensive and yet to be thoroughly assessed in clinical practise. Recently, a therapy using autologous adipose-derived stem cells has been described. Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae, and studies remain in progress. The aim of this present article is to review the pertinent literature, describing the advantages and limitations of

  3. Modern management of anal fistula.

    PubMed

    Limura, Elsa; Giordano, Pasquale

    2015-01-01

    Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. For the simple and most distal fistulae, conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore, well accepted in clinical practise. However, for the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcome, which is quite inevitable following conventional surgical treatment. For this reason, over the last two decades, many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function. Among them, the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula. Another technique, the anal fistula plug, derived from porcine small intestinal submucosa, is safe but modestly effective in long-term follow-up, with success rates varying from 24%-88%. The failure rate may be due to its extrusion from the fistula tract. To obviate that, a new designed plug (GORE BioA®) was introduced, but long term data regarding its efficacy are scant. Fibrin glue showed poor and variable healing rate (14%-74%). FiLaC and video-assisted anal fistula treatment procedures, respectively using laser and electrode energy, are expensive and yet to be thoroughly assessed in clinical practise. Recently, a therapy using autologous adipose-derived stem cells has been described. Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae, and studies remain in progress. The aim of this present article is to review the pertinent literature, describing the advantages and limitations of

  4. New Techniques for Treating an Anal Fistula

    PubMed Central

    2012-01-01

    Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing. Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure. This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane. Recently, cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae. PMID:22413076

  5. Anorectal conditions: anal fissure and anorectal fistula.

    PubMed

    Fox, Audralan; Tietze, Pamela H; Ramakrishnan, Kalyanakrishnan

    2014-04-01

    Anal fissures are linear splits in the anal mucosa. Acute fissures typically resolve within a few weeks; chronic fissures persist longer than 8 to 12 weeks. Most fissures are posterior and midline and are related to constipation or anal trauma. Painful defecation and rectal bleeding are common symptoms. The diagnosis typically is clinical. High-fiber diet, stool softeners, and medicated ointments relieve symptoms and speed healing of acute fissures but offer limited benefit in chronic fissures. Lateral internal sphincterotomy is the surgical management of choice for chronic and refractory acute fissures. Anorectal fistula is an abnormal tract connecting the anorectal mucosa to the exterior skin. Fistulas typically develop after rupture or drainage of a perianal abscess. Fistulas are classified as simple or complex; low or high; and intersphincteric, transsphincteric, suprasphincteric, or extrasphincteric. Inspection of the perianal area identifies the skin opening, and anoscopy visualizes internal openings. The goal of management is to obliterate the tract and openings with negligible sphincter disruption to minimize incontinence. Fistulotomy is effective for simple fistulas; patients with complex fistulas may require fistulectomy. Other procedures that are used include injection of fibrin glue or insertion of a bioprosthetic plug into the fistula opening. PMID:24742084

  6. Current management of anal fistulas in Crohn's disease

    PubMed Central

    Eder, Piotr; Banasiewicz, Tomasz; Matysiak, Konrad; Łykowska-Szuber, Liliana

    2015-01-01

    Anal fistulas occurring in Crohn's disease (CD) comprise a risk factor of severe course of inflammation. They are frequently intractable due to various factors such as penetration of the anal canal or rectal wall, impaired wound healing, and immunosuppression, among others. Anal fistulas typical to CD develop from fissures or ulcers of the anal canal or rectum. Accurate identification of the type of fistula, such as low and simple or high and complex, is crucial for prognosis as well as for the choice of treatment. If fistulotomy remains the gold standard in the surgical treatment of the former, it is contraindicated in high and complex fistulas due to possible risk of damage to the anal sphincter with subsequent faecal incontinence. Therefore, the latter require a conservative and palliative approach, such as an incision and drainage of abscesses accompanying fistulas or prolonged non-cutting seton placement. Currently, conservative, sphincter-preserving, and definitive procedures such as mucosal advancement or dermal island flaps, the use of plugs or glue, video assisted anal fistula treatment, ligation of the intersphincteric track, and vacuum assisted closure are gaining a great deal of interest. Attempting to close the internal opening without injuring the sphincter is a major advantage of those methods. However, both the palliative and the definitive procedures require adjuvant therapy with medical measures. PMID:26557938

  7. Biomaterials in the Treatment of Anal Fistula: Hope or Hype?

    PubMed Central

    Scoglio, Daniele; Walker, Avery S.; Fichera, Alessandro

    2014-01-01

    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

  8. Introducing the operation method for curing anal fistula by laser

    NASA Astrophysics Data System (ADS)

    Ji, Bingzhi

    1993-03-01

    The key to the treatment of anal fistula lies in scavenging the infected anal gland thoroughly, which is the source of anal fistula infection. The fistula tract at the internal orifice of the anal fistula is cut 1 cm using laser with the infectious source completely degenerated and the wound gassified and scanned. The residual distal fistula softens and disappears upon the action of organic fibrinolysin.

  9. [APPLICATION OF FISTULA PLUG WITH THE FIBRIN ADHESIVE IN TREATMENT OF RECTAL FISTULAS].

    PubMed

    Aydinova, P R; Aliyev, E A

    2015-05-01

    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. PMID:26419026

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

    PubMed Central

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

    2016-01-01

    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. PMID:26816676

  11. Application of YAG laser technique in the treatment of anal fistula

    NASA Astrophysics Data System (ADS)

    Liu, Jian-xun; Zhang, Xinrong

    1993-03-01

    The method of treating anal fistula with YAG laser technique is described in this essay. One-hundred-twenty patients have been treated successfully with this method and no recurrence was found in our series. Anal fistula is a common disorder in the anus and rectum. The tunnel of fistula zigzags around the external or internal sphincters. If the drainage is poor, and the skin around the external opening grows rapidly, false healing may occur and cause recurrent abscess. In this case, a fistula can not be cured except by operation.

  12. High-Flow Carotid Cavernous Fistula and the Use of a Microvascular Plug System: Initial Experience

    PubMed Central

    Shwe, Yamin; Paramasivam, Srinivasan; Ortega-Gutierrez, Santiago; Altschul, David; Berenstein, Alejandro; Fifi, Johanna T.

    2015-01-01

    Purpose We report our initial experience using a detachable microvascular plug system to occlude the internal carotid artery during endovascular treatment of high-flow carotid cavernous fistula. Case and Technique An 87-year-old patient was admitted for acute-onset double vision with associated right-eye ptosis. Exam revealed a pupil-sparing, partial right third cranial nerve palsy. MRI showed a carotid cavernous fistula with high-flow drainage. Digital subtraction angiography showed a high-flow, right-sided, direct carotid cavernous fistula with flow from the proximal right internal carotid artery. The ophthalmic artery, posterior communicating artery and anterior communicating arteries supplied retrograde flow to the fistula through the internal carotid artery. Obliteration of the fistula was achieved through coil embolization in combination with proximal and distal microvascular plugs (Reverse Medical, Irvine, Calif., USA). Conclusion The microvascular plug is a new addition to current endovascular embolization devices for the treatment of high-flow, direct carotid cavernous fistulas. This technique offers easy navigability through tortuous arteries, precise localization and immediate occlusion, which may allow shorter procedure and fluoroscopy times and increased cost-effectiveness. Larger case series are needed to support our observation. PMID:26019711

  13. Persistent orocutaneous and anal fistulae induced by nicorandil: a case report

    PubMed Central

    2009-01-01

    Introduction Although nicorandil is prescribed widely, awareness of its potential to cause serious complications to the gastrointestinal tract mucosa is limited. Whilst nicorandil-induced oral and anal ulceration is well documented in the literature, nicorandil-induced fistulation is not. This is the first report in the literature of a single patient demonstrating simultaneous orocutaneous and anal fistulae during nicorandil therapy. Two separate cases of orocutaneous and anal fistulae associated nicorandil usage have previously been documented in specialist journals. Case presentation A 71-year-old Caucasian man presented with a 3-year history of concurrent orocutaneous and anal fistulae. He had been exposed to 30 mg twice-daily nicorandil therapy for 4 years. Both fistulae responded poorly to intensive and prolonged conventional treatment but healed promptly on reduction and eventual withdrawal of nicorandil therapy. Conclusion Management of resistant cases of orocutaneous and anal fistulae in patients on high-dose nicorandil therapy may be impossible without reduction or even withdrawal of nicorandil. PMID:19946537

  14. Bacteriological comparison of low anal fistula operated by ordinary methods and laser methods

    NASA Astrophysics Data System (ADS)

    Yang, Yuanrong; Xiong, Yigai

    1996-09-01

    Since 1989, 42 cases with low anal fistula were operated with laser and ordinary methods respectively. During the operation, secreted or charred tissues were extracted from the surface of the wound for bacteria culture. Experimental group (laser method): no bacteria were found in 24 cases operated by laser method. Control group (ordinary method): bacterial were found in 16 out of 18 cases operated by ordinary methods. The results of two different group showed that they had statistical difference for P < 0.001. So, CO2 laser is proved to be a definitely practical tool in surgical use for its bacteria killing power. While the anal fistula were operated by the laser, the neurotic carboatomic tissue can block blood vessel and prevent infection from spreading. The high temperature produced by the carboatomic action have enough ability to kill directly the bacteria living in the anal fistula.

  15. [Gangrenous pyoderma and enterocutaneous fistulas after ileal pouch-anal anastomosis].

    PubMed

    Fadrique, Alfonso García; Ferrer, Francisco Villalba; Esteban, Marcos Bruna; Vila, José Vicente Roig

    2007-05-01

    We describe the medical-surgical management of a patient with a complex inflammatory bowel disease who developed 2 acute episodes of pyoderma gangrenosum and enterocutaneous fistulas after ileal pouch-anal anastomosis for ulcerative colitis. The rarity of this postsurgical complication is emphasized. A good response to topical tacrolimus was achieved in cutaneous wounds. A less favorable response to infliximab was achieved in the abdominal fistulas, requiring surgical excision of the pouch. PMID:17498458

  16. A decade of selective use of adjustable cutting seton combined with fistulotomy for anal fistula.

    PubMed

    Kamrava, Allen; Collins, J Craig

    2011-10-01

    Previous studies have demonstrated that the division of sphincter muscle in the treatment of anal fistula may precipitate fecal incontinence. Cutting setons may pose a particular risk of unrecoverable injury to the sphincter apparatus. To evaluate if the use of an adjustable cutting seton mitigates this risk, we performed a retrospective review of all patients operated on for anal fistulae in a 10-year period by a single surgeon. Adjustable cutting setons (consisting of heavy silk ligature with patient-controllable tension) were used selectively. Forty-seven patients met the study criteria. Ninety-four per cent of the fistulae treated were transsphincteric. All of the fistulae were treated with at least partial fistulotomy. Ninety-nine per cent of patients were followed to completion of treatment. One (2%) patient subsequently developed fecal incontinence, and four (9%) developed a recurrent or persistent fistula in the same location. Adjustable cutting setons have been used in our practice with a high success rate and low risk of complications. Our data support adjustable cutting setons as a useful tool in the surgeon's repertoire for treating fistulae that involve the anal sphincter complex. PMID:22127093

  17. Percutaneous Transcatheter Embolization of a Large Pulmonary Arteriovenous Fistula with an Amplatzer Vascular Plug

    SciTech Connect

    Ferro, Carlo; Rossi, Umberto G. Bovio, Giulio; Seitun, Sara; Rossi, Giovanni A.

    2007-04-15

    Percutaneous transcatheter embolization has become the treatment of choice for pulmonary arteriovenous fistulas (PAVFs), in most cases replacing surgical intervention. However, while 'classic' devices, such as intravascular coils and detachable balloons, have proved to be successful for interventional occlusions of small or medium-sized PAVFs, they are not ideal in larger fistulas because of the risk for embolization to the systemic circulation. We describe the case of a 61-year-old woman with a symptomatic huge solitary pulmonary arteriovenous fistula (4.5 cm in diameter), occupying part of the lung in the lower right lobe with two feeding arteries (10 and 4 mm in diameter, respectively), who underwent successful transcatheter closure with an Amplatzer Vascular Plug, a new device designed for the occlusion of vascular abnormalities.

  18. Rectovaginal fistula with anal atresia in 5 dogs

    PubMed Central

    Rahal, Sheila C.; Vicente, Cristiane S.; Mortari, Ana C.; Mamprim, Maria J.; Caporalli, Evelyn H.G.

    2007-01-01

    Five dogs with rectovaginal fistula and atresia ani that had been treated by surgical correction of the malformations were studied retrospectively. Ages at presentation varied from 1 to 3 months and weight from 350 g to 7.5 kg. The histories included voiding of feces through the vulva, with or without tenesmus, usually observed after weaning. Atresia ani, presence of feces in the vaginal canal, abdominal distention, and discomfort on abdominal palpation were observed during clinical examination. Also, 3 dogs had partial tail agenesis. In all dogs, the rectovaginal fistula was isolated and transected, the vulvar and rectal defects were closed separately, and the atresia ani was repaired. Normal defecation was restored, but 1 dog had fecal incontinence that subsequently resolved. One dog died 2.5 months postoperatively, and follow-up was done on the others for periods ranging from 1.6 year to 7.7 years. Surgical correction in dogs with rectovaginal fistula and atresia ani may result in a favorable outcome, if it is done early. PMID:17824325

  19. Clinical Role of Modified Seton Procedure and Coring Out for Treatment of Complex Anal Fistulas Associated With Hidradenitis Suppurativa

    PubMed Central

    Tokunaga, Yukihiko; Sasaki, Hirokazu

    2015-01-01

    A variety of techniques have been described to treat complex anal fistulas. When complex anal fistulas are associated with hidradenitis suppurativa, the treatment has to be appropriately tailored for the severity and distribution of the disease so as to remove the external fistula tract to prevent recurrence while ensuring fecal continence. Between 2007 and 2011, a total of 10 males (ranging in age from 32 to 54 years) complained of recurrent purulent discharge in the buttocks and thigh regions. The discharge had started about 12 to 18 months prior, and had increased progressively resulting in complex anal fistulas and hidradenitis suppurativa in the buttocks. They underwent surgical operation according to a modified seton procedure for complex anal fistulas and coring out for hidradenitis suppurativa. They were discharged from the hospital in 4 to 5 days, while the seton dropped spontaneously about 6 to 8 months after surgery. They have been well without any morbidities or recurrence. The present paper demonstrates that cases of complex anal fistulas associated with hidradenitis suppurativa can be successfully treated with a modified seton procedure and coring out of hidradenitis suppurativa. PMID:26414817

  20. Renal Artery Stump to Inferior Vena Cava Fistula: Unusual Clinical Presentation and Transcatheter Embolization with the Amplatzer Vascular Plug

    SciTech Connect

    Taneja, Manish; Lath, Narayan Soo, Tan Bien; Hiong, Tay Kiang; Htoo, Maung Myint; Richard, Lo; Fui, Alexander Chung Yaw

    2008-07-15

    Fistulous communication between the renal artery stump and inferior vena cava following nephrectomy is rare. We describe the case of a 52-year-old man with a fistula detected on investigation for hemolytic anemia in the postoperative period. The patient had had a nephrectomy performed 2 weeks prior to presentation for blunt abdominal trauma. The fistula was successfully occluded percutaneously using an Amplatzer vascular plug. The patient recovered completely and was discharged 2 weeks later.

  1. Fistulas

    MedlinePlus

    A fistula is an abnormal connection between two parts inside of the body. Fistulas may develop between different organs, such as between ... two arteries. Some people are born with a fistula. Other common causes of fistulas include Complications from ...

  2. The Use of a Staged Drainage Seton for the Treatment of Anal Fistulae or Fistulous Abscesses

    PubMed Central

    Shin, Hyeon Keun; Kang, Wook Ho; Park, Chan Ho; Hong, Sa Min; Jeong, Seung Kyu; Kim, June Young; Yang, Hyung Kyu

    2012-01-01

    Purpose The aim of this retrospective study was to evaluate the rate of recurrence and incontinence after the treatment of fistulae or fistulous abscesses by using the staged drainage seton method. Methods According to the condition, a drainage seton alone or a drainage seton combined with internal opening (IO) closure and relocation of the seton was used. After a period of time, the seton was changed with 3-0 nylon; then, after another period of time, the authors terminated the treatment by removing the 3-0 nylon. Telephone interviews were used for follow-up. The following were evaluated: the relationship between the type of fistula and recurrence; the relationship between the type of fistula and the period of treatment; the relationship between the recurrence and presence of abscess; the relationship between IO closure and recurrence; the relationship between the period of seton change and recurrence; reported continence for flatus, liquid stool, and solid stool. Results The recurrence rate of fistulae or suppuration was 6.5%, but for cases of horseshoe extension, the recurrence rate was 57.1%. The rate of recurrence was related to the type of fistula (P = 0.001). Incontinence developed in 3.8% of the cases. No statistically significant relationship was found between the rate of recurrence and the presence of an abscess or between the closure of the IO and the period of seton change or removal. Conclusion In the treatment of anal fistulae or fistulous abscesses, the use of a staged drainage seton can reduce the rate of recurrence and incontinence. PMID:23346510

  3. Prospective evaluation of a new device for the treatment of anal fistulas

    PubMed Central

    Ratto, Carlo; Litta, Francesco; Donisi, Lorenza; Parello, Angelo

    2016-01-01

    AIM: To evaluate the safety of the implantation of a new device for the treatment of anal fistulas. The short-term clinical efficacy was also assessed. METHODS: This study took place at a tertiary care university hospital. Patients with a complex anal fistula of cryptoglandular origin were enrolled in the study and were treated with insertion of the new device. All patients were evaluated by clinical and physical examination, including an endoanal ultrasound at the baseline, and then at the 2 wk and 1, 2, 3 and 6-mo follow-up visits. RESULTS: Morbidity, continence status, and success rate were the main outcome measures. Ten patients underwent the placement of the new device. The fistulas were transphincteric in eight patients and extrasphincteric in the remaining two. The median duration of the surgical procedure was 34.5 (range, 27-42) min. Neither intra- nor postoperative complications occurred, and all patients were discharged the day after the procedure. At the 6-mo follow-up evaluation, the final success rate was 70%. Three failures were registered: a device expulsion (on the 10th postoperative day), the persistence of inflammatory tissue around the fistula tract (at the 2-mo follow up), and the persistence of serum discharge (at the 6-mo follow up). No patient experienced any change incontinence, as assessed by the Cleveland Clinic Fecal Incontinence score. CONCLUSION: The technical procedure is simple and has low risk of perioperative morbidity. The pre- and post-operative continence status did not change in any of the patients. The initial results at the 6-mo follow up seem to be promising. However, a longer follow-up period and a larger sample size are needed to confirm these preliminary results. PMID:27570429

  4. Advancement flap plasty for the closure of anal and recto-vaginal fistulas in Crohn's disease.

    PubMed

    Penninckx, F; D'Hoore, A; Filez, L

    2001-01-01

    The management of anal fistulas in patients with IBD continues to be extremely challenging and, indeed, somewhat frustrating. Despite a global closure rate of about 75%, all patients should be informed about the risk of infection, early failure, eventual temporary disfunctioning stoma and the possibility of late recurrence (about 15%). Closure of a RVF in Crohn's disease should not be considered an easy undertaking, especially in patients with several Crohn localisations. The technique can be adapted to the local situation. Construction of a temporary stoma is not mandatory. However, stoma construction seems to be beneficial when extensive perianal or recto-vaginal dissection including eventual tissue interposition is required. Advancement flaps are an attractive surgical alternative for the management of all anal transsphincteric fistulas, also in Crohn's disease, because sphincter architecture and function are well preserved. Improved medical treatment and the changed approach from conservative to reparative surgery may well have resulted in a decreased need or at least in a delay of the need for a proctectomy. Although the surgical principles of advancement flap techniques are sound, these techniques have not been used for many decades. Skills needed, problematic approach, suboptimal quality of local tissues have contributed to its selective use and to the absence of prospective randomised studies. PMID:11475141

  5. Traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess

    PubMed Central

    Wang, Chen; Lu, Jin-Gen; Cao, Yong-Qing; Yao, Yi-Bo; Guo, Xiu-Tian; Yin, Hao-Qiang

    2012-01-01

    AIM: To evaluate the efficacy and safety of traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess. METHODS: Sixty patients with intersphincteric or transsphincteric anal fistulas with secondary tracks and abscess were randomly divided into study group [suture dragging combined with pad compression (SDPC)] and control group [fistulotomy (FSLT)]. In the SDPC group, the internal opening was excised and incisions at external openings were made for drainage. Silk sutures were put through every two incisions and knotted in loose state. The suture dragging process started from the first day after surgery and the pad compression process started when all sutures were removed as wound tissue became fresh and without discharge. In the FSLT group, the internal opening and all tracts were laid open and cleaned by normal saline postoperatively till all wounds healed. The time of healing, postoperative pain score (visual analogue scale), recurrence rate, patient satisfaction, incontinence evaluation and anorectal manometry before and after the treatment were examined. RESULTS: There were no significant differences between the two groups regarding age, gender and fistulae type. The time of healing was significantly shorter (24.33 d in SDPC vs 31.57 d in FSLT, P < 0.01) and the patient satisfaction score at 1 mo postoperative follow-up was significantly higher in the SDPC group (4.07 in SDPC vs 3.37 in FSLT, P < 0.05). The mean maximal postoperative pain scores were 5.83 ± 2.5 in SDPC vs 6.37 ± 2.33 in FSLT and the recurrence rates were 3.33 in SDPC vs 0 in FSLT. None of the patients in the two groups experienced liquid and solid fecal incontinence and lifestyle alteration postoperatively. The Wexner score after treatment of intersphincter fistulae were 0.17 ± 0.41 in SDPC vs 0.40 ± 0.89 in FSLT and trans-sphincter fistulae were 0.13 ± 0.45 in SDPC vs 0.56 ± 1.35 in FSLT. The maximal squeeze pressure and resting pressure declined after

  6. Occlusion of Arteriovenous Fistulas of In-Situ Saphenous Vein Bypass Grafts Using the Amplatzer Vascular Plug 4: Initial Experience

    SciTech Connect

    Libicher, Martin; Reichert, V.; Schwabe, H.; Matoussevitch, V.; Gawenda, M.

    2011-06-15

    We examined the safety and efficacy of vessel occlusion of the Amplatzer Vascular Plug 4 (AVP-4) in patients with arteriovenous fistulas after in-situ saphenous vein bypass grafts. We treated 18 fistulas of seven patients (four women, mean {+-} standard deviation age 76 {+-} 7 years, range 63-88 years). All fistulas were detected within 14 days after surgery. Initial diagnosis and follow-up was established by sonography. We measured the diameter of the feeding vessel and the time of vessel occlusion after plug deployment. Additionally, we recorded procedure time and the dose area product. Additional interventional procedures were necessary in three patients. We successfully used 19 AVP-4 for occlusion of all fistulas without thromboembolic complications. There was no need for recapturing the device, and we did not observe dislocation. Mean occlusion time was 9.6 min (range 5-22 min). Mean diameter of the feeding vessels was 3.5 mm (range 2.6-5.1 mm). Plug sizes ranged from 4-8 mm (mean 5.5 mm) resulting in an oversizing of 33-88%. Mean procedure time for patients with and without additional intervention was 91 {+-} 38 min and 35 {+-} 18 min, respectively. Mean dose area product was 11,790 cGy/cm{sup 2} (range 1,850-23,500 cGy/cm{sup 2}). Permanent occlusion of the fistulas was confirmed by ultrasound after a mean follow-up of 4 months (1-6 months). Occlusion of arteriovenous fistulas with an AVP-4 seems to be effective and safe in patients with in-situ saphenous vein bypass grafts. The AVP-4 is well suited for this purpose because of the appropriate diameter of the feeding vessels.

  7. High-Flow Renal Arteriovenous Fistula Treated with the Amplatzer Vascular Plug: Implementation of an Arterial and Venous Approach

    SciTech Connect

    Brountzos, Elias N. Ptohis, Nikolaos; Grammenou-Pomoni, Maria; Panagiotou, Irini; Kelekis, Dimitrios; Gouliamos, Athanasios Kelekis, Nikolaos

    2009-05-15

    We present a 28-year-old man with a large symptomatic arteriovenous fistula (AVF) treated with embolization using the Amplatzer vascular plug (AVP). Although embolization may be considered the first-line therapy in the treatment of AVFs, there is an inherent high risk of migration of the embolic agents into the venous and pulmonary circulations. This case is illustrative of the ease and safety of using this device in high-flow renal AVFs.

  8. Management of rare, low anal anterior fistula exception to Goodsall's rule with Kṣārasūtra

    PubMed Central

    Shindhe, Pradeep S.

    2014-01-01

    Anal fistula (bhagandara) is a chronic inflammatory condition, a tubular structure opening in the ano-rectal canal at one end and surface of perineum/peri-anal skin on the other end. Typically, fistula has two openings, one internal and other external associated with chronic on/off pus discharge on/off pain, pruritis and sometimes passing of stool from external opening. This affects predominantly male patients due to various etiologies viz., repeated peri-anal infections, Crohn's disease, HIV infection, etc., Complex and atypical variety is encountered in very few patients, which require special treatment for cure. The condition poses difficulty for a surgeon in treating due to issues like patient hesitation, trouble in preparing kṣārasūtra, natural and routine infection with urine, stool etc., and dearth of surgical experts and technique. We would like to report a complex and atypical, single case of anterior, low anal fistula with tract reaching to median raphe of scrotum, which was managed successfully by limited application of kṣārasūtra. PMID:25538355

  9. Management of rare, low anal anterior fistula exception to Goodsall's rule with Kṣārasūtra.

    PubMed

    Shindhe, Pradeep S

    2014-01-01

    Anal fistula (bhagandara) is a chronic inflammatory condition, a tubular structure opening in the ano-rectal canal at one end and surface of perineum/peri-anal skin on the other end. Typically, fistula has two openings, one internal and other external associated with chronic on/off pus discharge on/off pain, pruritis and sometimes passing of stool from external opening. This affects predominantly male patients due to various etiologies viz., repeated peri-anal infections, Crohn's disease, HIV infection, etc., Complex and atypical variety is encountered in very few patients, which require special treatment for cure. The condition poses difficulty for a surgeon in treating due to issues like patient hesitation, trouble in preparing kṣārasūtra, natural and routine infection with urine, stool etc., and dearth of surgical experts and technique. We would like to report a complex and atypical, single case of anterior, low anal fistula with tract reaching to median raphe of scrotum, which was managed successfully by limited application of kṣārasūtra. PMID:25538355

  10. Therapeutic management of complex anal fistulas by installing a nitinol closure clip: study protocol of a multicentric randomised controlled trial—FISCLOSE

    PubMed Central

    Dubois, Anne; Carrier, Guillaume; Pereira, Bruno; Gillet, Brigitte; Faucheron, Jean-Luc; Pezet, Denis; Balayssac, David

    2015-01-01

    Introduction Complex anal fistulas are responsible for pain, faecal incontinence and impaired quality of life. The rectal mucosa advancement flap (RMAF) procedure to cover the internal opening of the fistula remains a strategy of choice. However, a new procedure for closing anal fistulas is now available with the use of a nitinol closure clip (OTSC Proctology, OVESCO), which should ensure a better healing rate. This procedure is currently becoming more widespread, though without robust scientific validation, and it is therefore essential to carry out a prospective evaluation in order to determine the efficacy and safety of this new medical device for complex anal fistulas. Methods and analysis The FISCLOSE trial is aimed at evaluating the efficacy and safety of a nitinol closure clip compared to the RMAF procedure for the management of complex anal fistulas. This trial is a prospective, randomised, controlled, single-blind, bicentre and interventional study. Patients (n=46 per group) will be randomly assigned for management with either a closure clip or RMAF. The main objectives are to improve the healing rate of the anal fistula, lessen the postoperative pain and faecal incontinency, enhance the quality of life, and lower the number of reinterventions and therapeutic management costs. The primary outcome is the proportion of patients with a healed fistula at 3 months. The secondary outcomes are anal fistula healing (6 and 12 months), proctological pain (visual analogue scale), the faecal incontinence score (Jorge and Wexner questionnaire), digestive disorders and quality of life (Gastrointestinal Quality of Life Index and Euroqol EQ5D-3 L) up to 1 year. Ethics and dissemination The study was approved by an independent medical ethics committee 1 (IRB00008526, CPP Sud-Est 6, Clermont-Ferrand, France) and registered by the competent French authority (ANSM, Saint Denis, France). The results will be disseminated in a peer-reviewed journal and presented at

  11. Similar outcomes for anti-tumor necrosis factor-α antibody and immunosuppressant following seton drainage in patients with Crohn's disease-related anal fistula

    PubMed Central

    Lin, Xutao; Fan, Dejun; Cai, Zerong; Lian, Lei; He, Xiaowen; Zhi, Min; Wu, Xiaojian; He, Xiaosheng; Lan, Ping

    2016-01-01

    Anal fistula is common in patients with Crohn's disease (CD) and leads to significant morbidity. The efficacy of seton drainage combined with anti-tumor necrosis factor-α monoclonal antibody (anti-TNF-α) or immunosuppressant in the treatment of CD-related anal fistula remains unclear. The aim of the present study was to compare the efficacy between seton drainage combined with anti-TNF-α and seton drainage combined with immunosuppressant postoperatively on the treatment of CD-related anal fistula. A total of 65 patients with CD-related anal fistula who had received seton drainage combined with postoperative medication were divided into an antibiotics only group, anti-TNF-α group and immunosuppressant group; all patients were treated with antibiotics. Fistula closure, external orifice exudation rate and recurrence rate were assessed among these patients. The duration of follow-up ranged from 3 to 84 months with an average of 25.3 months. There were 11 (16.9%) cases of recurrence after seton drainage, 9 of which underwent a second seton drainage. In the total study group, 34 (52.3%) cases achieved complete fistula closure, and 10 (15.4%) cases showed external orifice exudation. No significant difference was found among these three groups, regarding fistula closure rate, closure time of fistula and recurrence rate. The external orifice exudation rate was significantly higher in the anti-TNF-α group compared with the antibiotics only group and immunosuppressant group (P=0.004 and P=0.026, respectively). Seton drainage is an effective treatment for CD-related anal fistula. The efficacy is similar whether combined with anti-TNF-α or immunosuppressant.

  12. Use of the Amplatzer Type 2 Plug for Flow Redirection in Failing Autogenous Hemodialysis Fistulae

    SciTech Connect

    Bozkurt, Alper Kırbaş, İsmail; Kasapoglu, Benan; Teber, Mehmet Akif

    2015-08-15

    PurposeTo present our experience with redirecting the outflow of mature arteriovenous fistulae (AVFs) in patients with cannulation and/or suboptimal flow problems by percutaneous intervention using the Amplatzer Vascular Plug II (AVP II).MethodsWe retrospectively reviewed patients who presented with difficulty in cannulation and/or suboptimal flow in the puncture zone of the AVF and who underwent intervention using the AVP II to redirect the outflow through a better cannulation zone from March 2009 to November 2012. The mean survival rate of all AVFs was estimated, and the effects of patient age, sex, and AVF age on the AVF survival time were determined.ResultsIn total, 31 patients (17 male and 14 female) with a mean age of 57.8 years (range, 20–79 years) were included. In 2 patients, the AVF failed within the first 15 days because of rapid thrombosis. In 9 patients, the new AVF route was working effectively until unsalvageable thrombosis developed. One of the 31 patients died 9 months before the last radiologic evaluation. The new AVF route was still being used for dialysis in the remaining 19 patients. The mean AVF survival rate was 1,061.4 ± 139.4 days (range, 788–1,334 days). Patient age, sex, and AVF age did not affect the survival time.ConclusionWe suggest that the AVP II is useful for redirecting the outflow of AVFs with cannulation problems and suboptimal flow. Patency of existing AVFs may be extended, thereby extending surgery-free or catheter intervention-free survival period.

  13. A New Device for Vascular Embolization: Report on Case of Two Pulmonary Arteriovenous Fistulas Embolization Using the Amplatzer Vascular Plug

    SciTech Connect

    Rossi, Michele; Rebonato, Alberto Greco, Laura; Stefanini, Giulio; Citone, Michele; Speranza, Annnarita; David, Vincenzo

    2006-10-15

    A pulmonary arteriovenous fistula (PAVF) is a rare vascular malformation commonly treated by embolization with coils or balloons to prevent the risk of several serious complications such as cerebral embolism and brain abscess. A 32-year-old female with two PAVFs and neurological ischemic manifestations has been successfully treated by transcatheter embolization of both fistulas using a new device (Amplatzer Vascular Plug). This self-expanding cylindrical nitinol mesh cage with high radial strength allows a chance of relocation until properly positioned. It is preferred to coils or balloons because a large caliber of feeding artery implied high risk of uncontrollable distal embolization. There appear to be no reports in the literature concerning use of this device, which could represent a useful innovative tool in embolotherapies, especially in large vascular areas.

  14. Operative considerations for rectovaginal fistulas

    PubMed Central

    Kniery, Kevin R; Johnson, Eric K; Steele, Scott R

    2015-01-01

    To describe the etiology, anatomy and pathophysiology of rectovaginal fistulas (RVFs); and to describe a systematic surgical approach to help achieve optimal outcomes. A current review of the literature was performed to identify the most up-to-date techniques and outcomes for repair of RVFs. RVFs present a difficult problem that is frustrating for patients and surgeons alike. Multiple trips to the operating room are generally needed to resolve the fistula, and the recurrence rate approaches 40% when considering all of the surgical options. At present, surgical options range from collagen plugs and endorectal advancement flaps to sphincter repairs or resection with colo-anal reconstruction. There are general principles that will allow the best chance for resolution of the fistula with the least morbidity to the patient. These principles include: resolving the sepsis, identifying the anatomy, starting with least invasive surgical options, and interposing healthy tissue for complex or recurrent fistulas. PMID:26328032

  15. Percutaneous closure of a coronary fistula with single Amplatzer Vascular Plug II in a five-month-old female: The youngest case report.

    PubMed

    Gulgun, Mustafa; Slack, Michael

    2016-02-01

    Coronary artery fistula (CAF) is a rare clinical abnormality characterized by a connection between one or more coronary arteries and an adjacent cardiac chamber or vascular structure. Although CAF complications are more common in older children over time, there is still no consensus in terms of treatment indications in children with asymptomatic fistula. We describe an asymptomatic infant diagnosed with a severely dilated right coronary artery and a coronary-cameral fistula treated successfully by transcatheter device closure. The Amplatzer Vascular Plug II appears to be safe, effective and relatively easy to use for CAF closure in infants. PMID:26852309

  16. Anal Canal Adenocarcinoma in a Patient with Longstanding Crohn’s Disease Arising From Rectal Mucosa that Migrated From a Previously Treated Rectovaginal Fistula

    PubMed Central

    Maejima, Taku; Kono, Toru; Orii, Fumika; Maemoto, Atsuo; Furukawa, Shigeru; Liming, Wang; Kasai, Shoji; Fukahori, Susumu; Mukai, Nobutaka; Yoshikawa, Daitaro; Karasaki, Hidenori; Saito, Hiroya; Nagashima, Kazuo

    2016-01-01

    Patient: Female, 50 Final Diagnosis: Anal canal adenocarcinoma Symptoms: — Medication: — Clinical Procedure: CT • MRI • biopsy Specialty: Surgery Objective: Unknown ethiology Background: This study reports the pathogenesis of anal canal adenocarcinoma in a patient with longstanding Crohn’s disease (CD). Case Report: A 50-year-old woman with a 33-year history of CD presented with perianal pain of several months’ duration. She had been treated surgically for a rectovaginal fistula 26 years earlier and had been treated with infliximab (IFX) for the previous 4 years. A biopsy under anesthesia revealed an anal canal adenocarcinoma, which was removed by abdominoperineal resection. Pathological examination showed that a large part of the tumor consisted of mucinous adenocarcinoma at the same location as the rectovaginal fistula had been removed 26 years earlier. There was no evidence of recurrent rectovaginal fistula, but thick fibers surrounded the tumor, likely representing part of the previous rectovaginal fistula. Immunohistochemical analysis using antibodies against cytokeratins (CK20 and CK7) revealed that the adenocarcinoma arose from the rectal mucosa, not the anal glands. Conclusions: Mucinous adenocarcinoma can arise in patients with CD, even in the absence of longstanding perianal disease, and may be associated with adenomatous transformation of the epithelial lining in a former fistula tract. PMID:27373845

  17. [Anal suppurations].

    PubMed

    Senéjoux, A

    2001-01-15

    Anal suppurations can be classified according to their origin: from the anal canal, from above the anal canal, or independent from the ano-rectum. Wherever suppuration comes from, an abscess can be present at the acute phase. Anal fistulas represent about 70% of anal suppurations. They always begin by cryptoglandular infection, which can spread to the intersphincteric space and then pass through the anal sphincter. Treatment of anal fistula is a double challenge: healing the suppuration, and preserving anal continence. Among suppurations independent from the ano-rectum pilonidal disease is the most frequent (15% of the suppurations). Other causes of ano-perineal suppurations are infected fissure, Verneuil's disease, and gland, recto-vaginal fistulas and Crohn's disease. PMID:11234090

  18. Anal Canal Adenocarcinoma in a Patient with Longstanding Crohn's Disease Arising From Rectal Mucosa that Migrated From a Previously Treated Rectovaginal Fistula.

    PubMed

    Maejima, Taku; Kono, Toru; Orii, Fumika; Maemoto, Atsuo; Furukawa, Shigeru; Liming, Wang; Kasai, Shoji; Fukahori, Susumu; Mukai, Nobutaka; Yoshikawa, Daitaro; Karasaki, Hidenori; Saito, Hiroya; Nagashima, Kazuo

    2016-01-01

    BACKGROUND This study reports the pathogenesis of anal canal adenocarcinoma in a patient with longstanding Crohn's disease (CD). CASE REPORT A 50-year-old woman with a 33-year history of CD presented with perianal pain of several months' duration. She had been treated surgically for a rectovaginal fistula 26 years earlier and had been treated with infliximab (IFX) for the previous 4 years. A biopsy under anesthesia revealed an anal canal adenocarcinoma, which was removed by abdominoperineal resection. Pathological examination showed that a large part of the tumor consisted of mucinous adenocarcinoma at the same location as the rectovaginal fistula had been removed 26 years earlier. There was no evidence of recurrent rectovaginal fistula, but thick fibers surrounded the tumor, likely representing part of the previous rectovaginal fistula. Immunohistochemical analysis using antibodies against cytokeratins (CK20 and CK7) revealed that the adenocarcinoma arose from the rectal mucosa, not the anal glands. CONCLUSIONS Mucinous adenocarcinoma can arise in patients with CD, even in the absence of longstanding perianal disease, and may be associated with adenomatous transformation of the epithelial lining in a former fistula tract. PMID:27373845

  19. Efficacy of magnetic resonance imaging in the diagnosis of perianal hidradenitis suppurativa, complicated by anal fistulae: A report of two cases and review of the literature

    PubMed Central

    Takiyama, Hirotoshi; Kazama, Shinsuke; Tanoue, Yusuke; Yasuda, Koji; Otani, Kensuke; Nishikawa, Takeshi; Tanaka, Toshiaki; Tanaka, Junichiro; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Nozawa, Hiroaki; Miyagawa, Takuya; Yamada, Daisuke; Yamaguchi, Hironori; Ishihara, Soichiro; Sunami, Eiji; Watanabe, Toshiaki

    2015-01-01

    Background Perianal hidradenitis suppurativa (PHS) is a chronic recurrent inflammatory disease of the apocrine glands present in the skin and soft tissue adjacent to the anus. It is often misdiagnosed or treatment is delayed, resulting in the formation of an abscess or, in the worst case, leading to sepsis. It is difficult to treat perianal lesions merged with fistulae completely due to its high recurrence rate. Therefore, we should diagnose it correctly and treat it with appropriate methods. Presentation of case We report two cases of PHS with anal fistulae that were examined preoperatively using magnetic resonance imaging (MRI) and treated safely by surgery without any recurrence. Discussion The anal sphincter area cannot be visualized and evaluated directly by fistulography. Also CT has only limited resolution, making it difficult to distinguish between soft tissues and inflammatory streaks. Endosonography is not suitable for the examination of supra-sphincteric or extra-sphincteric extensions, as it is limited by insufficient penetration of the ultrasonic beams. MRI can demonstrate the entire course of the fistulae owing to its high contrast resolution. Conclusion Our findings support the idea that PHS with complicated anal fistulae can be diagnosed accurately using MRI and treated safely and completely with surgery. PMID:26339787

  20. Late-presenting left internal mammary to great cardiac vein fistula treated with a vascular plug.

    PubMed

    Franco-Gutierrez, Raul; Estevez-Loureiro, Rodrigo; Calviño-Santos, Ramon

    2010-10-01

    A 73-year-old patient, who underwent triple bypass surgery in another hospital in 1991 after suffering an acute myocardial infarction, was admitted to our institution after an episode of unstable angina. Evidence of a left internal mammary artery grafted to the great cardiac anterior interventricular vein (GCV), with Qp:Qs > 1.5:1, was demonstrated by angiography. We report the closure of said fistula using a percutaneous left radial artery access and the deployment of an Amplatzer vascular occlusion device via the antegrade approach. PMID:20944199

  1. Embolization of a giant arterioportal fistula requiring multiple Amplatzer vascular plugs.

    PubMed

    Ward, Thomas J; Marin, Michael L; Lookstein, Robert A

    2015-12-01

    Arterioportal fistulas (APFs) are rare vascular communications between the mesenteric arterial tree and the portal vein. The causes and presentations of this entity are varied. APFs related to tumor, infection, and trauma have been described. Patients may be asymptomatic or present with hemobilia, portal hypertension, or mesenteric steal syndrome. Small APFs require no intervention, with treatment indicated for large or symptomatic APFs. The treatment has shifted from surgical ligation or hepatic resection to an endovascular-first approach. We describe an endovascular treatment option for the management of an acquired extrahepatic (type 2) APF and present a review of the literature. PMID:24840744

  2. Synchronous mucinous adenocarcinoma of the rectosigmoid seeding onto a pre-existing anal fistula.

    PubMed

    Sandiford, Nemandra; Prussia, Patsy R; Chiappa, Antonio; Zbar, Andrew P

    2006-01-01

    Carcinoma within a long-standing fistula-in-ano is rare and may be defined by specific neoplastic involvement of the fistulous track in the absence of rectal mucosal carcinoma. The presence of a carcinoma of mucinous histology occurring synchronously in the perianal region and the colon is exceptionally rare. We present a case with a review of the literature concerning its aetiopathogenesis and treatment. A 72-year-old man with a 2 months history of dark red rectal bleeding and mucus per rectum with alternating constipation and diarrhoea, was observed. Clinical examination and a barium enema showed a perianal fistula and an annular stenosing lesion of the rectosigmoid. Preoperative CT scan confirmed the colonic lesion. Colonic resection and wide fistula excision were performed. Histology showed an adenocarcinoma with a clear resection margins. The fistula also showed a similar histology. Chemoradiation (5-Fluorouracil (425 mg/m2) and Leucovorin (20 mg/m2) with 4500 cGy external beam radiotherapy was utilized. Subsequent clinical follow-up and CT examination of the patient has not revealed recurrent disease at 14 months. PMID:16961916

  3. Ureteric Embolization for Lower Urinary Tract Fistulae: Use of Two Amplatzer Vascular Plugs and N-Butyl Cyanoacrylate Employing the 'Sandwich' Technique

    SciTech Connect

    Saad, Wael E. A. Kalagher, S.; Turba, U. C.; Sabri, S. S.; Park, A.-W.; Stone, J.; Angle, J. F.; Matsumoto, A. H.

    2013-08-01

    PurposeThis study describes and evaluated the effectiveness of occluding distal ureters in the clinical setting of urinary vaginal (vesicovaginal or enterovesicovaginal) fistulae utilizing a new technique which combines Amplatzer vascular plugs and N-butyl cyanoacrylate.MaterialsThis is a retrospective study (January 2007-December 2010) of patients with urinary-vaginal fistulae undergoing distal ureter embolization utilizing an Amplatzer- N-butyl cyanoacrylate-Amplatzer sandwich technique. An 8-12-mm type-I or type-II Amplatzer vascular plug was delivered using the sheath and deployed in the ureter distal to the pelvic brim. Instillation of 0.8-1.5 cc of N-butyl cyanoacrylate into ureter proximal to the Amplatzer plug was performed. This was followed by another set of 8-12-mm type-I or type-II Amplatzer vascular plugs in a technique referred to as the 'sandwich technique.'ResultsFive ureters in three patients were occluded utilizing the above-described technique during the 4-year study period. Mean maximum size Amplatzer used per ureter was 10.8 mm (range, 8-12). One ureter required three Amplatzer plugs and the rest required two. Two patients (3 ureters) were clinically successful with complete resolution of symptoms in 36-48 h. The third patient (2 ureters) was partly successful and required a second Amplatzer- N-butyl cyanoacrylate sandwich technique embolization. The mean clinical follow-up was 11.3 months (range, 1.7-29.2).ConclusionsThe Amplatzer- N-butyl cyanoacrylate-Amplatzer sandwich technique for occluding the distal ureter is safe and effective with a quick (probably due to the N-butyl cyanoacrylate) and durable (probably due to the Amplatzer plugs) clinical response.

  4. Redo Ileal pouch-anal anastomosis combined with anti-TNF-α maintenance therapy for Crohn's disease with pelvic fistula: report of two cases.

    PubMed

    Araki, Toshimitsu; Okita, Yoshiki; Fujikawa, Hiroyuki; Ohi, Masaki; Tanaka, Koji; Inoue, Yasuhiro; Uchida, Keiichi; Mohri, Yasuhiko; Kusunoki, Masato

    2014-10-01

    Pouch failure has been reported to occur after ileal pouch-anal anastomosis for Crohn's disease. We report two cases of patients with Crohn's disease, who underwent redo ileal pouch-anal anastomosis (redo-IPAA) combined with anti-TNF-α maintenance therapy, with good functional results. The first patient, a man with presumed ulcerative colitis, suffered pelvic fistula recurrence and anastomotic dehiscence. He underwent redo-IPAA, at which time longitudinal ulcers were found. Infliximab was started 4 days postoperatively and continued. The second patient, a woman treated for ulcerative colitis, underwent laparoscopic IPAA 8 years later. After the development of a pelvic fistula, twisted mesentery of the ileal pouch was found intraoperatively and Crohn's disease was diagnosed. Adalimumab therapy resulted in fistula closure. Redo-IPAA was performed to normalize the twisted mesentery of the ileal pouch. No complications have been observed in either patient, both of whom have experienced good functional results after closure of the covering stomas. PMID:24442570

  5. Gastrointestinal fistula

    MedlinePlus

    Entero-enteral fistula; Enterocutaneous fistula; Fistula - gastrointestinal ... cause diarrhea , malabsorption of nutrients, and dehydration . Entero-enteral fistulas may have no symptoms. Enterocutaneous fistulas cause ...

  6. Anal Abscess/Fistula

    MedlinePlus

    Skip to main content ASCRS Patients Educational Resources Diseases and Conditions Patient Education Library Patient Success Stories Treatments and Screening Resources Find a Surgeon Hereditary Colorectal Cancer Registries Helpful Links Physicians ...

  7. [Advances on endoscopic treatment of intestinal fistulas].

    PubMed

    Wu, X W; Ren, J A; Li, J S

    2016-03-01

    Intestinal fistulas are severe complications after abdominal surgical procedures. The endoscopic therapy makes it possible to close fistulas without surgical interventions. When patients achieved stabilization and had no signs of systemic sepsis or inflammation, these therapies could be conducted, which included endoscopic vacuum therapy, fibrin glue sealing, stents, fistula plug, suture, and Over The Scope Clip (OTSC). Various techniques may be combined. Endoscopy vacuum therapy could be applied to control systemic inflammation and prevent continuing septic contamination by active drainage. Endoscopic stent is placed over fistulas and gastrointestinal continuity is recovered. The glue sealing is applied for enterocutaneous fistulas, and endoscopy suture has the best results seen in fistulas <1 cm in diameter. Insertion of the fistula plug is used to facilitate fistula healing. The OTSC is effective to treat leaks with large defects. Endoscopic treatment could avoid reoperation and could be regarded as the first-line treatment for specific patients. PMID:26932894

  8. Vascular plugs - A key companion to Interventionists - 'Just Plug it'.

    PubMed

    Ramakrishnan, Sivasubramanian

    2015-01-01

    Vascular plugs are ideally suited to close extra-cardiac, high flowing vascular communications. The family of vascular plugs has expanded. Vascular plugs in general have a lower profile and the newer variants can be delivered even through a diagnostic catheter. These features make them versatile and easy to use. The Amplatzer vascular plugs are also used for closing intracardiac defects including coronary arterio-venous fistula and paravalvular leakage in an off-label fashion. In this review, the features of currently available vascular plugs are reviewed along with tips and tricks of using them in the cardiac catheterization laboratory. PMID:26304581

  9. MRI of perianal fistulae: a pictorial kaleidoscope.

    PubMed

    Kumar, N; Agarwal, Y; Chawla, A Singh; Jain, R; Thukral, B Bhushan

    2015-12-01

    Perianal fistulae are an abnormal communication between the anorectum and the perianal skin. A seemingly benign condition, it can be a cause of considerable distress to the patient if it is not mapped out adequately before embarking upon surgical correction. The persistence of residual disease complicates and up-stages the grade of the remnant fistula with increased risk of anal incontinence following surgery secondary to damage to the anal sphincter complex. Magnetic resonance imaging (MRI) can play a critical role in mapping the fistulae tract in relation to the anal sphincter complex and hence, act as a reliable guide for the surgeon to chart the optimised management of perianal fistulae. This review illustrates the role of MRI in the imaging evaluation of perianal fistulae, to facilitate a well-planned surgical course. PMID:26455651

  10. The proposed use of radiofrequency ablation for the treatment of fistula-in-ano.

    PubMed

    Keogh, Kenneth M; Smart, Neil J

    2016-01-01

    Fistula in ano is a very common presentation to colorectal clinic. Embarrassment due to the symptoms makes accurate estimations of incidence difficult. It is estimated that up to 40% of peri-anal abscess will be accompanied by or preceded by a fistula. Fistulae can be classified into simple fistulae that involve no or minimal sphincter muscle and complex, which involve significant amounts of the anal sphincter muscle, possibly with multiple tracts. For complex fistulae a seton suture is usually placed through the tract and out through the anus to form a loop allowing pockets of sepsis to drain internally and externally and a mature tract of fibrous tissue to develop. Following this period definitive fistula treatment is considered. This can involve a number of procedures that have tremendously varied success rates in the literature. The first stage of surgical treatment is often a core fistulectomy, which entails surgical removal of the tract. This may be followed by insertion of fibrin glue, a collagen plug or formation of a rotation skin flap from surrounding tissue in order to close the resultant tissue defect. All current treatments have a significant failure rate. If this wound breaks down the surgery can leave a large painful peri-anal wound that can lead to ongoing fistulation. Should this occur resiting of the seton will be required with the patient only getting back to square one after months of healing around the seton. In addition removing cores of fibrous tissue passing through the sphincter can threaten the sphincter function resulting in impaired continence. Having seen radiofrequency ablation used to close varicose veins the authors propose that one could use similar techniques to close a fibrous tract matured with a seton in order to close a fistula. The authors propose that a short length radiofrequency catheter could be used to treat fistula in ano. This would in theory be less painful with less tissue destruction. In addition there would be no

  11. AB193. Rectourethral fistula

    PubMed Central

    Jiang, Hai

    2016-01-01

    Objective To investigate the treatment of rectourethral fistula. Methods Eleven cases of male patients with rectourethral fistula were treated in our department from 2011 to 2015. Age 16–66 years old. Causes: three cases of patients with congenital closed anus, four cases of traumatic pelvic fracture with urethral distraction and rectum injury, four cases after radical prostatectomy. The size of the fistula was 0.5–1.5 cm. In addition to the leakage of urine in the large fistula, urine mixed with stool samples. Three patients with congenital closed anal postoperative patients with posterior or anterior median sagittal approach for resection of the fistula, hierarchical closed urethral and rectal wall defect, at least three layer (between the urethral and rectal suture layer), indwelling catheter for 3–4 weeks, no cystostomy. Sigmoid colostomy underwent prior to the surgery. Of which six cases were repaired by perineal approach, one case by abdominal perineal approach, one case by abdominal repair. According to size of fistula and the surrounding scar decide whether or not to adopt tissue interposition, this group of five cases with gracilis muscle flap, one case with bulbocavernosus muscle flap interposed between the rectum and urethra; one case repaired by sigmoid colon pull-through procedure. Post-operation indwelling catheterization for 3–4 weeks with cystostomy. Results A total of 10 patients were successful, and no leakage of urine was found after removal of the catheter. One patient improved, occasionally a small amount of drops of urine voiding from anus. Reoperation was successful after 6 months. Recovered enteric continuity 3–6 months post-operation. Conclusions The median sagittal approach provide good exposure for the repair of congenital rectourethral fistula; perineal approach is a good choice for patients caused by trauma or surgery; complete resection of scar around the fistula, tension-free anastomosis, tissue interposition and sigmoid

  12. Adenocarcinoma of the anal canal: A report of two cases with review of literature.

    PubMed

    Kulkarni, Medha Pradip; Momin, Yasmin Altaf; Pandav, Amitkumar Bapuso; Sulhyan, Kalpana Ranjitsingh

    2016-01-01

    Adenocarcinoma of the anal canal accounts for about 20% of all anal canal cancers. It is subclassified into two types. (1) Colorectal type, which arises from the mucosa above dentate line and (2) extramucosal type, which includes adenocarcinoma arising in anorectal fistulae and adenocarcinoma arising from anal glands. Anal gland adenocarcinomas are extremely rare. In this article, we present two cases of anal adenocarcinoma, one colorectal type, and other anal gland carcinoma along with review of literature. PMID:27510691

  13. Vascular plugs – A key companion to Interventionists – ‘Just Plug it’

    PubMed Central

    Ramakrishnan, Sivasubramanian

    2015-01-01

    Vascular plugs are ideally suited to close extra-cardiac, high flowing vascular communications. The family of vascular plugs has expanded. Vascular plugs in general have a lower profile and the newer variants can be delivered even through a diagnostic catheter. These features make them versatile and easy to use. The Amplatzer vascular plugs are also used for closing intracardiac defects including coronary arterio-venous fistula and paravalvular leakage in an off-label fashion. In this review, the features of currently available vascular plugs are reviewed along with tips and tricks of using them in the cardiac catheterization laboratory. PMID:26304581

  14. German S3-Guideline: Rectovaginal fistula

    PubMed Central

    Ommer, Andreas; Herold, Alexander; Berg, Eugen; Fürst, Alois; Schiedeck, Thomas; Sailer, Marco

    2012-01-01

    Background: Rectovaginal fistulas are rare, and the majority is of traumatic origin. The most common causes are obstetric trauma, local infection, and rectal surgery. This guideline does not cover rectovaginal fistulas that are caused by chronic inflammatory bowel disease. Methods: A systematic review of the literature was undertaken. Results: Rectovaginal fistula is diagnosed on the basis of the patient history and the clinical examination. Other pathologies should be ruled out by endoscopy, endosonography or tomography. The assessment of sphincter function is valuable for surgical planning (potential simultaneous sphincter reconstruction). Persistent rectovaginal fistulas generally require surgical treatment. Various surgical procedures have been described. The most common procedure involves a transrectal approach with endorectal suture. The transperineal approach is primarily used in case of simultaneous sphincter reconstruction. In recurrent fistulas. Closure can be achieved by the interposition of autologous tissue (Martius flap, gracilis muscle) or biologically degradable materials. In higher fistulas, abdominal approaches are used as well. Stoma creation is more frequently required in rectovaginal fistulas than in anal fistulas. The decision regarding stoma creation should be primarily based on the extent of the local defect and the resulting burden on the patient. Conclusion: In this clinical S3-Guideline, instructions for diagnosis and treatment of rectovaginal fistulas are described for the first time in Germany. Given the low evidence level, this guideline is to be considered of descriptive character only. Recommendations for diagnostics and treatment are primarily based the clinical experience of the guideline group and cannot be fully supported by the literature. PMID:23255878

  15. Plugging meter

    DOEpatents

    Nagai, Akinori

    1979-01-01

    A plugging meter for automatically measuring the impurity concentration in a liquid metal is designed to have parallel passages including a cooling passage provided with a plugging orifice and with a flow meter, and a by-pass passage connected in series to a main passage having another flow meter, so that the plugging points may be obtained from the outputs of both flow meters. The plugging meter has a program signal generator, a flow-rate ratio setter and a comparator, and is adapted to change the temperature of the plugging orifice in accordance with a predetermined pattern or gradient, by means of a signal representative of the temperature of plugging orifice and a flow-rate ratio signal obtained from the outputs of both flow meters. This plugging meter affords an automatic and accurate measurement of a multi-plugging phenomenon taking place at the plugging orifice.

  16. Anal Cancer

    MedlinePlus

    ... saved articles window. My Saved Articles » My ACS » Anal Cancer Download Printable Version [PDF] » Whether you (or ... the topics below to get started. What Is Anal Cancer? What is anal cancer? What are the ...

  17. Plug valve

    DOEpatents

    Wordin, John J.

    1989-01-01

    An improved plug valve wherein a novel shape for the valve plug and valve chamber provide mating surfaces for improved wear characteristics. The novel shape of the valve plug is a frustum of a body of revolution of a curved known as a tractrix, a solid shape otherwise known as a peudosphere.

  18. Tracheoesophageal fistula.

    PubMed

    Slater, Bethany J; Rothenberg, Steven S

    2016-06-01

    Tracheoesophageal fistula (TEF) is a relatively rare congenital anomaly. Surgical intervention is required to establish esophageal continuity and prevent aspiration and overdistension of the stomach. Since the first successful report of thoracoscopic TEF repair in 2000, the minimally invasive approach has become increasingly utilized. The main advantages of the thoracoscopic technique include avoidance of a thoracotomy, improved cosmesis, and superior visualization of the anatomy and fistula afforded by the laparoscope׳s magnification. PMID:27301604

  19. Anal Cancer

    MedlinePlus

    ... are here Home > Types of Cancer > Anal Cancer Anal Cancer This is Cancer.Net’s Guide to Anal Cancer. Use the menu below to choose the ... social workers, and patient advocates. Cancer.Net Guide Anal Cancer Introduction Statistics Risk Factors and Prevention Screening ...

  20. Nephrocutaneous fistula.

    PubMed Central

    Charles, J. C.

    1990-01-01

    The author presents a case of spontaneous nephrocutaneous fistula associated with a complete staghorn calculus in a nonfunctioning kidney. A renal scan, an intravenous pyelogram, and a right retrograde pyelogram confirmed the need for a nephrectomy. The procedure and results are described here. Images Figure 1 Figure 2 Figure 3 PMID:2395179

  1. Anal cancer

    MedlinePlus

    ... Sexual activity. Having many sexual partners and having anal sex are both major risks. This may be due ... have sex with many partners or have unprotected anal sex are at high risk of these infections. Using ...

  2. Anal cancer

    MedlinePlus

    ... the last part of your large intestine where solid waste from food (stool) is stored. Stool leaves your body through the anus when you have a bowel movement. Anal cancer is fairly rare. It spreads ... Squamous cell carcinoma. This is the most common type of anal cancer. It starts in cells that ...

  3. Anal fissure.

    PubMed

    Metcalf, Amanda M

    2002-12-01

    Anal fissure is a common condition with a characteristic presentation. Despite increased pharmaceutical options in the medical management of anal fissures, surgical therapy is not in danger of becoming obsolete. Lateral internal sphincterotomy remains an attractive option for many patients suffering from this painful condition. PMID:12516855

  4. Condylomata acuminata within perianal fistulae tracts: report of two cases.

    PubMed

    Panidis, Stavros; Paramythiotis, Daniel; Papadopoulos, Vasileios N; Michalopoulos, Antonios

    2015-04-01

    The commonest sights of appearance of condylomata acuminata are in the genital and anal regions. Herein we present two cases of condylomata within perianal fistulae tracts, resulting in recurrence in one case and a malignant-like tumour in the second. To our knowledge, these are the first cases reported in the literature. PMID:24872374

  5. Conservative treatment for anal incontinence

    PubMed Central

    Carter, Dan

    2014-01-01

    Anal incontinence (AI) in adults is a troublesome condition that negatively impacts upon quality of life and results in significant embarrassment and social isolation. The conservative management of AI is the first step and targets symptomatic relief. The reported significant improvement with conservative treatments for AI is close to 25% and involves prescribed changes in lifestyle habits, a reduced intake of foods that may cause or aggravate diarrhea or rectal urgency, and the use of specific anti-diarrheal agents. The use of a mechanical barrier in the form of an anal plug and the outcomes and principles of pelvic kinesitherapies and biofeedback options are outlined. This review discusses a gastroenterologist's approach towards conservative therapy in patients referred with anal incontinence. PMID:24759347

  6. Coronary artery fistula

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/007315.htm Coronary artery fistula To use the sharing features on this page, please enable JavaScript. Coronary artery fistula is an abnormal connection between one of ...

  7. Pulmonary arteriovenous fistula

    MedlinePlus

    Pulmonary arteriovenous fistula is an abnormal connection between an artery and vein in the lungs. As a result, blood passes ... Pulmonary arteriovenous fistulas are usually the result of abnormal development of the blood vessels of the lung. Most occur in ...

  8. Pulmonary arteriovenous fistula

    MedlinePlus

    ... medlineplus.gov/ency/article/001090.htm Pulmonary arteriovenous fistula To use the sharing features on this page, please enable JavaScript. Pulmonary arteriovenous fistula is an abnormal connection between an artery and ...

  9. Tracheoesophageal fistula repair - slideshow

    MedlinePlus

    ... page: //medlineplus.gov/ency/presentations/100103.htm Tracheoesophageal fistula repair - series To use the sharing features on ... Editorial team. Related MedlinePlus Health Topics Esophagus Disorders Fistulas Tracheal Disorders A.D.A.M., Inc. is ...

  10. Anal fissure

    MedlinePlus

    ... pain interferes with normal bowel movements Petroleum jelly Zinc oxide, 1% hydrocortisone cream, Preparation H, and other ... anal muscle Prescription creams such as nitrates or calcium channel blockers, applied over the fissure to help ...

  11. Anal fissure

    PubMed Central

    Schlichtemeier, Steven; Engel, Alexander

    2016-01-01

    SUMMARY An anal fissure is a common, mostly benign, condition that can be acute or chronic. The diagnosis is usually made on history and physical examination, but further investigations are sometimes necessary. Primary fissures are usually benign and located in the posterior or anterior position. Secondary fissures are lateral or multiple and often indicate a more serious underlying pathology. The management of primary anal fissures is generally non-operative and includes increased dietary fibre, sitz baths, topical ointments and botulinum toxin injections. If these treatments are ineffective the patient will need a surgical referral. Secondary anal fissures require further investigation. Multidisciplinary management is preferable and is essential in the case of malignancy. PMID:27041801

  12. Plug and drill template

    NASA Technical Reports Server (NTRS)

    Orella, S.

    1979-01-01

    Device installs plugs and then drills them after sandwich face sheets are in place. Template guides drill bit into center of each concealed plug thereby saving considerable time and fostering weight reduction with usage of smaller plugs.

  13. Esophageal Atresia and Tracheoesophageal Fistula

    MedlinePlus

    ... Return to Web version Esophageal Atresia and Tracheoesophageal Fistula Overview What is esophageal atresia? In babies who ... gets into the stomach. What is a tracheoesophageal fistula? A fistula (say “fist-you-lah”) is a ...

  14. Anal Warts

    MedlinePlus

    ... entire pelvic region to include the vaginal or penile area to look for other warts that may require treatment. MUST I BE HOSPITALIZED FOR SURGICAL TREATMENT? Surgical treatment of anal warts is usually performed as outpatient surgery. HOW MUCH TIME WILL I LOSE FROM WORK ...

  15. Unusual Case of Urethrorectal Fistula in Adolescence in a Patient with a History of Congenital Anorectal Malformation

    PubMed Central

    Sotirova, Ira; Papatsoris, Athanasios; Skolarikos, Andreas; Papaconstantinou, Ioannis; Dellis, Athanasios

    2016-01-01

    Abstract Background: Urethrorectal fistula is a rare and debilitating condition. Spontaneous closure is rarely effective, and appropriate management regarding timing of repair and surgical approach remains controversial. Case Presentation: We present a case of an 18-year-old male found to have a urethrorectal fistula after diagnostic work up for unejaculation. The patient gradually developed recurrent urinary tract infections and urine and semen leak from his rectum. He had a medical history of an anorectal reconstruction in the second postnatal day due to an anorectal malformation. Imaging with a rectal endoscopic ultrasound scan revealed a suprasphincteric urethrorectal fistula that was further confirmed with semirigid urethrocystoscopy and placement of a nitinol guidewire through the urethral fistula orifice. Its anal orifice was 3 cm above the anal verge at the 12th hour of the rectum. The fistula orifice on the rectum was identified with a transanal approach and the fistula was managed with the performance of an advancement mucosal flap and bladder catheterization. The patient developed a recurrence with this approach and finally underwent fistula ligation and reconstruction using a scrotal flap. The patient has not had a recurrence of the fistula during his follow-up. Conclusion: This is an unusual case of iatrogenic urethrorectal fistula as it presented in adolescence many years from the initial operation of anorectal reconstruction and with unusual symptoms.

  16. Anal fissure - series (image)

    MedlinePlus

    ... rectum through which passes stool during defecation. The anal sphincter is a critical mechanism for control of ... Anal fissures are tears in the skin overlying the anal sphincter, usually due to increased tone of ...

  17. Spontaneous aortocaval fistula.

    PubMed

    Rajmohan, B

    2002-01-01

    Spontaneous aortocaval fistula is rare, occurring only in 4% of all ruptured abdominal aortic aneurysms. The physical signs can be missed but the presence of low back pain, palpable abdominal aortic aneurysm, machinery abdominal murmur and high-output cardiac failure unresponsive to medical treatment should raise the suspicion. Pre-operative diagnosis is crucial, as adequate preparation has to be made for the massive bleeding expected at operation. Successful treatment depends on management of perioperative haemodynamics, control of bleeding from the fistula and prevention of deep vein thrombosis and pulmonary embolism. Surgical repair of an aortocaval fistula is now standardised--repair of the fistula from within the aneurysm (endoaneurysmorraphy) followed by prosthetic graft replacement of the aneurysm. A case report of a 77-year-old woman, initially suspected to have unstable angina but subsequently diagnosed to have an aortocaval fistula and surgically treated successfully, is presented along with a review of literature. PMID:12432197

  18. Improving arteriovenous fistula cannulation skills.

    PubMed

    Ball, Lynda K

    2005-01-01

    Cannulation of arteriovenous fistulae is technically more challenging than cannulation of arteriovenous grafts. With the advent of the National Vascular Improvement Initiative, Fistula First, the United States has seen an increase in the number of arteriovenous fistulae. The problem we now face is how to refocus and reeducate nurses to the intricacies of arteriovenous fistula cannulation. Through evidenced-based practice and current best-demonstrated practices, this article will provide the tools needed to improve arteriovenous fistulae cannulation skills. PMID:16425809

  19. Rotating arc spark plug

    DOEpatents

    Whealton, John H.; Tsai, Chin-Chi

    2003-05-27

    A spark plug device includes a structure for modification of an arc, the modification including arc rotation. The spark plug can be used in a combustion engine to reduce emissions and/or improve fuel economy. A method for operating a spark plug and a combustion engine having the spark plug device includes the step of modifying an arc, the modifying including rotating the arc.

  20. Coronary-cameral fistulas: indications and methods for closure.

    PubMed

    Carminati, Mario; Giugno, Luca; Chessa, Massimo; Butera, Gianfranco; Piazza, Luciane; Bussadori, Claudio

    2016-05-17

    Coronary-cameral fistulas (CCF) are anomalous connections between one or more coronary arteries and a cardiac chamber, most commonly the right ventricle or right atrium. The major indications for closure are: significant left to right shunt, myocardial ischaemia, prevention of endoarteritis or rupture. Nowadays, the first option for treatment is transcatheter closure. According to the morphology of the fistulas the most appropriate occluder device should be selected: coils (e.g., Gianturco coils, controlled-release coils, PFM coils), vascular plugs or a patent ductus arteriosus (PDA) device or muscular ventricular septal defect (VSD) device. The way to deploy the occluders could be direct arterial or venous through an arteriovenous loop, according to the anatomy of the fistulas assessed by multiple angiograms in different projections. A test occlusion of the fistula with balloon catheter and simultaneous coronary angiogram is recommended for choosing the proper device type and size and the best position for deployment to achieve complete occlusion of the fistula without compromising the flow in coronary side branches. PMID:27174108

  1. The application of a new cyanoacrylate glue in pediatric surgery for fistula closure.

    PubMed

    Hosseini, Seyed Mohammad Vahid; Bahador, Ali; Foroutan, Hamid Reza; Sabet, Babak; Geramizadeh, Bita; Zarenezhad, Mohammad

    2011-03-01

    Surgical glues have been used in pediatric surgery because of the fragility of tissue, and to prevent major surgeries. The present report describes our experience with using a new cyanoacrylate Glubran 2 (Viareggio, Italy) in the treatment of five cases of tracheoesophageal atresia with fistula (one fistula protection, three recurrent fistula, and one unstable patients), two cases of hypospadias, one case of vesicutanouse fistula after bladder extrophy, and one case of cloacal extrophy from January-December 2008. Three cases of recurrent tracheoesophageal atresia with fistula were treated by bronchoscpic glue injection. The other two cases benefited from glue through its ability to plug the fistula and to act as a protecting layer on anastomosis. In two cases with hypospadias excessive use of the glue caused skin necrosis, which was repaired. The wounds of cloacal extrophy were protected from nearby colostomy contamination and infection, and the vesicocutanouse fistula was closed by deepithelialization and sealing with glue. Based on the outcomes of the cases, it may be possible to suggest that Glubran 2 may be used safely in Pediatric Surgery as a sealant for the prevention and treatment of fistulas. PMID:23365480

  2. The Application of a New Cyanoacrylate Glue in Pediatric Surgery for Fistula Closure

    PubMed Central

    Hosseini, Seyed Mohammad Vahid; Bahador, Ali; Foroutan, Hamid Reza; Sabet, Babak; Geramizadeh, Bita; Zarenezhad, Mohammad

    2011-01-01

    Surgical glues have been used in pediatric surgery because of the fragility of tissue, and to prevent major surgeries. The present report describes our experience with using a new cyanoacrylate Glubran 2 (Viareggio, Italy) in the treatment of five cases of tracheoesophageal atresia with fistula (one fistula protection, three recurrent fistula, and one unstable patients), two cases of hypospadias, one case of vesicutanouse fistula after bladder extrophy, and one case of cloacal extrophy from January–December 2008. Three cases of recurrent tracheoesophageal atresia with fistula were treated by bronchoscpic glue injection. The other two cases benefited from glue through its ability to plug the fistula and to act as a protecting layer on anastomosis. In two cases with hypospadias excessive use of the glue caused skin necrosis, which was repaired. The wounds of cloacal extrophy were protected from nearby colostomy contamination and infection, and the vesicocutanouse fistula was closed by deepithelialization and sealing with glue. Based on the outcomes of the cases, it may be possible to suggest that Glubran 2 may be used safely in Pediatric Surgery as a sealant for the prevention and treatment of fistulas. PMID:23365480

  3. Congenital parotid fistula.

    PubMed

    Natasha, Shiggaon

    2014-01-01

    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. PMID:25231049

  4. Anal fissure - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100154.htm Anal fissure - series—Normal anatomy To use the sharing ... rectum through which passes stool during defecation. The anal sphincter is a critical mechanism for control of ...

  5. Labyrinthine fistulae: a retrospective analysis.

    PubMed

    Vanclooster, C; Debruyne, F; Vantrappen, G; Desloovere, C; Feenstra, L

    1997-01-01

    A retrospective analysis has been conducted of 57 labyrinthine fistulae found in 375 cholesteatoma cases, primarily treated by removal of the matrix of the cholesteatoma and covering the fistula with a mixture of bone paste and fibrin glue. CT-scan with slices of 1 mm demonstrated the fistula in almost 90% of the cases. Eighteen percent of the ears were pre-operatively totally deaf. Large fistulae are riskier than smaller ones for post-operative perceptive losses, but even in very large and multiple fistulae the hearing may be preserved in most cases. PMID:9241379

  6. Rectourethral Fistula Management.

    PubMed

    Ramírez-Martín, Daniel; Jara-Rascón, José; Renedo-Villar, Teresa; Hernández-Fernández, Carlos; Lledó-García, Enrique

    2016-03-01

    Rectourethral fistula (RUF) is a rare condition that occurs, in most cases, as a consequence of prostate cancer treatments. Clinical suspicion and proper assessment prior to surgery are essential to adapt and successfully carry out an appropriate treatment plan. There are no randomized trials to guide clinical practice, and therefore, scientific evidence in this respect is limited. Expert recommendations seem to agree on the transperineal approach with flap interposition as the surgical treatment of choice in cases of complex fistulas, especially in those that have undergone prior radiation. Undoubtedly, the key to the successful treatment of the disease is the multidisciplinary and standardized management by physicians with experience in the field. PMID:26874534

  7. Mechanism of non-specific-fistula-in-ano: Hormonal aspects-Review.

    PubMed

    El-Tawil, A M

    2012-02-01

    Abscesses could occur anywhere, but quite few that could proceed forward and develop fistulae. Crypto glandular abscess formation concept has been forming the basis for almost all designed strategies for management of cases of idiopathic fistula-in-ano for ages. Yet, this hypothesis failed to explain the reason(s) for the recorded lower incidences of idiopathic anal fistula in females than in males. Gram negative bacteria are largely the causative agents for these anal glands' abscesses that processed further and developed fistulae. Lipopolysaccharide component (LPS) of the bacterial cell wall could significantly attenuate the expression of mRNA of the oestrogen receptors and accordingly reduces the down signalling pathway. Yet, this kind of action could be inhibited in the presence of oestrogen. In addition, tumour necrosis factor-alpha (TNFα) is a key proinflammatory cytokine that induces the secretion of other cytokines and enzymes in various cells and tissues. And LPS could activate pro-inflammatory cytokine by activating plasma membrane proteins (e.g. the toll like receptor 4 [TLR4] and CD14 that leads to the production of TNFα and other pro-inflammatory cytokines). This activation could be enhanced by testosterone but inhibited by oestrogen. These are likely the reasons for the higher prevalence of idiopathic fistula-in-ano in males than in females. PMID:21840183

  8. Rectovaginal fistula in Crohn's disease.

    PubMed

    Cohen, J L; Stricker, J W; Schoetz, D J; Coller, J A; Veidenheimer, M C

    1989-10-01

    Rectovaginal fistulas in the setting of Crohn's disease present a difficult management dilemma. Some patients with this problem require proctocolectomy, yet other patients with minimal symptoms never require an operation for treatment of the rectovaginal fistula. For a small percentage of patients, local surgical repair of the fistula may be warranted. Since 1980, this study has attempted local repair in seven patients with symptomatic rectovaginal fistulas from Crohn's disease. Five patients underwent staged repair of the fistula. Closure of the colostomy was eventually possible in three of these patients. Two of the three patients have had no evidence of recurrence at followup in excess of two years. The third patient required an ileostomy for intestinal disease and had no recurrence of the fistula. Two patients underwent primary repair of the rectovaginal fistula without fecal diversion; in one of these patients, the fistula recurred ten days after operation, necessitating a diverting ileostomy. The other patient remains cured 26 months after repair. The results of this review indicate that in the setting of quiescent rectal disease, an attempt to repair the fistula can be expected to have a reasonable chance of success. The presence of a rectovaginal fistula in a patient with Crohn's disease does not mandate removal of the rectum. PMID:2791765

  9. Embolization of Brain Aneurysms and Fistulas

    MedlinePlus

    ... Professions Site Index A-Z Embolization of Brain Aneurysms and Arteriovenous Malformations/Fistulas Embolization of brain aneurysms ... Aneurysms and Fistulas? What is Embolization of Brain Aneurysms and Fistulas? Embolization of brain aneurysms and arteriovenous ...

  10. Single stage management of a unique variant of congenital pouch colon with triplet fistula and normal anus.

    PubMed

    Pandey, Vaibhav; Gangopadhyay, Ajay Narayan; Gupta, Dinesh Kumar; Sharma, Shiv Prasad

    2015-01-01

    Congenital pouch colon (CPC) in the female patient presents with highly variable and anomalous anatomy. We herein report the first case of CPC with uterus didelphys having normal anal opening, H-type vestibular fistula, two other fistulous communications between pouch colon and two vagina managed in a single stage with excellent postoperative outcome. PMID:26166988

  11. Single stage management of a unique variant of congenital pouch colon with triplet fistula and normal anus

    PubMed Central

    Pandey, Vaibhav; Gangopadhyay, Ajay Narayan; Gupta, Dinesh Kumar; Sharma, Shiv Prasad

    2015-01-01

    Congenital pouch colon (CPC) in the female patient presents with highly variable and anomalous anatomy. We herein report the first case of CPC with uterus didelphys having normal anal opening, H-type vestibular fistula, two other fistulous communications between pouch colon and two vagina managed in a single stage with excellent postoperative outcome. PMID:26166988

  12. Friction pull plug welding: chamfered heat sink pull plug design

    NASA Technical Reports Server (NTRS)

    Coletta, Edmond R. (Inventor); Cantrell, Mark A. (Inventor)

    2005-01-01

    The average strength of a pull plug weld is increased and weak bonding eliminated by providing a dual included angle at the top one third of the pull plug. Plugs using the included angle of the present invention had consistent high strength, no weak bonds and were substantially defect free. The dual angle of the pull plug body increases the heat and pressure of the weld in the region of the top one third of the plug. This allows the plug to form a tight high quality solid state bond. The dual angle was found to be successful in elimination of defects on both small and large plugs.

  13. Bellows sealed plug valve

    DOEpatents

    Dukas, Jr., Stephen J.

    1990-01-01

    A bellows sealed plug valve includes a valve body having an inlet passage and an outlet passage, a valve chamber between the inlet and outlet passages. A valve plug has substantially the same shape as the valve chamber and is rotatably disposed therein. A shaft is movable linearly in response to a signal from a valve actuator. A bellows is sealingly disposed between the valve chamber and the valve actuator and means are located between the bellows and the valve plug for converting linear movement of the shaft connected to the valve actuator to rotational movement of the plug. Various means are disclosed including helical thread mechanism, clevis mechanism and rack and pinion mechanism, all for converting linear motion to rotational motion.

  14. Friction plug welding

    NASA Technical Reports Server (NTRS)

    Takeshita, Riki (Inventor); Hibbard, Terry L. (Inventor)

    2001-01-01

    Friction plug welding (FPW) usage is advantageous for friction stir welding (FSW) hole close-outs and weld repairs in 2195 Al--Cu--Li fusion or friction stir welds. Current fusion welding methods of Al--Cu--Li have produced welds containing varied defects. These areas are found by non-destructive examination both after welding and after proof testing. Current techniques for repairing typically small (<0.25) defects weaken the weldment, rely heavily on welders' skill, and are costly. Friction plug welding repairs increase strength, ductility and resistance to cracking over initial weld quality, without requiring much time or operator skill. Friction plug welding while pulling the plug is advantageous because all hardware for performing the weld can be placed on one side of the workpiece.

  15. [Malignant esophageal-respiratory fistula and esophageal stenosis treated with a Gianturco-Z-stent].

    PubMed

    Solt, J; Boros, S; Zoltán, I; Horváth, O P; Andics, L; Bajor, J

    1998-10-11

    Oesophago-respiratory fistula in most instances in a complication of advanced malignant tumours of the oesophagus or the lung. In our patient group eleven oesophago-respiratory and one gastro-respiratory fistulas were encountered. Three patients were operated upon. In one of them with achalasia, early oesophageal carcinoma was discovered in the background of the fistula. Two patients had fistulas without of oesophageal narrowing, therefore, stent implantation into the trachea and bronchus was performed. One of them was previously managed endoscopically with lyodura plug and fibrin glue, but only temporary occlusion of the fistula was obtained. In five patients, seven conventional oesophageal prosthesis (6 Cook, 1 Rüsch) were used to close the fistulas. In one of these patients, three oesophago-respiratory fistulas developed one after the other at the level of the prosthesis funnel. They were closed with three prostheses connected with short silicone tubes. In the last two patients, Gianturco-Z stent was employed. Its advantages over the plastic prostheses include small basic and lager final luminal diameter, lesser predilatation, easier implantation, lower complication and mortality rate. The silicone coated and double funnel stent with expansile force is effective in fistulas closure. On implantation, stent shortening in minimal, allowing precise placement of the stent even in proximal malignant oesophageal stenosis with oesophago-bronchial fistula. The high price of the stent is compensated for by the lower complication rate, shorter hospitalization and subsequent reduction is hospital expenses. Therefore these metal stents should be financed by the National Health Service, at least in specialized centers for managing patients with dysphagia. PMID:9805459

  16. Coronary artery fistulas

    PubMed Central

    Said, S.A.M.; Thiadens, A.A.H.J.; Fieren, M.J.C.H.; Meijboom, E.J.; van der Werf, T.; Bennink, G.B.W.E.

    2002-01-01

    The aetiology of congenital coronary artery fistulas remains a challenging issue. Coronary arteries with an anatomically normal origin may, for obscure reasons, terminate abnormally and communicate with different single or multiple cardiac chambers or great vessels. When this occurs, the angiographic morphological appearance may vary greatly from discrete channels to plexiform network of vessels. Coronary arteriovenous fistulas (CAVFs) have neither specific signs nor pathognomonic symptoms; the spectrum of clinical features varies considerably. The clinical presentation of symptomatic cases can include angina pectoris, myocardial infarction, fatigue, dyspnoea, CHF, SBE, ventricular and supraventricular tachyarrhythmias or even sudden cardiac death. CAVFs may, however, be a coincidental finding during diagnostic coronary angiography (CAG). CAG is considered the gold standard for diagnosing and delineating the morphological anatomy and pathway of CAVFs. There are various tailored therapeutic modalities for the wide spectrum of clinical manifestations of CAVFs, including conservative pharmacological strategy, percutaneous transluminal embolisation and surgical ligation. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:25696067

  17. Congenital Median Upper Lip Fistula

    PubMed Central

    al Aithan, Bandar

    2012-01-01

    Congenital median upper lip fistula (MULF) is an extremely rare condition resulting from abnormal fusion of embryologic structures. We present a new case of congenital medial upper lip fistula located in the midline of the philtrum of a 6 year old girl. PMID:22953305

  18. Laparoscopic management of cholecystocolic fistula

    PubMed Central

    CONDE, Lauro Massaud; TAVARES, Pedro Monnerat; QUINTES, Jorge Luiz Delduque; CHERMONT, Ronny Queiroz; PEREZ, Mario Castro Alvarez

    2014-01-01

    Introduction Cholecystocolic fistula is a rare complication of gallbladder disease. Its clinical presentation is variable and nonspecific, and the diagnosis is made, mostly, incidentally during intraoperative maneuver. Cholecystectomy with closure of the fistula is considered the treatment of choice for the condition, with an increasingly reproducible tendency to the use of laparoscopy. Aim To describe the laparoscopic approach for cholecystocolic fistula and ratify its feasibility even with the unavailability of more specific instruments. Technique After dissection of the communication and section of the gallbladder fundus, the fistula is externalized by an appropriate trocar and sutured manually. Colonic segment is reintroduced into the cavity and cholecystectomy is performed avoiding the conversion procedure to open surgery. Conclusion Laparoscopy for resolution of cholecystocolic fistula isn't only feasible, but also offers a shorter stay at hospital and a milder postoperative period when compared to laparotomy. PMID:25626940

  19. Clearance of a Mucus Plug

    NASA Astrophysics Data System (ADS)

    Bian, Shiyao; Zheng, Ying; Grotberg, James B.

    2008-11-01

    Mucus plugging may occur in pulmonary airways in asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis. How to clear the mucus plug is essential and of fundamental importance. Mucus is known to have a yield stress and a mucus plug behaves like a solid plug when the applied stresses are below its yield stress τy. When the local stresses reaches τy, the plug starts to move and can be cleared out of the lung. It is then of great importance to examine how the mucus plug deforms and what is the minimum pressure required to initiate its movement. The present study used the finite element method (FEM) to study the stress distribution and deformation of a solid mucus plug under different pressure loads using ANSYS software. The maximum shear stress is found to occur near the rear transition region of the plug, which can lead to local yielding and flow. The critical pressure increases linearly with the plug length and asymptotes when the plug length is larger than the half channel width. Experimentally a mucus simulant is used to study the process of plug deformation and critical pressure difference required for the plug to propagate. Consistently, the fracture is observed to start at the rear transition region where the plug core connects the films. However, the critical pressure is observed to be dependent on not only the plug length but also the interfacial shape.

  20. Hemorrhoids and anal fissures in inflammatory bowel disease.

    PubMed

    D'Ugo, S; Stasi, E; Gaspari, A L; Sileri, P

    2015-12-01

    Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and fissures. Most literature has been focused on anal sepsis and fistulae, as they carry the majority of disease burden and often alter the natural course of the disease. Hemorrhoids and anal fissures in patients with IBD have been overlooked, although they can represent a challenging problem. The management of hemorrhoids and fissures in IBD patients may be difficult and may significantly differ compared to the non-affected population. Historically surgery was firmly obstructed, and hemorrhoidectomy or sphincterotomy in patients with associated diagnosis of IBD was considered harmful, although literature data is scant and based on small series. Various authors reported an incidence of postoperative complications higher in IBD than in the general populations, with potential severe events. Considering that a spontaneous healing is possible, the first line management should be a medical therapy. In patients non-responding to conservative measures it is possible a judicious choice of surgical options on a highly selective basis; this can lead to acceptable results, but the risk of possible complications needs to be considered. In this review it is analyzed the current literature on the incidence, symptoms and treatment options of hemorrhoids and anal fissures in patients with Crohn's disease and ulcerative colitis. PMID:26446683

  1. Friction pull plug welding: chamfered heat sink pull plug design

    NASA Technical Reports Server (NTRS)

    Coletta, Edmond R. (Inventor); Cantrell, Mark A. (Inventor)

    2002-01-01

    Friction Pull Plug Welding (FPPW) is a solid state repair process for defects up to one inch in length, only requiring single sided tooling (OSL) for usage on flight hardware. Experimental data has shown that the mass of plug heat sink remaining above the top of the plate surface after a weld is completed (the plug heat sink) affects the bonding at the plug top. A minimized heat sink ensures complete bonding of the plug to the plate at the plug top. However, with a minimal heat sink three major problems can arise, the entire plug could be pulled through the plate hole, the central portion of the plug could be separated along grain boundaries, or the plug top hat can be separated from the body. The Chamfered Heat Sink Pull Plug Design allows for complete bonding along the ISL interface through an outside diameter minimal mass heat sink, while maintaining enough central mass in the plug to prevent plug pull through, central separation, and plug top hat separation.

  2. Anal Warts and Anal Intradermal Neoplasia

    PubMed Central

    Echenique, Ignacio; Phillips, Benjamin R.

    2011-01-01

    For the last five millennia we have been dealing with the annoyance of verrucas. Anogenital human papillomavirus (HPV) infection is the most common sexually transmitted disease in the United States and is increasing in incidence. As in other gastrointestinal conditions, HPV infection can lead to a stepwise transition from normal cells to dysplastic cells and then to invasive anal cancer. Knowledge of the natural history of HPV infection, risk factors, diagnostic tools, and therapeutic methods gives us the tools to adequately prevent, evaluate, treat, and counsel our patients. In this review, the authors detail the diagnosis, management, and treatment of anal condyloma and anal intraepithelial neoplasia with a focus on prevention, early detection, and treatment using current data and technology. PMID:22379403

  3. Successful Treatment of Rectovaginal Fistula Complicating Ulcerative Colitis With Infliximab: A Case Report and Review of the Literature

    PubMed Central

    Nirei, Takako; Kazama, Shinsuke; Hiyoshi, Masaya; Tsuno, Nelson Hirokazu; Nishikawa, Takeshi; Tanaka, Toshiaki; Tanaka, Junichiro; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Nozawa, Hiroaki; Kanazawa, Takamitsu; Yamaguchi, Hironori; Ishihara, Soichiro; Sunami, Eiji; Kitayama, Joji; Watanabe, Toshiaki

    2015-01-01

    Rectovaginal fistula is a rare complication of ulcerative colitis (UC) regardless of surgical history of rectum. Various surgical treatment modalities for the closure of rectovaginal fistula have been developed, but a radically curative therapy remains to be developed. Recently, infliximab, the chimeric anti-human tumor necrosis factor alpha (TNF-α) antibody, has been largely applied for the treatment of inflammatory bowel disease (IBD), and a few reports have shown its partial effectiveness in the management of rectovaginal fistulas associated with UC. In the present report, we describe the successful management of a rectovaginal fistula, following the stapled ileo-anal canal anastomosis in a UC patient, by administration of infliximab. The patient was a 40-year-old female, initially diagnosed as UC (total colitis type) at the age of 15. She received a restorative proctocolectomy at the age of 22, and developed a rectovaginal fistula at the eighth postoperative day. The surgical treatment of the fistula was repeated four times during the 10-year period, but it recurred in intervals ranging between 2 months and 5 years after the operation. The last recurrence occurred at the age of 32, but the surgical repair was considered difficult and a conservative management was indicated. At the age of 40, infusions of infliximab were started. Four weeks after the first infusion, drainage from the fistula was evidently reduced, and 2 weeks later, the fistula was completely closed. Thereafter, no recurrence of the fistula is observed, as confirmed by the abdominal magnetic resonance imaging (MRI) and the barium-enema study. From the present case, we concluded that infliximab may be an effective strategy for the management of fistulas associated with UC. PMID:25368705

  4. Anal condyloma acuminatum.

    PubMed

    McCutcheon, Tonna

    2009-01-01

    Anal condyloma acuminatum is a human papillomavirus (HPV) that affects the mucosa and skin of the anorectum and genitalia. Anal condyloma acuminatum is the most commonly diagnosed sexually transmitted disease in the United States. To date, there are more than 100 HPV types, with HPV-6, HPV-10, and HPV-11 predominately found in the anogenital region and causing approximately 90% of genital warts. Risk factors for anal condyloma acuminatum include multiple sex partners, early coital age, anal intercourse, and immunosuppression. Transmission occurs by way of skin-to-skin contact through sexual intercourse, oral sex, anal sex, or other contact involving the genital area. The virus may remain latent for months to years until specific mechanisms cause production of viral DNA, leading to the presentation of anal condyloma acuminatum.Patients with anal condyloma acuminatum may be asymptomatic or present with presence of painless bumps, itching, and discharge or bleeding. It is not uncommon to have involvement of more than one area, and multiple lesions may also be present and extend into the anal canal or rectum. To date, there is no serologic testing or culture to detect anal condyloma acuminatum; therefore, diagnosis is made clinically or by detection of HPV DNA. Multiple factors determine the choice of treatment, which may range from patient-applied medications to surgical intervention. Despite treatment choice, recurrence rates are high, indicating the importance of patient education on prevention of HPV infection and reinfection. Unfortunately, at this time, no cure exists for anal condyloma acuminatum; however, recently Gardasil and Cervarix (in Australia only) vaccines have become available and are showing promising results. PMID:19820442

  5. Plug Flow Reactor Simulator

    Energy Science and Technology Software Center (ESTSC)

    1996-07-30

    PLUG is a computer program that solves the coupled steady state continuity, momentum, energy, and species balance equations for a plug flow reactor. Both homogeneous (gas-phase) and heterogenous (surface) reactions can be accommodated. The reactor may be either isothermal or adiabatic or may have a specified axial temperature or heat flux profile; alternatively, an ambient temperature and an overall heat-transfer coefficient can be specified. The crosssectional area and surface area may vary with axial position,more » and viscous drag is included. Ideal gas behavior and surface site conservation are assumed.« less

  6. Plug Flow Reactor Simulator

    SciTech Connect

    Larson, Richard S.

    1996-07-30

    PLUG is a computer program that solves the coupled steady state continuity, momentum, energy, and species balance equations for a plug flow reactor. Both homogeneous (gas-phase) and heterogenous (surface) reactions can be accommodated. The reactor may be either isothermal or adiabatic or may have a specified axial temperature or heat flux profile; alternatively, an ambient temperature and an overall heat-transfer coefficient can be specified. The crosssectional area and surface area may vary with axial position, and viscous drag is included. Ideal gas behavior and surface site conservation are assumed.

  7. PERFACT procedure to treat supralevator fistula-in-ano: A novel single stage sphincter sparing procedure

    PubMed Central

    Garg, Pankaj

    2016-01-01

    AIM: To prospectively perform the PERFACT procedure in supralevator anal fistula/abscess. METHODS: Magnetic resonance imaging was done preoperatively in all the patients. Proximal cauterization around the internal opening, emptying regularly of fistula tracts and curettage of tracts (PERFACT) was done in all patients with supralevator fistula or abscess. All types of anal fistula and/or abscess with supralevator extension, whether intersphincteric or transsphincteric, were included in the study. The internal opening along with the adjacent mucosa was electrocauterized. The resulting wound was left open to heal by secondary intention so as to heal (close) the internal opening by granulation tissue. The supralevator tract/abscess was drained and thoroughly curetted. It was regularly cleaned and kept empty in the postoperative period. The primary outcome parameter was complete fistula healing. The secondary outcome parameters were return to work and change in incontinence scores (Vaizey objective scoring system) assessed preoperatively and at 3 mo after surgery. RESULTS: Seventeen patients were prospectively enrolled and followed for a median of 13 mo (range 5-21 mo). Mean age was 41.1 ± 13.4 years, M:F - 15:2. Fourteen (82.4%) had a recurrent fistula, 8 (47.1%) had an associated abscess, 14 (82.4%) had multiple tracts and 5 (29.4%) had horseshoe fistulae. Infralevator part of fistula was intersphincteric in 4 and transsphincteric in 13 patients. Two patients were excluded. Eleven out of fifteen (73.3%) were cured and 26.7% (4/15) had a recurrence. Two patients with recurrence were reoperated on with the same procedure and one was cured. Thus, the overall healing rate was 80% (12/15). All the patients could resume normal work within 48 h of surgery. There was no deterioration in incontinence scores (Vaizey objective scoring system). This is the largest series of supralevator fistula-in-ano (SLF) published to date. CONCLUSION: PERFACT procedure is an effective single

  8. Bronchobiliary fistula: a case report

    PubMed Central

    Fischer, James D.

    1998-01-01

    Fewer than 20 cases of bronchobiliary fistula have been reported in the literature. In this report a newborn female infant was referred for investigation of gastroesophageal reflux. Upper gastrointestinal endoscopy and 24-hour pH monitoring revealed severe reflux. A fundoplication was carried out. In the immediate postoperative period bile was noticed coming from the endotracheal tube. Bronchoscopy revealed an abnormal opening just to the left of the carina. Fistulography and HIDA scanning confirmed the presence of a bronchobiliary fistula. A right thoracotomy was used to divide the fistula. The child made an uncomplicated recovery. Pathological examination of the excised specimen demonstrated tissue most consistent with an esophageal origin. PMID:9854540

  9. Playing with Plug-ins

    ERIC Educational Resources Information Center

    Thompson, Douglas E.

    2013-01-01

    In today's complex music software packages, many features can remain unexplored and unused. Software plug-ins--available in most every music software package, yet easily overlooked in the software's basic operations--are one such feature. In this article, I introduce readers to plug-ins and offer tips for purchasing plug-ins I have…

  10. A Very Rare Cause of Anal Atresia: Currarino Syndrome

    PubMed Central

    Buyukbese Sarsu, Sevgi; Parmaksiz, Mehmet Ergun; Cabalar, Esra; Karapur, Ali; Kaya, Cihat

    2016-01-01

    Currarino syndrome (triad) is an extremely rare condition characterized by presacral mass, anorectal malformation, and sacral bone deformation. The complete form of this syndrome displays all three irregularities. Herein, we report a male case who was admitted to our hospital with symptoms of urinary system infection and persistent constipation 2 years after colostomy operation performed with the indication of rectovestibular fistula and anal atresia, diagnosed as Currarino syndrome based on imaging modalities. In a patient who was admitted because of the presence of anal atresia, in order to preclude potential complications, probable concomitancy of this syndrome should not be forgotten. Early diagnosis is important for the prevention of meningitis, urinary tract infections, and malignant change. PMID:27081429

  11. A Very Rare Cause of Anal Atresia: Currarino Syndrome.

    PubMed

    Buyukbese Sarsu, Sevgi; Parmaksiz, Mehmet Ergun; Cabalar, Esra; Karapur, Ali; Kaya, Cihat

    2016-05-01

    Currarino syndrome (triad) is an extremely rare condition characterized by presacral mass, anorectal malformation, and sacral bone deformation. The complete form of this syndrome displays all three irregularities. Herein, we report a male case who was admitted to our hospital with symptoms of urinary system infection and persistent constipation 2 years after colostomy operation performed with the indication of rectovestibular fistula and anal atresia, diagnosed as Currarino syndrome based on imaging modalities. In a patient who was admitted because of the presence of anal atresia, in order to preclude potential complications, probable concomitancy of this syndrome should not be forgotten. Early diagnosis is important for the prevention of meningitis, urinary tract infections, and malignant change. PMID:27081429

  12. [Clinical study of enterovesical fistulas].

    PubMed

    Atsuta, Takeshi; Magaribuchi, Toshihiro; Takao, Noriyasu; Shirahase, Toshiaki; Taki, Yoji; Takeuchi, Hideo

    2014-08-01

    We conducted a retrospective review of 16 patients who were diagnosed with enterovesical fistula in our hospital between January 2000 and July 2013. The patient's median age was 74 years old and 4 were female. Most of the chief complaints were pneumaturia and fecaluria. There was a vesicosigmoidal fistula in 12 patients, an ileovesical fistula in 2, and a rectovesical fistula in 2. The main underlying cause was diverticulitis in 9 patients and a sigmoid colon carcinoma in 3. Diagnoses were made based on the findings of cystoscopy, barium enema, abdominal computed tomography and so on. Treatment varied in each case depending on the etiology and the patient's condition. The procedure was mostly open surgery, but laparoscopic sigmoidectomy was performed preserving the bladder in the two most recent cases. PMID:25179986

  13. What Is Anal Cancer?

    MedlinePlus

    ... anal papillae are also called fibroepithelial polyps . Skin tags: Skin tags are benign growths of connective tissue that are covered by squamous cells. Skin tags are often mistaken for hemorrhoids (swollen veins inside ...

  14. Stages of Anal Cancer

    MedlinePlus

    ... following stages are used for anal cancer: Stage 0 (Carcinoma in Situ) In stage 0 , abnormal cells ... or check-ups. Treatment Options by Stage Stage 0 (Carcinoma in Situ) Treatment of stage 0 is ...

  15. Anal Dysplasia Screening

    PubMed Central

    2007-01-01

    Executive Summary Objective This review considered the role of the anal Pap test as a screening test for anal dysplasia in patients at high risk of anal SCC. The screening process is now thought to be improved with the addition of testing for the human papillomavirus (HPV) in high-risk populations. High-resolution anoscopy (a method to view the rectal area, using an anoscope, a lighted instrument inserted into the rectum) rather than routine anoscopy-guided biopsy, is also now considered to be the diagnostic standard. Clinical Need: Target Population and Condition Anal cancer, like cervical cancer, is a member of a broader group of anogenital cancers known to be associated with sexually transmitted viral HPV infection. Human papillomavirus is extremely prevalent, particularly in young, sexually active populations. Sexual practices involving receptive anal intercourse lead to significantly elevated risk for anal dysplasia and cancer, particularly in those with immune dysfunctions. Anal cancer is rare. It occurs at a rate of about 1 to 2 per 100,000 in the general population. It is the least common of the lower gastrointestinal cancers, representing about 4% of them, in contrast to colorectal cancers, which remain the third most commonly diagnosed malignancy. Certain segments of the population, however, such as HIV-positive men and women, other chronic immune-suppressed patients (e.g., after a transplant), injection drug users, and women with genital dysplasia /cancer, have a high susceptibility to anal cancer. Those with the highest identified risk for anal cancer are HIV-positive homosexual and bisexual men, at a rate of 70 per 100,000 men. The risk for anal cancer is reported to be increasing dramatically in HIV-positive males and females, particularly since the introduction of highly active antiretroviral therapy in the mid-1990s. The introduction of effective viral therapy has been said to have transformed the AIDS epidemic in developed countries into a chronic

  16. Arteriovenous Fistula Embolization in Suspected Parauterine Choriocarcinoma.

    PubMed

    Alturkistani, Husain; Almarzooqi, Mohamed-Karji; Oliva, Vincent; Gilbert, Patrick

    2016-01-01

    This is a case of choriocarcinoma that did not regress after chemotherapy treatment. A 30-year-old female patient (gravida 2, para 2), presented to our ER with stroke and persistent mild pelvic pain 2 months after a Caesarean section. Computed tomography (CT) revealed an ischemic left hemicerebellar region and a hypervascular mass in the pelvic region. This mass was not present on routine fetal ultrasound during pregnancy. The lesion was treated by chemotherapy after closure of a foramen ovale and insertion of an inferior vena cava (IVC) filter. After that, 2 courses of EMACO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, and Vincristine) chemotherapy regimen were given. Posttreatment CT showed the hypervascular mass without any changes. Arteriography showed the arteriovenous fistulae that were embolized successfully with plugs, coils, and glue. Embolization was considered due to the risk of acute hemorrhagic life-threatening complications. Eight chemotherapy courses were added after embolization. Treatment by endovascular approach and reduction of the hypervascular mass can be a valuable adjunct to chemotherapy treatment of choriocarcinoma. PMID:27403360

  17. Arteriovenous Fistula Embolization in Suspected Parauterine Choriocarcinoma

    PubMed Central

    Almarzooqi, Mohamed-Karji; Oliva, Vincent; Gilbert, Patrick

    2016-01-01

    This is a case of choriocarcinoma that did not regress after chemotherapy treatment. A 30-year-old female patient (gravida 2, para 2), presented to our ER with stroke and persistent mild pelvic pain 2 months after a Caesarean section. Computed tomography (CT) revealed an ischemic left hemicerebellar region and a hypervascular mass in the pelvic region. This mass was not present on routine fetal ultrasound during pregnancy. The lesion was treated by chemotherapy after closure of a foramen ovale and insertion of an inferior vena cava (IVC) filter. After that, 2 courses of EMACO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, and Vincristine) chemotherapy regimen were given. Posttreatment CT showed the hypervascular mass without any changes. Arteriography showed the arteriovenous fistulae that were embolized successfully with plugs, coils, and glue. Embolization was considered due to the risk of acute hemorrhagic life-threatening complications. Eight chemotherapy courses were added after embolization. Treatment by endovascular approach and reduction of the hypervascular mass can be a valuable adjunct to chemotherapy treatment of choriocarcinoma. PMID:27403360

  18. Friction pull plug welding: top hat plug design

    NASA Technical Reports Server (NTRS)

    Coletta, Edmond R. (Inventor); Cantrell, Mark A. (Inventor)

    2001-01-01

    Friction Pull Plug Welding is a solid state repair process for defects up to one inch in length, only requiring single sided tooling, or outside skin line (OSL), for preferred usage on flight hardware. The most prevalent defect associated with Friction Pull Plug Welding (FPPW) was a top side or inside skin line (ISL) lack of bonding. Bonding was not achieved at this location due to the reduction in both frictional heat and welding pressure between the plug and plate at the end of the weld. Thus, in order to eliminate the weld defects and increase the plug strength at the plug `top` a small `hat` section is added to the pull plug for added frictional heating and pressure.

  19. Friction pull plug welding: top hat plug design

    NASA Technical Reports Server (NTRS)

    Coletta, Edmond R. (Inventor); Cantrell, Mark A. (Inventor)

    2002-01-01

    Friction Pull Plug Welding is a solid state repair process for defects up to one inch in length, only requiring single sided tooling, or outside skin line (OSL), for preferred usage on flight hardware. The most prevalent defect associated with Friction Pull Plug Welding (FPPW) was a top side or inside skin line (ISL) lack of bonding. Bonding was not achieved at this location due to the reduction in both frictional heat and welding pressure between the plug and plate at the end of the weld. Thus, in order to eliminate the weld defects and increase the plug strength at the plug `top` a small `hat` section is added to the pull plug for added frictional heating and pressure.

  20. Congenital urethrocutaneous fistula in an adolescent male

    PubMed Central

    Kale, Satish M.; Mody, Nikunj B.; Patil, Surendra B.; Sadawarte, Pranam

    2015-01-01

    A urethrocutaneous fistula is a common complication after hypospadias repair, but congenital fistula is a rare anomaly. We present a 16-year-old boy with this unusual anomaly. Its etiology, embryology, and management are discussed in brief. PMID:26424989

  1. Frequent Hemodialysis Fistula Infectious Complications

    PubMed Central

    Lok, Charmaine E.; Sontrop, Jessica M.; Faratro, Rose; Chan, Christopher T.; Zimmerman, Deborah Lynn

    2014-01-01

    Background Few studies have examined if infectious arteriovenous access complications vary with the cannulation technique and whether this is modified by dialysis frequency. We compared the infection rate between fistulas cannulated using buttonhole versus stepladder techniques for patients treated with short daily (SDH) or nocturnal hemodialysis at home (NHD). We also compared patients receiving conventional intermittent hemodialysis (CIHD) using stepladder cannulation. Methods Data were prospectively collected from 631 patients dialyzed with a fistula from 2001 to 2010 (Toronto and Ottawa, Canada). We compared the person-time incidence rate of bacteremia and local fistula infections using the exact binomial test. Results Forty-six (7.3%) patients received SDH (≥5 sessions/week, 2-4 h/session), 128 (20.3%) NHD (≥4 sessions/week, ≥5 h/session) and 457 (72%) CIHD (3 sessions/week, ≤4 h/session). Fifty percent of SDH and 72% of NHD patients used the buttonhole technique. There were 39 buttonhole-related bacteremias (rate: 0.196/1,000 fistula days) and at least 2 local buttonhole site infections. Staphylococcus aureus accounted for 85% of the bacteremias. There were 5 (13%) infection-related hospitalizations and 3 (10%) serious metastatic infections, including fistula loss. In comparison, there was 1 possible fistula-related infection in CIHD during follow-up (rate: 0.002/1,000 fistula days). Conclusions The rate of buttonhole-related infections was high among patients on frequent hemodialysis and more than 50 times greater than that among patients on CIHD with the stepladder technique. Most bacteremias were due to S. aureus – with serious consequences. The risks and benefits of buttonhole cannulation require individual consideration with careful monitoring, prophylaxis and management. PMID:25473405

  2. Heterosexual anal sexuality and anal sex behaviors: a review.

    PubMed

    McBride, Kimberly R; Fortenberry, J Dennis

    2010-03-01

    Little research addresses the role of anal sexuality and anal sexual behaviors as a widely practiced but relatively less frequent element of a heterosexual sexual repertoire. However, the importance of anal sex in sexual health is increasingly well-defined by epidemiological and clinical studies. This article reviews existing data on a range of heterosexual anal sex practices and provides conceptual and methodological recommendations for new research. PMID:20358456

  3. Gastrocolic Fistula: A Shortcut through the Gut

    PubMed Central

    Forbes, Nauzer; Al-Dabbagh, Raed; Lovrics, Peter; Morgan, David

    2016-01-01

    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.

  4. Anal itching - self-care

    MedlinePlus

    Anal itching occurs when the skin around your anus becomes irritated. You may feel intense itching around ... Anal itching may be caused by: Spicy foods, caffeine, alcohol, and other irritating foods and beverages Scents ...

  5. Spark Plug Defects and Tests

    NASA Technical Reports Server (NTRS)

    Silsbee, F B; Loeb, L B; Sawyer, L G; Fonseca, E L; Dickinson, H C; Agnew, P G

    1920-01-01

    The successful operation of the spark plug depends to a large extent on the gas tightness of the plug. Part 1 of this report describes the method used for measuring the gas tightness of aviation spark plugs. Part 2 describes the methods used in testing the electrical conductivity of the insulation material when hot. Part 3 describes the testing of the cold dielectric strength of the insulation material, the resistance to mechanical shock, and the final engine test.

  6. [Anal intraepithelial neoplasia].

    PubMed

    de Parades, Vincent; Fathallah, Nadia; Barret, Maximilien; Zeitoun, Jean-David; Lemarchand, Nicolas; Molinié, Vincent; Weiss, Laurence

    2013-01-01

    Anal intraepithelial lesions are caused by chronic infection with oncogenic types of human papillomavirus. Their incidence and prevalence are increasing, especially among patients with HIV infection. Their natural history is not well known, but high-grade intraepithelial lesions seem to have an important risk to progress to squamous cell carcinoma. Their treatment can be achieved by many ways (surgery, coagulation, imiquimod, etc.) but there is a high rate of recurrent lesions. Pretherapeutic evaluation should benefit from high-resolution anoscopy. Periodic physical examination and anal cytology may probably be interesting for screening the disease among patients with risk factors. Vaccine against oncogenic types of papillomavirus may prevent the development of anal intraepithelial neoplasia. PMID:23122632

  7. Plug Loads Conservation Measures

    Energy Science and Technology Software Center (ESTSC)

    2010-12-31

    This software requires inputs of simple plug loads inventory information and calculates the energy and cost benefits of various retrofit opportunities. This tool includes energy conservation measures for: Vending Machine Misers, Delamp Vending Machine, Desktop to Laptop retrofit, CRT to LCD monitors retrofit, Computer Power Management Settings, and Energy Star Refrigerator retrofit. This tool calculates energy savings, demand reduction, cost savings, building life cycle costs including: simple payback, discounted payback, net-present value, and savings tomore » investment ratio. In addition this tool also displays the environmental benefits of a project.« less

  8. Plug Loads Conservation Measures

    SciTech Connect

    Ian Metzger, Jesse Dean

    2010-12-31

    This software requires inputs of simple plug loads inventory information and calculates the energy and cost benefits of various retrofit opportunities. This tool includes energy conservation measures for: Vending Machine Misers, Delamp Vending Machine, Desktop to Laptop retrofit, CRT to LCD monitors retrofit, Computer Power Management Settings, and Energy Star Refrigerator retrofit. This tool calculates energy savings, demand reduction, cost savings, building life cycle costs including: simple payback, discounted payback, net-present value, and savings to investment ratio. In addition this tool also displays the environmental benefits of a project.

  9. Rectal duplications accompanying rectovestibular fistula: report of two cases.

    PubMed

    Pampal, Arzu; Ozbayoglu, Asli; Kaya, Cem; Pehlivan, Yildiz; Poyraz, Aylar; Ozen, I Onur; Percin, Ferda E; Demirogullari, Billur

    2013-08-01

    Rectal duplication (RD) cysts are rare congenital anomalies that can be diagnosed with the presence of another opening in the perineum. They seldom accompany anorectal malformations (ARM). Two cases of RD accompanying ARM at opposite ends of the phenotypic spectrum, are described. A 3-month-old baby and a 2-year-old girl with ARM were scheduled for posterior sagittal anorectoplasty. The infant had an orifice at the anal dimple and the other had an orifice at the vestibulum posterior to the rectovestibular fistula. The infant presented with no other anomalies whereas the older one presented with an unusual coexistence of caudal duplication and caudal regression syndromes. Perioperatively both orifices were found to be related to retrorectal cysts, and were excised. Clinicians should always be alert when dealing with complex malformations. Because these malformations have variable anatomical and clinical presentations, they can represent a diagnostic and therapeutic challenge. PMID:23910814

  10. Diagnosis and Surgical Management of Uroenteric Fistula.

    PubMed

    Gill, Harcharan S

    2016-06-01

    Uroenteric fistulae can occur between any part of the urinary tract and the small and large bowel. Classification is generally based on the organ of origin in the urinary tract and the termination of the fistula in the segment of the gastrointestinal tract. Surgery is often necessary. Congenital fistulae are rare, with most being acquired. Uroenteric fistulae most frequently occur in a setting of inflammatory bowel disease. Imaging often helps in the diagnosis. Management of urinary fistulae includes adequate nutrition, diversion of the urinary tract, diversion of the gastrointestinal tract, treatment of underling inflammatory process or malignancy, and surgery. PMID:27261796

  11. Polysaccharides and bacterial plugging

    SciTech Connect

    Fogler, H.S.

    1991-11-01

    Before any successful application of Microbial Enhanced Oil Recovery process can be realized, an understanding of the cells' transport and retentive mechanisms in porous media is needed. Cell transport differs from particle transport in their ability to produce polysaccharides, which are used by cells to adhere to surfaces. Cell injection experiments have been conducted using Leuconostoc cells to illustrate the importance of cellular polysaccharide production as a transport mechanism that hinders cell movement and plugs porous media. Kinetic studies of the Leuconostoc cells, carried out to further understand the plugging rates of porous media, have shown that the cells' growth rates are approximately equal when provided with monosaccharide (glucose and fructose) or sucrose. The only difference in cell metabolism is the production of dextran when sucrose is supplied as a carbon source. Experimentally it has also been shown that the cells' growth rate is weakly dependent upon the sucrose concentration in the media, and strongly dependent upon the concentration of yeast extract. The synthesis of cellular dextran has been found to lag behind cell generation, thus indicating that the cells need to reach maturity before they are capable of expressing the detransucrase enzyme and synthesizing insoluble dextran. Dextran yields were found to be dependent upon the sucrose concentration in the media. 10 refs., 9 figs., 9 tabs.

  12. Embolotherapy of an Arterioportal Fistula

    SciTech Connect

    Chen, Qi Tack, Carl; Morcos, Morcos; Ruggiero, Mary Ann; Schlossberg, Peter; Fogel, Joshua; Weng Lijun; Farkas, Jeffrey

    2007-09-15

    We present a complex case of a splanchnic arterioportal vein fistula in a patient who presented with weight loss, abdominal pain, diarrhea, and pancreatitis. We report successful use of the Guglielmi Detachable Coil (GDC) and N-butyl cyanoacrylate glue for the therapeutic embolization of the fistula between the superior mesenteric artery, the common hepatic artery, and the portal vein. On the day following the procedure, the patient reported total remission of the abdominal pain and diarrhea. These results were maintained at 3 months follow-up.

  13. Encopresis and anal masturbation.

    PubMed

    Aruffo, R N; Ibarra, S; Strupp, K R

    2000-01-01

    Current pediatric and psychiatric studies on encopresis and its treatment are heavily influenced by mechanical, physiological, and behavioral considerations. Although psychodynamic treatment has generally been considered to be of little benefit, and its findings suspect, the authors suggest that a psychodynamic approach adds substantially to the understanding of some cases of encopresis; that the anal sensations and anal erotic feelings reported by a number of encopretic children are intense, and that the encopretic symptom, soiling, in these children is the result of a conscious form of anal masturbation in which the fecal mass is used for stimulation; and that any study of encopresis is incomplete that does not include what encopretic children, engaged in a sound therapeutic relationship, know and say about their soiling. The authors further suggest that physical treatments of those children whose encopresis is psychologically driven may be contraindicated. The presence of a large stool does not in itself substantiate a physical illness. Further research is needed to elucidate the prevalence of anal masturbation in encopretic children. PMID:11212192

  14. Rotating plug bearing and seal

    DOEpatents

    Wade, Elman E.

    1977-01-01

    A bearing and seal structure for nuclear reactors utilizing rotating plugs above the nuclear reactor vessel. The structure permits lubrication of bearings and seals of the rotating plugs without risk of the lubricant draining into the reactor vessel below. The structure permits lubrication by utilizing a rotating outer race bearing.

  15. Plug Would Collimate X Rays

    NASA Technical Reports Server (NTRS)

    Anders, Jeffrey E.; Adams, James F.

    1989-01-01

    Device creates narrow, well-defined beam for radiographic measurements of thickness. Cylindrical plug collimates and aligns X rays with respect to through holes in parts. Helps in determination of wall thickness by radiography. Lead absorbs X rays that do not pass axially through central hole. Lead/vinyl seals prevent off-axis rays from passing along periphery of plug.

  16. Glovebox plug for glove changing

    DOEpatents

    Carlson, David O.; Shalkowski, Jr., Edward

    1992-01-01

    A plug for use in plugging a glove opening of a glovebox when the glove is eplaced. An inflated inner tube which is retained between flat plates mounted on a threaded rod is compressed in order to expand its diameter to equal that of the inside of the glove opening.

  17. Glovebox plug for glove changing

    SciTech Connect

    Carlson, D.O.; Shalkowski, E. Jr.

    1991-04-05

    This invention is comprised of a plug for use in plugging a glove opening of a glovebox when the glove is replaced. An inflated inner tube which is retained between flat plates mounted on a 05 threaded rod is compressed in order to expand its diameter to equal that of the inside of the glove opening.

  18. Mechanics Model of Plug Welding

    NASA Technical Reports Server (NTRS)

    Zuo, Q. K.; Nunes, A. C., Jr.

    2015-01-01

    An analytical model has been developed for the mechanics of friction plug welding. The model accounts for coupling of plastic deformation (material flow) and thermal response (plastic heating). The model predictions of the torque, energy, and pull force on the plug were compared to the data of a recent experiment, and the agreements between predictions and data are encouraging.

  19. Prevention of anastomotic fistula formation after low-position Dixon Operation

    PubMed Central

    Gao, Feng; Xu, Ming; Song, Feng; Zhang, Xin; Zhao, Yong

    2014-01-01

    Objective: This study aimed to investigate the main points of preventing anastomotic fistula formation after low-position Dixon operation. Methods: From September 2004 to October 2007, our department continuously conducted 146 cases of low-position Dixon operations. The operation mode involved transabdominal radical resection based on total mesorectal excision for all cases. Except for tumor infiltration, one side of the pelvic vegetative nerve was maintained and ligations were conducted at the superior rectal artery root. Mesorectum at the anastomosis site was removed up to the tunica muscularis recti. The anastomotic stoma blood supply was good and had no tension. An anal tube was inserted when the anastomotic stoma was within 3 cm away from the anal margin. For all cases, a presacral drainage tube was placed via the perineal position. Results: For all 146 cases, no anastomotic leakage occurred and the post-operative complications included two cases of anastomotic bleeding, three cases of anastomotic stenoses, 48 cases of increased defecation (4-6 times of defecation daily), 34 cases of anal irritation symptoms, and 6 cases of poor loose stool control capacities. Conclusion: Ensuring enough blood supply for the anastomotic bowel on the two sides, eliminating tension and accurate anastomosis at the anastomosis site could be effective measures to prevent anastomotic fistula in the low position anus preserving surgery of colorectal cancer. PMID:25225516

  20. New technique for the management of vesicorectal fistulas

    SciTech Connect

    Leifer, G.; Jacobs, W.H.

    1988-08-01

    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.

  1. Static Gas-Charging Plug

    NASA Technical Reports Server (NTRS)

    Indoe, William

    2012-01-01

    A gas-charging plug can be easily analyzed for random vibration. The design features two steeped O-rings in a radial configuration at two different diameters, with a 0.050-in. (.1.3-mm) diameter through-hole between the two O-rings. In the charging state, the top O-ring is engaged and sealing. The bottom O-ring outer diameter is not squeezed, and allows air to flow by it into the tank. The inner diameter is stretched to plug the gland diameter, and is restrained by the O-ring groove. The charging port bushing provides mechanical stop to restrain the plug during gas charge removal. It also prevents the plug from becoming a projectile when removing gas charge from the accumulator. The plug can easily be verified after installation to ensure leakage requirements are met.

  2. [Death after anal "fisting"].

    PubMed

    Preuss, Johanna; Strehler, Marco; Dettmeyer, Reinhard; Madea, Burkhard

    2008-01-01

    A 45-year-old homeless woman was found dead at her usual sleeping place. Apart from traces of blood on the lower abdomen of the body, the police investigations did not produce any clues pointing to an unnatural death. At autopsy, it was found, however, that death had been caused by extensive disruptions of the intestine. After being confronted with the results, the sexual partner of the victim admitted manual anal penetration, but claimed that this had been done by mutual agreement. The court did not accept that statement and sentenced him to life imprisonment for murder. The frequency of such fatal outcomes of anal penetration, the relationship between the perpetrator and the victim and the special features at the scene are discussed. PMID:18389861

  3. Management of Complex Perineal Fistula Disease.

    PubMed

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

    2016-06-01

    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

  4. [Magnetic resonance imaging in the exploration of abdominal and anoperineal fistulas in Crohn's disease].

    PubMed

    Boudghène, F; Aboun, H; Grange, J D; Wallays, C; Bodin, F; Bigot, J M

    1993-01-01

    In a twelve month period, ten patients with fistulas related to Crohn's disease were explored by magnetic resonance imaging performed with a high-field supraconductive magnet. This technique demonstrated 3 cases of peri-anal abcesse invisible by other imaging modalities, and in 8 cases, fistules tracts, including 5 complex fistules, and one communicating with the bladder. This examination defined the extension of these lesions relative to the elevator plane, and demonstrated diffusion to the inferior space in 4 cases, to the superior space in 2 cases, and to both spaces in 2 cases. This method seems to be efficacious and does not expose the patient to X-rays. PMID:8330690

  5. Plug cluster module demonstration

    NASA Technical Reports Server (NTRS)

    Rousar, D. C.

    1978-01-01

    The low pressure, film cooled rocket engine design concept developed during two previous ALRC programs was re-evaluated for application as a module for a plug cluster engine capable of performing space shuttle OTV missions. The nominal engine mixture ratio was 5.5 and the engine life requirements were 1200 thermal cycles and 10 hours total operating life. The program consisted of pretest analysis; engine tests, performed using residual components; and posttest analysis. The pretest analysis indicated that operation of the operation of the film cooled engine at O/F = 5.5 was feasible. During the engine tests, steady state wall temperature and performance measurement were obtained over a range of film cooling flow rates, and the durability of the engine was demonstrated by firing the test engine 1220 times at a nominal performance ranging from 430 - 432 seconds. The performance of the test engine was limited by film coolant sleeve damage which had occurred during previous testing. The post-test analyses indicated that the nominal performance level can be increased to 436 seconds.

  6. Guidable pipe plug

    DOEpatents

    Glassell, Richard L.; Babcock, Scott M.; Lewis, Benjamin E.

    2001-01-01

    A plugging device for closing an opening defined by an end of a pipe with sealant comprises a cap, an extension, an inner seal, a guide, and at least one stop. The cap has an inner surface which defines a chamber adapted for retaining the sealant. The chamber is dimensioned slightly larger than the end so as to receive the end. The chamber and end define a gap therebetween. The extension has a distal end and is attached to the inner surface opposite the distal end. The inner seal is attached to the extension and sized larger than the opening. The guide is positioned forward of the inner seal and attached to the distal end. The guide is also dimensioned to be inserted into the opening. The stop is attached to the extender, and when the stop is disposed in the pipe, the stop is movable with respect to the conduit in one direction and also prevents misalignment of the cap with the pipe. A handle can also be included to allow the cap to be positioned robotically.

  7. Screening for Anal Cancer in Women

    PubMed Central

    Moscicki, Anna-Barbara; Darragh, Teresa M.; Berry-Lawhorn, J. Michael; Roberts, Jennifer Margaret; Khan, Michelle J.; Boardman, Lori A.; Chiao, Elizabeth; Einstein, Mark H.; Goldstone, Stephen E.; Jay, Naomi; Likes, Wendy M.; Stier, Elizabeth A.; Welton, Mark Lane; Wiley, Dorothy J.; Palefsky, Joel M.

    2015-01-01

    Objective The incidence of anal cancer is higher in women than men in the general population and has been increasing for several decades. Similar to cervical cancer, most anal cancers are associated with human papillomavirus (HPV) and it is believed that anal cancers are preceded by anal high-grade squamous intraepithelial lesions (HSIL). Our goal was to summarize the literature on anal cancer, HSIL and HPV infection in women, and provide screening recommendations in women. Methods A group of experts convened by the ASCCP and the International Anal Neoplasia Society reviewed the literature on anal HPV infection, anal SIL and anal cancer in women. Results Anal HPV infection is common in women but is relatively transient in most. The risk of anal HSIL and cancer varies considerably by risk group, with HIV-infected women and those with a history of lower genital tract neoplasia (LGTN) at highest risk compared with the general population. Conclusions While there are no data yet to demonstrate that identification and treatment of anal HSIL leads to reduced risk of anal cancer, women in groups at the highest risk should be queried for anal cancer symptoms and have digital anorectal examinations to detect anal cancers. HIV-infected women and women with LGTN, may be considered for screening with anal cytology with triage to treatment if HSIL is diagnosed. Healthy women with no known risk factors or anal cancer symptoms do not need to be routinely screened for anal cancer or anal HSIL. PMID:26103446

  8. Do We Know What Causes Anal Cancer?

    MedlinePlus

    ... anal cancer be prevented? Do we know what causes anal cancer? Researchers have found some risk factors that increase ... now being done to learn how HPV might cause anal cancer. There is good evidence that HPV causes many ...

  9. Bilorrhea secondary to bronchobiliary fistula.

    PubMed

    Olivencia-Yurvati, A H; Rollins, Christine

    2014-01-01

    Bronchobiliary fistula (BBF) is a rare condition which occurs most commonly as a complication of hydatid cyst liver disease. The following report describes a patient who presented with biliptysis 6 months following decortication of an empyema that had occurred following partial hepatectomy of a colon cancer metastasis. This is the only case to our knowledge that describes the presentation of a BBF in this context. The patient was diagnosed with BBF and successfully underwent open thoracotomy for fistulectomy and repair. PMID:25058780

  10. Perilymph Fistula: Rare but Real

    PubMed Central

    Gleeson, Susan E.; Williams, D. Malcolm

    1989-01-01

    Although perilymph fistula is a rare diagnosis, it is important that family physicians be aware of the signs and symptoms that suggest its presence. When a patient develops sudden loss of hearing and/or vestibular dysfunction after experiencing trauma to the head or ears, after barotrauma, or after performing a vigorous Valsalva manoeuvre, he should be referred promptly to an otolaryngologist for assessment and proper management of the condition. ImagesFigure 1 PMID:21249027

  11. The epidemiology of anal incontinence and symptom severity scoring

    PubMed Central

    Nevler, Avinoam

    2014-01-01

    For many patients, anal incontinence (AI) is a devastating condition that can lead to social isolation and loss of independence, contributing to a substantial economic health burden, not only for the individual but also for the allocation of healthcare resources. Its prevalence is underestimated because of poor patient reporting, with many unrecorded but symptomatic cases residing in nursing homes. Endosonography has improved our understanding of the incidence of post-obstetric sphincter tears that are potentially suitable for repair and those cases resulting from anorectal surgery, most notably after fistula and hemorrhoid operations. The clinical scoring systems assessing the severity of AI are discussed in this review, along with their limitations. Improvements in the standardization of these scales will advance our understanding of treatment response in an era where the therapeutic options have multiplied and will permit a better comparison between specific therapies. PMID:24759339

  12. Initial clinical use of a novel mechanical thrombectomy device, XCOIL™, in hemodialysis graft and fistula declot procedures

    PubMed Central

    Monsky, Wayne L.; Latchaw, Richard E.

    2016-01-01

    PURPOSE We aimed to evaluate the safety and effectiveness of a novel catheter-based mechanical thrombectomy device, XCOIL™, as a first line therapy to restore patency of thrombosed dialysis grafts and fistulae. METHODS In 2010, 18 consecutive/sequential patients (11 male, 7 female; median age, 52 years; age range, 32–69 years) with occluded arteriovenous grafts (n=15) or fistulae (n=3) were treated with XCOIL™ (NexGen Medical Systems Inc.) without adjunctive thrombolytic drugs. XCOIL™ was advanced distal to the thrombus within the outflow vein as well as distal to the arterial inflow platelet thrombin plug, using a 4F angiographic catheter. The percentage of thrombus cleared, primary patency, procedure time, and XCOIL™ performance were documented. RESULTS Thrombosis occurred 1–30 days prior to the procedure. Thrombosed segments of graft/fistula measured 10–50 cm. Pre- and postprocedure angiography demonstrated that in 15 of 18 cases (83%) XCOIL™ removed 80%–100% of the venous outflow thrombus. In 11 of 14 cases (79%), the platelet thrombin plug was also removed. Thrombectomy procedure time averaged 8 min, with one to three passes with the XCOIL™ required. No evidence of distal embolization or graft/vessel injury was found on angiography following clot removal. In four cases in whom patency was not restored with XCOIL™, subsequent use of other clot removal devices also failed to restore patency. In one case with severe venous stenosis, the device failed to deploy and the thrombus was not captured. No intraprocedural complications related to XCOIL™ use occurred. CONCLUSION XCOIL™ is an effective and safe first-line therapy option for the treatment of thrombosed hemodialysis grafts/fistulae. Rapid removal of intact thrombus and platelet thrombin plug can be achieved without adjunctive thrombolytics. PMID:27015445

  13. Improved plug valve computer-aided design of plug element

    SciTech Connect

    Wordin, J.J.

    1990-02-01

    The purpose of this document is to present derivations of equations for the design of a plug valve and to present a computer program which performs the design calculations based on the derivations. The valve is based on a plug formed from a tractrix of revolution called a pseudosphere. It is of interest to be able to calculate various parameters for the plug for design purposes. For example, the surface area, volume, and center of gravity are important to determine friction and wear of the valve. A computer program in BASIC has been written to perform the design calculations. The appendix contains a computer program listing and verifications of results using approximation methods. A sample run is included along with necessary computer commands to run the program. 1 fig.

  14. Computed tomography demonstration of cholecystogastric fistula.

    PubMed

    Chou, Chung Kuao

    2016-06-01

    Cholecystogastric fistula is a rare complication of chronic cholecystitis or long-standing cholelithiasis. It results from the gradual erosion of the approximated, chronically inflamed wall of the gall bladder and stomach with fistulous tract formation. The present case describes the direct visualization of a cholecystogastric fistula by computed tomography in a patient without prior biliary system complaints. PMID:27257453

  15. Duodenocaval fistula: case report and literature review

    SciTech Connect

    Rheudasil, J.M.; Chuang, V.P.; Amerson, J.R.

    1988-03-01

    Duodenocaval fistulae are rare but may well be the source of gastrointestinal hemorrhage with associated sepsis in patients undergoing surgery and subsequently receiving radiation to the right upper abdomen. Management of these fistulae may be challenging. Diagnosis usually requires a high index of suspicion, particularly in post irradiated patients.

  16. Idiopathic Aortic Root to Right Atrial Fistula.

    PubMed

    Campisi, Salvatore; Cluzel, Armand; Vola, Marco; Fuzellier, Jean Francois

    2016-06-01

    An aorta to right atrium fistula is rare. We report a case of idiopathic aortic root to right atrial fistula with right heart failure and review the literature. doi: 10.1111/jocs.12751 (J Card Surg 2016;31:373-375). PMID:27109166

  17. [AORTOENTERIC FISTULA, A POOR PROGNOSIS FINDING].

    PubMed

    Benoit, A; Thai, M; Medart, L; Desiron, Q; Fraipont, V

    2016-05-01

    We report the case of a patient admitted with upper gastrointestinal bleeding. The CT scan revealed an aorto-duodenal fistula. This case highlights the progression of radiological imaging in parallel with the clinical course. We take this opportunity to write a brief literature review mainly focused on the description and diagnostic modalities of aortoenteric fistulas. PMID:27337841

  18. Arterio-Ureteric Fistula Following Iliac Angioplasty

    SciTech Connect

    Aarvold, Alexander; Wales, Lucy Papadakos, Nikolaos; Munneke, Graham; Loftus, Ian; Thompson, Matt

    2008-07-15

    Arterio-ureteric fistulae are rare but can be associated with significant morbidity and mortality. We describe a novel case in which an arterio-ureteric fistula occurred as a complication following external iliac artery angioplasty and stenting, in a patient who had undergone previous pelvic surgery, radiotherapy, ureteric stenting, and urinary diversion surgery. Prompt recognition enabled successful endovascular management using a covered stent.

  19. Physiologic assessment of coronary artery fistula

    SciTech Connect

    Gupta, N.C.; Beauvais, J. )

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.

  20. Anal adenocarcinoma complicating chronic Crohn’s disease

    PubMed Central

    Papaconstantinou, Ioannis; Mantzos, Dionysios S.; Kondi-Pafiti, Agathi; Koutroubakis, Ioannis E.

    2015-01-01

    Introduction Colorectal adenocarcinoma and Crohn’s disease are known to be associated entities. However, a carcinoma arising within a chronic perianal fistulous tract in a patient with Crohn’s disease is a rare complication. Presentation of case We present a case of a 40-year-old male patient with a long-standing perianal Crohn’s disease who developed an anal mucinous adenocarcinoma within the fistulous tracts. Discussion Although, Crohn’s disease and colorectal carcinoma association is well established, few cases have been reported where the cancer has originated within a perianal fistula. Constant mucosal regeneration occurring within a fistula seems to be the predominant pathogenetic mechanism, while immunosuppressants and anti-TNF agents may also contribute to the malignant transformation. Unfortunately, the lack of suspicion and the inadequate physical examination or colonoscopy due to exacerbation of the perianal symptoms could lead to delayed diagnosis; and thus, a poor prognosis. Conclusion Albeit a rare complication, clinicians should maintain a high degree of vigilance about the possible development of adenocarcinoma in patients with long-standing perianal Crohn’s disease. Thus, these patients should be kept under regular surveillance with examination under anaesthesia and biopsies or curettage of the tracts. PMID:25884608

  1. Can Anal Cancer Be Found Early?

    MedlinePlus

    ... Next Topic Signs and symptoms of anal cancer Can anal cancer be found early? Many anal cancers can be found early in the course of the ... they reach an advanced stage. Other anal cancers can cause symptoms like those of diseases other than ...

  2. Tracheoinnominate artery fistula following tracheostomy.

    PubMed

    Keçeligil, H T; Erk, M K; Kolbakir, F; Yildirim, A; Yilman, M; Unal, R

    1995-10-01

    Tracheoinnominate artery fistula is a relatively rare but highly lethal complication occurring in patients with long-standing tracheostomies. Early evaluation of this problem and prompt aggressive therapy are necessary. When massive haemorrhage begins, immediate arterial compression, control of the airway and subsequent treatment of the injured artery may be lifesaving. Immediate surgical exploration through a median sternotomy is necessary to control the proximal and distal innominate artery. After the damaged artery has been excised, vascular reconstruction can be performed to preserve the connection between the proximal and distal ends of the innominate artery. A pedicled pericardial patch was successfully used for the tracheal reconstruction. PMID:8574535

  3. Black Anal Canal: Acute Necrosis

    PubMed Central

    Martins, Catarina; Gonçalves, Cláudia; Alves, Paulo; Gil, Inês; Canhoto, Manuela; Silva, Filipe; Cotrim, Isabel; Amado, Cristina; Eliseu, Liliana; Vasconcelos, Helena

    2016-01-01

    Acute ischemia of the rectum or anal canal resulting in necrosis is extremely uncommon because both the rectum and the anal canal have excellent blood supplies. We present a case with spontaneous necrosis of the anal canal without rectal involvement. Surgical debridement was accomplished, and the recovery was uneventful. The patient was elderly, with probable atherosclerotic arterial disease, and presented with hypotension. Due to the lack of other precipitating factors, the hypoperfusion hypothesis seems to be the most suitable in this case. To the best of our knowledge, no similar cases have been reported in the literature on this subject.

  4. Craniosynostosis, anal anomalies, and porokeratosis (CDAGS syndrome): case report and literature review.

    PubMed

    Chouery, Eliane; Guissart, Claire; Mégarbané, Hala; Aral, Bernard; Nassif, Charbel; Thauvin-Robinet, Christel; Faivre, Laurence; Mégarbané, André

    2013-12-01

    CDAGS syndrome is an autosomal recessive syndrome characterized by craniosynostosis, large open fontanelles, hearing loss, anal anomalies, genitourinary malformations and porokeratosis. To our knowledge, only four families from different geographic regions and ethnic backgrounds have been reported until now and no molecular defect has been identified. Here we report two sisters presenting with craniosynostosis, microcephaly, short downslanting palpebral fissures, sparse hair, eyelashes, and eyebrows and porokeratosis that appeared at the age of one month. The youngest sister had an imperforate anus with rectoperineal fistula. Array-CGH did not reveal any pathological CNV. Molecular analysis of the c16orf57, RECQL4 and MCM5 genes was normal. PMID:24095818

  5. Saphenofemoral arteriovenous fistula as hemodialysis access

    PubMed Central

    2010-01-01

    Background An upper limb arteriovenous (AV) fistula is the access of choice for haemodialysis (HD). There have been few reports of saphenofemoral AV fistulas (SFAVF) over the last 10-20 years because of previous suggestions of poor patencies and needling difficulties. Here, we describe our clinical experience with SFAVF. Methods SFAVFs were evaluated using the following variables: immediate results, early and late complications, intraoperative and postoperative complications (up to day 30), efficiency of the fistula after the onset of needling and complications associated to its use. Results Fifty-six SFAVF fistulas were created in 48 patients. Eight patients had two fistulas: 8 patent (16%), 10 transplanted (20%), 12 deaths (24%), 1 low flow (2%) and 20 thrombosis (39%) (first two months of preparation). One patient had severe hypotension during surgery, which caused thrombosis of the fistula, which was successfully thrombectomised, four thrombosed fistulae were successfully thrombectomised and revised on the first postoperative day. After 59 months of follow-up, primary patency was 44%. Conclusion SFAVF is an adequate alternative for patients without the possibility for other access in the upper limbs, allowing efficient dialysis with good long-term patency with a low complication rate. PMID:20955561

  6. Anal Pap smears and anal cancer: what dermatologists should know.

    PubMed

    Liszewski, Walter; Ananth, Amy T; Ploch, Lauren E; Rogers, Nicole E

    2014-11-01

    Squamous epithelial cells are susceptible to infection by the human papillomavirus. Infection of squamous epithelium with oncogenic human papillomavirus types is associated with development of dysplasia and potential malignant transformation. Historically, cervical cancer has been the most prevalent human papillomavirus-induced squamous neoplasia. However, because of widespread screening via Pap smear testing, rates of cervical cancer in the United States have decreased dramatically during the past 50 years. Rates of anal cancer, in contrast, have doubled during the past 30 years. The groups at highest risk for development of anal cancer are men who have sex with men, HIV-positive patients, and patients immunosuppressed as a result of solid-organ transplantation. By detecting dysplasia before it develops into invasive cancer, anal Pap smears may be a potentially useful screening tool for anal cancer, particularly in individuals known to be at increased risk. However, at this time, sufficient data supporting the benefit of anal Pap smear screening are lacking. With insufficient evidence, no national health care organizations currently recommend the use of anal Pap smears as a routine screening test, even among high-risk groups. PMID:25088812

  7. Endotherapy of leaks and fistula

    PubMed Central

    Goenka, Mahesh Kumar; Goenka, Usha

    2015-01-01

    Perforations, leaks and fistula involving gastrointestinal (GI) tract are increasing encountered in clinical practice. There is a changing paradigm for their management with surgical approach being replaced by conservative approach including endoscopic therapy. Clips (through the scope and over the scope) and covered stent are front runners for endotherapy for GI leaks and fistula. Over the scope clips introduced recently, can treat larger defects compared to through the scope clips. Covered stents are suited for larger defects and those associated with luminal narrowing. However cervical esophagus, gastro-esophageal junction, stomach and right colonic lesions may be better for clip therapy rather than stenting. Recent developments in this field include use of endovac therapy which consists of a sponge with suction device, biodegradable stent, use of fibrin glue and some endo-suturing device. Conservative therapy with no surgical or endoscopic intervention, may be suitable for a small subset of patients. An algorithm based on location, size of defect, associated stricture, infection and available expertise needs to be developed to reduce the mortality and morbidity of this difficult clinical problem. PMID:26140097

  8. Mayer-Rokitansky-Kuster-Hauser syndrome and anal canal stenosis: case report and review of literature.

    PubMed

    Joshi, Milind; Singh, Sangram; Vyas, Tanmay; Chourishi, Vighya; Jain, Anvesh

    2010-12-01

    Mayer-Rokitansky-Kuster-Hauser (MRKH) is a characteristic syndrome in which the mullerian structures are absent or rudimentary. It is also associated with anomalies of the genitourinary and skeletal systems. There are very few cases reported regarding its association with anorectal malformations, particularly perineal fistulas. To the best of our knowledge, there have not been any reported cases of anal canal stenosis in patients with MRKH. We describe a very rare association of MRKH with anal canal stenosis and multiple renal calculi. The patient underwent corrective surgery for the anomalies and removal of renal calculi. She has been under regular follow-up for the last few months and is doing well. PMID:21129528

  9. The changing face of obstetric fistula surgery in Ethiopia

    PubMed Central

    Wright, Jeremy; Ayenachew, Fekade; Ballard, Karen D

    2016-01-01

    Objective To examine the incidence and type of obstetric fistula presenting to Hamlin Fistula Ethiopia over a 4-year period. Study design This is a 4-year retrospective survey of obstetric fistula treated at three Hamlin Fistula Hospitals in Ethiopia, where approximately half of all women in the country are treated. The operation logbook was reviewed to identify all new cases of obstetric fistula presenting from 2011 to 2015. New cases of urinary fistula were classified by fistula type (high or low), age, and parity of the woman. Results In total, 2,593 new cases of urinary fistulae were identified in the study period. The number of new cases fell by 20% per year over the 4 years (P<0.001). A total of 1,845 cases (71.1%) were low (ischemic) fistulae, and 804 cases (43.6%) of these had an extreme form of low circumferential fistula. A total of 638 (24.6%) women had a high bladder fistula, which predominantly occurs following surgery, specifically cesarean section or emergency hysterectomy, and 110 (4.2%) women had a ureteric fistula. The incidence of high fistulae increased over the study period from 26.9% to 36.2% (P<0.001). A greater proportion of multiparous women had a high bladder fistula (70.3%) compared with primigravid women (29.7%) (P<0.001). Conversely, a greater proportion of primiparous women experienced a low circumferential fistulae (68.6%) compared with multiparous women (31.4%) (P<0.001). Conclusion There appears to be a decline in the number of Ethiopian women being treated for new obstetric urinary fistulae. However, the type of fistula being presented for treatment is changing, with a rise in high fistulae that very likely occurred following cesarean section and a decline in the classic low fistulae that arise following obstructed childbirth. PMID:27445505

  10. Post-traumatic recto-spinal fistula.

    PubMed

    Lantsberg, L; Laufer, L; Greenberg, G; Hertzanu, Y

    2000-01-01

    Acquired recto-spinal fistula has been described elsewhere as a rare complication of colorectal malignancy and Crohn's enterocolitis. We treated a young man who developed a recto-spinal fistula as a result of a high fall injury. The patient presented with meningeal signs, sepsis and perianal laceration. Computerized axial tomography revealed air in the supersellar cistern. Gastrografin enema showed that contrast material was leaking from the rectum into the spinal canal. Surgical management included a diverting sigmoid colostomy, sacral bone curettage and wide presacral drainage. To the best of our knowledge, rectospinal fistula of traumatic origin has not been previously reported in the English literature. PMID:10663732

  11. [Vesicovaginal fistula in Africa. 230 cases].

    PubMed

    Falandry, L

    1992-02-15

    The author reports 230 cases of vesico-vaginal fistula taken from a series of 271 obstetrical fistulae treated by the same operator. The fistula was obstetrical in most cases (93 percent), occurring in young women and primiparas. Associated lesions (urethro-vaginal, recto-vaginal and perineal) were observed in 23.4 percent of the patients. Also studied were 7 pure urethro-vaginal fistulae and 2 urethro-vesical fistulae. Surgical treatment, usually (85.6 percent) through the lower route, consisted of closing the orifice of the fistula by simple separate sutures performed on the bladder and the vagina (Chassar Moir) in 95 cases. A filler tissue, a muscular and fatty pedicle flap (Martius technique), was used in 55 cases. Complementary techniques were considered indispensable in 49 cases. Eighteen patients underwent palliative surgery. Among 230 fistula patients whose postoperative follow-up ranged from 6 months to 1 year, 180 (80 percent) were considered cured (no incontinence and recovery of mictional function), and 17 were considered partially cured (sphincteral leakage during efforts); there were 29 failures. Far from being eradicated in Africa, vesico-vaginal fistulae continue to be one of the major public health problems, with an average annual prevalence of 2 percent. This critical situation is due to different social, economic, traditional and cultural factors which stay firmly inalterable. There is a need for a fistula management strategy based on a classification of the lesions encountered to increase the chances of success. The author describes the main prognostic and therapeutic groups: simple fistulae where success was obtained as a rule (group I, 33 percent of the cases in this series); difficult fistulae (group II, 43 percent), with the dual problem of attaining watertightness and healing, where the support of a well-vascularized filler tissue has proved necessary (Martius); complex fistulae (group III, 23.9 percent), where the associated lesions call

  12. [HPV-induced anal lesions].

    PubMed

    Wieland, U; Kreuter, A

    2015-06-01

    Human papillomavirus (HPV) infections belong to the most common sexually transmitted infections. To date, more than 200 completely classified HPV-types have been reported, and those belonging to the genus alpha predominantly infect the anogenital region. Condylomata acuminata are caused by the two low-risk types HPV6 and HPV11 in more than 90 % of cases. Treatment of genital warts might be either ablative (e.g. electrocautery, surgical excision, or laser therapy) or topical (e.g. podophyllotoxine, trichloroacetic acid, or imiquimod), and depends on the size, location, morphology and anatomical region. Recurrences after treatment are frequent. Therefore, combination therapies (e.g. topical and ablative) play an important role in daily routine. HIV-infected individuals, especially HIV-positive MSM, have a strongly increased risk for anal dysplasia and anal cancer. Condylomata acuminata and a large proportion of anal dysplasia and anal carcinoma are preventable by prophylactic HPV-vaccination. PMID:25859930

  13. Electrocautery for Precancerous Anal Lesions

    Cancer.gov

    Results from a randomized clinical trial conducted in Amsterdam suggest that electrocautery is better than topical imiquimod or fluorouracil at treating potentially precancerous anal lesions in HIV-positive men who have sex with men.

  14. A Minimally Invasive Approach for Postoperative Pancreatic Fistula

    SciTech Connect

    Yamazaki, Shintaro Kuramoto, Kenmei; Itoh, Yutaka; Watanabe, Yoshika; Ueda, Toshisada

    2003-11-15

    Pancreas fistula is a well-known and severe complication of pancreaticoduodenectomy. It is difficult to control with conservative therapy, inducing further complications and severe morbidity. Until now, re-operation has been the only way to resolve pancreatic fistula causing complete dehiscence of the pancreatic-enteric anastomosis (complete pancreatic fistula). Percutaneous transgastric fistula drainage is one of the treatments for pancreatic fistula. This procedure allows both pancreas juice drainage and anastomosis re-construction at the same time. This is effective and minimally invasive but difficult to adapt to a long or complicated fistula. In particular, dilatation of the main pancreatic duct is indispensable. This paper reports the successful resolution of a postoperative pancreatic fistula by a two-way-approach percutaneous transgastric fistula drainage procedure. Using a snare catheter from the fistula and a flexible guidewire from the transgastric puncture needle, it can be performed either with or without main pancreatic duct dilatation.

  15. Hot cell shield plug extraction apparatus

    DOEpatents

    Knapp, Philip A.; Manhart, Larry K.

    1995-01-01

    An apparatus is provided for moving shielding plugs into and out of holes in concrete shielding walls in hot cells for handling radioactive materials without the use of external moving equipment. The apparatus provides a means whereby a shield plug is extracted from its hole and then swung approximately 90 degrees out of the way so that the hole may be accessed. The apparatus uses hinges to slide the plug in and out and to rotate it out of the way, the hinge apparatus also supporting the weight of the plug in all positions, with the load of the plug being transferred to a vertical wall by means of a bolting arrangement.

  16. CT in the diagnosis of enterovesical fistulae

    SciTech Connect

    Goldman, S.M.; Fishman, E.K.; Gatewood, O.M.B.; Jones, B.; Siegelman, S.S.

    1985-06-01

    Enterovesical fistulae are difficult to demonstrate by conventional radiographic methods. Computed tomography (CT), a sensitive, noninvasive method of documenting the presence of such fistulae, is unique in its ability to outline the extravesical component of the primary disease process. Twenty enterovesical fistulae identified by CT were caused by diverticulitis (nine), carcinoma of the rectosigmoid (two), Crohn disease (three), gynecologic tumors (two), bladder cancer (one), cecal carcinoma (one), prostatic neoplasia (one), and appendiceal abscess (one). The CT findings included intravesical air (90%), passage of orally or rectally administered contrast medium into the bladder (20%), focal bladder-wall thickening (90%), thickening of adjacent bowel wall (85%), and an extraluminal mass that often contained air (75%). CT proved to be an important new method in the diagnosis of enterovesical fistulae.

  17. Benign Duodenocolic Fistula: a Case Report.

    PubMed

    Soheili, Marzieh; Honarmand, Shirin; Soleimani, Heshmatollah; Elyasi, Anvar

    2015-08-01

    Benign duodenocolic fistula (DCF), known as a fistula between the duodenum and colon with or without cecum of nonmalignant origin, is an unusual complication of different gastrointestinal diseases. The present paper records a case in which the patient presented with chronic diarrhea, abdominal pain, weight loss as well as having a history of gastric ulcer. Most frequently the condition presents with signs of malabsorption such as weight loss and diarrhea, but other symptoms include nausea, vomiting (sometimes with fecal), and abdominal pain. Gastrointestinal inflammatory conditions are the usual causes. The most common ones are perforated duodenal ulcer and Crohn's disease. Barium enemas are usually diagnostic. Treatment consists of excising the fistula and repairing the duodenal and colonic defects. Closure of the fistula provides quick relief. PMID:26545997

  18. Enterocutaneous Fistula: Proven Strategies and Updates.

    PubMed

    Gribovskaja-Rupp, Irena; Melton, Genevieve B

    2016-06-01

    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

  19. Clinical Characteristics of Odontogenic Cutaneous Fistulas

    PubMed Central

    Lee, Eun-Young; Kang, Ji-Yeon; Kim, Kyung-Won; Choi, Ki Hwa; Yoon, Tae Young

    2016-01-01

    Background Odontogenic cutaneous fistula appears as dimpling or a nodule with purulent discharge, usually in the chin or jaw. Affected patients usually seek help from dermatologists or surgeons rather than from dentists. However, clinical symptoms of facial skin fistula without dental problems can lead to misdiagnosis. Objective The purpose of this study was to investigate the clinical characteristics of patients with odontogenic cutaneous fistulas. Methods This retrospective observational study was performed at Chungbuk National University Hospital by analyzing patients who visited from April 1994 to September 2014. Following clinical and radiographic examinations, the paths and origins of sinus fistulas were determined. Investigated factors were gender, age, morphology, location, originating tooth, time to evolution, recurrence, and treatment method. Results Thirty-three patients (22 males, 11 females; average age 49.2 years) were examined during the investigation period. Thirty-four fistulas were diagnosed as odontogenic cutaneous fistulas. The most common morphology was dimpling (n=14, 41.2%). The various locations observed were related to the originating tooth. The most common site was the mandibular body related to mandibular molars. The referral clinical diagnosis was of odontogenic origin in 6 cases (18.2%). The majority of patients had experienced recurrence after treatment in previous clinics that had failed to diagnose odontogenic cutaneous fistula. Surgical fistulectomy and/or tooth treatment were performed in all cases. All patients were followed-up for 1 year. None showed signs of recurrence. Conclusion Extraoral and dental examinations are required to make a diagnosis of odontogenic cutaneous fistula. Thus, cooperation between dermatologists and dentists is essential. PMID:27489421

  20. Acquired tracheoesophageal fistula in infancy and childhood.

    PubMed

    Szold, A; Udassin, R; Seror, D; Mogle, P; Godfrey, S

    1991-06-01

    Acquired tracheoesophageal fistula (TEF) is a rare entity in the pediatric age group. We report two pediatric patients with acquired TEF caused by shells of pistachio nuts. In both patients the primary operation did not resolve the problem and a second intervention for recurrent fistula was needed. The special nature of acquired TEF, particularly the one described herein, requires delayed surgical intervention and meticulous separation of the respiratory and alimentary tracts by an intercostal muscle flap. PMID:1941455

  1. Sphincteroplasty for anal incontinence

    PubMed Central

    Pescatori, Lorenzo Carlo; Pescatori, Mario

    2014-01-01

    Sphincteroplasty (SP) is the operation most frequently performed in patients suffering from moderate-to-severe anal incontinence (AI) who do not respond to conservative treatment. Other costly surgeries, such as artificial bowel sphincter (ABS) and electro-stimulated graciloplasty, have been more or less abandoned due to their high morbidity rate. Minimally invasive procedures are widely used, such as sacral neuromodulation and injection of bulking agents, but both are costly and the latter may cure only mild incontinence. The early outcome of SP is usually good if the sphincters are not markedly denervated, but its effect diminishes over time. SP is more often performed for post-traumatic than for idiopathic AI. It may also be associated to the Altemeier procedure, aimed at reducing the recurrence rate of rectal prolapse, and may be useful when AI is due either to injury to the sphincter, or to a narrowed rectum following the procedure for prolapse and haemorrhoids (PPH) and stapled transanal rectal resection (STARR). The outcome of SP is likely to be improved with biological meshes and post-operative pelvic floor rehabilitation. SP is more effective in males than in multiparous women, whose sphincters are often denervated, and its post-operative morbidity is low. In conclusion, SP, being both low-cost and safe, remains a good option in the treatment of selected patients with AI. PMID:24759337

  2. Three Distinct Urethral Fistulae 35 Years After Pelvic Radiation

    PubMed Central

    Sharma, Arindam; Kurtz, Michael P.; Eswara, Jairam R.

    2014-01-01

    Introduction: While the development of fistulae is a well-known complication of radiotherapy, such fistulae can often be challenging to manage. Case Presentation: We describe the case of a 37 year old male who developed in succession a urethrocutaneous fistula to the thigh, a rectourethral fistula and a peritoneo-urethral fistula 35 years after radiotherapy for pediatric pelvic rhabdomyosarcoma. These complications were managed successfully after multiple surgical procedures. Discussion: We subsequently discuss the different approaches currently employed for the management of radiation induced urinary fistulas and describe the rationale behind our approach towards their surgical management. PMID:24783170

  3. Congenital lacrimal fistula: A major review.

    PubMed

    Chaung, Jia Quan; Sundar, Gangadhara; Ali, Mohammad Javed

    2016-08-01

    The purpose of this article is to review and summarize the etiopathogenesis, symptomatology, systemic associations, management, complications and clinical outcomes of congenital lacrimal fistulae. The authors performed an electronic database (PubMed, MEDLINE, EMBASE and Cochrane Library) search of all articles published in English on congenital lacrimal fistulae. Congenital subsets of patients from series of mixed lacrimal fistulae were included in the review. These articles were reviewed along with their relevant cross-references. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. The prevalence of congenital lacrimal fistulae is reported to be around 1 in 2000 live births. They are frequently unilateral, although familial cases tend to be bilateral. Lacrimal and systemic anomalies have been associated with lacrimal fistulae. Exact etiopathogenesis is unknown but mostly believed to be an accessory out budding from the lacrimal drainage system during embryogenesis. Treatment is indicated when significant epiphora or discharge is present and is mostly achieved by various fistulectomy techniques with or without a dacryocystorhinostomy. Congenital lacrimal fistulae are a distinct clinical entity with unique features. Surgical management can be challenging and successful outcomes are usually achieved with widely accepted protocols. PMID:27191932

  4. Hemodynamic Simulations in Dialysis Access Fistulae

    NASA Astrophysics Data System (ADS)

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

    2010-11-01

    Arteriovenous fistulae are created surgically to provide adequate access for dialysis in patients with End-Stage Renal Disease. It has long been hypothesized that the hemodynamic and mechanical forces (such as wall shear stress, wall stretch, or flow- induced wall vibrations) constitute the primary external influence on the remodeling process. Given that nearly 50% of fistulae fail after one year, understanding fistulae hemodynamics is an important step toward improving patency in the clinic. We perform numerical simulations of the flow in patient-specific models of AV fistulae reconstructed from 3D ultrasound scans with physiologically-realistic boundary conditions also obtained from Doppler ultrasound. Comparison of the flow features in different geometries and configurations e.g. end-to-side vs. side-to-side, with the in vivo longitudinal outcomes will allow us to hypothesize which flow conditions are conducive to fistulae success or failure. The flow inertia and pulsatility in the simulations (mean Re 700, max Re 2000, Wo 4) give rise to complex secondary flows and coherent vortices, further complicating the spatio- temporal variability of the wall pressure and shear stresses. Even in mature fistulae, the anastomotic regions are subjected to non-physiological shear stresses (>10.12pcPa) which may potentially lead to complications.

  5. SAMI Automated Plug Plate Configuration

    NASA Astrophysics Data System (ADS)

    Lorente, N. P. F.; Farrell, T.; Goodwin, M.

    2013-10-01

    The Sydney-AAO Multi-object Integral field spectrograph (SAMI) is a prototype wide-field system at the Anglo-Australian Telescope (AAT) which uses a plug-plate to mount its 13×61-core imaging fibre bundles (hexabundles) in the optical path at the telescope's prime focus. In this paper we describe the process of determining the positions of the plug-plate holes, where plates contain three or more stacked observation configurations. The process, which up until now has involved several separate processes and has required significant manual configuration and checking, is now being automated to increase efficiency and reduce error. This is carried out by means of a thin Java controller layer which drives the configuration cycle. This layer controls the user interface and the C++ algorithm layer where the plate configuration and optimisation is carried out. Additionally, through the Aladin display package, it provides visualisation and facilitates user verification of the resulting plates.

  6. Halliburton Composite Bridge Plug Assembly

    SciTech Connect

    Starbuck, J.M.; Luttrell, C.R.; Aramayo, G.

    2005-01-15

    The overall objectives of this CRADA were to assist Halliburton in analyzing a composite bridge plug and to determine why their original design was failing in the field. In Phase 1, finite element analyses were done on the original composite slip design and several alternative designs. The composite slip was the component in the bridge plug that was failing. The finite element code ABAQUS was used for these calculations and I-DEAS was used as the pre- and post-processor in the analyses. Several different designs and materials were analyzed and recommendations were made towards improving the design. In Phase 2, the objective was to develop finite element models that would accurately represent the deformations in the entire all-composite 4-1/2' diameter bridge plug assembly. The finite element code LS-DYNA was used and the results from this effort were intended to expand Halliburton's composite design and analysis capabilities with regard to developing future composite components for downhole tools. In addition to the finite element modeling, this effort involved the utilization of micromechanics to determine the necessary composite material properties that were needed as input for finite element codes.

  7. Bilateral pulmonary arteriovenous fistulae treated with balloon embolization.

    PubMed Central

    Kumar, S.; Ruttley, M. J.; Fisher, D. J.

    1986-01-01

    A patient with bilateral pulmonary arteriovenous fistulae is described who was treated successfully by embolization of the two fistulae with detachable balloons introduced percutaneously through the femoral vein. Images Figure 1 Figure 2 Figure 3 PMID:3714608

  8. Chronic utero-rectal fistula with menochezia and amenorrhea.

    PubMed

    Pinto, P; Sharma, L; Kini, P

    1990-09-01

    Utero-intestinal fistulas are commonly acute in nature and usually follow malignancies of the intestines. Here we report a chronic uterorectal fistula with uncommon symptom of cyclical rectal bleeding (menochezia) and amenorrhea. PMID:1974538

  9. Modified prosthesis for the treatment of malignant esophagotracheal fistula

    SciTech Connect

    Buess, G.; Schellong, H.; Kometz, B.; Gruessner, R.J.; Junginger, T.

    1988-04-15

    Esophagotracheal fistula is usually a sequela of irradiation or laser treatment of advanced carcinoma of the esophagus or the tracheobronchial tree. Resection of the tumor in these cases is not possible, and palliative bypass surgery is highly risky. The peroral placement of a prosthesis is less invasive, but conventional prostheses often fail to occlude the fistula. The authors regularly use an endoscopic multiple-diameter bougie for dilation. After dilation, a specially designed prosthesis is pushed through the tumor stenosis to block the fistula. This procedure can be done without general anesthesia. The funnels of conventional prostheses cannot cover the fistula when there is either a wide, proximal esophagus above the fistula or a high fistula. To cope with this particular situation, a special fistula funnel was developed. It perfectly occludes the fistulas in all patients. Of 21 patients, 19 were discharged without further aspiration.

  10. Scintimaging of bronchopleural fistula. A simple method of diagnosis

    SciTech Connect

    Lowe, R.E.; Siddiqui, A.R.

    1984-01-01

    A bronchopleural fistula in a patient with empyema was demonstrated by xenon-133 ventilation lung scanning. Because of its ease and simplicity, the ventilation study should be one of the first diagnostic tests performed when bronchopleural fistula is suspected.

  11. Urethrovaginal Fistula in a 5-Year-Old Girl

    PubMed Central

    Coulibaly, Noël; Sangaré, Ibrahima Séga

    2015-01-01

    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

  12. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    SciTech Connect

    Leonhardt, Henrik Mellander, Stefan; Snygg, Johan; Loenn, Lars

    2008-05-15

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. 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 immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered

  13. Plug Load Behavioral Change Demonstration Project

    SciTech Connect

    Metzger, I.; Kandt, A.; VanGeet, O.

    2011-08-01

    This report documents the methods and results of a plug load study of the Environmental Protection Agency's Region 8 Headquarters in Denver, Colorado, conducted by the National Renewable Energy Laboratory. The study quantified the effect of mechanical and behavioral change approaches on plug load energy reduction and identified effective ways to reduce plug load energy. Load reduction approaches included automated energy management systems and behavioral change strategies.

  14. Iatrogenic Portobiliary Fistula Treated by Stent-Graft Placement

    SciTech Connect

    Lorenz, Jonathan M.; Zangan, Steven M. Leef, Jeffrey A.; Ha, Thuong G. Van

    2010-04-15

    Stent-graft exclusion of an ischemic, hilar portobiliary fistula after liver transplantation has not been reported. Isolated reports have described peripheral or nonischemic fistulas, and alternative treatment options have ranged from balloon tamponade to surgical repair. We present a unique case of a hilar portobiliary fistula successfully treated to resolution by unilateral placement of a stent-graft.

  15. Non-plugging injection valve

    DOEpatents

    Carey, Jr., Henry S.

    1985-01-01

    A valve for injecting fluid into a conduit carrying a slurry subject to separation to form deposits capable of plugging openings into the conduit. The valve comprises a valve body that is sealed to the conduit about an aperture formed through the wall of the conduit to receive the fluid to be injected and the valve member of the valve includes a punch portion that extends through the injection aperture to the flow passage, when the valve is closed, to provide a clear channel into the conduit, when the valve is opened, through deposits which might have formed on portions of the valve adjacent the conduit.

  16. Initial Study of Friction Pull Plug Welding

    NASA Technical Reports Server (NTRS)

    Rich, Brian S.

    1999-01-01

    Pull plug friction welding is a new process being developed to conveniently eliminate defects from welded plate tank structures. The general idea is to drill a hole of precise, optimized dimensions and weld a plug into it, filling the hole perfectly. A conically-shaped plug is rotated at high angular velocity as it is brought into contact with the plate material in the hole. As the plug is pulled into the hole, friction rapidly raises the temperature to the point at which the plate material flows plastically. After a brief heating phase, the plug rotation is terminated. The plug is then pulled upon with a forging force, solidly welding the plug into the hole in the plate. Three aspects of this process were addressed in this study. The transient temperature distribution was analyzed based on slightly idealized boundary conditions for different plug geometries. Variations in hole geometry and ram speed were considered, and a program was created to calculate volumes of displaced material and empty space, as well as many other relevant dimensions. The relation between the axially applied forging force and the actual forging pressure between the plate and plug surfaces was determined for various configurations.

  17. The Management of Delayed Post-Pneumonectomy Broncho-Pleural Fistula and Esophago-Pleural Fistula.

    PubMed

    Noh, Dongsub; Park, Chang-Kwon

    2016-04-01

    Broncho-pleural fistula (BPF) and esophago-pleural fistula (EPF) after pulmonary resection are challenging to manage. BPF is controlled by irrigation and sterilization, but such therapy is not sufficient to promote closure of EPF, which usually requires surgical management. However, it is generally difficult to select an appropriate surgical method for closure of BPF and EPF. Here, we report a case of concomitant BPF and EPF after left completion pneumonectomy, in which both fistulas were closed through a right thoracotomy. PMID:27066439

  18. The Management of Delayed Post-Pneumonectomy Broncho-Pleural Fistula and Esophago-Pleural Fistula

    PubMed Central

    Noh, Dongsub; Park, Chang-Kwon

    2016-01-01

    Broncho-pleural fistula (BPF) and esophago-pleural fistula (EPF) after pulmonary resection are challenging to manage. BPF is controlled by irrigation and sterilization, but such therapy is not sufficient to promote closure of EPF, which usually requires surgical management. However, it is generally difficult to select an appropriate surgical method for closure of BPF and EPF. Here, we report a case of concomitant BPF and EPF after left completion pneumonectomy, in which both fistulas were closed through a right thoracotomy. PMID:27066439

  19. Magnetic Resonance Imaging for Perianal Fistula.

    PubMed

    Tolan, Damian J M

    2016-08-01

    Perianal fistulas and other inflammatory diseases of the anus and perianal soft tissues are a cause of substantial morbidity, and are a major part of the practice of any colorectal surgeon. Magnetic resonance imaging (MRI) has a key role in the assessment of patients for the extent of fistulizing Crohn disease, complications related to fistulas, and to assist in confirming the diagnosis or proposing an alternative. Technique is critical and in particular, the selection of sequences for diagnosis and characterization of abnormalities with the main choices being between standard anatomical sequences (T1 or T2), assessing for edema (FS T2 or STIR), assessing abnormal contrast enhancement (FS T1), and assessing for abnormal diffusion or a combination of these. Guidance on MRI sequence selection, classification of fistulas, the current guidance on the role of MRI in assessing patients, and advice on how to provide useful structured reports, as well as how to detect complications of perianal sepsis are included. PMID:27342895

  20. Vascular access for hemodialysis: arteriovenous fistula.

    PubMed

    Malovrh, Marko

    2005-06-01

    The long-term survival and quality of life of patients on hemodialysis (HD) is dependant on the adequacy of dialysis via an appropriately placed vascular access. The optimal vascular access is unquestionably the autologous arteriovenous fistula (AVF), with the most common method being the conventional radio-cephalic fistula at the wrist. Recent clinical practice guidelines recommend the creation of native fistula or synthetic graft before the start of chronic HD therapy to prevent the need for complication-prone dialysis catheters. This could also have a beneficial effect on the rapidity of worsening kidney failure. A multidisciplinary approach (nephrologists, surgeons, radiologists and nurses) should improve the HD outcome by promoting the use of AVF. An important additional component of this program is the Doppler ultrasound for preoperative vascular mapping. Such an approach may be realized without unsuccessful surgical explorations, with a minimal early failure rate and a high maturation, even in patients with diabetes mellitus. PMID:15966992

  1. Repair of tracheo-oesophageal fistula.

    PubMed

    Muniappan, Ashok; Mathisen, Douglas J

    2016-01-01

    Acquired non-malignant tracheo-oesophageal fistula (TOF) most commonly develops after prolonged intubation or tracheostomy. It may also develop after trauma, oesophagectomy, laryngectomy and other disparate conditions. TOF leads to respiratory compromise secondary to chronic aspiration and pulmonary sepsis. Difficulty with oral intake usually leads to nutritional compromise. After diagnosis, the goals are to eliminate or reduce ongoing pulmonary contamination and to restore proper nutrition. Operative repair of benign TOF is generally performed through a cervical approach. The majority of patients require tracheal resection and reconstruction to address concomitant tracheal or laryngotracheal stenosis. Muscle flap interposition between tracheal and oesophageal repairs reduces the risk of fistula recurrence. Operative repair of the fistula is associated with generally good outcomes with a minimal risk of mortality. PMID:26933202

  2. Congenital urethrovaginal fistula with transverse vaginal septum.

    PubMed

    Amer, Mohamed Ibrahim; Ahmed, Mortada El-Sayed; Ali, Ali Hagag

    2016-08-01

    Congenital urethrovaginal fistula is an extremely rare genitourinary anomaly. Literature search identified only five reported cases, all of which were associated with urogenital abnormalities. Transverse vaginal septum is another rare condition, resulting from abnormalities in the vertical fusion between the vaginal components of the Mullerian ducts and the urogenital sinus; and associated fistulous connection of the vagina with the urethra is even rarer. Herein we describe the case of a 35-year-old woman who presented with dyspareunia, and a 1-year history of infertility, who was found to have a urethrovaginal fistula with low transverse vaginal septum. The patient was successfully treated with excision of the septum and closure of the urethrovaginal fistula. PMID:27170419

  3. Pancreatic Pseudocyst Pleural Fistula in Gallstone Pancreatitis

    PubMed Central

    Abdalla, Sala; Nikolopoulos, Ioannis; Kerwat, Rajab

    2016-01-01

    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. PMID:27274876

  4. [A vertebral arteriovenous fistula diagnosed by auscultation].

    PubMed

    Iglesias Escalera, G; Diaz-Delgado Peñas, R; Carrasco Marina, M Ll; Maraña Perez, A; Ialeggio, D

    2015-01-01

    Cervical artery fistulas are rare arteriovenous malformations. The etiology of the vertebral arteriovenous fistulas (AVF) can be traumatic or spontaneous. They tend to be asymptomatic or palpation or continuous vibration in the cervical region. An arteriography is necessary for a definitive diagnosis. The treatment is complete embolization of the fistula. We present the case of a two year-old male, where the mother described it «like a washing machine in his head». On palpation during the physical examination, there was a continuous vibration, and a continuous murmur in left cervical region. A vascular malformation in vertebral region was clinically suspected, and confirmed with angio-MRI and arteriography. AVF are rare in childhood. They should be suspected in the presence of noises, palpation or continuous vibration in the cervical region. Early diagnosis can prevent severe complications in asymptomatic children. PMID:24598790

  5. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation

    PubMed Central

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

    2015-01-01

    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. PMID:26955353

  6. Endovascular therapy for tracheoinnominate artery fistula: a temporizing measure.

    PubMed

    Wall, L Philipp; Gasparis, Antonios; Criado, Enrique

    2005-01-01

    Tracheoinnominate artery fistula remains an uncommon, highly fatal complication of tracheostomy and peritracheal pathology. Endovascular placement of a covered stent can provide control of the fistula. Depending on the conditions of the trachea and peritracheal tissues, the fistula may heal or the stent may become infected and/or further erode into the trachea. We report on a case of a patient with a tracheoinnominate artery fistula related to peritracheal tumor invasion, radiation therapy, and tracheostomy. The fistula was initially excluded with a covered stent, but a few weeks later hemoptysis recurred secondary to deep tracheal erosion by the covered stent. PMID:15714376

  7. Rectovaginal fistula: a new approach by stapled transanal rectal resection.

    PubMed

    Li Destri, Giovanni; Scilletta, Beniamino; Tomaselli, Tiziana Grazia; Zarbo, Giuseppe

    2008-03-01

    Many surgical procedures have been developed to repair rectovaginal fistulas even if no "procedure of choice" is reported. The authors report a case of relatively uncommon, complex, medium-high post-obstetric rectovaginal fistula without sphincteral lesions and treated with a novel tailored technique. Our innovative surgical management consisted of preparing the neck of the fistula inside the vagina and folding it into the rectum so as to enclose the fistula within two semicontinuous sutures (stapled transanal rectal resection); no fecal diversion was performed. Postoperative follow-up at 9 months showed no recurrence of the fistula. PMID:17899300

  8. Endovascular Management of Posttraumatic Arteriovenous Fistulae

    SciTech Connect

    Koshy, Chiramel George Keshava, Shyamkumar Nigudala; Surendrababu, Narayanam R. S.; Moses, Vinu; Stephen, Edwin; Agarwal, Sunil

    2009-09-15

    Surgery is considered to be the treatment of choice for vascular injuries caused by trauma. However, endovascular techniques are emerging as an alternative means of treatment. In this article, we describe three patients with posttraumatic arteriovenous fistulae in different body regions that were managed using endovascular techniques. Each case had its unique set of associated problems requiring innovative methods and a multidisciplinary approach. While the short-term results are encouraging, long-term follow-up of posttraumatic arteriovenous fistulae that have been treated with endovascular techniques is still required.

  9. Choleduodenal fistula with gastric outlet obstruction.

    PubMed

    Dong, Matthew; Guerron, Alfredo Daniel; Morris-Stiff, Gareth; Chalikonda, Sricharan

    2016-01-01

    Bouveret's syndrome, cholecystoduodenal fistula with gastric outlet obstruction secondary to an impacted gallstone, is a rare but serious complication of cholelithiasis. We report the case of a 69-year-old woman who presented with epigastric pain and vomiting in whom cross-sectional imaging revealed a duodenal mass with cholecystoduodenal fistula and pneumobilia. Endoscopic evaluation identified a large gallstone obstructing the pyloric channel. She underwent laparotomy and stone extraction with pyloroplasty, had an unremarkable recovery. She was asymptomatic at 15 months follow-up. PMID:27053537

  10. Cisplatin and Fluorouracil Compared With Carboplatin and Paclitaxel in Treating Patients With Inoperable Locally Recurrent or Metastatic Anal Cancer

    ClinicalTrials.gov

    2016-03-22

    Anal Basaloid Carcinoma; Anal Canal Cloacogenic Carcinoma; Anal Squamous Cell Carcinoma; Metastatic Anal Canal Carcinoma; Recurrent Anal Canal Carcinoma; Stage IIIB Anal Canal Cancer; Stage IV Anal Canal Cancer

  11. Laparoscopic repair for vesicouterine fistulae

    PubMed Central

    Maioli, Rafael A.; Macedo, André R. S.; Garcia, André R. L.; de Almeida, Silvio H. M.; Rodrigues, Marco Aurélio Freitas

    2015-01-01

    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. Discussion: Laparoscopy has

  12. Formation of a vesicovaginal fistula in a pig model

    PubMed Central

    Lindberg, Jennifer; Rickardsson, Emilie; Andersen, Margrethe; Lund, Lars

    2015-01-01

    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 the bladder and the vagina was made, and the mucosa between them was sutured together with absorbable sutures. A durometer ureteral stent was introduced into the fistula, secured with sutures to the bladder wall, allowing for the formation of a persistent fistula tract. Six weeks postoperatively cystoscopy was performed to examine the fistula in vivo. Thereafter, the pigs were euthanized with intravenous pentobarbital. Results Two out of four (50%) pigs developed persistent fistulas. No per- or postoperative complications occurred. Conclusion This study indicates that this pig model of vesicovaginal fistula can be an effective and cheap way to create a fistula between the bladder and vagina. PMID:26317081

  13. 21 CFR 886.4155 - Scleral plug.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... stainless steel with or without a gold, silver, or titanium coating. The special controls for the surgical grade stainless steel scleral plug (with or without a gold, silver, or titanium coating) are: (i) The... titanium coating). The special controls for scleral plugs made of other materials are: (i) The device...

  14. Plug-In Tutor Agents: Still Pluggin'

    ERIC Educational Resources Information Center

    Ritter, Steven

    2016-01-01

    "An Architecture for Plug-in Tutor Agents" (Ritter and Koedinger 1996) proposed a software architecture designed around the idea that tutors could be built as plug-ins for existing software applications. Looking back on the paper now, we can see that certain assumptions about the future of software architecture did not come to be, making…

  15. Why do we have to review our experience in managing cases with idiopathic fistula-in-ano regularly?

    PubMed Central

    Fucini, Claudio; Giani, Iacopo

    2011-01-01

    “Why do we have to review our experience in managing idiopathic fistula-in-ano regularly?” In order to answer this apparently simple question, we reviewed our clinical and surgical cases and most important relevant literature to find a rational and scientific answer. It would appear that whatever method you adopt in fistula management, there is a price to pay regarding either rate of recurrence (higher with conservative methods) or impairment of continence (higher with traditional surgery). Since, at the moment, reliable data to identify a treatment as a gold standard in the management of anal fistulas are lacking, the correct approach to this condition must consider all the anatomic and clinicopathological aspects of the disease; this knowledge joined to an eclectic attitude of the surgeon, who should be familiar with different types of treatment, is the only guarantee for a satisfactory treatment. As a conclusion, it is worthwhile to remember that adequate initial treatment significantly reduces recurrence, which, when it occurs, is usually due to failure to recognise the tract and primary opening at the initial operation. PMID:21876617

  16. Combined sphincter repair and postanal repair for the treatment of complicated injuries to the anal sphincters.

    PubMed Central

    Browning, G. G.; Henry, M. M.; Motson, R. W.

    1988-01-01

    The management of seven patients with multiple injuries to the anal sphincter musculature and its nerve supply, from major pelvic trauma, anal fistula surgery, or obstetric trauma, was reviewed. All were either incontinent of solid stools or had defunctioning colostomies. Anal manometry was abnormal in all patients. Concentric needle electromyography (EMG) showed anterior division of the external sphincter in all the patients; five also had posterior division of both the external sphincter and puborectalis. EMG abnormalities were found in the lateral quadrants of these muscles, particularly the external sphincter. Single fibre needle EMG showed evidence of reinnervation in the external sphincter in six patients, and in the puborectalis in two, indicating partial denervation of the muscles. Treatment was by anterior sphincter repair using an overlapping technique, combined with postanal repair; the repairs were protected by a defunctioning colostomy. When assessed 4-60 months (mean 17 months) after colostomy closure all seven patients were continent of solid and semi-formed stools, but had urgency of defaecation. None could control liquid stool or flatus. After complicated sphincter injuries planned surgical reconstruction, based on EMG assessment of the sphincter muscles, can restore acceptable continence. PMID:3190132

  17. Microwave Lung Ablation Complicated by Bronchocutaneous Fistula: Case Report and Literature Review

    PubMed Central

    Bui, James T.; Gaba, Ron C.; Knuttinen, M. Grace; Omene, Benedictta O.; Shon, Andrew; Martinez, Brandon K.; Owens, Charles A.

    2011-01-01

    Microwave ablation is a developing treatment option for unresectable lung cancer. Early experience suggests that it may have advantages over radiofrequency (RF) ablation with larger ablation zones, shorter heating times, less susceptibility to heat sink, effectiveness in charred lung, synergism with multiple applicators, no need for grounding pads, and similar survival benefit. Newer microwave ablation devices are being developed and as their use becomes more prevalent, a greater understanding of device limitations and complications are important. Herein we describe a microwave lung ablation complicated by bronchocutaneous fistula (BCF) and its treatment. BCF treatment options include close monitoring, surgical closure, percutaneous sealant injection, and endoscopic plug or sealant in those who are not surgical candidates. PMID:22654252

  18. Separator plugs for liquid helium

    NASA Technical Reports Server (NTRS)

    Lee, J. M.; Yuan, S. W. K.; Hepler, W. A.; Frederking, T. H. K.

    1984-01-01

    Work performed during Summer 1984 (from June to Sept. 30) in the area of porous media for use in low temperature applications is discussed. Recent applications are in the area of vapor - liquid phase separation, pumping based on the fountain effect and related subsystems. Areas of potential applications of the latter are outlined in supplementary work. Experimental data have been developed. The linear equations of the two-fluid model are inspected critically in the light of forced convection evidence reported recently. It is emphasized that the Darcy permeability is a unique throughput quantity in the porous media application areas whose use will permit meaningful comparisons of data not only in one lab but also within a group of labs doing porous plug studies.

  19. Plug-in Hybrid Initiative

    SciTech Connect

    Goodman, Angie; Moore, Ray; Rowden, Tim

    2013-09-27

    Our main project objective was to implement Plug-in Electric Vehicles (PEV) and charging infrastructure into our electric distribution service territory and help reduce barriers in the process. Our research demonstrated the desire for some to be early adopters of electric vehicles and the effects lack of education plays on others. The response of early adopters was tremendous: with the initial launch of our program we had nearly 60 residential customers interested in taking part in our program. However, our program only allowed for 15 residential participants. Our program provided assistance towards purchasing a PEV and installation of Electric Vehicle Supply Equipment (EVSE). The residential participants have all come to love their PEVs and are more than enthusiastic about promoting the many benefits of driving electric.

  20. Internal anal sphincter: an anatomic study.

    PubMed

    Uz, A; Elhan, A; Ersoy, M; Tekdemir, I

    2004-01-01

    The anatomy of the internal anal sphincter and surrounding structures was investigated in 24 cadavers using a surgical microscope (6-25 x magnification). An understanding of the anatomy of the internal anal sphincter is helpful in avoiding complications during surgical procedures in the anorectal region. The external anal sphincter was composed of three ellipsoid rings of skeletal muscle (subcutaneous, superficial, and deep) that encircle the anal canal; in contrast, we found that the internal anal sphincter was composed of flat rings of smooth muscle bundles stacked one on top of the other, like the slats of a Venetian blind. In each anal canal, the average number of ring-like slats observed was 26.33 +/- 2.93 (range = 20-30) and each was covered by its own fascia. The smooth muscle fibers and fascia coalesced at three equidistant points around the anal canal to form three columns that extended distally into the lumen and differed in form from the other anal columns. When viewed from an anterior position, the columns were located anteriorly at the observer's right (5 o'clock position), posteriorly at the right (1 o'clock position), and laterally at the left (9 o'clock position). This heretofore unreported anatomy of the internal anal sphincter may play an important role in closing off the lumen of the anal canal and maintaining bowel continence. PMID:14695582

  1. Friction pull plug welding: dual chamfered plate hole

    NASA Technical Reports Server (NTRS)

    Coletta, Edmond R. (Inventor); Cantrell, Mark A. (Inventor)

    2001-01-01

    Friction Pull Plug Welding (FPPW) is a solid state repair process for defects up to one inch in length, only requiring single sided tooling (OSL) for usage on flight hardware. Early attempts with FPPW followed the matching plug/plate geometry precedence of the successful Friction Push Plug Welding program, however no defect free welds were achieved due to substantial plug necking and plug rotational stalling. The dual chamfered hole has eliminated plug rotational stalling, both upon initial plug/plate contact and during welding. Also, the necking of the heated plug metal under a tensile heating/forging load has been eliminated through the usage of the dual chamfered plate hole.

  2. Management of labyrinthine fistulas in cholesteatoma.

    PubMed

    Vanden Abeele, D; Offeciers, F E

    1993-01-01

    Surgical management of labyrinthine fistulas caused by cholesteatoma remains controversial. In 213 patients with middle ear surgery for cholesteatoma, 18 patients (18 ears-8.5%) presented a labyrinthine fistula. These cases are reviewed in the present paper. Symptoms, audiometry, pre-operative imaging, surgical procedure and results are discussed. In all cases total removal of the pathology was pursued with preservation of cochlear function. A two-stage closed technique was used. During the first stage reconstruction with tympano-ossicular allografts, according to the technique of J. Marquet, was performed. A second look followed one year later. Three ears were deaf pre-operatively. Improvement of bone conduction was observed in more than 50% and hearing preservation in all other cases but one. In one ear total deafness occurred from extensive intralabyrinthine invasion by cholesteatoma, demanding a labyrinthectomy. The hearing was preserved in four cases in which an amputation of a large part of the membranous labyrinth could be observed. Since neither pre-operative clinical examination nor imaging can be relied on to reveal a fistula, the surgeon needs to be prepared for unexpected fistulas. PMID:8213141

  3. Coronary Artery Fistula: Two Rare Cases.

    PubMed

    Wehbe, Mahmoud Sleiman; Vondran, Maximilian; Sauer, Matthias; Mohr, Friedrich-Wilhelm; Schroeter, Thomas

    2015-11-01

    Coronary artery fistula (CAF) is an incidental finding in up to 0.2% of cardiac catheterization studies and is a rare pathologic condition affecting up to 1% of the general population. We report two cases of CAF diagnosed by coronary angiography and managed by surgical ligation, with excellent postoperative outcome. Anatomic location, clinical presentation, investigation, and treatment of CAF are discussed. PMID:26522575

  4. A Balance Test for Chronic Perilymph Fistula

    PubMed Central

    Hornibrook, Jeremy

    2012-01-01

    Perilymph fistula is defined as a leak of perilymph at the oval or round window. It excludes other conditions with “fistula” tests due to a dehiscent semicircular canal from cholesteotoma and the superior canal dehiscence syndrome. First recognized as a complication of stapedectomy, it then became apparent that head trauma and barotraumatic trauma from flying or diving could be a cause. Descriptions of “spontanenous” perilymph fistulas with no trauma history followed. It is likely that most perilymph fistula patients have a congential potential weakness of the otic capsule at the round or oval window. The vestibular symptoms have been assumed to be due to endolymphatic hydrops, but there is poor evidence. Their unilateral disequilibrium, nausea, and subtle cognitive problems suggest they are due to otolith disfunction and that these patients have a specific balance abnormality, unlike subjects with unilateral vestibular hypofuction. In this series of twenty patients with a confirmed fistula a logical simplification of Singleton's “eyes-closed turning” test predicted a PLF in twelve with a trauma history. In four no cause was found. In three a prior traumatic event was later recalled, but one patient had concealed it. PMID:23028388

  5. CT demonstration of an aortoesophageal fistula.

    PubMed

    Longo, J M; Lopez-Rasines, G; Ortega, E; Pagola, M A

    1987-01-01

    A case of aortoesophageal fistula (AEF) is reported in a patient with esophageal bleeding resulting from ingestion of a foreign body. CT showed a saccular aneurysm in close proximity to the esophageal lumen at the level of the bleeding site. AEF has not previously been described on CT. PMID:3107831

  6. Endovascular Treatment of an Aortobronchial Fistula

    SciTech Connect

    Numan, Fueruezan Arbatli, Harun; Yagan, Naci; Demirsoy, Ergun; Soenmez, Binguer

    2004-01-15

    A 67-year-old man operated on 8 years previously for type B aortic dissection presented with two episodes of massive hemoptysis. An aortobronchial fistula was suspected with spiral computed tomography angiography, and showed a small pseudoaneurysm corresponding to the distal anastomotic site. The patient underwent endovascular stent-graft implantation and is asymptomatic 8 months after the procedure.

  7. Perianal Fistula With and Without Abscess: Assessment of Fistula Activity Using Diffusion-Weighted Magnetic Resonance Imaging

    PubMed Central

    Bakan, Selim; Olgun, Deniz Cebi; Kandemirli, Sedat Giray; Tutar, Onur; Samanci, Cesur; Dikici, Suleyman; Simsek, Osman; Rafiee, Babak; Adaletli, Ibrahim; Mihmanli, Ismail

    2015-01-01

    Background: Magnetic resonance imaging (MRI) is highly accurate for the depiction of both the primary tract of fistula and abscesses, in patients with perianal disease. In addition, MRI can be used to evaluate the activity of fistulas, which is a significant factor for determining the therapeutic strategy. Objectives: This study aimed to determine the usefulness of diffusion-weighted (DW) MRI for assessing activity and visibility of perianal fistula. Patients and Methods: Fifty-three patients with 56 perianal fistulas were included in the current retrospective study. The T2-weighted imaging (T2WI) and DWMRI were performed and apparent diffusion coefficient (ADC) values of fistulas were measured. Fistulas were classified into two groups: only perianal fistulas and fistulas accompanied by abscess. Fistulas were also classified into two groups, based on clinical findings: positive inflammatory activity (PIA) and negative inflammatory activity (NIA). Results: Mean ADC value (mm2/s) of PIA group was significantly lower than that of NIA group, regarding lesions in patients with abscess-associated fistulas (1.371 × 10-3 ± 0.168 × 10-3 vs. 1.586 × 10-3 ± 0.136 × 10-3; P = 0.036). No statistically significant difference was found in mean ADC values between PIA and NIA groups, in patients with only perianal fistulas (P = 0.507). Perianal fistula visibility was greater with combined evaluation of T2WI and DWMRI than with T2WI, for two reviewers (P = 0.046 and P = 0.014). Conclusion: The DWMRI is a useful technique for evaluating activity of fistulas with abscess. Perianal fistula visibility is greater with combined T2WI and DWMRI than T2WI alone. PMID:26715982

  8. Conservative management of anal leiomyosarcoma

    SciTech Connect

    Minsky, B.D.; Cohen, A.M.; Hajdu, S.I. )

    1991-10-01

    Leiomyosarcomas of the large intestine are unusual neoplasms, comprising less than 0.1% of all malignancies of the colon and rectum. Six cases of leiomyosarcoma of the anus have been reported. The optimal treatment for this neoplasm is not known. The standard surgical approach is abdominoperineal resection. The authors report the seventh case of this rare neoplasm and outline its treatment using local excision and iridium 192 brachytherapy in an attempt to preserve the anal sphincter. In selected patients, conservative surgery followed by radiation therapy may be an alternative to radical surgery, with the goals of local control of the disease and anal sphincter preservation. However, more experience is needed before this approach could be recommended routinely.

  9. May-Thurner syndrome: High output cardiac failure as a result of iatrogenic iliac fistula

    PubMed Central

    Singh, Shantanu; Singh, Shivank; Jyothimallika, Juthika; Lynch, Teresa J

    2015-01-01

    May-Thurner syndrome (MTS) also termed iliocaval compression or Cockett-Thomas syndrome is a common, although rarely diagnosed, condition in which the patient has an anatomical variant wherein the right common iliac artery overlies and compresses the left common iliac vein against the fifth lumbar spine resulting in increased risk of iliofemoral deep venous thrombosis. This variant has been shown to be present in over 23% of the population but most go undetected. We present a patient with MTS who developed high output cardiac failure due to an iatrogenic iliac fistula. The patient underwent an extensive workup for a left to right shunt including MRI and arterial duplex in the vascular lab. He was ultimately found to have a 2.1 cm left common iliac artery aneurysm and history of common iliac stent. We took the patient to the operating room for aortogram with placement of an endovascular plug of the left internal iliac artery and aorto-bi-iliac stent graft placement with CO2 and IV contrast. Subsequently the patient underwent successful stent placement in the area that was compressed followed by 6 mo of anticoagulation with warfarin. The flow from the fistula decreased significantly. PMID:25789305

  10. [Anal cancer in HIV patients].

    PubMed

    Quéro, Laurent; Duval, Xavier; Abramowitz, Laurent

    2014-11-01

    Despite effective highly active antiretroviral treatment, anal cancer incidence has recently strongly increased in HIV-infected population. Treatment strategy in HIV-infected patients does not differ from general population. HIV-infected patients treated by chemo-radiotherapy are exposed to high-grade toxicities and should be closely monitored to deliver the optimal treatment. Close collaboration between oncologist and infectiologist is highly recommended to adjust antiretroviral therapy if necessary. PMID:25418596

  11. Laparoscopic Resection of Chronic Sigmoid Diverticulitis with Fistula

    PubMed Central

    Abbass, Mohammad A.; Tsay, Anna T.

    2013-01-01

    Background and Objectives: 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. Methods: 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. Results: 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. Conclusions: Patients with sigmoid diverticulitis with fistula can be successfully treated with laparoscopic excision, with similar outcomes for patients without fistula. PMID:24398208

  12. Elements of an anal dysplasia screening program.

    PubMed

    Jay, Naomi

    2011-01-01

    The incidence of anal cancer in HIV-infected men who have sex with men (MSM) is highly elevated compared to the general population, as is the incidence of its precursor lesion, high-grade anal intraepithelial neoplasia (HGAIN). MSM in general and other immunocompromised populations are also at higher risk. Treatment of HGAIN may prevent development of cancer, similar to the decrease in cervical cancers that has occurred since the advent of cervical cancer screening programs in women. Cervical cancer screening tools have been adapted and validated for screening, diagnosis, and treatment of anal HGAIN. Anal cancer screening programs have now been available for more than a decade, although they are not yet standards of care. Incorporating screening procedures into practice depends on the available resources in a particular community. This article discusses the procedures for anal cancer screening including cytology, digital anal rectal examinations, high-resolution anoscopy, and biopsy. PMID:22035526

  13. Friction Pull Plug Welding in Aluminum Alloys

    NASA Technical Reports Server (NTRS)

    Brooke, Shane A.; Bradford, Vann; Burkholder, Jonathon

    2011-01-01

    NASA fs Marshall Space Flight Center (MSFC) has recently invested much time and effort into the process development of Friction Pull Plug Welding (FPPW). FPPW, is a welding process similar to Friction Push Plug Welding in that, there is a small rotating part (plug) being spun and simultaneously pulled (forged) into a larger part. These two processes differ, in that push plug welding requires an internal reaction support, while pull plug welding reacts to the load externally. FPPW was originally conceived as a post proof repair technique for External Tank. FPPW was easily selected as the primary process used to close out the termination hole on the Constellation Program fs ARES I Upper Stage circumferential Self ] Reacting Friction Stir Welds (SR ]FSW). The versatility of FPPW allows it to also be used as a repair technique for both SR ]FSW and Conventional Friction Stir Welds. To date, all MSFC led development has been concentrated on aluminum alloys (2195, 2219, and 2014). Much work has been done to fully understand and characterize the process fs limitations. A heavy emphasis has been spent on plug design, to match the various weldland thicknesses and alloy combinations. This presentation will summarize these development efforts including weld parameter development, process control, parameter sensitivity studies, plug repair techniques, material properties including tensile, fracture and failure analysis.

  14. Friction Pull Plug Welding in Aluminum Alloys

    NASA Technical Reports Server (NTRS)

    Brooke, Shane A.; Bradford, Vann

    2012-01-01

    NASA's Marshall Space Flight Center (MSFC) has recently invested much time and effort into the process development of Friction Pull Plug Welding (FPPW). FPPW, is a welding process similar to Friction Push Plug Welding in that, there is a small rotating part (plug) being spun and simultaneously pulled (forged) into a larger part. These two processes differ, in that push plug welding requires an internal reaction support, while pull plug welding reacts to the load externally. FPPW was originally conceived as a post proof repair technique for the Space Shuttle fs External Tank. FPPW was easily selected as the primary weld process used to close out the termination hole on the Constellation Program's ARES I Upper Stage circumferential Self-Reacting Friction Stir Welds (SR-FSW). The versatility of FPPW allows it to also be used as a repair technique for both SR-FSW and Conventional Friction Stir Welds. To date, all MSFC led development has been concentrated on aluminum alloys (2195, 2219, and 2014). Much work has been done to fully understand and characterize the process's limitations. A heavy emphasis has been spent on plug design, to match the various weldland thicknesses and alloy combinations. This presentation will summarize these development efforts including weld parameter development, process control, parameter sensitivity studies, plug repair techniques, material properties including tensile, fracture and failure analysis.

  15. Mesh plug repair and groin hernia surgery.

    PubMed

    Robbins, A W; Rutkow, I M

    1998-12-01

    Since the mid-1980s, dramatic progress has been made in the evolution of hernia surgery, highlighted by the increasing use of prosthetic mesh. Among the mesh-based "tension-free" hernioplasties, the use of mesh plugs has garnered a large number of spirited enthusiasts, and plug herniorrhaphy has become the fastest growing hernia repair currently employed by the American surgeon. To demonstrate the simplicity and effectiveness of mesh plugs, a 9-year experience with almost 3300 patients is reported. Technical details are discussed and presentation of a literature search serves to further emphasize the utilitarian nature of this elegantly unsophisticated surgical operation. PMID:9927981

  16. Ischemic steal syndrome following arm arteriovenous fistula for hemodialysis.

    PubMed

    Zamani, Payman; Kaufman, James; Kinlay, Scott

    2009-11-01

    Arteriovenous fistulae in the arm are commonly used for hemodialysis in end-stage renal disease. Although physiological steal with reverse flow in the artery distal to the fistula is common, hand ischemia or infarction are rare. The ischemic steal syndrome (hand or forearm ischemia) is usually a result of arterial disease proximal or distal to the fistula and/or poor collateral supply to the hand. The diagnosis is primarily clinical; however, markedly reduced digital pressures and pulse volume recordings support the diagnosis. Management requires imaging for focal stenoses or disease in arteries proximal and distal to the fistula from the aorta to the hand. We present a case caused by subclavian artery occlusion that was initially missed due to focusing investigation only on the fistula. We describe the percutaneous treatments and surgical revisions that attempt to restore flow to the hand without compromising the fistula. PMID:19808723

  17. Porous plug for Gravity Probe B

    NASA Astrophysics Data System (ADS)

    Wang, Suwen; Everitt, C. W. Francis; Frank, David J.; Lipa, John A.; Muhlfelder, Barry F.

    2015-11-01

    The confinement of superfluid helium for a Dewar in space poses a unique challenge due to its propensity to minimize thermal gradients by essentially viscous-free counterflow. This poses the risk of losing liquid through a vent pipe, reducing the efficiency of the cooling process. To confine the liquid helium in the Gravity Probe B (GP-B) flight Dewar, a porous plug technique was invented at Stanford University. Here, we review the history of the porous plug and its development, and describe the physics underlying its operation. We summarize a few missions that employed porous plugs, some of which preceded the launch of GP-B. The design, manufacture and flight performance of the GP-B plug are described, and its use resulted in the successful operation of the 2441 l flight Dewar on-orbit for 17.3 months.

  18. 40 CFR 146.92 - Injection well plugging.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... pressure, and perform a final external mechanical integrity test. (b) Well plugging plan. The owner or... 40 Protection of Environment 24 2012-07-01 2012-07-01 false Injection well plugging. 146.92... to Class VI Wells § 146.92 Injection well plugging. (a) Prior to the well plugging, the owner...

  19. 40 CFR 146.92 - Injection well plugging.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... pressure, and perform a final external mechanical integrity test. (b) Well plugging plan. The owner or... 40 Protection of Environment 24 2013-07-01 2013-07-01 false Injection well plugging. 146.92... to Class VI Wells § 146.92 Injection well plugging. (a) Prior to the well plugging, the owner...

  20. 40 CFR 146.92 - Injection well plugging.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... pressure, and perform a final external mechanical integrity test. (b) Well plugging plan. The owner or... 40 Protection of Environment 23 2011-07-01 2011-07-01 false Injection well plugging. 146.92... to Class VI Wells § 146.92 Injection well plugging. (a) Prior to the well plugging, the owner...

  1. 40 CFR 146.92 - Injection well plugging.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... pressure, and perform a final external mechanical integrity test. (b) Well plugging plan. The owner or... 40 Protection of Environment 23 2014-07-01 2014-07-01 false Injection well plugging. 146.92... to Class VI Wells § 146.92 Injection well plugging. (a) Prior to the well plugging, the owner...

  2. Rectovesical Fistula Related to Transurethral Resection of a Bladder Lesion

    PubMed Central

    Topaktaş, Ramazan; Tepeler, Abdulkadir; Kurt, Omer; Erdem, Mehmet Remzi; Armağan, Abdullah; Önol, Şinasi Yavuz

    2011-01-01

    A rectovesical fistula (RVF) is an uncommon complication of urooncologic surgery. Although several RVFs have been reported, our case is the first reported RVF in the literature that iatrogenically occurred after transurethral resection of the bladder. A single-stage primary repair with omental flap interposition without a colostomy was successfully performed because of the persistence of the fistula during followup. After 6 months of followup, no fistula or bladder mass was detected. PMID:21969833

  3. [Obstetric vesicovaginal fistula: reporting two cases in France].

    PubMed

    Labarrère, A; Gueye, A; Ouaki, F; Pires, C; Pierre, F; Fritel, X

    2011-05-01

    Obstetric vesicovaginal fistula is nowadays rare in developed countries. We are reporting two cases of patients with obstetric vesicovaginal fistula that occurred after operative vaginal deliveries performed in a French hospital. Early postpartum symptoms were vaginal urine leakage and infectious syndrome. The fistula has been cured by vaginal surgery one case and combined (laparotomy and vagina surgery) in the other case. Patients were totally healed a few months following the surgery. PMID:21514873

  4. Superior mesenteric arteriovenous fistula embolisation complicated by bowel ischaemia

    PubMed Central

    Hussein, Maher; Issa, Ghada; Muhsen, Shirin; Haydar, Ali

    2013-01-01

    Superior mesenteric arteriovenous fistulas are rare, especially when iatrogenic in origin. Management of these fistulas can be surgical or endovascular. Endovascular embolisation is the preferred modality with a low rate of complications. Among the reported complications, bowel ischaemia is considered an unlikely occurrence. We report a case of a complex iatrogenic arterioportal fistula that was managed by endovascular embolisation and controlled through both its inflow and outflow, and was later complicated by bowel ischaemia. PMID:23682091

  5. Oophorovesicular-colonic fistula: a rare complication of Crohn's disease.

    PubMed

    Goldberg, S D; Gray, R R; Cadesky, K I; Mackenzie, R L

    1988-11-01

    Salpingitis and vesicular fistulas are rare complications of Crohn's disease. In this report the authors describe a case of oophorovesicular-colonic fistula secondary to Crohn's disease. The patient presented with bleeding from the bladder during menstruation, fecaluria and pneumaturia. A single-stage left salpingo-oophorectomy, sigmoid resection and repair of the fistula were carried out, with complete resolution of symptoms and preservation of fertility potential. PMID:3179852

  6. Hybrid and Plug-in Electric Vehicles

    SciTech Connect

    2014-05-20

    Hybrid and plug-in electric vehicles use electricity either as their primary fuel or to improve the efficiency of conventional vehicle designs. This new generation of vehicles, often called electric drive vehicles, can be divided into three categories: hybrid electric vehicles (HEVs), plug-in hybrid electric vehicles(PHEVs), and all-electric vehicles (EVs). Together, they have great potential to reduce U.S. petroleum use.

  7. Increased anal basal pressure in chronic anal fissures may be caused by overreaction of the anal-external sphincter continence reflex.

    PubMed

    van Meegdenburg, Maxime M; Trzpis, Monika; Heineman, Erik; Broens, Paul M A

    2016-09-01

    Chronic anal fissure is a painful disorder caused by linear ulcers in the distal anal mucosa. Even though it counts as one of the most common benign anorectal disorders, its precise etiology and pathophysiology remains unclear. Current thinking is that anal fissures are caused by anal trauma and pain, which leads to internal anal sphincter hypertonia. Increased anal basal pressure leads to diminished anodermal blood flow and local ischemia, which delays healing and leads to chronic anal fissure. The current treatment of choice for chronic anal fissure is either lateral internal sphincterotomy or botulinum toxin injections. In contrast to current thinking, we hypothesize that the external, rather than the internal, anal sphincter is responsible for increased anal basal pressure in patients suffering from chronic anal fissure. We think that damage to the anal mucosa leads to hypersensitivity of the contact receptors of the anal-external sphincter continence reflex, resulting in overreaction of the reflex. Overreaction causes spasm of the external anal sphincter. This in turn leads to increased anal basal pressure, diminished anodermal blood flow, and ischemia. Ischemia, finally, prevents the anal fissure from healing. Our hypothesis is supported by two findings. The first concerned a chronic anal fissure patient with increased anal basal pressure (170mmHg) who had undergone lateral sphincterotomy. Directly after the operation, while the submucosal anesthetic was still active, basal anal pressure decreased to 80mmHg. Seven hours after the operation, when the anesthetic had completely worn off, basal anal pressure increased again to 125mmHg, even though the internal anal sphincter could no longer be responsible for the increase. Second, in contrast to previous studies, recent studies demonstrated that botulinum toxin influences external anal sphincter activity and, because it is a striated muscle relaxant, it seems reasonable to presume that it affects the striated

  8. Elastocapillary powered manipulation of liquid plug in microchannels

    NASA Astrophysics Data System (ADS)

    George, D.; Anoop, R.; Sen, A. K.

    2015-12-01

    We report the manipulation of a liquid plug inside a rectangular microchannel, when one of the channel walls is a deformable membrane, which adjoins another parallel microchannel. Elastocapillary flow of a driving liquid (DL) through the adjoining microchannel, when approaches the plug, tries to pull the membrane near the plug, which is initially deflected into the plug, towards the DL. The plug is transported due to a differential pressure that develops across the plug owing to the increase in the radius of curvature of the trailing meniscus of the plug. A theoretical model is proposed to predict the plug velocity, which depends on a parameter J and plug length L ˜ . The predictions of the theoretical model show good agreement with experimental data. The dynamic behaviour of the plug and DL is presented and discussed.

  9. Treatment of tracheopharyngeal and tracheo-oesophageal fistulas following laryngectomy and fistula classification based on individual silicone casts.

    PubMed

    Herzog, Michael; Lorenz, Kai J; Glien, Alexander; Greiner, Ingo; Plontke, Stefan; Plößl, Sebastian

    2015-10-01

    Persistent tracheopharyngeal (TPF) and tracheo-oesophageal (TEF) fistulas after laryngectomy create a therapeutic challenge. The current classification of TPFs and TEFs is based on clinical experience without detailed anatomical information. In this study, casts of TPFs/TEFs were obtained from 16 patients; these were the first steps in manufacturing customised prostheses. Fistulas were classified according to the shape and dimension of the tracheopharyngeal and tracheo-oesophageal silicone casts and prostheses as well as on epithetic requirements. Four different types of fistulas were classified: Type A, a fistula with a straight axis between the neopharynx and oesophagus; Type B, a fistula with a stenosis of the neopharynx but a straight axis; Type C, the axis between the neopharynx and oesophagus is flexed anteriorly; and Type D, neighbouring structures are absent creating a large defect. This classification system might improve the manufacturing processes of customised prostheses in individual cases with challenging tracheopharyngeal and tracheo-oesophageal fistulas. PMID:25178413

  10. [Congenital broncho-biliary fistula: a case report].

    PubMed

    Pérez, Cinthia G; Reusmann, Aixa

    2016-10-01

    Congenital tracheo-or-bronchobiliary fistula or congenital he-patopulmonary fistula is a rare malformation with high morbidity and mortality if the diagnosis is not made early. The tracheo-or-bronchobiliary fistula is a communication between the respiratory (trachea or bronchus) and biliary tract. To date, only 35 cases have been published worldwide. We report a case of a neonate with right pneumonia and bilious fluid in the endotracheal tube. Diagnosis was made using bronchoscopy with fluoroscopy. Videothoracoscopy was used to remove the bronchobiliary fistula. Subsequently, a left he-patectomy with Roux-en-Y biliary-digestive anastomosis was performed as bile ductus hypoplasia was present. PMID:27606661